Procedures Review ARRT—Links to content specs - PowerPoint Presentation

1. Procedures Review

2. ARRT—Links to content specsARRT Content Specifications 2022Handbook

3. ProceduresHead, Spine, Pelvis 18 questionsThorax/ Abdomen 20 questionsExtremities 28 questionsTOTAL 66 questions

4. Procedures-Body Planes

5. Procedures- Patient Position

6. Procedures- Body Habitus

7. ProceduresEXTREMES IN BODY HABITUSHypersthenic Asthenic5% of populationBody large and heavyBony framework thick, short, and wideLungs and heart highStomach transverseColon/ large bowel peripheralGallbladder high and lateral10% of population Body slender and lightBony framework delicateThorax long and narrowStomach very low and long “fish hook”Colon/ large bowel low, medial, and redundantGallbladder low and medial

8. Procedures SthenicHyposthenic50% of population Build average and athleticSimilar to hypersthenic, but modified by elongation of abdomen and thoraxSomewhat slighter, less robustSimilar to asthenic, but stomach, intestines, and gallbladder situated higher in abdomen

9. Procedures-- Quadrants

10. Procedures

11. ProceduresAnatomical positioning/ terminologySuperior Inferior Anterior/ Ventral Posterior/ Dorsal Medial Lateral Proximal Distal Cephalad Caudad

12. ProceduresSkeletal motion terminologySupinationPronationAbductionAdductionFlexionExtensionEversionInversionRotationCircumduction

13. ProceduresPreliminary Steps and Procedural Guidelines Read the request carefully- Exam typeCondition of patientMode of travelModificationsPrepare the radiographic departmentRoom- neat and orderly—CLEANAll accessories needed prior to bringing patient in

14. ProceduresPreliminary Steps and Procedural GuidelinesIdentify the correct patientEvaluate special needsIntroduce yourself/ establish rapportRemember HIPAAInstruct patientChange if necessaryRemove clothing and objects that may obscure anatomy (artifacts)

15. ProceduresPreliminary Steps and Procedural GuidelinesSpeak in a well modulated voiceGive clear and succinct explanation of procedureAddress any questions/ concerns of the patientObtain short pertinent patient historyDetermine positioning/ projections for examUse ALARA when exposing patientPerform examAccurately label with appropriate ID per institutional policy

16. General GuidelinesLong BonesHow many views?What are they??Joint spacesHow many views?Typically-what are they?Other- ex..Zygomatic arches, Os Calsis, PatellaImmobilizationCommunicationReduce timeRespirationsVaries per procedure

17. Procedures- Example questionsThe plane that passes vertically through the body dividing into left and right halves is termed the:Midsagittal planeMidcoronal planeSagittal planeTransverse planeCorrect Answer—A. Midsagittal plane

18. The position of the asthenic gallbladder as compared to the position of the sthenic gallbladder, is more:Superior and lateralSuperior and medialInferior and lateralInferior and medialCorrect answer—D. Inferior and medial

19. What is the relationship between the midsagittal and midcoronal planes?ParallelPerpendicular45 degrees70 degreesCorrect Answer:B. perpendicular

20. With the patient recumbent and head positioned at a level lower than the feet, the patient is said to be in the:Trendelenburg positionFowler positionDecubitus positionSims positionCorrect answer:A. Trendelenburg position

21. Prior to x-ray examinations of the skull and cervical spine, the patient should remove:DenturesEarringsNecklaces1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:D. 1, 2 and 3

22. Image identification markers should include:Patient’s name and/ or ID numberDateA right or left marker1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:D. 1, 2, and 3

23. The radiographer should be able to:Take a short patient history prior to the examination.Modify routine protocol to obtain similar images in patients unable to moveEvaluate patient condition and needs1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:D. 1, 2, and 3

24. The best way to control voluntary motion is:ImmobilizationCareful explanationShort exposure timePhysical restraintCorrect answer:B. Careful explanation

25. Before bringing the patient into the radiographic room the radiographer should:Be certain the x-ray room is clean and orderlyCheck that all necessary accessories are available in the roomCheck that x-ray table is clean and pillowcases are fresh1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:D. 1, 2, and 3

26. The lower portion of the costal margin is approximately at the same level as that of the :MidthoraxUmbilicusXiphoid tipThird lumbar vertebraCorrect answer:D. Third lumbar vertebra

27. Procedures- Skeletal systemTerms to knowCondyleCoracoidCoranoidEpicondyleFacetMalleolusSpine or spinous processStyloidTrochanterTubercleTuberosityAntrumGrooveFissureForamenFossaFoveaMeatus or canalSinusSulcusTissue typesCortical (hard, compact)Cancellous (spongy)

28. Procedures- Skeletal system FunctionsSupportReservoir for mineralsMuscle attachment/ movementProtectionHematopoiesis

29. Procedures- Joint ClassificationsGive examples of eachGliding Ball and socketPivotCondyloid (ellipsoidal)HingeSaddleBicondylarIntercarpal joints, AC Shoulder/ hipProximal radioulnar joint/ atlantoaxial jointRadiocarpal and MCP Elbow, IP joints, ankle1st CMP joint (thumb)TMJ, Knee

30. Procedures- Joint ClassificationsCategoryStructureFunctionSynarthroticFibrousImmovableAmphiarthroticCartilaginousPartially moveableDiarthroticSynovialFreely Moveable

31. Procedures- Appendicular skeleton

32. Procedures– Exams of appendicular skeletonShoulderScapulaAC JointsClavicleHumerusForearmWristHandFinger/ fingersPelvisHipFemurPatellaKneeLower leg/ Tib FibAnkleFootToe/ toesCalcaneus/ Os Calcis

33. Procedures- ARRTUSE MERRILL’S– NOT HOSPITAL PROTOCOLReview and make notes on unusual projections that are unfamiliarDon’t worry so much about the others– you do it daily

34. Procedures- Carpal bonesProximal Row- Lateral to medialScaphoidLunate/ semilunarTriquetrum/ triangularPisiformDistal Row- Lateral to medialTrapezium/ greater multangularTrapezoid/ lesser multangularCapitate/ os magnumHamate/ unciform

35. Procedures– Types of Fractures SimpleDisplacedCompoundIncompleteGreenstickTorus/ buckleStress/ fatigueAvulsionHairlineComminutedButterflySpiralObliqueTransverseBoxerMonteggiaCollesTrimalleolarJonesPottsPathologic

36. Procedures- Axial Skeleton

37. Procedures of the Axial SkeletonSkull, Sinuses, Facial Bones, Etc.Cervical SpineThoracic SpineLumbar SpineSacrum/ CoccyxScoliosis SeriesSI JointsChestUpper AirwayRibsSternumSC Joints

38. Procedures- Other SystemsRespiratoryChestRoutineAxialDecubitusBiliarySurgical CholangiographyT- tube cholangiographyERCP

39. Procedures- other systemsDigestiveAbdomenAPErectDecubitusSwallowing Study/ ModifiedEsophogramUGISmall bowel seriesBEWater soluble enemaUrinary KUBIVURetrograde UrogramCystogramVCUCystourethrogramReproductiveFemaleHSG—NO LONGER ON ARRT SpecsMaleUltrasound

40. Procedures- Other SystemsCentral Nervous SystemMyelogramJoint ArthrographyAny joint spaceCirculatoryAngiographyArteriographyVenographyBasic anatomyBasic pathologiesAneurysmCVAHypertensionMIPEDVT

41. Procedures Example QuestionsIn the AP projection of the knee thePatella is visualized through the femurCR is directed ½” distal to the patellaCR is directed 3-5 degrees cephalad when the distance between the tabletop and ASIS is 17cm1 only1and 2 only2 and 3 only1, 2, and 3Correct answer:A. 1 only

42. Procedures- Example QuestionsA Colles fracture usually involves the followingTransverse fracture of the distal radiusPosterior and outward displacement of the handChip fracture of the ulnar styloid process1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:D. 1, 2, and 3

43. Procedures- Example Questions Which of the following projections require(s) that the humeral epicondyles be superimposed?Lateral thumbLateral wristLateral humerus1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:C. 2 and 3 only

44. Procedures- Example Questions In the 15-20 degree mortise oblique position of the ankle the,Talofibular joint is visualizedTalotibial joint is visualizedPlantar surface should be vertical1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:D. 1, 2, and 3

45. Procedures- Example QuestionsThe following projection(s) should not be performed until a transverse fracture of the patella has been ruled out:AP kneeLateral kneeAxial/ tangential patella1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:C. 2 and 3 only

46. Procedures- Example QuestionsWhich of the following best demonstrates the cuboid, sinus tarsi, and tuberosity of the fifth metatarsal?Lateral footLateral oblique footMedial oblique footWeight-bearing footCorrect answer:C. Medial oblique footThe left sacroiliac joint is placed perpendicular to the IR when the patient is placed in a Left lateral position25-30 degree RAO position25-30 degree RPO position30-40 degree RPO positonCorrect answer:C. 25-30 degree RPO position

47. Procedures- Example Questions The proximal tibiofibular articulation is best demonstrated in which of the following positions?Medial obliqueLateral obliqueAPLateralCorrect answer:A. Medial obliqueAn axial projection of the clavicle is often helpful in demonstrating a fracture not visualized using a perpendicular central ray. When examining the clavicle in the AP axial projection, how should the central ray be directed?CephaladCaudadMediallyLaterallyCorrect answer:A. Cephalad

48. Procedures- Example QuestionsThe scapular Y projection of the shoulder demonstratesA lateral projection of the shoulderAnterior or posterior dislocationAn oblique projection of the shoulder1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:C. 2 and 3 only

49. Procedures- Example QuestionsIn the AP axial projection (Towne method) of the skull, with the central ray directed 30 degrees caudad to the OML and passing midway between the external auditory meati, which of the following is best demonstrated?Facial bonesFrontal boneOccipital boneBasal foraminaCorrect answer:C. Occipital boneWhich of the following is a functional study used to demonstrate the degree of AP motion present in the cervical spine?Open-mouth projectionMoving mandible APFlexion and extension lateralsRight and left bendingCorrect answer:C. Flexion and extension laterals

50. Procedures- Example QuestionsThe AP projection of the coccyx requires that the central ray be directed15 degrees cephalad2” above the pubic symphysisMidline at the level of the lesser trochanter1 only2 only1 and 2 only1 and 3 onlyCorrect answer:B. 2 only

51. Procedures- Example Questions Which of the following is (are) demonstrated in the oblique projection of the thoracic spine?Intervertebral jointsZygapophyseal jointsIntervertebral foramina1 only2 only1 and 2 only1 and 3 onlyCorrect answer:B. 2 only

52. Procedures- Example QuestionsThe thoracic vertebrae are unique in that they participate in the following articulationsCostovertebralCostotransverseCostochondral1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:B. 1 and 2 only

53. Procedures- Example Question In order to demonstrate undistorted air/ fluid levels, the CR must always be directedParallel with the long axis of the body/ partParallel with the floorPerpendicular to the long axis of the body/ partPerpendicular to the floorCorrect answer:B. Parallel with the floorAll of the following statements regarding the PA projection of the skull, with the central ray perpendicular to the IR are true, exceptOrbitomeatal line is perpendicular to the IRPetrous pyramids fill the orbitsMidsagittal plane (MSP) is parallel to the IRCentral ray exits the nasionCorrect answer:C. Midsagittal plane (MSP) is parallel to the IR

54. Procedures- Example Questions Which of the paranasal sinues is composed of many thin-walled air cells?FrontalSphenoidEthmoidMaxillaryCorrect answer:C. EthmoidThe intervertebral joints of the thoracic spine are demonstrated with the Midcoronal plane 45 degrees to the IRMidsagittal plane 45 degrees to the IRMidcoronal plane 70 degrees to the IRMidsagittal plane parallel to the IRCorrect answer:D. Midsagittal plane parallel to the IR

55. Procedures- Example Questions Which of the following structures is subject to blowout fracture?Ethmoid sinusesZygomatic archMandibular condyleOrbital floorCorrect answer:D. Orbital floorAspirated foreign bodies in older children and adults are most likely to lodge in the Right main bronchusLeft main bronchusEsophagusProximal stomachCorrect answer:A. Right main bronchus

56. Procedures- Example Questions Which of the following is (are) important when positioning the patient for a PA projection of the chest?The patient should be examined erect.Clavicles should be brought above the apices.Scapulae should be brought lateral to the lung fields.1 only1 and 2 only1 and 3 only1, 2, and 3Correct answer:C. 1 and 3 only

57. Procedures- Example QuestionsChest radiography should be performed using 72” SID whenever possible in order toVisualize vascular markingsObtain better lung detailMaximize magnification of the heart1 only1 and 2 only2 and 3 only1, 2, and 3 Correct answer:B. 1 and 2 only

58. Procedures- Example QuestionsBlunting of the costophrenic angles seen on a PA projection of the chest can be an indication ofPleural effusionAscitesBronchitisEmphysemaCorrect answer:A. Pleural effusionWhich of the following conditions is characterized by “flattening” of the diaphragm? EmphysemaEmpyemaAtelectasisPneumoniaCorrect answer:A. Emphysema

59. Procedures- Example QuestionsInspiration and expiration projections of the chest may be performed to demonstratePneumothoraxPresence of foreign bodyBronchitis1 only1 and 2 only1 and 3 only1, 2, and 3Correct answer:B. 1 and 2 only

60. Procedures- Example Questions Which of the following criteria are used to evaluate a good PA projection of the chest?Ten posterior ribs should be visualizedSternoclavicular joints should be symmetricalScapulae should be outside the lung fields1 and 2 only1 and 3 only2 and 3 only1, 2, and 3Correct answer:D. 1, 2, and 3

61. Procedures- Example QuestionsAll of the following statements regarding respiratory structures are true, exceptThe right lung has three lobesThe uppermost portion of a lung is its apexThe lobes of the left lung are separated by the horizontal fissureThe trachea bifurcates into mainstem bronchiCorrect answer:C. The lobes of the left lung are separated by the horizontal fissureTo demonstrate the pulmonary apices below the level of the clavicles in the AP position, the CR should be directedPerpendicular15-20 degrees caudad15-20 degrees cephalad40 degrees cephaladCorrect answer:C. 15- 20 degrees cephalad

62. Procedures- Example QuestionsRadiographic indications of atelectasis include(s)Decreased radiographic density/ increased brightness of the affected sideElevation of the hemidiaphragm of the affected sideFlattening of the hemidiaphragm of the affected side1 only3 only1 and 2 only1 and 3 onlyCorrect answer:C. 1 and 2 only

63. Procedures- Example Questions During IV urography, the prone position is generally recommended to demonstrateFilling of the obstructed uretersThe renal pelvisThe superior calyces1 only1 and 2 only1 and 3 only1, 2, and 3Correct answer:B. 1 and 2 only

64. Procedures- Example QuestionsThe contraction and expansion of arterial walls in accordance with forceful contraction and relaxation of the heart is calledHypertensionElasticityPulsePressureCorrect answer:C. Pulse

65. Procedures- Example QuestionsWhich of the following projections of the abdomen could be used to demonstrate air or fluid levels when the erect position cannot be obtained?AP TrendelenburgDorsal decubitusLateral decubitus1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:C. 2 and 3 only

66. Procedures- Example QuestionsWhich of the following best describes the relationship between the esophagus and trachea?Esophagus is posterior to the tracheaTrachea is posterior to the esophagusEsophagus is lateral to the tracheaTrachea is lateral to the esophagusCorrect answer:A. Esophagus is posterior to the tracheaTo demonstrate esophageal varices, the patient must be examined in the Recumbent positionErect positionAnatomic positionFowler positionCorrect answer:A. Recumbent position

67. Procedures- Example QuestionsThe usual preparation for an upper GI series is Clear fluids 8 hours prior to examinationNPO after midnightEnemas until clear before examinationLight breakfast before examinationCorrect answer:B. NPO after midnightWhich of the following positions would best demonstrate a double contrast of the left and right colic flexures?Left lateral decubitusAP recumbentRight lateral decubitusAP erectCorrect answer:D. AP erect

68. Procedures- Example QuestionsIn which of the following positions are a barium- filled pyloric canal and duodenal bulb best demonstrated during a GI series?RAOLeft lateralRecumbent PARecumbent APCorrect answer:A. RAOWhat position is frequently used to project the GB away from the vertebrae in the asthenic patient?RAOLAOLeft lateral decubitusPA erectCorrect answer:C. LAO

69. Procedures- Example QuestionsWhich of the following barium/ air filled anatomic structures is best demonstrated in the RAO position?Splenic flexureHepatic flexureSigmoid colonIleocecal valveCorrect answer:B. Hepatic flexure

70. Procedures- Example QuestionsIn what order should the following studies be performed?Barium enemaIntravenous urogramUpper GI3, 1, 21, 3, 22,1, 32, 3,1Correct answer:C. 2, 1, 3

71. Procedures- Example QuestionsAll of the following statements regarding the urinary system are true, exceptThe left kidney is usually higher than the rightThe kidneys move inferiorly in the erect positionThe upper, expanded part of the ureter is the hilumVessels, nerves, and lymphatics pass through the renal hilumCorrect answer:C. The upper, expanded part of the ureter is the hilum

72. Procedures- Example QuestionsWhich of the following examinations require(s) restriction of the patient’s diet?GI seriesAbdominal surveyUrogram1 only1 and 2 only1 and 3 only1, 2, and 3Correct answer:C. 1 and 3 only

73. Procedures- Example QuestionsDuring a gastrointestinal examination, the AP recumbent projection of a stomach of average size and shape will usually demonstrate:Barium-filled fundusDouble contrast of distal stomach portionsBarium-filled duodenum and pylorus1 only1 and 2 only1 and 3 only1, 2, and 3Correct answer:B. 1 and 2 only

74. Procedures- Example QuestionsWhich of the following examinations require(s) catheterization of the ureters?Retrograde urogramCystogramVoiding cystogram1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:A. 1 only

75. Procedures- Example QuestionsSome common mild side effects of intravenous administration of water- soluble iodinated contrast agents include:Flushed feelingBitter tasteUrticaria1 only1 and 2 only1 and 3 only1, 2, and 3Correct answer:B. 1 and 2 only

76. Procedures- Example QuestionsHysterosalpingograms may be performed for the following reasonsDemonstration of fistulous tractsInvestigation of infertilityDemonstration of tubal patency1 only1 and 2 only1 and 3 only1, 2, and 3Correct answer:D. 1, 2, and 3

77. Procedures- Example QuestionsA postvoid image of the urinary bladder is usually requested at the completion of and IVU and may be helpful in demonstratingResidual urineProstate enlargementUreteral tortuosity1 only1 and 2 only1 and 3 only1, 2, and 3Correct answer:B. 1 and 2 only

78. Procedures- Example QuestionsDuring routine intravenous urography, the oblique position demonstrates theKidney of the side up parallel to the IRKidney of the side up perpendicular to the IRUrinary bladder parallel to the IRUrinary bladder perpendicular to the IRCorrect Answer:A. Kidney of the side up parallel to the IR

79. Procedures- Example QuestionsTo better demonstrate contrast filled distal ureters during intravenous urography, it is helpful to Use a 15 degree AP Trendelenburg positionApply compression to the proximal uretersApply compression to the distal ureters1 only2 only1 and 2 only1 and 3 onlyCorrect Answer:A. 1 only

80. Procedures- Example QuestionsThe space located between the arachnoid mater and dura mater is the Subarachnoid spaceSubdural spaceEpidural spaceEpiarachnoid spaceCorrect answer:B. Subdural space

81. Procedures- Example QuestionsDuring a GI examination, the lateral recumbent projection of a stomach of average shape will demonstrateAnterior and posterior aspects of the stomachMedial and lateral aspects of the stomachDouble-contrast body and antral portions1 only1 and 2 only2 and 3 only1, 2, and 3Correct answer:A. 1 only

82. Procedures- Example QuestionsThe method by which contrast-filled vascular images are removed from superimposition upon bone is calledPositive maskingReversalSubtractionRegistrationCorrect answer:C. Subtraction

83. Procedures- Example QuestionsIndicate the correct sequence of oxygenated blood as it returns form the lungs to the heartPulmonary veins, left atrium, left ventricle, aortic valvePulmonary artery, left atrium, left ventricle, aortic valvePulmonary veins, right atrium, right ventricle, pulmonary semilunar valvePulmonary artery, right atrium, right ventricle, pulmonary semilunar valveCorrect answer:A. Pulmonary veins, left atrium, left ventricle, aortic valve

84. Procedures- Example QuestionsIn myelography, the contrast medium is generally injected into theCisterna magnaIndividual intervertebral disksSubarachnoid space between the first and second lumbar vertebraeSubarachnoid space between the third and fourth lumbar vertebraeCorrect answer:D. Subarachnoid space between the third and fourth lumbar vertebrae

85. Procedures- Example QuestionsThe upper chambers of the heart are theVentriclesAtriaPericardiaMyocardiaCorrect answer:B. Atria

86. Procedures- Example QuestionsMyelography is a diagnostic examination used to demonstratePosterior protrusion of herniated intervertebral diskAnterior protrusion of herniated intervertebral diskInternal disk lesions1. only2 only1 and 2 only1 and 3 onlyCorrect answer:A. 1 only

87. Procedures- Example QuestionsThe four major arteries supplying the brain include theBrachiocephalic arteryCommon carotid arteriesVertebral arteries1 and 2 only1 and 3 only2 and 3 only1, 2, and 3Correct answer:C. 2 and 3 only

88. Procedures- Example QuestionsVenous, or deoxygenated, blood is returned to the heart viaInferior vena cavaSuperior vena cavaCoronary sinus1 only2 only1 and 2 only1, 2, and 3Correct answer:D. 1, 2, and 3

89. Procedures- Example QuestionsThe apex of the heart is formed by the Left atriumRight atriumLeft ventricleRight ventricleCorrect answer:C. Left ventricle

90. ProceduresHandbookSTUDY WHAT YOU DON’T KNOW……Know what you know…….Merrill’s (textbooks)---not Hospital……Read the questions……Take your time……Choose answers that make the most sense—best possible answer