FLUOROSCOPY EXAM / ORAL BOARD

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What are 2 types of fluoro recording systems?: Plumbicon and vidicon.
What else can be used to record fluoro studies other than a videotape?: Cine film.
What is fluoroscopic x-ray used for?: To study the dynamics of various parts in motion.
What mA range is used to prolong tube life or to prevent tube failure?: 0.5 - 5.0 mA.
Why is patient dose decreased when SID is decreased in fluoro?: Positioning the image intensifier closer to the pt decreases the SID & pt dose. Pt dose decreases 'cause as the SID is decreased the # of x-ray photons at the input phosphor increases; this results in the ABC (automatic brightness control) decreasing the mA to compensate for the increase in x-ray photons.
The fluoro exposure rate must not exceed ___ R per minute.: 10 R per minute.
What is the maximum distance between the focal spot and xray table?: 12 inches.
When does the automatic timer go off in fluoro?: At 5 minutes.
What activates the production of x-rays during fluoro?: Dead man switch (foot switch); NOT THE "FOOT PEDAL"!
How many light photons are emitted for each absorbed x-ray photon?: 5000 light photons.
Where are photoelectrons initially released from?: The photocathode of the image intensifier.
What component of an image intensifier focuses the electrons emitted from the photocathode toward the output phosphor?: Negatively charged electrostatic lenses.
What is the diameter of a fluoro input screen?: 5 - 12 inches; made of cesium iodide.
What percentage of light from an image intesifier's output screen is transmitted to the cine camera when in use?: 85 - 95%.
Name 3 sizes of spot films.: 70, 90, and 105mm.
Recite the order of how fluoroscopic x-rays are received by the patient resulting in a light image visible to the human eye.: TPIC MRM: Tube, Patient, Image Intensifier, Camera(s), Monitor, Recorder, Monitor. *Be prepped to discuss each aspect in detail during the oral board.
How is the stomach situated in an asthenic patient?: Low and medial; located in the pelvis when standing.
What position is the pt upon insertion of an enema tip for barium enema?: Sims position (Laying on the side with one leg/knee drawn up). Similar to the recovery position.
Which position best demonstrates the stomach at its most superior point?: PA prone.
Which position best demonstrates the gallbladder away from the vertebrae in the asthenic pt?: LAO.
At what level does the esophagus start and end?: Starts at level of C6 and ends at level of T11.
What is the difference between the left and right lung?: Left lung has 2 lobes. Right lung has 3 lobes.
How is the rectum situated in relation to the bladder and vagina?: In males the rectum is posterior to the bladder. In females the vagina is situated between the bladder anteriorly and the rectum posteriorly.
When does barium reach the first part of the ileocecal valve?: 2 - 3 hours.
When does barium reach the rectum?: 24 hours.
What is seen in profile on an RAO stomach shot?: The pylorus and duodenal loop and bulb.
Which body habitus requires more obliquity during an RAO stomach?: Hypersthenic. (Range is from 40 - 70 degrees)
What is the central ray for a stomach overhead?: L2. The elbow can also be used as a reference, or midway between the xiphoid process and navel towards the left side of the pt.
What does the acronym G.E.R.D. stand for?: Gastroesophageal reflux disease.
Why is the PA axial / RAO sigmoid overhead called the "blow-out" shot?: It's the first overhead performed after the enema tip is removed following a barium enema. The rectum is usually full of barium and could lead to a "blow-out".
Where are "black spots" mostly located on scout KUB's?: In the colon.
How do you know when enough barium has been inserted/retrograded into the patient for a barium enema?: When the barium reaches the cecum.
Describe the explanation/instruction given to pt's scheduled for a barium enema.: Schedule for earliest available time slot. Ask if they've had a BE before. They'll be on a 48-hour low residue diet. Drink an entire bottle of magnesium citrate, and four 5mg bisacodyl tablets. Insert a 10mg bisacodyl suppository 1 hour prior to the exam ensuring they remove the foil wrap and insert into the anus (not the mouth); leaving it in place for 45 minutes. Remove the suppository 15 minutes prior to evacuation of bowels. If pt is diabetic, tell them not to take their insulin on the day of their exam. Taking insulin when fasting results in insulin shock. Cardiac meds may be taken with small sips of water. NPO 8 hours prior to exam.
What term describes food poisoning of the small intestines?: Enteritis.
How do the ureters extend from the kidney?: Medially, then inferiorly and posteriorly articulating to the superoposterior aspect of the bladder.
What is the difference between negative and positive contrast?: Air is negative contrast and appears dark or dense on a radiograph. Barium is positive contrast and appears white on a radiograph because it uptakes x-rays well.
Why must a pt not chew gum or smoke prior to a fluoro exam?: Smoking or chewing gum results in increased gastric secretions which would dilute contrast making it less radiopaque.
Why is barium contraindicated for use on pt's with perforation during a fluro study?: Barium is not absorbed by the body because it's a water insoluble salt. If barium leaked into the peritoneal cavity it may lead to peritonitis or bacterial infection. Water soluble contrast should be used instead, i.e. gastroview.
What is located at the distal end of the esophagus?: The cardiac sphincter.
When can the rugae of the stomach be visualized?: When the stomach is empty.
What type of body habitus falls between asthenic and sthenic?: Hyposthenic (35%). It's the most difficult body habitus to classify.
Where is the C-loop of the duodenum located in relation to the pancreas?: Around the head of the pancreas.
Which portion of the colon is continuous with the cecum?: The ascending colon.
How does the ascending colon bend at its intersection with the transverse colon?: Anteriorly, then transverse.
How does the descending colon bend from its intersection with the transverse colon?: Posteriorly, then inferiorly.
In which type of body habitus does barium pass the fastest?: Hypersthenic.
What type of contrast is used in pt's with suspected perforation?: Water-soluble, i.e. Gastroview. It's easily absorbed and then excreted via the kidneys.
What do dilated bowel loops that appear as "ladder-like projections" in the small bowel signify?: Small bowel obstruction(s).
Why is the RAO the best position for an overhead of the esophagus?: It shows the esophagus in between the vertebrae and heart.
Which position/technique demonstrates esophageal varices well?: Trendelenburg with valsalva maneuver.
Which of the following procedures takes the longest to complete? SBFT, UGI or BASW.: SBFT (Small Bowel Follow Through). Patient must drink contrast and be monitored until the contrast reaches the cecum. It takes 2 - 3 hours for barium to reach the cecum, but when mixed with 10 - 30cc's of Gastroview, it passes faster. *Gastroview should not be used if pt is allergic to shellfish.
What should the exposure time in fluoro be and why?: 0.1 sec or one-tenth of a second; to avoid motion. Also, shorter exposure time along with pulsed exposures significantly reduces exposure dose considering lengthy duration of fluoro exams.
What is the typical time interval for SBFT spot films/overheads?: 15 - 30 minutes; Mostly 15 minutes, until contrast reaches the cecum. Radiologist may use a compression paddle to expedite bowel movement.
Which type of timer accuracy test is performed for single phase x-ray units?: Spinning top test which shows a series of dots or impulses.
Which type of timer accuracy test is performed for three phase x-ray units?: Spinning top test which shows a solid arc exposure in portion of a circle and measured in degrees.
What components are placed within a filament circuit in an x-ray tube?: Step-down transformer which provides low voltage to heat up the filament(s) for thermionic emission and rheostat to control the amount of mA to emit.
What are 2 types of computer memory?: RAM (randowm access) and ROM (read only).
What is the 2-dimensional picture element in x-ray?: Pixel.
What is the 3-dimentional picture element in x-ray?: Voxel.
How much flux gain does a typical image intensifier have?: 50
What is the preferred phosphor for image intensifiers?: Cesium iodide.
What is used to synchronize x-ray exposure with proper film position/alignment?: Grid controlled x-ray tubes.
How many Addison's planes are there?: There are nine Addison's planes.
What are the characteristics of the heart and pelvis in a sthenic pt?: The heart of moderately transverse. The pelvis is small.
Which body habitus demonstrates high/long lungs and a wide pelvis?: Asthenic.
A pt is scheduled for a SBFT, IVP, UGI and BE on the same day. What sequence should the exams be performed?: IVP 1st 'cause contrast will be excreted the fastest & not interfere with the latter exams. BE 2nd. UGI 3rd. SBFT 4th.
For which exam is the esophagus of most importance?: Barium swallow which is performed to identify possible perforations, reflux, varices, strictures, and blockage, hiatal hernia.
Which exam requires overheads afterward that focus on the stomach?: UGI. Overheads taken are AP, PA, RAO and right lateral stomach.
What are premalignant intraluminal lesions that can be caused by eating too much red meat?: Polyps.
What is the central ray for PA axial "blow-out"?: Prone; 30 - 40 degrees caudal to MSP/level to ASIS;.
What is the central ray for AP axial "blow-out"?: Supine; 30 - 40 degrees cephalic to MSP/level to ASIS.
Why perform a PA or AP axial "blow-out"?: To open the S-shaped sigmoid colon.
Which positions best demonstrates the open hepatic flexure?: RAO or LPO. *When pt is prone, flexure closest to IR is open.
Which positions best demonstrate the open splenic flexure?: LAO or RPO. *When pt is supine, flexure furthest from IR is open.
What does a left lateral decubitus position of the large intestine demonstrate on a radiograph?: Pt lays on their lt side. Pt's rt side is up, so film is marked anatomically with the rt-side (red) marker.
Structures shown: Lateral aspect of ascending colon & hepatic flexure and medial aspect of splenic flexure & descending colon.
What 2 ducts connect to form the common bile duct?: The common hepatic duct from the liver and the cystic duct from the gallbladder connect to form the common bile duct.
What does a right lateral decubitus position of the large intestine demonstrate on a radiograph?: Pt lays on their rt side. Pt's lt side is up, so film is marked anatomically with the lt-side (blue) marker.
Structures shown: Distal aspect of descending colon & splenic flexure and lateral aspect of ascending colon & hepatic flexure.
Which vein and artery convey blood to and from the liver?: The portal vein and hepatic artery.
What are the dimensions of the adult liver?: 8.5 inches long at its widest point, 6.5 inches high at it longest point and 4.5 inches high at its shortest point.
How much bile is secreted per day?: 1 - 3 pints.
What circular muscle controls the hepatopancreatic ampulla?: The sphincter of Oddi, aka sphincter of the hepatopancreatic ampulla.
What are the 4 parts of the pancreas?: Head, neck, body and tail.
What is the modality of choice for visualization of the gall bladder?: Sonography (ultrasound).
What is the universal contrast media of choice used in fluoroscopy?: Barium sulfate.
What is the average empyting time of the stomach?: 2 - 3 hours.
What term implies to the contraction waves by which the digestive tube propels its contents toward the rectum?: Peristalsis.
What exam incorporates the use of both single and double contrast?: Biphasic exam.
How far is an enema tip inserted?: 3 - 4 inches so as not to injure the rectum.
What type of exam is performed to demonstrate haustra, lumen, and polyps?: Double-contrast study.
What term describes the inflammation of the colon?: Colitis, which has a grainy appearance.
What is a good position reference point for the overhead views of the esophagus?: Top of the film at the level of the gonion ensuring that the cardia of the stomach is included, as well as the barium filled column.
Why is a cross-table lateral rectum overhead performed prone instead of supine?: For ease, pt comfort, and ensuring the sigmoid is not superimposed on the sacrum and coccyx.
Why is a right lateral stomach overhead performed instead of left lateral?: To show the natural emptying of the stomach into the pylorus.
Which view best demonstrates both the splenic and hepatic flexures?: AP or PA erect, which shows the natural emptying of both as well.
Which view best demonstrates the lesser and greater curvature of the stomach?: PA prone 'cause the stomach is closer to the film.
Why is a left lateral stomach overhead not performed?: Natural emptying is best demonstrated on a right lateral recumbent overhead with the help of gravity. The left lateral position would produce air in the lesser curvature where peristaltic activity is greatest.
What is seen on a double contrast study of the bowel?: Barium appears white (radiopaque) and air appears dark or black (radioluscent).
How can you tell the difference between the jejunum and ileum on a radiograph?: The jejunum appears feathery 'cause of its villi. The ileum appears solid and tubular.
Which quadrant of the body is the duodenal bulb located?: Right upper quadrant (RUQ).
What is the minimal amount of kVp required to penetrate barium?: 90 kVp.
What is required before administering iodinated contrast?: Consent form signed by the patient.
What is the age in which pt's are required to have a BUN/creatinine level test before administering iodinated contrast?: 50 yrs and up.
What are the side effects of barium sulfate?: Side effects are minimal, i.e. constipation. Pt's should be instructed to drink plenty of water after the exam.
What do decubitus views demonstrate besides anatomy during a barium enema?: Air/fluid levels.
What is the purpose for using glucagon?: It relaxes the bowel.
What are 2 special planes used to localize a specific area of the body?: Occlusal plane (used for many skull projections) and interiliac plane (used for projections of the lumbar, sacrum and pelvis).
What is located on the lesser curvature and marks the beginning of the pyloris of the stomach?: Insicura angularis.

*Insicura means angle.
Which of the following is longer: The ascending or descending colon?: The descending colon is longer than the ascending colon.
What is described as inflamed diverticuli usually occluded by fecaliths?: Diverticulitis, which occurs frequently in the sigmoid.
What is the "sniper" position which is used during BASW, UGI, and BE?: RAO.
What are the 2 parts of the digestive system?: Accessory glands and alimentary canal.
What is included in the accessory glands?: Salivary glands, liver, gallbladder, and pancreas.
What is the musculomembranous tube that extends from the mouth ot the anus?: The alimentary canal, which is 29 - 30 feet (8.6 - 8.9 meters) long.
What is the length of the alimentary canal?: 8.6 - 8.9 meters long, or 29 - 30 feet.
What is the function of the mouth?: Mastication and converting food into a boLus by insalivation.
What are the two organs of swallowing?: Esophagus and pharynx.
Where does the digestive process begin?: The stomach.
Where is the digestive process completed?: Small intestine.
What is the function of the large intestine?: Storage and removal of undigested food as fecal matter into the anus (egestion) and water absorption.
What is length and diameter of the average adult esophagus?: 10 inches long and 3/4 inches in diameter.
What are the 4 layers of the esophagus?: Fibrous, muscular, submucosal, and mucosal.
How is the esophagus situated in relation to the vertebrae, trachea and heart?: The esophagus is anterior to the vertebral bodies, and posterior to the trachea & heart.
Where does the esophagus join the stomach?: At the esophogastric junction level to the xiphoid tip or T-11.
What is the expanded portion of the terminal esophagus which lies in the abdomen?: Cariac antrum.
What are the 4 divisions of the stomach?: Cardia, fundus, body, and pylorus.
What section of the stomach surrounds the esophageal opening?: Cardia.
What is the superior portion of the stomach that expands sueriorly and fills the dome of the left hemidiaphragm?: Fundus.
What is the gas-filled fundus called when the pt is in the upright position?: Gas bubble.
What portion of the stomach descends and begins at the level of the cardiac notch?: The body.
What are the longitudinal folds called on the mucosal layer of the body of the stomach?: Rugae, which appear smooth when the stomach is full.
What is the right border of the stomach called?: Lesser curvature.
What is the left border of the stomach called?: Greater curvature, which is 4 - 5 times longer than the lesser curvature.
What are the muscles that control the cardiac orifice of the stomach?: Cardiac sphincter.
What controls the exit of the stomach into the small intestine?: Pyloric sphincter.
How is the stomach situated in a hypersthenic pt?: High and almost horizontal.
How is the stomach situated in an asthenic pt?: Low and vertical.
What is the milky white substance called when food food that's been mechanically and chemically altered in the stomach transported to the duodenum?: Chyme.
What are the 3 main functions of the small intestine?: Comletes the digestion of food, absorbs end products of digestion into the blood lymph, and secretes hormones.
What is the length and diameter of the small intestine in the average adult?: 22 feet long, 1-1/2 inches in diameter in the proximal part and 1 inch in the distal part.
What are the 3 portions of the small intestine?: Duodenum, jejunum and ileum.
What is the length of the duodenum?: 8 - 10 inches.
What are the finger-like projections in the mucosa of the small intestine called?: Villi, which assist in the process of digestion and absorption.
What is the widest portion of the small intestine?: Duodenum.
What is the 1st or superior portion of the duodenum called?: Duodenal bulb/loop.
How long is the 2nd portion of the duodenum?: 3 - 4 inches.
What 3 ducts unite to form the hepatopancreatic ampulla?: The common bile duct and the pancreatic duct.
What is the sharp curve called where the duodenum joins the jejunum?: The duodenojejunal flexure or angle of Treitz.
What supports the duodenojejunal flexure?: The ligament of Treitz.
What is the most fixed portion of the small intestine?: The duodenal loop.
What are freely movable loops that the jejunum and ileum are gathered into?: Gyri.
What are the four main parts of the large intestine?: Cecum, colon, rectum, and anal canal.
How long is the large intestine?: 5 feet.
What is the external band of longitudinal muscle contained in the muscular portion of the intestinal wall that forms into 3 thickened bands?: Taeniae coli.
The bands described as taeniae coli which create a pulling muscle tone forms a series of pouches called ________?: Haustra or lumen.
What is the length and diameter of the cecum?: 2-1/2 inches long and 3 inches in diameter.
What is the wormlike tube attached to the posteromedial side of the cecum?: Vermiform appendix which is 3 inches long.
What projects into the lumen of the cecum and guards the opening between the ilieum and cecum?: The ileocecal valve.
What are the subdivisions of the colon?: Ascending colon, transverse colon, descending colon, and sigmoid colon.
What is the other name for the hepatic flexure?: Right colic flexure.
What is the other name for the splenic flexure?: Left colic flexure.
What is the longest and most movable part of the colon?: The transverse colon.
At what level does the sigmoid colon end?: At the 3rd sacral segment.
How long is the rectum?: 6 inches.
How long is the constricted distal portion of the anal canal?: 1 inch.
What is the dilation just above the anal canal called?: The rectal ampulla.
What are the 2 principle components of a fluoroscope?: Tube and fluorescent screen.
Why is pt dose much higher in fluoroscopic than radiographic procedures?: Shorted SOD; entrance exposure is significantly greater than exit exposure as a result of attenuation processes within the patient.
State some radiation safety features of fluoroscopic equipment.: Bucky slot cover, 5 minute timer, tabletop exposure, lead curtain, max of 10R per minute, deadman switch, minimum of 12" SID, and max of 5 mA.
What are some variables that affect fluoroscopic pt dose?: Exposure rate, tissue thickness/density, and length of exposure.
What is defined as diminished resolution and contrast at the image periphery?: Vignetting.
What component of the fluoroscopic system functions to maintain constant brightness & contrast of the output screen image, correcting for fluctuations in x-ray beam attenuation with adjustments in kVp and/or mAs?: The ABC (automatic brightness control) of the image intensifier.
What landmark or body structure is at the level of C-1?: Mastoid tip.
What landmark or body structure is at the level of C-2/3?: Gonion.
What landmark or body structure is at the level of C-3/4?: Hyoid bone.
What landmark or body structure is at the level of C-5?: Thyroid cartilage.
What landmark or body structure is at the level of C-6?: Beginning of esophagus.
What landmark or body structure is at the level of C-7/T-1?: Vertebral prominence.
What landmark or body structure is at the level of T-1?: Approximately 2" above the jugular notch.
What landmark or body structure is at the level of T-2/3?: Jugular notch, aka manubrial notch, sternal notch, or suprasternal notch.
What landmark or body structure is at the level of T-4/5?: Sternal angle.
What landmark or body structure is at the level of T-7?: Level of inferior angle of scapulae.
What landmark or body structure is at the level of T-9/10?: Level of xiphoid process.
What landmark or body structure is at the level of T-11?: Level of xiphoid tip; end of esophagus; cardiac sphincter/antrum.
What landmark or body structure is at the level of L-2/3?: Inferior costal margin.
What landmark or body structure is at the level of L-4/5?: Level of most superior aspect of iliac crests.
What landmark or body structure is at the level of S-1/2?: Level of ASIS.
What landmark or body structure is at the level of the coccyx?: Level of pubic symphysis and greater trochanters.
What are the 4 types of body habitus?: Sthenic (50%)
Hyposthenic (35%)
Asthenic (10%)
Hypersthenic (5%)
What is the dominant type of body habitus?: Sthenic (50%)
What is the function of the gallbladder?: Stores bile (which is produced by the liver) until it secretes it into the cystic duct to the pancreatic duct and finally into the duodenum.
What is another term for gallstones?: Cholelithiasis.
What causes jaundice, aka yellow pigment disease?: Increased levels of bilirubin.
How long are the 3 parts of the small intestine?: Duodenum is 8 - 10 inches.
Jejunum is 9 feet.
Ileum is 13 feet.
What is the twisting of the small intestine called?: Volvulus.
What results from the loss of blood supply to the small intestine?: Ischemia.
Where does the small bowel terminate?: The ileocecal valve.
What is described as inflammation of the vermiform appendix due to occlusion by fecal matter?: Appendicitis.
What are small saccular protrusions of intestinal mucosa through the intestinal wall?: Diverticula, which are most commonly found in the sigmoid colon.
What is the purpose of a scout?: To check for:
Abdominal contents
Radiopaque paterial (i.e. gallstones, residual barium, calcification, masses)
Organ location & size.
In what position does air replace barium in the duodenal bulb and pylorus of the stomach?: LPO.
Which projection provides the best visualization of the pyloric canal, right retrogastric space, and duodenal bulb in profile in the hypersthenic pt?: Right lateral recumbent. *It would also show the anterior and posterior stomach surfaces.
Where does barium travel in the stomach when a pt is supine?: To the superior posterior fundus.
How much obliquity is needed for an RAO stomach?: 40 - 70 degrees. More obliquity for hypersthenic pts.
What can poor pt prep for a large intestine exam result in?: Retained fecal matter in the colon mimics or conceals pathologic conditions.
What is the central ray for an AP projection of the large bowel?: MSP and level to the iliac crest.
What is the central ray for the cross-table lateral recumbent rectosigmoid projection?: MCP and level to ASIS.
What is the decreased peristaltic movement of the esophagus where the cardiac sphincter does not relax?: Achalasia (difficulty swallowing).
What is the length of the trachea?: 5 inches long, 1 inch in diameter, contains 20 C-shaped hyaline cartilage which prevents collapse, and ends at the bronchi at level of T-5.
What is the process of chewing food for swallowing?: Mastication.
What is the act of swallowing?: Deglutition.
What is the evacuation of waste or undigested material?: Egestion.
What is the space between the teeth, cheeks and lips?: Vestibule.
What are rough projections on the tongue which contain taste buds?: Papillae.
What are the 2 layers of the peritonal cavity?: Parietal layer which lines the walls of the entire abdominal cavity.

Visceral layer which forms serous outer coat of the organs.
What are the 4 portions that the peritoneal cavity is divided into?: Mesentery, transverse mesocolon, greater omentum, and lesser omentum.
What is fan-shaped, encloses the jejunum and ileum, allows free movement of the intestines, and prevents strangulation?: Mesocolon.
What attaches the transverse colon to the posterior abdominal wall?: Transverse mesocolon.
What has a "lacy-apron" appearance, extends from the greater curvature of the stomach & 1st part of the duodenum to the transverse colon?: Greater omentum.
What attaches the liver to the lesser curvature of the stomach and the 1st part of the duodenum?: Lesser omentum.
Which projection best demonstrates the fundus filled with barium?: LPO.
Which projection best demonstrates the left retrogastric space?: Left lateral.
Which exam uses direct injection of contrast into the bowel through an intestinal tube, i.e. bilbao/sellink tube?: Enteroclysis or small intestine enema.
How high should the barium bag for a BE be hung?: 20 inches (18 - 24 inches).
What is the function of the kidneys?: To remove waste products from the blood
Balance water and electrolyte levels
Secrete substances that affect blood pressure.
What are the dimensions of the kidneys?: 4.5 inches long, 2 - 3 inches wide, and 1-1/4 inches thick.
*Extend from level of T12 - L3.
What is the average amount of urine excreted by the kidney each day?: 1 - 2 liters a day.
What is the outer layer of the kidneys called?: Cortex.
What is the inner layer of the kidneys called?: Medulla.
What is the basic unit of the kidney?: Nephron.
Recite the route of filtration in the kidney.: Apices - minor calyces - major calyces - renal pelvis - hilum - ureter.
What is the longitudinal slit on the medial border of the kidney which transmits blood, lymphatic vessels, and nerves to the ureters?: Hilum.
What part of the body converys urine from the renal pelvis to the bladder through rhythymic peristaltic motion?: Ureters.
What is micturition?: Urination.
What is the function of the bladder?: Serves as a reservoir for urine; has a max capacity of 500mL.
What is the function of the esophagus?: To propel food to the stomach through peristaltic movement.

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