CAMRT - Canadian Association of Medical Radiation Technologists Radiographic Procedures: Skeletal System Questions and Answers — Questions and Answers
Question 1: When performing an AP projection of the hip on an ambulatory adult patient, what is the correct positioning of the patient's foot and lower leg to place the femoral neck parallel to the image receptor?
- Invert the foot 15-20 degrees internally. (Correct answer)
- Evert the foot 15-20 degrees externally.
- Place the foot in a neutral, dorsiflexed position.
- Plantar flex the foot as much as possible.
Correct answer: Invert the foot 15-20 degrees internally.
To compensate for the natural anteversion of the femoral neck, the entire lower limb must be medially (internally) rotated 15 to 20 degrees. This maneuver places the femoral neck parallel to the image receptor, demonstrating it in true profile without foreshortening, and minimizes the visibility of the lesser trochanter.
Question 2: A trauma patient is brought in on a backboard following a high-speed motor vehicle collision. The initial request is for a portable pelvis radiograph to rule out a fracture. Which of the following projections is performed first and requires no manipulation of the patient's lower limbs?
- Judet View (Oblique)
- AP Pelvis (Correct answer)
- AP Axial Inlet View
- Taylor Method (Outlet View)
Correct answer: AP Pelvis
In a trauma setting, the AP pelvis projection is the primary initial view. It is performed without any patient manipulation, such as rotating the limbs, to prevent the displacement of potentially unstable fractures. This single projection provides a crucial overview of the entire pelvic girdle and is a standard part of the initial trauma survey.
Question 3: When evaluating a lateral cervical spine radiograph for technical adequacy, which of the following is the most critical criterion for ensuring the entire spine is visualized for diagnostic purposes?
- The rami of the mandible are perfectly superimposed.
- The spinous processes are seen in profile with no rotation.
- The C7-T1 vertebral space is clearly demonstrated. (Correct answer)
- The prevertebral soft tissue shadow is within normal limits.
Correct answer: The C7-T1 vertebral space is clearly demonstrated.
The C7-T1 junction is a common site for trauma that can be obscured by the shoulder girdle. It is mandatory for a diagnostic lateral cervical spine radiograph to clearly demonstrate all seven cervical vertebrae and the superior aspect of T1. If this area is not visualized, a supplementary view, such as a swimmer's (Twining method), must be performed.
Question 4: A patient presents to the emergency department with pain in the anatomical snuffbox after a fall on an outstretched hand (FOOSH). To best demonstrate a potential non-displaced scaphoid fracture, which additional projection is most critical to perform with the routine wrist series?
- Carpal tunnel view (Gaynor-Hart method)
- Ball-catcher's view (Norgaard method)
- AP oblique wrist with 45-degree medial rotation
- PA wrist with ulnar deviation (Correct answer)
Correct answer: PA wrist with ulnar deviation
Ulnar deviation of the wrist elongates the scaphoid bone, correcting its natural foreshortening and opening the adjacent joint spaces. This movement is essential for visualizing subtle, non-displaced fractures of the scaphoid waist that may not be apparent on a standard PA projection.
Question 5: The Judet method, which consists of two 45-degree oblique projections of the pelvis, is specifically designed to visualize the anatomy of the:
- Sacroiliac joints
- Pubic symphysis
- Femoral head and neck
- Acetabulum (Correct answer)
Correct answer: Acetabulum
The Judet views (iliac and obturator oblique) are specialized projections used to assess for fractures of the acetabulum. By rotating the patient 45 degrees for each view, the anterior and posterior columns of the acetabulum are projected free of superimposition, which is critical for accurate diagnosis and surgical planning.
Question 6: A 14-year-old athlete presents with localized pain and swelling over the tibial tuberosity. Osgood-Schlatter disease is suspected. Besides the standard AP projection, which view is most essential for diagnosing this condition?
- Medial oblique of the knee
- Intercondylar fossa view (tunnel view)
- Lateral view of the knee (Correct answer)
- Tangential view of the patella (sunrise/skyline)
Correct answer: Lateral view of the knee
Osgood-Schlatter disease is a traction apophysitis of the tibial tuberosity. A lateral projection of the knee provides a clear profile of the tuberosity and the insertion of the patellar tendon. This view is best for visualizing characteristic findings such as soft tissue swelling, fragmentation, or prominence of the apophysis.
CAMRT - Canadian Association of Medical Radiation Technologists Radiographic Procedures: Skeletal System Questions and Answers
When performing an AP projection of the hip on an ambulatory adult patient, what is the correct positioning of the patient's foot and lower leg to place the femoral neck parallel to the image receptor?