Question 1

A patient comes to radiology for a thoracic spine routine.The patient has a history of arthritis of the spine.The radiologist requests that additional projections be taken to demonstrate the zygapophyseal joints.What position(s) and/or projection(s) would be ideal to demonstrate these structures?

Accepted Answer

The 70° oblique projections are ideal for demonstrating the zygapophyseal joints as they provide a clear view of the joint space by projecting it parallel to the image receptor. A "pillar view" projection does not exist, a swimmer's lateral projection would not provide the desired view, and spot AP and lateral projections would not provide as clear of a view as the 70° oblique projections.

Question 2

For an average-size adult, which of the following would receive the highest skin dose?

Accepted Answer

The answer of For an average-size adult, which of the...

Question 3

The structure labeled A, which should be well demonstrated on this projection, is the:

Accepted Answer

The answer of The structure labeled A, which should be...

Question 4

A critique of the image demonstrates which repeatable error?

Accepted Answer

The image is not demonstrating any repeatable error.

Question 5

A digital image taken of a lateral thoracic spine projection demonstrates poor visibility of the spine.The image was taken on a full 14- × 17-inch (35- × 43-cm) IR.The following factors were used during the exposure: 80 kV, 80 mAs, 40-inch (102-cm) SID, and collimation to the size of the IR.Which one of the following modifications will result in a more diagnostic image?

Accepted Answer

Collimating to the area of interest, in this case, the spine, reduces scatter radiation and improves image contrast, leading to a more diagnostic image.

Question 6

A patient comes to radiology for a follow-up study of the cervical spine.The patient had spinal fusion between C5 and C6 performed 6 months earlier.His physician wants to assess the cervical spine for anteroposterior mobility.Which of the following projections would provide this assessment?

Accepted Answer

Hyperflexion and hyperextension projections would provide an assessment of anteroposterior mobility of the cervical spine as they demonstrate the flexibility of the spine in these extreme positions.

Question 7

A radiograph of an RAO of the cervical spine reveals that the lower intervertebral foramina are not open.The upper vertebral foramina are well visualized.Which positioning error most likely lead to this radiographic outcome?

Accepted Answer

Insufficient rotation of the upper body can result in the lower intervertebral foramina not being open, while the upper foramina are well visualized. Proper rotation is necessary to align the foramina parallel to the image receptor.

Question 8

A patient enters the emergency department (ED) because of a motor vehicle accident (MVA).The patient is on a backboard and wearing a cervical collar.The technologist is concerned about the artifacts that the collar will project on the spine during the horizontal beam lateral projection.What should the technologist do in this situation?

Accepted Answer

Leaving the cervical collar on during the exposure is the safest option to prevent further injury to the patient's spine, especially when the full extent of the injuries is not yet known.

Question 9

Which of the following projections will project the dens within the shadow of the foramen magnum?

Accepted Answer

The AP projection using the Fuchs method is specifically designed to project the dens within the shadow of the foramen magnum. This projection is used to evaluate the atlantoaxial joint, which is formed by the dens and the atlas (C1 vertebra). The AP open mouth projection is used to evaluate the odontoid process and the cervical vertebrae C1-C2, but it does not necessarily project the dens within the foramen magnum shadow. The Twining method is a specialized projection used to evaluate the submentovertex view of the dens, but it is not as commonly used as the AP Fuchs method.

Question 10

A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral joints are not open.The following analog factors were used for this projection: 5° cephalad angle, 40-inch (100-cm) SID, grid, slight extension of the skull, and the CR centered to the thyroid cartilage.Which of the following modifications should be made during the repeat exposure?

Accepted Answer

The intervertebral joints not being open indicates that the CR was not angled enough or angled in the wrong direction. Increasing the angle of the CR (in this case, angle it more cephalad) will help open up the intervertebral joints and produce a better image. Therefore, choice D is the best option.Keeping the CR perpendicular to the image receptor (choice A) would not help to open up the intervertebral joints. Increasing the SID to 72 inches (choice B) may reduce magnification, but it will not solve the problem of the intervertebral joints not being open. Centering the CR to the gonion (choice C) is not relevant to this projection.

Question 11

A patient comes to the radiology department for a cervical spine routine.The study is ordered for nontraumatic reasons.The AP open-mouth projection reveals that the base of the skull and upper incisors are superimposed, but they are obscuring the upper portion of the dens.On the repeat exposure, what should the technologist do to demonstrate the upper portion of the dens?

Accepted Answer

The Fuchs or Judd method is used to demonstrate the upper portion of the dens when the base of the skull and upper incisors are superimposed on the AP open-mouth projection. This method requires the patient to open their mouth widely and pull their tongue out of their mouth, which will displace the soft tissues and allow for better visualization of the dens. Increasing the flexion or extension of the skull may not solve the problem of superimposition of the base of the skull and upper incisors. The AP chewing projection is used to visualize the temporomandibular joint, and is not indicated for demonstrating the upper portion of the dens.

Question 12

A radiograph of an AP open-mouth projection reveals that the base of the skull is superimposed over the dens.What positioning error led to this radiographic outcome?

Accepted Answer

Excessive extension of the skull led to the base of the skull being superimposed over the dens. This is because the extension causes the skull to move backward, making the base of the skull appear larger and superimpose over the dens, which is located anteriorly.

Question 13

A patient enters the ED with a cervical spine injury as a result of a fall.The initial horizontal beam lateral projection reveals no subluxation or fracture.The ED physician is concerned about a whiplash injury.Which of the following routines would be most helpful in diagnosing this type of injury?

Accepted Answer

Whiplash injuries are best diagnosed using lateral flexion and extension views of the cervical spine. These views can help identify any abnormal movement or instability in the cervical spine, which is a hallmark of whiplash injury. The swimmer's lateral position and oblique projections are useful in evaluating other types of cervical spine injuries, but may not be as helpful in diagnosing whiplash injuries. The AP Ottonello method is not a standard view for evaluating the cervical spine and would not be helpful in this scenario.

Question 14

A radiograph of a lateral projection (nontrauma) of the cervical spine reveals that the ramus of the mandible is superimposed over the spine.What could the technologist have done to prevent this?

Accepted Answer

By elevating the chin to place the acanthiomeatal line (AML) parallel with the floor, the ramus of the mandible will not obstruct the cervical spine on the radiograph. AML is an imaginary line that connects the acanthion (the point where the upper lip meets the base of the nose) to the external auditory meatus (the opening of the ear canal). It is used to align the head in radiographic imaging. Rotation of the skull (choice B), caudad angulation of the CR (choice C), or having the patient hold weights (choice D) would not prevent superimposition of the mandible and spine.

Question 15

A radiograph of an AP thoracic spine projection reveals that the upper thoracic spine is overexposed.The lower vertebrae have acceptable density and contrast.Which one of the following modifications will improve the visibility of the upper thoracic spine?

Accepted Answer

Using a compensating (wedge) filter will improve the visibility of the upper thoracic spine by decreasing the amount of radiation reaching that area, therefore reducing overexposure. Placing the upper spine under the cathode side of the tube (option A) would increase the amount of radiation received and worsen the overexposure. Increasing kV (option C) would decrease contrast, but would not necessarily address the overexposure issue. Using a breathing technique (option D) is not applicable to this scenario.

Question 16

What is the recommended kV range for thoracic spine projections when using digital systems?

Accepted Answer

The recommended kV range for thoracic spine projections when using digital systems is 75 to 85 kV. This range provides optimal penetration and contrast for imaging the thoracic spine, ensuring that both bony structures and soft tissues are adequately visualized.

Question 17

This radiographic image represents which of the following projections and/or positions?

Accepted Answer

The answer of This radiographic image represents which of the...

Question 18

A lateral projection of the thoracic spine reveals that the upper aspect, which is a primary area of interest on this patient, is obscured by the patient's broad shoulders.Which of the following options will best demonstrate this region of the spine?

Accepted Answer

When the upper aspect of the thoracic spine is obscured by the patient's broad shoulders, a cervicothoracic (swimmer's) lateral position should be performed. This position allows for the shoulders to be pulled forward and out of the way, which will demonstrate the upper thoracic spine without obstruction. A compensating filter and increased kV will not help in this situation. Angling the CR cephalad may help to demonstrate the upper thoracic spine but will not completely remove the obstruction caused by the patient's broad shoulders. Performing the projection with the patient holding weights during exposure is not a viable option as it may cause discomfort to the patient and will not remove the obstruction caused by the patient's broad shoulders.

Question 19

A radiograph of a lateral thoracic spine reveals that there is excessive density along the posterior aspect of the spine.Even with good collimation, the scatter radiation reaching the image receptor obscures the spinous processes.What can the technologist do to improve the visibility of the posterior elements of the spine?

Accepted Answer

By placing a lead mat on the tabletop just posterior to the patient, the scatter radiation can be reduced and the visibility of the posterior elements of the spine can be improved. This technique, known as a "backscatter shield," is particularly useful when there is excessive density along the posterior aspect of the spine. Using higher-speed screens and film or a higher-ratio grid may reduce scatter radiation to some extent, but they do not address the specific issue of excessive density along the posterior aspect of the spine. Increasing the kV and lowering the mAs may further increase scatter radiation and worsen the problem.

Question 20

A radiograph of an AP open-mouth projection of the cervical spine reveals that the zygapophyseal joints are not symmetric.No fracture or subluxation is present.Which one of the following positioning errors most likely led to this radiographic outcome?

Accepted Answer

The zygapophyseal joints are not symmetric, which indicates that the cervical spine is rotated. This most likely occurred due to incorrect patient positioning, where the patient's head and/or neck was not aligned properly with the central ray. Excessive or insufficient CR angulation or excessive flexion of the head would not cause asymmetry of the zygapophyseal joints.

Quiz 8: Cervical and Thoracic Spine