Radiography Best Practices

• A radiographer should advise a student that reaching inside a glove with ungloved fingers when removing it will result in hand contamination.
• Having a patient repeat or demonstrate instructions is the best way to ensure understanding.
• Hypotension (low blood pressure) is the most likely cause of dizziness when an 80-year-old patient is helped into a sitting position after a lumbar spine series.

Health Hazards

• Carcinogenic chemicals are considered a health hazard on Safety Data Sheets (SDS).

Morphine Sulfate Side Effects

• Depressed respiratory rate is a potential side effect of morphine sulfate that radiographers should be most concerned about.

Shock

• Cool, clammy skin and a blood pressure of 58/40 are most consistent with a patient experiencing shock.

Rib Projections

• The RAO (Right Anterior Oblique) position best demonstrates the left posterolateral ribs.

Sternum Oblique Adjustments

• A radiographer should decrease the degree of chest rotation when performing an oblique sternum on a hypersthenic patient compared to an asthenic patient.

Hand Position

• When the hand is pronated, the 1st metacarpal is in an oblique position.

Digital Image Processing

• Brightness and contrast are primarily determined by the look-up table (LUT) during digital image processing.

Orthopnea

• Fowler's position is best suited for a patient who suffers from orthopnea (difficulty breathing when lying down).

Bremsstrahlung X-Ray Energy

• When a 75 keV electron slows to 40 keV near a nucleus, a 35 keV Bremsstrahlung x-ray is created.

Cervical Spine Apophyseal Joints

• Oblique positions are used to demonstrate the apophyseal joints of the cervical spine.

Mandible Fractures

• Lateral fractures are likely to occur in the mandible, both at the side of impact and the opposite side.

Ilium Anatomy

• The ala is the broad, curved portion of the ilium.

Tube Warm-Up

• Skipping the tube warm-up can cause anode cracking.

Diabetes Medications

• Insulin and metformin are categorized as hypoglycemics.

Effective Dose Calculation

• An effective dose would be 1.5 mSv where a dosimeter reads 1.5 mSv from fluoroscopy with a lead apron and the thyroid weighting factor of 0.05.

Intramuscular Injection Angle

• A 90-degree angle of needle insertion is recommended for intramuscular injections.

Cerebrovascular Accident (CVA) Symptoms

• Slurred speech, blurred vision, and unilateral weakness are most likely signs of a cerebrovascular accident (CVA).

Emergency Cart Drugs

• Epinephrine aids in respiration by relaxing bronchioles, opening the patient's airway.

Pharmacokinetics and Liver Disease

• Metabolism is the primary pharmacokinetic concern when administering drugs to a patient with liver disease.

Aspiration

• An aspirated object is most likely to become lodged in the right primary bronchus.

Grid Ratios and Image Quality

• Higher ratio grids increase image contrast and patient exposure.

Upper Gastrointestinal (UGI) Series - RAO Position

• The pylorus and duodenal bulb are demonstrated during a Right Anterior Oblique (RAO) position of the Upper Gastrointestinal (UGI) series.

Hip Replacement Precautions

• Internal rotation is permitted after a posterior hip replacement, but is not with an anterior approach.

Oblique Sternum Angulation

• For an anteroposterior (AP) oblique sternum, 15 to 20 degrees of central ray angulation is correct for an average (sthenic) trauma patient on a backboard.

Compton's Effect

• Compton's effect is primarily responsible for fogging the x-ray image by secondary or scattered x-rays in non-contrast radiography.

Iodinated Contrast Media Reaction

• Provide an emesis basin when a patient reports feeling flushed and nauseated after an iodinated contrast injection,

Acute Radiation Syndrome (ARS)

• Bone marrow destruction is the most likely cause of death in the hematopoietic form of acute radiation syndrome (ARS).

Short Dimension Grids

• A short dimension grid is useful when it is difficult to center accurately to a grid.

Ankle Mortise Articulation

• The talotibial articulation is considered part of the ankle mortise.

Mean Marrow Dose

• Mean marrow dose is 0.21 mGy when average absorbed dose is 0.7 mGy and 30% of active bone marrow is exposed.

Grid Artifacts in Portable Radiography

• Light colored, evenly spaced wavy lines could appear when the grid frequency is too close to the sampling frequency.

Dropout Artifacts

• Dropout artifacts appear as an area of decreased resolution.

Legal Doctrines in Radiography

• Under the respondeat superior legal doctrine, the hospital might be accountable for a radiographer's error if the failure to follow policy injures a patient.

Trifocus Image Intensifier

• The automatic brightness control (ABC) increases exposure when a radiographer uses a 30/23/15 cm trifocus image intensifier in fluoroscopy.

Abdominal X-Ray Sequence

• The upright abdomen x-ray should be performed first on an ambulatory outpatient with orders for both upright and supine abdominal x-rays.

AP Oblique Foot Projection

• Rotate the foot 30 degrees medially to demonstrate the articular surfaces of the cuboid bone on an anteroposterior (AP) oblique foot projection.

High Voltage Generator

• The rectifier converts alternating current to direct current in the high voltage generator.

Urinary System Exams

• Intravenous urograms (IVU) demonstrate the urinary system but have an increased risk of contrast media reactions.

Parenteral Administration

• Intramuscular is the route to administer medications when a prescriptions requires parental.

Spatial Resolution

• Increase the source to image distance (SID) if an image is lacking spatial resolution.

Fluoroscopic Image Intensifier

• The input phosphor of a fluoroscopic image intensifier converts x-rays into light.

Personal Monitoring Devices

• A thermoluminescent dosimeter (TLD) contains a lithium fluoride detector that is read by heating the detector.

Correct Rotation

• The fibula will appear posterior to the tibia if the correct amount of rotation is applied when the patient is rotated towards the affected side for a lateral projection of the lower leg.

Pulmonary Apices

• Angle the central ray 5 to 10 degrees cephalad to project the clavicles above the apices.

Radiation Exposure

• Radiation exposure will increase with a reduction in source to image receptor distance (SID).

Infection Control

• Fomite is used to describe potential sources of infection such as used hypodermic needles and other inanimate objects.

Compton Interactions

• Compton's effect involves the outermost electron shell of the target atom in the diagnostic energy range.

Scapula Views

• The LAO position will produce an image of the left lateral scapula (Y view) with the least amount of magnification.

Kilovoltage Peak (KVP) and Image Impact

• Increased kilovoltage peak (KVP) increases the exposure to the image receptor (IR)

Intercondyloid Fossa

• The intercondyloid fossa will likely be open but overlapped by the patellar apex when the central ray is 90-degrees to the lower leg with the patient leaning forward approximately 30-degrees.

Source to Skin Distance (SSD)

• The source to skin-distance (SSD) for a fixed fluoroscope should be 15 inches.

Bremsstrahlung X-Rays

• With a 90 kVp setting, possible energy levels for general (bremsstrahlung) x-rays are 20 keV, 50 keV and 80 keV.

HIV Stages

• Latent is the medical term for the disease stage when a patient with a diagnosed human immunodeficiency virus (HIV) does not exhibit symptoms.

Fetal Dose Calculation

• The medical physicist is responsible for performing the calculations necessary to determine fetal dose in the event that the pregnant patient is inadvertently irradiated.

DICOM

• DICOM allows medical images to be transferred to the imaging system from different manufacturers with a consistency gray scale appearance.

AP Elbow Projection

• Keep the arm in partial flexion and include an AP projection of the distal humerus and an AP projection of the proximal forearm if an inability to fully extend the elbow exists.

Milliampere (MA)

• Increasing the milliamperage (mA) increases the number of x-rays exiting the tube.

Shoulder Projections

• The lesser tubercle appears in full profile medially when the humeral epicondyles are positioned perpendicular to the image receptor.

Digital Image Monitor

• Decrease the window width if higher contrast is desired when viewing a digital image on the display monitor.

X-Ray Tube Components

• An induction motor is composed of a rotor and stator in a x-ray tube.

Data Measurement

• 66,786 bytes of data are equal to 534, 288 bits.

CR Plate Issues

• Insufficient phosphor stimulation to the computed radiography (CR) plate causes quantum mottle.

Photon Reaching Image Receptor

• A shorter source to image receptor distance (SID) increases the number of photons that reach the image receptor (IR).

Filters

• Use a compensating filter for an anteroposterior (AP) axial foot projection.

Radiographic Image Detail

• Magnification factor, source to image receptor distance (SID) and focal spot size all affect the recorded detail of a radiographic image.

Radiation and Pregnancy

• Neonatal death, mental retardation and leukemia are radiation effects that a lower radiation limit is intended to prevent.

Intravenous Contrast Media

• Flush the IV before and after the administration of contrast with saline when administering contrast media through an existing IV.

AP Knee Projection

• Direct the central ray 3-5 degrees cephalad for an anteroposterior (AP) projection of the knee in which the patient is unable to fully extend the knee joint.

Fluoroscopy Contrast

• Reduce milliamperes (mA), reduce kilovolts peak (kVp) and use a smaller collimator field to increases contrast in fluoroscopy.

Ionizing Radiation

• Bone marrow suppression is likely to occur within weeks of exposure to ionizing radiation.

Radiation Exposure

• The primary beam is the source of radiation exposure radiographers should avoid at all costs.

Legal Terms

• "Respondeat superior" means "let the master answer".

Factors Affecting Image Receptor

• Exposure time affects the number of x-ray photons that reach the image receptor (IR).

Characteristic X-Rays

• Characteristic x-rays have fixed discrete energies and a discrete emission spectrum.

Rib Images

• Take exposures during shallow respiration for obtaining images of the lower ribs.

Exposure Estimation

• 0.163 mSv will be the radiographer's exposure at 3 ½ feet when receiving 0.5 mSv of exposure at 2 feet from the source of radiation.

C-Arm Fluoroscope

• The intensifier over the table and the x-ray tube under the table would result in the least dose to the radiographer.

Lithotripsy

• Lithotripsy is the crushing of a renal stone.

Technical Factor Changes

• Adjust to 400 mA to double the x-ray photons reaching the image receptor with original technique of 200 milliamperes (mA), 0.3 seconds, 80 kilovoltspeak, and a 12:1 grid.

Radiation

• Diagnostic x-rays exhibit the lowest relative biologic effectiveness (RBE).

Venipuncture

• The basilic is the venipuncture site located at the ulnar aspect of the forearm.

Iodinated Contrast Media

• Benadryl is commonly used to pre-medicate patients prior to administration of iodinated contrast media.

Myelography

• Myelography is commonly performed by injecting a contrast median into the subarachnoid space below the termination of the cord.

Excessive Noise Prevention

• Increasing milliampere-seconds (mAs) can prevent an image with excessive noise.

Clavicle Foreshortening

• Decreasing central ray (CR) angulation to zero minimizes clavicle foreshortening on a PA clavicle radiograph.

Photoelectric Interaction

• A photoelectron and characteristic radiation are products of photoelectric interaction.

Knee Flexion

• The patellofemoral space appears closed from excessive knee flexion on a lateral knee projection

Radiation Intensity

• Radiographer will establish an uncontrolled area at 35.4 feet to ensure exposure is less than 0.08 mGya per hour; 1 mGya per hour at 10 ft originally.

Ankle Radiographs

• The ankle was internally rotated if the fibula is directly superimposed by the tibia on a lateral ankle radiograph.

Digital Image

• Pixel size is inversely related with spatial resolution.

Skull Radiographs

• Ensure the midsagittal plane is parallel to the image receptor for a PA skull.

X-Ray Frequency

• Wavelength has a reciprocal decrease in magnitude as x-ray frequency increases.

KVP Affect

• Beam quality increases and remnant radiation increases with increasing kilovolts peak (kVp).

Gonadal Shielding

• Shield ovaries one inch medial to anterior superior iliac spine (ASIS).

Physician Approval

• Radiographer may place compression bands to reduce patient motion without a physician’s approval.

Fetal Dose Monitor Placement

• Fetal dose monitor should be at the waist outside the lead apron.

1st Digit Projection

• Direct the central ray to the 1st metacarpal-phalangeal joint (MCP) for an anteroposterior projection of the 1st digit.

Portable Exam MAS Change

• Change mAs to 5 using 32 inch distance so the initial image acquired at 75 kilovolts peak (kVp), 8 milliampere-seconds(mAs), and a 40 inch SID.

Scatter Location

• Scatter is greater near the entrance surface of the patient in the C-arm cross table position.

AEC Settings

• Use the same technique when acquiring a 30 minute radiograph to acquire a plain abdominal x-ray prior to performing a small bowel series on a patient where the initial image was acquired at 80 kilovolts peak (kVp) using automatic exposure control.

Minimum Source

• The minimum source is 12 inches to skin distance (SSD).

X-Ray Beam Wavelength

• Kilovoltage is primarily responsible for altering the wavelength of the x-ray beam.

Transmission Based Precautions

• Droplet precautions are a category of Transmission Based Precautions according to the Center for Disease Control (CDC).

Exposure Calculation

• Exposure is 0.62 mGya per hour after originally recording at 2mGya per hour at a distance of 40 inches from source if technical factors remain the same; distance changes to 72 inches.

Cephalic Central Ray

• Results in the patellofemoral joint space appears open when a 5 to 7 degree cephalic central ray (CR) angle is used for a lateral knee projection.

Abdominal Radiograph

• The patient is rotated toward the left side if the spinal processes of the lumbar spine are projected on the left side of the vertebrae in the image.

Danellus Miller Method

• The central ray (CR) is perpendicular in the cross table lateral (Danellus-Miller method).

Joint Commission

• A minimum of two patient identifiers must be used to validate identity.

Spatial Resolution

• Sharpness level better shown at 0.48mm/pixel, best spatial resolution in computed radiography (CR) image.

Radiation

• Radiation induced leukemia in pediatric patients show at twice the rate of adults.

Zygapophyseal Joints

• 70-degree oblique w/perpendicular central ray will show zygapophyseal joints of the thoracic region.

SID Indicator

• 3.5 inches is the max variation when 70-inch-source is used.

Photoelectric Absorption

• Describes the complete absorption of a photon with subsequent emission of an electron.

Superimposition free wrist

• External oblique elbow demonstrates ulnar head free of superimposition.

X-Ray Collimator Alignment

• Light and x-ray beam must be within 2.4cm with source to image receptor(SID) distance of 48 inches.

Fluoroscopic Protection

• Bucky slot cover, lead fluoroscopy and automatic collimation feature are designed to reduce exposure to the patient during fluoroscopic procedures.

Drug Names

• Before official approval name used is Chemical.

Radiographs

• Cervical spine- lateral projection is least likely radiographer to use stationary grid.

Facial Bones

• Mentomeatal must be perpendicular with image receptor for parietoachanthial (Waters) projection of the facial bones.

Radiation procedure

• Radiographic projection of the lumbar spine and of the pelvis can use shadow shield to prevent radiation.

Pelvis projections

• Femoral necks will be demonstrated with minimal foreshortening and image will be properly centered to the center of the pelvis when two inches inferior to the anterior superior iliac spine (ASIS) and the patients feet internally rotated approximately 15 degrees.

Mammogram Exposure Time

• Use .5 second.

Spinal Column Joints

• In lumbar region zygapophyseal joints open laterally at right angles to a midsagittal plane.

Post Processing Technique

• Automatic rescaling is the postprocessing technique allowing different images to demonstrate similar density and contrast.

AP Knee Image result

• Knee was internally rotated shows the fibula totally superimposed by the tibia .

Digital Windows

• Brightness is controlled by adjusting window level.

Scapular anterior

• Coracoid process shows through the patients body.

Pituitary Gland

• Lateral sinus projection facilitates the detection of tumors in the pituitary gland.

Trust Effective listening

• Effective listening involves offering your undivided attention, maintain eye contact with the patient and demonstrate caring with appropriate facial expression.

SID

• 72 inches equivalent to source to image receptor distance (SID) of 183 cm.

Decreasing Exposure

• Double distance from patient results in greatest decrease of radiographers exposure .

Image Receptors

• Quantum mottle would most likely be result from under exposure of the image receptor.

Poorest Recorded Detail

• 4 inch OID; 44 inch SID cause the poorest recorded detail.

Repeat Exam Performance

• 3/40 second should be performed with repeat exam using 500 mA at 85 kVp if performed with a fixed technique of 250 milliamperes (mA), 100 kilovolts peak (kVP), and 3/20 second.

Personal Device Monitoring

• Optically stimulated luminescence (OSL) dosimeter utilizes to a laser light an aluminum oxide.

Contrast Numerical

• 1.5 provides the lowest osmolality.

Phantom Artifact

• The CR failed to completely erase the previous causes phantom image.

Visualizing the Tumor

• Anteroposterior (AP) axial projection is added to better visualize tumor below the right clavicle in which posteroanterior (PA) and lateral chest projections are inconclusive in demonstrating the lesion.

Hypovolemic Shock

• Gun shot wound most likely to cause hypovolemic shock.

SNR

• Increased milliampere-seconds (mAs) factor contributes to higher signal-to-noise ratio (SNR).

Lumber spine image

• Pars interartucularis the structure representing the neck of the "scotty dog".

Radiolysis of Water

• Best explanation is indirect towards biologic damage to deoxyribonucleic acid (DNA) during radiolysis.

Use of Grid

• 16:1 ratio will result in highest exposure of x-ray.

Proximal Tibiofibular

• AP medial oblique projection demonstrates the proximal tibiofibular joint.

Oblique Elbow Radiograph

• Radial head and neck are clearly seen in appearance correctly position anteroposterior (AP) medial oblique elbow radiograph.

Pleural Effusions

• Pleural Effusions the first place seen is posterior costophrenic angles.

Actions in exam concerns

• Should go to Radiology manager and explain to not perform barium enema with HIV patient.

barium enema Projections

• Anteroposterior (AP) axial (butterfly) best demonstrate sigmoid colon in double contrast barium enema.

Posteroanterior (PA) chest

• Inferior border of the scapula is used to position the central ray (CR).

Electron stream

• Like charges repel fundamental principle cathode assembly’s focusing cup focuses electron stream.

Ferrous Material

• Becomes magnetized when placed in a metal field.

Contributes to scattering

• Collimation minimize scattering.

Procedures

• To minimize radiation exposure it is best fluoroscopy on pulsed fluoroscopy.

Spatial Resolution

• Increased sampling frequency maximizes spatial resolution in digital imaging.

C-Diff

• Use soap and water when washing hands on pt with 54 with clostridium difficile.

KUB Factors

• Tissue masses with ascites and internal bleeding requires in technical factors when performing a KUB.

Facial Bone Positioning

• Face is rotated away from image receptor with magnified Mandibular Ramus.

Forearm Fractures

• Colle’s fracture Distal forearm.

Interventional Procedures

• Maximize appropriate kilovolts peak (kVp) to order to minimize patient dose during the interventional procedure.

Correct Central Ray

• 40 degrees Cephalad plantodorsal calcaneus orientation for central ray foot plantar.

Multiple CR images

• Clean input area of image reader.

X-Ray emmisions

• Both increase when increasing kVp
• Quantity increases and average energy increases when transition 60 to 90.

Projection of Elbow

• External oblique demonstrates the radial head of the elbow.

Shades of Gray

• Digital system with Bit depth of 10 one pixel can have 1024 shades of gray.

Contaimated Stethoscope

• Indirect transmission to obtain infection.

Protective Shielding

• Reduction in number of genetic mutations/radiation, Reduction in reduction gonadal exposure/repeat radiographs, and reduction in number of repeat radiographs with volume of tissue irradiated.

Hearing Impaired-

• get pt attention before speaking actions most effective.

Dosimeters

• Optically stimulated luminescent dosimeters are best for pregnancy.

Correct superimpose

• A greater trochanter correctly positioned AP.

Chest Projection

• PA chest projections is 45-degree.

Spine Projections

• Left posterior oblique decreases patients thyroid dose.

Creatine and Bun

• Decreased ability to see renal cortex.

Intervertebral Cervical

• 15-degree caudal central ray angle to repeat exposure.

Gloves Protection

• Nitrile best gloves against hazard matierals.

Patient Exposure

• Pulsed fluoroscopy, small collimator setting, image intensifier tube, flat panel digital image helps decrease.

Safe Radiographer

• Maintain center of gravity when moving patient.

Electron Cloud

• Filament.

Diaphragm Technique

• Place patient in recumbent position.

Routine Chest Radiograph

• Lateral Decubitis view for nodules.

Electrons to Light

• Photocathode turn to electrons converts.

Speak problems

• Aphasia describes that cannot speak.

Radiographer Body safe

• Kept close to body and shoulder width.

Grid Cutoff

• A 90-cm SID is used with a 100-cm focused grid.

primary beam

• 90%