Case Studies & Practical Application Flashcards

A patient arrives for a chest X-ray but is unable to stand or sit upright due to injury. Which projection is most appropriate?

Answer: AP supine

An AP supine projection is performed when the patient cannot stand or sit upright, allowing imaging while lying flat. Image quality is somewhat reduced compared to PA erect but is the safest option for this patient.

During a barium enema procedure, the patient complains of sudden severe abdominal pain and the radiograph shows free air under the diaphragm. What is the most likely complication?

Answer: Perforation of the colon

Free air (pneumoperitoneum) under the diaphragm following a barium enema indicates perforation of the colon, a serious emergency requiring immediate cessation of the procedure and physician notification.

A pediatric patient is brought in for a femur X-ray. Multiple healed fractures in various stages of healing are noted on the image. The radiographer should:

Answer: Inform the radiologist of the findings immediately

Multiple fractures in various stages of healing in a pediatric patient are a classic radiographic sign of non-accidental trauma (child abuse). The radiographer has an ethical and legal duty to report this finding immediately to the radiologist and follow institutional protocol.

A patient scheduled for an IVU (intravenous urogram) reports a previous allergic reaction to iodinated contrast media. The radiographer should:

Answer: Notify the radiologist before proceeding

A history of contrast allergy requires notification of the radiologist before proceeding. The radiologist will decide whether premedication, alternative contrast, or a different imaging modality is appropriate for patient safety.

Which positioning aid is most useful when performing a lateral hip radiograph on a patient with a suspected hip fracture?

Answer: Sandbag on the unaffected side

For a suspected hip fracture, a frog-leg lateral is contraindicated. The cross-table lateral (Danelius-Miller) is performed with the patient supine; a sandbag or support stabilizes the unaffected leg elevated while the IR is placed vertically alongside the injured hip.

An image of the lumbar spine shows the vertebral endplates are not parallel and the disc spaces appear wedge-shaped. What adjustment should be made?

Answer: Angle the central ray cephalad

When the intervertebral disc spaces appear wedge-shaped on an AP lumbar spine, the vertebral endplates are not parallel to the IR. Angling the central ray cephalad (typically 5-8 degrees) opens the disc spaces and projects them as parallel lines.