Ouhsc Advanced Imaging & Critique Test 2

Front 1

Name all the carpal bones

Back 1

Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate

Front 2

Which wrist bone is most commonly fractured?

Back 2

Distal radius, followed by scaphoid

Front 3

Where is the anatomical snuffbox?

Back 3

Posterior surface of wrist, triangular depression visible when thumb is abducted & extended

Front 4

When the posterior fat pad of the elbow is visualized on x-ray, what does that mean?

Back 4

Elbow pathology

Supinator & Anterior fat pads are typically seen in lateral elbow x-rays

Front 5

Why are correct exposure factors so important for a lateral elbow x-ray?

Back 5

Visualization of fat pads may be the only evidence of injury

Front 6

What causes carpal tunnel syndrome?

Back 6

Compression of the median nerve inside the carpal tunnel

Front 7

What percentage of all fractures are hand fractures?

Back 7

10%

Front 8

Norgaard Method (AP Oblique Hands)

Back 8

- "BALL CATCHERS" position
- helpful for diagnosing rheumatoid arthritis & fractures of the base of the 5th metacarpal
- use 45 degree sponges to support hands, CR placed perpendicular midway between hands at MCP joint level

Front 9

Lateral Hand in Flexion

Back 9

- helps evaluate radiolunate angle (can show fractures, dislocation, or ligament injury); normally angle is 10 degrees
- Hand lateral w/ fingers flexed, 1st digit not superimposing; CR perpendicular to 2nd MCP joint

Front 10

What does an AP wrist show you that a PA wrist doesn't?

Back 10

Carpal interspaces b/c of beam divergence (more parallel to divergence from CR)

Front 11

What's seen differently between the PA Oblique Wrist & the AP Oblique Wrist

Back 11

- PA Oblique shows scaphoid & trapezium
- AP Oblique shows triquetrum, hamate, & pisiform

Front 12

Which joint spaces should be open on a correctly positioned PA oblique wrist/

Back 12

Trapeziotrapezoid & scaphotrapezial joint spaces

Front 13

AP Oblique Wrist

Back 13

- from pronated position, rotate wrists externally (laterally) 45 degrees
- CR perpendicular to midcarpal area
- separates pisiform from adjacent carpals

Front 14

Ulnar Deviation

Back 14

- position for a PA projection, turn hand outward until wrist is in extreme ulnar deviation
- CR perpendicular to midcarpal area
- this creates correct foreshortening of the scaphoid (becomes perpendicular to IR)

Front 15

Radial Deviation

Back 15

- position for a PA projection, turn hand medially until wrist is in extreme radial deviation
- CR perpendicular to midcarpal area
- opens interspaces of carpals on medial side of wrist

Front 16

PA Axial - Stecher Method

Back 16

- IR & wrist placed on 20 degree sponge (placing scaphoid perpendicular to CR); CR perpendicular entering scaphoid
- can use a 20 degree CR angulation if no sponges are available
- shows scaphoid fractures (account for more than 60% of carpal injuries); part of the anatomical snuff box is formed by scaphoid (hard to get blood to the injured site when it's cut off or narrowed)

Front 17

Gaynor-Hart Method (Carpal Canal)

Back 17

- move hand as close as possible to vertical in relation to IR (pull fingers back into extreme hyperextension)
- CR 25-30 degrees to long axis of hand, enters 1" proximal to base of 3rd MC
- allows view of carpal sulcus

Front 18

What happens if the hand cannot be hyperextended enough for the Gaynor-Hart Method?

Back 18

When hand cannot be extended within 15 degrees of vertical, CR is angled 15 degrees past parallel w/ palmar surface

Front 19

Fracture of the radial shaft alone usually occurs in the ________________ (proximal/distal) 1/3 of the shaft

Back 19

Distal

Front 20

What kind of fracture comprises 1/3 of elbow fractures?

Back 20

Fracture of radial head (identified using "Mason Classification")

Front 21

"Nightstick Fracture"

Back 21

- fracture of ulnar shaft
- mechanism of injury is most often a direct blow acquired in a defensive maneuver

Front 22

Elbow dislocations are often due to....

Back 22

Falls on an outstretched hand

80-90% are posteriolateral dislocations

Front 23

What is the "carrying angle"?

Back 23

Valgus angle formed between distal humerus & proximal ulna (normal = 5-15 degrees)

Front 24

Radial Head Series

Back 24

- forearm/elbow placed in lateral position flexed 90 degrees
- hand rotated internally & externally to various positions for 4 total images
- radial tuberosity faces anteriorly for supination & neutral images; faces posteriorly for pronation & internal rotation images

Front 25

Coyle Method (Axiolateral)

Back 25

- used on patients who can't fully extend elbow (trauma)
- 2 total images
- Image 1: elbow flexed 90 degrees w/ hand pronated, CR 45 degrees TOWARDS the shoulder (following humerus away from elbow) [see the radial head & capitulum]
- Image 2: elbow flexed 80 degrees w/ hand pronated; CR 45 degrees AWAY from shoulder (following humerus towards elbow) [see coronoid process & trochlea]

Front 26

What comprises the primary curve of the spine?

Back 26

Thoracic & Sacrum/Pelvic Region

Concave anteriorly (Kyphotic)

Front 27

What comprises the secondary curve of the spine?

Back 27

Cervical & Lumbar

Convex anteriorly (Lordotic)

Front 28

What is the vertebra prominens?

Back 28

C7; prominent spinous process that projects almost horizontally to the posterior

Front 29

Intervertebral Joint Components

Back 29

Between 2 vertebral bodies

Front 30

Zygapophyseal Joint Components

Back 30

Articulation processes of the vertebral arches

Front 31

Costovertebral Joint Components

Back 31

Heads of ribs articulating w/ bodies of vertebrae

Front 32

Intervertebral Foramina Components

Back 32

Formed by vertebral notches

Front 33

Fuchs Method (AP Odontoid/Dens)

Back 33

- chin & tip of mastoid processes are perpendicular to IR (like MML perpendicular to IR)
- CR enters neck on MSP just distal to tip of chin
- do this when the Open Mouth Odontoid method doesn't work

Front 34

AP Oblique C-Spine (RPO/LPO)

Back 34

- 72" SID
- body at a 45 degree angle w/ IR
- CR 15-20 degrees cephalic entering C4
- looking at intervertebral foramina & pedicles FARTHEST from IR

Front 35

PA Oblique C-Spine (RAO/LAO)

Back 35

- 72" SID
- body at a 45 degree angle w/ IR
- CR 15-20 degrees caudal entering C4
- looking at intervertebral foramina & pedicles CLOSEST to IR

Front 36

Where is the CR centered to on AP T-Spine?

Back 36

T7, halfway between jugular notch & xiphoid process

Front 37

AP Oblique T-Spine (LPO/RPO)

Back 37

- Rotated 20 degrees posterior so that coronal plane forms 70 degree angle w/ IR
- see the zygapophyseal joints
- AP shows joint FARTHEST from IR

Front 38

PA Oblique T-Spine (LAO/RAO)

Back 38

- Rotated 20 degrees anterior so that coronal plane forms a 70 degree angle w/ IR
- PA shows joint CLOSEST to IR

Front 39

Where is the CR centered for the L5/S1 Spot Image?

Back 39

2" posterior to ASIS & 1.5" inferior to iliac crest

Front 40

AP Oblique L-Spine (RPO/LPO)

Back 40

- from supine, rotate patient 45 degrees
- see the zygapophyseal joints CLOSEST to the IR

Front 41

PA Oblique L-Spine

Back 41

- from prone, rotate patient 45 degrees
- see the zygapophyseal joints FARTHEST from IR

Front 42

On oblique L-spine, when the z-joints aren't well seen and the pedicle is anterior on the vertebral body, the patient..... (isn't rotated enough/rotated too much)

Back 42

Isn't rotated enough

Front 43

On oblique L-spine, when the z-joints aren't well seen and the pedicle is posterior on the vertebral body, the patient..... (isn't rotated enough/rotated too much)

Back 43

Rotated too much

Front 44

Scottie Dog Parts - Ears

Back 44

Superior Articulating Process

Front 45

Scottie Dog Parts - Nose

Back 45

Transverse Process

Front 46

Scottie Dog Parts - Eye

Back 46

Pedicle

Front 47

Scottie Dog Parts - Neck

Back 47

Pars Interarticularis

Front 48

Scottie Dog Parts - Feet

Back 48

Inferior Articulating Process

Front 49

Scottie Dog Parts - Body

Back 49

Lamina

Front 50

Ankylosing Spondylitis

Back 50

- rheumatoid arthritis variant involving SI joints & spine
- "bamboo sign" seen on lateral images (disc spaces become calcified)
- "dagger sign" on AP images (ossification of supraspinous & interspinous ligaments)

Front 51

Clay Shoveler's Fracture

Back 51

Avulsion fracture of spinous process in lower C- & upper T-spine region

Front 52

Hangman's Fracture

Back 52

Fracture of anterior arch of C2 owing to hyperextension

Front 53

Teardrop Fracture

Back 53

Fracture occurs when a triangular fragment of bone is separated from the anteroinferior corner of the vertebral body b/c of either an avulsion force sustained during hyperextension, or a compressive force sustained during hyperflexion

Front 54

Subluxation

Back 54

Incomplete or partial dislocation of the vertebrae

Front 55

Spondylolisthesis

Back 55

- forward displacement of a vertebra over a lower vertebra
- usually at L5-S1
- AP images may show "inverted Napoleon hat" sign

Front 56

Spondylolysis

Back 56

- breaking down of vertebra
- break in the "neck" of the Scottie dog ("dog collar") is a fracture in region of pars interarticularis

Front 57

Name the Tarsals

Back 57

Calcaneus, Talus, Navicular, Cuboid, Medial / Intermediate / Lateral Cunieforms

Front 58

What's the largest sesamoid bone in the body?

Back 58

Patella

Front 59

Jones Fracture

Back 59

Avulsion fracture of the base of the 5th metatarsal

Front 60

What other kinds of fractures is a fracture of the calcaneus related to?

Back 60

Vertebral compression fracture of thoracolumbar spine

Front 61

Hallux Valgus

Back 61

- bunion
- increase in bone or inflammation of joint of great toe

Front 62

Sesamoiditis

Back 62

- results from lots of stress placed on sesamoid bone
- looks eaten away in x-ray (nonuniform cortical outline)

Front 63

How must the ankle be placed in a lateral foot x-ray?

Back 63

Dorsiflexed

Front 64

Lateromedial Foot

Back 64

- true lateral projection
- turn patient to unaffected side (LPO/RPO position)
- metatarsals are more superimposed

Front 65

Dorsoplantar Axial Calcaneus

Back 65

- can be used if calcaneus fracture is highly suspected or confirmed on Oblique/Lateral Foot x-rays
- CR 40 degrees caudal, through dorsal surface of ankle joint

Front 66

Lewis Method (Sesamoid)

Back 66

- prone
- dorsiflex great toe & adjust ball of foot perpendicular to IR
- CR perpendicular to head of 1st metatarsal

Front 67

Holly Method (Sesamoid)

Back 67

- supine or seated on table
- patient holds toe flexed w/ gauze strip
- CR perpendicular to head of 1st metatarsal

Front 68

What's the most commonly injured weight bearing joint of the body?

Back 68

Ankle joint

Front 69

What needs to be seen on a good ankle x-ray?

Back 69

- tibiotalar joint space
- talofibular joint space (Mortise)
- tibiofibular joint space (Oblique)
- include base of 5th metatarsal on lateral

Front 70

What angle should be on the CR in a lateral knee x-ray?

Back 70

5-7 degrees cephalic

Front 71

Merchant Method

Back 71

- knees flexed 40 degrees off the table, IR placed on holder around ankles, CR above shoulder
- CR 30 degrees caudal from horizontal plane
- minimum of 60" SID to reduce magnification

Front 72

Settegast Method

Back 72

- typical Sunrise view
- prone, flex knee 90 degrees, CR 15-20 angled entering the joint space
- don't attempt until transverse fracture of patella has been ruled out

Front 73

Hughston

Back 73

- prone, tib/fib flexed 50-60 degrees from the table (if tall enough, patient can rest foot on tube)
- CR 45 degrees cephalic, entering patellofemoral joint
- good for bilateral knee comparison

Front 74

How much should the feet be internally rotated on an AP Femur - Upper Portion?

Back 74

15-20 degrees

Front 75

Teufel Method

Back 75

- visualizes the fovea capitis & superoposterior wall of acetabulum
- semi-prone, rotated 38 degrees from table, affected side down (support body on forearm & flexed knee of elevated side)
- CR 12 degrees cephalic entering level of inferior coccyx & 2" lateral to MSP toward side being examined

Front 76

Judet Method - Internal Oblique Position

Back 76

- supine w/ affected hip up
- CR enters 2" inferior to ASIS of affected side
- used to see suspected fractures of iliopubic column & posterior rim of acetabulum

Front 77

Judet Method - External Oblique Position

Back 77

- supine w/ affected hip down
- CR enters pubic symphysis
- used for suspected fracture of ilioischial column & anterior rim of acetabulum

Front 78

Taylor Method (AP Axial Outlet)

Back 78

- supine
- males: CR 20-35 degrees cephalic centered 2" distal to superior border of pubic symphysis
- females: CR 30-45 degrees cephalic centered 2" distal to superior border of pubic symphysis

Front 79

PA Anterior Pelvic Bones

Back 79

- prone
- long axis of IR centered @ level of greater trochanters
- center CR to IR
- will see pubic & ischial bones not magnified or superimposing sacrum/coccyx

Front 80

RPO/LPO Ilium

Back 80

- elevate unaffected side 40 degrees to place broad surface of wing of affected ilium parallel to IR
- center long axis of IR to level of ASIS, center CR to IR

Front 81

RAO/LAO Ilium

Back 81

- elevate unaffected side 40 degrees to place affected ilium perpendicular to IR
- center IR to level of ASIS, center CR to IR

Front 82

What does DEXA stand for?

Back 82

Dual Energy X-ray Absortiometry

Front 83

How many fractures is osteoporosis responsible for annually?

Back 83

3 Million

Front 84

Estrogen & Bone Density

Back 84

- estrogen inhibits bone resorption
- calcium supplements enhance the effect of estrogen on bone density
- increased risk of breast cancer, deep vein thrombosis, & pulmonary emoblism

Front 85

Bone Mineral Density (BMD)

Back 85

- amount of mineral in a specific site divided by the area measured
- predictor of fracture risk
- high BMD = skeletal strength

Front 86

Equipment Used for BMD

Back 86

- dual energy levels: measurement of bone density is dependent on ATTENUATION OF THE BEAM.
- soft tissue & bone attenuation depends on the energy of the beam
- able to optimize the differentiation in the densities of the attenuation

Front 87

Pencil Beam DEXA

Back 87

- uses 40 keV & 70 keV
- measurement made by x-ray source & detector moving back & forth and upward

Front 88

Fan Beam DEXA

Back 88

- uses 70 kVp & 140 kVp
- x-ray source is emitted from under the patient in a narrow fan shape & moves slowly up while exposing

Front 89

Quantitative Computed Tomography (QCT)

Back 89

- measures trabecular bone loss
- costs more, takes longer, higher dose (30-70 mrem)
- separate measures of cortical & trabecular BMD as true volumetric density
- spiral multi-slice 3D imaging

Front 90

OU Peripheral Quantitative Computed Tomography (pQCT) Lab

Back 90

- measures trabecular, cortical, & subcortical bone density by making cross-sectional images
- can also see muscle density, intramuscular & subcutaneous fat

Front 91

World Health Organization (WHO) Definitions of Diseases

Back 91

- Osteoporosis -2.5 standard deviations below normal
- Osteopenia -1.0 to -2.49 standard deviations below normal
- Normal above -1.0

Risk of fracture doubles for each standard deviation below normal

Front 92

What does the T-score predict?

Back 92

Fracture risk (advanced age is independent risk)

Front 93

Radiologic Positions for DEXA

Back 93

AP Hip (Proximal Femur)
AP Lumbar Spine
Forearm
Total Body

Front 94

When are total body DEXAs done?

Back 94

To study osteoporosis, obesity, fat distribution & diabetes

Front 95

Treatment of Osteoporosis

Back 95

- selective estrogen receptor modulators (SERMs)
- acts as estrogen agonists or antagonists, dependent on target tissue

Front 96

Tamoxifen

Back 96

- estrogen antagonist in breast tissue
- partial agonist in bone, cholesterol metabolism & the endometrium
- doesn't completely stop bone loss
- increases risk of endometrial cancer

Front 97

Raloxifene (Evista)

Back 97

- inhibits action of estrogen in breast & endometrium
- estrogen agonist on bone & lipid metabolism
- reduces markers of bone turnover to premenopausal concentrations
- works best for vertebral fractures

Front 98

Bisphosphonates

Back 98

- inhibitors of bone resorption, reducing activity of osteoclasts
- oral bio-availability is impaired by food, calcium, iron, coffee, tea, & OJ
- ex. Alendronate (Fosamax) [proven to reduce fractures in at-risk patients]

Front 99

Bone Builder Drug

Back 99

- Forteo
- stimulates osteoblasts to build more bone
- reduces fractures by 90%
- normal side effects (dizziness, nausea, vomiting, muscle weakness)

Front 100

How many people in the US suffer from osteoporosis?

Back 100

More than 28 million

Front 101

Facts about Hip Fractures

Back 101

- only 15% are walking unassisted after 6 months
- 50% are never able to walk unassisted again
- 15-20% will die within a year

Front 102

Men account for _______ (what percentage) of all hip fractures

Back 102

30%

Osteoporosis in men is under-diagnosed

Front 103

Prevention of Osteoporosis in Males

Back 103

- active lifestyle w/ weight-bearing exercises
- stop smoking
- get a baseline scan
- recommended amount of calcium

Front 104

How many lobes does each breast contain?

Back 104

15 & 20

Outlet of ductal system is nipple

Front 105

Terminal Ductal Lobular Unit (TDLU)

Back 105

- where in-situ cancers develop
- part of ductal structure starting at the extra lobular terminal duct & ending at terminal ductules

Front 106

Fibroglandular Breast

Back 106

- post-puberty, before 1st pregnancy
- nulliparous females
- greatest exposure needed / most dense

Front 107

Fibroglandular Fatty Breast

Back 107

- older, after several pregnancies
- fibroglandular replaced w/ adipose tissue
- easier to penetrate

Front 108

Postmeopausal Breast

Back 108

- primarily adipose tissue
- atrophy of glandular tissue
- be careful not to over-penetrate the tissue

Front 109

Diagnostic Mammography

Back 109

Done for patients with symptoms

Front 110

Screening Mammography

Back 110

Done for patients without symptoms

Front 111

Routine Mammo Views

Back 111

Craniocaudal (CC)
Medial Lateral Oblique (MLO)

Front 112

ACS & ACR Guidelines for Mammo

Back 112

- baseline mammo at age 35-40; mammo yearly at 40
- physical exam by physician every 3 years age 20-39 w/ monthly self-breast exams beginning at age 20

Front 113

Risk Factors for Breast Cancer

Back 113

- age, sex, early onset of menarche, late onset of menopause, hormone-replacement therapy, family history, first pregnancy after 30, never breast fed, obesity

Front 114

How common is breast cancer in males?

Back 114

1300 men may develop breast cancer annually in US & 1/3 may die

Front 115

Risk Factors for Breast Cancer in Males

Back 115

- over age 60
- family history
- Klinefelter's Syndrome

Front 116

Patient Prep for Mammogram

Back 116

- remove all clothing, jewelry from chest area
- gown opening in the front
- deodorant is always helpful

Front 117

Symptoms seen on Breast physically

Back 117

- changes in symmetry (contours, architectural, changes in symmetry)
- masses, calcification
- dilation of veins or ducts

Front 118

Mammographic Positioning

Back 118

- need to visualize the entire breast
- include the nipple, pectoralis muscle, & inframammary crese

Front 119

Breast Compression

Back 119

- 25-45 lbs of pressure
- flattens breast structures to prevent superimposition
- decreases OID by decreasing tissue thickness, improving visibility of detail
- immobilizes patient

Front 120

What kind of labeling needs to be on a mammo image?

Back 120

- facility name, patient name (first & last), unique patient ID number, date of exam
- lead markers w/ projection & side placed @ edge of IR closest to axilla

Front 121

Radiation Protection for Mammogram

Back 121

- gonadal shielding on anterior abdomen
- head turned away from side being radiographed

Front 122

CC Mammo View

Back 122

- mammographer should be on patient's medial side
- mobile inferior border of breast is raised to level of inframammary crease
- breast gently pulled onto IR w/ all medial tissue & as much of the lateral tissue as possile
- if patient "slumps" it will help relax muscles

Front 123

CC Image Evaluation

Back 123

- nipple pointing straight ahead in center of field & in profile
- all breast tissue & some retroglandular fat should be seen
- pectoralis muscle visible in 30% of patients
- posterior nipple line (PNL) measures within 1 cm of depth of PNL on MLO

Front 124

MLO Mammo View

Back 124

- patient standing facing IR; superior border of IR @ axilla
- determine obliquity of the pectoral muscle (between 60-90 degrees)
- patient's arm over corner of IR & hand resting on handgrip, elbow flexed
- hold breast tissue btw. thumb & fingers and place on IR; as compression starts, bring hand up & out in the direction you want the tissue to go

Front 125

MLO Image Evaluation

Back 125

- nipple in profile
- inframammary fold visible & open
- superior & anterior breast tissue adequately compressed
- PNL measuring within 1 cm of depth on CC

Front 126

When would a lateral mammo image be taken?

Back 126

Localizing lesions, looking @ air fluid levels (milk of calcium)

Front 127

When would a tangential view mammo be taken?

Back 127

Look at superficial structures (skin calcifications)

Front 128

Implant Displaced Views

Back 128

- to see as much of breast tissue as possible without implant superimposing (85% of breast tissue may not be seen)

Front 129

Cancer in Breast Tissue Cells

Back 129

- in-situ cancers have disruption within duct where an overgrowth (hyperplasia) has occured
- microcalcifications sometimes formed within duct

Front 130

When the cancer breaks out of the duct wall, it becomes an ________________________

Back 130

Invasive Tumor

Front 131

Breast Biopsy - Palpable Lesions

Back 131

- open excisional biopsy
- fine needle aspiration biopsy
- large core needle biopsy

Front 132

Breast Biopsy - Non-Palpable Lesions

Back 132

- guided mammographically
- stercotactic biopsy, excisional or vacuum-assisted large core needle biopsy

Front 133

Treatment Options for Breast Cancer

Back 133

- mastectomy
- excision & radiation therapy and/or chemo
- excision

Front 134

Mastectomy on Breast Cancer

Back 134

- 98% cure rate
- large area of breast involved; used for multi-focal cancers
- recurrence after previous excision
- patient preference

Front 135

Excision & Radiation/Chemo on Breast Cancer

Back 135

- survival rate same as mastectomy, recurrence rate is higher
- small unifocal breast cancer
- radiation reduces recurrence rate especially if surgical margins aren't clear
- Tamoxifen is recommended to reduce risk of re-development