Explanation:

Radiographers should be familiar with their Practice Standards published by the American
Society of Radiologic Technologists (ASRT). The Standards provide a legal role definition
and identify Clinical, Quality, and Professional Standards of practice—each Standard has its
own rationale and identifies general and specific criteria related to that Standard. The student
radiographer can access the individual standards, their rationale, and criteria on the
The ARRT establishes principles of professional conduct to ensure the best services
possible to patients entrusted to our care. These principles are detailed in the ARRT two part Standards of Ethics, which includes the Code of Ethics and the Rules of Ethics. The 10-part Code of Ethics is aspirational; the 22 Rules of Ethics are enforceable and violation can result in professional sanction.

Explanation:

Most institutions now have computerized, paperless systems for patient information
transmittal; these systems must ensure confidentiality in compliance with Health Insurance Portability and Accountability Act (HIPAA) of 1996 regulations. The health care professional generally has access to the computerized system only via personal password, thus helping ensure confidentiality of patient information. All medical records and other individually identifiable health information, whether electronic, on paper, or oral, are covered by HIPAA legislation and by subsequent Department of Health and Human Services (HHS) rules that took effect in April of 2001.

Explanation:

Accepting responsibility to perform a function outside the scope of practice is a violation of Ethical Rule #7, which states that it is a violation to “delegate or accept delegation of a radiologic technology function or any other prescribed health care function when the
delegation or acceptance could reasonably be expected to create an unnecessary danger to a patient’s life, health, or safety. Actual injury to a patient need not be established under this clause.” So, accepting a responsibility outside the scope of practice is a violation of an ARRT rule. However, choices 2 and 3 are in violation of the aspirational Code of Ethics.

Explanation:

Assault is to threaten harm; battery is to carry out the threat. A patient may feel sufficiently intimidated to claim assault by a radiographer who threatens to repeat a difficult examination if the patient does not try to cooperate better. A radiographer who performs an examination on a patient without the patient’s consent or after the patient has refused the examination may be liable for battery. A charge of battery may also be made against a radiographer who treats a patient roughly or who performs an examination on the wrong patient. A radiographer who discloses confidential information to unauthorized individuals may be found liable for invasion of privacy or defamation. A radiographer whose disclosure of confidential information is in some way detrimental to the patient may be accused of defamation. Spoken defamation is slander; written defamation is libel.

Explanation:

A radiographer who discloses confidential information to unauthorized individuals may be found guilty of invasion of privacy or defamation. A radiographer whose disclosure of confidential information is in some way detrimental to the patient may be accused of defamation.Spoken defamation is slander; written defamation is libel. Assault is to threaten harm; battery is to carry out the threat.

Explanation:

The AHA identifies 12 important areas in its “Patient’s Bill of Rights.” These include the
right to refuse treatment (to the extent allowed by law), the right to confidentiality of records and communication, and the right to continuing care. Other patient rights identified are the right to informed consent, privacy, respectful care, access to personal medical records, refusal to participate in research projects, and an explanation of one’s hospital bill.

Explanation:

The ARRT establishes principles of professional conduct to ensure the best services
possible to patients entrusted to our care. These principles are detailed in the ARRT two part Standards of Ethics, which includes the Code of Ethics and the Rules of Ethics. The10-part Code of Ethics is aspirational; the 22 Rules of Ethics are enforceable and violation can result in professional sanction. The ARRT Ethics Committee provides peer review of cases(misdemeanor, felony, etc.) to ensure adherence to standards of professional behavior and possession of the moral character required to practice in the health care professions. If the violator’s actions demonstrate that moral character is lacking, that individual can be sanctioned—i.e., reprimanded, suspended, revoked, ineligible for certification, etc.—or other sanctions deemed appropriate by the Ethics Committee.

Explanation:

Patient rights can be exercised on the patient’s behalf by a designated surrogate or
proxy decision maker if the patient lacks decision-making capacity, is legally incompetent,
or is a minor. Many people believe that potential legal and ethical issues can be avoided by
creating an Advance Health Care Directive or Living Will. Since all persons have the right to make decisions regarding their own health care, this legal document preserves that right in the event an individual is unable to make those decisions. An Advance Health Care Directive, or Living Will, names the individual authorized to make all health care decisions and can include specifics regarding DNR (do not resuscitate), DNI (do not intubate), and or other end-of-life decisions.

Explanation:

The Constitution of the United States expresses the categorical laws of the country. Its impact with respect to health care and health care professionals lies, in part, in its assurance of the right to privacy. The right to privacy indicates that the patient’s modesty and dignity will be respected. It also refers to the health care professional’s obligation to respect the confidentiality of privileged information. Inappropriate communication of privileged information to anyone but the appropriate health care professionals is inexcusable.

Explanation:

Patient rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision maker if the patient lacks decision-making capacity, is legally incompetent,
or is a minor. Many people believe that potential legal and ethical issues can be avoided by
creating an Advance Health Care Directive or Living Will. Since all persons have the right to make decisions regarding their own health care, this legal document preserves that right in theevent an individual is unable to make those decisions. An Advance Health Care Directive, or LivingWill, names the individual authorized to make all health care decisions and can include specifics regarding DNR (do not resuscitate), DNI (do not intubate), and/or other end-of-life decisions.

Explanation:

The interaction between patient and radiographer generally leaves a lasting impression of the patient’s health care experience. Communication may be verbal or nonverbal.Verbal communication involves tone and rate of speech as well as what is being said. It involves personalization and respect. Nonverbal communication involves facial expression, professional appearance, orderliness of radiographic room, and preparation and efficiency of the radiographer.

Explanation:

Special consideration must be given to each patient according to his or her condition.
Elderly and very thin patients, and those who will be required to lie on the x-ray table for
a lengthy period of time, benefit greatly from a foam pad between themselves and the x-ray table. Should an injured patient require assistance with dressing and undressing, it is important to remember that clothing should be removed from the uninjured side first and placed on the injured side first.

Explanation:

When transferring a patient from stretcher to x-ray table, several rules apply that will
help reduce back strain. Pull, do not push the patient; pushing increases friction and makes the transfer more difficult. Use the biceps muscles for pulling; do not bend at the waist and pull, as this motion increases back strain.

Explanation:

Normal body temperature varies from person to person depending on several factors,
including age. Normal adult body temperature taken orally is 98.6◦F (37◦C). Rectal temperature is generally 0.5◦ to 1.0◦ higher, whereas axillary temperature is usually 0.5◦ to 1.0◦ lower.Variation of 0.5◦ to 1.0◦ is generally considered within normal limits. Body temperature is usually lowest in the early morning and highest at night. Infants up to 4 years of age have normal body temperatures of between 99◦F and 99.7◦F. Children aged 5 to 13 years have a normal range of 97.8◦F to 98.6◦F.
Obtaining vital signs involves the measurement of body temperature, pulse rate, respiratory rate, and arterial blood pressure. Increased body temperature, or fever, usually signifies infection. Symptoms of fever include general malaise, increased pulse and respiratory rates, flushed skin that is hot and dry to the touch, and occasional chills. Very high, prolonged fevers can cause irreparable brain damage.

Explanation:

Blood pressure within vessels is greatest during ventricular systole (contraction) and
lowest during diastole (relaxation). Blood pressure measurements are recorded with the systolic pressure on top and the diastolic pressure on the bottom, as in 100/75 (read “one hundred over seventy-five”). Normal adult systolic pressure ranges between 100 and 140 mmHg; the normal diastolic range is between 60 and 90 mmHg. Prehypertension is present when blood pressure measurements are between 120 and 140 mmHg systolic and/or between 80 and 90 mmHg diastolic. Blood pressure consistently above 140/90 is considered hypertension. Left undiagnosed and untreated, hypertension can lead to renal, cardiac, or brain damage.
Hypotension is characterized by a systolic pressure of less than 90 mmHg. Hypotension is
seen in individuals with a decreased blood volume as a result of hemorrhage, infection, fever, and anemia. Orthostatic hypotension occurs in some individuals when they rise quickly from a recumbent position. Dyspnea is the medical term used to describe difficulty in breathing.

Explanation:

The radiographer must be alert to the patient’s appearance and condition, and any
subsequent changes in them. Notice the color, temperature, and moistness of the patient’s
skin: paleness frequently indicates weakness; the diaphoretic patient has pale, cool skin; fever is frequently accompanied by hot, dry skin; “sweaty” palms may indicate anxiety, a patient who becomes cyanotic (bluish lips, mucous membranes, nail beds) needs oxygen and requires immediate medical attention.

Explanation:

Body areas having superficial arteries are best suited for determination of a patient’s
pulse rate. The five most readily palpated pulse points are the radial, carotid, temporal, femoral, and popliteal pulse. Of these, the radial pulse is the most frequently used. The apical pulse, at the apex of the heart, may be readily evaluated with the use of a stethoscope.

Explanation:

Blood pressure among individuals varies with age, sex, fatigue, mental or physical
stress, disease, and trauma. The blood pressure within vessels is greatest during ventricular contraction/systole and lowest during ventricular relaxation/diastole. Blood pressure measurements are recorded with the systolic pressure on top and the diastolic pressure on the bottom.Normal adult systolic pressure ranges between 100 and 140 mmHg; the normal diastolic range is between 60 and 90 mmHg. Prehypertension is present when blood pressure measurements are between 120 and 140 mmHg systolic and/or between 80 and 90 mmHg diastolic.
Blood pressure consistently above 140/90 is considered hypertension. Left undiagnosed and untreated, hypertension can lead to renal, cardiac, or brain damage. Hypotension is characterized by a systolic pressure of less than 90 mmHg. Hypotension is seen in individuals with a decreased blood volume as a result of hemorrhage, infection, fever, and anemia.

Explanation:

A patient’s respirations should be counted after counting the pulse rate, while still
holding the patient’s wrist. Respiratory action may become more deliberate, or less natural, in the patient who is aware that his or her respirations are being counted. The normal respiratory rate is 12 to 18 breaths per minute. The respiratory rate of young children is somewhat higher, up to 30 breaths per minute. While the radiographer is counting respirations, he or she should be assessing the respiratory pattern (even, uneven) and depth (normal, shallow, deep) as well

Explanation:

Obtaining vital signs involves the measurement of body temperature, pulse rate, respiratory rate, and arterial blood pressure. A thermometer is used to take the patient’s temperature.A watch with a second hand is required to time the patient’s pulse rate and respirations. To measure blood pressure, a sphygmomanometer and stethoscope are required. A tongue blade is used to depress the tongue for inspection of the throat and is not part of vital sign assessment

Explanation:

Pathogens are causative agent microorganisms capable of producing disease. Pathogens termed opportunistic are usually harmless, but can become harmful if introduced into a part of the body where they do not normally reside, or when introduced into an immuno compromised
host. Bloodborne pathogens reside in blood and can be transmitted to an individual exposed to that blood or body fluids of the exposed individual. Common bloodborne pathogens include hepatitis C, hepatitis B, and human immunodeficiency virus (HIV). Because radiography often involves exposure to sickness and disease, the radiographer must be aware of, and conscientiously practice, infection control and effective preventive measures

Explanation:

Infectious microorganisms can be transmitted from one patient to other patients or to
health care workers, and from health care workers to patients. They are transmitted by means of either direct or indirect contact. Direct contact involves touch. Diseases transmitted by direct contact include skin infections such as boils and sexually transmitted diseases such as syphilis.
Indirect contact involves transmission of microorganisms via airborne contamination,
fomites, and vectors. Pathogenic microorganisms expelled from the respiratory tract through the mouth or nose can be carried as evaporated droplets through the air or on dust and settle on clothing, utensils, or food. Patients with respiratory tract infections and disease transported to the radiology department, therefore, should wear a mask to prevent such transmission during a cough or sneeze; it is not necessary for the health care professional or transporter to wear a mask (as long as the patient does). Many such microorganisms can remain infectious while awaiting transmission to another host. A contaminated inanimate object such as a food utensil, doorknob, or IV pole is referred to as a fomite. A vector is an insect or animal carrier of infectious organisms, such as a rabid animal (e.g., rabies; although the rabid animal is the vector, rabies is contracted by contact), a mosquito that carries malaria, or a tick that carries Lyme disease.

Explanation:

Protective, or reverse, isolation is used to keep the susceptible patient from becoming infected. Burn patients who have lost their means of protection (their skin) have increased susceptibility to bacterial invasion. Patients whose immune systems are compromised (e.g.,
transplant recipients, leukemia) are unable to combat infection and are more susceptible to infection. These patients are treated with strict isolation technique, taking care to protect the patient from contamination.

Explanation:

Indirect contact involves transmission of microorganisms via airborne contamination,
fomites, and vectors. Pathogenic microorganisms expelled from the respiratory tract through the mouth or nose can be carried as evaporated droplets through the air or on dust and settle on clothing, utensils, or food. A contaminated inanimate object such as a pillowcase, x-ray table, or IV pole is referred to as a fomite. A vector is an insect or animal carrier of infectious organisms, such as a rabid animal (rabies), a mosquito that carries malaria, or a tick that carries Lyme disease.

Explanation:

Health care practitioners must exercise strict infection-control precautions so that they
or their equipment will not be the source of nosocomial infection. Contaminated waste products, soiled linen, and improperly sterilized equipment are all means by which microorganisms can travel. Not every patient will come in contact with these items; however, the health care professional is in constant contact with patients and is therefore a constant threat to spread infection. Microorganisms are most commonly spread by way of the hands; therefore, handwashing before and after each patient is the most effective means of controlling the spread of microorganisms. Disinfectants, antiseptics, and germicides are used in many handwashing liquids to kill microorganisms

Explanation:

Antisepsis retards the growth of pathogenic bacteria. Alcohol is an example of an antiseptic. Medical asepsis refers to the destruction of pathogenic microorganisms through the
process of disinfection. Examples of disinfectants are hydrogen peroxide, chlorine, and boric acid. Surgical asepsis (sterilization) refers to the removal of all microorganisms and their spores (reproductive cells) and is practiced in the surgical suite. Bacteriogenesis refers to the formation
of bacteria.

Explanation:

Airborne precaution is employed with patients suspected or known to be infected with the tubercle bacillus (TB), chickenpox (varicella), and measles (rubeola). Airborne precaution
requires the patient to wear a mask to avoid the spread of acid-fast bacilli (in bronchial secretions) and other pathogens during coughing. If the patient is unable or unwilling to wear a mask, the radiographer must wear one. An N95 Particulate Respirator is the mask required for health care workers. The radiographer should wear gloves, but a gown is required only if flagrant contamination is likely. Patients with airborne precautions require a private, specially ventilated (negative pressure) room.

A private room is indicated for all patients on droplet precaution, that is, diseases transmitted via large droplets expelled from the patient while speaking, sneezing, or coughing. The pathogenic droplets can infect others when they come in contact with mouth or nasal mucosa or conjunctiva. Rubella (“German measles”), mumps, and influenza are among the diseases spread by droplet contact; a private room is required for the patient, and health care practitioners must wear a mask.

Explanation:

When performing bedside radiography in an isolation room, the radiographer should wear a gown, gloves, and mask. The cassettes are prepared for the examination by placing a pillowcase over them to protect them from contamination. Whenever possible, one person should manipulate the mobile unit and remain “clean,” while the other handles the patient. The mobile unit should be cleaned with a disinfectant before exiting the patient’s room.

Explanation:

Lyme disease is a condition that results from transmission of an infection by a vector (“deer” tick). Vectors are insects and animals carrying disease. Droplet contact involves contact with secretions (from the nose, mouth) that travel via a sneeze or cough. Airborne route involves evaporated droplets in the air that transfer disease.

Explanation:

Epidemiologic studies indicate that HIV and AIDS can be transmitted only by intimate contact with blood or body fluids of an infected individual. This can occur through the sharing of contaminated needles, through sexual contact, from mother to baby at childbirth, and from transfusion of contaminated blood. HIV and AIDS cannot be transmitted by inanimate objects. HBV is another bloodborne infection and affects the liver. It is thought that more than one million people in the United States have chronic hepatitis B and, as such, can transmit the disease to others. Acid-fast bacillus isolation is employed with patients suspected or known to be infected with the TB. Acid-fast bacillus isolation requires that the patient wear a mask to avoid the spread of acid-fast bacilli (in bronchial secretions) during coughing

Explanation:

Symptoms of inadequate oxygen supply include dyspnea, cyanosis, diaphoresis, and distention of the veins of the neck. The patient who experiences some or all of these symptoms will be very anxious and must not be left unattended. The radiographer must call for help, assist the patient to a sitting or semi-Fowler position (the recumbent position makes breathing more difficult), and have oxygen and emergency drugs available.

Explanation:

Patient preparation differs for various contrast examinations. To obtain a diagnostic examination of the stomach, it must first be empty. The usual UGI preparation is NPO (nothing by mouth) after midnight (approximately 8 hours before the examination). Any material in the stomach can simulate the appearance of disease. An iodinated contrast agent, usually in the form of several pills, is taken by the patient the evening before a scheduled GB examination and only water is allowed the morning of the examination. The patient scheduled for a BE
(lower GI) requires a large bowel that is very clean prior to the administration of barium; this requires the administration of cathartics (laxatives) and cleansing enemas. Preparation for an IVU requires that the patient be NPO after midnight; some institutions may require that the large bowel be cleansed of gas and fecal material. Aftercare for barium examinations is also very important. Patients are typically instructed to take milk of magnesia and to drink plenty
of water. Because water is removed from the barium sulfate suspension in the large bowel, it is essential to make patients understand the importance of these instructions to avoid barium
impaction in the large bowel.

Explanation:

Patient preparation varies among contrast examinations. A patient scheduled for a UGI series must be NPO (receive nothing by mouth) after midnight. A BE (lower GI) requires that the large bowel be very clean prior to the administration of barium; this requires the administration of cathartics (laxatives) and cleansing enemas. Preparation for an IVU/IVP requires that the patient be NPO after midnight; some institutions also require that the large bowel be cleansed of gas and fecal material.

Explanation:

The diameter of a needle is identified as its gauge. As the diameter of its bore decreases, the gauge increases. Hence, a 23-gauge needle has a smaller diameter bore than an18-gagaugeneedle.Hypodermic needles are generally used for phlebotomy (i.e., blood samples), while butterflies and IV catheters are used more frequently for injections such as contrast media. If an infusion injection is required, an IV catheter is generally preferred. The hub of the hypodermic needle is attached to a syringe, while the hub of the butterfly tubing or IV catheter may be attached to a syringe or an IV bottle or bag via an IV infusion set.

Explanation:

Extravasation occurs when medication or contrast medium is introduced into the tissues surrounding a vein rather than into the vein itself. It can occur when the patient’s veins are particularly deep or small. The needle should be removed, pressure applied to prevent formation of a hematoma, and warm moist heat applied to relieve pain.

Explanation:

(B) Although radiographic contrast media are usually administered orally or intravenously, there are a number of routes or methods of drug administration. Drugs and medications may be administered either orally or parenterally. Parenteral refers to any route other than the digestive
tract (orally) and includes topical, subcutaneous, intradermal, intramuscular, intravenous, and
intrathecal.

Explanation:

The antecubital vein is the most commonly used injection site for contrast medium administration. It is not used for infusions that take longer than 1 hour because of its location
at the bend of the elbow. The basilic vein, located on the dorsal surface of the hand, is used when the antecubital vein is inaccessible. The cephalic vein may also be used. Strict aseptic technique must be used for all intravenous injections.

Explanation:

When scheduling patient examinations, it is important to avoid the possibility of residual contrast medium overlying areas of interest of later examinations. The IVU should be scheduled first because the contrast medium used is excreted very rapidly. The BE should be scheduled next. The UGI is scheduled last. Any barium remaining from the previous BE is unlikelyto interfere with the stomach or duodenum, although a preliminary scout image shouldbe taken in each case.

Explanation:

The IV bottle or bag should be hung 18 to 24 inches above the level of the vein. If placed lower than the vein, solution will stop flowing and blood will return into the tubing. If hung too high, solution can run too fast. Occasionally, the position of the needle or catheter in
the vein will affect the flow rate. If the bevel is adjacent to the vessel wall, flow may decrease or stop altogether. Often, just changing the position of the patient’s arm will remedy the situation

Explanation:

Objective vertigo is the sensation of having objects (or “the room”) spinning about the person; subjective vertigo is the sensation of the person spinning about. It is often associated with an inner-ear disturbance. Patients experiencing true vertigo (as opposed to dizzinessor lightheadedness) are often very nauseous and must be protected from falls. A patient who reports feeling dizzy or faint (syncope) should be immediately assisted to a chair. Bending
forward and placing the head between the knees will often help relieve the lightheadednessas blood flow to the brain increases. In more severe cases, a patient who cannot be assisted
to a chair should be lowered to a recumbent position. Elevation of the lower legs, or use of the Trendelenburg position, is helpful. Orthostatic, or postural, hypotension is a decrease in
blood pressure that occurs on rising to the erect position. It can be severe enough to cause fainting in individuals who have been confined to bed for several days. A nosebleed (epistaxis)
may be a result of any one of many causes, including hypertension, dry nasal mucous membranes, sinusitis, or trauma. The patient should be seated or placed in a Fowler position. The radiographer should place cold cloths over the patient’s nose and back of the neck

Explanation:

The midcoronal plane is perpendicular to the MSP and divides the body into anterior and posterior halves. The midsagittal (or median sagittal) plane passes vertically through the midline of the body, dividing it into left and right halves. Any plane parallel to the MSP is termed a sagittal plane. A transverse plane passes across the body, also perpendicular to a sagittal plane. These planes, especially the MSP, are very important reference points in radiographic positioning.

Explanation:

The position, shape, and motility of various organs can differ greatly from one body habitus to another. The position of the diaphragm, lungs, stomach, gallbladder, and large and
small intestines vary greatly with body habitus. The large extreme (hypersthenic) will have structures higher and more lateral, whereas these structures in individuals of the small extreme habitus (asthenic) have structures low and medial.

Explanation:

The midsagittal plane passes vertically through the midline of the body, dividing it into left and right halves. Any plane parallel to the MSP is termed a sagittal plane. The midco plane is perpendicular to the MSP and divides the body into anterior and posterior halves. The transverse plane passes across the body, also perpendicular to a sagittal plane. These planes, especially the MSP, are very important reference points in radiographic positioning

Explanation:

Motion obliterates recorded detail; it is therefore essential that the radiographer be able to reduce patient motion as much as possible. Even the slightest movement can cause severe degradation of the radiographic image. Suspension of patient respiration for parts other than the extremities is an effective means of reducing voluntary motion; patient understanding
and cooperation is required, thus making good communication the most effective means of reducing voluntary motion. The single most important way to reduce involuntary motion is to
use the shortest possible exposure time.

Explanation:

The patient must remove any metallic objects if they are within the area(s) of interest. Dentures, earrings, necklaces, and braided hair can obscure bony details in the skull or cervical spine. The radiographer must be certain that the patient’s belongings are cared for properly and returned following the examination

Explanation:

Correct and complete patient information on every radiograph is of paramount importance. Each radiographic image must be accurately labeled with such patient information as name or identification number, institution name, date of examination, and side marker. Other information may be included according to institution policy.

Explanation:

The acquisition of pertinent clinical history is one of the most valuable contributions to the diagnostic process. Because the diagnostic radiologist rarely has the opportunity to speak with the patient, this is a crucial responsibility of the radiographer. As the radiographer obtains a brief pertinent clinical history, the radiographer also assesses the patient’s condition by observing and listening. To provide safe and effective care, the radiographer must be able to
assess the severity of a trauma patient’s injury, their degree of motor control, the need for support equipment, or radiographic accessories. In patients too injured or ill to move, the radiographershould be capable of modifying routine positions to obtain images with the required anatomic part/information.

Explanation:

When the patient is recumbent with his or her head lower than his or her feet, the patient is said to be in the Trendelenburg position. In the Fowler position, the patient’s head
is positioned higher than his or her feet. The decubitus position is used to describe the patient as recumbent (prone, supine, or lateral) with the central ray directed horizontally. The Sims position is the left anterior oblique position assumed for enema tip insertion.

Explanation:

A patient will naturally feel more comfortable and confident if brought into a clean, orderly x-ray room that has been prepared appropriately for the examination to be performed.
A disorderly, untidy room and a disorganized radiographer hardly inspire confidence; more likely, they will increase anxiety and apprehension.

Explanation:

Surface landmarks, prominences, and depressions are very useful to the radiographer in locating anatomic structures not visible externally. The lower costal margin is about the same
level as L3. The umbilicus is the same approximate level as the L3 to L4 interspace. The xiphoid tip is about the same level as T10. The fourth lumbar vertebra is at the same approximate level as the iliac crest.

Explanation:

To better visualize the joint space in the lateral projection of the knee, 20◦ to 30◦
flexion is recommended. The femoral condyles are superimposed so as to demonstrate the femoropatellar joint and the articulation between the femur and the tibia. The correct degree of forward or backward body rotation is responsible for the visualization of the femoropatellar joint. Cephalad tube angulation of 5◦ to 7◦ is responsible for demonstrating the articulationbetween the femur and the tibia (by removing the magnified medial femoral condyle from superimposition on the joint space).

Explanation:

The knee joint is formed by the femur, tibia, and patella. The most superior aspect of the tibia is the tibial plateau—formed by the tibial condyles just distal to it. The proximal tibia also presents the tibial tuberosity on its anterior surface, just distal to the condyles. Proximal tothe tibial plateau, and articulating with it, are the femoral condyles. The term proximal refers to a part located closer to the point of attachment; the term distal refers to a part located farther away from the point of attachment.

Explanation:

For the lateral projections of the hand, wrist, forearm, and elbow, the elbow must be flexed 90◦ to superimpose the distal radius and ulna and humeral epicondyles. Although a lateral humerus can be performed with the elbow flexed, if the patient is unable to flex the arm, it may be left anteroposterior (AP) and a transthoracic lateral projection of the upper one half to two thirds of the humerus may be obtained. Because a coronal plane passing through the
epicondyles is perpendicular to the IR in this position, the epicondyles will be superimposed. To obtain a lateral projection of the thumb (first digit), the patient’s wrist must be somewhat
internally rotated. Remember that an oblique projection of the thumb is obtained in a PA projection of the hand.

Explanation:

With the patient in the AP position, the central ray is directed cephalad. The reverse is true when examining the clavicle in the PA position. This serves to project the pulmonary apices away from the clavicle. Patients having clavicular pain are more comfortably examinedin the PA erect or AP recumbent position.

Explanation:

If a transverse fracture of the patella is present and the knee is flexed, there is a danger of separation of the fractured segments. Because both a lateral knee and axial patella require knee flexion, they should be avoided until a transverse fracture is ruled out. When present, a transverse fracture may be seen through the femur on the AP projection. The axial (“sunrise”) projection of the patella is generally used for demonstrating vertical patellar

Explanation:

The lateral oblique projection of the foot demonstrates the navicular and first and second cuneiforms. To demonstrate the rest of the tarsals and intertarsal spaces, including the cuboid, sinus tarsi, and tuberosity of the fifth metatarsal, a medial oblique is required (plantar surface and IR form a 30◦ angle). Weight-bearing lateral feet are used to demonstrate the longitudinal arches.

Explanation:

The subtalar, or talocalcaneal, joint is a three-faceted articulation formed by the talus and os calsis (calcaneus). The plantodorsal and dorsoplantar projections of the os calsis should exhibit radiographic density sufficient to visualize the subtalar joint. If the evaluation of the subtalar joint is desired, special views (such as Broden and Isherwood methods) would be required.

Explanation:

With the femoral condyles of the affected side rotated medially/internally to form a 45◦
angle with the IR, the proximal tibiofibular articulation is placed parallel with the IR and the fibula is free of superimposition with the tibia. The lateral oblique completely superimposes
the tibia and fibula. The AP and lateral projections superimpose enough of the tibia and fibula so that the tibiofibular articulation is “closed.”

Explanation:

The medial oblique projection (15◦–20◦ mortise view) of the ankle is valuable because it demonstrates the tibiofibular joint as well as the talotibial joint, thereby visualizing all the major articulating surfaces of the ankle joint. To demonstrate maximum joint volume, it is recommended that the plantar surface be vertical.

Explanation:

The scapular Y projection requires that the coronal plane be about 60◦ to the IR,
thus resulting in an oblique projection of the shoulder. The vertebral and axillary borders of the scapula are superimposed on the humeral shaft and the resulting relationship between the glenoid fossa and humeral head will demonstrate anterior or posterior dislocation. Lateral or medial dislocation is evaluated on the AP projection.

Explanation:

The AP axial position projects the anterior structures (frontal and facial bones) downward, thus permitting visualization of the occipital bone without superimposition (Towne method). The dorsum sella and posterior clinoid processes of the sphenoid bone should be visualized within the foramen magnum. This projection may also be obtained by angling the central ray 30◦ caudad to the OML . The frontal bone is best shown with the patient PA and a perpendicular central ray. The parietoacanthial projection is the single best positionfor facial bones. Basal foramina are well demonstrated in the submentovertical project

Explanation:

In the “true” PA projection of the skull with perpendicular central ray exiting the nasion, the petrous pyramids should fill the orbits. As the central ray (CR) is angled caudally, the petrous pyramids are projected lower in the orbits, and at approximately 25◦ to 30◦, they are below
the orbits. The orbitomeatal line (OML) must be perpendicular to the image receptor or the petrous pyramids will not be projected into the expected location in the angled projection.
The midsagittal plane (MSP) must be perpendicular to the image receptor or the skull will be rotated.

Explanation:

The sacroiliac joints angle posteriorly and medially 25◦ to the midsagittal plane (MSP). Therefore, to demonstrate them with the patient in the anteroposterior (AP) position (RPO, LPO), the affected side must be elevated 25◦. This places the joint space perpendicular to the IR and parallel to the central ray. When performed with the posteroanterior (PA) position (right anterior oblique [RAO], left anterior oblique [LAO], the unaffected side will be elevated

Explanation:

Intervertebral joints are well visualized in the lateral projection of all the vertebral groups. Thoracic and lumbar intervertebral foramina are well demonstrated in the lateral projection.
Thoracic and lumbar apophyseal joints are demonstrated in an oblique position—thoracic requires a 70◦ oblique, lumbar requires a 45◦ oblique. Cervical articular facets (forming apophyseal joints) are 90◦ to the midsagittal plane (MSP) and are therefore well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45◦ to the MSP (and 15◦–20◦ to a transverse plane) and are therefore demonstrated in the oblique position

Explanation:

There are 12 thoracic vertebrae, which are larger in size than cervical vertebrae and which increase in size as they progress inferiorly toward the lumbar region. Thoracic spinous processes are fairly long and are sharply angled caudally. The bodies and transverse processes have articular facets for the diarthrotic rib articulations. These structures form the costovertebral (head of rib with body of vertebra) and costotransverse (tubercle of rib with transverse process of vertebra) articulations. The costochondral articulation describes where the anterior end of the rib articulates with its costal cartilage.

Explanation:

With the body in the supine position, the abdominal viscera exert greaterpressure on the diaphragm and it usually assumes a position 2 to 4 inches higher than when erect. When the body is erect, the diaphragm is more easily moved to a lower position during inspiration.
For this reason, chest radiography is performed erect to allow maximum lung expansion

Explanation:

The degree of anterior and posterior motion is occasionally diminished with a “whiplash”-type injury. Anterior (forward, flexion) and posterior (backward, extension) motion is evaluated in the lateral position with the patient assuming flexion and extension as best as possible. Left and right bending images of the vertebral column are frequently obtained to evaluate scoliosis.

Explanation:

The parietocanthial projection (Water’s method) of the skull is valuable for the demonstration of facial bones or maxillary sinuses. The head is rested on extended chin so that theorbitomeatal line (OML) forms a 37◦ angle with the image receptor. This projects the petrous pyramids below the floor of the maxillary sinuses and provides an oblique frontal view of thefacial bones.

Explanation:

The thoracic intervertebral foramina are demonstrated in the lateral projection. The midsagittal plane (MSP) is parallel to the image receptor; the midcoronal plane (MCP) is perpendicular to the image receptor. The thoracic apophyseal joints are demonstrated in an oblique position with the coronal plane 70◦ to the image receptor (MSP 20◦ to the image receptor). The apophyseal joints closest to the image receptor are demonstrated in the posteroanterior (PA) (right/left anterior oblique [RAO/LAO]) oblique and those away from the image receptor in the anteroposterior (AP) (left/right posterior oblique [LPO/RPO]) oblique.

Explanation:

The straight posteroanterior (PA) (0◦) projection effectively demonstrates the mandibular body but the rami and condyles are superimposed on the occipital bone and petrous portion
of the temporal bone. To better visualize the rami and condyles, the central ray is directed cephalad 20◦ to 30◦. This projects the temporal and occipital bones

Explanation:

Because the right main bronchus is wider and more vertical, aspirated foreign bodies are more likely to enter it than the left main bronchus, which is narrower and angles more sharply from the trachea. An aspirated foreign body does not enter the esophagus or stomach, as they are digestive, not respiratory, structures.

Explanation:

The chest should be examined in the erect position whenever possible to demonstrate any air or fluid levels. The shoulders should be relaxed and depressed to move the clavicles below the lung apices. The shoulders should be rolled forward to move the scapulae out of the lung fields.

Explanation:

Chest radiographs are performed in the erect position at 72 inches SID whenever
possible. The long source-to-image receptor distance (SID) is easily achieved with a minimum patient exposure due to the low tissue densities being examined (ribs and lungs). The longer SID minimizes magnification of the heart and provides better visualization of pulmonary vascular markings.

Explanation:

Fluid in the thoracic cavity between the visceral and parietal pleura is called pleural effusion. In the erect position, fluid gravitates to the lowest point, settling in, and “blunting,”the costophrenic angles. Ascites is an accumulation of serous fluid in the peritoneal cavity. Bronchitis is an inflammation of the bronchial tubes. Pulmonary emphysema is a chronic pulmonary disease characterized by increase beyond the normal in the size of air spaces distal to the terminal bronchiole, and with destructive changes in the walls of the bronchioles

Explanation:

Emphysema is characterized by irreversible trapping of air, which gradually increases and overexpands the lungs, thus producing the characteristic flattening of the diaphragm and widening of the intercostal spaces . The increased air content of the lungs requires a compensating decrease in technical factors. Empyema describes pus in the pleural cavity as a result of an infection of the lungs. Atelectasis is a collapsed or airless lung. Pneumonia is an inflammation of the lung; there are more than 50 causes of pneumonia.

Explanation:

Phase of respiration is exceedingly important in thoracic radiography; lung expansion and the position of the diaphragm strongly influence the appearance of the finished radiograph. Inspiration and expiration radiographs of the chest are taken to demonstrate air in the pleural cavity (pneumothorax), to demonstrate degree of diaphragm excursion, or to detect the presence of foreign body. The expiration image will require a somewhat greater exposure (6–8 kV or more) to compensate for the diminished quantity of air in the lungs.

Explanation:

To evaluate sufficient inspiration and lung expansion, 10 posterior ribs should be visualized. Sternoclavicular joints should be symmetrical; any loss of symmetry indicates rotation. Accurate positioning and selection of technical factors is critical to the diagnostic value of theradiographic images. Even slight rotation or leaning can cause significant distortion of the heart size and shape. To visualize maximum lung area, the shoulders are rolled forward to remove the scapulae from the lung fields.

Explanation:

The trachea (windpipe) bifurcates into left and right mainstem bronchi, each entering its respective lung hilum. The left bronchus divides into two portions, one for each lobe of the left lung. The right bronchus divides into three portions, one for each lobe of the right lung. The lungs are conical in shape, consisting of upper pointed portions, termed the apices (singular:apex), and the broad lower portions (or bases). The lungs are enclosed in a double-walled serous membrane called the pleura.

Explanation:

When the shoulders are relaxed, the clavicles are usually carried below the pulmonary apices. To examine the portions of lungs lying behind the clavicles, the CR is directed cephalad 15◦ to 20◦ to project the clavicles above the apices, when the patient is examined in the APposition.

Explanation:

When the body is erect, the diaphragm is more easily moved to a lower position
during inspiration. For this reason, chest radiography is performed erect to allow maximum lung expansion. With the body in the supine position, the abdominal viscera exert greater pressure on the diaphragm and it usually assumes a position 2 to 4 inches higher than whenerect.

Explanation:

With the body in the anteroposterior (AP) recumbent position, barium flows easily into the fundus of the stomach, displacing it somewhat superiorly. The fundus, then, is filled with barium, while the air that had been in the fundus is displaced into the gastric body, pylorus, and duodenum, illustrating them in double-contrast fashion. Air-contrast delineation of these
structures allows us to see through the stomach to retrogastric areas and structures. Bariumfilled duodenum and pylorus is best demonstrated in the right anterior oblique (RAO) position.

Explanation:

With the body in the AP recumbent position, barium flows easily into the fundus of the stomach, displacing the stomach somewhat superiorly. The fundus, then, is filled with
barium, while the air that had been in the fundus is displaced into the gastric body, pylorus, and duodenum, illustrating them in double-contrast fashion. Air-contrast delineation of these structures allows us to see through the stomach to the retrogastric areas and structures. Anterior and posterior aspects of the stomach are visualized in the lateral position; medial and lateral aspects of the stomach are visualized in the AP projection.

Explanation:

Air or fluid levels will be clearly demonstrated only if the central ray is directed parallel to them. Therefore, to demonstrate air or fluid levels, erect or decubitus positions should be
used. A “three-way abdomen” study is often performed to evaluate possible obstruction or free air or fluid within the abdomen and usually consists of anteroposterior (AP) recumbent, AP erect, and left lateral decubitus projections of the abdomen.

Explanation:

The trachea (windpipe) is a tube-like passageway for air that is supported by C-shaped cartilaginous rings. The trachea is part of the respiratory system and is continuous with the main stem bronchi. The esophagus, part of the alimentary canal, is a hollow tube-like structure connecting the mouth and stomach, and lies posterior to the trachea. If one inadvertently aspirates food or drink into the trachea, choking occurs.

Explanation:

Esophageal varices are tortuous dilatations of the esophageal veins. They are much less
pronounced in the erect position and must always be examined with the patient recumbent. The recumbent position affords more complete filling of the veins, as blood flows against gravity.

Explanation:

The upper gastrointestinal (GI) tract must be empty for best x-ray evaluation. Any food or
liquid mixed with the barium sulfate suspension can simulate pathology. Preparation therefore is to withhold food and fluids for 8 to 9 hours before the examination, typically after midnight, as fasting examinations are usually performed first thing in the morning.

Explanation:

To demonstrate structures via double contrast, the barium must be moved away from the area and replaced with air. The anteroposterior (AP) erect position will accomplish that for both the colic flexures. The erect position allows barium to move downward, while air rises to fill the flexures. The decubitus positions are useful to demonstrate the lateral and medial walls of the ascending and descending colon.

Explanation:

The right anterior oblique (RAO) position affords a good view of the pyloric canal
and duodenal bulb. It is also a good position for the barium-filled esophagus, projecting it
between the vertebrae and heart. The left lateral projection of the stomach demonstrates theleft retrogastric space; the recumbent posteroanterior (PA) is used as a general survey of the gastric surfaces, and the recumbent anteroposterior (AP) with a slight left oblique affords a double contrast of the pylorus and duodenum.

Explanation:

There are four types of body habitus. Listed from largest to smallest, they are hypersthenic, sthenic, hyposthenic, and asthenic. The position, shape, and motility of various organs can differ greatly from one body type to another. The typical asthenic gallbladder (GB) is situated low and medial, often very close to the midline. To move the GB away from the midline, left anterior oblique (LAO) position is used. The GB of hypersthenic individuals occupies a high lateral, and transverse position.

Explanation:

In the prone oblique positions (right/left anterior oblique [RAO/LAO]) the flexure
disclosed is the one closer to the IR. Therefore, the RAO position will open up the hepatic flexure. The anteroposterior (AP) oblique positions (right/left posterior oblique [RPO/LPO]) demonstrate the side away from the IR.

Explanation:

When scheduling patient examinations, it is important to avoid the possibility of residual contrast medium covering areas of interest on later examinations. The intravenous pyelogram (IVP) should be scheduled first because the contrast medium used is excreted
rapidly. The barium enema (BE) should be scheduled next. The gastrointestinal (GI) series is scheduled last. Any barium remaining from the previous BE should not be enough to interfere with the stomach or duodenum, although a preliminary scout image should be taken in each case.

Explanation:

The anteroposterior (AP) projection provides a survey of the abdomen, showing the size
and shape of the liver, spleen, and kidneys. When performed erect, it should demonstrate both hemidiaphragms. The lateral projection is sometimes requested and is useful for evaluating the prevertebral space occupied by the aorta. Ventral and dorsal decubitus positions provide a lateral view of the abdomen useful for demonstration of air–fluid levels.

Explanation:

A patient having a gastrointestinal (GI) series is required to be NPO (nothing by mouth)
for at least 8 hours prior to the examination; food or drink in the stomach can simulate disease. A patient scheduled for a pyelogram must have the preceding meal withheld so as to avoid the possibility of aspirating vomitus in case of allergic reaction. An abdominal survey does not require the use of contrast medium and no patient preparation is required.

Explanation:

The kidneys lie obliquely in the posterior portion of the trunk, with their superior
portions angled posteriorly and their inferior portions and ureters angled anteriorly. Therefore, to facilitate filling of the most anteriorly placed structures, the patient is examined in the prone position. Opacified urine then flows to the most dependent part of the kidney and ureter—the ureteropelvic region, inferior calyces, and ureters.

Explanation:

Retrograde urograms require catheterization of the urethra and/or ureter(s). Radiographs
that include the kidney(s) and ureter(s) in their entirety are made after retrograde filling of the structures. A cystogram or (voiding) cystourethrogram requires urethral catheterization only. Radiographs are made of the contrast-filled bladder and frequently of the contrast-filled urethra during voiding. Cystoscopy is required for location and catheterization of the vesicoureteral
orifices.

Explanation:

Because the urinary structures have so little subject contrast, artificial contrast material
must be employed for better visualization of these structures. Contrast agents used
for urographic procedures can have unpleasant, and (rarely) even lethal, side effects. Intravenous injection of contrast frequently produces a warm, flushed feeling, a bitter or metallic taste, or mild nausea. These side effects are of short duration and usually pass as quickly as they come. More serious side effects include urticaria, respiratory discomfort/distress, and, rarely, anaphylaxis. An antihistamine is appropriate treatment for simple side effects, but the radiographer must always be prepared to deal quickly and efficiently with patients experiencing
more serious reactions. Nonionic contrast agents are far less likely to produce side
effects.

Explanation:

The most commonly performed radiologic examination of the reproductive system is
hysterosalpingography, which is employed for evaluation of the uterus, oviducts, and ovaries of the female reproductive system. The procedure serves to delineate the position, size, and shape of the structures, and demonstrate pathology such as polyps, tumors, and fistulas. However, it is most often used to demonstrate patency of the oviducts in cases of infertility and is sometimes therapeutic in terms of opening a blocked oviduct.

Explanation:

An anteroposterior (AP) postvoid bladder image is usually required to detect any residual urine in the evaluation of tumor masses or enlarged prostate glands. An erect image is occasionally requested to demonstrate renal mobility and ureteral tortuosity.

Explanation:

During intravenous urography, both oblique positions are generally obtained. The 30◦
oblique KUB (kidney, ureters, bladder) places the kidney of the side away from the x-ray table parallel to the IR. The kidney closer to the x-ray table is placed perpendicular to the IR. The oblique positions provide an oblique projection of the urinary bladder.

Explanation:

A 15◦ to 20◦ anteroposterior (AP) Trendelenburg position during intravenous (IV) urography is often helpful in demonstrating filling of the distal ureters and the area of the vesicoureteral orifices. In this position, the contrast-filled urinary bladder moves superiorly, encouraging filling of the distal ureters and superior bladder, and provides better delineation of these areas. The central ray should be directed perpendicular to the IR. Compression of the distal ureters is used to prolong filling of the renal pelvis and calyces. Compression of the proximal ureters is not advocated.