Review Notes for the

RADIOGRAPHY EXAM Appleton

c. The erect position may be used, but is not
Chapter 2: Radiographic Procedures (300) required.
 Weight-bearing images are not
1. Which of the following projections or positions
recommended.
will best demonstrate subacromial or
subcoracoid dislocation? (Ballinger & Frank, vol 1, p 485)
Ans. A
(A) Tangential
(B) AP axial
3. Which of the positions illustrated in Figure 2-1
(C) Transthoracic lateral
should be used to demonstrate the cervical
(D) PA oblique scapular Y
apophyseal articulations?
————————————————
————————— 1. A
2. B
 The "scapular Y" refers to the
3. C
characteristic Y formed by the humerus,
(A) 1 only
acromion, and coracoid processes.
(B) 2 only
o The patient is positioned in a PA (C) 1 and 3 only
oblique position an RAO or LAO, (D) 2 and 3 only
depending on which is the affected ————————————————
side. —————————
o The midcoronal plane is adjusted Three positions of the cervical spine are
approximately 60º to the film, and illustrated.
the affected arm is left relaxed at the  Figure B is the left lateral position.
patient's side. 1. Lateral projections of the cervical
spine are done to demonstrate the
 The scapular Y position is employed
1.) intervertebral disk
to demonstrate anterior
spaces,
(subcoracoid) or posterior
2.) apophyseal joints,
(subacromial) humeral dislocation.
3.) spinous processes.
1. The humerus is normally  Figure A is an RAO; Figure C is an LPO.
superimposed on the scapula in this 1. Anterior oblique positions (LAO, RAO)
position; any deviation from this may of the cervical spine demonstrate the
indicate dislocation. intervertebral foramina closer to the
film,
(Ballinger & Frank, vol 1, pp 179-181)
2. while Posterior oblique positions
Ans. D
(LPO, RPO) demonstrate the
intervertebral foramina farther from
2. The sternoclavicular joints are best
the film.
demonstrated with the patient PA and
(Ballinger & Frank, pp 400-403)
(A) in a slight oblique position, affected side Ans. B
adjacent to the image recorder.
(B) in a slight oblique position, affected side 4. In which of the following positions /
away from the image recorder. projections will the talocalcaneal joint be
(C) erect and weight-bearing. visualized?
(D) erect, with and without weights. (A) Dorsoplantar projection of the foot
———————————————— (B) Plantodorsal projection of the os
————————— calcis
(C) Medial oblique position of the foot
a. Sternoclavicular joints should be
(D) Lateral foot
performed PA whenever possible to keep
————————————————
the object-to-image distance (OID) to a
—————————
minimum.
 The talocalcaneal, or subtalar, joint is a
b. The Oblique position (about 15º) opens
three-faceted articulation formed by the
the joint closest to the image recorder.
“talus” and the “os calcis” (calcaneus).

Reviewer A&R
Question & Answer
1
Review Notes for the
RADIOGRAPHY EXAM Appleton
o The plantodorsal and dorsoplantar parallel with the film.
projections of the os calcis should exhibit o Some articulations, such as the knee,
sufficient density to visualize the require angulation to better visualize the
talocalcaneal joint (Fig. 2-36). joint space.
 This is the only "routine" projection (Ballinger & Frank, vol 1, p 17)
that will demonstrate the Ans. D
talocalcaneal joint.
 If evaluation of the talocalcaneal joint is 7. With the patient and the x-ray tube positioned
desired, special views (such as the Broden as illustrated in Figure 2-2, which of the
and Isherwood methods) are required. following will be obtained?
(Ballinger & Frank, vol 1, p 215) 1. Intercondyloid fossa
Ans. B 2. Patellofemoral articulation
3. Tangential patella
5. Which of the following projections is most (A) 1 only
likely to demonstrate the carpal pisiform free (B) 1 and 2 only
of superimposition? (C) 2 and 3 only
(A) Radial flexion (D) 1, 2, and 3
(B) Ulnar flexion —————————————————
(C) AP oblique The relationship between the thigh, lower leg,
(D) AP 6. patella, and central ray should be noted.
———————————————— The central ray is directed parallel to the plane
— of the patella, thereby providing a tangential
 In the direct PA projection of the wrist, projection of the patella (patella in profile)
the carpal pisiform is superimposed on and an unobstructed view of the
the carpal triquetrum. patellofemoral articulation (Fig. 2-37).
 The AP oblique projection (medial surface A "tunnel view" is required in order to
adjacent to the film) separates the demonstrate the intercondyloid fossa and the
pisiform and triangular and projects the articulating surfaces of the tibia and femur.
pisiform as a separate structure. (Ballinger & Frank, vol 1, p 311)
The pisiform is the smallest and Ans. C
most palpable carpal.
(Ballinger & Frank, p 117) 8. Which of the following are part of the bony
Ans. C thorax?
1. 12 thoracic vertebrae
6. Angulation of the central ray may be required. 2. Scapulae
1. to avoid superimposition of overlying 3. 24 ribs
structures. (A) 1 only
2. to avoid foreshortening or self- (B) 1 and 2 only
superimposition. (C) 1 and 3 only
3. in order to project through certain (D) 1, 2, and 3
articulations. —————————————————
(A) 1 only  The bony thorax consists of 12 pairs of
(B) 2 only ribs and the structures to which they are
(C) 1 and 3 only attached anteriorly and posteriorly: the
(D) 1, 2, and 3 sternum and the 12 thoracic vertebrae
————————————————— (Fig. 2-38).
 If structures are overlying or underlying o These structures form a bony cage
the area to be demonstrated (as with that surrounds and protects the vital
structures overlying the occipital bone in organs within (the heart, lungs, and
the AP skull), central ray angulation is great vessels).
employed (as in AP axial skull to visualize  The scapulae, together with the clavicles,
occipital bone). form the shoulder (1pectoral) girdle.
o If structures would be foreshortened or (Bontrager, p 336)
self-superimposed, as in the scaphoid, Ans. C
central ray angulation may be employed
to place the structure more closely 9. All of the following statements regarding an

Reviewer A&R
Question & Answer
2
Review Notes for the
RADIOGRAPHY EXAM Appleton
exact PA projection of the skull, with the described as Diarthrotic?
central ray perpendicular to the film, are true 1. Knee
except 2. Intervertebral joints
(A) The orbitomeatal line is perpendicular to 3. Temporomandibular joint (TMJ)
the film. (A) 1 only
(B) The petrous pyramids fill the orbits. (B) 2 only
(C) The midsagittal plane (MSP) is parallel to (C) 1 and 3 only
the film. (D) 1, 2, and 3
(D) The central ray exits at the nasion. ——————————————————
————————————————— ———————
In the exact PA projection of the skull with the  Diarthrotic, or (synovial joints) such as the
perpendicular central ray exiting the nasion, knee and the TMJ, are freely movable.
the petrous pyramids should fill the orbits (Fig. o Most diarthrotic joints are associated
2-39). with a joint capsule containing
As the central ray is angled caudally, the synovial fluid.
petrous pyramids are projected lower in the o Diarthrotic joints are the most
orbits, and at about 25 to 30º, they are below numerous in the body and are
the orbits. subdivided according to type of
The orbitomeatal line must be perpendicular movement.
to the film or the petrous pyramids will not be  Amphiarthrotic joints are partially
projected into the expected location. movable joints whose articular surfaces
The MSP must be perpendicular to the film or are connected by cartilage, such as
the skull will be rotated. intervertebral joints.
With the MSP parallel to the film, a lateral  Synarthroticjoints, such as the cranial
skull projection is obtained. sutures, are immovable.
(Ballinger & Frank, vol 2, p 242) (Bontrager, pp 10-13)
Ans. C Ans. C

10. Which of the following statements regarding 12. "Flattening" of the hemidiaphragms is
the radiograph in Figure 2-3 is (are) true? characteristic of which of the following
1. The tibial eminences are well conditions?
visualized. (A) Pneumothorax
2. The intercondyloid fossa is (B) Emphysema
demonstrated between the femoral (C) Pleural effusion
condyles. (D) Pneumonia
3. The femorotibial articulation is well —————————————————
demonstrated.
Chest radiographs demonstrating emphysema
(A) 1 only
will show the characteristic irreversible
(B) 1 and 2 only
trapping of air that gradually increases and
(C) 1 and 3 only
overexpands the lungs.
(D) 2 and 3 only
This produces the characteristic flattening of
—————————————————
the diaphragm and widening of the intercostal
The pictured radiograph is an AP projection of
spaces.
the knee with the knee extended.
 The increased air content of the lungs
 The tibial intercondylar eminences are
requires a compensating decrease in
well demonstrated on the tibial plateau,
technical factors.
and the femorotibial joint is well
 Pneumonia is inflammation of the
visualized.
lungs, usually caused by bacteria,
o The intercondyloid fossa is not
virus, or chemical irritant.
demonstrated here.
 Pneumothorax is a collection of air or
 A "tunnel" view of the knee is required to
gas in the pleural cavity (outside the
demonstrate the intercondyloid fossa.
lungs), with an accompanying
(Ballinger & Frank, vol 1, p 290)
collapse of the lung.
Ans. C
 Pleural effusion is excessive fluid
between the parietal and visceral
11. Which of the following articulations may be

Reviewer A&R
Question & Answer
3
Review Notes for the
RADIOGRAPHY EXAM Appleton
layers of pleura. the stomach.
(Bontrager, p 80) 2. barium-filled fundus.
Ans. B 3. double-contrast body and antral
portions.
13. Which of the following structures is (are) (A) 1 only
located in the right lower quadrant (RLQ)? (B) 1 and 2 only
1. Gallbladder (C) 2 and 3 only
2. Hepatic flexure (D) 1, 2, and 3
3. Cecum —————————————————
(A) 1 only With the body in the AP recumbent position,
(B) 1 and 2 only barium flows easily into the fundus of the
(C) 3 only stomach, displacing the stomach somewhat
(D) 1, 2, and 3 superiorly.
————————————————— The fundus, then, is filled with barium, while
1. The gallbladder is located on the the air that had been in the fundus is
posterior surface of the liver in the displaced into the gastric body, pylorus, and
right upper quadrant (RUQ). duodenum, illustrating them in double-
2. The hepatic flexure, so named contrast fashion.
because of its close proximity to the Air-contrast delineation of these structures
liver, is also in the (RUQ) allows us to see through the stomach to the
1. The vermiform appendix projects retrogastric areas and structures.
from the first portion of the large  Anterior and posterior aspects of the
bowel, the cecum, located in the right stomach are visualized in the Lateral
lower quadrant (RLQ). position;
(Bontrager, p 104)  medial and lateral aspects of the
Ans. C stomach are visualized in the AP
projection.
14. The number 4 in the radiograph in Figure 2-4 (Ballinger & Frank, vol 2, p 110)
represents which of the following renal Ans. C
structures?
(A) Vesicoureteral junction 16. The ridge that marks the bifurcation of the
(B) Renal pelvis trachea into the right and left primary bronchi
(C) Minor calyx is the.
(D) Major calyx (A) root.
————————————————— (B) hilus.
The pictured radiograph is one of a series of (C) carina.
intravenous pyelogram (intravenous urography) (D) epiglottis.
films. It was done prone at 20 min after injection —————————————————
of the contrast medium. The urinary collecting
a) The carina is an internal ridge located at
system is well demonstrated. The renal pelvis
the bifurcation of the trachea into right
(number 1) is the proximal expanded end of the
and left primary, or mainstem, bronchi.
ureter lying within the renal sinus. The minor
b) The epiglottis is a flap of elastic cartilage
calyces (number 3) receive urine from the
that functions to prevent fluids and solids
collecting tubules of the renal pyramids and
from entering the respiratory tract during
convey it to the major calyces (number 2), which
swallowing.
empty into the renal pelvis. Urine is carried down
c) The root of the lung attaches the lung, via
the ureters by peristaltic waves. The vesicoureteral
dense connectivetissue, to the
junction (number 4) is located at the distal end of
mediastinum. The root of the left lung is
the ureter, where it unites with the urinary
at the level of T6, and the root of the right
bladder. (Bontrager, pp 543-544)
is at T5.
Ans. A
d) The hilus (hilum) is the slitlike opening on
the medial aspect of the lung through
15. During a gastrointestinal examination, the AP
which arteries, veins, lymphatics, and so
recumbent projection of a stomach of average
forth, enter and exit.
shape will usually demonstrate
(Bontrager, p 68)
1. anterior and posterior aspects of

Reviewer A&R
Question & Answer
4
Review Notes for the
RADIOGRAPHY EXAM Appleton
Ans. C to the lateral surface of the affected
hip.
17. Which projection of the foot will best
demonstrate the longitudinal arch? (A) 1 only
(B) 1 and 2 only
(A) Mediolateral
(C) 1 and 3 only
(B) Lateromedial
(D) 1, 2, and 3
(C) Lateral weight-bearing
—————————————————
(D) 30º medial oblique
————————————————— The cassette for a cross-table lateral projection of
The bones of the foot are arranged to form a the hip is placed in a vertical position. The top
number of longitudinal and transverse arches. edge of the cassette should be placed directly
The longitudinal arch facilitates walking and is above the iliac crest and adjacent to the lateral
evaluated radiographically in Lateral weight- surface of the affected hip. The cassette is
bearing (erect) projections. positioned parallel to the femoral neck; the central
Recumbent laterals would not demonstrate ray is perpendicular to the femoral neck and
any structural change that occurs when the cassette. (Ballinger, vol 2, p 290)
individual is erect. Ans. C
(Ballinger, vol 1, p 256)
0Ans. C 20. In the AP axial projection (Towne method) of
the skull, with the central ray directed 30º
18. Which of the following articulate(s) with the caudad to the orbitomeatal line (OML) and
bases of the metatarsals? passing midway between the external
1. The heads of the first row of auditory meatus, which of the following is
phalanges best demonstrated?
2. The cuboid
(A) Occipital bone
3. The cuneiforms
(B) Frontal bone
(A) 1 only
(C) Facial bones
(B) 1 and 2 only
(D) Basal foramina
(C) 2 and 3 only
—————————————————
(D) 1, 2, and 3
————————————————— The AP axial position projects the anterior
structures (frontal and facial bones) downward,
The foot is composed of the 7 tarsal bones, 5
thus permitting visualization of the occipital bone
metatarsals, and 14 phalanges.
without superimposition (Grashey / Towne
The metatarsals and phalanges are miniature
method). The dorsum sella and posterior clinoid
long bones; each has a shaft, base (proximal),
processes of the sphenoid bone should be
and head (distal).
visualized within the foramen magnum. This
The bases of the first to third metatarsals
projection may also be obtained by angling the
articulate with the three cuneiforms.
central ray 30º caudad to the OML (Fig. 2-40). The
The bases of the fourth and fifth metatarsals
frontal bone is best shown with the patient PA and
articulate with the cuboid.
a perpendicular central ray. The parietoacanthial
The heads of the metatarsals articulate with
projection is the single best position for facial
the bases of the first row of phalanges.
bones. Basal foramina are well demonstrated in
(Cornuelle & Gronefeld, p 174)
the submentovertical projection. (Ballinger &
Ans. C
Frank, vol 2, p 270)
Ans. A
19. The cross-table or axiolateral projection of the
hip requires the cassette to be placed
21. The best way to control voluntary motion is
1. in contact with the lateral surface of
(A) immobilization of the part.
the body, with the top edge slightly
(B) careful explanation of the procedure.
above the iliac crest.
(C) short exposure time.
2. in a vertical position and exactly
(D) physical restraint.
perpendicular to the long axis of the
—————————————————
femoral neck.
3. just above the iliac crest and adjacent Patients who are able to cooperate are usually

Reviewer A&R
Question & Answer
5
Review Notes for the
RADIOGRAPHY EXAM Appleton
able to control voluntary motion if they are used instead of a direct frontal projection.
provided with an adequate explanation of the
a) In the RAO position, the heart
procedure. Once patients understand what is
superimposes a homogeneous density
needed, most will cooperate to the best of their
over the sternum, there by providing
ability (by suspending respiration and holding still
clearer radiographic visualization of its
for the exposure). Certain body functions and
bony structure.
responses, such as heart action, peristalsis, pain,
b) If the LAO position were used to project
and muscle spasm, cause involuntary motion that
the sternum to the right of the thoracic
is uncontrollable by the patient. The best and only
vertebrae, the posterior ribs and
way to control involuntary motion is by always
pulmonary markings would cast confusing
selecting the shortest possible exposure time.
shadows over the sternum becauseof
Involuntary motion may also be minimized by
their differing densities.
careful explanation, immobilization, and (as a last
c) The Lateral projection requires that the
resort and only in certain cases) restraint.
shoulders be rolled back sufficiently to
(Ballinger & Frank, vol 1, pp 12-13)
project the sternum completely anterior
Ans. B
to the ribs. Prominent pulmonary vascular
markings can be obliterated using a
22. Figure 2-5 illustrates which of the following
"breathing technique," that is, using an
positions?
exposure time long enough (with
(A) AP
appropriately low milliamperage) to equal
(B) Medial oblique
at least a few respirations. (Ballinger &
(C) Lateral oblique
Frank, vol 1, pp 476-477)
(D) Partial flexion
————————————————— Ans. A
The radiograph is a lateral oblique (external
24. Which of the following are demonstrated in
rotation) projection of the elbow, removing the
the oblique position of the cervical spine?
proximal radius from superimposition with the
ulna and demonstrating its articulation with the 1. Intervertebral foramina
ulna at the radial notch, that is, the proximal 2. Apophyseal joints
radioulnar articulation. An AP projection of the 3. Intervertebral joints
elbow would demonstrate partial overlap of the (A) 1 only
proximal radius and ulna. A medial oblique would (B) 1 and 2 only
demonstrate complete overlap of the proximal (C) 2 and 3 only
radius and ulna; this position is used to (D) 1, 2, and 3
demonstrate the coronoid process in profile and —————————————————
the olecranon process within the olecranon fossa.
a) Intervertebral joints are well visualized in
(Ballinger & Frank, vol 1, p 135)
the lateral projection of all the vertebral
Ans. C
groups.
b) Cervical articular facets (forming
23. What are the positions most commonly
apophyseal joints) are 90º to the
employed for a radiographic examination of
midsagittal plane and are therefore well
the sternum?
demonstrated in the lateral projection.
1. Lateral a) The cervical intervertebral foramina lie
2. RAO 45º to the midsagittal plane (and 15 to
3. LAO 20º to a transverse plane) and are
(A) 1 and 2 only therefore demonstrated in the oblique
(B) 1 and 3 only position.
(C) 2 and 3 only (Bontrager, p 294)
(D) 1, 2, and 3 Ans. A
—————————————————
25. Aspirated foreign bodies in older children and
Because the sternum and vertebrae would be
adults are most likely to lodge in the
superimposed in a direct PA or AP projection, a
slight oblique (just enough to separate the (A) right main bronchus.
sternum from superimposition on the vertebrae) is (B) left main bronchus.

Reviewer A&R
Question & Answer
6
Review Notes for the
RADIOGRAPHY EXAM Appleton
(C) esophagus. for 48 h.
(D) proximal stomach. 3. Instruct the patient to withhold
————————————————— the Glucophage for 48 h after the
 Because the right main bronchus is wider exam.
and more vertical, aspirated foreign
(A) 1 only
bodies are more likely to enter it than the
(B) 1 and 2 only
left main bronchus, which is narrower and
(C) 1 and 3 only
angles more sharply from the trachea.
(D) 1, 2, and 3
o An aspirated foreign body does not
—————————————————
enter the esophagus or the
stomach,as they are not respiratory Glucophage (metformin hydrochloride) is used
structures, but rather digestive as an adjunct to appropriate diet to lower
structures. blood glucose in patients who have type 2
(Tortora & Grabowski, p 814) diabetes and whose hyperglycemia is not
Ans. A. being managed satisfactorily with diet alone.
Patients on Glucophage who are having
26. Which of the following projections of the
intravascular iodinated contrast studies can
abdomen may be used to demonstrate air or
develop an acute alteration of renal function
fluid levels?
or acute acidosis.
1. Dorsal decubitus If you discover while taking patient history
2. Lateral decubitus that your IVP patient takes Glucophage daily,
3. AP Trendelenburg you should still continue with the exam.
(A) 1 only In these patients, however, Glucophage
(B) 1 and 2 only should be discontinued for 48 h subsequent to
(C) 1 and 3 only the procedure and continued again only after
(D) 1, 2, and 3 renal function has been re-evaluated and
————————————————— found to be normal.
(PDR, 55 ed, 2001)
 Air or fluid levels will be clearly
Ans. C
demonstrated only if the central ray is
directed parallel to them.
28. In which of the following ways was the image
o Therefore, to demonstrate air or fluid
seen in Figure 2-6 obtained?
levels, the erect or decubitus position
should be used. (A) PA, chin extended, OML forming 37º to table
 Dorsal and ventral decubitus positions (B) PA, OML and central ray (CR) perpendicular to
made with a horizontal x-ray beam can table
also be used to demonstrate air or fluid (C) PA, OML perpendicular to table, CR 25º caudad
levels. (D) PA, OML perpendicular to table, CR 25º
o Small amounts of air are best cephalad
demonstrated in the Lateral —————————————————The
decubitus position, affected side up. illustrated radiograph is a PA axial projection
o Small amounts of fluid are best (Caldwell Method) of the frontal and anterior
demonstrated in the lateral decubitus ethmoidal sinuses. The frontal sinuses are seen
position, affected side down. centrally in the vertical plate of the frontal bone
(Cornuelle & Gronefeld, pp 76-77) behind the glabella and extending laterally over
Ans. B the superciliary arches. The ethmoidal sinuses are
seen adjacent and inferior to the medial aspect of
27. What should you do if you discover while the orbits. The patient is positioned with the OML
taking the patient history that a patient perpendicular to the film and the CR angled about
scheduled for an intravenous pyelogram (IVP) 25º caudally. This angle projects the petrous
takes Glucophage (metformin hydrochloride) pyramids at the lower rim of the orbits; superior
daily? orbital fissures are well demonstrated in this
position. A caudal angle of 15 to 20º would project
1. Proceed with the exam. the petrous pyramids in the lower third of the
2. Reschedule the exam until the orbits. In the PA position with chin extended
patient has been off Glucophage (choice A) and OML 37º to the table

Reviewer A&R
Question & Answer
7
Review Notes for the
RADIOGRAPHY EXAM Appleton
(parietoacanthial projection, Waters' method), the (B) 1 and 2 only
petrous pyramids are projected below the (C) 1 and 3 only
maxillary sinuses. With the patient PA and the CR (D) 1, 2, and 3
angled 25º cephalad (Haas method), the occipital —————————————————
bone and sella turcica are demonstrated.
The illustrated radiograph is a PA axial projection
(Ballinger & Frank, vol 2, pp 366-367)
(Caldwell method) of the frontal and anterior
Ans. C
ethmoidal sinuses. The frontal sinuses are seen
centrally in the vertical plate of the frontal bone
29. Which of the following statements regarding
behind the glabella and extending laterally over
the radiograph in Figure 2-6 is (are) true?
the superciliary arches. The ethmoidal sinuses are
1. The position is used to demonstrate seen adjacent and inferior to the medial aspect of
the frontal and ethmoidal sinuses. the orbits. The patient is positioned with the OML
2. The sphenoidal sinuses are seen near perpendicular to the film; the central ray should be
the medial aspect of the orbits. angled 15º caudally to place the petrous pyramids
3. The chin should be elevated more to in the lower third of the orbits (a little too much
bring the petrous ridges below the caudal angle was used here; the petrosae are
maxillary sinuses. projected to the inferior rim of the orbits).
Projecting the petrous pyramids below the orbits
(A) 1 only is the objective of the parietocanthial projection
(B) 1 and 2 only (Waters' method). (Ballinger & Frank, vol 2, pp
(C) 1 and 3 only 366-367)
(D) 1, 2, and 3 Ans. A
—————————————————The
illustrated radiograph is a PA axial projection 31. All the following positions may be used to
(Caldwell method) of the frontal and anterior demonstrate the sternoclavicular articulations
ethmoidal sinuses. except
The frontal sinuses are seen centrally in the
(A) weight-bearing.
vertical plate of the frontal bone behind the
(B) RAO.
glabella and extending laterally over the
(C) LAO.
superciliary arches.
(D) PA.
The ethmoidal sinuses are seen adjacent and
—————————————————
inferior to the medial aspect of the orbits. The
patient is positioned with the OML perpendicular Sternoclavicular articulations may be examined
to the film; the central ray should be angled 15º with the patient PA, either bilaterally with the
caudally to place the petrous pyramids in the patient's head resting on the chin or unilaterally
lower third of the orbits (a little too much caudal with the patient's head turned toward the side
angle was used here; the petrosae are projected to being examined.
the inferior rim of the orbits).
The sternoclavicular articulations may also be
Projecting the petrous pyramids below the orbits
examined in the oblique position, with either the
is the objective of the parietocanthial projection
patient rotated slightly or the central ray angled
(Waters' method).
slightly medialward.
(Ballinger & Frank, vol 2, pp 366-367)
Ans. A Weight-bearing positions are frequently used for
evaluation of acromioclavicular joints. (Ballinger &
30. Which of the following statements regarding Frank, vol 1, p 485)
the radiograph in Figure 2-6 is (are) true? Ans. A
1. The position is used to demonstrate
the frontal and ethmoidal sinuses. 32. Which of the following is a radiologic
2. The sphenoidal sinuses are seen near procedure that functions to dilate a stenotic
the medial aspect of the orbits. vessel?
3. The chin should be elevated more to
(A) Percutaneous nephrolithotomy
bring the petrous ridges below the
(B) Percutaneous angioplasty
maxillary sinuses.
(C) Renal arteriography
(D) Surgical nephrostomy
(A) 1 only
—————————————————

Reviewer A&R
Question & Answer
8
Review Notes for the
RADIOGRAPHY EXAM Appleton
Plaque deposited on arterial walls in cases of Ans. B
atherosclerosis causes arterial stenosis.
Percutaneous transluminal angioplasty (PTA) is a 34. Which of the following positions is required in
procedure that uses a balloon catheter to order to demonstrate small amounts of fluid
permanently increase the size of the arterial in the pleural cavity?
lumen, thus reopening the vessel and restoring
(A) Lateral decubitus, affected side up
blood flow.
(B) Lateral decubitus, affected side down
Percutaneous nephrolithotomy is a procedure
(C) AP Trendelenburg
performed to remove a renal calculus from a
(D) AP supine
kidney or proximal ureter.
—————————————————
Renal arteriography is the radiologic investigation
of the renal arteries. Air or fluid levels will be clearly delineated only if
Nephrostomy is the surgical formation of an the central ray is directed parallel to them.
artificial opening into the kidney. Therefore, to demonstrate air or fluid levels, the
(Ballinger & Frank, vol 2, p 561) erect or decubitus position should be used. Small
Ans. B amounts of fluid within the pleural space are best
demonstrated in the lateral decubitus position,
33. When examining a patient whose elbow is in affected side down. Small amounts of air within
partial flexion, how should the AP projection the pleural space are best demonstrated in the
be obtained? lateral decubitus position, affected side up.
(Ballinger and Frank, vol 1, p 476)
1. With humerus parallel to film, central
Ans. B
ray perpendicular
2. With forearm parallel to film, central 35. Place the following anatomic structures in
ray perpendicular order from anterior to posterior:
1. Trachea
3. Through the partially flexed elbow,
2. Apex of heart
resting on the olecranon process,
3. Esophagus
central ray perpendicular
(A) Trachea, esophagus, apex of heart
(B) Esophagus, trachea, apex of heart
(A) 1 only
(C) Apex of heart, trachea, esophagus
(B) 1 and 2 only
(D) Apex of heart, esophagus, trachea
(C) 2 and 3 only
—————————————————
(D) 1, 2, and 3
————————————————— The relationship of these three structures can be
appreciated in a lateral projection of the chest.
When a patient's elbow needs to be examined in
The heart is seen in the anterior half of the
partial flexion, the lateral projection offers little
thoracic cavity, with its apex extending inferior and
difficulty, but the AP projection requires special
anterior. The air-filled trachea can be seen in
attention.
about the center of the chest, and the air-filled
If the AP is made with a perpendicular central ray esophagus just posterior to the trachea (Fig. 2-41).
and the olecranon process resting on the tabletop, (Ballinger & Frank, vol 1, p 458)
the articulating surfaces are obscured. With the Ans. C
elbow in partial flexion, two exposures are
necessary. 36. Which of the following projections will best
demonstrate the carpal scaphoid?
1.) One is made with the forearm parallel to the
(A) Lateral wrist
film (humerus elevated), which demonstrates the
(B) Ulnar flexion
proximal forearm.
(C) Radial flexion
(D) Carpal tunnel
2.)The other is made with the humerus parallel to —————————————————
the film (forearm elevated), which demonstrates The carpal scaphoid is somewhat curved and
the distal humerus. In both cases, the central ray is consequently foreshortened radiographically in
perpendicular if the degree of flexion is not too The PA position. To better separate it from the
great, or angled slightly into the joint space with adjacent carpals,
greater degrees of flexion. (Ballinger and Frank, vol
1, pp 106-107) The ulnar flexion (ulnar deviation) maneuver is

Reviewer A&R
Question & Answer
9
Review Notes for the
RADIOGRAPHY EXAM Appleton
frequently employed. In addition to correcting (D) 1, 2, and 3
foreshortening of the scaphoid, —————————————————
A lateral projection of the lumbar spine is
Ulnar flexion / deviation opens the interspaces
illustrated. The intervertebral joints (disk spaces)
between adjacent lateral carpals.
are well demonstrated. Because the intervertebral
Radial flexion is used to better demonstrate medial foramina, which are formed by the pedicles, are
carpals. (Ballinger and Frank, vol 1, p 118) 90º to the MSP, they are also well demonstrated in
Ans. B the lateral projection. The articular facets,
Forming the apophyseal joints, lie 30 to 50º to the
37. In which of the following positions was the MSP and therefore are visualized in the oblique
radiograph in Figure 2-7 made? position. (Ballinger & Frank, vol 1, pp 230-231)
(A) AP with perpendicular plantar surface Ans. B
(B) 45º lateral oblique
(C) 20º medial oblique 40. In order to better demonstrate the
(D) 45º medial oblique mandibular rami in the PA position, the
—————————————————
(A) skull is obliqued toward the affected side.
The fact that the distal tibiofibular articulation is
(B) skull is obliqued away from the affected side.
visualized is evidence that this is a 45º medial
(C) central ray is angled cephalad.
(internal) oblique.
(D) central ray is angled caudad.
A 15 to 20º oblique is performed for the ankle
—————————————————
mortise (joint) and would demonstrate some
The straight PA (0º) projection effectively
superimposition of the distal tibia and fibula.
demonstrates the mandibular body, but the rami
In the AP ankle, there is some superimposition of
and condyles are superimposed on the occipital
the fibula over the tibia and talus, thereby
bone and petrous portion of the temporal bone.
obscuring the medial aspect of the ankle mortise.
(Ballinger and Frank, vol 1, p 279) To better visualize the rami and condyles, the
Ans. D central ray is directed cephalad 20 to 30º. This
projects the temporal and occipital bones above
38. Which of the following anatomic structures is the area of interest.
indicated by the number 2 in Figure 2-7? (Ballinger & Frank, vol 2, p 341)
(A) Talus Ans. C
(B) Medial malleolus
(C) Lateral malleolus 41. What should the patient be instructed to
(D) Lateral tibial condyle remove prior to x-ray examination of the
—————————————————The chest?
ankle mortise is formed by the distal tibia and 1. Dentures
fibula and the talus. 2. Earrings
The distal tibia (the medial and larger bone) forms 3. Necklaces
a club-shaped projection, the medial malleolus (A) 1 only
(number 2). (B) 1 and 2 only
The distal fibula's projection is the lateral (C) 3 only
malleolus (number 1). (D) 1, 2, and 3
The distal articular surfaces of both the tibia and —————————————————
fibula articulate with the superior surface of the
The patient must remove any metallic foreign
talus (number 3) to form the ankle joint.
objects if they are within the area(s) of interest.
(Cornuelle & Gronefeld, pp 193-195)
Dentures, earrings, or necklaces can obscure bony
Ans. B
details in a skull or cervical spine survey. However,
only the necklace needs to be removed for a chest
39. Which of the following is (are) demonstrated
x-ray.
in the lumbar spine pictured in Figure 2-8?
The radiographer should keep in mind that hair
1. Intervertebral joints
braids that extend as far as the shoulders and
2. Pedicles
apices, as well as many T-shirt logos, also cast
3. Apophyseal joints
confusing shadows on the radiologic image. The
(A) 1 only
radiographer must be certain that the patient's
(B) 1 and 2 only
belongings are cared for properly and returned
(C) 1 and 3 only

Reviewer A&R
Question & Answer
10
Review Notes for the
RADIOGRAPHY EXAM Appleton
following the examination. hepatic flexure and ascending colon, with the
(Ballinger & Frank, vol 1, p 14) splenic flexure self-superimposed on the
Ans. C descending colon. Therefore, the radiograph must
have been made in either an RAO (if the patient
42. The left sacroiliac joint is positioned was prone) or an LPO (if the patient was supine)
perpendicular to the film when the patient is position.
positioned in a The LAO and RPO positions areused to
(A) left lateral position. demonstrate the splenic flexure and descending
(B) 25 to 30º LAO position. colon free of self-superimposition.
(C) 25 to 30º LPO position. AP or PA axial is generally used to visualize the
(D) 30 to 40º LPO position. rectosigmoid colon.
————————————————— (Ballinger & Frank, vol 2, p 146)
Sacroiliac joints lie obliquely within the pelvis and Ans. D
open anteriorly at an angle of 25 to 30º to the
midsagittal plane. A 25 to 30º oblique position 45. In which of the following positions was the
places the joints perpendicular to the film. The left radiograph in Figure 2-9 taken?
sacroiliac joint may be demonstrated in the LAO (A) LPO
and RPO positions with little magnification (B) RPO
variation. (C) AP axial
(Ballinger & Frank, vol 1, p 327) (D) Right lateral decubitus
Ans. B —————————————————
The pictured radiograph is an oblique position of
43. A Lateral projection of the hand in extension is the large bowel, illustrating an "open" view of the
often recommended to evaluate hepatic flexure and ascending colon, with the
1. a fracture. splenic flexure self-superimposed on the
2. a foreign body. descending colon. Therefore, the radiograph must
3. soft tissue. have been made in either an RAO (if the patient
(A) 1 only was prone) or an LPO (if the patient was supine)
(B) 2 only position.
(C) 2 and 3 only The LAO and RPO positions are used to
(D) 1 and 3 only demonstrate the splenic flexure and descending
————————————————— colon free of self-superimposition. AP or PA axial is
The lateral hand in extension, with appropriate generally used to visualize the rectosigmoid colon.
technique adjustment, is recommended to (Ballinger & Frank, vol 2, p 146
evaluate foreign body location in soft tissue. Ans. A
A small lead marker is frequently taped to the spot
thought to be the point of entry. 46. Which of the following statements is (are) true
The physician then uses this external marker and regarding lower-extremity venography?
the radiograph to determine the exact foreign
1. The patient is often examined in the
body location.
semierect position.
Extension of the hand in the presence of a fracture
2. Contrast medium is injected through a
would cause additional and unnecessary pain, and
vein in the foot.
possibly additional injury. (Ballinger & Frank, vol 1,
3. Filming begins at the hip and proceeds
p 79)
inferiorly.
Ans. C
(A) 1 only
(B) 1 and 2 only
44. The radiograph seen in Figure 2-9 best
(C) 1 and 3 only
demonstrates the
(D) 1, 2, and 3
(A) descending colon. —————————————————
(B) rectosigmoid region.
To increase the concentration of contrast media in
(C) splenic flexure.
the deep veins of the leg, a Fowler's position is
(D) hepatic flexure.
used with the x-ray table angled at least 45º.
—————————————————The
pictured radiograph is an Oblique position of the Tourniquets can also be used to force the contrast
large bowel, illustrating an "open" view of the into the deep veins of the leg, especially when the

Reviewer A&R
Question & Answer
11
Review Notes for the
RADIOGRAPHY EXAM Appleton
patient is examined in the recumbent position. Ventral and dorsal decubitus positions provide a
lateral view of the abdomen that is useful for
Contrast medium is injected through a superficial
demonstration of air-fluid levels.
vein in the foot.
(Ballinger & Frank, vol 1, p 38)
Filming may be performed with or without Ans. B
fluoroscopy, and may include AP, lateral, and 30º
obliques of the lower leg in internal rotation. 49. Which of the following positions will
Filming begins at the ankle and proceeds demonstrate the right axillary ribs?
superiorly, usually including the inferior vena cava.
1. RAO
(Ballinger & Frank, vol 2, p 542)
2. LAO
Ans. B
3. RPO
(A) 1 only
47. Which of the following statements is (are)
(B) 1 and 2 only
correct regarding the parietoacanthial
(C) 2 and 3 only
projection ( Waters' method ) of the skull?
(D) 1, 2, and 3
1. The head is rested on the extended —————————————————
chin. The axillary portion of the ribs is best
2. The OML is perpendicular to the film. demonstrated in a 45º oblique position.
3. The maxillary antra should be projected The axillary ribs are demonstrated in the AP
above the petrosa. oblique projection with the affected side adjacent
to the film, and in the PA oblique projection with
(A) 1 only
the affected side away from the film. Therefore,
(B) 1 and 2 only
the right axillary ribs would be demonstrated in
(C) 1 and 3 only
the RPO (AP oblique with affected side adjacent to
(D) 1, 2, and 3
the film) and LAO (PA oblique with affected side
—————————————————
away from the film) positions. (Ballinger & Frank,
The parietoacanthial projection (Waters' position) vol 1, pp 428-431)
of the skull is valuable for the demonstration of Ans. C
facial bones or maxillary sinuses.
The head is rested on the extended chin so that 50. In which projection of the foot are the sinus
the orbitomeatal line forms a 37º angle with the tarsi, cuboid, and tuberosity of the fifth
film. metatarsal best demonstrated?
This projects the petrous pyramids below the floor (A) Lateral oblique foot
of the maxillary sinuses and provides an oblique (B) Medial oblique foot
frontal view of the facial bones. (C) Lateral foot
(Ballinger & Frank, vol 2, pp 316-317) (D) Weight-bearing foot
Ans. C ———————————————————
——————
48. Which of the following will best demonstrate To best demonstrate most of the tarsals and
the size and shape of the liver and kidneys? intertarsal spaces (including the cuboid, sinus tarsi,
and tuberosity of the fifth metatarsal),
(A) Lateral abdomen
(B) AP abdomen A medial oblique is required (plantar surface and
(C) Dorsal decubitus abdomen film form a 30º angle).
(D) Ventral decubitus abdomen The Lateral oblique demonstrates the interspaces
————————————————— between the first and second metatarsals and
between the first and second cuneiforms.
The AP projection provides a general survey of the
Weight-bearing lateral feet are used to
abdomen, showing the size and shape of the liver,
demonstrate the longitudinal arches.
spleen, and kidneys.
(Cornuelle & Gronefeld, p 189)
When performed erect, it should demonstrate Ans. B
both hemidiaphragms.
51. The manubrial notch is at approximately the
The Lateral projection is sometimes requested and
same level as the
is useful for evaluating the prevertebral space
(A) fifth thoracic vertebra.
occupied by the aorta.
(B) T2-3 interspace.

Reviewer A&R
Question & Answer
12
Review Notes for the
RADIOGRAPHY EXAM Appleton
(C) T4-5 interspace. 54. Which of the following criteria are used to
(D) costal margin. evaluate a PA projection of the chest?
————————————————— 1. Ten posterior ribs should be visualized.
2. Sternoclavicular joints should be
Surface landmarks, prominences, and depressions
symmetrical.
are very useful to the radiographer in locating
3. The scapulae should be lateral to the
anatomic structures that are not visible externally.
lung fields.
The fifth thoracic vertebra is at approximately the
same level as the sternal angle. The T2-3 (A) 1 and 2 only
interspace is about at the same level as the (B) 1 and 3 only
manubrial (suprasternal) notch. The costal margin (C) 2 and 3 only
is about the same level as L3. (Saia, p 77) (D) 1, 2, and 3
Ans. B —————————————————
In order to evaluate sufficient inspiration and lung
52. What is the position of the gallbladder in an
expansion, 10 posterior ribs should be visualized.
asthenic patient?
The sternoclavicular joints should be symmetrical;
(A) Superior and medial any loss of symmetry indicates rotation. In order
(B) Superior and lateral to visualize maximum lung area, the shoulders are
(C) Inferior and medial rolled forward to move the scapulae laterally from
(D) Inferior and lateral the lung fields. (Ballinger & Frank, vol 1, p 527)
————————————————— Ans. D
The position, shape, and motility of various organs
can differ greatly from one body habitus to 55. Which of the following is (are) valid criteria for
another. a lateral projection of the forearm?
The hypersthenic individual is large and heavy; the
1. The radius and ulna should be
lungs and heart are high, the stomach is high and
superimposed proximally and distally.
transverse, the gallbladder is high and lateral, and
the colon is high and peripheral. In contrast, the 2. The coronoid process and radial head
other habitus extreme is the asthenic individual. should be superimposed.
This patient isslender and light, and has a long and
3. The radial tuberosity should face
narrow thorax, a low and long stomach, a low and
anteriorly.
medial gallbladder, and a low medial and
(A) 1 only
redundant colon. The radiographer must take
(B) 1 and 2 only
these characteristic differences into consideration
(C) 2 and 3 only
when radiographing individualsof various body
(D) 1, 2, and 3
types. (Ballinger & Frank, vol 1, p 72)
—————————————————
Ans. C
To accurately position a lateral forearm, the elbow
must form a 90º angle with the humeral
53. To demonstrate esophageal varices, the
epicondyles superimposed.
patient must be examined in
The radius and ulna are superimposed only
(A) the recumbent position. distally. Proximally, the coronoid process and
(B) the erect position. radial head are superimposed, and the radial head
(C) the anatomic position. faces anteriorly. Failure of the elbow to form a 90º
(D) Fowler's position. angle or the hand to be lateral results in a less
————————————————— than satisfactory lateral projection of the forearm.
(Saia, p 97)
Esophageal varices aretortuous dilatations of the
Ans. C
esophageal veins. They are much less pronounced
in the erect position and must always be examined
56. All of the following bones are associated with
with the patient recumbent.
condyles except the
The recumbent position affords more complete (A) femur.
filling of the veins, as blood flows against gravity. (B) tibia.
(Ballinger & Frank, vol 2, p 88) (C) fibula.
Ans. A (D) mandible.
—————————————————

Reviewer A&R
Question & Answer
13
Review Notes for the
RADIOGRAPHY EXAM Appleton
The distal femur is associated with two large (A) 1 only
condyles; the deep depression separating them is (B) 1 and 2 only
the intercondyloid fossa (Fig. 2-42). The proximal (C) 2 and 3 only
tibia has two condyles; their superior surfaces are (D) 1, 2, and 3
smooth, forming the tibial plateau. The mandible —————————————————
has a condyle that articulates with the mandibular Superimposition of bony details frequently makes
fossa of the temporal bone, forming the angiographic demonstration of blood vessels less
temporomandibular joint. than optimal. The method used to remove these
The fibula has a proximal styloid process and a superimposed bony details is called Digital
distal malleolus, but no condyle.(Tortora & subtraction angiography (DSA) accomplishes this
Grabowski, p 234) through the use of a computer.
Ans C The advantages of DSA over film angiography
include greater sensitivity to contrast medium,
57. Which of the following projections of the immediate availability of images, and lower total
ankle would best demonstrate the distal cost. Although DSA applications are increasing,
tibiofibular joint? film angiography is still preferred in cases in
(A) Medial oblique 15 to 20º whichresolution is critical.
(B) Lateral oblique 15 to 20º (Ballinger & Frank, vol 3, p 178)
(C) Medial oblique 45º Ans. B
(D) Lateral oblique 45º
————————————————— 60. The usual patient preparation for an upper GI
To best demonstrate the distal tibiofibular series is
articulation, a 45º medial oblique projection of the (A) clear fluids 8 h prior to exam.
ankle is required. (B) NPO after midnight.
The 15º medial oblique is used to demonstrate the (C) enemas until clear before exam.
ankle mortise (joint). Although the joint is well (D) light breakfast the day of the exam.
demonstrated in the 15º medial oblique, there is —————————————————
some superimposition of the distal tibia and fibula, The upper GI tract must be empty for best x-ray
and greater obliquity is required to separate the evaluation. Any food or liquid that mixes with the
bones. barium sulfate suspension can simulate pathology.
(Ballinger & Frank, vol 1, pp 279-280) Preparation therefore is to withhold food and
Ans. C. fluids for 8 to 9 h before the exam, typically NPO
after midnight, as fasting exams are usually
58. To obtain an AP projection of the right ilium, performed first thing in the morning. Enemas until
the patient's clear prior to the exam is a part of the typical
preparation for barium enema / air contrast.
(A) left side is elevated 40º.
(Cornuelle & Gronefeld, pp 450-451)
(B) right side is elevated 40º.
Ans. B
(C) left side is elevated 15º.
(D) right side is elevated 15º.
61. Which projection(s) of the abdomen would be
—————————————————
used to demonstrate pneumoperitoneum?
When the pelvis is observed in the anatomic
1. Right lateral decubitus
position, the ilia are seen to oblique forward,
2. Left lateral decubitus
giving the pelvis a "basin-like" appearance. To view
3. Upright
the right iliac bone, the radiographer must place it
(A) 2 only
parallel to the film by elevating the left side about
(B) 1 and 3 only
40º (RPO).
(C) 2 and 3 only
The left iliac bone is radiographed in the 40º (LPO)
(D) 1, 2, and 3
oblique position. (Ballinger & Frank, vol 1, p 308)
—————————————————
Ans. A
An erect abdomen or left lateral decubitus should
59. The advantages of digital subtraction be performed for demonstration of air-fluid levels
angiography over film angiography include in the abdomen.
The right lateral decubitus position is used to
1. greater contrast medium sensitivity.
demonstrate the layering of gallstones. It will not
2. immediately available images.
show free air within the peritoneum because of
3. increased resolution.

Reviewer A&R
Question & Answer
14
Review Notes for the
RADIOGRAPHY EXAM Appleton
the overlying gastric bubble on the elevated left Ans. D
side of the body. (Bontrager, pp 107, 111)
Ans. C 64. What instructions might a patient be given
following an upper GI examination?
62. Which of the following structures should be
1. Drink plenty of fluids.
visualized through the foramen magnum in
2. Take a mild laxative.
the AP axial projection (Grashey method) of
3. Increase dietary fiber.
the skull for occipital bone?
(A) 1 only
1. Posterior clinoid processes
(B) 1 and 2 only
2. Dorsum sella
(C) 2 and 3 only
3. Posterior arch of C1
(D) 1, 2, and 3
(A) 1 only
—————————————————
(B) 2 only
(C) 1 and 2 only Barium can dry and harden in the large bowel,
(D) 2 and 3 only causing symptoms ranging from mild constipation
————————————————— to bowel obstruction. It is therefore essential that
The AP axial projection (Grashey method) of the the radiographer provide clear instructions,
skull requires that the central ray be angled 30º especially to outpatients, for follow-up care, along
caudad if the OML is perpendicular to the image with therationale for this care. In order to avoid
recorder (37º caudad if the IOML is perpendicular the possibility of fecal impaction, patients should
to the image recorder). The frontal and facial drink plenty of fluids for the next few days,
bones are projected down and away from increase their dietary fiber, and take a mild
superimposition on the occipital bone. If laxative such as milk of magnesia. (Adler & Carlton,
positioning is accurate, the dorsum sella and p 258)
posterior clinoid processes will be demonstrated Ans. D
within the foramen magnum.
If the central ray is angled excessively, the
posterior aspect of the arch of C1 will appear in 65. Which of the following tube angle and
the foramen magnum. direction combinations is correct for an axial
(Ballinger & Frank, vol 2, p 246) projection of the clavicle, with the patient in
Ans. C the AP recumbent position on the x-ray table?
(A) 10 to 15º caudad
63. Which of the following criteria is (are)
(B) 10 to 15º cephalad
required for visualization of the greater
(C) 25 to 30º cephalad
tubercle in profile?
(D) 25 to 30º caudad
1. Epicondyles parallel to the film —————————————————
2. Arm in external rotation
When the clavicle is examined in the AP
3. Humerus in AP position
recumbent position, the central ray must be
(A) 1 only
directed 25 to 30º cephalad in order to project
(B) 1 and 3 only
most of the clavicle's length above the ribs. The
(C) 2 and 3 only
direction of the central ray is reversed when
(D) 1, 2, and 3
examining the patient in the prone position.
—————————————————
(Cornuelle & Gronefeld, p 162)
The greater and lesser tubercles are prominences
Ans. C
on the proximal humerus separated by the
intertubercular (bicipital) groove.
66. Which of the following should be performed
The AP projection of the humerus / shoulder
to rule out subluxation or fracture of the
places the epicondyles parallel to the film and the
cervical spine?
shoulder in external rotation, and demonstrates
the greater tubercle in profile. (A) Oblique cervical spine, seated
The lateral projection of the humerus places the (B) AP cervical spine, recumbent
shoulder in extreme internal rotation with the (C) Horizontal beam lateral
epicondyles perpendicular to the film and (D) Laterals in flexion and extension
demonstrates the lesser tubercle in profile. —————————————————
(Ballinger & Frank, vol 1, pp 161-162) When a cervical spine is requested to rule out

Reviewer A&R
Question & Answer
15
Review Notes for the
RADIOGRAPHY EXAM Appleton
subluxation or fracture, the patient will arrive in superior to the EAM. (Saia, p 144)
the radiology area on a stretcher. The patient Ans. C
should not be moved before a subluxation is ruled 69. During myelography, contrast medium is
out. Any movement of the head and neck could introduced into the
cause serious damage to the spinal cord.
(A) subdural space.
A horizontal beam lateral is performed and (B) subarachnoid space.
evaluated. The physician will then decide what (C) epidural space.
further films are required. (D) epidermal space.
(Ballinger & Frank, vol 1, p 350) —————————————————
Ans. C The CNS (brain and spinal cord) is located within
three protective membranes, the meninges.
67. What portion of the humerus articulates with
a) The inner membrane is the pia mater,
the ulna to help form the elbow joint?
(A) Semilunar / trochlear notch b) The middle membrane is the arachnoid,
(B) Radial head
c) The outer membrane is the dura mater.
(C) Capitulum
(D) Trochlea The subarachnoid space is located between the pia
————————————————— and arachnoid mater and contains cerebrospinal
The distal humerus articulates with the proximal fluid (CSF).
radius and ulna to form the elbow joint.
During myelography, the needle is introduced into
Specifically, the semilunar / trochlear notch of the
the subarachnoid space (L3-4 or L4-5), a small
proximal ulna articulates with the trochlea of the
amount of CSF is removed, and the contrast
distal medial humerus.
medium is introduced (Fig. 2-44).
The capitulum is lateral to the trochlea and
articulates with the radial head (Fig. 2-43). The subdural space is located between the
(Ballinger & Frank, vol 1, p 90) arachnoid and dura mater. The epidural space is
Ans. D located between the two layers of the dura mater.
(Saia, pp 197-198)
68. The true lateral position of the skull uses Ans. B
which of the following principles?
70. Which of the following positions will best
1. Interpupillary line perpendicular to
demonstrate the left axillary portion of the
the film
ribs?
2. MSP perpendicular to the film (A) Left lateral
(B) PA
3. Infraorbitomeatal line (IOML) parallel
(C) LPO
to the transverse axis of the film
(D) RPO
(A) 1 only —————————————————
(B) 1 and 2 only The axillary portions of the ribs are foreshortened
(C) 1 and 3 only and self-superimposed in the AP and PA positions.
(D) 1, 2, and 3 However, they are "opened" and placed more
————————————————— parallel to the film in the oblique positions. Thus,
the right axillary portions are best demonstrated in
A lateral projection is generally included in a
the RPO position. The LPO position demonstrates
routine skull series.
the left axillary ribs. The affected side should be
The patient is placed in a PA oblique position. placed closest to the film. (Ballinger & Frank, vol 1,
p 448)
The MSP is positioned parallel to the film,
Ans. C
The IOML is adjusted so as to be parallel to the
long axis of the cassette. 71. Which of the following statements is (are) true
regarding the radiograph in Figure 2-10?
The interpupillary line must be perpendicular to
1. The patient is placed in an RAO
the film.
position.
In a routine lateral projection of the skull, the 2. The midcoronal plane is about 60º to
central ray should enter approximately 2 in the film.

Reviewer A&R
Question & Answer
16
Review Notes for the
RADIOGRAPHY EXAM Appleton
3. The acromion process is free of (A) Eye
superimposition. (B) Front foot
(A) 1 only (C) Body
(B) 1 and 2 only (D) Neck
(C) 2 and 3 only —————————————————
(D) 1, 2, and 3 The 45º oblique position of the lumbar spine is
————————————————— generally performed for demonstration of the
A right "scapular Y" is illustrated; this refers to the apophyseal joints. In a correctly positioned oblique
characteristic Y formed by the humerus, acromion, lumbar spine, "scotty dog" images are
and coracoid. demonstrated Fig. 2-45.
1. The patient is positioned in a PA oblique The scotty's ear corresponds to the superior
positionin this case, an RAO to articular process,
demonstrate the right side. his nose to the transverse process,
his eye to the pedicle,
2. The midcoronal plane is adjusted to
his neck to the pars interarticularis,
approximately 60º to the film, and the
his body to the lamina, and
affected arm is left relaxed at the
his front foot to the inferior articular process.
patient's side.
(Saia, p 131)
The scapular Y position is employed to Ans. D
demonstrate anterior or posterior humeral
dislocation. 74. Which of the following will separate the radial
head, neck, and tuberosity from
The humerus is normally superimposed on the
superimposition on the ulna?
scapula in this position; any deviation from
(A) AP
this may indicate dislocation.
(B) Lateral
(Ballinger & Frank, vol 1, pp 179-181)
(C) Medial oblique
Ans. D
(D) Lateral oblique
—————————————————
72. Examples of synovial pivot articulations
In the AP projection of the elbow, the proximal
include the
radius and ulna are partially superimposed. In the
1. atlantoaxial joint lateral position, the radial head is partially
2. radioulnar joint superimposed on the coronoid process, facing
3. temporomandibulon joint anteriorly. In the medial oblique position, there is
even greater superimposition.
(A) 1 only
The lateral oblique projection completely
(B) 1 and 2 only
separates the proximal radius and ulna, projecting
(C) 2 and 3 only
the radial head, neck, and tuberosity free of
(D) 1, 2, and 3 only
superimposition with the proximal ulna. (Ballinger
—————————————————
& Frank, vol 1, p 105)
Synovial pivot joints are diarthrotic, i.e.: freely
Ans. D
movable.
Pivot joints permit rotation motion. Examples 75. To better demonstrate contrast-filled distal
include the proximal radioulnar joint which ureters during IV urography, it is helpful to
permits supination and pronation of the hand.
1. use a 15º AP Trendelenburg position.
The atlantoaxial joint is the articulation between 2. apply compression to the proximal
C1 and C2 and permits rotation of the head. ureters.
3. apply compression to the distal
The temporomandibular joint is diarthrotic, having
ureters.
both hinge and plamar movements. (Tortora &
(A) 1 only
Grabowski, pp 257-258)
(B) 2 only
Ans. B (C) 1 and 2 only
(D) 1 and 3 only
73. The pars interarticularis is represented by —————————————————A 15
what part of the "scotty dog" seen in a to 20º AP Trendelenburg position during IV
correctly positioned oblique lumbar spine? urography is often helpful in demonstrating filling

Reviewer A&R
Question & Answer
17
Review Notes for the
RADIOGRAPHY EXAM Appleton
of the distal ureters and the area of the projection). (Ballinger & Frank, vol 2, p 242)
vesicoureteral orifices. Ans. C
In this position, the contrast-filled urinary bladder
moves superiorly, encouraging filling of the distal 78. All of the following statements regarding
ureters and superior bladder, and provides better respiratory structures are true except
delineation of these areas. The central ray should
(A) The right lung has two lobes.
be directed perpendicular to the cassette.
(B) The uppermost portion of the lung is the
Compression of the distal ureters is used to
apex.
prolong filling of the renal pelves and calyces.
(C) Each lung is enclosed in pleura.
Compression of the proximal ureters is not
(D) The trachea bifurcates into mainstem
advocated. (Ballinger & Frank, vol 2, p 170)
bronchi.
Ans. A
—————————————————
The trachea (windpipe) bifurcates into left and
76. When the patient is unable to assume the
right mainstem bronchi, each entering its
upright body position, how should a lateral
respective lung hilum.
projection of the sinuses be obtained?
The left bronchus divides into two portions, one
(A) Horizontal beam lateral for each lobe of the left lung.
(B) Transthoracic lateral The right bronchus divides into three portions, one
(C) Recumbent RAO or LAO for each lobe of the right lung (Fig. 2-47)
(D) Recumbent RPO or LPO
The lungs are conical in shape, consisting of upper
———————————————————
pointed portions, termed the apices (plural of
——————
apex), and broad lower portions (or bases).
Sinus radiographs should be performed in the
The lungs are enclosed in a double-walled serous
upright position in order to demonstrate fluid
membrane called the pleura.
levels and to distinguish between fluid and other
(Bontrager, pp 69-70)
pathologies.
Ans. A
When the patient cannot assume the upright
position, the lateral projection can be obtained
79. During atrial systole, blood flows into the right
using a horizontal ("cross-table") x-ray beam. A
ventricle by way of what valve?
transthoracic lateral position is used to obtain a
lateral position of the upperone-half to two-thirds (A) Pulmonary semilunar
of the humerus when the arm cannot be (B) Aortic
abducted. (Ballinger & Frank, vol 2, p 378) (C) Mitral
Ans. A (D) Tricuspid
—————————————————
77. With the patient in the PA position and the
Venous blood is returned to the right atrium via
OML and central ray perpendicular to the film,
the superior (from the upper body) and inferior
the resulting radiograph will demonstrate the
(from the lower body) vena cava (Fig. 2-48). During
petrous pyramids
atrial systole, blood passes through the tricuspid
(A) below the orbits. valve into the right ventricle.
(B) in the lower one-third of the orbits. During ventricular systole, the pulmonary artery
(C) completely within the orbits. (the only artery to carry deoxygenated blood)
(D) above the orbits. carries blood to the lungs for oxygenation. Blood is
————————————————— returned via the pulmonary veins (the only veins
For the PA projection of the skull, the OML is to carry oxygenated blood) to the left atrium.
adjusted perpendicular to the film, and the MSP During atrial systole, blood passes through the
must be perpendicular to the film. mitral (bicuspid) valve into the left ventricle.
The central ray is directed so as to exit the nasion. During ventricular systole, oxygenated blood is
In this position, the petrous pyramids should pumped through the aortic semilunar valve into
completely fill the orbits. When caudal angulation the aorta.
is used with this position, the petrous pyramids are (Tortora & Grabowski, pp 669-670)
projected in the lower portion, or out of, theorbits. Ans. D
If cephalad angulation is employed with this
position, the petrous pyramids are projected up 80. The PA chest radiograph seen in Figure 2-11
toward the occipital region (as in the nuchofrontal demonstrates

Reviewer A&R
Question & Answer
18
Review Notes for the
RADIOGRAPHY EXAM Appleton
1. rotation. chest radiograph. The letter A indicates a left
2. scapulae removed from lung fields. posterior rib, B represents a left anterior rib, and C
3. excessively high contrast. represents the right costophrenic angle.
(A) 1 only (Ballinger & Frank, vol 1, pp 525-526)
(B) 1 and 2 only Ans. D
(C) 2 and 3 only
(D) 1, 2, and 3 83. What should be done if the patient is unable
————————————————— to extend his or her head sufficiently for the
acanthioparietal projection (reverse Waters'
A PA projection of the chest is pictured. Adequate
method)?
inspiration is demonstrated by visualization of 10
posterior ribs above the diaphragm. 1. Place a support behind the patient's
Rotation of the chest is demonstrated by unequal shoulders.
distance between the sternum and medial 2. Angle cephalad.
extremities of the clavicles. Pulmonary apices and 3. Angle caudad.
costophrenic angles are demonstrated adequately. (A) 1 only
An air-filled trachea is seen in the lower cervical (B) 1 and 2 only
and upper thoracic region as a midline area of (C) 3 only
increased density. Adequate long scale contrast (D) 1 and 3 only
has been achieved, as indicated by visualization of —————————————————
pulmonary vascular markings.
The reverse Waters' method is used when the
(Cornuelle & Gronefeld, p 46)
patient is unable to assume the prone position.
Ans. B
The head and neck are extended enough to place
81. The letter A in Figure 2-11 indicates the OML 37º to the plane of the image recorder.
(A) a left anterior rib. A support can be placed behind the patient's
(B) a right posterior rib. shoulders to facilitate this.
(C) a left posterior rib.
The mentomeatal line should be perpendicular to
(D) a right anterior rib.
the plane of the image recorder, but if the patient
—————————————————
is unable to assume this position, the CR is angled
A PA projection of the chest is pictured. Adequate cephalad so as to be parallel to the mentomeatal
inspiration is demonstrated by visualization of 10 line.
posterior ribs above the diaphragm. Rotation of (Ballinger & Frank, vol 1, p 320)
the chest is demonstrated by asymmetric Ans. B
sternoclavicular joints. The apices and
costophrenic angles should be included on every 84. Which of the following are demonstrated in
chest radiograph. The letter A indicates a left the lateral projection of the thoracic spine?
posterior rib, B represents a left anterior rib, and C
1. Intervertebral spaces
represents the right costophrenic angle.
2. Apophyseal joints
(Ballinger & Frank, vol 1, pp 525-526)
3. Intervertebral foramina
Ans. C
(A) 1 only
(B) 2 only
(C) 1 and 3 only
82. The letter C in Figure 2-11 indicates
(D) 1, 2, and 3
(A) the left cardiophrenic angle.
—————————————————
(B) the right cardiophrenic angle.
(C) the left costophrenic angle. The thoracic apophyseal joints are 70º to the
(D) the right costophrenic angle. midsagittal plane and are demonstrated in a steep
————————————————— (70º) oblique position.
A PA projection of the chest is pictured. Adequate The thoracic intervertebral foramina, formed by
inspiration is demonstrated by visualization of 10 the vertebral notches of the pedicles, are 90º to
posterior ribs above the diaphragm. Rotation of the MSP. They are therefore well demonstrated in
the chest is demonstrated by asymmetric the lateral position.
sternoclavicular joints. The apices and
The intervertebral foramina of the thoracic and
costophrenic angles should be included on every

Reviewer A&R
Question & Answer
19
Review Notes for the
RADIOGRAPHY EXAM Appleton
lumbar vertebrae are also demonstrated in the (C) Lateral projection
lateral position. (D) Submentovertical projection
(Ballinger & Frank, vol 1, p 361) —————————————————
Ans. C
Figure 2-12 illustrates an anatomic lateral view of
the paranasal sinuses.
85. The two palpable bony landmarks that are
Number 1 points to the frontal sinuses
generally used for accurate localization of the
Number 2 to the ethmoidal sinuses; both can be
hip are the
visualized using the PA axial projection (Caldwell
(A) anterior superior iliac spine (ASIS) and method).
symphysis pubis. Number 3 is the sphenoidal sinuses, which are well
(B) iliac crest and greater trochanter. demonstrated in the SMV projection. Number 4 is
(C) symphysis pubis and greater trochanter. the maxillary sinuses, which are best
(D) iliac crest and symphysis pubis. demonstrated using the parietoacanthial
————————————————— projection (Waters' method).
The lateral projection demonstrates the four pairs
The dome of the acetabulum lies midway between
of paranasal sinuses superimposed on each other.
the ASIS and the symphysis pubis.
(Bontrager, pp 416-418)
On an adult of average size, a line perpendicular to
Ans. B
this point will parallel the plane of the femoral
neck.
88. During chest radiography, the act of
In an AP projection of the hip, the central ray
inspiration.
should be directed to a point approximately 2 in
down that perpendicular line, so as to enter the 1. elevates the diaphragm.
distal portion of the femoral head. (Ballinger & 2. raises the ribs.
Frank, vol 1, pp 274, 286) 3. depresses the abdominal viscera.
Ans. A (A) 1 only
(B) 1 and 2 only
86. The structure labeled 2 in Figure 2-12 is the (C) 2 and 3 only
(A) maxillary sinus. (D) 1, 2, and 3
(B) sphenoidal sinus. —————————————————
(C) ethmoidal sinus.
With inspiration, the diaphragm moves inferiorly
(D) frontal sinus.
and depresses the abdominal viscera. The ribs and
—————————————————
sternum are elevated. As the ribs are elevated,
Figure 2-12 illustrates an anatomic lateral view of their angle is decreased. Radiographic density can
the paranasal sinuses. Number 1 points to the vary considerably in appearance depending on the
frontal sinuses and phase of respiration during which the exposure is
made.
Number 2 to the ethmoidal sinuses; both can be
(Cornuelle & Gronefeld, pp 252-254)
visualized using the PA axial projection (Caldwell
Ans. C
method).
Number 3 is the sphenoidal sinuses, which are well 89. The radiograph shown in Figure 2-13
demonstrated in the SMV projection. demonstrates the articulation between the
Number 4 is the maxillary sinuses, which are best 1. talus and the calcaneus.
demonstrated using the parietoacanthial 2. calcaneus and the cuboid.
projection (Waters' method). 3. talus and the navicular.
The lateral projection demonstrates the four pairs (A) 1 only
of paranasal sinuses superimposed on each other. (B) 1 and 2 only
(Bontrager, pp 416-418) (C) 2 and 3 only
Ans. C (D) 1, 2, and 3
—————————————————
87. Which of the following would best evaluate
The illustrated radiograph is that of a medial
the structure labeled 4 in Figure 2-12?
oblique foot. With the foot rotated medially, so
(A) PA axial projection (Caldwell method) that the plantar surface forms a 30º oblique with
(B) Parietoacanthial projection (Waters' method) the image recorder, the sinus tarsi, the tuberosity

Reviewer A&R
Question & Answer
20
Review Notes for the
RADIOGRAPHY EXAM Appleton
of the fifth metatarsal, and several articulations (A) Foot
should be demonstrated: the articulations (B) Elbow
between the talus and the navicular, between the (C) Orbit
calcaneus and the cuboid, between the cuboid and (D) Pelvis
the bases of the fourth and fifth metarsals, and —————————————————
between the cuboid and the lateral (third) The orbits are formed by portions of seven bones:
cuneiform. (Ballinger & Frank, vol 1, pp 244-245) the frontal, lacrimal, ethmoid, palatine, sphenoid,
Ans. C zygoma, and maxilla.
The orbital walls are very thin and fragile and are
90. Which of the following correctly identifies the
subject to "blowout" fractures.
position illustrated in Figure 2-14?
These fractures of the thin, delicate orbital wall
(A) AP axial mastoids (Towne / Grashey)
may be demonstrated using the parietoacanthial
(B) Axiolateral TMJ (open mouth)
(Waters') projection, radiographic tomography,
(C) Axiolateral mastoids (Laws)
and/or computed tomography. (Saia, p 151)
(D) Posterior profile mastoids (Stenvers)
Ans. C
—————————————————
The pictured radiograph shows an axiolateral 93. Which of the following is the correct sequence
projection (Laws method) of the right mastoid. of events when performing a double-contrast
upper GI series?
The mastoid air cells are easily recognized in the
temporal region just posterior to the auditory (A) Patient is given gas-producing substance,
canal. In the posterior profile (Stenvers) position, then given a small amount of high-density
the skull is seen more PA, with the mastoid tip barium, then placed recumbent.
projected adjacent to the upper cervical spine. (B) Patient is placed recumbent, given a small
amount of high-density barium, then given a
The AP axial (Towne / Grashey) position would
gas-producing substance.
demonstrate the petrous portions bilateral to the
(C) Patient is given a gas-producing substance,
foramen magnum. The TMJ is visualized
placed recumbent, then given a small amount
suboptimally in the closed position.
of high-density barium.
(Saia, pp 158-159)
(D) Patient is given a small amount of high-
Ans. C
density barium, placed recumbent, then
given a gas-producing substance.
91. What process is best seen using a
—————————————————
perpendicular CR with the elbow in acute
Many upper GI series are performed as double-
flexion and with the posterior aspect of the
contrast studies today to better see the mucosal
humerus adjacent to the image recorder?
lining and small lesions within the stomach.
(A) Coracoid
For successful results, the examination
(B) Coronoid
preliminaries must be performed in the following
(C) Olecranon
sequence:
(D) Glenoid
————————————————— The patient begins in the erect position and is
given a gas-producing substance, followed by a
When the elbow is placed in acute flexion with the
small quantity of high-density barium.
posterior aspect of the humerus adjacent to the
image recorder and a perpendicular CR is used, the The small amount of barium coats the gastric
olecranon process of the ulnais seen in profile. mucosa and the air distends the stomach, making
it possible to virtually "see through" the stomach
The coronoid process is best visualized in the
(which would be impossible if the stomach were
medial oblique position.
distended with opaque barium). (Ballinger &
The coracoid and glenoid are associated with the Frank, vol 2, p 100)
scapula. (Ballinger & Frank, vol 1, p 138) Ans. A
Ans. C
94. To make the patient as comfortable as
92. A "blowout" fracture is usually related to possible during a single-contrast barium
which of the following structures? enema (BE), the radiographer should

Reviewer A&R
Question & Answer
21
Review Notes for the
RADIOGRAPHY EXAM Appleton
1. instruct the patient to relax the (C) left lateral decubitus.
abdominal muscles to prevent (D) right lateral decubitus.
intraabdominal pressure. —————————————————
The illustration shows the patient positioned on
2. instruct the patient to concentrate on
his left side, with the cassette behind his back. This
breathing deeply to reduce colonic
is a left lateral decubitus position.
spasm.
The x-ray beam is directed horizontally in
3. prepare a warm barium suspension decubitus positions to demonstrate air-fluid levels.
(98 to 105ºF) to aid in retention. Air or fluid levels will be clearly delineated only if
the central ray is directed parallel to them.
(A) 2 only If the patient were lying on the right side, it would
(B) 1 and 2 only be a right lateral decubitus position.
(C) 2 and 3 only If the patient were lying on his or her back with a
(D) 1, 2, and 3 horizontal x-ray beam, it would be a dorsal
————————————————— decubitus position.
Lying prone with a horizontal x-ray beam is termed
To reduce anxiety prior to the examination, the
a ventral decubitus position.
radiographer should give the patient a full
(Bontager, p 20)
explanation of the enema procedure. This
Ans. C
explanation should include keeping the anal
sphincter tightly contracted, relaxing the
97. Which of the following projections will best
abdominal muscles, and deep breathing. The
demonstrate the tarsal navicular free of
barium suspension should be either just below
superimposition?
body temperature (at 85 to 90ºF) to prevent injury
and bowel irritation or cold (at 41ºF) to produce (A) AP oblique, medial rotation
less colonic irritation and to stimulate contraction (B) AP oblique, lateral rotation
of the anal sphincter. (Saia, p 186) (C) Mediolateral
Ans. B (D) Lateral weight-bearing
—————————————————
95. The pedicle is represented by what part of the The medial oblique projection requires that the leg
"scotty dog" seen in a correctly positioned be rotated medially until the plantar surface of the
oblique lumbar spine? foot forms a 30º angle with the cassette.
(A) Eye This position demonstrates the navicular with
(B) Front foot minimal bony superimposition.
(C) Body The lateral oblique projection of the foot
(D) Neck superimposes much of the navicular on the
———————————— cuboid. The navicular is also superimposed on the
————— cuboid in the lateral projections.
The 45º oblique position of the lumbar spine is (Ballinger & Frank, p 245)
generally performed for demonstration of the Ans. A
apophysealjoints.
In a correctly positioned oblique lumbar spine, 98. At what level do the carotid arteries
"scotty dog" images are demonstrated. bifurcate?
The scotty's ear corresponds to the superior
(A) Foramen magnum
articular process,
(B) Trachea
his nose to the transverse process,
(C) Pharynx
his eye to the pedicle,
(D) C4
his neck to the pars interarticularis,
—————————————————
his body to the lamina, and
The common carotid arteries function to supply
his front foot to the inferior articular process (Fig.
oxygenated blood to the head and neck.
2-49). (Saia, p 131)
Ans. A Major branches of the common carotid arteries
(internal carotids) function to supply the anterior
96. The position shown in Figure 2-15 is known as brain, while the posterior brain is supplied by the
(A) ventral decubitus. vertebral arteries (branches of the subclavian). The
(B) dorsal decubitus. carotid arteries bifurcate into internal and external

Reviewer A&R
Question & Answer
22
Review Notes for the
RADIOGRAPHY EXAM Appleton
carotid arteries at the level of C4. common bile duct (number 8). The common bile
duct and pancreatic duct (number 9) unite to form
The foramen magnum and pharynx are superior to
the short hepatopancreatic ampulla (of Vater),
the level of bifurcation, and the larynx is inferior to
which empties into the duodenum (number 1).
the level of bifurcation.
(Tortora & Grabowski, p 875)
(Ballinger & Frank, vol 2, p 15)
Ans. A
Ans. D
[Link] is the structure indicated by the number
99. During a double-contrast BE, which of the
7 in Figure 2-16?
following positions would afford the best
(A) Common hepatic duct
double-contrast visualization of both colic
(B) Common bile duct
flexures?
(C) Cystic duct
(A) LAO and RPO (D) Pancreatic duct
(B) Lateral —————————————————
(C) Left lateral decubitus
Figure 2-16 illustrates the biliary system. Bile
(D) AP or PA erect
leaves the liver through the right and left hepatic
—————————————————
ducts (number 5), which join to form thecommon
With the patient in the erect position, barium hepatic duct (number 6). Bile enters the
moves inferiorly and air rises to provide double- gallbladder through the cystic duct (number 7).
contrast visualization of the hepatic and splenic The neck of the gallbladder is indicated by the
flexures. number 4, its body by the number 3, and its
fundus by the number 2. The gallbladder stores
The LAO and RPO positions are used to
and concentrates bile, and when it contracts, bile
demonstrate especially the hepatic flexure; the
flows out through the cystic duct and down the
splenic flexuregenerally appears self-
common bile duct (number 8). The common bile
superimposed in this position.
duct and pancreatic duct (number 9) unite to form
A left lateral decubitus position will demonstrate a the short hepatopancreatic ampulla (of Vater),
double-contrast visualization of right-sided bowel which empties into the duodenum (number 1).
structuresthat is, the right side of the ascending (Tortora & Grabowski, p 875)
colon, the right side of the sigmoid and rectum, Ans. C
and so on.
[Link] order to evaluate the interphalangeal joints
The lateral position offers a singularly valuable
in the oblique and lateral positions, the fingers
view of the rectum.
(Ballinger & Frank, vol 2, p 146) (A) rest on the cassette for immobilization.
Ans. D (B) must be supported parallel to the film.
(C) are radiographed in natural flexion.
[Link] is the structure indicated by the number (D) are radiographed in palmar flexion.
6 in Figure 2-16? —————————————————
(A) Common hepatic duct The fingers must be supported parallel to the film
(B) Common bile duct (e.g., on a "finger sponge") in order that the joint
(C) Cystic duct spaces parallel the x-ray beam. When the fingers
(D) Pancreatic duct are flexed or resting on the cassette, the
————————————————— relationship between the joint spaces and the film
changes, and the joints appear "closed." (Ballinger
Figure 2-16 illustrates the biliary system. Bile
& Frank, vol 1, pp 76-77)
leaves the liver through the right and left hepatic
Ans. B
ducts (number 5), which join to form the common
hepatic duct (number 6). Bile enters the
[Link] of the following examinations involves
gallbladder through the cystic duct (number 7).
the introduction of a radiopaque contrast
The neck of the gallbladder is indicated by the medium through a uterine cannula?
(number 4), its body by the (number 3), and its (A) Retrograde pyelogram
fundus by the (number 2). The gallbladder stores (B) Voiding cystourethrogram
and concentrates bile, and when it contracts, bile (C) Hysterosalpingogram
flows out through the cystic duct and down the (D) Myelogram

Reviewer A&R
Question & Answer
23
Review Notes for the
RADIOGRAPHY EXAM Appleton
————————————————— recommended. The femoral condyles are
Hysterosalpingography involves the introduction superimposed so as to demonstrate the
of a radiopaque contrast medium through a patellofemoral joint and the articulation between
uterine cannula into the uterus and uterine the femur and the tibia. The correct degree of
(Fallopian) tubes. forward or backward body rotation is responsible
This examination is often performed to document for visualization of the patellofemoral joint.
patency of the uterine tubes in cases of infertility. Cephalad tube angulation of 5 to 7º is responsible
A retrograde pyelogram requires cystoscopy and for demonstrating the articulation between the
involves introduction of contrast through the femur and the tibia (by removing the magnified
vesicoureteral orifices and into the renal collecting medial femoral condyle from superimposition on
system. the joint space). (Ballinger & Frank, p 293)
A voiding cystourethrogram also requires Ans. D
cystoscopy and involves filling the bladder with
contrast and documenting the voiding mechanism. [Link] order to demonstrate the pulmonary apices
A myelogram is performed to investigate the with the patient in the AP position, the
spinal canal. (Ballinger & Frank, vol 2, p 199) (A) central ray is directed 15 to 20º cephalad.
Ans. C (B) central ray is directed 15 to 20º caudad.
(C) exposure is made on full exhalation.
[Link] of the following statements regarding (D) patient's shoulders are rolled forward.
large-bowel radiography are true except —————————————————
(A) The large bowel must be completely empty When the shoulders are relaxed, the clavicles are
prior to examination. usually carried below the pulmonary apices. In
(B) Retained fecal material can simulate pathology. order to examine the portions of the lungs lying
(C) Single-contrast studies help to demonstrate behind the clavicles, the central ray is directed
polyps. cephalad 15 to 20º to project the clavicles above
(D) Double-contrast studies help to demonstrate the apices when the patient is examined in the AP
intraluminal lesions. position. (Ballinger & Frank, vol 1, p 472)
————————————————— Ans. A
Perhaps the most important prerequisite to a
[Link] of the pars petrosae in the
successful BE exam is a thoroughly clean large
posterior profile position (Stenvers method)
bowel. Any retained fecal material can simulate
requires
pathology. A single-contrast examination
1. the use of the IOML.
demonstrates the anatomy and contour of the
2. the MSP to be rotated 45º.
large bowel, as well as anything that may project
3. that the head rest on the forehead,
out from the bowel wall (e.g., diverticula). In a
nose, and chin.
double-contrast exam, the bowel wall is coated
(A) 1 only
with barium and then the lumen filled with air.
(B) 1 and 2 only
This enables visualization of any intraluminal
(C) 2 and 3 only
lesions such as polyps and tumor masses. (Saia, p
(D) 1, 2, and 3
186)
———————————————
Ans. C
The posterior profile position (Stenvers method)
[Link] the lateral projection of the knee, the demonstrates a profile image of the pars petrosa,
placing it parallel to the film.
1. femoral condyles are superimposed.
2. patellofemoral joint is visualized. The patient is recumbent prone with the head
3. knee is flexed about 20 to 30º. resting on the forehead, nose, and zygoma. The
IOML is placed parallel to the film. The MSP is
(A) 1 only
rotated 45º. The central ray is directed 12º
(B) 2 only
cephalad and exits just anterior to the dependent
(C) 1 and 3 only
EAM. For patients unable to assume the prone
(D) 1, 2, and 3
position, an anterior profile position (Arcelin
—————————————————
method) may be performed using a 10º caudal
To better visualize the joint space in the lateral angle. (Ballinger & Frank, vol 2, pp 390-391)
projection of the knee, 20 to 30º flexion is
Ans. B

Reviewer A&R
Question & Answer
24
Review Notes for the
RADIOGRAPHY EXAM Appleton
[Link] of the following would be obtained
[Link]-contrast examinations of the stomach with the position illustrated in Figure 2-17?
or large bowel are performed to better
1. Splenic flexure and descending colon
visualize the
2. Hepatic flexure and ascending colon
(A) position of the organ. 3. Hepatic flexure and descending colon
(B) size and shape of the organ.
(A) 1 only
(C) diverticula.
(B) 3 only
(D) gastric or bowel mucosa.
(C) 1 and 2 only
—————————————————
(D) 1 and 3 only
Double-contrast studies of the stomach or large
—————————————————
intestine involve coating the organ with a thin
layer of barium sulfate, then introducing air. An RPO position is illustrated. The oblique
This permits seeing through the organ to projections in a barium enema are used to "open
structures behind it and, most especially, allows up" the flexures and adjacent colon.
visualization of the mucosal lining of the organ.
The RAO and LPO positions demonstrate the
A barium-filled stomach or large bowel hepatic flexure and adjacent ascending colon.
demonstrates the position, size, and shape of the
The LAO and RPO positions demonstrate the
organ and any lesion that projects out from its
splenic flexure and descending colon.
walls, such as diverticula. Polypoid lesions, which
(Ballinger & Frank, vol 2, p 141)
project inward from the wall of an organ, may go
Ans. A
unnoticed unless a double-contrast exam is
performed.
[Link] which of the following conditions is
(Ballinger & Frank, vol 2, p 104)
operative cholangiography a useful tool?
Ans. D
1. Biliary tract calculi
[Link] sigmoid colon is located in the 2. Patency of the biliary ducts
(A) left upper quadrant (LUQ). 3. Function of the sphincter of Oddi
(B) left lower quadrant (LLQ). (A) 1 only
(C) right upper quadrant (RUQ). (B) 2 only
(D) right lower quadrant (RLQ). (C) 2 and 3 only
————————————————— (D) 1, 2, and 3
—————————————————
The approximately 5-ft-long large intestine (colon)
Operative cholangiography plays a vital role in
functions in the formation, transport, and
biliary tract surgery. The contrast medium is
evacuation of feces.
injected, and filming occurs following a
The colon commences at the terminus of the small
cholecystectomy. This procedure is used to
intestine; its first portion is the saclike cecum in
investigate the patency of the bile ducts, the
the RLQ, located inferior to the ileocecal valve.
function of the hepatopancreatic sphincter (of
The ascending colon is continuous with the cecum Oddi), and previously undetected biliary tract
and is located along the right side of the calculi. (Ballinger & Frank, vol 2, p 76)
abdominal cavity. It bends medially and anteriorly, Ans. D
forming the right colic (hepatic) flexure.
[Link] the patient positioned as illustrated in
The colon traverses the abdomen as the
Figure 2-18, which of the following structures
transverse colon and bends posteriorly and
is best demonstrated?
inferiorly to form the left colic (splenic) flexure.
(A) Patella
The descending colon continues down the left side
(B) Patellofemoral articulation
of the abdominal cavity, and at about the level of
(C) Intercondyloid fossa
the pelvic brim, in the LLQ, the colon moves
(D) Tibial tuberosity
medially to form the S-shaped sigmoid colon. The
—————————————————
rectum, about 5 in in length, lies between the
sigmoid and the anal canal. (Ballinger & Frank, vol The PA axial projection (Camp-Coventry method)
2, p 89) of the intercondyloid fossa ("tunnel view") is
Ans. B pictured.

Reviewer A&R
Question & Answer
25
Review Notes for the
RADIOGRAPHY EXAM Appleton
The knee is flexed about 40º, and the central ray is 115.A patient is usually required to drink barium
directed caudally 40º and perpendicular to the sulfate suspension in order to demonstrate
tibia (Fig. 2-50). which of the following structures?
The patella and patellofemoral articulation are 1. Esophagus
demonstrated in the axial / tangential view of the 2. Pylorus
patella. (Saia, pp 112-113) 3. Ilium
Ans. C (A) 1 only
(B) 1 and 2 only
[Link] of the following structures is illustrated (C) 2 and 3 only
by the number 4 in Figure 2-19? (D) 1, 2, and 3
—————————————————
(A) Maxillary sinus
(B) Coronoid process Oral administration of barium sulfate is used to
(C) Zygomatic arch demonstrate the upper digestive tract: the
(D) Coracoid process esophagus; the fundus, body, and pylorus of the
————————————————— stomach; and the small bowel, consisting of
The parietoacanthial projection (Waters' method) duodenum, jejunum, and ileum. Consistent care
demonstrates a distorted view of the frontal and must be taken to read and record patient
ethmoidal sinuses. information accurately and correctly.
The maxillary sinuses (number 4) are well The large bowel is usually demonstrated via rectal
demonstrated, projected free of the petrous administration of barium. (Bontrager, pp 442-443)
pyramids. This is also the best single position for Ans. B
the demonstration of facial bones. The mandibular
angle is illustrated by the (no.1), the zygomatic [Link] radiograph seen in Figure 2-20 was made
arch by (no.2), and the coronoid process by (no.3). in what position?
(Bontrager, p 430) (A) PA
Ans. A (B) RAO
(C) LPO
[Link] of barium sulfate is contraindicated (D) Right lateral
in which of the following situations? —————————————————
1. Suspected perforation of a hollow The LPO position of the stomach is shown.
Viscus The fundus is the most posterior portion of the
2. Suspected large-bowel obstruction stomach and therefore readily fills with barium
3. Presurgical patients and moves superiorly in the supine position.
(A) 1 only In the LPO position, barium flows out of the
(B) 1 and 3 only pylorus to fill the fundus, and air moves up to fill
(C) 2 and 3 only the barium-coated pylorus. Therefore, the LPO
(D) 1, 2, and 3 position provides a double-contrast view of the
————————————————— pyloric portion of the stomach.(Saia, p 177)
Ans. C
Barium sulfate suspension is the usual contrast
medium of choice for investigation of the
[Link] of the positions illustrated in Figure 2-
alimentary tract. There are, however, a few
21 will best demonstrate the lumbar
exceptions. Whenever there is the possibility of
intervertebral foramina?
escape of contrast medium into the peritoneal
(A) Number 1
cavity, barium sulfate is contraindicated and a
(B) Number 2
water-soluble iodinated medium is recommended,
(C) Number 3
as it is easily aspirated before surgery.
(D) Number 4
Rupture of a hollow viscus (e.g., perforated ulcer)
—————————————————
and patients who are scheduled for surgery are
two examples. Patients with suspected large- Four positions for the lumbar spine are illustrated.
bowel obstruction should also ingest only water- Number 1 is an RPO, and number 2 is an LAO.
soluble iodinated media. (Ballinger & Frank, vol 2, The posterior oblique positions (LPO and RPO)
p 94) demonstrate the apophyseal joints closer to the
Ans. D film, while the anterior oblique positions (LAO and
RAO) demonstrate the apophyseal joints further

Reviewer A&R
Question & Answer
26
Review Notes for the
RADIOGRAPHY EXAM Appleton
from the film (Fig. 2-51). Number 3 is the AP
projection, which demonstrates the lumbar bodies [Link] of the following may be used to
and disk spaces and the transverse and spinous evaluate the glenohumeral joint?
processes. Number 4 is the lateral position, which
1. Scapular Y projection
provides the best demonstration of the lumbar
2. Inferosuperior axial
bodies, intervertebral disk spaces, spinous
3. Transthoracic lateral
processes, pedicles, and intervertebral foramina.
(A) 1 only
(Bontrager & Frank, vol 1, pp 431, 434-435)
(B) 1 and 2 only
Ans. D
(C) 2 and 3 only
(D) 1, 2, and 3
[Link] of the positions illustrated in Figure 2-
—————————————————
21 will best demonstrate the lumbar
The scapular Y projection is an oblique projection
apophyseal joints closest to the film?
of the shoulder and is used to demonstrate
(A) Number 1
anterior or posterior shoulder dislocation.
(B) Number 2
(C) Number 3 The inferosuperior axial projection may be used to
(D) Number 4 evaluate the glenohumeral joint when the patient
————————————————— is able to abduct the arm.
Four positions for the lumbar spine are illustrated. The transthoracic lateral projection is used to
Number 1 is an RPO, and number 2 is an LAO. The evaluate the glenohumeral joint and upper
posterior oblique positions (LPO and RPO) humerus when the patient is unable to abduct the
demonstrate the apophyseal joints closer to the arm. (Ballinger & Frank, vol 1, p 142)
film, Ans. D
while the anterior oblique positions (LAO and RAO)
demonstrate the apophyseal joints further from [Link] lower-limb venography, tourniquets
the film (Fig. 2-51). Number 3 is the AP projection, are applied above the knee and ankle to
which demonstrates the lumbar bodies and disk
1. suppress filling of the superficial veins.
spaces and the transverse and spinous processes.
2. coerce filling of the deep veins.
Number 4 is the lateral position, which provides
3. outline the anterior tibial vein.
the best demonstration of the lumbar bodies,
intervertebral disk spaces, spinous processes, (A) 1 and 2 only
pedicles, and intervertebral foramina. (Bontrager (B) 1 and 3 only
& Frank, vol 1, pp 431, 434-435) (C) 2 and 3 only
Ans. A (D) 1, 2, and 3
—————————————————
[Link] apophyseal articulations of the thoracic During lower-limb venography, tourniquets are
spine are demonstrated with the applied above the knee and ankle to suppress
filling of the more superficial veins and coerce
(A) coronal plane 45º to the film.
filling of the deep veins.
(B) midsagittal plane 45º to the film.
(C) coronal plane 70º to the film. The anterior tibial vein may be blocked when
(D) midsagittal plane 70º to the film. tourniquets are used.
—————————————————
The patient is positioned so that the table is tilted
The thoracic apophyseal joints are demonstrated with the head up to slowthe transit time of the
by placing the patient in an oblique position with contrast medium, in order that films may be
the coronal plane 70º to the film (MSP 20º to the obtained of the entire lower-limb and pelvic area.
film). This may be accomplished by first placing the (Ballinger & Frank, vol 2, p 542)
patient lateral, then obliquing the patient 20º "off Ans. A
lateral." The apophyseal joints closest to the film
are demonstrated in the PA oblique, and those [Link] of the following women is likely to have
remote from the film in the AP oblique. the most homogeneous, glandular breast
Comparable detail is obtained using either tissue?
method, because the object-image distance (OID)
(A) A postpubertal adolescent
is about the same. (Ballinger & Frank, vol 1, p 327)
(B) A 20 year old with one previous pregnancy
Ans. C
(C) A menopausal woman

Reviewer A&R
Question & Answer
27
Review Notes for the
RADIOGRAPHY EXAM Appleton
(D) A postmenopausal 65 year old pp 228-232)
————————————————— Ans. C
Breast tissue is most dense, glandular, and
radiographically homogeneous in appearance in [Link] of the following examinations
the postpubertal adolescent. require(s) special identification markers in
Following pregnancy and lactation, changes occur addition to the usual patient name and
within the breast that reduce the glandular tissue number, date, and side marker?
and replace it with fatty tissue (a process called
1. IVP
fatty infiltration). Menopause causes further
2. Tomography
atrophy of glandular tissue. (Ballinger & Frank, vol
3. Abdominal survey
2, pp 429-431)
Ans. A (A) 1 only
(B) 1 and 2 only
[Link] of the following positions / projections (C) 2 and 3 only
of the skull will result in the most shape (D) 1, 2, and 3
distortion? —————————————————
(A) 0º PA IVP images should indicate the amount of time
(B) 23º Caldwell elapsed postinjection. Tomographic images should
(C) 37º Towne / Grashey indicate the fulcrum level. Abdominal survey
(D) 25º Haas images should be marked according to body
————————————————— position (such as erect or decubitus). (Cornuelle &
Gronefeld, p 15)
Accurate positioning skills include a knowledge of
Ans. D.
anatomy (the position of the structure with
respect to the image recorder) and geometric
[Link] of the following is most likely to be the
principles (how the x-ray tube angle will project or
correct routine for a radiographic
distort the anatomic structure).
examination of the forearm?
Shape distortion is related to the alignment of the
(A) PA and medial oblique
x-ray tube, the object being examined, and the
(B) AP and lateral oblique
image recorder.
(C) PA and lateral
When all three are parallel to one another, shape (D) AP and lateral
distortion is minimal. If one or more are out of —————————————————
alignment, shape distortion occurs. The two types
In order to demonstrate the radius and ulna free
of shape distortion are foreshortening and
of superimposition, the forearm must be
elongation.
radiographed in the AP position, with the hand
Foreshortening occurs asa result of the anatomic supinated. Pronation of the hand causes
structure within the body being at an angle with overlapping of the proximal radius and ulna. Two
the image recorder. For example, in the supine views, at right angles to each other, are generally
position, the kidneys are not parallel to the image required for each examination. Therefore, AP and
recorder: Their lower pole is anterior to their lateral is the usual routine for an exam of the
upper pole. Another example is the curved carpal forearm.
scaphoid: Its full length will not be appreciated in (Ballinger & Frank, vol 1, p 98)
the PA projection, as because of its curve it will be Ans. D
self-superimposed and foreshortened.
[Link] uppermost portion of the iliac crest is at
Elongation occurs as a result of x-ray tube
approximately the same level as the
angulation. Elongation is often used intentionally
tosee structures better. The axial projection of the (A) costal margin.
sigmoid colon during BE "opens" the S-shaped (B) umbilicus.
sigmoid to allow visualization of its entire length. (C) xiphoid tip.
(D) fourth lumbar vertebra.
The AP axial skull (Townes / Grashey) projects the
—————————————————
facial bones inferiorly to better see the occipital
bone. The greater the tube angulation, the greater Surface landmarks, prominences, and depressions
the elongation (distortion) produced. (Shephard, are very useful to the radiographer in locating

Reviewer A&R
Question & Answer
28
Review Notes for the
RADIOGRAPHY EXAM Appleton
anatomic structures that are not visible externally. 2. anterior or posterior dislocation.
The costal margin is at about the same level as L3. 3. a lateral projection of the shoulder.
The umbilicus is at approximately the same level
(A) 1 only
as the L3-4 interspace.
(B) 1 and 2 only
The xiphoid tip is at about the same level as T10.
(C) 1 and 3 only
The fourth lumbar vertebra is at approximately the
(D) 2 and 3 only
same level as the iliac crest. (Saia, p 77)
—————————————————
Ans. D
The “scapular Y” projection requires that the
[Link] of the following fracture classifications coronal plane be about 60º to the film, thus
describes a small bony fragment pulled from a resulting in an oblique projection of the shoulder.
bony process? The vertebral and axillary borders of the scapula
are superimposed on the humeral shaft, and the
(A) Avulsion fracture
resulting relationship between the glenoid fossa
(B) Torus fracture
and humeral head will demonstrate anterior or
(C) Comminuted fracture
posterior dislocation.
(D) Compound fracture
Lateral or medial dislocation is evaluated on the
—————————————————
AP projection. (Ballinger & Frank, vol 1, p 179)
a) An avulsion fracture is a small bony Ans. B
fragment pulled from a bony process as a
result of a forceful pull of the attached [Link] of the following projection(s) require(s)
ligament or tendon. that the shoulder be placed in internal
b) A comminuted fracture is one in which rotation?
the bone is broken or splintered into
1. AP humerus
pieces.
2. Lateral forearm
c) A torus fracture is a greenstick fracture
3. Lateral humerus
with one cortex buckled and the other
intact. (A) 1 only
d) A compound fracture is an open fracture (B) 1 and 2 only
in which the fractured ends have (C) 3 only
perforated the skin. (Saia, pp 119-120) (D) 1, 2, and 3
Ans. A —————————————————
[Link] of the following is proximal to the When the arm is placed in the AP position, the
carpal bones? epicondyles are parallel to the plane of the
cassette and the shoulder is placed in external
(A) Distal interphalangeal joints
rotation. In this position, an AP projection of the
(B) Proximal interphalangeal joints
humerus, elbow, and forearm can be obtained; it
(C) Metacarpals
places the greater tubercle of the humerus in
(D) Radial styloid process
profile.
——————————————————
For the lateral projection of the humerus, the arm
The term proximal refers to structures closer to is internally rotated, elbow somewhat flexed, with
the point of attachment. the back of the hand against the thigh and the
For example, the elbow is described as being epicondyles superimposed and perpendicular to
proximal to the wrist; that is, the elbow is closer to the film. The lateral projections of the humerus,
the point of attachment (the shoulder) than the elbow, and forearm all require that the
wrist is. Referring to the question, then, the epicondyles be perpendicular to the plane of the
interphalangeal joints (both proximal and distal) cassette. (Ballinger & Frank, pp 161, 164)
and the metacarpals are both distal to the carpal Ans. C
bones. The radial styloid process is proximal to the
carpals. (Bontrager, p 23) [Link] fifth metacarpal is located on which
Ans. D aspect of the hand?
(A) Medial
[Link] scapular Y projection of the shoulder
(B) Lateral
demonstrates
(C) Ulnar
1. an oblique projection of the shoulder. (D) Volar

Reviewer A&R
Question & Answer
29
Review Notes for the
RADIOGRAPHY EXAM Appleton
————————————————— (D) transverse plane.
—————————————————
The fifth metacarpal is located on the medial
aspect of the hand. a) The median sagittal, or midsagittal, plane
Remember to always view a part in its anatomic passes vertically through the midline of
position. With the arm in the anatomic position, the body, dividing it into left and right
the fifth metacarpal and the ulna lie medially. halves.
(Bontrager, p 23)
b) Any plane parallel to the MSP is termed a
Ans. A
sagittal plane.
[Link] the patient's head in a PA position and c) The midcoronal plane is perpendicular to
the central ray directed 20º cephalad, which the MSP and divides the body into
part of the mandible will be best visualized? anterior and posterior halves.
(A) Symphysis d) A transverse plane passes through the
(B) Rami body at right angles to a sagittal plane.
(C) Body These planes, especially the MSP, are very
(D) Angle important reference points in
————————————————— radiographic positioning (Fig. 2-52). (Saia,
With the patient in the PA position, the rami are p 75)
well visualized with a perpendicular ray or with 20 Ans. B
to 25º cephalad angulation.
[Link] order to demonstrate a profile view of the
A portion of the mandibular body is demonstrated,
glenoid fossa, the patient is AP recumbent and
but most of it is superimposed over the cervical
obliqued 45º
spine. (Ballinger & Frank, vol 2, pp 432-433)
Ans. B (A) toward the affected side.
(B) away from the affected side.
[Link] intravenous (IV) urography, the prone (C) with the arm at the side in the anatomic
position is generally recommended to position.
demonstrate (D) with the arm in external rotation.
—————————————————
1. filling of obstructed ureters.
2. the renal pelvis. In the AP projection of the shoulder, there is
3. the superior calyces. superimposition of the humeral head and glenoid
(A) 1 only fossa.
(B) 1 and 2 only
With the patient obliqued 45º toward the affected
(C) 1 and 3 only
side, the glenohumeral joint is open, and the
(D) 1, 2, and 3
glenoid fossa is seen in profile.
—————————————————
The patient's arm is abducted somewhat and
The kidneys lie obliquely in the posterior portion
placed in internal rotation.
of the trunk, with their superior portion angled
(Ballinger & Frank, vol 1, pp 182-183)
posteriorly and their inferior portion and ureters
Ans. A
angled anteriorly. Therefore, in order to facilitate
filling of the most anteriorly placed structures, the
[Link] of the following is (are) accurate
patient is examined in the prone position.
criticism(s) of the open-mouth projection of
Opacified urine then flows to the most dependent
C1-2 seen in Figure 2-22?
part of the kidney and ureter: the ureteropelvic
region, inferior calyces, and ureters. (Saia, p 187) 1. The MSP is not centered and
Ans. B perpendicular to the midline of the table.
2. The neck should be flexed more.
[Link] plane that passes vertically through the 3. The neck should be extended more.
body, dividing it into anterior and posterior
(A) 1 only
halves, is termed the
(B) 1 and 2 only
(A) median sagittal plane. (C) 3 only
(B) midcoronal plane. (D) 1 and 3 only
(C) sagittal plane. —————————————————

Reviewer A&R
Question & Answer
30
Review Notes for the
RADIOGRAPHY EXAM Appleton
The radiograph illustrated shows the odontoid (C) Angle the central ray 35 to 45º cephalad.
process superimposed on the base of the skull. (D) Angle the central ray 35 to 45º caudad.
The maxillary teeth can be seen significantly —————————————————
superior to the base of the skull.
In the PA position, portions of the barium-filled
A diagnostic image of C1-2 depends on adjusting
hypersthenic stomach superimpose upon
the flexion of the neck so that the maxillary
themselves. Thus, patients with a hypersthenic
occlusal plane and the base of the skull are
body habitus usually present a high transverse
superimposed (see the dotted lines in Fig. 2-53).
stomach, with poorly defined curvatures. If the PA
Accurate adjustment of these structures will
stomach is projectedwith a 35 to 45º cephalad
usually allow good visualization of the odontoid
central ray, the stomach "opens up." That is, the
process and the atlantoaxial articulation. Too
curvatures, the antral portion, and the duodenal
much flexion superimposes the teeth on the
bulb all appear as a sthenic habitus stomach would
odontoid process; too much extension
appear. A 35 to 40º RAO position is used to
superimposes the base of the skull on the
demonstrate many of these structures in the
odontoid process.
average, or sthenic, body habitus. A lateral
(Ballinger & Frank, vol 1, pp 388-389)
position is used to demonstrate the anterior and
Ans. B
posterior gastric surfaces and retrogastric space.
(Bontrager, pp 450-451)
[Link] is a diagnostic examination used
Ans. C
to demonstrate
1. extrinsic spinal cord compression [Link] of the following is recommended in
resulting from disk herniation. order to better demonstrate the tarso-
2. post-traumatic swelling of the spinal metatarsal joints in the dorsoplantar
cord. projection of the foot?
3. internal disk lesions.
(A) Invert the foot
(A) 1 only
(B) Evert the foot
(B) 2 only
(C) Angle the central ray 10º posteriorly
(C) 1 and 2 only
(D) Angle the central ray 10º anteriorly
(D) 1 and 3 only
—————————————————
—————————————————
In the dorsoplantar projection of the foot, the
Myelography is used to demonstrate
central ray may be directed perpendicularly or
encroachment on and compression of the spinal
angled 10º posteriorly.
cord as a result of disk herniation, tumor growth,
or post-traumatic swelling of the cord. Angulation serves to "open" the tarsometatarsal
joints that are not well visualized on the
This is accomplished by placing positive or
dorsoplantar projection with perpendicular ray.
negative contrast medium into the subarachnoid
Inversion and eversion of the foot do not affect
space.
the tarsometatarsal joints.
Myelography will demonstrate posterior
protrusion of herniated intervertebral disks or
(Ballinger & Frank, vol 1, p 242)
spinal cord tumors. Anterior protrusion of a
Ans. C
herniated intervertebral disk does not impinge on
the spinal cord, and is not demonstrated in
[Link] tissue that occupies the central cavity
myelography. Internal disk lesions can be
within the shaft of a long bone in an adult is
demonstrated only by injecting contrast medium
into the individual disks (diskography). (A) red marrow.
(Saia, p 198) (B) yellow marrow.
Ans. C (C) cortical tissue.
(D) cancellous tissue.
[Link] of the following techniques would —————————————————
provide a PA projection of the gastroduodenal
The central cavity of a long bone is the medullary
surfaces of the barium-filled, high and
canal. It contains yellow bone marrow, the most
transverse stomach?
abundant type of marrow in the body. Red marrow
(A) Place the patient in a 35 to 40º RAO position. is found within the cancellous tissue forming the
(B) Place the patient in a lateral position. extremities of long bones. (Saia, pp 87, 89)

Reviewer A&R
Question & Answer
31
Review Notes for the
RADIOGRAPHY EXAM Appleton
Ans. B All patients must be screened prior to entering the
magnetic field to be sure that they do not have
[Link] of the following positions will provide any metal on or within them.
an AP projection of the L5-S1 interspace?
Proper screening includes questioning the patient
(A) Patient AP with 30 to 35º angle cephalad about any eye injury involving metal, cardiac
(B) Patient AP with 30 to 35º angle caudad pacemakers, aneurysm clips, insulin pumps, heart
(C) Patient AP with 0º angle valves, shrapnel, or any metal in the body.
(D) Patient lateral, coned to L5
This is extremely important, and if there is any
—————————————————
doubt, the patient should be rescheduled for a
The routine AP projection of the lumbar spine
time after it has been determined that it is safe for
demonstrates the intervertebral disk spaces
him or her to enter the room.
between the first four lumbar vertebrae.
Patients who have done metalwork or welding are
The space between L5 and S1, however, is angled
frequently sent to diagnostic radiology for
with respect to the other disk spaces.
screening films of the orbits to ensure that there
Therefore, the central ray must be directed 30 to are no metal fragments near the optic nerve.
35º cephalad to parallel the disk space, and thus
Any external metallic objects, such as bobby pins,
project it open onto the film.
hair clips, or coins in the pocket, must be removed,
(Ballinger & Frank, vol 1, p 440) or they will be pulled by the magnet and can cause
Ans. A harm to the patient.
Credit cards and any other plastic cards with a
[Link] of the following bony landmarks is in
magnetic strip will be wiped clean if they come in
the same transverse plane as the symphysis
contact with the magnetic field.
pubis?
(Torres, pp 312-313)
(A) Ischial tuberosity Ans. C
(B) Most prominent part of the greater trochanter
(C) Anterior superior iliac spine [Link] of a part toward the midline of the
(D) Anterior inferior iliac spine body is termed
————————————————— (A) eversion.
(B) inversion.
The most prominent part of the greater trochanter
(C) abduction.
is at the same level as the pubic symphysisboth
(D) adduction.
are valuable positioning landmarks.
—————————————————
The ASIS is in the same transverse plane as S2. The
ASIS and the pubic symphysis are the bony These are all terms used to describe particular
landmarks used to locate the hip joint, which is body movements.
located midway between the two points. (Saia, p
Eversion refers to movement of the foot caused by
77)
turning the ankle outward.
Ans. B
Inversion is foot motion caused by turning the
[Link] are instructed to remove all jewelry, ankle inward.
hair clips, metal prostheses, coins, and credit
Abduction is movement of a part away from the
cards before entering the room for an
midline.
examination in
Adduction is movement of a part toward the
(A) sonography.
midline. (Bontrager, p 26)
(B) computed axial tomography (CAT).
Ans. D
(C) magnetic resonance imaging (MRI).
(D) nuclear medicine. [Link] which of the following positions was the
————————————————— radiograph in Figure 2-23 probably made?
Patients are instructed to remove all jewelry, hair
(A) AP recumbent
clips, metal prostheses, coins, and credit cards
(B) PA recumbent
before entering the room for an MRI scan.
(C) PA upright
MRI does not use radiation to produce images, but (D) AP Trendelenburg
instead uses a very strong magnetic field. ——————————————————

Reviewer A&R
Question & Answer
32
Review Notes for the
RADIOGRAPHY EXAM Appleton
The radiograph shown in Figure 2-23 is a PA trapezium articulate?
recumbent projection. If the patient was AP,
(A) Fifth metacarpal
barium would be located in the fundus of the
(B) First metacarpal
stomach because the fundus is more posterior,
(C) Distal radius
and barium would flow down to fill the posterior
(D) Distal ulna
structure.
—————————————————
If the patient was in the Trendelenburg position,
barium flow to the fundus would be even more The first metacarpal, on the lateral side of the
facilitated. hand, articulates with the most lateral carpal of
If the patient was erect, air-fluid levels would be the distal carpal row, the greater multangular /
clearly defined. Additionally, the barium-filled trapezium.
stomach tends to spread more horizontally in the
This articulation forms a rather unique and very
PA position (as is seen in the radiograph).
versatile saddle joint, named for the shape of its
(Ballinger & Frank, vol 2, p 102)
articulating surfaces. (Saia, pp 87-88)
Ans. B
Ans. B
[Link] of the following vertebral groups
[Link] of the following positions will most
form(s) lordotic curve(s)?
effectively move the gallbladder away from
1. Cervical the vertebrae in the asthenic patient?
2. Thoracic
(A) LAO
3. Lumbar
(B) RAO
(A) 1 only
(C) LPO
(B) 2 only
(D) Erect
(C) 1 and 2 only
—————————————————
(D) 1 and 3 only
————————————————— The position of the gallbladder varies with the
body habitus of the patient.
The lordotic curves are secondary curves; that is,
Hypersthenic patients are more likely to have their
they develop sometime after birth. The cervical
gallbladder located high and lateral.
and lumbar vertebrae form lordotic curves.
The asthenic patient's gallbladder is most likely to
The thoracic and sacral vertebrae exhibit the
occupy a low and medial position, occasionally
primary kyphotic curves, those that are present at
superimposed on the vertebrae or iliac fossa.
birth. (Saia, p 123)
The LAO position is most often used to move the
Ans. D
gallbladder away from the spine.
[Link] of the following is (are) required for a The erect position would make the gallbladder
lateral projection of the skull? move even more inferior and medial. (Ballinger &
Frank, vol 2, p 62)
1. The IOML is parallel to the film.
Ans. A
2. The MSP is perpendicular to the film.
3. The central ray enters 2 in superior to
[Link] ileocecal valve is normally located in
the external auditory meatus (EAM).
which of the following body regions?
(A) 1 only
(B) 1 and 3 only (A) Right iliac
(C) 2 and 3 only (B) Left iliac
(D) 1, 2, and 3 (C) Right lumbar
————————————————— (D) Hypogastric
—————————————————
In the lateral position of the skull, the midsagittal
plane must be parallel to the film and the The abdomen is divided into nine regions.
interpupillary line vertical. Flexion of the head is
The upper lateral regions are the left and right
adjusted until the IOML is parallel to the film. The
hypochondriac, with the epigastric separating
central ray should enter about 2 in superior to the
them.
EAM. (Saia, p 144)
The middle lateral regions are the left and right
Ans. B
lumbar, with the umbilical region between them.
[Link] which of the following does the The lower lateral regions are the left and right iliac,

Reviewer A&R
Question & Answer
33
Review Notes for the
RADIOGRAPHY EXAM Appleton
with the hypogastric region between them. descending colon,
that is, the lateral side of the descending colon and
The ileocecal valve, cecum, and appendix (if
the medial side of the ascending colon
present) are located in the lower right
(Fig. 2-54).
abdomentherefore, the right iliac region.
(Saia, p 77) The left lateral decubitus, then, would
Ans. A demonstrate the lateral side of the ascending
colon and the medial side of the descending colon.
[Link] of the following is (are) true regarding (Saia, pp 180, 181)
radiographic examination of the Ans. C
acromioclavicular joints?
[Link] of the following articulations
1. The procedure is performed in the
participate(s) in formation of the ankle
erect position.
mortise?
2. Use of weights can improve
1. Talotibial
demonstration of the joints.
2. Talocalcaneal
3. The procedure should be avoided if
3. Talofibular
dislocation or separation is suspected.
(A) 1 only
(B) 1 and 3 only
(A) 1 only
(C) 2 and 3 only
(B) 1 and 2
(D) 3 only
(C) 1 and 3 only
——————————————————
(D) 2 and 3 only
————————————————— The ankle mortise, or ankle joint, is formed by the
articulation of the tibia, fibula, and talus
Evaluation of the acromioclavicular joints requires
(Fig. 2-55).
bilateral AP or PA erect projections with and
without the use of weights. Two articulations form the ankle mortise, the
talotibial and talofibular. The calcaneus is not
Weights are used to emphasize the minute
associated with the formation of the ankle
changes within a joint caused by separation or
mortise. (Ballinger & Frank, vol 1, p 228)
dislocation.
Ans. B
Weights should be anchored from the patient's
wrists rather than held in the patient's hands, as [Link] of the following skull positions will
this encourages tightening of the shoulder muscles demonstrate the cranial base, sphenoidal
and obliteration of any small separation. (Saia, p sinuses, atlas, and odontoid process?
100) (A) AP axial
Ans. B (B) Lateral
(C) Parietoacanthial
[Link] of the following structures is (are) most (D) Submentovertical (SMV)
likely to be demonstrated in a right lateral ———————————————————
decubitus position of a double-contrast BE? ——————
The SMV projection is made with the patient's
1. Lateral wall of the descending colon
head restingon the vertex and the central ray
2. Medial wall of the ascending colon
directed perpendicular to the IOML. This position
3. Lateral wall of the ascending colon
may be used as part of a sinus survey to
(A) 1 only
demonstrate the sphenoidal sinuses or as a view
(B) 3 only
of the cranial base for the basal foramina
(C) 1 and 2 only
(especially the foramina ovale and spinosum). It
(D) 2 and 3 only
also demonstrates the bony part of the auditory
——————————————————
(eustachian) tubes. AP or PA axial projections are
When performing decubitus positions of the frequently used to demonstrate the occipital
double-contrast barium enema, the heavy barium region or evaluate the sellar region. A lateral
moves to the side that is down, while the air rises projection is usually part of a routine skull
to the side that is up. Therefore, evaluation. The parietoacanthial projection is the
single best position to demonstrate facial bones.
The right lateral decubitus will best demonstrate
(Ballinger & Frank, vol 1, p 277)
the up or left-sided walls of the ascending and

Reviewer A&R
Question & Answer
34
Review Notes for the
RADIOGRAPHY EXAM Appleton
Ans. D large femoral condyles, and the popliteal surface is
a smooth surface just superior to the
[Link] of the following statements is (are) true intercondyloid fossa. The intertubercular groove is
with respect to the radiograph in Figure 2-24? found on the proximal humerus between the
1. The coracoid process is seen partially humeral tubercles. (Saia, p 105)
superimposed on the third rib. Ans. B
2. This projection is performed to
evaluate the acromioclavicular articulation. [Link] intrathecal injection is associated with
3. This projection is performed to which of the following examinations?
evaluate possible shoulder dislocation. (A) IVP
(A) 1 only (B) Retrograde pyelogram
(B) 1 and 2 only (C) Myelogram
(C) 1 and 3 only (D) Arthrogram
(D) 2 and 3 only ———————————————————
——————————————————— ——————
—————— An intrathecal injection is one made within the
The radiograph in Figure 2-24 illustrates a lateral meninges. A myelogram requires an intrathecal
projection of the scapula. The axillary and injection in order to introduce contrast medium
vertebral borders are superimposed. The acromion into the subarachnoid space. An IVP requires an
and coracoid process are visualized; the coracoid intravenous injection; a retrograde pyelogram
process is partially superimposed on the axillary requires that contrast be introduced into the
portion of the third rib. A scapular Y projection is ureters by way of cystoscopy. An arthrogram
often performed to demonstrate shoulder requires that contrast medium be introduced into
dislocation, but the affected arm is left to rest at a joint space. (Saia, p 198)
the patient's side; the arm in the illustrated Ans. C
radiograph is abducted somewhat to better view
the body of the scapula. (Ballinger & Frank, vol 1, p [Link] Figure 2-25, which of the following is
166) represented by the number 1?
Ans. A (A) Pedicle
(B) Lamina
[Link] of the following is (are) located on the (C) Spinous process
posterior aspect of the femur? (D) Superior articular process
1. Intercondyloid fossa ———————————————————
2. Intertrochanteric crest ——————
3. Intertubercular groove The typical vertebra is divided into two portions,
(A) 1 only the body (anteriorly) and the vertebral arch
(B) 1 and 2 only (posteriorly). The vertebral arch supports seven
(C) 1 and 3 only processes: two transverse, one spinous (number
(D) 2 and 3 only 3), two superior articular processes (number 4),
——————————————————— and two inferior articular processes (number 2).
—————— The superior articular processes and the
The femur is the longest and strongest bone in the superjacent inferior articular processes join to
body. The femoral shaft is bowed slightly form apophyseal joints. Pedicles (number 5)
anteriorly and presents a long, narrow ridge project posteriorly from the vertebral body
posteriorly, called the linea aspera. The proximal (number 6). Their upper and lower surfaces form
femur consists of a head that is received by the vertebral notches. Superjacent vertebral notches
pelvic acetabulum. The femoral neck, which joins form intervertebral foramina. The lamina is
the head and shaft, normally angles upward about represented by the number 1. The transverse and
120º and forward (in anteversion) about 15º. The spinous processes serve as attachments for
greater and lesser trochanters are large processes muscles, or articulation for ribs in the thoracic
on the posterior proximal femur. The region. The superior and inferior surfaces of the
intertrochanteric crest runs obliquely between the vertebral body are covered with articular cartilage,
trochanters; the intertrochanteric line parallels the and between the vertebral bodies lie the
intertrochanteric crest on the anterior femoral intervertebral disks. (Saia, p 123)
surface. The intercondyloid fossa a deep notch Ans. B
found on the distal posterior femur between the

Reviewer A&R
Question & Answer
35
Review Notes for the
RADIOGRAPHY EXAM Appleton
[Link] of the following statements is (are) ———————————————————
correct with respect to evaluation criteria for ——————
a PA projection of the chest for lungs? In the lateral projection of the ankle, the tibia and
1. The sternoclavicular joints should be fibula are superimposed and the foot is somewhat
symmetrical. dorsiflexed to better demonstrate the talotibial
2. The sternum is seen lateral without joint. The talofibular joint is not visualized because
rotation. of superimposition with other bony structures. It
3. Ten anterior ribs are demonstrated may be well visualized in the medial oblique
above the diaphragm. projection of the ankle. (Ballinger & Frank, vol 1, p
(A) 1 only 230)
(B) 1 and 2 only Ans. C
(C) 1 and 3 only
(D) 1, 2, and 3 [Link] the lateral projection of the ankle, the
——————————————————— 1. talotibial joint is visualized.
—————— 2. talofibular joint is visualized.
In the PA projection of the chest, there should be 3. tibia and fibula are superimposed.
no rotation, as evidenced by symmetrical (A) 1 only
sternoclavicular joints. The shoulders are rolled (B) 1 and 2 only
forward to remove the scapulae from the lung (C) 1 and 3 only
fields. Inspiration should be adequate to (D) 1, 2, and 3
demonstrate 10 posterior ribs above the ———————————————————
diaphragm (the anterior ribs angle downward; the ——————
tenth anterior rib is the last attached to the In the lateral projection of the ankle, the tibia and
sternum and is very unlikely to be imaged on fibula are superimposed and the foot is somewhat
inspiration). The sternum should be seen lateral dorsiflexed to better demonstrate the talotibial
without rotation in the lateral position of the joint. The talofibular joint is not visualized because
chest. (Ballinger & Frank, vol 1, pp 404, 455) of superimposition with other bony structures. It
Ans. A may be well visualized in the medial oblique
projection of the ankle. (Ballinger & Frank, vol 1, p
[Link] coronoid process should be visualized in 230)
profile in which of the following positions? Ans. B
(A) Scapular Y
(B) AP scapula [Link] of the following positions are likely to be
(C) Medial oblique elbow employed for both single-contrast and double-
(D) Lateral oblique elbow contrast examinations of the large bowel
——————————————————— except
—————— (A) lateral rectum.
The coronoid process is located on the proximal (B) AP axial rectosigmoid.
anterior ulna. The medial oblique projection of the (C) right and left lateral decubitus abdomen.
elbow demonstrates the coronoid process in (D) RAO and LAO abdomen.
profile, as well as the ulnar olecranon process ———————————————————
within the humeral olecranon fossa. The lateral ——————————————————
oblique elbow projects the proximal radius and Radiographic examinations of the large bowel
ulna free of superimposition. The coracoid process generally include the AP or PA axial position to
is located on the scapula. (Ballinger & Frank, vol 1, "open" the S-shaped sigmoid colon, the lateral
p 134) position especially for the rectum, and the LAO
Ans. C and RAO (or LPO and RPO) to "open" the colic
flexures. The left and right decubitus positions are
[Link] the lateral projection of the ankle, the usually employed only in double-contrast barium
1. talotibial joint is visualized. enemas to better demonstrate double contrast of
2. talofibular joint is visualized. the medial and lateral walls of the ascending and
3. tibia and fibula are superimposed. descending colon. (Ballinger & Frank, vol 2, pp 132,
(A) 1 only 137)
(B) 1 and 2 only Ans. C
(C) 1 and 3 only
(D) 1, 2, and 3 [Link] of the following positions is essential in

Reviewer A&R
Question & Answer
36
Review Notes for the
RADIOGRAPHY EXAM Appleton
radiography of the paranasal sinuses? (D) 1, 2, and 3
(A) Erect ———————————————————
(B) Recumbent ——————
(C) Oblique The visualization of the scapular spine indicates
(D) Trendelenburg that this is a view of the posterior aspect of the
——————————————————— scapula. The scapula's anterior, or costal, surface is
—————— that which is adjacent to the ribs. The scapula has
Because sinus exams are performed to evaluate no sternal articulation. (Tortora & Grabowski, p
the presence or absence of fluid, they must be 221)
performed in the erect position with a horizontal Ans. A
x-ray beam. The PA axial (Caldwell) projection
demonstrates the frontal and ethmoidal sinus [Link] Figure 2-27, which of the following is
groups, and the parietoacanthial projection represented by the number 2?
(Waters') shows the maxillary sinuses. The lateral (A) Acromion process
position demonstrates all the sinus groups, and (B) Scapular spine
the SMV is frequently used to demonstrate the (C) Coracoid process
sphenoidal sinuses. (Ballinger & Frank, vol 2, p (D) Acromioclavicular joint
361) ———————————————————
Ans. A ——————
Figure 2-27 depicts a posterior view of the right
[Link] of the following can be used to scapula and its articulation with the humerus
demonstrate the intercondyloid fossa? (number 4). The scapula presents two borders: the
1. Patient PA, knee flexed 40º, central lateral or axillary border (number 7) and the
ray directed caudad 40º to the medial or vertebral border (number 9). It also
popliteal fossa presents three angles: the inferior angle (number
2. Patient AP, cassette under flexed 8), the superior angle (number 12), and the lateral
knee, central ray directed cephalad to angle (number 6). The processes of the scapula are
knee, perpendicular to tibia the coracoid (number 2), the acromion (number
3. Patient PA, patella parallel to film, 3), and the scapular spine (number 13). The
heel rotated 5 to 10º lateral, central scapula has a (supra)scapular notch (number 1), a
ray perpendicular to knee joint supraspinatus fossa (number 11), and an
infraspinatus fossa (number 10). (Tortora &
(A) 1 only Grabowski, p 221)
(B) 1 and 2 only Ans. C
(C) 2 and 3 only
(D) 1, 2, and 3 [Link] Figure 2-27, which of the following is
——————————————————— represented by the number 12?
—————— (A) Vertebral border
Statement 1 describes the PA axial (Camp- (B) Axillary border
Coventry) projection, and statement 2 describes (C) Inferior angle
the AP axial (Beclere) projection, for (D) Superior angle
demonstration of the intercondyloid fossa. The ———————————————————
positions are actually the reverse of each other. ——————
Statement 3 describes the method of obtaining a Figure 2-27 depicts a posterior view of the right
PA projection of the patella. (Ballinger & Frank, vol scapula and its articulation with the humerus
1, pp 302-305) (number 4). The scapula presents two borders: the
Ans. B lateral or axillary border (number 7) and the
medial or vertebral border (number 9). It also
[Link] scapula pictured in Figure 2-27 presents threeangles: the inferior angle (number
demonstrates 8), the superior angle (number 12), and the lateral
1. its posterior aspect. angle (number 6). The processes of the scapula are
2. its costal surface. the coracoid (number 2), the acromion (number
3. its sternal articular surface. 3), and the scapular spine (number 13). The
(A) 1 only scapula has a (supra)scapular notch (number 1), a
(B) 1 and 2 only supraspinatus fossa (number 11), and an
(C) 1 and 3 only infraspinatus fossa (number 10). (Tortora &

Reviewer A&R
Question & Answer
37
Review Notes for the
RADIOGRAPHY EXAM Appleton
Grabowski, p 221) [Link] the lateral projection of the knee, the
Ans. D central ray is angled 5º cephalad in order to
prevent superimposition of which of the
[Link] stress studies of the ankle may be following structures on the joint space?
performed (A) Lateral femoral condyle
1. to demonstrate fractures of the distal (B) Medial femoral condyle
tibia and fibula. (C) Patella
2. following inversion or eversion injuries. (D) Tibial eminence
3. to demonstrate a ligament tear. ———————————————————
(A) 1 only ——————
(B) 1 and 2 only For the lateral projection of the knee, the patient
(C) 2 and 3 only is turned onto the affected side. This places the
(D) 1, 2, and 3 lateral femoral condyle closest to the film and the
——————————————————— medial femoral condyle remote from the film.
—————— Consequently, there is significant magnification of
After forceful eversion or inversion injuries of the themedial femoral condyle and, unless the central
ankle, AP stress studies are valuable to confirm the ray is angled slightly cephalad, subsequent
presence of a ligament tear. Keeping the ankle in obliteration of the joint space. (Ballinger & Frank,
an AP position, the physician guides the ankle into vol 1, p 293)
inversion and eversion maneuvers. Characteristic Ans. B
changes in the relationship of the talus, tibia, and
fibula will indicate ligament injury. Inversion stress [Link] body habitus characterized by a long and
demonstrates the lateral ligament, while eversion narrow thoracic cavity and low, midline
stress demonstrates the medial ligament. A stomach and gallbladder is the
fractured ankle would not be manipulated in this (A) asthenic.
manner. (Ballinger & Frank, vol 1, p 233) (B) hyposthenic.
Ans. C (C) sthenic.
(D) hypersthenic.
[Link] evaluating a PA axial projection of the ———————————————————
skull with a 15º caudal angle, the radiographer ——————
should see The four types of body habitus describe
1. petrous pyramids in the lower third of differences in visceral shape, position, tone, and
the orbits. motility. One body type is hypersthenic,
2. equal distance from the lateral border characterized by the very large individual with
of the skull to the lateral rim of the short, wide heart and lungs; high transverse
orbit bilaterally. stomach and gallbladder; and peripheral colon.
3. symmetrical petrous pyramids. The sthenic individual is the average, athletic, most
predominant type. The hyposthenic patient is
(A) 1 and 2 only somewhat thinner and a little more frail, with
(B) 1 and 3 only organs positioned somewhat lower. The asthenic
(C) 2 and 3 only type is smaller in the extreme, with a long thorax;
(D) 1, 2, and 3 a very long, almost pelvic stomach; and a low
——————————————————— medial gallbladder. The colon is medial and
—————— redundant. Hypersthenic patients usually
A PA axial projection of the skull with a 15º caudad demonstrate the greatest motility. (Saia, p 76)
angle will show the petrous pyramids in the lower Ans. A
third of the orbits. If no angulation is used, the
petrous pyramids will fill the orbits. Either PA [Link] of the following structures is (are)
projection should demonstrate symmetrical located in the LUQ?
petrous pyramids and an equal distance from the 1. Stomach
lateral border of the skull to the lateral border of 2. Spleen
the orbit on both sides. This determines that there 3. Cecum
is no rotation of the skull. (Ballinger & Frank, vol 2, (A) 1 only
p 244) (B) 2 only
Ans. D (C) 1 and 2 only
(D) 1, 2, and 3

Reviewer A&R
Question & Answer
38
Review Notes for the
RADIOGRAPHY EXAM Appleton
——————————————————— (B) 1 and 2 only
—————— (C) 1 and 3 only
The stomach and spleen are both normally located (D) 1, 2, and 3
in the LUQ. The cecum is the most distal end of the ———————————————————
large bowel and is normally located in the RLQ. ——————
(Ballinger & Frank, vol 1, p 39) A lateral projection of the scapula superimposes
Ans. C its medial and lateral borders (vertebral and
axillary, respectively). The coracoid and acromion
[Link] the posterior oblique position of the processes should be readily identified separately
cervical spine, the intervertebral foramina (not superimposed) in the lateral projection. The
that are best seen are those erect position is probably the most comfortable
(A) nearest the film. position for a patient with scapula pain. (Ballinger
(B) furthest from the film. & Frank, vol 1, p 205)
(C) seen medially. Ans. C
(D) seen inferiorly.
——————————————————— [Link] of the following statements are true
—————— regarding Figure 2-28?
The cervical intervertebral foramina lie 45º to the 1. The radiograph was made in the RAO
midsagittal plane and 15 to 20º to a transverse position.
plane. When the posterior oblique position (LPO or 2. The central ray should enter more
RPO) is used, the cervical intervertebral foramina inferiorly.
demonstrated are those further from the film. 3. The sternum should be projected onto
There is therefore some magnification of the the right side of the thorax.
foramina. In the anterior oblique position (LAO or (A) 1 and 2 only
RAO), the foramina disclosed are those closer to (B) 1 and 3 only
the film. (Ballinger & Frank, vol 1, p 341) (C) 2 and 3 only
Ans. B (D) 1, 2, and 3
———————————————————
[Link] of the following positions ——————
demonstrates all the paranasal sinuses? The pictured radiograph is an RAO position of the
(A) Parietoacanthial sternum. The sternum is projected to the left side
(B) PA axial of the thorax, over the heart and other mediastinal
(C) Lateral structures, in the RAO position, thus promoting
(D) True PA more uniform density. Although the upper limits of
——————————————————— the sternum are well demonstrated in the figure,
—————— not all of the xiphoid process is seen, because the
The parietoacanthial (Waters') projection central ray was directed somewhat too superiorly.
demonstrates the maxillary sinuses. The PA axial The central ray should be directed midway
with a caudal central ray (Caldwell) demonstrates between the jugular (manubrial) notch and the
the frontal and ethmoidal sinus groups. The lateral xiphoid process. (Ballinger & Frank, vol 1, pp 274-
projection, with the central ray entering 1 in 277)
posterior to the outer canthus, demonstrates all Ans. A
the paranasal sinuses. X-ray examinations of the [Link] better visualize the knee joint space in the
sinuses should always be performed erect, to radiograph in Figure 2-29, the radiographer
demonstrate leveling of any fluid present. should
(Bontrager, p 428) (A) flex the knee more acutely.
Ans. C (B) flex the knee less acutely.
(C) angle the CR 5 to 7º cephalad.
[Link] the lateral projection of the scapula, the (D) angle the CR 5 to 7º caudad.
1. vertebral and axillary borders are ———————————————————
superimposed. ——————
2. acromion and coracoid processes are In the lateral projection of the knee, the joint
superimposed. space is obscured by the magnified medial femoral
3. patient may be examined in the erect condyle unless the central ray is angled 5 to 7º
position. cephalad. The degree of flexion of the knee is
(A) 1 only important when evaluating the knee for possible

Reviewer A&R
Question & Answer
39
Review Notes for the
RADIOGRAPHY EXAM Appleton
transverse patellar fracture. In such a case, the The PA axial (Caldwell) projection of the paranasal
knee should not be flexed more than 10º. The sinuses is used to demonstrate the frontal and
knee should normally be flexed 20 to 30º in the ethmoidal sinuses. The central ray is angled
lateral position. (Ballinger & Frank, vol 1, p 293) caudally 15º to the OML. This projects the petrous
Ans. C pyramids into the lower one-thirdof the orbits,
thus permitting optimal visualization of the frontal
[Link] of the following is (are) demonstrated and ethmoidal sinuses. (Ballinger & Frank, vol 1, pp
in the AP projection of the cervical spine? 366-367)
1. Intervertebral disk spaces Ans. D
2. C3-7 cervical bodies
3. Apophyseal joints [Link] and intubation are effective
(A) 1 only techniques used to restore breathing when
(B) 1 and 2 only there is (are)
(C) 2 and 3 only (A) respiratory pathway obstruction above the
(D) 1, 2, and 3 larynx.
——————————————————— (B) crushed tracheal rings due to trauma.
—————— (C) lower respiratory pathway closure due to
The AP projection of the cervical spine inflammation and swelling.
demonstrates the bodies and intervertebral spaces (D) respiratory pathway obstruction below the
of the last five vertebrae (C3-7). The cervical larynx.
apophyseal joints are 90º to the midsagittal plane ———————————————————
and are therefore demonstrated in the lateral ——————
projection. (Ballinger & Frank, vol 1, pp 394-395) The upper respiratory passageways include the
Ans. B nose,pharynx, and associated structures. The
lower respiratory passageways include the larynx,
[Link] portion of a long bone where cartilage trachea, bronchi, and lungs. If obstruction of the
has been replaced by bone is known as the breathing passageways occurs in the upper
(A) diaphysis. respiratory tract, above the larynx (that is, in the
(B) epiphysis. nose or pharynx), tracheostomy or intubation may
(C) metaphysis. be performed in order to restore breathing.
(D) apophysis. Tracheostomy or intubation cannot remedy
——————————————————— obstructed passageways in the lower respiratory
—————— tract. (Tortora & Grabowski, pp 813-814)
Long bones are composed of a shaft, or diaphysis, Ans. A
and two extremities, or epiphyses. In the growing
bone, the cartilaginous epiphyseal plate is [Link] order to demonstrate the first two cervical
gradually replaced by bone. The ossified growth vertebrae in the AP projection, the patient is
area of long bones is the metaphysis. Apophysis positioned so that
refers to vertebral joints formed by articulation of (A) the glabellomeatal line is vertical.
superjacent articular facets. (Saia, p 87) (B) the acanthiomeatal line is vertical.
Ans. C (C) a line between the mentum and the mastoid
tip is vertical.
[Link] of the following statements is (are) true (D) a line between the maxillary occlusal plane and
regarding the PA axial projection of the the mastoid tip is vertical.
paranasal sinuses? ———————————————————
1. The central ray is directed caudally to ——————
the OML. To clearly demonstrate the atlas and axis without
2. The petrous pyramids are projected superimposition of the teeth or the base of the
into the lower third of the orbits. skull, a line between the maxillary occlusal plane
3. The frontal sinuses are visualized. (edge of upper teeth) and mastoid tip must be
(A) 1 only vertical. If the head is flexed too much, the teeth
(B) 1 and 2 only will be superimposed. If the head is extended too
(C) 1 and 3 only much, the cranial base will be superimposed on
(D) 1, 2, and 3 the area of interest. A line between the mentum
——————————————————— and the mastoid tip is used to demonstrate the
—————— odontoid process only through the foramen

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
magnum (Fuchs method). (Ballinger & Frank, vol 1, (A) Oblique the hand no more than 45º.
p 292) (B) Use a support sponge for the phalanges.
Ans. D (C) Clench the fist to bring the carpals closer to the
film.
[Link] of the following is recommended to (D) Utilize ulnar flexion.
demonstrate small amounts of air within the ———————————————————
peritoneal cavity? ——————
(A) Lateral decubitus, affected side up The oblique projection of the hand should
(B) Lateral decubitus, affected side down demonstrate minimal overlap of the third, fourth,
(C) AP Trendelenburg and fifth metacarpals. Excessive overlap of these
(D) AP supine metacarpals is caused by obliquing the hand more
——————————————————— than 45º. The use of a 45º foam wedge ensures
—————— that the fingers will be extended and parallel to
Air or fluid levels will be clearly delineated only if the film, thus permitting visualization of the
the central ray is directed parallel to them. interphalangeal joints and avoiding foreshortening
Therefore, the erect or decubitus position should of the phalanges. Clenching of the fist and ulnar
be used. Small amounts of fluid within the flexion are maneuvers used to better demonstrate
peritoneal cavity are best demonstrated in the the carpal scaphoid. (Ballinger & Frank, vol 1, p
lateral decubitus position, affected side down. 107)
Small amounts of air within the peritoneal cavity Ans. A
are best demonstrated in the lateral decubitus
position, affected side up. (Ballinger & Frank, vol 2, [Link] motion can be caused by
pp 40-41) 1. peristalsis.
Ans. A 2. severe pain.
3. heart muscle contraction.
[Link] the average patient, the central ray for a (A) 1 only
lateral projection of a barium-filled stomach (B) 2 only
should enter (C) 1 and 2 only
(A) midway between the midcoronal line and the (D) 1, 2, and 3
anterior abdominal surface. ———————————————————
(B) midway between the vertebral column and the ——————
lateral border of the abdomen. Patients who are able to cooperate are usually
(C) at the midcoronal line at the level of the iliac able to control voluntary motion. However, certain
crest. body functions and responses create involuntary
(D) perpendicular to the level of L2. motion that is not controllable by the patient.
——————————————————— Severe pain, muscle spasm, and chills all cause
—————— involuntary movements. Peristaltic activity of the
Lateral projections of the barium-filled stomach intestinal tract and motion caused by contraction
(Fig. 2-56) may be performed recumbent or of the heart muscle are other sources of
upright for the demonstration ofthe retrogastric involuntary motion. (Ballinger & Frank, vol 1, p 12)
space. With the patient in the (usually right) lateral Ans. D
position, the central ray is directed to a point
midway between the midcoronal line and the [Link] of the following positions is used to
anterior surface of the abdomen, at the level of L1. demonstrate vertical patellar fractures and
When the patient is in the LPO or RAOposition, the the patellofemoral articulation?
central ray should be directed midway between (A) AP knee
the vertebral column and lateral border of the (B) Lateral knee
abdomen. For the PA projection, the central ray is (C) Tangential patella
directed perpendicular to the film at the level of (D) "Tunnel" view
L2. (Ballinger & Frank, vol 2, pp 114-115) ———————————————————
Ans. A ——————
In the tangential ("sunrise") projection of the
[Link] of the following is an important patella, the central ray is directed parallel to the
consideration in order to avoid excessive longitudinalplane of the patella, thereby
metacarpophalangeal joint overlap in the demonstrating a vertical fracture and providing
oblique projection of the hand? the best view of the patellofemoral articulation.

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
The AP knee could demonstrate a vertical fracture be part of the departmental routine, but more
through the superimposed femur, but it does not often than not it is requested as a supplemental
demonstrate the patellofemoral articulation. The view to rule out nephroptosis. With the patient
"tunnel" view of the knee is used to demonstrate erect, the kidneys normally change position,
the intercondyloid fossa. (Ballinger & Frank, vol 1, dropping no more than 2 in. More marked
pp 314-315) dropping of the kidney is termed nephroptosis, a
Ans. C condition that is actually due to loss of the
surrounding perinephric fat. (Ballinger & Frank, vol
[Link] what position was the radiograph in Figure 2, p 170)
2-30 made? Ans. C
(A) Flexion
(B) Extension [Link] erect left and right bending films of the
(C) Left bending thoracic and lumbar vertebrae, to include 1 in
(D) Right bending of the iliac crest, are performed to
——————————————————— demonstrate
—————— (A) spondylolisthesis.
The radiograph shown is a lateral projection of the (B) subluxation.
cervical spine taken in flexion. Flexion and (C) scoliosis.
extension views are useful in certain cervical (D) arthritis.
injuries, such as whiplash, to indicate the degree ———————————————————
of anterior and posterior motion. The structure ——————
labeled 1 is an apophyseal joint; because Scoliosis is a lateral curvature of the spine and is
apophyseal joints are positioned 90º to the MSP, typically noted in early adolescence. These young
they are well visualized in the lateral projection. patients usually return for follow-up studies, and it
The structure labeled 2 is a vertebral body. is imperative to limit their radiation dose as much
(Ballinger & Frank, vol 1, pp 398, 399) as possible. Examining the patient in the PA
Ans. A position is frequently advisable, because the
gonadal dose is significantly reduced and there is
[Link] structure labeled 1 in Figure 2-30 is the usually no appreciable loss of detail. Thyroid and
(A) intervertebral disk space. breast shields are also a valuable protection,
(B) apophyseal joint. especially for the patient who requires follow-up
(C) intervertebral foramen. examinations. Bending films would not be
(D) spinous process. performed on a patient with suspected
——————————————————— subluxation or spondylolisthesis, as further serious
—————— injury could result. (Ballinger & Frank, vol 1, p 396)
The radiograph shown is a lateral projection of the Ans. C
cervical spine taken in flexion. Flexion and
extension views are useful in certain cervical [Link] which of the following projections is the
injuries, such as whiplash, to indicate the degree talofibular joint best demonstrated?
of anterior and posterior motion. The structure (A) AP
labeled 1 is an apophyseal joint; because (B) Lateral oblique
apophyseal joints are positioned 90º to the MSP, (C) Medial oblique
they are well visualized in the lateral projection. (D) Lateral
The structure labeled 2 is a vertebral body. ———————————————————
(Ballinger & Frank, vol 1, pp 398, 399) ——————
Ans. B The AP projection demonstrates superimposition
of the distal fibula on the talus; the joint space is
[Link] the erect position is requested as part not well seen. The 15 to 20º medical oblique
of an IVP, it is used to demonstrate position shows the entire mortise joint; the
(A) the adrenal glands. talofibular joint is well visualized, as well as the
(B) the renal surfaces. talotibial joint. There is considerable
(C) kidney mobility. superimposition of the talus and fibula in the
(D) the bladder neck. lateral and lateral oblique projections. (Ballinger &
——————————————————— Frank, vol 1, p 280)
—————— Ans. C
The erect position in intravenous urography may

Reviewer A&R
Question & Answer
42
Review Notes for the
RADIOGRAPHY EXAM Appleton
[Link] the posterior profile projection (Stenvers elbow should demonstrate the coronoid
method) of the petrous pyramids, the process free of superimposition and the
1. central ray is directed 12º cephalad. olecranon process within the olecranon fossa?
2. MSP is 45º to the film. (A) AP
3. head rests on the zygoma, nose, and (B) Lateral
chin. (C) Medial oblique
(A) 1 and 2 only (D) Lateral oblique
(B) 1 and 3 only ———————————————————
(C) 2 and 3 only ——————
(D) 1, 2, and 3 On the AP projection of the elbow, the radial head
——————————————————— and ulna are normally somewhat superimposed.
—————— The lateral oblique demonstrates the radial head
The Stenvers method places the petrous pyramids free of ulnar superimposition. The lateral
parallel with the plane of the film. The mastoid tip projection demonstrates the olecranon process in
is seen in profile next to the mandibular condyle profile. The medial oblique demonstrates
and upper cervical spine. The internal and external considerable overlap of the proximal radius and
auditory canals are demonstrated. The auditory ulna, but should clearly demonstrate the coronoid
ossicles and inner ear structures are frequently process free of superimposition and the olecranon
visualized. The patient is positioned so that the process within the olecranon fossa. (Saia, pp 97-
head rests on the forehead, nose, and zygoma, 98)
and the IOML is parallel to the film. The MSP is Ans. C
adjusted so as to be 45º to the film, and the
central ray is directed 12º cephalad to a point 1 in [Link] of the following will best demonstrate
anterior to the EAM closest to the film. The acromioclavicular separation?
zygoma, nose, and chin form the "three-point (A) AP recumbent, affected shoulder
landing" used in the parietoorbital projection (B) AP recumbent, both shoulders
(Rhese method) of the optic foramen. (Ballinger & (C) AP erect, affected shoulder
Frank, vol 2, pp 408-409) (D) AP erect, both shoulders
Ans. A ———————————————————
——————
[Link] of the following sequences correctly Acromioclavicular joints are usually examined
describes the path of blood flow as it leaves when separation or dislocation is suspected. They
the left ventricle? must be examined in the erect position, because in
(A) Arteries, arterioles, capillaries, venules, veins the recumbent position, a separation appears to
(B) Arterioles, arteries, capillaries, veins, venules reduce itself. Both AC joints are examined
(C) Veins, venules, capillaries, arteries, arterioles simultaneously for comparison, because
(D) Venules, veins, capillaries, arterioles, arteries separations may be minimal. (Ballinger & Frank,
——————————————————— vol 1, p 152)
—————— Ans. D
Blood is oxygenatedin the lungs and carried to the
left atrium by the four pulmonary veins. From the [Link] of the following statements regarding
left atrium, blood flows through the bicuspid myelography is (are) correct?
(mitral) valve into the left ventricle. Blood leaving 1. Spinal puncture may be performed in
the left ventricle is bright red, oxygenated blood the prone or flexed lateral position.
that travels through the systemic circulation, 2. Contrast medium distribution is
delivering oxygenated blood via arteries and regulated through x-ray tube angulation.
returning deoxygenated blood to the lungs via 3. The patient's neck must be in extension
veins. From the left ventricle, blood first goes during Trendelenburg positions.
through the largest arteries, then goes to (A) 1 only
progressively smaller arteries (arterioles), tothe (B) 1 and 2 only
capillaries, to the smallest veins (venules), and on (C) 1 and 3 only
to progressively larger veins. (Tortora & (D) 1, 2, and 3
Grabowski, p 669) ———————————————————
Ans. A ——————
Myelography is the radiologic examination of the
[Link] of the following projections of the structures within the spinal canal. Opaque contrast

Reviewer A&R
Question & Answer
43
Review Notes for the
RADIOGRAPHY EXAM Appleton
medium is usually used. Following injection, the [Link] inhalation of liquid or solid particles into
contrast medium is distributed to the vertebral the nose, throat, or lungs is referred to as
region of interest by gravity; the table is angled (A) asphyxia
Trendelenburg for visualization of the cervical (B) aspiration
region and in Fowler's position for visualization of (C) atelectasis
the thoracic and lumbar regions. Although the (D) asystole
table is Trendelenburg, care must be taken that ———————————————————
the patient's neck be kept in acute extension in ——————
order to compress the cisterna magna and keep Inhalation of a foreign substance such as water or
contrast medium from traveling into the ventricles food particles into the airway and/or bronchial
of the brain. (Saia, pp 197-198) tree is called aspiration. Asphyxia is caused by
Ans. C deprivation of oxygen as a result of interference
with ventilation, from trauma, electric shock, etc.
[Link] term that refers to parts closer to the Atelectasis is incomplete expansion of a lung or
source or beginning is portion of a lung. Asystole is cardiac standstill-
(A) cephalad. failure of heart muscle to contract and pump
(B) caudad. blood to vital organs. (Tortora & Grabowski, p 846)
(C) proximal. Ans. B
(D) medial.
——————————————————— [Link] retrograde
—————— cholangiopancreatography (ERCP) usually
There are many terms (with which the involves
radiographer must be familiar) that are used to 1. cannulation of the hepatopancreatic
describe radiographic positioning techniques. ampulla.
Cephalad refers to that which is toward the head, 2. introduction of contrast medium into
and caudad to that which is toward the feet. the common bile duct.
Structures close to the source or beginning are 3. introduction of barium directly into the
said to be proximal, while those lying close to the duodenum.
midline are said to be medial. (Bontrager, p 23) (A) 1 only
Ans. C (B) 1 and 2 only
(C) 1 and 3 only
[Link] the patient PA, MSP centered to the grid, (D) 1, 2, and 3
the OML forming a 37º angle with the film, ———————————————————
and the central ray perpendicular and exiting ——————
the acanthion, which of the following is best ERCP may be performed to investigate
demonstrated? abnormalities of the biliary system or pancreas.
(A) Occipital bone The patient's throat is treated with a local
(B) Frontal bone anesthetic in preparation for the passage of the
(C) Facial bones endoscope. The hepatopancreatic ampulla (of
(D) Basal foramina Vater) is located, and a cannula is passed through
——————————————————— it so that contrast medium may be introduced into
—————— the common bile duct. Spot films of the common
The parietoacanthial projection (Waters' position) bile duct and pancreatic duct are frequently taken
provides an oblique frontal projection of the facial in the oblique position. Direct injection of barium
bones. The maxilla (and antra), zygomatic arches, mixture into the duodenum occurs during an
and orbits are well demonstrated. The patient is enteroclysis procedure of the small bowel.
positioned PA with the head resting on the (Ballinger & Frank, vol 2, p 80)
extended chin so that the OML forms a 37º angle Ans. B
with the film. The position may be reversed if the
patient is AP and the central ray is directed 30º [Link] of the following is (are) associated with
cephalad to the IOML. This position is not a Colles' fracture?
preferred, however, because the facial bones are 1. Transverse fracture of the radial head
significantly magnified as a result of increased 2. Chip fracture of the ulnar styloid
object-film distance. (Saia, p 146) 3. Posterior or backward displacement
Ans. C (A) 1 only
(B) 1 and 3 only

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
(C) 2 and 3 only posteriorly. The pubic arch of the male is
(D) 1, 2, and 3 significantly narrower than that of the female.
——————————————————— (Saia, pp 106-108)
—————— Ans. A
A Colles' fracture is usually caused by a fall onto an
outstretched (extended) hand, in order to "brake" [Link] of the following interventional
a fall. The wrist then suffers an impacted procedures can be used to increase the
transverse fracture of the distal inch of the radius, diameter of a stenosed vessel?
with an accompanying chip fracture of the ulnar 1. percutaneous transluminal angioplasty
styloid process. Because of the hand position at (PTA)
the time of the fall, the fracture is usually 2. stent placement
displaced backward approximately 30º. 3. peripherally inserted central catheter
(Bontrager, pp 130, 598) (PICC line)
Ans. C (A) 1 only
(B) 1 and 2 only
[Link] best visualize the lower ribs, the exposure (C) 1 and 3 only
should be made (D) 1, 2, and 3
(A) on normal inspiration. ———————————————————
(B) on inspiration, second breath. ——————
(C) on expiration. Radiologic interventional procedures function to
(D) during shallow breathing. treat pathologic conditions, as well as provide
——————————————————— diagnostic information. Percutaneous Transluminal
—————— Angioplasty (PTA) uses an inflatable balloon
Full or forced expiration is used to elevate the catheter, under fluoroscopic guidance, to increase
diaphragm and demonstrate the ribs below the the diameter of a plaque-stenosed vessel. A stent
diaphragm to best advantage (with exposure is a cage-like metal device that can be placed in
adjustment). Deep inspiration is used to depress the vessel to provide support to the vessel wall. A
the diaphragm and demonstrate as many ribs peripherally insulated central catheter (PICC line)
above the diaphragm as possible. Shallow is also placed under fluoroscopic control. It is
breathing is occasionally used to visualize the ribs simply a venous access catheter that can be left in
above the diaphragm, while obliterating place for several months. It provides convenient
pulmonary vascular markings. (Ballinger & Frank, venous access for patients requiring frequent
vol 1, p 472) blood tests, chemotherapy, or large amounts of
Ans. C antibiotics. (Bontrager, pp 692-693)
Ans. B
[Link] of the following statements regarding
the male pelvis is (are) true? [Link] structure(s) best demonstrated on an AP
1. The angle formed by the pubic arch is axial projection of the skull with the central
less than that of the female. ray directed 40 to 60º caudally is (are) the
2. The pelvic outlet is wider than that of (A) entire foramen magnum and the jugular
the female. foramina.
3. The ischial tuberosities are further (B) petrous pyramids.
apart. (C) occipital bone.
(A) 1 only (D) rotundum foramina.
(B) 1 and 2 only ———————————————————
(C) 2 and 3 only ——————
(D) 1, 2, and 3 The general survey AP axial projections (Grashey
——————————————————— or Towne method) are performed with the central
—————— ray directed caudally at an angle of 30º with the
The architectural features of the female pelvis are OML perpendicular or 37º and the IOML
designed to accommodate childbearing. The perpendicular. These AP axial projections
female pelvis as a whole is broader and more demonstrate the dorsum sellae and posterior
shallow than its male counterpart, having a wider clinoid processes within the foramen magnum (a
and more circular pelvic outlet. The ischial portion of the foramen magnum is obscured by
tuberosities and acetabula are further apart. The overlying bony shadows). A 40 to 60º angulation
sacrum is wider and extends more sharply shows the entire foramen magnum and the jugular

Reviewer A&R
Question & Answer
45
Review Notes for the
RADIOGRAPHY EXAM Appleton
foramina bilaterally. (Ballinger & Frank, vol. 2, p ———————————————————
250) ——————
Ans. A Placing the patient in a 20 to 30º AP
Trendelenburg position during an upper GI exam
[Link] imaging of the ileocecal valve is helps to demonstrate the presence of a hiatal
generally part of a(n) hernia. A 10 to 15º Trendelenburg position with
(A) esophagram. the patient rotated slightly to the right will also
(B) upper GI series. help demonstrate regurgitation and hiatal hernia.
(C) small-bowel series. Filling of the duodenal bulb and demonstration of
(D) ERCP. the duodenal loop are best seen in the RAO
——————————————————— position. Congenital hypertrophic pyloric stenosis
—————— is caused by excessive thickening of the pyloric
The ileocecal valve is located at the terminal ileum, sphincter. It is noted in infancy and is
where it meets the first portion of the large bowel, characterized by projectile vomiting. The pyloric
the cecum. Most small-bowel examinations are valve will let very little pass through, and as a
performed following oral administration of barium result the stomach becomes enlarged
sulfate suspension. The first small-bowel (hypertrophied). (Ballinger & Frank, vol 2, p 99)
radiograph is taken 15 min after the first swallow Ans. C
of barium, with subsequent radiographs made
every 15 to 30 min, depending on how quickly the [Link] of the following would be the best
barium is moving through the smallbowel. Each choice for a right shoulder exam to rule out
film is shown to the radiologist, and a decision is fracture?
made regarding the time of the next film. When (A) Internal and external rotation
the barium reaches the terminal ileum, (B) AP and tangential
fluoroscopy may be performed and compression (C) AP and AP axial
spot films taken of the ileocecal valve. (Ballinger & (D) AP and scapular Y
Frank, vol 2, p 116) ———————————————————
Ans. C ——————
The AP projection will give a general survey and
[Link] contraction and expansion of arterial show medial / lateral and inferior / superior joint
walls in accordance with forceful contraction relationahips. The scapular Y position (LAO or RAO)
and relaxation of the heart is called is employed to demonstrate anterior (subcoracoid)
(A) hypertension. or posterior (subacromial) humeral dislocation.
(B) elasticity. The humerus is normally superimposed on the
(C) pulse. scapula in this position; any deviation from this
(D) pressure. may indicate dislocation. Rotational views must be
——————————————————— avoided in cases of suspected fracture. The AP and
—————— scapular Y combination is the closest totwo views
As the heart contracts and relaxes while at right angles to each other. (Ballinger & Frank,
functioning to pump blood from the heart, those vol 1, pp 164, 180)
arteries that are large and those that are in closest Ans . D
proximity to the heart will feel the effect of the
heart's forceful contractions in their walls. The [Link] of the following is a functional study
arterial walls pulsate in unison with the heart's used to demonstrate the degree of AP motion
contractions. This movement may be detected present in the cervical spine?
with the fingers in various parts of the body, and is (A) Open-mouth projection
referred to as the pulse. (Saia, p 199) (B) Moving mandible AP
Ans. C (C) Flexion and extension laterals
(D) Right and left bending AP
[Link] AP Trendelenburg position is often used ———————————————————
during an upper GI examination to ——————
demonstrate The degree of anterior and posterior motion is
(A) the duodenal loop. occasionally diminished with a "whiplash"-type
(B) filling of the duodenal bulb. injury. Anterior (forward, flexion) and posterior
(C) hiatal hernia. (backward, extension) motion is evaluated inthe
(D) hypertrophic pyloric stenosis. lateral position, with the patient assuming the best

Reviewer A&R
Question & Answer
46
Review Notes for the
RADIOGRAPHY EXAM Appleton
possible flexion and extension. Left- and right- the central ray be directed
bending films of the thoracic and lumbar vertebrae 1. 15º cephalad.
are frequently obtained when evaluating scoliosis. 2. 2 in superior to the pubic symphysis.
(Saia, p 126) 3. midline at the level of the lesser
Ans. C trochanter.
(A) 1 only
[Link] of the following bones participate in (B) 2 only
the formation of the acetabulum? (C) 1 and 2 only
1. Ilium (D) 1 and 3 only
2. Ischium ———————————————————
3. Pubis ——————
(A) 1 and 2 only The AP projection of the sacrum requires a 15º
(B) 1 and 3 only cephalad angle centered at a point midway
(C) 2 and 3 only between the pubic symphysis and the ASIS. The AP
(D) 1, 2, and 3 projection of the coccyx requires the central ray to
——————————————————— be directed 10º caudally and centered 2 in
—————— superior to the pubic symphysis. (Saia, p 132)
The acetabulum is the bony socket that receives Ans. A
the head of the femur to form the hip joint. The
upper two-fifths of the acetabulum is formed by [Link] of the following would best
the ilium, the lower anterior one-fifth is formed by demonstrate arthritic changes in the knees?
the pubis, and the lower posterior two-fifths is (A) AP recumbent
formed by the ischium. Thus, the acetabulum is (B) Lateral recumbent
formed by all three of the bones that form the (C) AP erect
pelvis: the ilium, the ischium, and the pubis. (D) Medial oblique
(Ballinger & Frank, vol 1, pp 325-326) ———————————————————
Ans. D ——————
Arthritic changes in the knee result in changes in
[Link] of the following radiologic procedures the joint bony relationships. These bony
requires that a contrast medium be injected relationships are best evaluated in the AP position.
into the renal pelvis via a catheter placed Narrowing of the joint spaces is more readily
within the ureter? detected on AP weight-bearing projections than
(A) Nephrotomography on recumbent projections. (Ballinger & Frank, vol
(B) Retrograde urography 1, p 294)
(C) Cystourethrography Ans. C
(D) IV urography
——————————————————— [Link] of the following positions will
—————— demonstrate the lumbosacral apophyseal
Retrograde urography requires ureteral articulation?
catheterization so that a contrast medium can be (A) AP
introduced directly into the pelvicalyceal system. (B) Lateral
This procedure provides excellent opacification (C) 30º RPO
and structural information but does not (D) 45º LPO
demonstrate the function of these structures. ———————————————————
Intravenous studies such as the intravenous ——————
urogram demonstrate function. The articular facets (apophyseal joints) of the L5-
Cystourethrography is an examination of the S1 articulation form a 30º angle with the MSP;
bladder and urethra, frequently performed during they are therefore well demonstrated in a 30º
voiding. Nephrotomography is performed after oblique position. The 45º oblique demonstrates
intravenous administration of a contrast agent; it the apophyseal joints of L1 through L4. (Ballinger
may be used to evaluate small intrarenal lesions & Frank, vol 1, p 372)
and renal hypertension. (Ballinger & Frank, vol 2, p Ans. C
179)
Ans. B [Link] of the following statements is (are) true
regarding the images seen in Figure 2-31?
[Link] AP projection of the sacrum requires that 1. Image A is positioned in internal

Reviewer A&R
Question & Answer
47
Review Notes for the
RADIOGRAPHY EXAM Appleton
rotation. muscles, relaxes during urination; however, the
2. Image B is positioned in internal vesicoureteral orifices may also relax and cause
rotation. reflux. (Ballinger & Frank, vol 2, p 182)
3. The greater tubercle is better Ans. C
demonstrated in image A.
(A) 1 only [Link] AP axial projection, or "frog leg" position,
(B) 2 only of the femoral neck places the patient in a
(C) 1 and 3 only supine position with the affected thigh
(D) 2 and 3 only (A) adducted 25º from the horizontal.
——————————————————— (B) abducted 25º from the vertical.
—————— (C) adducted 40º from the horizontal.
When the shoulder is placed in internal rotation, a (D) abducted 40º from the vertical.
greater portion of the glenoid fossa is ———————————————————
superimposed by the humeral head and the lesser ——————
tubercle is visualized, as in image B. The external The patient is supine with the leg abducted (drawn
rotation position (image A) removes the humeral away from the midline) approximately 40º. This
head from a large portion of the glenoid fossa and 40º abduction from the vertical places the long
better demonstrates the greater tubercle. (Saia, p axis of the femoral neck parallel to the film.
96) Adduction is drawing the extremity closer to the
Ans. C midline of the body. (Ballinger & Frank, vol 1, p
338)
Ans. D

[Link] the patient is recumbent and the [Link] of the following precaution(s) should
central ray is directed horizontally, the patient be observed when radiographing a patient
is said to be in the who has sustained a traumatic injury to the
(A) Trendelenburg position. hip?
(B) Fowler's position. 1. When a fracture is suspected,
(C) decubitus position. manipulation of the affected
(D) Sims position. extremity should be performed by a
——————————————————— physician.
—————— 2. The AP axiolateral projection should
The decubitus position is used to describe the be avoided.
patient who is recumbent (prone, supine, or 3. To evaluate the entire region, the
lateral) with the central ray directed horizontally. pelvis is typically included in the initial
When the patient is recumbent with the head examination.
lower than the feet, he or she is said to be in the
Trendelenburg position. In the Fowler's position, (A) 1 only
the patient's head is positioned higher than the (B) 1 and 3 only
feet. The Sims position is the (LAO) position (C) 2 and 3 only
assumed for enema tip insertion. (Bontrager, p 20) (D) 1, 2, and 3
Ans. C ———————————————————
——————
[Link] of the following radiologic Typically, traumatic injury to the hip requires a
examinations can demonstrate ureteral cross-table (axiolateral) lateral projection, as well
reflux? as an AP projection of the entire pelvis. Both of
(A) Intravenous urogram these are performed using minimal manipulation
(B) Retrograde pyelogram of the affected extremity, reducing the possibility
(C) Voiding cystourethrogram of further injury. A physician should perform any
(D) Nephrotomogram required manipulation of the traumatized hip.
——————————————————— (Ballinger & Frank, vol 1, pp 287, 290)
—————— Ans. B
Ureteral reflux is best demonstrated during
voiding. It can occur even when the bladder is only [Link] of the following are characteristics of
partially filled with a contrast medium. The the hypersthenic body type?
vesicourethral orifice, as well as other sphincter 1. Short, wide, transverse heart

Reviewer A&R
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Review Notes for the
RADIOGRAPHY EXAM Appleton
2. High and peripheral large bowel (A) 1 only
3. Diaphragm positioned low (B) 1 and 2 only
(A) 1 and 2 only (C) 1 and 3 only
(B) 1 and 3 only (D) 1, 2, and 3
(C) 2 and 3 only ———————————————————
(D) 1, 2, and 3 ——————
——————————————————— Although routine elbow projections may be
—————— essentially negative, conditions may exist (such as
The hypersthenic body type is large and heavy. an elevated fat pad) that seem to indicate the
The thoracic cavity is short, the lungs are short presence of a small fracture of the radial head. In
with broad bases, and the heart is usually in an order to demonstrate the entire circumference of
almost transverse position. The diaphragm is high; the radial head, four exposures are made with the
the stomach and gallbladder are high and elbow flexed 90º and with the humeral
transverse. The large bowel is positioned high and epicondyles superimposed and perpendicular to
peripheral (and often requires that 14 × 17 the cassette: one with the hand supinated as much
cassettes be placed crosswise for filming a BE). as possible, one with the hand lateral, one with
(Ballinger & Frank, vol 1, p 41) the hand pronated, and one with the hand in
Ans. A internal rotation, thumb down. Each maneuver
changes the position of the radial head, and a
[Link] to the start of an IV urogram, which of different surface is presented for inspection.
the following procedures should be carried (Ballinger & Frank, vol 1, pp 102-103)
out? Ans. D
1. Have patient empty the bladder.
2. Review the patient's allergy history. [Link] radiograph pictured in Figure 2-32 may be
3. Check the patient's creatinine level. used to evaluate
(A) 1 only 1. polypoid lesions.
(B) 2 only 2. the lateral wall of the descending
(C) 1 and 2 only colon.
(D) 1, 2, and 3 3. the posterior wall of the rectum.
——————————————————— (A) 1 only
—————— (B) 1 and 2 only
Prior to the start of an IVP, the patient should be (C) 2 and 3 only
instructed to empty the bladder. This is advised to (D) 1, 2, and 3
avoid dilution of the contrast agent. Diluted ———————————————————
contrast within the bladder will not affect the ——————
diagnosis of renal abnormalities, but itmay The pictured radiograph was made in the right
obscure bladder abnormalities. The patient's lateral decubitus position. It is part of a series of
allergy history should be reviewed in order to radiographs made during an air-contrast (double-
avoid the possibility of a severe reaction to the contrast) BE examination. A double-contrast
contrast agent. The patient's creatinine level and examination of the large bowel is performed in
blood urea nitrogen (BUN) should be checked; order to see through the bowel to its posterior
significant elevation of these blood chemistry wall and to visualize any intraluminal (e.g.,
levels often suggests renal dysfunction. The polypoid) lesions or masses. Various body
normal BUN level is 8 to 25 mg/100 mL; normal positions are used to redistribute the barium and
creatinine range is 0.6 to 1.5 mg/100 mL. (Ballinger air. In order to demonstrate the medial and lateral
& Frank, vol 2, p 168) walls of the bowel, decubitus positions are
Ans. D performed. The radiograph presents a right lateral
decubitus position, because the barium has
[Link] demonstrate the entire circumference of gravitated to the right side (the side of the hepatic
the radial head, exposure(s) must be made flexure). The air rises and delineates the medial
with the side of the ascending colon and the lateral side of
1. epicondyles perpendicular to the the descending colon. The posterior wall of the
cassette. rectum could be visualized using the ventral
2. hand pronated and supinated as much decubitus position and a horizontal beam lateral of
as possible. the rectum. (Ballinger & Frank, vol 2, pp 149-151)
3. hand lateral and in internal rotation. Ans. B

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
reducing breast exposure during scoliosis
[Link] myelography, the contrast medium is examinations?
generally injected into the
1. Use of a high-speed imaging system
(A) cisterna magna. 2. Use of breast shields
(B) individual intervertebral disks. 3. Use of compensating filtration
(C) subarachnoid space between the first and
(A) 1 only
second lumbar vertebrae.
(B) 1 and 2 only
(D) subarachnoid space between the third and
(C) 2 and 3 only
fourth lumbar vertebrae.
(D) 1, 2, and 3
—————————————————
—————————————————
Generally, contrast medium is injectedinto the
Spinal column studies are often required for
subarachnoid space between the third and fourth
evaluation of adolescent scoliosis, thus presenting
lumbar vertebrae (Fig. 2-57). Because the spinal
a twofold problem: radiation exposure to youthful
cord ends at the level of the first or second lumbar
gonadal and breast tissues, and significantly
vertebra, this is considered to be a relatively safe
differing tissue densities / thicknesses.
injection site.
The use of a high-speed film / screen combination
The cisterna magna can be used, but the risk of
helps reduce the exposure required for the
contrast entering the ventricles and causing side
examination.
effects increases.
Exposure dose concerns can also be resolved with
Diskography requires injection of contrast medium
theuse of a compensating filter (for uniform
into the individual intervertebral disks. (Saia, pp
density) that incorporates lead shielding for the
197-198)
breasts and gonads (Fig. 2-58). (Ballinger & Frank,
Ans. D
vol 1, pp 456-457)
Ans. D
[Link] of the following conditions is often the
result of ureteral obstruction or stricture?
[Link] type of articulation is evaluated in
(A) Pyelonephrosis arthrography?
(B) Nephroptosis
(A) Synarthrodial
(C) Hydronephrosis
(B) Diarthrodial
(D) Cystourethritis
(C) Amphiarthrodial
—————————————————
(D) Cartilaginous
Hydronephrosis is a collection of urine in the renal
—————————————————
pelvis due to obstructed outflow, as from a
Diarthrodial joints are freely movable joints that
stricture or obstruction.
distinctively contain a joint capsule. Contrast is
If the obstruction occurs at the level of the injected into this joint capsule to demonstrate the
bladder or along the course of the ureter, it will be menisci, articular cartilage, bursae, and ligaments
accompanied by the condition of hydroureter of the joint under investigation.
above the level of obstruction. These conditions
Synarthrodial joints are immovable joints,
may be demonstrated during intravenous
composed of either cartilage or fibrous connective
urography.
tissue.
The term pyelonephrosis refers to some condition
Amphiarthrodial joints allow only slight
of the renal pelvis.
movement.
Nephroptosis refers to drooping or downward (Ballinger & Frank, vol 1, p 65)
displacement of the kidneys. This may be Ans. B
demonstrated using the erect position during IV
urography. [Link] of the following describes correct
centering for the lateral position of a barium-
Cystourethritis is inflammation of the bladder and
filled stomach?
urethra. (Taber's, p 1014)
Ans. C (A) Midway between the vertebrae and the left
lateral margin of the abdomen
[Link] of the following is (are) effective in (B) Midway between the midcoronal plane and the

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
anterior surface of the abdomen (B) 1 and 2 only
(C) Midway between the midsagittal plane and the (C) 2 and 3 only
right lateral margin of the abdomen (D) 1, 2, and 3
(D) Midway between the midcoronal plane and the —————————————————
posterior surface of the abdomen
Mammographic identification markers are
—————————————————
generally placed according to established
A right lateral stomach position is generally standards. In the mediolateral and oblique
performed recumbent; a left lateral is generally projections, they are placed along the upper
performed upright. In either case, a plane located border of the breast. In the craniocaudad
midway between the midcoronal plane and the projection, they are placed along the lateral side of
anterior surface of the abdomen is centered on the breast. (Ballinger & Frank, vol 2, pp 444-445)
the grid at the level of the pylorus (midway Ans. B
between the umbilicus and the xiphoid process).
Centering midway between the MSP / vertebrae [Link] modifying the PA axial projection of the
and the left lateral surface of the abdomen is skull to demonstrate superior orbital fissures,
correct for the AP or PA projection of the stomach. the central ray is directed
(Ballinger & Frank, vol 2, p 114) (A) 20 to 25º caudad.
Ans. B (B) 20 to 25º cephalad.
(C) 30 to 35º caudad.
[Link] the AP projection of the ankle, the (D) 30 to 35º cephalad.
———————————————————
1. plantar surface of the foot is vertical.
——————
2. fibula projects more distally than the
The PA projection can be easily modified by
tibia
redirecting the central ray to demonstrate a
3. calcaneus is well visualized.
variety of structures. The central ray can be
(A) 1 only directed (1) 25 to 30º caudad for the rotundum
(B) 1 and 2 only foramina; (2) 20 to 25º caudad for the superior
(C) 2 and 3 only orbital fissures;or (3) 20 to 25º cephalad for the
(D) 1, 2, and 3 inferior orbital fissures. (Ballinger & Frank, vol 2, p
————————————————— 242)
Ans. A
In order to demonstrate the ankle joint space to
best advantage, the plantar surface of the foot
[Link] blood from the head and
should be vertical in the AP projection of the
thorax is returned to the heart by the
ankle. Note that the fibula is the more distal of the
two long bones of the lower leg, and forms the (A) pulmonary artery.
lateral malleolus. (B) pulmonary veins.
(C) superior vena cava.
The calcaneus is not well visualized in this
(D) thoracic aorta.
projection because of superimposition with other
—————————————————
tarsals. (Ballinger & Frank, vol 1, p 275)
Ans. B Deoxygenated (venous) blood from the upper
body (head, neck, thorax, and upper extremities)
[Link] of the following describe(s) the correct empties into the superior vena cava.
placement of mammographic markers?
Deoxygenated (venous) blood from the lower body
1. In the mediolateral projection, they (abdomen, pelvis, and lower extremities) empties
are placed along the upper border of into the inferior vena cava.
the breast.
The superior and inferior venae cavae empty into
2. In the craniocaudal projection, they
the right atrium. The coronary sinus, which returns
are placed along the lateral aspect of
venous blood from the heart, also empties into the
the breast.
right atrium.
3. In the oblique projection, they are
placed along the lateral aspect of the Deoxygenated blood passes from the right atrium
breast. through the tricuspid valve into the right ventricle.
From the right ventricle, blood is pumped (during
(A) 1 only

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
ventricular systole) through the pulmonary (D) Emergency and trauma radiography
semilunar valve into the pulmonary arterythe —————————————————
only artery that carries deoxygenated blood.
Standard radiographic protocols may be reduced
From the pulmonary artery, blood travels to the to include two views, at right angles to
lungs, picks up oxygen, and is carried by the four each other, in emergency and trauma radiography.
pulmonary veins (the only veins carrying
Department policy and procedure manuals include
oxygenated blood) to the left atrium.
protocols for radiographic examinations. In the
The oxygenated blood passes through the mitral best interest of the patient, andin order to enable
(or bicuspid) valve during atrial systole and into the radiologist to make an accurate diagnosis,
the left ventricle. standard radiographic protocols should be
followed. If the radiographer must deviate from
During ventricular systole, oxygenated blood from
the protocol or believes that additional projections
the left ventricle passes through the aortic
might be helpful, then this should be
semilunar valve into the aorta, and into the
discussedwith the radiologist.
systemic circulation.
Emergency and trauma radiography is occasionally
(Tortotra & Grabowski, p 669)
an exception to this rule. If the emergency room
Ans. C
physician's request varies from the department
protocol, the radiographer must respect this.
236.A flat and upright abdomen is requested on an
acutely ill patient, to demonstrate the A note should be added to the request so that the
presence of air-fluid levels. Because of the radiologist is informed of the reason for a change
patient's condition, the x-ray table can be in protocol. For example, a patient who has been
tilted upright only 70º (rather than the desired involved in a motor vehicle accident may need
90º). How should the central ray be directed? many radiographic studies, but the emergency
room physician may order an AP chest and an AP
(A) Perpendicular to the film
and cross-table lateral C-spine only.
(B) Parallel to the floor
(C) 20º caudad Standard protocol may include a lateral chest and
(D) 20º cephalad a cone-down view of the atlas and axis as well as
————————————————— cervical oblique views. The emergency room
physician has made a decision based on
Whenever a part is being radiographed for
experience and expertise that overrules standard
demonstration of air-fluid levels, the central ray
protocols. At a later time, when the patient has
must be directed parallel to the floor. In this
been stabilized, the patient may be sent back to
example, the patient was unable to tolerate the
radiology for additional views.
90º tilt of the x-ray table. If the radiographer were
to compensate for this by directing the central ray (Dowd & Wilson, vol 2, pp 1056-1057)
perpendicular to the film (angling 20º caudad), it is Ans. D
very possible that any air-fluid level would be
blurred andindistinct, and would go unrecognized. [Link] of the following is a condition in which
an occluded blood vessel stops blood flow to a
Remember that air or fluid always levels out
portion of the lungs?
parallel to the floor. Thus, if the air-fluid level
needs to be demonstrated, the central ray must (A) Pneumothorax
also be parallel to the floor. (Ballinger & Frank, vol (B) Atelectasis
2, p 376) (C) Pulmonary embolism
(D) Hypoxia
Ans. B
————————————————
[Link] radiographic protocols may be Blood pressure in the pulmonary circulation is
reduced to include two views, at right angles relatively low, and therefore pulmonary vessels
to each other, in which of the following can easily become blocked by blood clots, air
situations? bubbles, or fatty masses, resulting in a pulmonary
embolism. If the blockage stays in place, it results
(A) Barium examinations
in an extra strain on the right ventricle, which is
(B) Spine radiography
now unable to pump blood. This occurrence can
(C) Skull radiography
result in congestive heart failure.

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
Pneumothorax is air in the pleural cavity. likely to be located
Atelectasis is a collapsed lung or part of a lung.
(A) high, transverse, and lateral.
Hypoxia is a condition of low tissue oxygen.
(B) low, transverse, and lateral.
(Tortora & Grabowski, p 651)
(C) high, vertical, and toward the midline.
Ans. C (D) low, vertical, and toward the midline.
—————————————————
[Link] the ingestion of a fatty meal, what
The four body types (from largest to smallest) are
hormone is secreted by the duodenal mucosa
to stimulate contraction of the gallbladder? 1.) hypersthenic, 2.) sthenic, 3.) hyposthenic,
(A) Insulin 4.) asthenic.
(B) Cholecystokinin
The abdominal viscera of the asthenic person are
(C) Adrenocorticotropic hormone
generally located quite low, vertical, and toward
(D) Gastrin
the midline. The opposite is true of the
——————————————————
hypersthenic individual: Organs are located high,
About 30 min after the ingestion of fatty foods, transverse, and lateral. (Saia, p 76)
cholecystokinin is released from the duodenal Ans. D
mucosa and absorbed into the bloodstream.
[Link] which of the following is zonography
As a result, the gallbladder is stimulated to
associated?
contract, releasing bile into the intestine.
(Ballinger & Frank, vol 2, p 64) 1. Thick tomographic cuts
Ans. B 2. Long exposure amplitude
3. Less blurring than with
[Link] axiolateral position (Law method) of pluridirectional tomography because
examining the mastoids uses which of the a narrow exposure angle is used
following?
(A) 1 only
1. OML
(B) 2 only
2. MSP parallel to the tabletop
(C) 1 and 3 only
3. 15º caudad angulation
(D) 2 and 3 only
(A) 1 only —————————————————
(B) 2 only
A zonogram is a thick tomographic section, or
(C) 1 and 2 only
"cut"; it appears more similar to conventional
(D) 2 and 3 only
radiography.
—————————————————
A thick tomographic slice is produced by using a
A direct lateral of the mastoids is contraindicated
short exposure amplitude (arc), resulting in limited
because of superimposed structures; an angled
blurring of the radiographic image.
projection is necessary to separate the structures
of interest. The patient's head is placed in a true Pluridirectional tomography produces maximal
lateral position, placing the IOML parallel to the blurring of the radiographic image and generally
long axis of the film and the interpupillary line uses a long exposure amplitude, resulting in a thin
perpendicular to the film. tomographic section or "cut." (Ballinger & Frank,
vol 3, pp 46-47)
The MSP is then rotated 15º toward the tabletop,
Ans. C
and the central ray is angled 15º caudad.
An alternative method is to angle the MSP 15º [Link] of the following are components of a
toward the tabletop and the interpupillary line 15º trimalleolar fracture?
from the [Link] either case, the central ray
1. Fractured lateral malleolus
enters approximately 2 in above and posterior to
2. Fractured medial malleolus
the uppermost EAM. (Ballinger & Frank, vol 2, p
3. Fractured posterior tibia
400)
Ans. D (A) 1 only
(B) 1 and 3 only
[Link] stomach of an asthenic patient is most (C) 2 and 3 only

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
(D) 1, 2, and 3 (D) 1, 2, and 3
————————————————— —————————————————
A trimalleolar fracture involves three separate Major branches of the common carotid arteries
fractures. The lateral malleolusis fractured in the (internal carotids) function to supply the anterior
"typical" fashion, but the medial malleolus is brain, while the posterior brain is supplied by the
fractured on both its medial and posterior aspects. vertebral arteries (branches of the subclavian).
The trimalleolar fracture is frequently associated The brachiocephalic (innominate) artery is
with subluxation of the articular surfaces. unpaired and is one of the three branches of the
(Laudicina, p 184) aortic arch, from which the right common carotid
Ans. D artery is derived. The left common carotid artery
comes directly off the aortic arch. (Tortora &
[Link] of the augmented breast is Grabowski, p 724)
best accomplished using Ans. C
(A) the Cleopatra method.
[Link] of the following articulates with the
(B) the Eklund method.
base of the first metatarsal?
(C) magnification films.
(D) the cleavage view. (A) First cuneiform
————————————————— (B) Third cuneiform
(C) Navicular
Over 2 million women in the United States have
(D) Cuboid
had breast augmentation (implants) for cosmetic
—————————————————
or reconstructive purposes. The augmented breast
presents a challenge to the radiographer, because a. The base of the first metatarsal articulates
breast implants can obscure up to 85 percent of with the first (medial) cuneiform.
breast tissue.
b. The base of the second metatarsalarticulates
The Ecklund method of mammography pushes the with the second (intermediate) cuneiform;
implant posteriorly against the chest wall, with the
c. the third base of the metatarsal articulates
breast tissue then being pulled forward and
with the third (lateral) cuneiform.
compressed.
d. The bases of the fourth and fifth metatarsals
The Cleopatra projection is performed in the
articulate with the cuboid.
seated position with the patient leaning backward
and laterally over the cassette. This adjustment e. The navicular articulates with the first and
from the craniocaudad projection demonstrates second cuneiforms anteriorly and the talus
the tail of the breast and often a portion of the posteriorly. (Saia, p 102)
axilla. Ans. A
Magnification mammography utilizes a 0.1-mm
[Link] of the following is a major cause of
focal spot and is used to evaluate calcifications and
bowel obstruction in children?
the margins of any lesions (to determine if they
are likely to be benign or malignant). (A) Appendicitis
(B) Intussusception
The cleavage view is a bilateral craniocaudal view
(C) Regional enteritis
of the medial aspect of the breasts.
(D) Ulcerative colitis
(Cornuelle & Gronefeld, p 202)
—————————————————
Ans. B
Intussusception is the telescoping of one part of
[Link] four major arteries supplying the brain the intestinal tract into another. It is a major cause
include the of bowel obstruction in children, usually in the
region of the ileocecal valve, and is much less
1. brachiocephalic artery.
common in the adult. Radiographically,
2. common carotid arteries.
intussusception appears as the classic "coil spring,"
3. vertebral arteries.
with barium trapped between folds of the
(A) 1 and 2 only telescoped bowel. The diagnostic BE procedure
(B) 1 and 3 only can occasionally reduce the intussusception,
(C) 2 and 3 only though care must be taken to avoid perforation of

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
the bowel. (B) 1 and 2 only
(C) 1 and 3 only
Appendicitis occurs when an obstructed appendix
(D) 1, 2, and 3
becomes inflamed. Distention of the appendix
—————————————————
occurs and, if the appendix is left untended,
gangrene and perforation can result. The chest should be examined in the upright
position whenever possible in order to
Regional enteritis (Crohn's disease) is a chronic
demonstrate any air-fluid levels. For the lateral
granulomatous inflammatory disorder that can
projection, the patient elevates the arms and
affect any part of the GI tract but generally
flexes and grasps the elbows. The midsagittal and
involves the area of the terminal ileum.
midcoronal planes must remain vertical in order to
Ulceration and formation of fistulous tracts often avoid distortion of the heart. In the PA projection,
occur. the shoulders should be relaxed and depressed in
order to move the clavicles below the lung apices,
Ulcerative colitis occurs most often in the young
and the shoulders should be rolled forward to
adult; its etiology is unknown, although
move the scapulae out of the lung fields. (Ballinger
psychogenic or autoimmune factors seem to be
& Frank, vol 1, pp 528-529)
involved. (Bortrager, p 107)
Ans. A
Ans. B
[Link] of the following is represented by the
[Link] of the following are well demonstrated
number 3 in Figure 2-34?
in the lumbar spine pictured in Figure 2-33?
(A) Inferior vena cava
1. Apophyseal articulations
(B) Aorta
2. Intervertebral foramina
(C) Gallbladder
3. Inferior articular processes
(D) Psoas muscle
(A) 1 only —————————————————
(B) 1 and 2 only
A cross-sectional image of the abdomen is pictured
(C) 1 and 3 only
in Figure 2-34. The large structure on the right,
(D) 1, 2, and 3
labeled 1, is the [Link] gallbladder is seen as a
—————————————————
somewhat darker density on the medial border of
An oblique projection of the lumbar spine is the liver. The left kidney is labeled 4; the right
illustrated. kidney is clearly seen on the other side. The
This is a 45º LPO position demonstrating the vertebra is labeled number 5, and the psoas
apophyseal joints closest to the film. muscles are seen just posterior to the vertebra.
Just anterior to the body of the vertebra is the
The apophyseal joints are formed by the
circular aorta, labeled 3 (some calcification can be
articulation of the inferior articular facets of one
seen as brighter densities). The somewhat
vertebra with the superior articular facets of the
flattened inferior vena cava (number 2) is seen to
vertebra below.
the left of, and slightly anterior to, the aorta.
Note the "scotty dog" images that appear in the (Bontrager, p 100)
oblique lumbar spine. Ans. B
Intervertebral foramina are best visualized in the
[Link] of the following bones participates in
lateral lumbar position. (Bontrager, p 320)
the formation of the knee joint?
Ans. C
1. Femur
[Link] of the following is (are) recommended 2. Tibia
when positioning the patient for a lateral 3. Patella
projection of the chest?
(A) 1 and 2 only
1. The patient should be examined (B) 1 and 3 only
upright. (C) 2 and 3 only
2. The shoulders should be depressed. (D) 1, 2, and 3
3. The shoulders should be rolled —————————————————
forward.
The knee (tibiofemoral joint) is the largest joint of
(A) 1 only the body, formed by the articulation of the femur

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
and tibia. Ans. C
However, it actually consists of three articulations:
[Link] of the following examinations
1. the patellofemoral joint, require(s) ureteral catheterization?
1. Retrograde pyelogram
2. the lateral tibiofemoral joint (lateral
2. Cystourethrogram
femoral condyle with tibial plateau), and
3. Cystoscopy
3. the medial tibiofemoral joint (medial (A) 1 only
femoral condyle with tibial plateau). (B) 1 and 2 only
(C) 2 and 3 only
a) the knee is classified as a synovial (diarthrotic)
(D) 1, 2, and 3
hinge-type joint,
———————————————————
b) the patello-femoral joint is actually a gliding ——————
joint, Retrograde pyelograms require catheterization of
the ureter(s). Radiographs that include the
c) the medial and lateral tibiofemoral joints are
kidney(s) and ureter(s) in their entirety are made
hinge-type. (Ballinger & Frank, vol 1, p 226)
after retrograde filling of the structures. A
Ans. A cystogram or (voiding) cystourethrogram requires
uretheral catheterization only. Radiographs are
[Link] of the following are palpable bony made of the contrast-filled bladder and frequently
landmarks used in radiography of the pelvis of the contrast-filled urethra during voiding.
except the Cystoscopy is required for location of the
vesicoureteral orifices. (Saia, pp 186, 188)
(A) femoral neck.
Ans. A
(B) pubic symphysis.
(C) greater trochanter.
[Link] of the following may be determined by oral
(D) iliac crest.
cholecystography except
—————————————————
(A) liver function.
Femoral necks are nonpalpable bony landmarks.
(B) ability of the gallbladder to concentrate bile.
The ASIS, pubic symphysis, and greater trochanter
(C) emptying power of the gallbladder.
are palpable bony landmarks used in radiography
(D) pancreatic function.
of the pelvis and for localization of the femoral
—————————————————
necks. (Ballinger & Frank, vol 1, p 274)
Ans. A A successful oral cholecystogram depends on the
ability of the liver to remove contrast from the
[Link] deviation of the nasal septum may be portal bloodstream and to excrete it with bile.
best demonstrated in the
A healthy gallbladder should concentrate and
(A) lateral projection. store bile as well as contrast medium.
(B) PA axial (Caldwell method) projection.
With a functioning gallbladder and liver, an
(C)Parietoacanthial (Waters' method) projection.
opacified gallbladder should result.
(D) AP axial (Grashey / Towne method) projection.
————————————————— The pancreas plays an integral part in the digestive
process, but it is not in the biliary system.
The full length of the nasal septum is best
(Ballinger & Frank, vol 2, p 58)
demonstrated in the parietoacanthial (Waters'
Ans. D
method) projection. This is also the single best
view for facial bones.
[Link] medial oblique projection of the elbow
The PA axial (Caldwell method) projection demonstrates the
superimposes the petrous structures over the
1. olecranon process within the
nasal septum, while the lateral projection
olecranon fossa.
superimposes and obscures good visualization of
2. radial head free of superimposition.
the septum.
3. coronoid process free of
The AP axial projection is used to demonstrate the superimposition.
occipital bone. (Ballinger & Frank, vol 2, pp 316- (A) 1 only
317) (B) 2 only

Reviewer A&R
Question & Answer
56
Review Notes for the
RADIOGRAPHY EXAM Appleton
(C) 1 and 3 only Lateral rotation will obscure the articulation even
(D) 1, 2, and 3 more. (Ballinger & Frank, vol 1, p 297)
————————————————— Ans. C
In the AP projection of the elbow, the radial head
[Link] the patient's zygomatic arch has been
and ulna are normally somewhat superimposed.
traumatically depressed or the patient has flat
The lateral oblique demonstrates the radial head cheekbones, the arch may be demonstrated
free of superimposition with the ulna. by modifying the SMV projection and rotating
the patient's head
The lateral projection demonstrates the olecranon
process in profile. (A) 15º toward the side being examined.
(B) 15º away from the side being examined.
The medial oblique position demonstrates
(C) 30º toward the side being examined.
considerable overlap of the proximal ulna, but
(D) 30º away from the side being examined.
should clearly demonstrate the coronoid process
—————————————————
free of superimposition and the olecranon process
within the olecranon fossa. (Saia, p 98) When one cheekbone is depressed, a tangential
projection is required to "open up" the zygomatic
Ans. C
arch and draw it away from the overlying cranial
bones.
[Link] the posterior oblique position of the
cervical spine, the central ray should be This is accomplished by placing the patient in the
directed SMV position, rotating the head 15º toward the
affected side, and centering to the zygomatic arch.
(A) parallel to C4.
A 30º rotation places the mandibular shadow over
(B) perpendicular to C4.
the zygomatic arch. (Ballinger & Frank, vol 2, pp
(C) 15º cephalad to C4.
328-329)
(D) 15º caudad to C4.
Ans. A
—————————————————
The posterior oblique positions of the cervical [Link] of the following barium-filled anatomic
spine (LPO and RPO) require that the central ray structures is best demonstrated in the LAO
be directed 15º to C4. position?
The posterior obliques demonstrate the (A) Hepatic flexure
intervertebral foramina farther away from the (B) Splenic flexure
film. (C) Sigmoid colon
(D) Ileocecal valve
The anterior oblique positions require a 15º caudal
—————————————————
angulation and demonstrate the intervertebral
foramina closest to the film. (Ballinger & Frank, vol In the PA (prone) oblique positions (RAO and LAO),
1, pp 402-403) the flexure disclosed is the one closer to the film.
Ans. C Therefore, the LAO position will "open up" the
splenic flexure, and the RAO will demonstrate the
[Link] of the following positions would best hepatic flexure.
demonstrate the proximal tibiofibular
The AP (supine) oblique positions (RPO and LPO)
articulation?
demonstrate the side farther from the film. (Saia,
(A) AP p 179)
(B) 90º mediolateral Ans. B
(C) 45º internal rotation
(D) 45º external rotation [Link] of the localization lines seen in Figure
————————————————— 2-35 is used for the SMV (Schüller method)
projection of the skull?
In the AP projection, the proximal fibula is at least
partially superimposed on the lateral tibial (A) Line 1
condyle. (B) Line 2
(C) Line 3
Medial rotation of 45º will "open" the proximal
(D) Line 4
tibiofibular articulation.
—————————————————

Reviewer A&R
Question & Answer
57
Review Notes for the
RADIOGRAPHY EXAM Appleton
The SMV (Schüller method) projection of the skull recommended for a particular position. For
requires that the patient's neck be extended, example, if it is recommended that the central ray
placing the vertex adjacent to the film holder / be angled 30º to the OML, then the central ray
upright Bucky, so that the IOML is parallel with the would be angled 37º to the IOML.
film. (Saia, p 142)
Ans. B
This projection is useful for demonstrating the
ethmoidal and sphenoidal sinuses, pars petrosae,
[Link] is the name of the condition that results
mandible, and foramina ovale and spinosum. In
in the forward slipping of one vertebra on the
the illustration,
one below it?
line 1 represents the glabellomeatal line (GML),
(A) Spondylitis
line 2 is the orbitomeatal line (OML), (B) Spondylolysis
(C) Spondylolisthesis
line 3 is the infraorbitomeatal line (IOML)
(D) Spondylosis
line 4 is the acanthomeatal line (AML). —————————————————
(Saia, p 144) The forward slipping of one vertebra on the one
Ans. C below it is called spondylolisthesis.
Spondylolysis is the breakdown of the pars
[Link] Figure 2-35, which of the localization lines is
interarticularis; it may be unilateral or bilateral
used for the lateral projection of the skull?
The results in forward slipping of the involved
(A) Line 1
vertebrathe condition of spondylolisthesis.
(B) Line 2
(C) Line 3 The Inflammation of one or more vertebrae is
(D) Line 4 called spondylitis.
—————————————————
Spondylosis refers to degenerative changes
The lateral projection of the skull requires that the occurring in the vertebra.
patient be in the prone oblique position with the (Ballinger & Frank, vol 1, p 321)
MSP parallel to the film and the interpupillary line
Ans. C
perpendicular to the film.
The IOML (line 3) must be parallel to the long axis [Link] a lateral projection of the nasal bones, the
of the film. central ray is directed
The supraorbital margins, anterior clinoid (A) 1/2 in posterior to the anterior nasal spine.
processes, and posterior clinoid processes should (B) 3/4 in posterior to the glabella.
be superimposed. (Saia, p 144) (C) 3/4 in distal to the nasion.
Ans. C (D) 1/2 in anterior to the EAM.
—————————————————
[Link] of the localization lines seen in Figure
The patient is placed in a true lateral position, and
2-35 are separated by 7º?
the central ray is directed perpendicular to a point
(A) Lines 1 and 3 3/4 in distal to the nasion.
(B) Lines 2 and 3
An 8 × 10 cassette divided in half or an occlusal
(C) Lines 1 and 4
film is used for this procedure. (Ballinger & Frank,
(D) Lines 3 and 4
vol. 2, p 315)
—————————————————
Ans. C
Accurate positioning of the skull requires the use
of several baselines. [Link] displacement of a tibial fracture
The OML (line 2) and the IOML (line 3) are usually would be best demonstrated in the
separated by 7º. The orbitomeatal line and the
(A) AP projection.
glabellomeatal line are usually separated by 8º
(B) lateral projection.
(therefore, there is 15º between the GML and the
(C) medial oblique projection.
IOML). It is useful to remember these differences,
(D) lateral oblique projection.
because central ray angulation must be adjusted
—————————————————
when using a baseline other than the one

Reviewer A&R
Question & Answer
58
Review Notes for the
RADIOGRAPHY EXAM Appleton
A frontal projection (AP or PA) demonstrates the 1. pneumothorax.
medial and lateral relationship of structures. 2. foreign body.
3. atelectasis.
A lateral projection demonstrates the anterior and
(A) 1 only
posterior relationship of structures.
(B) 1 and 2 only
Two views, at right angles to each other, are (C) 1 and 3 only
generally taken of most structures. (D) 1, 2, and 3
(Saia, pp 80, 82) —————————————————
Ans. B
The phase of respiration is exceedingly important
in thoracic radiography, as lung expansion and the
[Link] of the following positions would best
position of the diaphragm strongly influence the
demonstrate the left apophyseal articulations
appearance of the finished radiograph. Inspiration
of the lumbar vertebrae?
and expiration radiographs of the chest are taken
(A) LPO
to demonstrate air in the pleural cavity
(B) RPO
(pneumothorax), to demonstrate atelectasis
(C) Left lateral
(partial or complete collapse of one or more
(D) PA
pulmonary lobes) or the degree of diaphragm
————————————————
excursion, or to detect the presence of a foreign
The posterior oblique positions (LPO and RPO) of
body.
the lumbar vertebrae demonstrate the apophyseal
joints closer to the film. The expiration film will require a somewhat
greater exposure (6 to 8 kV more) to compensate
The left apophyseal joints are demonstrated in the
for the diminished quantity of air in the lungs.
LPO position,
(Ballinger & Frank, vol 1, p 444)
while the right apophyseal joints are Ans. D
demonstrated in the RPO position.
[Link] arthrography may be performed to
The lateral position is useful to demonstrate the
evaluate
intervertebral disk spaces, intervertebral foramina,
and spinous processes. (Saia, p 131) (A) humeral dislocation.
Ans. A (B) complete or incomplete rotator cuff tears.
(C) osteoarthritis.
[Link] fractures of the orbit are best (D) acromioclavicular joint separation.
demonstrated using the —————————————————
(A) lateral projection of the facial bones. Shoulder arthrograms (Fig. 2-59) are used to
(B) parietoacanthial projection (Waters' method). evaluate rotator cuff tear, glenoid labrum (a ring of
(C) posteroanterior projection with a 15º caudal fibrocartilaginous tissue around the glenoid fossa),
angle. and frozen shoulder.
(D) Sweet's localization method.
Acromioclavicular joint separation is demonstrated
—————————————————
on erect AP films with and without the use of
Blowout fractures of the orbital floor are well weights.
demonstrated by using the Waters' method
Routine radiographs demonstrate arthritis, and the
[parietoacanthial (PA) projection] and by using
addition of a transthoracic humerus or scapular Y
tomographic studies. A PA with the OML
would demonstrate dislocation. (Ballinger & Frank,
perpendicular and the central ray angled 30º
vol 1, p 496)
caudad will demonstrate the orbital floor in
Ans. B
profile.
Sweet's localization method shows the exact [Link] angle is formed by the median sagittal
placement of foreign bodies within the eye. plane and the film in the parietoorbital
(Ballinger & Frank, vol 2, p 270) projection (Rhese method) of the optic canal?
Ans. B
(A) 90º
(B) 37º
[Link] and expiration projections of the
(C) 53º
chest may be performed to demonstrate
(D) 45º

Reviewer A&R
Question & Answer
59
Review Notes for the
RADIOGRAPHY EXAM Appleton
————————————————— The xiphoid (or ensiform) process is located
opposite T10. (Saia, p 77)
In the parietoorbital projection, the patient is PA
Ans. C
with the acanthomeatal line perpendicular to the
film.
[Link] the AP projection of the scapula, the
The head rests on the zygoma, nose, and chin, and
1. patient's arm is abducted at right
the MSP should form a 53º angle with the film (37º
angles to the body.
with the central ray).
2. patient's elbow is flexed with the
Radiographically, the optic canal should appear in hand supinated.
the lower outer quadrant of the orbit. Incorrect 3. exposure is made during quiet
rotation of the MSP results in lateral displacement, breathing.
and incorrect positioning of the baseline results in (A) 1 and 2 only
longitudinal displacement. (Ballinger & Frank, vol (B) 1 and 3 only
2, pp 290-291) (C) 3 only
Ans. C (D) 1, 2, and 3
[Link] lymphatic vessels are located using —————————————————
(A) ethiodized oil. With the patient in the AP position, the scapula
(B) blue dye. and upper thorax are normally superimposed.
(C) a tiny scalpel.
With the arm abducted, the elbow flexed, and the
(D) water-soluble iodinated media.
hand supinated, much of the scapula is drawn
—————————————————
away from the ribs.
Peripheral lymphatic vessels are very difficult to
The patient should not be rotated toward the
identify because of their small size and colorless
affected side, as this causes superimposition of
lymphatic fluid. In order to locate these vessels, a
ribs on the scapula.
blue dye such as 11% patent blue violet or 4% sky
blueis used. The exposure is made during quiet breathing to
obliterate pulmonary vascular markings. (Ballinger
This dye is absorbed specifically by the lymphatic
& Frank, vol 1, pp 202-203)
vessels following subcutaneous injection.
Ans. D
Ethiodized oil is the contrast medium employed to
radiographically demonstrate the lymphatic [Link] short, thick processes that project
vessels and nodes. posteriorly from the vertebral body are the
Water-soluble iodinated medium is too rapidly (A) transverse processes.
diluted with lymph to be useful. (B) vertebral arches.
(Ballinger & Frank, vol 3, p 84) (C) laminae.
Ans. B (D) pedicles.
—————————————————
[Link] of the following is located at the
The typical vertebra has two parts, the body and
interspace between the fourth and fifth
the vertebral arch.
thoracic vertebrae?
The body is the dense, anterior bony mass.
(A) Manubrium
Posteriorly attached is the vertebral arch, a ringlike
(B) Jugular notch
structure.
(C) Sternal angle
(D) Xiphoid process The vertebral arch is formed by two pedicles
————————————————— (short, thick processes projecting posteriorlyfrom
the body) and two laminae (broad, flat processes
There are several surface landmarks and
projecting posteriorly and medially from the
localization points that can help the radiographer
pedicles). (Saia, p 123)
in positioning various body structures.
Ans. D
The jugular notch, located at the superior aspect
of the manubrium, is approximately opposite the
[Link] of the following are mediastinal structures
T2-3 interspace.
except the
The sternal angle is located opposite the T4-5
interspace. (A) esophagus.

Reviewer A&R
Question & Answer
60
Review Notes for the
RADIOGRAPHY EXAM Appleton
(B) thymus. The ribs below the diaphragm are best
(C) heart. demonstrated with the diaphragm elevated.
(D) terminal bronchiole.
This is accomplished by placing the patient in a
—————————————————
recumbent position and by taking the exposure at
The mediastinum is the space between the lungs the end of exhalation.
that contains the heart, great vessels, trachea,
Conversely, the ribs above the diaphragm are best
esophagus, and thymus gland.
demonstrated with the diaphragm depressed.
It is bounded anteriorly by the sternum and
Placing the patient in the erect position and taking
posteriorly by the vertebral column, and extends
the exposure at the end of deep inspiration
from the upper thorax to the diaphragm.
accomplishes this.
(Ballinger & Frank, vol 1, p 511)
(Ballinger & Frank, vol 1, p 428)
Ans. D
Ans. C
[Link] of the following sinus groups is
[Link] obtain an exact axial projection of the
demonstrated with the patient positioned as
clavicle, place the patient
for a parietoacanthial projection (Waters'
(A) supine and angle the central ray 30º caudally.
method) and the central ray directed through
(B) prone and angle the central ray 30º cephalad.
the patient's open mouth?
(C) supine and angle the central ray 15º cephalad.
(A) Frontal (D) in a lordotic position and direct the central ray
(B) Ethmoidal at right angles to the coronal plane of the
(C) Maxillary clavicle.
(D) Sphenoidal *The exact axial projection is performed by placing
————————————————— the patient in a lordotic position, leaning against
the vertical grid device. This places the clavicle at
This is a modification of the parietoacanthial
right angles, or nearly so, to the plane of the film.
projection (Waters' method) in which the patient
The central ray is directed to enter the inferior
is requested to open the mouth, and then the skull
border of the clavicle, at right angles to its coronal
is positioned so that the OML forms a 37º angle
plane. Other axial projections may include a prone
with the film. The central ray is directed through
position with a 25 to 30º caudal angle. However,
the sphenoidal sinuses and exits the open mouth.
none of these produces an exact axial projection of
The routine parietoacanthial projection (with the clavicle. (Ballinger & Frank, vol 1, p 159)
mouth closed) is used to demonstrate the
maxillary sinuses projected above the petrous 02280B|Extremity imaging
pyramids. Which of the following projections of the
calcaneus is obtained with the leg extended, the
The frontal and ethmoidal sinuses are best
plantar surface of the foot vertical and
visualized in the PA axial position (modified
perpendicular to the film, and the central ray
Caldwell method).
directed 40º caudad?
(Saia, p 150)
(A) Axial plantodorsal projection
Ans. D
(B) Axial dorsoplantar projection
(C) Lateral projection
[Link] better demonstrate the ribs below the
(D) Weight-bearing lateral projection
diaphragm,
—————————————————
1. suspend respiration at the end of full
An axial dorsoplantar projection of the calcaneus is
exhalation.
described; the central ray enters the dorsal surface
2. suspend respiration at the end of
of the foot and exits the plantar surface.
deep inhalation.
3. perform the exam in the recumbent The plantodorsal projection is done supine and
position. requires cephalad angulation. The central ray
(A) 1 only enters the plantar surface and exits the dorsal
(B) 2 only surface.
(C) 1 and 3 only (Ballinger & Frank, vol 1, p 263)
(D) 2 and 3 only Ans. D
—————————————————

Reviewer A&R
Question & Answer
61
Review Notes for the
RADIOGRAPHY EXAM Appleton
[Link] of the following projections of the position into the AP position, the stomach will
calcaneus is obtained with the leg extended, move into a more horizontal position. Although
the plantar surface of the foot vertical and the cardiac sphincter and the pyloric sphincter are
perpendicular to the film, and the central ray relatively fixed, the fundus is quite mobile, and will
directed 40º caudad? vary in position.
(Dowd & Wilson, vol 2, p 778)
(A) Axial plantodorsal projection
Ans. D
(B) Axial dorsoplantar projection
(C) Lateral projection
[Link] a patient in the PA position and the OML
(D) Weight-bearing lateral projection
perpendicular to the table, a 15 to 20º caudal
—————————————————
angulation would place the petrous ridges in
An axial dorsoplantar projection of the calcaneus is the lower third of the orbit. In order to
described; the central ray enters the dorsal surface achieve the same result in a baby or a small
of the foot and exits the plantar surface. (done child, it is necessary for the radiographer to
prone) modify the angulation to
The plantodorsal projection is done supine and (A) 10 to 15º caudal.
requires cephalad angulation. (B) 25 to 30º caudal.
(C) 15 to 20º cephalic.
The central ray enters the plantar surface and exits
(D) No change in angulation is necessary.
the dorsal surface.
—————————————————
(Ballinger & Frank, vol 1, p 263)
Ans. B With a patient in the PA position and the OML
perpendicular to the table, a 15 to 20º caudal
[Link] GI radiography, the position of the angulation would place the petrous ridges in the
stomach may vary depending on lower third of the orbit.
In order to achieve the same result in a baby or a
1. respiratory phase. small child, it is necessary for the radiographer to
2. body habitus. decrease the angulation or modify the angulation
3. patient position. to 10 to 15º caudal.
(A) 1 and 2 only The reason for this can be understood by
(B) 1 and 3 only examining the baselines for skull positioning. In
(C) 2 and 3 only the adult skull, the OML and IOML are about 7º
(D) 1, 2, and 3 apart. In a baby or small child, the difference is
————————————————— larger, about 15º apart.
During GI radiography, the position of the stomach Remember that in adults, the head makes up
may vary depending on the respiratory phase, the about one-seventh the length of the body. In
body habitus, and the patient position. children, the head is about one-fourth the length
Inspiration causes the lungs to fill with air and the of the body.
diaphragm to descend, thereby pushing the These differences must be considered in
abdominal contents downward. radiographic examination of the skull for babies.
On expiration, the diaphragm will rise, allowing the (Ballinger & Frank, vol 3, p 26)
abdominal organs to ascend. Ans. A
Bodyhabitus is an important factor in determining [Link] patient positioned for an operative
the size and shape of the stomach. cholangiography is in a
An asthenic patient may have a long, J-shaped (A) 15 to 20º LPO.
stomach, while the stomach of a hypersthenic (B) 15 to 20º RPO.
patient may be transverse. (C) 45º LPO.
The body habitus is an important consideration in (D) 45º RPO.
determining the positioning and placement of the —————————————————
cassette. The patient position for operative cholangiography
The patient position can also alter the position of is 15 to 20º RPO. Remember that the gallbladder
the stomach. If a patient turns from the RAO lies in the right upper quadrant. Because the

Reviewer A&R
Question & Answer
62
Review Notes for the
RADIOGRAPHY EXAM Appleton
radiographs are obtained during surgery, they 2. Baker's cyst.
must be obtained with the patient in the supine 3. torn rotator cuff.
rather than the prone position. A slight oblique (15
(A) 1 and 2 only
to 20º) will allow visualization of the biliary tract
(B) 1 and 3 only
free of superimposition from the vertebrae. The
(C) 2 and 3 only
LPO would place the biliary vessels over the spine.
(D) 1, 2, and 3
A 45º oblique is too steep for visualization of the
—————————————————
gallbladder and biliary tree.
(Ballinger & Frank, vol 2, p 76) Knee arthrography may be performed to
Ans. B demonstrate torn meniscus (cartilage), Baker's
cyst, loose bodies, and ligament damage.
[Link] performing tomography, it is of
A torn rotator cuff would be demonstrated on a
paramount importance that the radiographer
shoulder, not a knee arthrogram.
1. properly apply immobilization. (Bontrager, p 726)
2. provide adequate radiation protection Ans. A
whenever possible.
3. obtain and check a scout film. [Link] for a myelographic cervical
puncture include
(A) 1 and 2 only
(B) 1 and 3 only 1. demonstration of the upper level of a
(C) 2 and 3 only spinal block.
(D) 1, 2, and 3 2. suspected mass lesion in the upper
————————————————— cervical [Link] of lumbar puncture.
(A) 1 and 2 only
When performing tomography, it is of paramount
(B) 1 and 3 only
importance that the radiographer properly apply
(C) 2 and 3 only
immobilization, provide adequate radiation
(D) 1, 2, and 3
protection whenever possible, and obtain and
————————————————
check a scout film.
Indications for a myelographic cervical puncture
Tomography differs from conventional
include demonstration of the upper level of a
radiography in several important respects.
spinal block or when lumbar puncture has failed.
Tomographic examinations are often lengthy, and
positioning is crucial. If there is a suspected mass lesion of the upper
cervical canal, cervical puncture is contraindicated.
A patient must be made as comfortable as
possible, and the exam should be thoroughly Cervical punctureis also contraindicated if the
explained. The sudden, quick movement of a thoracic or lumbar region needs to be
tomographic tube can frighten the patient if it is demonstrated. The contrast becomes too diluted if
unexpected. cervical puncture is performed. Lumbar puncture
is indicated in these instances. (Bontrager, p 735)
Proper padding and support devices should be
Ans. B
provided, and the part under examination should
be immobilized. Because tomographic
[Link] the lateral projection of the foot, the
examinations frequently use high mA.s
(milliampere-seconds) techniques, a single 1. plantar surface should be
exposure can result in a significant dose. Multiple perpendicular to the film.
exposures using high mA.s techniques require 2. metatarsals are superimposed.
proper shielding. In addition, a scout film not only 3. talofibular joint should be visualized.
will ensure proper technique and positioning, but (A) 1 only
also is used to decide the fulcrum levels necessary. (B) 1 and 2 only
(Dowd & Wilson, p 926) (C) 2 and 3 only
Ans. D (D) 1, 2, and 3
—————————————————
[Link] arthrography may be performed to
When the foot is positioned for a lateral
demonstrate a
projection, the plantar surface should be
1. torn meniscus. perpendicular to the film, so as to superimpose

Reviewer A&R
Question & Answer
63
Review Notes for the
RADIOGRAPHY EXAM Appleton
the metatarsals. (Ballinger & Frank, vol 2, p 80)
Ans. D
This may be accomplished with the patient lying
on either the affected or the unaffected side
[Link] of the following statements regarding
(usually the affected), that is, mediolateral or
pediatric positioning are true, except
lateromedial.
(A) For radiography of the kidneys, the central
The talofibular articulation is best demonstrated in
ray should be directed midway between the
the medial oblique projection of the ankle.
diaphragm and the symphysis pubis.
(Ballinger & Frank, vol 1, p 251)
(B) If a pediatric patient is in respiratory distress,
Ans. B
a chest radiograph should be obtained in the
AP projection rather than the standard PA
[Link] may be
projection.
performed for demonstration of
(C) Chest radiography on a neonate should be
1. uterine tubal patency. performed in the supine position.
2. mass lesions in the uterine cavity. (D) Radiography of pediatric patients with a
3. uterine position. myelomeningocele defect should be
(A) 1 and 2 only performed in the supine position.
(B) 1 and 3 only
(C) 2 and 3 only —————————————————
(D) 1, 2, and 3
Radiography of pediatric patients with a
——————————————————
myelomeningocele defect should be performed in
Hysterosalpingography may be performed for the prone position, rather than the routine supine
demonstration of uterine tubal patency, mass position. The supine position would put
lesions in the uterine cavity, and uterine position. unnecessary pressure on the protrusion of the
Although hysterosalpingography is often meninges and spinal cord. All of the other
performed to check tubal patency, the uterine statements in the question are true. The anatomic
anatomy, position, and morphology are also dimensions of children are different from those of
exhibited. adults, and this must be kept in mind when
performing pediatric radiography. The liver
In addition, polyps, fibroids, or space-occupying
occupies a larger area of the abdominal cavity in a
lesions within the uterus are well demonstrated.
child than in an adult. This causes the kidneys to
(Ballinger & Frank, vol 2, pp 218-219)
be in a lower position. Generally, the kidneys will
Ans. D
be midway between the diaphragm and the
symphysis pubis.
[Link] of the following equipment is
necessary for ERCP? Chest radiography for the pediatric patient varies
1. A fluoroscopic unit with spot film and depending on the age of the child. Neonates are
tilt table capabilities routinely radiographed in the supine position.
2. A fiberoptic endoscope
Although infants may also be examined in the
3. Polyethylene catheters
supine position, it is preferable to examine them
(A) 1 and 2 only
byplacing the infant securely in a support device to
(B) 1 and 3 only
obtain a good PA erect radiograph. Exceptions to
(C) 2 and 3 only
this rule are made if the infant is in respiratory
(D) 1, 2, and 3
distress. To avoid aggravating the respiratory
———————————————————
distress, an erect AP radiograph is usually
——————
obtained.
A fluoroscopic unit with spot film and tilt table
(Dowd & Wilson, vol 2, pp 1004-1005, 1013)
should be used for endoscopic retrograde
Ans. D
pancreatography. The Trendelenburg position is
sometimes necessary to fill the interhepatic ducts,
[Link] cholangiography may be performed
and a semierect position may be necessary to fill
to
the lower end of the common bile duct. Also
necessary are a fiberoptic endoscope for locating 1. visualize biliary stones or a neoplasm.
the hep-atopancreatic ampulla and polyethylene 2. determine function of the
catheters for the introduction of contrast media. hepatopancreatic ampulla.

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
3. examine the patency of the biliary tract.
293.T-tube cholangiography is performed
(A) 1 and 2 only
(B) 1 and 3 only (A) preoperatively.
(C) 2 and 3 only (B) during surgery.
(D) 1, 2, and 3 (C) postoperatively.
————————————————— (D) with a Chiba needle.
—————————————————
Operative cholangiography may be performed to
visualize biliary stones or a neoplasm, determine T-tube cholangiography, also referred to as
the function of the hep-atopancreatic ampulla, postoperative cholangiography, involves the
and examine the patency of the biliary introduction of contrast medium via the T-tube, or
tract. postoperative drainage tube.
Any strictures or obstructions may be localized The exam is usually performed several days after
when contrast medium is introduced into the surgery to check for residual stones and biliary
catheter and films are obtained. It is important tree function.
that no air bubbles are introduced into the biliary
A Chiba needle is not used for T-tube
tract because they can imitate radiolucent stones.
cholangiography, but rather is used for
The radiographer can coordinate the time of
percutaneous transhepatic cholangiography.
exposure with the anesthesiologist to obtain the
(Ballinger & Frank, vol 2, p 78)
radiographs during suspended respiration.
Ans. C
(Ballinger & Frank, vol 2, pp 76-77)
Ans. D
[Link] requires the use of
[Link] junction of the transverse colon and the 1. general anesthesia.
descending colon forms the 2. sterile technique.
(A) hepatic flexure. 3. fluoroscopy.
(B) splenic flexure.
(A) 1 and 2 only
(C) transverse flexure.
(B) 1 and 3 only
(D) sigmoid flexure.
(C) 2 and 3 only
—————————————————
(D) 1, 2, and 3
The approximately 5-ft-long large intestine (colon) —————————————————
functions in the formation, transport, and
Arthrography requires the use of local, rather than
evacuation of feces.
general, anesthesia.
The colon (Fig. 2-60) commences at the terminus
Sterile technique should be employed to avoid
of the small intestine; its first portion is the saclike
introducing infection into the joint.
cecum in the RLQ, located inferior to the ileocecal
valve. Other possible complications of arthrography
include pain, trauma to nearby structures, and
The ascending colon is continuous with the cecum
capsular rupture. It is recommended that contrast
and is located along the right side of the
agents with meglumine salts, rather than sodium
abdominal cavity. It bends medially and anteriorly,
salts, be used, as they have been found to be less
forming the right colic (hepatic) flexure.
painful when introduced into joint spaces.
The colon traverses the abdomen as the
Fluoroscopy is used for proper placement of the
transverse colon and bends posteriorly and
needle and to obtain films immediately after the
inferiorly to form the left colic (splenic) flexure.
introduction of contrast medium.
The descending colon continues down the left side (Ballinger & Frank, vol 1, pp 560-561)
of the abdominal cavity, and at about the level of Ans. C
the pelvic brim, in the LLQ, the colon moves
medially to form the S-shaped sigmoid colon. The [Link] contrast media of choice for use in
rectum, about 5 in in length, lies between the myelography are
sigmoid and the anal canal. (Ballinger & Frank, vol
(A) ionic non-water-soluble.
2, p 89)
(B) ionic water-soluble.
Ans. B (C) nonionic water-soluble.

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
(D) gas. wheneverpossible before performing a hand
————————————————— radiograph.
An antishock garment is used when a patient
The contrast media of choice for use in
has suffered a traumatic incident and is
myelography are nonionic water-soluble. For
suffering from internal bleeding; it functions
years, Pantopaque, a non-water-soluble (ethyl
to slow the rate of bleeding.
ester) contrast agent, was used for radiographic
demonstration of the spinal canal. Because it was An air cast may be used to temporarily
nonsoluble, it had to be removed after the support a fractured limb until surgery and/or a
procedure. Metrizamide was the first nonionic more permanent cast is in place. Both
contrast agent introduced for use in myelography, antishock garments and air splints are
but it has been replaced with iohexol and radiolucent; most rings are radiopaque.
iopamidol, which are cheaper and safer and do not (Adler & Carlton, pp 165-166)
dissipate as quickly. Ionic contrast media are not Ans. C
used for intrathecal injections because they are
too toxic, and gas or air does not provide adequate [Link] of the following is demonstrated in a
demonstration. (Bontrager, p 135) 25º RPO position with the central ray entering
Ans. C 1 in medial to the elevated ASIS?
(A) Left sacroiliac joint
[Link] of the following procedures will best
(B) Right sacroiliac joint
demonstrate the cephalic, basilic, and
(C) Left ilium
subclavian veins?
(D) Right ilium
(A) Aortofemoral arteriogram —————————————————
(B) Upper-limb venogram
 The sacroiliac joints angle posteriorly and
(C) Lower-limb venogram
medially 25º to the MSP.
(D) Renal venogram
————————————————— o Therefore, in order to demonstrate
The cephalic, basilic, and subclavian veins should the sacroiliac joints with the patient
be demonstrated on an upper-limb venogram. in the AP position, the affected side
must be elevated 25º.
Venography of the upper limb is usually performed
to rule out venous obstruction or thrombosis. o This places the joint space
perpendicular to the film and parallel
The injection site is usually in the hand or wrist,
to the central ray.
and films should be obtained up to the area of the
superior vena cava.  Therefore, the RPO position will
(Ballinger & Frank, vol 2, p 540) demonstrate the left sacroiliac joint, and
Ans. B the LPO position will demonstrate the
right sacroiliac joint.
[Link] of the following devices should not be o When the examination is performed
removed before positioning for a radiograph? with the patient PA, the unaffected
1. A ring when performing hand side will be elevated 25º.
radiography (Ballinger & Frank, vol 1, pp 442-443)
2. An antishock garment Ans. A
3. A pneumatic splint
(A) 1 and 2 [Link] of the following are appropriate
(B) 1 and 3 techniques for imaging a patient with a
(C) 2 and 3 possible traumatic spine injury?
(D) 1, 2, and 3 [Link] the patient to turn slowly
————————————————— and stop if anything hurts.
Neither an antishock garment nor a 5. Maneuver the x-ray tube head
pneumatic splint should be removed by the instead of moving the patient.
radiographer prior to performing radiographic 6. Call for help and use the log-rolling
examination. method to turn the patient.
(A) 1 and 2 only
A ring may certainly be removed (B) 1 and 3 only

Reviewer A&R
Question & Answer
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Review Notes for the
RADIOGRAPHY EXAM Appleton
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————
 When imaging a patient with a possible
traumatic spine injury, it is appropriate to
either maneuver the x-ray tube head or, if
the patient must be moved, to use the
log-rolling method.
o This cannot be done by one person; the
radiographer must summon assistance.
o If the patient is on a backboard and in a
neck collar, as most patients with
suspected spine injury are, it is never
appropriate to ask the patient to turn,
scoot, or slide over.
o The only movement that should be
permitted is movement of the entire
spine, body, and head together, as in log
rolling.
 Any twisting could cause severe and
permanent damage to the spinal cord,
resulting in paralysis or even death.
(Ehrlich et al, pp 229, 230)
Ans. C

[Link] which type of fracture are the splintered

ends of bone forced through the skin?
(A) Closed
(B) Compound
(C) Compression
(D) DepressedAnswers and Explanations
—————————————————
1.) The type of fracture in which the
splintered ends of bone are forced
through the skin is a compound
fracture.
2.) In a closed fracture, no bone
protrudes through the skin.
3.) Compression fractures are seen in
stressed areas, such as the vertebrae.
4.) A depressed fracture would not
protrude, but rather would be pushed
in.
(Ehrlich et al, p 231)
Ans. B

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Question & Answer
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