th

Appleton Rationale Part 1-C; 5 edition

1. (D) 1, 2, and 3
Special units have been designed to accommodate examinations with high patient volume.
Dedicated chest units are available that will transport a piece of unexposed film from the
magazine into position between a pair of intensifying screens, make a phototimed exposure,
and transport the exposed film to the automatic processor. Dedicated head units are
available for easy positioning of the skull, sinuses, mastoids, and so on. We are aware of the
importance of high-quality mammographic examinations; dedicated mammographic units with
molybdenum targets and other beneficial features are available.

2. (A) 1 only
The faster the intensifying screens used, the less the required mAs. Decreasing the intensity
(mAs, quantity) of photons significantly contributes to reducing total patient dose. Decreasing
the kilovoltage would increase patient dose because the primary beam would be made up of
less penetrating photons, and so the mAs would have to be increased. The importance of
patient shielding is never diminished.

3. (B) Plantodorsal projection of the os calcis

The talocalcaneal, or subtalar, joint is a three-faceted articulation formed by the talus and the
os calcis (calcaneus). The plantodorsal and dorsoplantar projections of the os calcis should
exhibit sufficient density to visualize the talocalcaneal joint (Fig. 2-36). This is the only
"routine" projection that will demonstrate the talocalcaneal joint. If evaluation of the
talocalcaneal joint is desired, special views (such as the Broden and Isherwood methods) are
required.

4. (B) 1 and 3 only

Rare earth phosphors have a much higher conversion efficiency (and therefore speed) and
have all but replaced the older calcium tungstate screens. The larger the phosphor and the
thicker the layer of phosphors (active layer), the greater the light emission and therefore the
speed. Antihalation backing is a component of single-emulsion film that prevents crossover of
fluorescent light within an image receptor.

5. (B) 0.1
Film that is unexposed and has been processed will not be completely clear. The blue-tinted
base contributes a small measure of density. A small but measurable amount of exposure
from background radiation can also be present, and processing itself produces a small
amount of density from chemical fog. Together, this is expressed as base-plus fog and
should never exceed a density of 0.2.
6. (A) 1 only
Retrograde pyelograms require catheterization of the ureter(s). Radiographs that include the
kidney(s) and ureter(s) in their entirety are made after retrograde filling of the structures. A
cystogram or (voiding) cystourethrogram requires uretheral catheterization only. Radiographs
are made of the contrast-filled bladder and frequently of the contrast-filled urethra during
voiding. Cystoscopy is required for location of the vesicoureteral orifices.

7. (C) 1 and 3 only

Diarthrotic, or synovial, joints, such as the knee and the TMJ, are freely movable. Most
diarthrotic joints are associated with a joint capsule containing synovial fluid. Diarthrotic joints
are the most numerous in the body and are subdivided according to type of movement.
Amphiarthrotic joints are partially movable joints whose articular surfaces are connected by
cartilage, such as intervertebral joints. Synarthroticjoints, such as the cranial sutures, are
immovable.

8. (B) remove clothing from the uninjured arm first

When assisting the patient with changing, first remove clothing from the unaffected side. If
this is done, removing clothing from the affected side will require less movement and effort.
The patient's clothing should be cut away only as a last resort in cases of extreme emergency
and with the patient's consent.

9. (A) Leukemia
Radiation effects that appear days or weeks following exposure (early effects) are in
response to relatively high radiation doses. These should never occur in diagnostic radiology
today; they occur only in response to doses much greater than those used in diagnostic
radiology. One of the effects that may be noted in such a circumstance is the hematologic

blood. Immediate local tissue effects can include effects on the gonads (temporary sterility)
and on the skin (epilation, erythema). Acute radiation lethality, or radiation death, occurs after
an acute exposure and results in death inweeks or days. Radiation-induced malignancy,
leukemia, and genetic effects are late effects (or stochastic effects) of radiation exposure.
These can occur years after survival of an acute radiation dose, or after exposure to low
levels of radiation over along period of time. Radiation workers need to be especially aware
of the late effects of radiation because their exposure to radiation is usually low-level over a
long period of time. Occupational radiation protection guidelines are therefore based on late
effects of radiation according to a linear, nonthreshold dose-response curve.

10. (A) entire foramen magnum and the jugular foramina

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 OML perpendicular or 37º and the
IOML perpendicular. These AP axial projections demonstrate the dorsum sellae and posterior
clinoid processes within the foramen magnum (a portion of the foramen magnum is obscured
by overlying bony shadows). A 40 to 60º angulation shows the entire foramen magnum and
the jugular foramina bilaterally.

11. (D) static electricity

Static electricity is a problem, especially in cool, dry weather. Sliding the film in and outof the
cassette / image receptor can be the cause of a static electrical discharge. Removing one's
sweater in the darkroom on a dry winter day can cause static electrical sparking. The film
exposed by a large static discharge ("tree static") frequently exhibits black, branching artifacts
such as those illustrated. Poor screen / film contact results in very blurry areas of the finished
radiograph. A foreign body in the image receptor will be sharply imaged on the finished
radiograph. An inverted focused grid will result in an area of exposure down the middle of the
film and grid cutoff everywhere else.

12. (B) 1 and 2 only

There are three types of beam restrictors: aperture diaphragms, cones and cylinders, and
collimators. The most practical and efficient type is the collimator. Its design makes available
an infinite number of field size variations that are not available with the other types of beam
restrictors. Because aperture diaphragms and flare cones have a fixed aperture size and
shape, their beam restriction is not as efficient as that of the variable-size collimator. Aperture
diaphragms, cones, and cylinders may be placed on a collimator track so that the illuminated
crosshairs are visualized. Although the collimator assembly contributes approximately 1.0
mm Al equivalent to the added filtration of the x-ray tube (because of the plastic exit portal
and silver-coated reflective mirror), its functions are unrelated to the cleanup of scattered
radiation. This is because the patient is the principal scatterer, and grids function to clean up
scattered radiation generated by the patient.

13. (B) one-half that expected

When radiographs demonstrate half the expected density and the mA meter registers half the
selected milliamperage, rectifier failure is generally suspected. The equipment is said to be
"half-waving" because the inverse voltage is not being rectified to useful voltage. The
equipment can be tested for rectifier failure with the use of a spinning top (synchronous type
for three-phase equipment) test.

14. (C) Voiding cystourethrogram

Ureteral reflux is best demonstrated during voiding. It can occur even when the bladder is
only partially filled with a contrast medium. The vesicourethral orifice, as well as other
sphincter muscles, relaxes during urination; however, the vesicoureteral orifices may also
relax and cause reflux.

15. (B) 1 and 2 only

Radiographic and fluoroscopic equipment is designed to help decrease the exposure dose to
patient and operator. One of the design features is the exposure cord. Exposure cords on
fixed equipment must be short enough to prevent the exposure from being made outside the
control booth. Exposure cords on mobile equipment must be long enough to permit the
operator to stand at least 6 ft from the x-ray tube.

16. (C) 2 and 3 only

After forceful eversion or inversion injuries of the ankle, AP stress studies are valuable to
confirm the presence of a ligament tear. Keeping the ankle in an AP position, the physician
guides the ankle into inversion and eversion maneuvers. Characteristic changes in the
relationship of the talus, tibia, and fibula will indicate ligament injury. Inversion stress
demonstrates the lateral ligament, while eversion stress demonstrates the medial ligament. A
fractured ankle would not be manipulated in this manner.

17. (D) 1, 2, and 3

Accurate positioning helps decrease the number of retakes. The use of high-kV and low-mAs
exposure factors limits the quantity of radiation delivered to the patient. Use of rare earth
screens can enable the technologist to reduce mAs by as much as 4 to 8 times. Patient
shielding should be used whenever appropriate and possible.
18. (D) 1, 2, and 3
The scapular Y projection is an oblique projection of the shoulder and is used to demonstrate
anterior or posterior shoulder dislocation. The inferosuperior axial projection may be used to
evaluate the glenohumeral joint when the patient is able to abduct the arm. The transthoracic
lateral projection is used to evaluate the glenohumeral joint and upper humerus when the
patient is unable to abduct the arm.

19. (A) osmolality

In classifying contrast agents, the total number of dissolved particles in solution per kilogram
of water defines the osmolality of the contrast agent. The toxicity defines how noxious or
harmful a contrast agent is. Contrast agents with low osmolality have been found to cause
less tissue toxicity than the ionic intravenous contrast agents. The viscosity defines the
thickness or concentration of the contrast agent. The viscosity of a contrast agent can affect
the injection rate. A thicker, or more viscous, contrast agent will be more difficult to inject
(more pressure is needed to push the contrast agent through the syringe and needle or the
angiocatheter). The miscibility of a contrast agent refers to its ability to mix with body fluids,
such as blood. Miscibility is an important consideration in preventing thrombosis formation. It
is generally preferable to use a contrast agent with low osmolality and low toxicity because
such an agent is safer for the patient and less likely to cause any untoward reactions. When
ionic and nonionic contrast agents are compared, a nonionic contrast agent has a lower
osmolality. To further understand osmolality, remember that wheneverintravenous contrast
media are introduced, there is a notable shift in fluid and ions. This shift is caused by an
inflow of water from interstitial regions into the vascular compartment, which increases the
blood volume and cardiac output. Consequently, there will be a decrease in systemic arterial
pressure and peripheral vascular resistance with peripheral vasodilation. Additionally, the
pulmonary pressure and heart rate increase. When the effects of osmolality on the patient are
understood, it becomes clear that an elderly patient or one with cardiac disease or impaired
circulation would greatly benefit from the use of an agent with lower osmolality.

20. (A) 1 and 2 only

The pictured radiograph is an RAO position of the sternum. The sternum is projected to the
left side of the thorax, over the heart and other mediastinal structures, in the RAO position,
thus promoting 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 central ray was
directed somewhat too superiorly. The central ray should be directed midway between the
jugular (manubrial) notch and the xiphoid process.

21. (C) 2 and 3 only

Some chemical agents used in health-care facilities function to kill pathogenic
microorganisms, while others function to inhibit the growth / spread of pathogenic
microorganisms. Germicides and disinfectants are used to kill pathogenic microorganisms,
whereas antiseptics (like alcohol) are used to stop their growth / spread. Sterilization is
another associated term; it refers to the killing of all microorganisms and their spores.

22. (A) 1 and 2 only

Limiting the size of the irradiated field is a most effective method of decreasing the production
of scattered radiation. The smaller the volume of tissue irradiated, the smaller the amount of
scattered radiation generated; this can be accomplished using compression (prone position
instead of supine or a compression band). Use of a grid does not affect the production of
scatter radiation, but rather removes it once it has been produced.

23. (C) 3 only

The patient must remove any metallic foreign objects if they are within the area(s) of interest.
Dentures, earrings, or necklaces can obscure bony details in a skull or cervical spine survey.
However, only the necklace needs to be removed for a chest x-ray. The radiographer should
keep in mind that hair braids that extend as far as the shoulders and apices, as well as many
T-shirt logos, also cast confusing shadows on the radiologic image. The radiographer must
be certain that the patient's belongings are cared for properly and returned following the
examination.

24. (A) reduce the diffusion of fluorescent light

Remnant radiation emerging from the patient causes fluorescence of the cassette's front
intensifying screen. This fluorescent light not only exposes the adjacent film emulsion, but
also can pass through the film base to the opposite emulsion. Because the fluorescent light
diffuses as it travels to the opposite emulsion, there is a decrease in image sharpness. This
occurrence, called crossover, is minimized by the incorporation of a light-absorbing dye in the
active layer.

25. (C) 1 and 3 only

As kVp is reduced, the number of high-energy photons produced at the target is reduced;
therefore, a decrease in radiographic density occurs. If a grid has been used improperly (off-
centered or out of focal range), the lead strips will absorb excessive amounts of primary
radiation, resulting in grid cutoff and loss of radiographic density. If the SID is inadequate (too
short), an increase in radiographic density will occur.

26. (A) ratio

Grids are used in radiography to trap scatter radiation that would otherwise cause fog on the
radiograph. Grid ratio is defined as the ratio of the height of the lead strips to the distance
between them. Grid frequency refers to the number of lead strips per inch. Focusing distance
and grid radius are terms denoting the distance range with which a focused grid may be
used.

27. (C) 1 and 2 only

Hypoglycemic reactions can be very severe and should be treated with an immediate dose of
sugar (e.g., in juice). Early symptoms of an insulin reaction are shaking, nervousness,
dizziness, cold and clammy skin, blurred vision, and slurred speech. Convulsions and coma
may result if the patient is not treated. Cyanosis is the lack of oxygenated blood, which is a
symptom of shock.
28. (C) Medial oblique elbow
The coronoid process is located on the proximal anterior ulna. The medial oblique projection
of the elbow demonstrates the coronoid process in profile, as well as the ulnar olecranon
process within the humeral olecranon fossa. The lateral oblique elbow projects the proximal
radius and ulna free of superimposition. The coracoid process is located on the scapula.

29. (D) 1, 2, and 3

Physicians often prescribe a mild laxative to aid in the elimination of barium sulfate. If a
laxative is not given, the patient should be instructed to increase dietary fluid and fiber and to
monitor bowel movements (the patient should have at least one within 24 h). Patients should
also be aware of the white-colored appearance of their stool that will be present until all
barium is expelled.

30. (B) epistaxis

The medical term for nosebleed is epistaxis. Vertigo refers to a feeling of "whirling" or a
sensation that the room is spinning. Some possible causes of vertigo include inner ear
infection and acoustic neuroma. Urticaria is a vascular reaction resulting in dilated capillaries
and edema and causing the patient to break out in hives. An aura may be classified as either
a feeling or a motor response (such as flashing lights, tasting metal, smelling coffee) that
precedes an episode such as a seizure or a migraine headache.

31. (B) 1 and 2 only

The term latitude may refer to either film latitude or exposure latitude. Exposure latitude
refers to the margin of error inherent in a particular group of exposure factors. Selection of
high-kVp and low-mAs factors will allow greater exposure latitude than low-kVp and high-mAs
factors. Film latitude is chemically built into the film emulsion and refers to the emulsion's
ability to record a long range of densities from black to white (long-scale contrast).

32. (C) health-care institution

Radiographs are the property of the health-care institution and are a part of every patient's
permanent medical record. They are often retained on file for about 7 years or, in the case of
pediatric patients, until the patient reaches maturity. They are not the personal property of
either the radiologist or the referring physician. If a patient changes doctors or needs a
second opinion, copies can be requested. The patient may also borrow the originals, which
must be returned, or he or she may pay for copies.

33. (A) Lateral decubitus, affected side up

Air or fluid levels will be clearly delineated only if the central ray is directed parallel to them.
Therefore, the erect or decubitus position should be used. Small amounts of fluid within the
peritoneal cavity are best demonstrated in the lateral decubitus position, affected side down.
Small amounts of air within the peritoneal cavity are best demonstrated in the lateral
decubitus position, affected side up.

34. (A) Erect

Because sinus exams are performed to evaluate the presence or absence of fluid, they must
be performed in the erect position with a horizontal x-ray beam. The PA axial (Caldwell)
projection demonstrates the frontal and ethmoidal sinus groups, and the parietoacanthial
projection (Waters') shows the maxillary sinuses. The lateral position demonstrates all the
sinus groups, and the SMV is frequently used to demonstrate the sphenoidal sinuses.
35. (B) 2 only

Three positions of the cervical spine are illustrated. Figure B is the left lateral position. Lateral
projections of the cervical spine are done to demonstrate the intervertebral disk spaces,
apophyseal joints, and spinous processes. Figure A is an RAO; Figure C is an LPO. Anterior
oblique positions (LAO, RAO) of the cervical spine demonstrate the intervertebral foramina
closer to the film, while posterior oblique positions (LPO, RPO) demonstrate the intervertebral
foramina farther from the film.

36. (D) rectifiers

Rectifiers (solid-state or the older valve tubes) permit the flow of current in only one direction.
They serve to change AC, which is needed in the low-voltage side of the x-ray circuit, to
unidirectional current. Unidirectional current is necessary for the efficient operation of the x-
ray tube. The rectification system is located between the secondary coil of the high-voltage
transformer and the x-ray tube. The filament transformer functions to adjust the voltage and
current going to heat the x-ray tube filament. The autotransformer varies the amount of
voltage being sent to the primary coil of the high-voltage transformer so that the appropriate
kVp can be obtained. The high-voltage transformer "steps up" the voltage to the required
kilovoltage and steps down the amperage to milliamperage.

37. (A) left side is elevated 40º

When the pelvis is observed in the anatomic position, the ilia are seen to oblique forward,
giving the pelvis a "basin-like" appearance. To view the right iliac bone, the radiographer
must place it parallel to the film by elevating the left side about 40º (RPO). The left iliac bone
is radiographed in the 40º LPO oblique position.

38. (B) Most prominent part of the greater trochanter

The most prominent part of the greater trochanter is at the same level as the pubic
symphysis
plane as S2. The ASIS and the pubic symphysis are the bony landmarks used to locate the
hip joint, which is located midway between the two points.

39. (D) 1/1000

One of the radiation protection guidelines for the occupationally exposed is that the x-ray
beam should scatter twice before reaching the operator. Each time the x-ray beam scatters,
its intensity at 1 m from the scattering object is one one-thousandth of its original intensity. Of
course, the operator should be behind a shielded booth while making the exposure, but
multiple scatterings further reduce the danger of exposure from scatter radiation.
40. (A) It increases the average energy of the primary beam
X-rays produced at the tungsten target make up a heterogeneous primary beam. Filtration
serves to eliminate the softer, less penetrating photons, leaving an x-ray beam of higher
average energy. Filtration is important in patient protection because unfiltered, low-energy
photons that are not energetic enough to reach the film stay in the body and contribute to
total patient dose.

41. (D) 1, 2, and 3

As the amount of time one spends in a controlled area decreases, radiation exposure should
decrease. Radiation exposure is affected considerably by one's proximity to the radiation
source, as defined by the inverse square law. Barriers (shielding) are an effective means of
reducing radiation exposure; primary barriers, such as walls, protect one from the primary
beam, and secondary barriers, such as lead aprons, are used to protect one from secondary
radiation.

42. (D) 1, 2, and 3

Vaporized tungsten may be deposited on the inner surface of the glass envelope at the tube
(port) window. It acts as an additional filter, thereby reducing tube output. The tungsten
deposit may also attract electrons from the filament, creating sparking and causing puncture
of the glass envelope and subsequent tube failure.

43. (A) kVp and mA

As body areas of different thicknesses and densities are scanned with the image intensifier,
image brightness and contrast require adjustment. The automatic brightness control (ABC)
functions to maintain constant brightness and contrast of the output screen image, correcting
for fluctuations in x-ray beam attenuation with adjustments in kVp and/or mA. There are also
brightness and contrast controls on the monitor that the radiographer can regulate.

44. (C) 2 and 3 only

The Levin and Salem-sump tubes are nasogastric (NG) tubes used for gastric
decompression. The Salem-sump tube is radiopaque and has a double lumen. One lumen is
for gastric air compression, and the other is for removal of fluids. The Levin tube is a single-
lumen tube that is used to prevent accumulation of intestinal liquids and gas during and
following intestinal surgery. The Swan-Ganz intravenous catheter is advanced to the
pulmonary artery and used to measure various heart pressures.

45. (C) a grid

The use of a grid requires an increase in mAs and, therefore, patient dose; the higher the grid
ratio, the greater the increase in mAs required. Collimation restricts the amount of tissue
being irradiated and therefore reduces patient dose. High kVp reduces the amount of
radiation absorbed by the patient's tissues (recall the photoelectric effect), and low mAs
reduces the quantity of radiation delivered to the patient. The higher the speed (fast) of the
intensifying screens, the less the required mAs.

46. (D) 1, 2, and 3

Operative cholangiography plays a vital role in biliary tract surgery. The contrast medium is
injected, and filming occurs following a cholecystectomy. This procedure is used to
investigate the patency of the bile ducts, the function of the hepatopancreatic sphincter (of
Oddi), and previously undetected biliary tract calculi.
47. (C) 1 and 3 only

When the shoulder is placed in internal rotation, a greater portion of the glenoid fossa is
superimposed by the humeral head and the lesser tubercle is visualized, as in image B. The
external rotation position (image A) removes the humeral head from a large portion of the
glenoid fossa and better demonstrates the greater tubercle.

48. (B) 1 and 2 only

Cyanosis is a condition resulting from a deficiency of oxygen circulating inthe blood. It is
characterized by bluish discoloration of the gums, nailbeds, and earlobes, and around the
mouth. Cyanosis may be accompanied by labored breathing or other types of respiratory
distress.

49. (D) 1 and 3 only

The lordotic curves are secondary curves; that is, they develop sometime after birth. The
cervical and lumbar vertebrae form lordotic curves. The thoracic and sacral vertebrae exhibit
the primary kyphotic curves, those that are present at birth.

50. (C) central ray is angled cephalad

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

51. (A) Epinephrine

Epinephrine (Adrenalin) is a bronchodilator. Bronchodilators may be administered in a spray
mister, such as for asthma, or by injection to relieve severe bronchospasm. Lidocaine
(Xylocaine) is an antiarrhythmic used to prevent or treat cardiac arrhythmias (dysrhythmia).
Nitroglycerin and verapamil are vasodilators. Vasodilators permit increased blood flow by
relaxing the walls of the blood vessels.

52. (B) 1 and 2 only

The heel effect is characterized by a variation in beam intensity, which gradually increases
from anode to cathode. This can be effectively put to use when performing radiographic
exams on large body parts with uneven tissue density. For example, the AP thoracicspine is
thicker caudally than cranially, and so the thicker portion is best placed under the cathode.
However, in the lateral projection of the thoracic spine, the upper portion is thicker because of
superimposed shoulders, and therefore that portion isbest placed under the cathode end of
the beam. The femur is also uneven in density, particularly in the AP position, and can benefit
from use of the heel effect. However, the sternum and its surrounding anatomy are fairly
uniform in thickness and would not benefit from use of the anode heel effect. The anode heel
effect is most pronounced when using large-size films, at short SIDs, and with an anode
having a steep (small) target angle.

53. (D) 1, 2, and 3

All of the tissues listed are considered especially radiosensitive tissues. Excessive radiation
to the reproductive organs can cause genetic mutations or sterility. Excessive radiation to the
blood-forming organs can cause leukemia or life span shortening. Lymphocyte cells are the
most radiosensitive cells in the body.

54. (D) 1, 2, and 3

The thicker and more dense the anatomic part being studied, the less bright will be the
fluoroscopic image. Both mA and kVp affect the fluoroscopic image in a way similar to the
way in which they affect the radiographic image. For optimum contrast, especially taking
patient dose into consideration, higher kVp and lower mA are generally preferred.

55. (A) AP oblique, medial rotation

The medial oblique projection requires that the leg be rotated medially until the plantar
surface of the foot forms a 30º angle with the cassette. This position demonstrates the
navicular with minimal bony superimposition. The lateral oblique projection of the foot
superimposes much of the navicular on the cuboid. The navicular is also superimposed on
the cuboid in the lateral projections.

56. (D) 1, 2, and 3

Radiographic contrast is the sum of film contrast and subject contrast. Subject contrast has
by far the greatest influence on radiographic contrast. Several factors influence subject
contrast, each as a result of beam attenuation differences in the irradiated tissues. As patient
thickness and tissue density increase, attenuation increases and subject contrast is
increased. As kilovoltage increases, higher-energy photons are produced, beam attenuation
is decreased, and subject contrast decreases.

57. (D) 1, 2, and 3

Prior to the start of an IVP, the patient should be instructed to empty the bladder. This is
advised to avoid dilution of the contrast agent. Diluted contrast within the bladder will not
affect the diagnosis of renal abnormalities, but itmay obscure bladder abnormalities. The
patient's allergy history should be reviewed in order to avoid the possibility of a severe
reaction to the contrast agent. The patient's creatinine level and blood urea nitrogen (BUN)
should be checked; significant elevation of these blood chemistry levels often suggests renal
dysfunction. The normal BUN level is 8 to 25 mg/100 mL; normal creatinine range is 0.6 to
1.5 mg/100 mL.

58. (B) atomic number but a different mass number

Isotopes are atoms of the same element (the same atomic number or number of protons) but
a different mass number. They differ, therefore, in the number of neutrons. Atoms with the
same mass number but different atomic number are isobars. Atoms with the same atomic
number but different neutron number are isotones. Atoms with the same atomic number and
mass number are isomers.
59. (C) Intercondyloid fossa

The PA axial projection (Camp-Coventry method) of the intercondyloid fossa ("tunnel view") is
pictured. The knee is flexed about 40º, and the central ray is directed caudally 40º and
perpendicular to the tibia (Fig. 2-50). The patella and patellofemoral articulation are
demonstrated in the axial / tangential view of the patella.

60. (A) 1 and 2 only

AECs were originally developed in order to achieve more consistent and reproducible film
densities. This consistency reduces the number of retakes, thereby reducing patient
exposure dose. The two AECs that are most commonly used employ either a photomultiplier
tube or an ion (or ionization) chamber. The ion chamber is positioned between the table and
the cassette, whereas the photomultiplier is located below the cassette (Fig. 5-11).

61. (C) 2 and 3 only

About half the silver in a film emulsion remains to form the image. The other half is removed
from the film during the fixing process. Therefore, fixer solution has a high silver content.
Silver is a toxic metal and cannot simply be disposed of into the public sewer system. As
silver is also a precious metal, it becomes financially wise to recycle the silver removed from
x-ray film. The three most commonly used silver recovery systems are the electrolytic,
metallic replacement, and chemical precipitation methods. In electrolytic units, an electric
current is passed through the fixer solution. Silver ions are attracted to, and become plated
onto, the negative electrode of the unit. The plated silver is periodically scraped from the
cathode and accurately measured so that the hospital can be appropriately reimbursed. The
electrolytic method is a practical recovery system for moderate- and high-use processors.
The metallic replacement (or displacement) method of silver recoveryuses a steel mesh /
steel wool type of cartridge that traps silver as fixer is run through it. This system is useful for
low-volume processors and is often also used as a backup to the electrolytic unit. Chemical
precipitation adds chemicals that release electrons into the fixer solution. This causes the
metallic silver to precipitate out, fall to the bottom of the tank, and form a recoverable sludge.
This method is used principally by commercial silver dealers.

62. (B) 100 mR/h

X-ray photons produced in the x-ray tube can radiate in directions other than the one desired.
The tube housing is therefore constructed so that very little of this leakage radiation is
permitted to escape. The regulation states that leakage radiation must not exceed 100 mR/h
at 1 m while the tube is operated at maximum potential.

63. (A) Trendelenburg

The patient is said to be in the Trendelenburg position when the head is positioned lower
than the feet. This position is helpful in several radiographic procedures, such as separating
redundant bowel loops and demonstration of hiatal hernias. It is also used in treating shock.
In Fowler's position, the head is higher than the feet. The Sims position is the left posterior
oblique (LPO) position with the right leg flexed up for insertion of the enema tip. Stenver's is a
radiographic position for mastoids.

64. (D) 1, 2, and 3

With the patient in the AP position, the scapula and upper thorax are normally superimposed.
With the arm abducted, the elbow flexed, and the hand supinated, much of the scapula is
drawn away from the ribs. The patient should not be rotated toward the affected side, as this
causes superimposition of ribs on the scapula. The exposure is made during quiet breathing
to obliterate pulmonary vascular markings.

65. (A) Isotopes

130 138
56Ba and 56Ba are isotopes of the same element, barium (Ba), because they have the
same atomic number but different mass numbers (numbers of neutrons). Isobars are atoms
with the same mass number but different atomic numbers. Isotones have the same number
of neutrons but different atomic numbers. Isomers have the same atomic number and mass
number; they are identical atoms existing at different energy states.

66. (C) 2 and 3 only

Target angle has a pronounced geometric effect on the effective, or projected, focal spot size.
As the target angle decreases, the effective (projected) focal spot becomes smaller. This is
advantageous because it will improve radiographic detail without creating a heat-loading
crisis at the anode (as would occur if the actual focal spot size were reduced to produce a
similar detail improvement). There are disadvantages, however. With a smaller target angle,
the anode heel effect increases; photons are more noticeably absorbed by the "heel" of the
anode, resulting in a smaller percentage of x-ray photons at the anode end of the x-ray beam
and a concentration of x-ray photons at the cathode end of the radiograph.

67. (C) 1 and 2 only

An exposed radiographic film contains an invisible (latent) image. Only through processing
can this image be converted to a permanent, visible (manifest) image. As the film exits the
developer section, it passes through the crossover assembly, and before it enters the fixer
section, it passes through the squeegee assembly. The squeegee assembly rollers function
to remove excess developer solution from the emulsion before the film enters the fixer. This
process helps to maintain fixer strength / activity. The rate of travel through the processor is
determined by the transport mechanism, that is, the speed of the rollers as established at
time of manufacture.

68. (D) 1, 2, and 3

The chest is composed of tissues with widely differing densities (bone and air). In an effort to
"even out" these tissue densities and better visualize pulmonary vascular markings, high
kilovoltage is generally used. This produces more uniform penetration and results in a longer
scale of contrast, with visualization of the pulmonary vascular markings as well as bone
(which is better penetrated) and air densities. The increased kilovoltage also affords the
advantage of greater exposure latitude (an error of a few kV will make little if any difference).
The fact that the kilovoltage is increased means that the mAs is accordingly reduced, and
thus patient dose is reduced as well. A grid is usually used whenever high kilovoltage is
required.

69. (A) 1 only

In the PA projection of the chest, there should be no rotation, as evidenced by symmetrical
sternoclavicular joints. The shoulders are rolled forward to remove the scapulae from the lung
fields. Inspiration should be adequate to demonstrate 10 posterior ribs above the diaphragm
(the anterior ribs angle downward; the tenth anterior rib is the last attached to the sternum
and is very unlikely to be imaged on inspiration). The sternum should be seen lateral without
rotation in the lateral position of the chest.

70. (C) The patient states that he experiences extreme pain in the upright position
Obtaining a complete and accurate history from the patient for the radiologist is an important
aspect of a radiographer's job. Both subjective and objective data should be collected.
Objective data include signs and symptoms that can be observed, such as a cough, a lump,
or elevated blood pressure. Subjective data relate to what the patient feels, and to what
extent. A patient may experience pain, but is it mild or severe? Is it localized or general?
Does the pain increase or decrease under different circumstances? A radiographer should
explore this with a patient and document the information on the requisition for the radiologist.

71. (B) 1 and 2 only

Grids are devices constructed of alternating strips of lead foil and radiolucent interspacing
material. They are placed between the patient and the film, and they function to remove
scatter radiation from the remnant beam before it forms the latent image. Stationary grids will
efficiently remove scatter radiation from the remnant beam; however, their lead strips will be
imaged on the radiograph. If the grid is made to move (usually in a direction perpendicular to
the lead strips) during the exposure, the lead strips will be effectively blurred. The motion of a
moving grid, or Potter-Bucky diaphragm, may be reciprocating (equal strokes back and forth),
oscillating (almost circular direction), or catapult (rapid forward motion and slow return).
Synchronous refers to a type of x-ray timer.

72. (D) 1, 2, and 3

Blood and all other body fluids are carriers of HIV in infected individuals. Standard
precautions are taken to avoid contact with any blood or body fluids. However, HIV cannot be
transmitted via inanimate objects, such as drinking fountains and glassware.

73. (C) Electronic

The synchronous timer is an old type of timer that does not permit very precise, short
exposures. The impulse timer permits a shorter,more precise exposure, and the electronic
timer may be used for exposures as short as 0.001 s. The phototimer, however, automatically
terminates the exposure when the proper density has been recorded on the film. The
important advantage of the phototimer, then, is that it can accurately duplicate radiographic
densities. It therefore is very useful in providing accurate comparison in follow-up
examinations, and in decreasing patient exposure dose by decreasing the number of
"retakes" needed because of improper exposure. Remember that proper functioning of the
phototimer depends on accurate positioning by the radiographer.

74. (C) Incorrect positioning of the part being imaged

In the left and right oblique cervical spine radiographs seen in Figure 4-3, radiograph A
appears lighter than radiograph B. The key to their density difference lies in the fact that both
were performed using AEC during a particular examination. If the focused grid had been
placed upside down, only the central portion of the image (along the long axis of the image
receptor) would have been imaged. The remainder would demonstrate grid cutoff. Incorrect
photocell selection would most likely produce unsatisfactory images in both instances, not
just in one of the obliques. The lack of blurriness indicates that this is not a case of patient
motion. However, incorrect or different positioning of the part being imaged will cause the
AEC photocell (the center cell is selected for the cervical spine) to react differently. When the
photocell is "reading" exit radiation emerging from the cervical bodies, one exposure is
recorded. When the photocell is "reading" exit radiation emerging from the cervical spinous
processes / soft tissue, quite another (much lower
difference in radiographic density between the two radiographs in this example. This example
demonstrates the critical relationship between exact positioning and recorded density when
using AEC.

75. (D) 1, 2, and 3

Differential absorption refers to the x-ray absorption characteristics of neighboring anatomic
structures. The radiographic representation of these structures is referred to as radiographic
contrast; it may be enhanced with high-contrast technical factors, especially using low
kilovoltage levels. At low kilovoltage levels, the photoelectric effect predominates.

76. (D) 1/5 s

The mAs is the exposure factor that regulates radiographic density. The equation used to
determine mAs is mA × s = mAs. Substituting the known factors,

400x = 60
x = 0.2 (1/6) s

77. (D) Sensitometry

Sensitometry is a method of quality control for daily monitoring of the automatic film
processor. A densitometer is a device used to read optical density. Crossover rollers should
be cleaned daily to prevent the buildup of crystallized solution on the rollers. A warm-up
procedure is performed on an x-ray tube for safe operation after prolonged disuse.
78. (C) 2 and 3 only
The OSL is rapidly becoming the most commonly used personnel monitor today. Film badges
and TLDs have been used successfully for years. A pocket dosimeter is used primarily when
working with large amounts of radiation and when a daily reading is desired.

79. (B) parietoacanthial projection (Waters' method)

Blowout fractures of the orbital floor are well demonstrated by using the Waters' method
[parietoacanthial (PA) projection] and by using tomographic studies. A PA with the OML
perpendicular and the central ray angled 30º caudad will demonstrate the orbital floor in
profile. Sweet's localization method shows the exact placement of foreign bodies within the
eye.

80. (A) Flexion

The radiograph shown is a lateral projection of the cervical spine taken in flexion. Flexion and
extension views are useful in certain cervical injuries, such as whiplash, to indicate the
degree of anterior and posterior motion. The structure labeled 1 is an apophyseal joint;
because apophyseal joints are positioned 90º to the MSP, they are well visualized in the
lateral projection. The structure labeled 2 is a vertebral body.

81. (A) femoral neck

Femoral necks are nonpalpable bony landmarks. The ASIS, pubic symphysis, and greater
trochanter are palpable bony landmarks used in radiography of the pelvis and for localization
of the femoral necks.

82. (B) 1 and 2 only

Emphysema is abnormal distention of the alveoli (or tissue spaces) with air. The presence of
abnormal amounts of air makes it necessary to decrease from normal exposure factors.
Congestive heart failure and pleural effusion involve abnormal amounts of fluid in the chest
and thus require an increase in exposure factors.

83. (A) ejects an inner-shell tungsten electron

Characteristic radiation is one of two kinds of x-rays produced at the tungsten target of the x-
ray tube. The incident, or incoming, high-speed electron ejects a K-shell tungsten electron.
This leaves a hole in the K shell, and an L-shell electron drops down to fill the K vacancy.
Because L electrons are at a higher energy level than K-shell electrons, the L-shell electron
gives up the difference in binding energy in the form of a photon, a "characteristic x-ray"
(characteristic of the K shell).
84. (B) First metacarpal
The first metacarpal, on the lateral side of the hand, articulates with the most lateral carpal of
the distal carpal row, the greater multangular / trapezium. This articulation forms a rather
unique and very versatile saddle joint, named for the shape of its articulating surfaces.

85. (C) attenuation

Absorption occurs when an x-ray photon interacts with matter and disappears, as in the
photoelectric effect. Scattering occurs when there is partial transfer of energy to matter, as in
the Compton effect. The reduction in the intensity of an x-ray beam as it passes through
matter is called attenuation.

86. (C) High-kVp exposure factors

When tissue densities within a part vary greatly (e.g., chest x-ray), the radiographic result can
be unacceptably high contrast. In order to "even out" these densities and produce a more
appropriate scale of grays, exposure factors using high kVp should be employed.
Radiographic contrast generally increases with an increase in screen speed. The higher the
grid ratio, the higher the contrast. Exposure factors using high mAs generally result in
excessive film density, frequently obliterating much of the gray scale.

87. (B) 1 and 3 only

Focal spot size affects recorded detail by its effect on focal spot blur: The larger the focal spot
size, the greater the blur produced. Recorded detail is significantly affected by distance
changes because of their effect on magnification. As SID increases, magnification decreases
and recorded detail increases. The method of rectification has no effect on recorded detail.
Single-phase rectified units produce "pulsed" radiation, whereas three-phase units produce
almost constant potential.

88. (B) 1 and 2 only

It is our ethical responsibility to minimize radiation exposure to ourselves and our patients,
particularly during early pregnancy. One way to do this is to inquire about the possibility of
our female patients being pregnant, or for the date of their last menstrual period (to determine
the possibility of irradiating a newly fertilized ovum). The safest time for a woman of
childbearing age to have elective radiographic exams is during the first10 days following the
onset of menstruation.

89. (B) 4 min

Each x-ray exposure made by the radiographer produces hundreds or thousands of heat
units at the target. If the examination requires several consecutive exposures, the potential
for extreme heat load is increased. Just as each x-ray tube has its own radiographic rating
chart, each tube also has its own anode cooling curve to describe its unique heating and
cooling characteristics. An x-ray tube generally cools most rapidly during the first 2 min of
nonuse. First, note that the tube is saturated with heat at 300,000 heat units. In order for
another 160,000 heat units to be safely applied, the x-ray tube must first release 160,000
heat units, which means that it has to cool down at least to 140,000 heat units. Find the
140,000 point on the vertical axis and follow across to where it intersects with the cooling
curve. It intersects at about the 4-min point.

90. (B) 1 and 2 only

Traditional x-ray imaging involves formation of the x-ray image directly on the image receptor
(film). In digital imaging, x-rays form an electronic image on a special radiation detector. This
electronic image can be manipulated by a computer and stored in the computer memory or
displayed as a matrix of intensities. This final digital image is often viewed on a computer
monitor and looks just like a traditional x-ray image, but the computer often has the capability
of postprocessing image enhancement.

91. (C) scoliosis

Scoliosis is a lateral curvature of the spine and is typically noted in early adolescence. These
young patients usually return for follow-up studies, and it is imperative to limit their radiation
dose as much as possible. Examining the patient in the PA position is frequently advisable,
because the gonadal dose is significantly reduced and there is usually no appreciable loss of
detail. Thyroid and breast shields are also a valuable protection, especially for the patient
who requires follow-up examinations. Bending films would not be performed on a patient with
suspected subluxation or spondylolisthesis, as further serious injury could result.

92. (B) hypotensive

Systolic blood pressure describes the pressure during contraction ofthe heart. It is expressed
as the top number when recording blood pressure. Diastolic blood pressure is the reading
during relaxation of the heart and is placed on the bottom when recording blood pressure. A
patient is considered hypertensive when systolic pressure is consistently above 140 mmHg,
and hypotensive when the systolic pressure is lower than 90 mmHg.

93. (B) 1 and 2 only

In fluoroscopy, the source of x-rays is 12-15inches below the x-ray tabletop. Since the SOD is
so short, patient skin dose can be quite high. Consequently, the x-ray intensity at the tabletop
is limited in order to keep patient dose (ESE) within safe limits. The radiation protection
guidelines state that x-ray intensity at tabletop must not exceed 2.1 R/min/mA at 80 kVp. In
equipment without high-level fluoroscopy capability the guideline can be expressed as 10
R/min tabletop limit. In equipment with high-level fluoroscopy capability, the tabletop limit is
20 R/min.

94. (C) Angle the central ray 10º posteriorly

In the dorsoplantar projection of the foot, the central ray may be directed perpendicularly or
angled 10º posteriorly. Angulation serves to "open" the tarsometatarsal joints that are not well
visualized on the dorsoplantar projection with perpendicular ray. Inversion and eversion of the
foot do not affect the tarsometatarsal joints.

95. (A) 1 and 2 only

Because the sternum and vertebrae would be superimposed in a direct PA or AP projection,
a slight oblique (just enough to separate the sternum from superimposition on the vertebrae)
is used instead of a direct frontal projection. In the RAO position, the heart superimposes a
homogeneous density over the sternum, therebyproviding clearer radiographic visualization
of its bony structure. If the LAO position were used to project the sternum to the right of the
thoracic vertebrae, the posterior ribs and pulmonary markings would cast confusing shadows
over the sternum becauseof their differing densities. The lateral projection requires that the
shoulders be rolled back sufficiently to project the sternum completely anterior to the ribs.
Prominent pulmonary vascular markings can be obliterated using a "breathing technique,"
that is, using an exposure time long enough (with appropriately low milliamperage) to equal at
least a few respirations.

96. (A) emphysema

Overdistention of the alveoli with air is emphysema. The condition is often a result of many
years of smoking and is characterized by dyspnea, especially when recumbent. Empyema is
pus in the thoracic cavity; pneumothorax is air or gas in the pleural cavity. Pneumoconiosis is
a condition of the lungs characterized by particulate matter having been deposited in lung
tissue; it sometimes results in emphysema.

97. (C) 0.03 s

The mAs formula is milliamperage × time = mAs. With two of the factors known, the third can
be determined. To find the mAs that was originally used, substitute the known values:
300 × 0.1 = 30
We have increased the kilovoltage to 86, an increase of 15 percent, which has an effect
similar to that of doubling the mAs. Therefore, only 15 mAs is now required as a result of the
kV increase:
mA × s = mAs; 500x = 15; x = 0.03 s exposure

98. (D)Radiography of pediatric patients with a myelomeningocele defect should be

performed in the supine position
Radiography of pediatric patients with a myelomeningocele defect should be performed in the
prone position, rather than the routine supine position. The supine position would put
unnecessary pressure on the protrusion of the meninges and spinal cord. All of the other
statements in the question are true. The anatomic dimensions of children are different from
those of adults, and this must be kept in mind when performing pediatric radiography. The
liver occupies a larger area of the abdominal cavity in a child than in an adult. This causes
the kidneys to be in a lower position. Generally, the kidneys will be midway between the
diaphragm and the symphysis pubis. Chest radiography for the pediatric patient varies
depending on the age of the child. Neonates are routinely radiographed in the supine
position. Although infants may also be examined in the supine position, it is preferable to
examine them byplacing the infant securely in a support device to obtain a good PA erect
radiograph. Exceptions to this rule are made if the infant is in respiratory distress. To avoid
aggravating the respiratory distress, an erect AP radiograph is usually obtained.

99. (B) excessive humidity

Unopened film is sealed in a moisture-proof package to protect it from excessive humidity.
The unopened bag will not protect it from radiation or excessive heat. Once the foil bag is
open, the film is much more susceptible to excessive humidity.

100. (C) beta, x-, and gamma radiations

The occupational dose limit is valid for beta, x, and gamma radiations. Because alpha
radiation is so rapidly ionizing, traditional personnel monitors will not record alpha radiation.
However, because alpha particles are capable of penetrating only a few centimeters of air,
they are practically harmless as an external source.