ARRT Thorax and Abdomen Procedures 5 — Questions and Answers
Question 1: Which maneuver can be used during fluoroscopy of the esophagus to demonstrate a small hiatal hernia that may not be visible in the upright position?
- Valsalva maneuver
- Müller maneuver
- Trendelenburg position with Valsalva (Correct answer)
- Standing single-contrast barium swallow
Correct answer: Trendelenburg position with Valsalva
The Trendelenburg (head-down) position combined with the Valsalva maneuver increases intra-abdominal pressure and gastroesophageal displacement, revealing small sliding hiatal hernias.
Question 2: The carina of the trachea is normally located at which vertebral level on a PA chest radiograph?
- T2–T3
- T4–T5 (Correct answer)
- T6–T7
- T8–T9
Correct answer: T4–T5
The carina, where the trachea bifurcates into the left and right main bronchi, is normally located at the level of T4–T5 on a PA chest radiograph.
Question 3: For an AP projection of the abdomen in a patient with suspected bowel obstruction, what position should be obtained in addition to the supine AP?
- Prone AP
- Upright AP abdomen (Correct answer)
- Left lateral decubitus only
- Right lateral decubitus only
Correct answer: Upright AP abdomen
An upright AP abdomen demonstrates air-fluid levels within distended bowel loops, which are diagnostic for bowel obstruction.
Question 4: On a lateral chest radiograph, the retrosternal space is normally radiolucent. Increased opacity in this region suggests which condition?
- Pericardial effusion
- Anterior mediastinal mass (Correct answer)
- Left lower lobe collapse
- Aortic aneurysm
Correct answer: Anterior mediastinal mass
The retrosternal (anterior mediastinal) space lies between the sternum and heart; increased opacity there is characteristic of an anterior mediastinal mass (thymoma, teratoma, lymphoma).
Question 5: To best demonstrate the left lung and heart on a lateral chest, which side of the patient should be placed against the IR?
- Right side against IR
- Left side against IR (Correct answer)
- Either side — it does not matter
- Posterior surface against IR (AP)
Correct answer: Left side against IR
Placing the left side against the IR minimizes magnification of the left-sided cardiac shadow and produces a truer representation of left lung structures.
Question 6: Which technical factor change would most effectively reduce radiation dose during a pediatric chest radiograph while maintaining diagnostic quality?
- Decrease kVp by 15 and double the mAs
- Increase kVp to 80–90 and decrease mAs proportionally (Correct answer)
- Use a grid and increase mAs by 4×
- Reduce SID to 48 inches and lower mAs
Correct answer: Increase kVp to 80–90 and decrease mAs proportionally
Higher kVp (80–90 range) with reduced mAs maintains image quality while lowering patient dose; the higher kVp requires less mAs to achieve sufficient exposure.
Question 7: A PA chest radiograph demonstrates the medial ends of the clavicles equidistant from the spinous processes. What does this indicate?
- Patient is rotated to the right
- Patient is rotated to the left
- The patient is in a true PA position without rotation (Correct answer)
- The SID is too short
Correct answer: The patient is in a true PA position without rotation
Equal distance from the spinous processes to each clavicular medial end confirms no patient rotation, indicating a true PA projection.
ARRT Thorax and Abdomen Procedures 5
Which maneuver can be used during fluoroscopy of the esophagus to demonstrate a small hiatal hernia that may not be visible in the upright position?