Procedures Chapter 13

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1

What is the purpose of supporting the head on a radiolucent sponge for the trauma lateral projection (dorsal decubitus position) of the cranium?

Increases patient comfort

Reduces magnification

Helps ensure demonstration of the posterior portion of the cranium in the image

Absorbs blood from the patient's injuries

Helps ensure demonstration of the posterior portion of the cranium in the image

2

As a means of improving efficiency in trauma imaging, generally only the most critical projection is obtained for a procedure.

True

False

False

3

An efficient method of performing multiple imaging procedures on the same patient is to:

Move the tube in one direction (e.g., superiorly to inferiorly)

Refer the patient for a CT

Use the shortest possible exposure time

Use the largest image receptor size available and put more than one body part on each image

Move the tube in one direction (e.g., superiorly to inferiorly)

4

Which of the following patient status changes require immediate notification of the ED physician?
(1) Cyanosis
(2) Seizures
(3) Increasing abdominal distention

1 and 2 only

1 and 3 only

2 and 3 only

1, 2, and 3

1, 2, and 3

5

Which of the following duties are part of a trauma radiographer’s responsibilities in the emergency department (ED)?
(1) Interpreting images for the ED physician
(2) Obtaining quality images efficiently
(3) Providing radiation protection

1 and 2 only

1 and 3 only

2 and 3 only

1, 2, and 3

2 and 3 only

6

What is the proper method for lifting an injured limb?

Lift the limb, supporting only the joint that is distal to the injury

Support the limb at the joints proximal and distal to the injury

Lift the limb, supporting only the joint that is proximal to the injury

Log-roll the patient

Support the limb at the joints proximal and distal to the injury

7

What anatomy should be included on a lateral projection of the lumbar spine taken with the patient in the dorsal decubitus position?

L1 to L5

T12 to L5

T10 to L5

T12 to the sacrum

T12 to the sacrum

8

If OML is positioned perpendicular to the image receptor for the trauma AP axial projection (Towne method) of the cranium, the central ray is directed:

30 degrees caudad

30 degrees cephalad

37 degrees caudad

37 degrees cephalad

30 degrees caudad

9

If a trauma patient loses consciousness during an imaging procedure, the imaging professional should:

a. assess the patient's airway

b. check the patient's pulse

c. notify the ED physician immediately

d. check the patient's pupil responses

c. notify the ED physician immediately

10

All of the following patient status changes require immediate notification of the ED physician except:

Loss of consciousness

Aggression

Seizures

Bluish nail beds

Aggression

11

If a grid is used to obtain a trauma AP axial oblique projection of the cervical spine, what is the central ray orientation?

Perpendicular

Horizontal

15 to 20 degrees lateromedial

45 degrees mediolateral

45 degrees mediolateral

12

Which projection is necessary if the top of T1 and the C7-T1 interspace is not clearly demonstrated on the lateral projection, dorsal decubitus position of the cervical spine?

a. AP projection, open-mouth position

b. lateral projection, swimmer's technique

c. lateral projection of the thoracic spine

d. AP axial c-spine

b. lateral projection, swimmer's technique

13
card image

Examine the image below. What anatomy is of interest?

Cranium

Facial bones

Cervical vertebrae

Brain

Facial bones

14
card image

Examine the image below. What error is present in this trauma image?

Not all of the required anatomy is demonstrated.

The image displays rotation from a true lateral position.

Preventable artifacts are visible.

There is no error evident in this trauma image.

Not all of the required anatomy is demonstrated.

15
card image

Examine the image below. What, if any, additional trauma projections are needed to provide a complete projection of the anatomy of interest?

Additional trauma projections are not needed to demonstrate the anatomy of interest.

Trauma oblique projections are required.

A cross-table lateral projection of the knee joint is required.

An AP projection of the knee joint is required.

A cross-table lateral projection of the knee joint is required.

16

All of the following trauma procedures may first be referred for CT, except:

Cervical spine

Cranium

Abdomen

Pelvis

Abdomen

17

Moving the x-ray tube in one direction, such as superiorly to inferiorly along the patient, to obtain projections in a trauma patient with multiple injuries is intended to:

Protect emergency department personnel from injury during trauma imaging

Reduce radiation exposure during trauma imaging

Increase efficiency in trauma imaging

This method is not recommended in trauma imaging

Increase efficiency in trauma imaging

18

Which of the following actions are technical considerations in trauma radiography?
(1) Monitoring patient status before, during, and after imaging procedures
(2) Removing immobilization to prevent artifacts
(3) Providing lead aprons for all essential personnel

1 and 2 only

1 and 3 only

2 and 3 only

1, 2, and 3

1 and 3 only

19

If a trauma patient loses consciousness during an imaging procedure, the imaging professional should:

a. assess the patient's airway

b. check the patient's pulse

c. notify the ED physician immediately

d. check the patient's pupil responses

c. notify the ED physician immediately

20

Where does the central ray enter the patient for the trauma AP projection of the abdomen?

MSP at a level 2 inches (5 cm) superior to the ASIS

MCP at a level 2 inches (5 cm) inferior to the ASIS

MCP at the level of the iliac crests

MSP at the level of the iliac crests

MSP at the level of the iliac crests

21
card image

Examine the image below. Where does the central ray enter the patient for this trauma projection?

MSP at the level of C4

MCP at the level of C4

MSP at the level of the C7-T1 interspace

MCP at the level of the C7-T1 interspace

MCP at the level of C4

22
card image

Examine the image below. What anatomy is labeled with the number 1?

Body of C3

Body of C4

Pedicle of C3

Pedicle of C4

Body of C4

23

Which of the following actions are technical considerations in trauma radiography?
(1) Monitoring patient status before, during, and after imaging procedures
(2) Removing immobilization to prevent artifacts
(3) Providing lead aprons for all essential personnel

1 and 2 only

1 and 3 only

2 and 3 only

1, 2, and 3

1 and 3 only

24

All of the following actions are best practices in trauma radiography except:

Using image evaluation criteria that take into account the patient's condition

Obtaining quality images in an efficient manner

Moving the image receptor and x-ray tube, rather than the patient, when needed projections are being obtained

Providing a minimum of two projections at right angles to each other

Using image evaluation criteria that take into account the patient's condition

25

One best practice in trauma radiography is to:

Accommodate the patient’s injury by moving the tube and IR, instead of the patient, whenever possible during positioning for imaging procedures.

Reduce repeats by altering the evaluation criteria of image quality to accommodate the patient’s condition

Anticipate the need to remove immobilization devices to avoid image artifacts

Obtain the single best projection of the injured part as quickly as possible

Accommodate the patient’s injury by moving the tube and IR, instead of the patient, whenever possible during positioning for imaging procedures.

26

If a grid is used to obtain a trauma AP axial oblique projection of the cervical spine, what is the central ray orientation?

Perpendicular

Horizontal

15 to 20 degrees lateromedial

45 degrees mediolateral

45 degrees mediolateral

27

Moving the x-ray tube in one direction, such as superiorly to inferiorly along the patient, to obtain projections in a trauma patient with multiple injuries is intended to:

Protect emergency department personnel from injury during trauma imaging

Reduce radiation exposure during trauma imaging

Increase efficiency in trauma imaging

This method is not recommended in trauma imaging

Increase efficiency in trauma imaging

28

All of the following duties are part of a trauma radiographer’s responsibilities in the emergency department (ED), except:

Obtaining quality images efficiently

Providing ethical radiation for patients, ED personnel, and self

Administering of pain medication under physician’s order

Providing patient care during imaging procedures

Administering of pain medication under physician’s order

29

While performing trauma imaging of a patient with injuries to the pelvis, you notice that the patient is sweating heavily and becoming drowsy. What should you do?

Continue with the imaging procedure as requested

Document the signs on the requisition after the procedure is complete

Notify the emergency department (ED) physician immediately

Give the patient a drink of water to lower the body temperature

Notify the emergency department (ED) physician immediately

30

Which imaging modality is often used to evaluate trauma to the abdomen?

a. CT

b. MRI

c. NM

d. sonography

d. sonography

31

The trauma radiographer must ensure other team members are protected from unnecessary radiation. Which of the following practices will accomplish this?
(1) lead aprons for all personnel that remain in the room during exposures
(2) short exposure times
(3) announcement of impending exposure to allow nonessential personnel to exit the room

a. 1 and 2

b. 1 and 3

c. 2 and 3

d. 1, 2, and 3

b. 1 and 3

32

While performing trauma imaging of a patient with injuries to the pelvis, you notice that the patient is sweating heavily and becoming drowsy. What should you do?

Continue with the imaging procedure as requested

Document the signs on the requisition after the procedure is complete

Notify the emergency department (ED) physician immediately

Give the patient a drink of water to lower the body temperature

Notify the emergency department (ED) physician immediately

33
card image

Examine the image below. What is the anatomy of interest?

Cervical spine

Cranium

Thoracic spine

Facial bones

Cervical spine

34

Which of the following duties are part of a trauma radiographer’s responsibilities in the emergency department (ED)?
(1) Interpreting images for the ED physician
(2) Obtaining quality images efficiently
(3) Providing radiation protection

1 and 2 only

1 and 3 only

2 and 3 only

1, 2, and 3

2 and 3 only

35

Where does the central ray enter the patient on a trauma AP projection of the chest?

3 inches (7.6 cm) superior to the jugular notch

3 inches (7.6 cm) superior to the xiphoid process

3 inches (7.6 cm) inferior to the jugular notch

3 inches (7.6 cm) inferior to the xiphoid process

3 inches (7.6 cm) inferior to the jugular notch

36
card image

Examine the image below. What anatomy is labeled with the number 1?

Body of C3

Body of C4

Pedicle of C3

Pedicle of C4

Body of C4

37

One best practice in trauma radiography is to:

Accommodate the patient’s injury by moving the tube and IR, instead of the patient, whenever possible during positioning for imaging procedures.

Reduce repeats by altering the evaluation criteria of image quality to accommodate the patient’s condition

Anticipate the need to remove immobilization devices to avoid image artifacts

Obtain the single best projection of the injured part as quickly as possible

Accommodate the patient’s injury by moving the tube and IR, instead of the patient, whenever possible during positioning for imaging procedures.

38

If OML is positioned perpendicular to the image receptor for the trauma AP axial projection (Towne method) of the cranium, the central ray is directed:

30 degrees caudad

30 degrees cephalad

37 degrees caudad

37 degrees cephalad

30 degrees caudad

39

What anatomy should be included on a lateral projection of the cervical spine taken with the patient in the dorsal decubitus position?

Everything from the sella turcica to the top of T1

C1 to C7

C1 to T1

Everything from the EAM to the top of C7

Everything from the sella turcica to the top of T1

40

What is the proper method for lifting an injured limb?

Lift the limb, supporting only the joint that is distal to the injury

Support the limb at the joints proximal and distal to the injury

Lift the limb, supporting only the joint that is proximal to the injury

Log-roll the patient

Support the limb at the joints proximal and distal to the injury

41

Which of the following would be considered a trauma radiography guideline?
(1) remove all splints
(2) do not move the patient unless necessary
(3) obtain a minimum of two radiographs of each body part

a. 1 and 2

b. 1 and 3

c. 2 and 3

d. 1, 2, and 3

c. 2 and 3

42

All of the following duties are part of a trauma radiographer’s responsibilities in the emergency department (ED), except:

Obtaining quality images efficiently

Providing ethical radiation for patients, ED personnel, and self

Administering of pain medication under physician’s order

Providing patient care during imaging procedures

Administering of pain medication under physician’s order

43

Which imaging modality has replaced conventional trauma skull radiography in most Level I trauma centers?

a. CT

b. MRI

c. nuclear medicine

d. angiography

a. CT

44

Which imaging modality is often used to evaluate trauma to the abdomen?

a. CT

b. MRI

c. NM

d. sonography

d. sonography

45

Extreme eversion of the foot is a sign of traumatic injury to the:

a. tibia and fibular

b. knee joint

c. pelvis

d. hip

d. hip

46

Whenever possible, the x-ray tube and image receptor should be positioned, rather than the patient, to obtain the trauma imaging projection.

True

False

True

47

If the infraorbitomeatal line (IOML) is positioned perpendicular to the image receptor for the trauma AP axial projection (Towne method) of the cranium, the central ray is directed:

30 degrees caudad

30 degrees cephalad

37 degrees caudad

37 degrees cephalad

37 degrees caudad

48

What are the best practices guidelines regarding immobilization in trauma radiography?

The radiographer should remove immobilization only during the imaging procedure and replace it after images have been evaluated.

Immobilization is never removed without a physician’s order.

Immobilization is always removed before imaging to help prevent artifacts.

The radiographer must evaluate the patient’s injuries to determine whether immobilization can be removed for a particular trauma imaging procedure.

Immobilization is never removed without a physician’s order.

49

Which projection is necessary if the top of T1 and the C7-T1 interspace is not clearly demonstrated on the lateral projection, dorsal decubitus position of the cervical spine?

a. AP projection, open-mouth position

b. lateral projection, swimmer's technique

c. lateral projection of the thoracic spine

d. AP axial c-spine

b. lateral projection, swimmer's technique

50
card image

Examine the image below. What, if any, additional trauma projections are needed to provide a complete projection of the anatomy of interest?

Additional trauma projections are not needed to demonstrate the anatomy of interest.

Trauma oblique projections are required.

Trauma AP axial projection is required.

Trauma lateral cervicothoracic projection is required.

Trauma lateral cervicothoracic projection is required.

51

Which of the following procedures are appropriate for trauma patients?
(1) remove immobilization devices that may cause imaging artifacts
(2) move tube and IR, instead of injured part, when possible
(3) perform all AP projections, then all lateral projections

a. 1 and 2

b. 1 and 3

c. 2 and 3

d. 1, 2, and 3

c. 2 and 3

52
card image

Examine the image below. What, if any, additional trauma projections are needed to provide a complete projection of the anatomy of interest?

Additional trauma projections are not needed to demonstrate the anatomy of interest.

Trauma oblique projections are required.

Trauma AP axial projection is required.

Trauma lateral cervicothoracic projection is required.

Trauma lateral cervicothoracic projection is required.

53

Which of the following are required to produce optimal radiographs during foreign body localization?
(1) small focal spot
(2) maximum control of motion
(3) exact AP or PA and lateral projections

a. 1 and 2

b. 1 and 3

c. 2 and 3

d. 1, 2, and 3

d. 1, 2, and 3

54

Which of the following are required to produce optimal radiographs during foreign body localization?
(1) small focal spot
(2) maximum control of motion
(3) exact AP or PA and lateral projections

a. 1 and 2

b. 1 and 3

c. 2 and 3

d. 1, 2, and 3

d. 1, 2, and 3

55

What anatomy should be included on a lateral projection of the lumbar spine taken with the patient in the dorsal decubitus position?

L1 to L5

T12 to L5

T10 to L5

T12 to the sacrum

T12 to the sacrum

56

Which projection must be evaluated prior to taking any other images on a trauma patient?

a. AP projection of the atlas and axis, open-mouth position

b. lateral projection, swimmer's technique

c. lateral projection of the c-spine, dorsal decubitus position

d. AP axial c-spine

c. lateral projection of the c-spine, dorsal decubitus position

57

What are the best practices guidelines regarding immobilization in trauma radiography?

The radiographer should remove immobilization only during the imaging procedure and replace it after images have been evaluated.

Immobilization is never removed without a physician’s order.

Immobilization is always removed before imaging to help prevent artifacts.

The radiographer must evaluate the patient’s injuries to determine whether immobilization can be removed for a particular trauma imaging procedure.

Immobilization is never removed without a physician’s order.

58

Which of the following steps is required for the trauma lateral projection (dorsal decubitus position) of the cranium?

Directing the central ray vertically to exit at the level of the foramen magnum

Directing the central ray horizontally to enter at the level of the foramen magnum

Elevating the head on a radiolucent sponge

Increasing SID to overcome increased OID

Elevating the head on a radiolucent sponge

59

Which imaging modality has replaced conventional trauma skull radiography in most Level I trauma centers?

a. CT

b. MRI

c. nuclear medicine

d. angiography

a. CT

60

Status of the patient should be noted:
(1) Before the imaging procedure
(2) During the imaging procedure
(3) After the imaging procedure

1 and 2 only

1 and 3 only

2 and 3 only

1, 2, and 3

1, 2, and 3

61
card image

What is the anatomy of interest in this trauma image?

Thoracic vertebrae

Abdomen

Pelvis

Lumbar vertebrae

Pelvis

62

Sonography is often used in trauma imaging of the:

Cervical spine

Abdomen

Cranium

Pelvis

Abdomen

63
card image

What is the anatomy of interest in this trauma image?

Thoracic vertebrae

Abdomen

Pelvis

Lumbar vertebrae

Pelvis

64

An efficient method of performing multiple imaging procedures on the same patient is to:

Move the tube in one direction (e.g., superiorly to inferiorly)

Refer the patient for a CT

Use the shortest possible exposure time

Use the largest image receptor size available and put more than one body part on each image

Move the tube in one direction (e.g., superiorly to inferiorly)

65

Where does the central ray enter the patient for the trauma AP projection of the abdomen?

MSP at a level 2 inches (5 cm) superior to the ASIS

MCP at a level 2 inches (5 cm) inferior to the ASIS

MCP at the level of the iliac crests

MSP at the level of the iliac crests

MSP at the level of the iliac crests

66

What is the ideal central ray direction for the AP axial oblique projections of the cervical spine on an injured patient?

45 degrees mediolaterally and 15 to 20 degrees caudad

15 to 20 degrees lateromedially and 45 degrees cephalad

45 degrees lateromedially and 15 to 20 degrees cephalad

15 to 20 degrees mediolaterally and 45 degrees caudad

45 degrees lateromedially and 15 to 20 degrees cephalad

67
card image

Examine the image below. What error is present in this trauma image?

Not all of the required anatomy is demonstrated.

The image displays rotation from a true lateral position.

Preventable artifacts are visible.

There is no error evident in this trauma image.

Not all of the required anatomy is demonstrated.

68

How is the central ray directed for the cross-table lateral projections of the humerus?

Vertical and perpendicular to the midhumerus

Horizontal and perpendicular to the midhumerus

Vertical and angled to open the elbow joint space

Horizontal and angled parallel to the angle of the injury

Horizontal and perpendicular to the midhumerus

69

Extreme eversion of the foot is a sign of traumatic injury to the:

a. tibia and fibular

b. knee joint

c. pelvis

d. hip

d. hip

70
card image

Examine the image below. What anatomy is of interest?

Cranium

Facial bones

Cervical vertebrae

Brain

Facial bones