Test Bank for Bontragers Textbook
of Radiographic
Positioning and Related Anatomy 9th Edition by Lampignano
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Chapter 08: Cervical and Thoracic Spine
Lampignano: Bontrager’s Textbook of Radiographic Positioning and Related Anatomy, 9th Edition
MULTIPLE CHOICE
1. On average, how many separate bones make up the adult vertebral column?
a. 33
b. 28
c. 26
d. 31
ANS: C REF: 292
2. The spinal cord tapers off to a point distally at the vertebral level of:
a. lower L5.
b. L3-4 intervertebral space.
c. L1-2.
d. L4-5 intervertebral space.
ANS: C REF: 292
3. Which of the following is the first compensatory spinal curvature to develop in the young child?
a. Thoracic
b. Cervical
c. Sacral
d. Lumbar
ANS: B REF: 293
4. Scoliosis is defined as an abnormal or exaggerated _____ curvature.
a. concave
b. convex
c. lateral
d. “swayback” lumbar
ANS: C REF: 293
5. Kyphosis is defined as a(n):
a. normal lumbar curvature.
b. normal convex sacral curvature.
c. normal compensatory curve of the thoracic spine.
d. abnormal thoracic curvature with increased convexity.
ANS: D REF: 293
6. The bony structures connected directly to the vertebral body are the:
a. pedicles.
b. articular processes.
c. laminae.
d. transverse processes.
ANS: A REF: 294
7. The most posterior aspect of a typical vertebra is the:
a. pedicle.
b. spinous process.
c. lamina.
d. body.
ANS: B REF: 294
8. The joints between articular processes of vertebra are termed _____ joints.
a. zygapophyseal
b. fibrous
c. intervertebral
d. synarthrodial
ANS: A REF: 294-296
9. Which aspect of the intervertebral disk is composed of semigelatinous material?
a. Nucleus pulposus
b. Annulus fibrosus
c. Conus medullaris
d. Cauda equina
ANS: A REF: 295
10. Which of the following statements is true?
a. All adult vertebrae are separated by intervertebral disks.
b. All thoracic vertebrae have at least one facet for rib articulation.
c. The intervertebral disks are tightly bound to the vertebral bodies to prevent movement within the vertebral column.
d. All of the above are true statements.
ANS: B REF: 298
11. Which of the following statements is true for a typical adult vertebra?
a. The transverse processes extend laterally from the junction of the pedicles and laminae.
b. The transverse processes are present only on thoracic vertebrae containing rib connections.
c. The spinous process extends posteriorly from the body of the vertebra.
d. All of the above are true statements.
ANS: A REF: 294
12. Which of the following features makes the cervical vertebra unique as compared with other vertebrae of the spine?
a. Transverse foramina and double (bifid) tips on spinous processes
b. Overlapping vertebral bodies
c. Presence of zygapophyseal joints
d. All of the above
ANS: D REF: 296
13. Where is the articular pillar located on a cervical vertebra?
a. Between the superior and inferior articular processes
b. Between the pedicle and the body
c. Between the spinous process and the lamina
d. Nowhere
ANS: A REF: 296
14. Which of the following best defines or describes the vertebral body of C1?
a. The smallest of all vertebral bodies
b. A column of bone supported by an intervertebral disk
c. A large bony mass
d. There is no vertebral body at C1.
ANS: D REF: 297
15. Which of the following thoracic vertebra(e) possess(es) no facets for costotransverse joints?
a. T9-10
b. T11-12
c. T1
d. None of the above
ANS: B REF: 298
16. The zygapophyseal joints for the typical cervical vertebra lie at an angle of ____ in relation to the midsagittal plane.
a. 45°
b. 60°
c. 70° to 75°
d. 90°
ANS: D REF: 299
17. The most prominent aspect of the thyroid cartilage corresponds to the vertebral level of:
a. C5.
b. C1-2.
c. C6-7.
d. C7-T1.
ANS: A REF: 304
18. The zygapophyseal joints for the thoracic spine lie at an angle of ____ in relation to the midsagittal plane.
a. 45°
b. 60°
c. 70° to 75°
d. 90°
ANS: C REF: 299
19. T2-3 intervertebral disk space is found:
a. at the level of the jugular notch.
b. at the level of the sternal angle.
c. at the level of the xiphoid process.
d. 2 inches (5 cm) below the jugular notch.
ANS: A REF: 304
20. The gonion corresponds to the vertebral level of:
a. C1.
b. C4-5.
c. C3.
d. C7.
ANS: C REF: 304
21. The xiphoid process corresponds to the vertebral level of:
a. T8.
b. T9-10.
c. T7.
d. T12.
ANS: B REF: 304
22. Along with increasing the source image receptor distance (SID), what other factor(s) will improve spatial resolution for lateral and oblique projections of the cervical spine?
a. Increasing object image receptor distance (OID)
b. Using a small focal spot
c. Using higher kV, lower mAs
d. Using a breathing technique
ANS: B REF: 305
23. Which of the following pathologic conditions is defined as “a condition of the spine characterized by rigidity of a vertebral joint”?
a. Spondylitis
b. Ankylosing spondylitis
c. Spondylosis
d. Scheuermann disease
ANS: C REF: 308
24. Which of the following clinical conditions will require a decrease in analog manual technical factors?
a. Advanced osteoporosis
b. Severe scoliosis
c. Moderate lordosis
d. Scheuermann disease
ANS: A REF: 308
25. Which factor is most important to open up the intervertebral joint spaces for a lateral thoracic spine projection?
a. Use sufficiently high kV.
b. Collimate the spine region to reduce scatter.
c. Keep the vertebral column parallel to the tabletop.
d. Angle the central ray (CR) 5° to 10° caudad.
ANS: C REF: 321
26. Which position or projection of the cervical spine will best demonstrate the zygapophyseal joint spaces between C1 and C2?
a. Anteroposterior (AP) axial
b. Lateral
c. 45° posterior or anterior oblique
d. AP open mouth
ANS: D REF: 296-297
27. Along with the upper incisors, what other bony landmark must be aligned for the AP open-mouth projection?
a. Base of skull
b. Tip of mandible
c. Inferior margin of lower incisors
d. Thyroid cartilage
ANS: A REF: 310
28. What type of CR angulation is required for the AP axial projection for the cervical spine?
a. None. CR is perpendicular to the image receptor.
b. 5° to 10° cephalad.
c. 15° to 20° cephalad.
d. 15° to 20° caudad.
ANS: C REF: 311
29. Why are the anterior oblique projections (right anterior oblique [RAO]/left anterior oblique [LAO]) preferred over the posterior oblique projections of the cervical spine?
a. To make the patient more comfortable
b. To reduce the thyroid dose
c. To prevent overlap of the mandible over the spine
d. To place the zygapophyseal joints closer to the image receptor
ANS: B REF: 312
30. Which of the following positions will demonstrate the left intervertebral foramina of the cervical spine?
a. RAO
b. Left posterior oblique (LPO)
c. Lateral
d. LAO
ANS: D REF: 313
31. Which of the following projections will best demonstrate the C4-5 zygapophyseal joints of the cervical spine?
a. AP axial
b. Posterior oblique
c. Lateral
d. Anterior oblique
ANS: C REF: 296
32. Which of the following is NOT a correct evaluation criterion for the AP axial C-spine projection?
a. C3-T2 vertebral bodies should be visualized.
b. Spinous processes are seen to be equal distances from the vertebral body lateral borders.
c. CR is at the lower margin of the thyroid cartilage.
d. All of the above are correct criteria.
ANS: D REF: 319
33. Which of the following factors does not apply to a lateral projection of the cervical spine?
a. Use a 72-inch (183-cm) SID.
b. Suspend respiration upon full inspiration prior to exposure.
c. Perform horizontal beam lateral projection if trauma is suspected.
d. Center CR to thyroid cartilage.
ANS: B REF: 313
34. The chin is extended for a lateral projection of the cervical spine to:
a. open up the C1-2 joint space.
b. demonstrate the articular pillars.
c. open up the intervertebral joint space.
d. prevent superimposition of the mandible upon the spine.
ANS: D REF: 313
35. The AP axial-vertebral arch projection may be performed to better demonstrate the:
a. C1 and C1-2 atlantoaxial joint spaces.
b. vertebral arch (articular pillars) of C4-7.
c. open intervertebral disk spaces of C3-T1.
d. dens within the foramen magnum.
ANS: B REF: 319
36. What type of CR angle is recommended when performing the AP axial C-spine projection erect?
a. 15° cephalad
b. 20° cephalad
c. 15° caudad
d. 25° cephalad
ANS: B REF: 311
37. What type of CR angle is required for posterior oblique (left posterior oblique [LPO]/right posterior oblique [RPO]) positions of the cervical spine?
a. 15° cephalad
b. 15° caudad
c. 5° to 10° cephalad
d. None. The CR is perpendicular to the image receptor (IR).
ANS: A REF: 312
38. Which of the following factors will enhance the visibility of the vertebral bodies during a lateral projection of the thoracic spine?
a. Use a high kV.
b. Increase SID.
c. Use an orthostatic (breathing) technique.
d. Flex the spine.
ANS: C REF: 321
39. Which of the following positions will best demonstrate the left zygapophyseal joints of the thoracic spine?
a. LPO
b. RPO
c. RAO
d. Lateral
ANS: B REF: 322
40. How much rotation of the body is required for an LAO projection of the thoracic spine (from the plane of the table)?
a. 20°
b. 45°
c. 50° to 60°
d. 70°
ANS: D REF: 322
41. Which of the following projections will project the dens within the shadow of the foramen magnum?
a. AP open mouth
b. AP projection (Fuchs method)
c. Twining method
d. None of the above
ANS: B REF: 317
42. A radiograph of an AP open-mouth projection of the cervical spine reveals that the zygapophyseal joints are not symmetric. No fracture or subluxation is present. Which one of the following positioning errors most likely led to this radiographic outcome?
a. Excessive CR angulation
b. Insufficient CR angulation
c. Rotation of the spine
d. Excessive flexion of the head
ANS: C REF: 310
43. A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral joints are not open. The following analog factors were used for this projection: 5° cephalad angle, 40-inch (100-cm) SID, grid, slight extension of the skull, and the CR centered to the thyroid cartilage. Which of the following modifications should be made during the repeat exposure?
a. Keep the CR perpendicular to the image receptor.
b. Increase the SID to 72 inches (183 cm).
c. Center the CR to the gonion.
d. Increase the CR angulation.
ANS: D REF: 319
44. A radiograph of an AP thoracic spine projection reveals that the upper thoracic spine is overexposed. The lower vertebrae have acceptable density and contrast. Which one of the following modifications will improve the visibility of the upper thoracic spine?
a. Place the upper spine under the cathode side of the tube.
b. Use a compensating (wedge) filter.
c. Increase the kV to decrease the contrast of the upper spine.
d. Use a breathing technique.
ANS: B REF: 320
45. A radiograph of a lateral thoracic spine reveals that there is excessive density along the posterior aspect of the spine. Even with good collimation, the scatter radiation reaching the image receptor obscures the spinous processes. What can the technologist do to improve the visibility of the posterior elements of the spine?
a. Use higher-speed screens and film.
b. Increase the kV, lower the mAs.
c. Use a higher-ratio grid.
d. Place a lead mat on the tabletop just posterior to the patient.
ANS: D REF: 321
46. A radiograph of an AP open-mouth projection reveals that the base of the skull is superimposed over the dens. What positioning error led to this radiographic outcome?
a. Excessive flexion of the skull
b. Excessive extension of the skull
c. Excessive CR angulation
d. Rotation of the skull
ANS: B REF: 310
47. A radiograph of a lateral projection (nontrauma) of the cervical spine reveals that the ramus of the mandible is superimposed over the spine. What could the technologist have done to prevent this?
a. Elevate the chin to place the acanthiomeatal line (AML) parallel with the floor.
b. Rotate the skull 20° to 30° toward the IR.
c. Angle the CR 3° to 5° caudad.
d. Have the patient hold 5 to 10 lb in each hand.
ANS: A REF: 313
48. A radiograph of an RAO of the cervical spine reveals that the lower intervertebral foramina are not open. The upper vertebral foramina are well visualized. Which positioning error most likely lead to this radiographic outcome?
a. Excessive CR angulation
b. Insufficient CR angulation
c. Insufficient rotation of the upper body
d. Incorrect CR placement
ANS: C REF: 312
49. A patient comes to the radiology department for a cervical spine routine. The study is ordered for nontraumatic reasons. The AP open-mouth projection reveals that the base of the skull and upper incisors are superimposed, but they are obscuring the upper portion of the dens. On the repeat exposure, what should the technologist do to demonstrate the upper portion of the dens?
a. Increase the flexion of the skull.
b. Increase the extension of the skull.
c. Perform the Fuchs or Judd method.
d. Perform the AP chewing projection.
ANS: C REF: 310
50. A patient enters the emergency department (ED) because of a motor vehicle accident (MVA). The patient is on a backboard and wearing a cervical collar. The technologist is concerned about the artifacts that the collar will project on the spine during the horizontal beam lateral projection. What should the technologist do in this situation?
a. Leave the collar on during the exposure.
b. Remove the cervical collar but be careful not to move the patient’s head.
c. Ask the patient to remove the collar herself (for liability reasons).
d. Ask a nurse to remove the collar and to hold the patient’s head while the technologist is initiating the exposure.
ANS: A REF: 310
51. A lateral projection of the thoracic spine reveals that the upper aspect, which is a primary area of interest on this patient, is obscured by the patient’s broad shoulders. Which of the following options will best demonstrate this region of the spine?
a. Use a compensating (wedge) filter and repeat the exposure with increased kV.
b. Angle the CR 10° to 15° cephalad.
c. Perform the projection with the patient erect and holding weights in hand during exposure.
d. Perform a cervicothoracic (swimmer’s) lateral position.
ANS: D REF: 315
52. A patient enters the ED with a cervical spine injury as a result of a fall. The initial horizontal beam lateral projection reveals no subluxation or fracture. The ED physician is concerned about a whiplash injury. Which of the following routines would be most helpful in diagnosing this type of injury?
a. Patient in the swimmer’s lateral position
b. Oblique projections of the cervical spine
c. Patient in hyperflexion and hyperextension lateral positions
d. AP Ottonello method
ANS: C REF: 316
53. A patient comes to radiology for a thoracic spine routine. The patient has a history of arthritis of the spine. The radiologist requests that additional projections be taken to demonstrate the zygapophyseal joints. What position(s) and/or projection(s) would be ideal to demonstrate these structures?
a. Pillar view projection of interest region
b. Swimmer’s lateral projection
c. Spot AP and lateral projections of interest region
d. 70° oblique projections
ANS: D REF: 322
54. For an average-size adult, which of the following would receive the highest skin dose?
a. AP “wagging jaw” cervical spine, 3-second exposure time
b. AP thoracic spine
c. Lateral cervical spine at 72-inch (183-cm) SID
d. Lateral thoracic spine
ANS: D REF: 321
55. What is the recommended kV range for thoracic spine projections when using digital systems?
a. 70 to 80 kV
b. 60 to 70 kV
c. 75 to 85 kV
d. 110 to 120 kV
ANS: C REF: 305 | 312
56. This radiographic image represents which of the following projections and/or positions?
a. AP Fuchs method
b. AP pillar projection
c. AP axial C-spine projection
d. AP open-mouth projection
ANS: D REF: 310
57. A critique of the image demonstrates which repeatable error?
a. Excessive flexion of the skull
b. Excessive extension of the skull
c. Mouth not open far enough
d. None of the above are repeatable errors.
ANS: D REF: 310
58. The structure labeled A, which should be well demonstrated on this projection, is the:
a. pedicle.
b. lamina.
c. odontoid process.
d. inferior articular process.
ANS: C REF: 310
59. A digital image taken of a lateral thoracic spine projection demonstrates poor visibility of the spine. The image was taken on a full 14- 17-inch (35- 43-cm) IR. The following factors were used during the exposure: 80 kV, 80 mAs, 40-inch (102-cm) SID, and collimation to the size of the IR. Which one of the following modifications will result in a more diagnostic image?
a. Decrease kV.
b. Decrease mAs.
c. Collimate to spine.
d. Increase SID.
ANS: C REF: 321
60. A patient comes to radiology for a follow-up study of the cervical spine. The patient had spinal fusion between C5 and C6 performed 6 months earlier. His physician wants to assess the cervical spine for anteroposterior mobility. Which of the following projections would provide this assessment?
a. Cervicothoracic projection
b. AP axial-vertebral arch projection
c. Judd or Fuchs projection
d. Hyperflexion and hyperextension projections
ANS: D REF: 316
61. Which of the following will best demonstrate a compression fracture of the thoracic spine?
a. AP projection
b. Lateral projection
c. Posterior oblique positions
d. Anterior oblique positions
ANS: B REF: 321
62. Which imaging modality will best demonstrate herniated nucleus pulposus in the cervical spine?
a. Computed tomography (CT)
b. Hyperflexion and hyperextension lateral projections
c. Magnetic resonance imaging (MRI)
d. Nuclear medicine
ANS: C REF: 307
63. A patient enters the ED due to an MVA. He is on a backboard and in a cervical collar. The initial lateral cervical spine projection demonstrates C1–6. The patient has broad and thick shoulders. Because the hospital is in a rural setting, no CT scanner is available. Which of the following modifications would best demonstrate the lower cervical spine safely?
a. Repeat the exposure and increase kV.
b. Repeat the exposure but ask the patient to stand up and do the lateral projection erect.
c. Repeat the exposure but have a student pull down on the arms during the exposure.
d. Perform the horizontal beam cervicothoracic (swimmer’s) lateral position.
ANS: D REF: 315
64. A patient comes to radiology for a follow-up study for a clay shoveler’s fracture. Which of the following projections will best demonstrate the extent of this fracture?
a. AP cervical spine
b. Lateral thoracic spine
c. Lateral cervical spine
d. AP axial-vertebral arch
ANS: C REF: 307
COMPLETION
1. The structure anterior arch of the atlas is labeled _____.
ANS: H
REF: 297
2. Stress from a severe whiplash type of injury may cause a fracture of the structure labeled _____.
ANS: I
REF: 297
3. The structure transverse process is labeled _____.
ANS: A
REF: 297
4. The body of C2 is labeled _____.
ANS: D
REF: 297
5. The superior articular facet is labeled _____.
ANS: G
REF: 297
6. The structure transverse foramen is labeled _____.
ANS: Q
REF: 296
7. The part vertebral foramen is labeled _____.
ANS: O
REF: 296
8. The structure pedicle is labeled _____.
ANS: L
REF: 296
9. The structure lamina is labeled _____.
ANS: M
REF: 296
MATCHING
Match the vertebra with the corresponding terms and/or structures. (You may use an answer more than once.)
b. C2
1. Dens
2. Vertebra prominens
3. Axis
4. Anterior arch
5. Typical cervical vertebra
6. Lateral masses
1. ANS: B REF: 297
2. ANS: A REF: 296
3. ANS: B REF: 296
4. ANS: C REF: 297
5. ANS: D REF: 296
6. ANS: C REF: 297
TRUE/FALSE
1. The PA projection (Judd method) is intended to demonstrate the atlantoaxial joints between C1 and C2.
ANS: F REF: 317
2. The posterior cervical oblique projections demonstrate the intervertebral foramina and pedicles on the side closest to the image receptor.
ANS: F REF: 312
3. An RPO position of the cervical spine requires a 45° oblique of the body with a 15° caudad CR angle.
ANS: F REF: 322
4. Another term for a breathing technique during exposure is the orthostatic technique.
ANS: T REF: 305
5. The anterior oblique thoracic spine demonstrates the upside zygapophyseal joints.
ANS: F REF: 322