#1: HUMERUS APL -full inspiration to improve the contrast

1. Patient: pedia -CR L to IR, level of surgical neck

2. Seen: epiphyseal plate, spiral
fracture, acromioclavicular
# 2 CERVICAL SPINE (LATERAL)
dislocation, bancart lesion (chip
fracture – glenoid cavity), Hillsachs
1. What vertebral bodies can you see on this
(chip fracture - head of the humerus)
radiograph? -Cervical
#48: Axillary border
#69: glenoid cavity
2. How many cervical bodies a normal
#76: olecranon process
individual has? - Seven (7)
3. Must include both elbow and
shoulder joint.
3. What cervical level has a long spinous
4. Epicondyles must be parallel to the
process? - Seventh cervical vertebra
film
5. Whitish appearance: bleeding or due to old image.
4. What cervical body has a tooth-like
6. Dislocation of the shoulder is best seen in lateral scapular Y.
structure? - C2 / Axis / Epistropheus
7. ACAP: Anterior-Coracoid; Acromion-Posterior
8. Frozen shoulder: inflamed shoulder
5. What is the other name of C2? – Axis
9. Ediopathic: no known cause
6. What cervical body has the Dens Odontoid? - C2 / Axis / Epistropheus
Humerus.
The patient is probably pedia because epiphyseal plates are still present
There is a fracture probably spiral on its midshaft 7. What projection is best to visualize the odontoid process? - Fuchs
Method
Position: not properly positioned due to pt discomfort, it is best not to try
moving it to correct position to prevent further damage. 8. What level of the cervical that has no body, but has a ring of bone with
hollow center? - C1 / Atlas
AP demonstrates entire humerus including elbow and shoulder joint.
Epicondyles should be parallel to the IR. 9. Identify where is the Gonion or Angle of the mandible?

Lateral, both epicondyles should be perpendicular to the IR. 10. What is this black structure? Other name? - Larynx / Voice box

Transthoracic Lateral Projection / Lawrence Method -for trauma pt 11. What is the location of the esophagus in relation with the trachea and
unaffected arm raise forearm resting on head vertebral column? - Esophagus lies anterior to the Vertebral column and
posterior to the trachea
 25. Fracture from hyperflexion of the neck, results in avulsion fractures on
12. What structure conveys food to the esophagus as well as air to the the spinous processes of C6 through T1. - clay shoveler's fracture
larynx?
- Pharynx 26. Fracture extends through the pedicles of C2, with or without subluxation
of C2 or C3, the neck is subjected to extreme hyperextension?
13. If this is a cervical x-ray, what can you say about the positioning?
- hangman's fracture
- It is a true lateral because the spinous process, no scotty dog, and
more depressed shoulders 27. It is when the anterior and posterior arches of C1 are fractured as the
skull slams onto the ring. - Jefferson fracture
14. What are the routine views for x-ray of the cervical spine?
- AP, AP Open mouth, Lateral
28. The characteristic of this condition is neck stiffness due to age-related
degeneration of intervertebral disk? - Spondylosis
15. Identify the seventh cervical vertebra. - the last cervical vertebra
29. Degeneration of one or many joints? - osteoarthritis
16. What projection is best to visualize the lower cervical and the upper
thoracic spine?
30. Collapse of vertebral bodies? - compression fracture
- swimmer’s projection/twinning method and Pavlow
31. What’s wrong with the radiograph? - C6 & C7 should be included
Method
17. In a typical vertebra, what are the two main parts? 32. Additional infos - Zygapophyseal joint is seen
- Body and transverse process
Handling & Storage Artifacts
18. In AP of the cervical spine, describe the direction and angulation of the An artifacts caused by improper handling &storage of film
CR. - Directed 15-20 degrees cephalad through the thyroid cartilage. Prevention: proper facility design
19. At what level would the upper border of the cassette coincide? Image Fog caused by: High temperature, humidity, or Film bin is not
- 2 inches above the EAM (External Auditory Meatus) shielded adequately from radiation
20. What is the approximate length of the trachea? - 4.5 inches Pressure Marks caused by: Film is stacked too high
COMMON HANDLING & STORAGE ARTIFACTS
21. What is the other name of trachea? - windpipe
Appearance on the Radiograph & Cause
22. The presence of pus in the Pleural cavity is called; - Empyema
Fog: The temperature or humidity is too high. The film bin is
inadequately shielded from radiation. The safelight is too bright, is
23. Seen in lateral cervical spine? - zygapophyseal joints
too close to the processing tray, or has an improper filter. The film
has been left in the x-ray room during other exposure.
24. Seen in oblique cervical spine? - Intervertebral foramina
Pressure or kink marks: The film is improperly or roughly handled. The 1. Quality of film?
film is stacked too high in storage. - patient is in good position: the head is round and the gonion is not
prominent.
Streaks of increased OD: The darkroom cassette has light leaks
- artifact is present due to poor handling and storing.
Crown, tree, & smudge static: The temperature or humidity is too low.
2. Waters Open Mouth Method or
Yellow-brown stains: Thiosulfate is left on the film because of inadequate Parieto-acanthial axial trans-oral
washing Seen: Sphenoidal Sinus, Orbits,
Kink Marks caused by: rough handling before processing Maxillae, Zygomatic arches,
- Appearance: increased OD. sinuses, Vomer which forms the
Nasal septum, etc.
Static: The most obvious artifact caused by: buildup of electron in
the emulsion. 3. Evaluation criteria:
-Three Distinct Pattern: crown, tree & smudge  Distance between lateral border
Hypo Retention: yellow brown appearance caused by: inadequate washing of the skull
- Silver sulfide slowly builds up & appears yellow on the  Orbits are equal
radiograph.  Petrous ridges should be
projected immediately below floor
The white area is due to thickness. If necessary, repeat and increase factors. of maxillary sinuses.
Wrong marker  Evidence of proper collimation

4. Paranasal sinuses
# 3 WATER’S OPEN MOUTH METHOD, • Frontal
PARIETOACANTHIAL PROJECTION • Maxillary /Antra of Highmore
POSSIBLE PATHO: SINUSITIS • Sphenoidal
Procedure: • Ethmoidal
 Seated erect - can also be seen in caldwel’s and in lateral (best) projection.
 MSP perpendicular to IR
 Hyper extend the neck so that OML forms 37 degrees with IR. 5. 3 Auditory Ossicles
 Center IR at level of acanthion 1. Malleus (hammer)
 MML is perpendicular to IR. 2. Incus (Anvil)
 Respiration is suspended for exposure 3. Stapes (Stirrup)
CR: Passes through Parietal area and exits acanthion. - Smallest one in the body.

6. Cephalic Index
MESOCEPHALIC – petrous project anteriorly and medially at an angle of
47 degrees from the MSP of skull.
DOLICO CEPHALIC – Petrous pyramids lie at an average angle of 54
degrees.
BRACHYCEPHALIC – petrous pyramids forms an average angle of 40
degrees.
10. TEA – Top of the ear attachment.
11. #41:zygoma/zygomatic bone
#42: mastoid air cells
#43: frontal sinus
12. Petrous ridge just below the maxillary sinus.
# 4 CHEST X-RAY (PA)
CHESTELEOGRAPHY
1. Identify the radiograph.
- CHEST PA
2. It is the presence of air in the
pleural cavity. – Pneumothorax
3. How do you call the blood in the
pleural cavity? – Hemothorax
4. What is the active tissue of the
lungs? – Parenchyma
5. What is the reference point when
taking a Chest X-ray? - Top of the
cassette must be 3 inches above the
acromion process.
6. What is the partition between the two halves of the lungs that divide it
into (R) and (L) Hemothorax? - Mediastinum / middle septum
7. What are the structural units or the divisions of the lobes of the lungs?
- Right Lung has 3 lobes (upper/middle/lower)
- Left lung has 2 lobes
8. What do you call the small units of each Bronchopulmonary segments?
- Lobules
9. How many lobes or division the (R) Lung has? Name each.
- 3 lobes (upper/middle/lower)
10. Enumerate the Bronchopulmonary segments of the Upper lobe of the
(R) Lung.
- Upper lobe: Apical, Posterior (axillary), Anterior
/ - Middle lobe: Lateral, Medial
- Lower lobe: Superior basal, Suprabasal, Posterior basal, Anterior
basal, Medial basal, Lateral basal
11. What is the respiration instruction when taking a Chest X- ray?
- deep suspended inspiration
12. What is called the lining membrane of the chest cavity and the covering
of each lung? – Pleura
13. What is the purpose of rolling the shoulder forward when taking a Chest
X-ray? - to throw away the scapula away from the lung fields
14. What is the suggested SID for the Chest X-ray? - 6 feet / 72 inches, the
same with lateral cervical vertebrae.
15. What is the reason why maintaining or employing a 72 inches TFD?
- in order to avoid cardiac magnification
16. If there is an infiltrate/lesion on the apex of the lungs and it was - trachea must be at the midline (if not = patient is slightly oblique
superimposed by the clavicle, what projection should be made in order to or has pathology)
visualize the apex clearly? - Chest Apico-Lordotic View (Lidblom) - sternoclaviculat joint is symmetric
26. Elevation and deformity of the scapula? - prengels deformity
17. What is the depression or indentation on the medial surface of each lung
where the structures like the bronchi and blood vessels enter and leave the
27. The pulmonary circulation:
lung? – Hilum
- R atrium - R ventricle - pulmonary artery - lung capillaries -
pulmonary vien - L atrium – ventricle
18. What divides the lung into lobes? - fissure or groove
28. Common pathology
19. What is the functional unit of the lungs? – Alveoli - Empyema (presence of pus), atelectasis, pneumothorax,
pneumonia (hazy or whitish appearance at the base of the lungs), PTB
20. At what vertebral level the larynx coincides with? - C4 or C5 (apices of the lungs are white)

21. What composes the mediastinum? 29. 2 types of distortion: Foreshortening and Elongation.
-Dorsal vertebrae, esophagus, trachea, superior vena cava, aorta, 30. Rules of Oblique:
heart - AP nearest: affected side on the film
22. The collapse of the lung and has a white chest appearance? – Atelectasis - PA furthest: affected side far on the film
31. Landmark for CR: inferior angle of the scapula or T6
23. Comprises the thorax?
- 12 thoracic vertebrae 32. Xiphoid process: T9 Xiphoid tip: T10
- 12 pairs of ribs
- 2 clavicles
- Sternum #5 UPPER GI SERIES

24. The joint between xipoid and sternum? - xiphisternal joint 1. Gastr/o: stomach :: Pathy: disease
-Gastropathy: disease of the stomach
25. To know if it is a good radiograph? 2. UGIS: Upper Gastro-intestinal series
- apex/apices
- bronchus 3. Since we want to examine an empty
- sharp costrophenic angle (if not = pleural effusion) stomach, what would be withheld for a
- diaphragm period of 8-9 hours before the
- scapula and shoulder out procedure? - Food and water
- 10 posterior ribs must be seen
4. What is the contrast medium generally used for the stomach?
- Barium
5. Identify the three types of the stomach – Eutonic (see image), Hypotonic,
and Steer-horn
6. Identify the 2 GI examination procedures.
- Single contrast and Double contrast
7. What is the best position in UGIS wherein the gastric peristalsis is very
active, that is why it is used for serial films? - Right Posterior Oblique
(RPO)
8. PA Axial of the stomach is also called? - Gordon’s Method
9. What are the two curvatures of the stomach? - Lesser and Greater
curvature
10. What do you call the folds of the stomach? - Ruggae
11. What part of the stomach is located above the cardiac opening?
- Fundus
12. In order to produce a Double Contrast stomach, what is given to the
patient? - Carbonated drink gas producing substance
13. What is the purpose of instructing the patient to roll over a few times at
least 3x before taking radiographs in UGIS?
- Contrast filling of contrast material
14. What medication is injected to the patient prior to the procedure in order
to relax GIT? - Glucagon
15. What I that part of the stomach that surrounds the superior opening of
the stomach? - Fundus
16. The ballooned-out portion of the stomach projecting to the left is called?
- Duodenal bulb
17. Please identify the three-stomach habitus.
- Eutonic, Hypotonic, Steer-horn
18. When the patient is in erect position, the barium mixture tends to
gravitate and fills up to what part of the stomach? - Distal end of the
stomach
19. What body position wherein the barium mixture extends to gravitate and
fills up to the distal end of the stomach. - Erect position
20. We will go to physiologic consideration of the stomach. The indentation
or the contraction of the stomach is greater on what part of the stomach?
- Greater curve
21. What is the normal average contraction of the stomach per minute?
- 2-3 times per minute
22. More than 5 contraction according to some authors is distinctively
abnormal that suggest what abnormality? - Hyper-peristalsis
23. What are the patient preparation before the patient will undergo UGIS?
- Patient is told to report to the Radiology Department, no breakfast.
- Light supper evening prior to the examination
- NPO
- No smoking, chewing gum or used of Anti-acid medication or
before the examination
24. One of the patient preparation if a light evening meal prior to the
examination. What is the reason why we are instructing the patient to have
this?
- To prevent the fermentation of the intestinal content and so that the
stomach would be emptied in a shorter period of time.
25. What are the two methods employed in the study of UGIS?
- Overhead or Conventional method
- Fluoroscopy and overhead technique
26. What are the purpose of taking a Scout film?
- For Patient Preparation, Technique and Possible Pathology
27. What is the main purpose why we are taking “Wolf Method”?
 - Applying greater intra-abdominal pressure to ensure more Scanogram or topogram of image before it is sliced.
consistent result demonstration of the small intestine, sliding gastro-
esophageal herniations through the esophageal hiatus. Common Pathologies: bleeding, tumor, cancer, AVM - Anterovenous
Malformations (seen with contrast), stroke.
INDICATIONS: Dyspepsia, Weight loss, Upper abdominal mass, Partial
2 types of stoke
obstruction
- Hemorrhagic: due to rupture of the blood vessel
- Schemic: presence of emboli (obstruction, blockage, or infarct) with dark-
CONTRA-INDCATIONS:
grey appearance.
- Patient with complete obstruction
- Patient with perforated viscera 2D vs. 3D
2D- what you see is what you get.
GI divided into 3 regions: Upper Alimentary tract, Small bowel, and large
3D- fully detailed mass if there is.
bowel
Pterion (anterior), Asterion (posterior)
28. Body Habitus (SHAH)
- Sthenic: 50% Indications: performed to assess brain: Tumors, Lesions, Injuries, Intracranial
- Hyposthenic: 35% bleeding, Structural anomalies (e.g hydrocephalus), Brain function, Other
- Asthenic: 10% - the stomach is vertical conditions.
- Hypersthenic: 5% - the stomach is transverse Procedure:
 The same with gallbladder • Head is positioned in normal AP of the skull.
29. Image cut-off: the fundus is not seen and image is flipped; if not = situs • 1 cm slice thickness is generally employed.
inversus. • The first slice/ line starts from OML to vertex of the skull.
• Gantry angulation is from 15-20 degrees caudal to the patient’s OML
#6 CT SCAN OF THE BRAIN (Axial) • Filming program is 1 film without contrast and one film with contrast.
SIZE: A3 297 mm x 420 mm, 29.7 CT scan: Imaging method in which a cross sectional image (slice) of a structure
cm x 42 cm or 11.7 in x 16.5 in in a body pane is reconstructed by a computer program.
PATHO: Brain Tumor and  From x-ray absorption of x-ray beams projected through body in image
Intracranial Hemorrhage / plane.
Hemangioma on the left side of the
brain. Type: Intracerebral bleeding Other names:
 Computerized Axial Tomography (CAT)
Seen: Left intracerebral bleeding,  Computerized Trans-axial Tomography (CTT)
frontal and maxillary sinuses, and  Computerized reconstruction tomography (CRT)
mastoid air cells (L & R).  Digital Axial Tomography (DAT)
Contrast medium: Iopamidol
Invented by Engr. Godfrey Newbold Hounsfield and Allan M. Cormack Gantry
- Framework that holds the x-ray tube and radiation detection system. - Rotate scan only (no translation required
Solid-state detectors: Calcium tungstate, Yttrium, Gadolinium - Has circular/ring artifacts
- 4 scans per minute.
CT numbers: Density of the structure - 1-12 seconds – accommodating scan time.
- Employ a curvilinear detector array with at least 30 elements and a fan-
Types of cut: Axial, Sagittal, & Coronal shaped beam.
What are the CT scanner designs and operational modes? - Most common modern design.
Generations: 4th generation
1st generation - Single detection fan shaped beam
- Used for heads only - 600-2000 stationary detectors in 360-degree ring
- Linear scan and rotates 180 degrees at 1 scan. - 15 scans per minute
- 4.5-5 minutes scan time - Rotate motion only
- Water filled bag - used in patient positioning and detector normalization - Disadvantage: patient dose is higher. It is also costs higher because of
during scanning and to eliminate air interference. large number of detectors and their associated electronics.
- Requires 15 sec to 5 min to gather sufficient data before reconstructing of
5th generation
image.
- Also known as electron beam tomography (EBT) or Cardiac Cine CT.
- Uses single ray pencil beam (3x26mm)
- Huge electron gun - replaced x-ray tube, which uses deflection coil to
- Uses single detector
direct a 30-degree beam of electrons in a 210-degree arc around a 360-
2nd generation degree anode ring.
- Introduced in 1975 as hybrid - Fan beam
- Single projection fan-shaped beam - 360-degree detector array
- Up to 30 detectors (5-30) - No moving of gantry
- 10-90 seconds scan time - 4 section within 50 sec.
- Linear scan and rotate (translate- rotate)
6th generation
- Equipped with Linear Detector array.
- Also known as helical/ spiral CT scan
- Disadvantage: because of having fan shape instead of pencil beam, it
- Scan time is 8-10 seconds
increases scatter radiation which affects the image.
- Were made by advance in slip ring connection technology
- Leak mask- added to detectors to assist in reducing scatter reaching the
- Sling ring - consists of brushes that fit into grooves to permit current and
detectors.
voltage to x-ray tube to be supplied while tube is in continuous rotation
3rd generation around gantry.
- Fan shaped beam - Permits scanning of entire body in helical pattern without stopping the
- Multiple rotating detectors (500-1000) tube.
- Has a curved array of 250-750 detectors
Advantages:
1. Shorter total scan time - Includes the midbrain, medulla and pons.
2. Permit to use less or no contrast media. - Oldest part of the brain
3. Can be completed in one breath hold. - Begins where the spinal cord swells and enters the skull.
4. Eliminates overlaps and missed areas due to air in lungs between scan
3 parts of the brainstem:
sections.
 Pons
5. Reduces the possibility of motion artifacts.
- Deeper part of brain
- Bulge in brainstem between 2 halves of cerebellum
- Serves as the bridge and relay station for cerebellum and rest of the brain
4 types of cranial bleeding: Epidural, Subdural, Subarachnoid, and
- Controls sleep and arousal
intracerebral bleeding.
 Medulla oblongata
Appearance:
- Lowest part of brainstem
epidural - Most vital part of brain
- Contains controls from heart and lungs.
subdural  Midbrain
- A small central part of the brainstem, developing from the middle of the
primitive or embryonic brain
Anatomy of the brain: - It enables your brain to integrate sensory information from your eyes and
Brain - one of the largest and most complex organs in the human body. ears with your muscle movements, thereby enabling your body to use this
information to make fine adjustments to your movements
3 divisions:
 Cerebrum Basal Ganglia
- Front part of brain Includes:
- Has 2 hemispheres (R &L) • Caudate
- It is responsible for the integration of complex sensory and neural • Putamen
functions and the initiation and coordination of voluntary activity in the • Globus pallidus
body. - Coordinates fine motion (ie: fingertip motion)
 Cerebellum Cortex
- Occupies the major portion of the inferior and posterior fossae. - Surface of cerebrum
- The "little brain" attached to the rear of the brain stem. It helps voluntary - Contains 16 billion neurons
movements and balance.
Hypothalamus
 Brainstem - Controls maintenance functions like eating, drinking, body temperature
- Middle part of brain and sexual drive
- Linked to reward and emotion - Delicate avascular membrane.
- Governs the endocrine system 3. Pia mater: Innermost membrane
Thalamus
Falx Cerebri: Formed when inner layers of dura mater below the dura mater
- Relay station for almost all information that comes & goes to the cortex.
sinuses join together.
Spinal Cord
- Large bundle of nerve fiber Subdural Spaces: A narrow space between the dura mater and arachnoid.
- Carries messages to and from brain and rest of the body. - Contains thin films of fluid and various blood vessels.

Limbic system Subarachnoidal Spaces: A wide space between the arachnoid and the pia
- Center of emotion, learning and memory. mater.
Includes:
• Cingulate gyri Epidural Space: Potential space between dura mater and inner table of the
• Hypothalamus skull.
• Amygdala (emotional reaction)
• Hippocampus (memory) White matter: Consists of myelinated axons that are commonly identified
on CT Brain section as light- appearing or white-appearing tissues.
Pituitary gland
- Lies in sella turcica Gray matter: Comprises the thin outer layer of the folds of the cerebral
- Connected to hypothalamus by pituitary stalk cortex
- “Master gland” - Composed of
- Controls other Endocrine Glands. condrite and cell bodies.
- Secretes hormones for sexual development, promote bone and muscle
growth and response to stress. Good radiograph because it
clearly shows the Skull
Pineal Gland GML must be perpendicular;
- Behind 3rd ventricle if not, angle the gantry.
- Helps regulate body’s internal clock and circadian rhythm.
- Responsible for secretion of melatonin.
Meninges # 7 ESOPHAGOGRAM /
- Covering of the brain and spinal cord. BARIUM SWALLOW
INDICATION:
3 layers: This exam is performed to
1. Dura mater: Outermost membrane assess frequent heartburn
2. Arachnoid: Between the pia mater and dura mater (pain), gastric reflux
(food/acid coming back up), aspiration (food or fluid in your wind pipe),
difficulty eating, drinking, or swallowing.
1. What procedure is this? Other name?
- Esophagogram, Barium Swallow, Cardiac Series
2. 1st image outlines the esophagus. On the 2nd image, the lower part of the
esophagus is not seen clearly.
3. Artifact
• Static electricity
• Double/twin exposure
• marker
4. Examination of what structure? - Esophagus /gullet
5. Name the Normal Structures of the Esophagus.
- Cricoid level of aortic knob left bronchus hiatal openings/
esophagogastric Junction
6. Examples of negative contrast? - air, oxygen, carbon dioxide
7. What contrast medium was used? - barium sulfate (BaS04)
8. What are the Two-Procedures in performing Esophagography?
- Full column
- Single contrast
- Double contrast
9. Is there any patient preparation for this procedure? Why?
- No preparation required, because it does not visualizing the lower
10. For a Full-Column, Single contrast examination of the esophagus, how
many w/v of barium is used? - 30% - 50%
11. How about an obstruction of a non-opaque FB lodged in the esophagus,
how it is detected by x-ray?
- Pledgets of cotton saturated barium suspension
12. What are the projections of the esophagus are commonly employed?
- PA, Lateral, Oblique
13. Why recumbent AP position is most preferred? What is its importance??
- It obtains more contrast filling of the esophagus especially the
proximal part by having the barium column flow against gravity.
14. What is the reference point in Esophagography? - T6
15. Describe the location of the esophagus in relation to the trachea and
vertebral column?
- Esophagus lies anterior to the Vertebral column and posterior to
the trachea.
16. What are the three segments of the esophagus?
- Intra-abdominal segment
- Cervical Segment
- Thoracic Segment
17. Location of esophagus in relation to the trachea and vertebral column?
- Anterior of the vertebral column and posterior of the trachea
18. Indication of Esophagography?
- Dysphagia and heartburn esophageal varices achalasia foreign
bodies anatomic anomalies carcinoma hiatal hernia
19. Length of esophagus? - 25cm long and 2cm in diameter
20. Quality of radiograph?
- bad, somewhat underexposed, hypo retention, and where is the
marker?
21. The patient is in LAO which is incorrect because the esophagus
superimposes the heart. RAO or LPO
should be the correct position.
22. Valsalva maneuver: the patient inhales
deep then exhales without letting any air
out. “naundo” or bagan nauro
- Reverse Valsalva or Muller’s maneuver:
the patient attempts to inhale with their
mouth closed and their nostrils plugged,
which leads to a collapse of the airway.
#8 Barium Enema (LGIS)
1. Identify the Procedure? The other name?
- Barium Enema, Lower gastro-intestinal series
2. What medication is injected to the patient prior to the procedure to
minimize peristalsis? - Glucagon

3. What are the Two basic radiologic methods of examining the large
intestine?
- RAO & LAO Single and Double Contrast 11. What projection is useful for the visualization of recto-sigmoid
especially if it is redundant? - RPO
4. What contrast agent is generally used in routine radiographic examination
of the colon? - Barium Sulfate 12. What do you call the last film taken in Barium Enema (BaE)?
5. Can you give me 1 brand name of barium contrast medium used in the - Post evacuation
examination of the colon. - Iopamidol
13. What level of the colon has the highest percentage of developing
6. In inserting the enema tip, at least how many inches the tip is inserted diverticular disease? - Sigmoid
into the rectum? - 1 ½ inch anterior
14. How many percentage? - 95%
7. At least how many inches the enema is adjusted above the level of the 15. What is the other name of Megacolon? - Aganglionic Megacolon
anus? - 4.5 inches 16. The other name of Hirschsprung’s disease? - Congenital
Megacolon
8. What should be applied to the enema tip for an easier insertion and
comfortable feeling of the patient? - Water soluble lubricant 17. What projection maybe used to show both flexures free of
superimposition?
9. What are the two projections employed in order to uncoil the two - RAO & LAO (Right anterior oblique and Left anterior oblique)
flexures of the colon? - RAO & LAO
18. What is the last 1 inch of the colon that serves as the terminal portion of
10. Identify the parts of the colon, in descending order. the Alimentary tract? - Anal canal

19. What is Colitis? - Inflammation of the Colon

20. What is the best position when inserting an enema tip for Barium
Enema?
- Sims position
21. The sac-like pouches in the wall of the large intestine that results from • Passes across the upper abdomen from the right colic flexure to the spleen
puckering of the colon. - Haustra in the upper left abdomen
22. What structure causes the puckering of the colon? - Teniae Coli
(5) Left Colic or Splenic Flexure
Large Intestine begins in the RIGHT LOWER QUADANT, just lateral to • Is bend in the colon where the transverse colon ends.
the ileocecal valve.
(6) Descending Colon
Colon is 5 feet in length. It extends from the ileo-cecal junction to the anus. • Extends down from the left colic flexure to the brim of the pelvis in
It forms an inverted U-shaped structure that passes up from the right lower the left lateral abdomen
adomen to the right upper abdomen. It then descends to the left lateral
abdomen to the pelvis. (7) Pelvic or Sigmoid Colon
• The S shaped curved part of the distal colon extending from descending
(1) Cecum colon.
• Proximal end of the large intestine
• A large blind pouch located inferior to the level of the ileo- cecal valve. (8) Rectum
• 2 ½ inches (6cm) long and 3 inches (7.6cm) In width. • Final part of the colon. Extends from the pelvic colon to the anus.
• 6 inches long (15cm)
Appendix Rectal Ampulla
• Is also called Vermiform Appendix • Just above the anal canal is a dilatation called rectal ampulla
• 3 inches(7.6cm) long
• Attached to the lower end of the cecum (9) Anal Canal
• The term vermiform means wormlke • Lower one- and one-half inches of the rectum. It ends at an opening the
Ileo-Cecal Valve anus. The anal canal extends up and forward for a distance of 1.5 inches
• Projects into the lumen of the cecum and guards the opening between the then turns backward to follow the sacral curve.
ileum and cecum.
HAUSTRA: are the puckered folds caused by the arrangement of the
(2) Ascending Colon longitudinal muscle.
• Passes up from the cecum to the under surface of the liver through the
right lateral abdomen. The muscular portion of the intestinal wall contains an external band of
longitudinal muscle that forms into three thickened bands called TAENIAE
(3) Right Colic or Hepatic Flexure COLI.
• Is bend to the left under the right liver surface.
MAIN FUNCTION OF LARGE INTESTINE: Reabsorption of fluids and
(4) Transverse Colon elimination of waste products.
Consists of 4 major parts: Cecum, Colon, Rectum, Anal Canal
NOTE: Large Intestine is not synonym with Colon. Colon consists of 4
sections of the colon are: Ascending colon, Transverse Colon, Descending
colon, Sigmoid colon
The right hepatic and left colic are also included.
The transverse colon has a wide range of motion and normally loops down.
Body Habitus:
1. Hypersthenic - the entire large intestine extends to the periphery of the
abdominal cavity. This type generally requires two radiographs placed
crosswise to include the entire large intestine.
2. Hyposthenic / Asthenic - The large intestine causes to be very low in the
abdomen which has its greatest capacity in the pelvic region.
3. Sthenic - The left colic of the large intestine often is quite high resting
under the left diaphragm.
Barium Enema - a special radiographic examination of the large intestine
after an introduction of barium suspension into the rectum.
Film Size: 14x17” or 35x43cm
Two basic radiologic methods of examining the Large Intestine:
1. Single Contrast Method - in which the colon is examined with Barium
Sulfate suspension only.
2. Double Contrast Method - this is performed in two-stage or a single stage
procedure.
• Two stage procedure: the colon is examined fist with Ba sulphate
suspension then immediately after evacuation of the barium, air is then
introduced to the colon through the enema catheter.
• Single stage procedure: Ba sulphate suspension and gas/air are introduced
respectively.
Contrast Media:
• Barium Sulfate (BaSO4) is the generally used in routine radiographic
examination of the colon.
• Air is the gaseous medium usually used in Double-Contrast enemas and
thus the examination is called “Air Contrast Study”
• Water soluble iodinated contrast agents- are administered orally to the
patient to study the colon when retrograde filling of the colon with barium
is not possible or is contraindicated.
PREPARATION OF INTESTINAL TRACT:
• Barium procedure needs the large bowel to be completely emptied of its
contents to render all portions of its inner wall would be visible for
inspection.
• When the colon is not prepared, retained fecal material are likely to
stimulate the appearance of polypoid or other tumor masses, when coated
with Barium Sulfate suspension.
Preliminary Preparation includes:
• Dietary restrictions
• Laxatives
• Cleansing enemas is given to clear the colon.
STANDARD BARIUM ENEMA APPARATUS:
• For patients who have inflamed hemorrhoids, fissures, stricture or other
abnormalities of the anus, a SOFT RUBBER RECTAL CATHETER of
SMALL CALIBER should be used.
• RETENTION TIPS are used with patients who have relaxed anal
sphincter, as well as others who cannot retain an enema.
• RETENTION TIP with RUBBER BALLON is used. This is a double
lumen tube with a thin rubber balloon at the distal end for inflation of air.
• The tubing is approximately 6 feet in length and soft plastic enema tips are
available in sizes.
Because of the danger of intestinal rupture, retention tips must be inserted
with extra care.
• For performance of a double contrast barium enema examination, a special
rectal tip is needed in order to instill air in the colon, or air can simply be
pumped in using SPHYGMOMANOMETER BULB.
• Most enema bags have a capacity of 3 quarts (3000ml).
PREPARATION OF BARIUM SUSPENSION:
• 12 to 25% weight volume of barium suspension is used for a single
contrast enema.
• 75-95% for double contrast enemas, a relatively high- density barium is
used.
The best recommendation regarding the accurate mixing of the barium is to
follow the manufacturer’s instruction.
INSERTION OF ENEMA TIP:
• Patient is instructed to turn in LEFT SIDE, lean forward about 35 to 40
degrees and rest the flexed right knee on the table above and in front of the
slightly flexed left knee (SIMS POSITION).
*SIMS position because it relaxes the abdominal muscles which decreases
intra-abdominal pressure on the rectum and makes relaxation of the anal
sphincter less difficult.
• The IV stand should be adjusted so that the enema contents are 18-24
inches above the level of the anus.
• Patient should be well covered and during insertion of the enema tip, anal
area would only be exposed.
• Rectal tube should be lubricated with a water soluble lubricant for easier
insertion and comfortable feeling on the patient’s part.
• The patient is advised to relaxed and take a deep breath so that there will
be no feeling of discomfort when inserting the tube.
• The right buttock should be pushed laterally to open the gluteal folds and
as the anal sphincter is relaxed, the rectal tube is inserted gently and slowly
into the anal orifice by:
• Following the angle of the anal canal, the tube is directed anteriorly into 1
½ inch and by
• Following the curve of the rectum, the tube is directed slightly superiorly.
CLINICAL INDICATIONS FOR BARIUM ENEMA:
1. Colitis - inflammation of large intestine.
Ulcerative Colitis - a severe form of colitis in which it is a chronic
condition often leading to coin like ulcers developed within the mucosal
wall.
2. Diverticula - out pouching of the mucosal wall resulting from a
herniation of the inner wall of the colon.
3. Neoplasm or Tumor - are very common in the large intestine.
4. Volvolus - the twisting of a portion of the intestine on its own mesentery.
5. Intussusception - the telescoping of one part of the bowel into another.
6. Appendicitis - a barium enema maybe performed to rule out appendicitis.
May be caused by injection or blockage of the blood vessels that feed the
appendix.
7. Polyps - Growth or mass protruding from a mucous membrane.
POSITIONING:
The most commonly taken images for a single-contrast barium enema are:
PA or AP, LAO, RAO, Angulations projection of the sigmoid, and lateral
for demonstration of the rectum.
1. Wellin Technique
• Developed a technique for double contrast enemas that reveals even the
smallest intraluminal lesions.
• Is a method of examination has been extremely valuable in the early
diagnosis of conditions such as Ulcerative colitis, regional colitis and
polyps
2. PA Projection: Central ray is directed perpendicular to the film at the
level of the iliac crests.
• The table may be placed in a slight trendelenberg position in order to help
separate redundant and overlapping loops.
3. PA Axial: to demonstrate the recto-sigmoid area with the CR directed 30-
40 degrees caudally entering at the midline of the body at the level of the
ASIS.
4. RAO Positon: 35 to 45 degrees to demonstrate hepatic flexure, ascending
portion of the colon and sigmoid portion.
5. LAO Position: 35 to 45 degrees to demonstrate splenic flexure and
descending portion of the colon.
6. AP Axial: Supine
• 30-40 degrees cephalad for the demonstration of the recto-sigmoid area.
7. LPO Position: 35 to 45 degrees to demonstrate hepatic flexure and
sigmoid portion.
8. RPO Position
• 35 to 45 degrees to demonstrate the left colic or splenic flexure and
ascending portion of colon.
7. Decubitus Position
• Taken with air contrast for visualization of polyps.
• Patient lying on either side with the gridded cassette supported behind the
patient.
8. Right Lateral Decubitus
• CR enters the patients midline at the level of the iliac crest.
• Shows the “UP” medial side of the ascending colon and lateral side of the
descending colon.
13. Left Lateral Decubitus
• Shows the “UP” medial side of the descending colon and the lateral side
of the descending colon.
14. Chassard-Lapine Method or AP Axial Position or BOREAU
PROJECTION (REVERSE)
• Used for the demonstration of the rectum, the recto- sigmoid junction, and
the sigmoid itself.
• CR is directed to lumbo-sacral region at the level of the greater trochanter.
MODIFICATIONS EMPLOYED IN BARIUM ENEMA
• Fletchers Modification
• LAO position: 30-35 degrees obliquity, 2 inches medial to the elevated
ASIS, CR directed at 30-35 degrees cranially or perpendicular
2. Billing’s Modification: Supine, RP is midway between the ASIS, 35 to
45 degrees cranially CR
3. Chassard Lapine: Is also called Jake-Knife Position
• To demonstrate the anterior and posterior surfaces of the lower portion of
the large bowel and permit the coil of the recto-sigmoid to be projected free
for overlapping.
4. Oppenheimer’s Modification
• CR 12 degrees caudally for the demonstration of the recto- sigmoid.
5. Robinson’s Modification
• The most important modification in Barium Enema, wherein it
demonstrate a direct lateral view of the recto- sigmoid colon without
overlapping.
6. Trendelenberg Position: Used to separate redundant and overlapping
loops of the large bowel by throwing them out from the pelvis.
Colostomy - is an opening in the colon serving some or all of the function
of the anus.
3 Purposes:
1. It may replace the anus as the distal opening of the GIT.
2. It may diverse the fecal stream from some more distal pathological
process (such as perforations).
3. It may decompress the obstructed colon.
Types of Colostomy:
1. Permanent Colostomy - is intended to replace the anus when the anus and
rectum must be removed.
2. Temporary Colostomy - is intended only as an interior measure,
depending restoration of colonic continuity after the acute condition
prompting colostomy has resolved.
DEFECOGRAPHY
- Is a relatively new radiologic procedure performed for the patient with a
defecation dysfunction.
- After the barium is instilled, patient is seated in lateral position on a
radiolucent Styrofoam
- Lateral image are taken through fluoroscopy during voiding by spot
filming at approximate rate of 1-2 frames per second.
#9 SKULL
- Good Radiograph
- Identify the anatomies seen.
- 8 Cranial Bones
 Frontal (1)
 Parietal (2)
 Sphenoid (1)
 Temporal (2)
 Occipital (1)
 Ethmoid (1)
- 14 Facial Bones
 Maxillary (2)
 Zygomatic (2)
 Mandible (1)
 Nasal (2)
 Inferior Nasal Concha (2)
 Lacrimal (2)
 Palatine (2)
#10 HYSTEROSALPINGOGRAPHY
 Vomer (1)

INDICATIONS: to see lesions, polyps, tumor, or fistulous tract.

Fistula: abnormal connections between 2 organs - The use of intensifying screen result is considerably lower radiation dose
being absorbed by the patient but it has the disadvantage of casing a
During 1st trimester, the egg travels through your fallopian tube to your reduction of an image resolution. On the other hand, it produces temporary
uterus. image that being watched in TV monitor.

IN THE IMAGE, there is leakage of contrast media (iodine based or water SCREEN CONSTRUCTION
soluble) - There is a catheter & balloon (to block the contrast from getting  Intensifying screens are made up of flexible sheets of plastic or
out) cardboard. They are cut in sizes corresponding to film sizes.
 The intensifying screen mounted inside the cassette are usually one on
#11 SIALOGRAPHY tube side and one on the back side in which the radiographic film is
Sialography - radiographic studies of sandwiched between the two screens in relation to this film that will be used
is double-emulsion film.
salivary glands and ducts using oil
LAYERS
based or water soluble iodinated
Less factor, less patient exposure
contrast. Higher speed, more sensitivity, less patient dose, less factor,…
3 Parate gland stensens duct Larger crystal = more sensitivity
Submandibular gland - whartons duct White: less penetration; Black: more penetration
Sublingual gland - duct of rivinus Protective layer prevents scratches
Saliva lubricates and dissolves foods BASE
and begins the chemical breakdown of  The base has 100 micrometer or 1 millimeter thick that serves as a
carbohydrates and lipids. mechanical support for the phosphor layer. It is made of high grade
Secretory stimulant: 2-3 minutes before sialographic procedure cardboard polyester or metal.
Have the pt. Suck on a wedge of fresh lemon to promote salivation and  Polyester is the best choice as a base material in screen construction just
open up the ducts for easier passage of the canula of catheter. as it is a base material for radiographic film.
 Requirements for a Base Material
a) It must be rugged and moisture resistant.
b) It must not suffer radiation damage nor discolor with age (shiny white)
#12 INTENSIFYING SCREEN c) It must be chemically inert and do not interact with the phosphor layer.
FUNCTION: d) It must be flexible
- Converts energy into visible e) It must not contain impurities that would image by x-rays.
light and produces image 90-
99% REFLECTIVE LAYER
1-10% x-ray. This visible light  A thin layer of substance attached between the base and phosphor layer
interacts with the radiographic with approximately 25 micrometer or 0.25 mm thick which is made up of
film forming the latent image. magnesium oxide or titanium dioxide.
- The intensifying screen acts as
amplifier of the remnant
radiation reaching the film.
 When x-rays interact with the phosphor, light is emitted with equal
intensity in all directions. Therefore, less than a half of the light is emitted
in the direction of the film.
 The reflective layer blocks the light emitted headed in the opposite
directions and re-direct it to the film.
 The reflective layer doubles the number of light photons reaching the
film.
 In some screens use special dyes in the phosphor layer to selectively
absorb those light emitted at a large angle of the film.
PHOSPHOR LAYER
 The sensitive part of the intensifying screen is the phosphor.
 The phosphor emits light during interaction by x-rays; it converts the
energy of the x-ray beam into visible light.
 Phosphor layers vary in thickness from 15-300 micrometer, depending on
the type of screen.
 The active substance of most phosphors before 1980 was crystalline
calcium tungstate embedded in a polymer matrix.
 Rare earth metals are the phosphor material in newer, faster screens. The
screen will glow brightly when stimulated by x-rays.
CHARACTERISTICS OF PHOSPHOR
1. The phosphor should have a high atomic number so that the probability
of x-ray interaction is high. This is called quantum detection efficiency.
2. The phosphor should emit a large amount of light per x-ray interaction.
This is called the x-ray conversion efficiency.
3. The light emitted must be of proper wavelength to match the sensitivity
of the x-ray film. This is called spectral matching.
4. Phosphor afterglow, the continuing emission of light after stimulation of
the phosphor by x-rays should be minimum
MATERIALS USED AS PHOSPHOR:
1. Barium Platinocyanide
 A phosphor that was never applied to diagnostic radiology with success.
2. Zinc sulfide
 It was once used for low kVp techniques but never gained wide
acceptance.
3. Barium Lead Sulfate
 A screen used particularly with high kVp techniques.
4. Calcium Tungstate
 A type of phosphor that has good quality control procedure. It can be able
to use with a low or high kVp techniques.
5. Rare Earth Metals
 Gadolinium, Lanthanum and Yttrium – this screen are faster than those
made of calcium tungstate.
PROTECTIVE LAYER
 This is 15 to 25 micrometers thick and it is applied over the emulsion to
make the screen resistant to abrasion and damage caused by handling. It
prevents build-up of static electricity and provides a surface for cleaning
without damage to the phosphor.
 The protective layer must be transparent to light.
CHARACTERISTICS:
 Quantum Detection Efficiency
 Conversion Efficiency: less x-ray, more light
 Spectral Matching: alignment of light to the film and IS.
 Phosphor Afterglow: should be minimum
 Photoelectric Effect: Albert Einstein
The film is a GREEN 400 screen: This green emitting rare earth screen has
a relative system speed of 400 when used with a medium speed green
sensitive film and 800 speeds when used with a high speed green film.
- This screen is highly recommended for all general radiographic
procedures, providing an optimal balance of dose reduction and image
quality.
- Rare earth green intensifying screens contain high efficiency green
emitting x-ray phosphor, GADOLINIUM OXYSULFIDE. These screens
are intended for use with orthochromatic or green sensitive x-ray film.
- Rare earth green screens are available in five (5) types: Green 600, Green
400, Green 200, Green 100, and Green Extremity.
 TWO TYPES OF SCREEN
A. Radiographic Screen
 It is a screen attached in the cassette which is used for radiography.
 The phosphor of screen are made up of Calcium Tungstate, Gadolinium
Oxysulfite, Lanthanum Oxybromide and Yttrium Oxysulfite crystals which
emit visible light upon exposure in radiation in a blue violet, green, and blue
green.
B. Fluoroscopic Screen
 It is a screen that is used in fluoroscopy.
 The phosphor of this screen is made up of Zinc cadmium sulfite which
emits light in yellow green range.
 This is used for direct viewing examination on a T.V. monitor.
 The exposure does not require film therefore the image produced is only
temporary.
 It helps in exposure of film to provide a permanent record.
SS: for bony study of distal tibia & fibiola & their joint
Mortise view: plantar surface vertically positioned
- rotate leg & foot 15°to 20° medially
CR: I. to ankle joint
SS: mortise joint free of superimposition also demons. jones fx (fracture on
base of 5th metatarsal)
Lateral: (mediolateral)
CR: - to the ankle jt. entering the medial malleolus note: articulation (jt.
space) bet. talus and fibula, tibia and fibula are not demonstrated
AP stressed studies (forced inversion and forced eversion) to evaluate the
joint separatitit and ligament tear or rupture
#14 WRIST PA
Quality: good, but lacks collimation.
Should expose the “wrist” only.

#13 ANKLE AP & MORTISE Procedure: Open Reduction Internal

Ankle AP and mortise view
Image on the left side is underexposed, incorrect positioning and the ankle
joint is not visible.
Image on the right side is mortise view, talo-tibial joint is visible, talo-
fibular joint is not clearly delineated probably not enough medial rotation
Position:
AP: plantar surface vertically
positioned
CR. L to ankle joint to a point
midway between malleoli
SS: distal tib.fib. and proximal
talus
Oblique (medial) plantar surface
vertically positioned
- rotate leg & foot 45° medially
CR: L midway between the
malleoli
Fixation (ORIF), this puts pieces of a
broken bone into place using surgery.
Screws, plates, sutures, or rods are used
to hold the broken bone together.
- Closed reduction-internal fixation: a
healthcare provider moves the bones
back into place without surgically
exposing the bone. It is performed to
patients with dislocation and no
fracture.
-metals can be called an ‘artifact’ but not a useless one.
-AP is better for interspaces visualization and Lateral to see what type of
fracture.
- Fracture: Radius
-PCAS: Posterior-Colles, Anterior-Smith
- Pisiform is better seen in AP - flex the elbow 90°
- Projection and view is opposite - CR 5-15° towards elbow
glenoid cavity and provide additional information when assessing for
- Always ask the pt. To remove all accessories and jewelries Always check glenohumeral instability.
the markers: Right side up if the pt is in PA position, Right side down if in Image shows no visible Pathology, humeral head in in place and centered in
AP glenoid cavity
Always ask female pt. If they are pregnant or if there's a possibility.
VELPEAU (MODIFIED AXILLARY VIEW)
Use in an acutely injured shoulder still in a sling without abduction
-used when pt cannot abducted arm
A true axillary view will have an eye" just posterior to the glenoid, If this
eye is not present, it means that glenoid is in oblique position which may
mask severe defects

Other axillary views;

 Inferosuperior Axial / Lawrence - supine, abduct the arm 90 deg, -arm
external rotation, CR horizontally through the axilla to the AC
 Inferosuperior Axial Proj. (Rafert Mod) - exaggerated external rotation,
thumb pointing downward & posteriorly 459 best for hill sach, CR same
but medial angulation of 15 degrees
 Inferosuperior Axial Projection / West point – prone, arm abducted at
90°
forearm hanged pointing downward, CR 25° AM
 Inferosuperior Axial Proj. (Clements Mod.) - Lateral recumbent on the
unaffected side, abduct the affected arm @ 90° pointing the ceiling,
horizontally to the midcoronal ~ CR 5-15° medially

#15 AXILLARY PATHOLOGY:

VIEW  Adhesive capsulitis - shoulder stiffness, pain, and significant loss of
SHOULDER passive range of motion.
Axillary view  Hill sachs defect - posterolateral humeral head depression fracture
(Superoinferior
 Bankart lesion - injuries of the anteroinferior aspect of the glenoid labral
axial)
complex
extend the
shoulder
 Glenohumeral instability - an Inability to maintain the humeral head - more oval, wide, shallow, greater than 90% pubic arch, coccyx, is more
centered in the glenoid fossa straight.

#16 PELVIS - Supero-inferior or lilienfeld method: inlet

- Axial/Taylor method: outlet
Male: 20-35* cephalad
Female3: 30-45* cephalad
Ref. point: 2” distal to symphysis pubis
- PA Axial: Inlet, prone, 35* cephalad
- Inlet: 45-50% lean backwards, CR: 1.5 inch above the symphysis pubis.
- L4: level of iliac crest

#17 MAMMOGRAM

- Early detection of any anomaly

within the breast.
1. Other name for breast?
- mammary gland

2. What is the second most common

- Has bilateral hip arthroplasty
cancer among women?
- Good quality radiograph
- breast cancer (skin cancer
- has an artifact (metal implant) but a good one.
being first)
- feet should be rotated inward 15-20*, but in the image it’s not.
- presence of air in the large intestine/colon
3. Location of breast?
POSITIONING - anterior and lateral chest wall
- Original Cleaves
- Modified Cleaves 4. Average breast?
- extends from the anterior
MALE pelvis portion of the second rib (clavicle)
- narrow, more rounded, les than 90% pubic arch, coccyx is more curved down to the sixth or seventh rib (mid-
inwards. sternum) and from the lateral border of the sternum into the axilia

Female pelvis 5. Small projection of the breast contains a collection of 15-20 duct
openings from secretory glands?
 - Nipple
6. Circular, darker pigmented area surrounding the nipple? - Areola
7. Are small oil glands whose purpose is to keep the nipple lubricated?
- Montgomery glands
8. Methods of localization commonly used to subdivide the breast into
smaller areas? - quadrant system and clock system
9. 3 types of breast tissue? - glandular, fibrous/ connective, adipose
10. 2 determinants contribute to the exposure factor in mammography?
- compressed breast thickness and tissue density
11. 3 classification of breast?
- Fibroglandular -15-30 years, pregnant or lactating women,
radiographically dense, very little fat
- Fibrofatty -30-50 years, young women with 3 or more pregnancies,
average radiographic dense, 50% fat and 50% fibroglandular
- Fatty -50 and above, postmenopausal, minimal radiographic dense,
breasts of children and men
12. Preparation?
- remove jewelry, powder, or antiperspirant that can cause artifacts
13. Compression of the breast? - 25-45 pounds of pressure
14. Father of Mammography? - Robert Egan
15. What do you mean by "LMLO"? - Left mediolateral oblique view
16. What is the small projection containing a collection of duct opening
from the secretory glands? - Lactiferous duct
17. What are the types of the breast tissue?
- Glandular tissues, Connective tissues and Parenchymal tissues
18. In this radiograph, where is the base and the apex?
19. Since there is a great difference in thickness of the breast, how will you
overcome this anatomic difference? Or what device are you going to apply
to overcome this difference?
- Compression device / machine
20. What projection would best demonstrate the entire breast tissue?
- Craniocaudal Projection
21. Describe the Medio-Lateral Oblique projection.
- pg. 70
22. What is the purpose of Cleopatra projection?
- To demonstrate the lateral aspect of the breast including the tail
23. What are the General Principles of Technique in Mammography?
- Mammography is an x-ray imaging method used to examine the
breast for the early detection of cancer and other breast diseases.
24. The hemispheric shadow of the female breast is cast over with what
muscle? - Pectorals
25. What are the ways of examining the breast? - Mammography
26. What are the muscles of the thoracic cage that may produce shadow
upon the mammographic film? - Pectoralis Major
27. What year did Dr. Egan began teaching about Mammography?
- mid 1950’s
28. In mid 1960’s, who developed the first dedicated
mammographic unit together with the CGR Company?
 - Wolfe and Ruzicka
#18 CYSTOGRAM
29. Who produced the first initial breast images in 1924? 1. What procedure is this?
- Kleinschmidt (appeared in 1927 – general medical textbook) -

30. What is the appropriate respiration instruction when taking the exposure
for mammogram?
- When full compression is achieved, instruct the patient to suspend
breathing.

31. What projection will best visualize the subareolar, central, medial, and
postero-medial aspect of the breast? - Craniocaudal projection

32. Describe “Cranio-Caudal”.

- Detection of calcification, Cyst, Carcinoma and other abnormalities of the
breast.

33. What is “MLO” projection in Mammography? - Medio-Lateral

Oblique
34. What projection best visualize the posterior and upper-outer quadrants
of the breast? - MLO projection Cystography / Retrograde Cystography

35. What projection best demonstrate the Upper-inner quadrant (UIQ) and 2. Which means a radiographic examination involving what part of the
the Lower-outer quadrant (LOQ) of the breast free of superimposition of the anatomy? - Urinary Bladder
upper-outer and lower-inner tissues? - Superoinferior Oblique
Projection 3. What contrast agents are usually employed in this procedure?
- Ionic solutions either sodium or meglumine dialrizo or the newer
36. What are the 4 quadrants of the Breast? non-ionic contrast media
- Upper-outer Quadrant (UOQ)
- Lower-outer Quadrant (LOQ) 4. When doing this procedure, is it necessary to observe aseptic technique?
- Outer-inner Quadrant (OIQ) - Yes (Sterilization technique – other name)
- Lower-inner Quadrant (LIQ)
5. What is the average length of female urethra? - 3.5 cm-4cm / 1 ½
- Low kVp, high mAs because it is a soft tissue. inch
- Metals are used to mark the nipple and the lesion.

6. What is necessary to distinguish diverticular or filling defects which
might be obscured in other views? - Supine
7. What is the position that would demonstrate the bladder neck?
- Pa projection
8. In this examination the CM can reach the UB by using what equipment?
- Fole / Catheter
9. Under normal condition, it is not unusual for how many CC contrast
medium remain in the UB even after voiding completely? - 10-20 cc
17. What is the centering point of a 10x12 cassette for the scout film?
- At the level of the soft tissue depression just above the most
prominent point of the greater trochanters.
18. What are the initial cystographic positions employed?
- AP anteroposterior
- RPO right postero oblique
- LPO left postero oblique
- Direct LATERAL
19. Ballon and Catheter, has leak (possible rupture in urinary bladder,
trauma patient due to leakage in peritoneum.
20. Separated symphysis pubis or dislocated.

10. What projection may show a residual in the bladder (Bladder retention, #19 T-TUBE CHOLANGIOGRAM
or will show reflux up to the ureters)? - AP Projection - Special procedure
- puspose: to see reaming stone or
11. What position best shows the anterior and posterior bladder walls? obstruction. A follow up procedure.
- Lateral position - Post operative cholangiogram
- Pancreatic duct + CBD =
12. What special procedure may be used in the visualization of the urethra? hepatopancreatic ampula or Ampula of
- Cystourethrography vater
- Good position: scotty dog is seen
13. What contrast media is employed in the examination of the lower - Contrast media: iodine based or
urinary tract? - water-soluble organic contrast water soluble
- Gallbladder: stores bile
14. What do you mean by “Retrograde”? - Liver: excretes bile
- X-ray examination of the bladder in which contrast dye is placed - Liver has 4 lobes: right, left, caudate,
into the bladder through the urethra. quadrate.
- Against

15. What way of injection of the CM is employed in Retrograde #20 BONE SCAN
Cystography, Cysto-urethrogram, and Voiding Cysto- urethrogram? • Size of film?
- Bolus or rapid insertion - 8x10
• How many % must occur in bone mineralization before changes in density
16. What is the position of the patient for the Preliminary radiograph? can be appreciated on xray film?
- Supine - 30% - 50%
  Liquid or capsulated iodine 131, 3-5 millicurrie
INDICATIONS • Whole body scan is done usually if the patient is suffering from?
 To detect metastatic bone lesions prior to xray changes  Papillary or follicular cancer of the thyroid gland
 To determine the extent of known primary and metastatic lesions • Define Nuclear Medicine?
 To assist in the planning of radiotherapy portals  Is a branch of medicine concerned with the use radionuclides which is
 To evaluate fractures safe, painless, and cost effective technique in the diagnosis and treatment of
• Radiopharceuticals used in performing bone scan? disease.
 PHOSPHATE COMPLEXES:
→ Technetium 99m Polyphospate IMAGE INTERPRETATION:
→ Technetium 99m Pyrophospate • Appearance of normal bone scan
→ Technetium 99m Ethane  Vary with age
Hydroxyl Diphosphate (EHDP)  On posterior view, sacro-iliac joint
→ Technetium 99m Methylene always has a highest uptake (normal)
Diphosphate (MDP)  Enhanced activity on the knees and feet
→ Technetium 99m Methylene due to an increase in activity and
Hydroxyl Diphosphate (MHDP) continuous movement and weight bearing
→ Technetium 99m Disodium
Oxidronate • Abnormal bone scan
 Areas of increased uptake
• Procedure/ imaging method:  Areas of decreased or absent uptake as
 Ask to urinate in order to visualize in the following conditions:
the sacrum.  Osteolytic tumors
 The conventional images are usually  Granulomata
made 2-3-4 hrs following an IV  Vascular lesions of the bone
injection of 20 millicure of Tc-99m
labeled phospate complexes • Male sthenic
 When injection is suspected or assessment of blood flow to primary • Possible bone metastasis due to hotspots on different areas.
tumor is required, 3phase of examination is required: • T-tube
→ Vascular Phase (1 minute) • Fluoroscopy: real time and better visualization
→ Blood pool image (5 minutes) • Quality Image
→ Static images (3-4 hrs) • additional infos: Indigestion/Dyspepsia: stomach pain, over-fullness and
bloating during and after eating. Other common symptoms include acid
• Indicate a problem related to the history of the patient? reflux, heartburn and excessive burping.
 Hot spots
• Radiopharmaceutical given in performing whole body survey scan? #21 BABY GRAM
 • Pigg-O Stat
- Examination use for skeletal malfunctionof wholebody especially the baby • Tam-em board,
- CHEST AP • Posi-Tot
- 1 SHOT • Papoose Board
- ARTIFACT: cut off artifact (upper, lower
extremities) Other Immobilizer:
- No pathology • Tape
• sheets or towels
- Head to feet should be included if possible. • sandbags
- Thoracic view is more visualized • covered radiolucent sponge blocks
- distended • compression bands
- exposure time: as short as possible to prevent motion blur. • Stockinette’s
- Optical density = white (ex. Bone) • Ace bandages

Pre-examination introduction and child and parent evaluation: Bone Ossification:

• Introduce yourself as the technologist who will be working with this child.
• Find out what information the attending physician has given to
the parent and patient.
• Explain what you are going to do and what your needs will be. Tears, fear,
and combative resistance are common reactions for a young child. The
technologist must take the time to communicate to the parent and the child
in language they can understand exactly what he or she is going to do.
Evaluation of Parent’s Role:
1. Parent is in room as an observer, lending support and comfort by his or
her presence.
2. Parent actively participates, assisting with immobilization.
3. Parent is asked to remain in the waiting area and not accompany the child
into the radiography room.
- The divisions of the hip bone between the ilium, the ischium, and the
pubis are evident. They appear as individual bones separated by a joint
space, which is the cartilaginous growth region in the area of the
acetabulum.
- The heads of the femora also appear to be separated by a joint space that
should not be confused with fracture sites or other abnormalities.
- These primary centers become the diaphysis (shaft or body) (D) of long
bones. Each secondary center of ossification involves the ends of long
bones and is termed an epiphysis (E).
- At the ends of the diaphysis are the metaphysis (M). The metaphysis is the
area where bone growth in length occurs.
- The space between the metaphysis and the epiphysis is made up of
cartilage known as the epiphyseal plate (EP). Epiphyseal plates are found
until skeletal growth is

IMMOBILIZATION CHILD PREPARATION

Note: pediatric radiography should always use as short exposure times and - After the child is brought into the room and the procedure is explained to
as high mA as possible to minimize image blurring that may result from the child’s and parent’s satisfaction, the parent or technologist must remove
patient motion. any clothing, bandages, or diapers from the body parts to be radiographed.
Types of immobilizer:
Removal of these items is necessary to prevent the items from casting
shadows and creating artifacts on the radiographic image because of low
exposure factors used for the patient’s small size.
Procedure:
AP Erect of Abdomen Clinical Indications:
• Pathology of the abdomen, including possible intestinal obstruction by
demonstration of air-fluid levels or free intraabdominal air.
Generally, this projection is part of a three-way or acute abdomen series
(supine, erect, and decubitus).
Technical Factors
• Minimum SID—40 inches (102 cm)
• IR size—determined by size of patient, lengthwise
• Grid if 10 cm or larger
• Shortest exposure time possible
• Analog—65 to 75 kV; newborn to 18 years old
• Digital systems—70 to 80 kV; newborn to 18 years old Shielding
Shield radiosensitive tissues outside region of interest.
• Gonadal shield on all boys—size appropriate for age (tape shield in place)
• No gonadal shielding on girls
Patient and Part Position
• Have patient sit or stand with back against upright IR.
• Seat younger child on large foam block with legs slightly apart.
Immobilize legs if necessary. Ask parent to hold arms away from side or
over the child’s head. Hold infant’s head between arms.
• Children 4 years old and older (unless too ill) can stand with
assistance. With parental assistance (if parent is not pregnant)
• Provide parent with lead apron and gloves.
• Position tube and cassette and set exposure factors before positioning.
• Position parent so that technologist’s view is not obstructed.
CR:
• With infants and small children, center CR and IR 1 inch (2.5 cm)
above umbilicus.
• With older children and adolescents, center CR at approximately 1 inch
(2.5 cm) to 2 inches (5 cm) (depending on the height of the child) above the
level of the iliac crest, which should place top collimation border and top of
film at level of the axilla to include the diaphragm on IR.
Respiration:
• With infants and children, watch the breathing pattern. When the abdomen
is still, make the exposure. If the patient is crying, make the exposure as the
patient takes a breath in to let out a cry.
• Children older than 5 years usually can hold their breath after a practice
session.
Evaluation Criteria Anatomy Demonstrated:
• Entire contents of abdomen are shown, including gas patterns and air-fluid
levels and soft tissue if not obscured by excessive fluid in distended
abdomen.
Position:
• Vertebral column is aligned to center of radiograph.
• No rotation exists; pelvis and hips should be symmetric.
• Collimation to area of interest.
Exposure:
• No motion is evident, and diaphragm and gas
Pattern Borders Appear Sharp.
• Bony pelvis and vertebral body outlines are evident through abdominal
contents without overexposing air-filled structures.