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The Complete Meaghan Piretti Radiographic
Positioning & Procedures Certification Practice Exam:
200 ARRT-Style Multiple-Choice Questions with
Detailed Answers, Clinical Rationales, and
Comprehensive Study Notes for Registry Success
SECTION 1: UPPER EXTREMITY PROCEDURES
1. Where are the sesamoid bones located in the hand?
• A) Lateral aspect of the 5th metacarpal
• B) Anterior (palmar) surface of the first metacarpal head (thumb)
• C) Dorsal side of the 2nd metacarpal
• D) Between each phalanx
Answer: B
Rationale: The sesamoid bones are found on the anterior (palmar) surface of the first metacarpal
head (thumb). These small, round bones are embedded within tendons and help reduce friction and
protect the tendon from excessive wear .
2. How many phalanges and joints does the thumb have?
• A) Three phalanges, two joints
• B) Two phalanges, one joint
• C) Two phalanges, two joints
• D) Three phalanges, three joints
Answer: C
Rationale: The thumb has two phalanges (proximal and distal) and two joints (MCP and IP), unlike
fingers 2-5, which have three phalanges and three joints .
3. List the carpal bones in the proximal row from lateral to medial.
• A) Trapezium, Trapezoid, Capitate, Hamate
• B) Scaphoid, Lunate, Triquetrum, Pisiform
• C) Scaphoid, Capitate, Hamate, Pisiform
• D) Lunate, Triquetrum, Pisiform, Hamate
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Answer: B
Rationale: The proximal row of carpal bones consists of the scaphoid, lunate, triquetrum, and
pisiform. The distal row consists of the trapezium, trapezoid, capitate, and hamate .
4. Which carpal bone is most commonly fractured?
• A) Lunate
• B) Scaphoid
• C) Triquetrum
• D) Pisiform
Answer: B
Rationale: The scaphoid is the most commonly fractured carpal bone, typically resulting from a fall
on an outstretched hand (FOOSH). Due to its tenuous blood supply, scaphoid fractures carry a risk of
avascular necrosis .
5. What is the recommended SID for hand and wrist radiography?
• A) 40 inches (100 cm)
• B) 44 inches (112 cm)
• C) 72 inches (183 cm)
• D) 56 inches (142 cm)
Answer: A
Rationale: The standard SID for hand and wrist radiography is 40 inches (100 cm). This distance
provides optimal magnification and spatial resolution for extremity imaging .
6. A "Stecher Method" is used to demonstrate which structure?
• A) Carpal tunnel
• B) Scaphoid
• C) Wrist joint
• D) Thumb
Answer: B
Rationale: The Stecher method is a projection used specifically to demonstrate the scaphoid with
the hand in ulnar deviation. This positioning elongates the scaphoid and projects it free of
superimposition from adjacent carpal bones .
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7. What is the recommended degree of wrist flexion for a carpal tunnel (Gaynor-Hart) view?
• A) 30 degrees
• B) 45 degrees
• C) 90 degrees
• D) 120 degrees
Answer: C
Rationale: The Gaynor-Hart method requires the wrist to be flexed approximately 90 degrees to
demonstrate the carpal tunnel. This tangential projection visualizes the carpal canal and its
contents .
8. Where is the central ray directed for a PA wrist projection?
• A) Capitate
• B) Mid-carpal area
• C) Radial styloid
• D) Ulnar styloid
Answer: B
Rationale: The central ray is directed to the mid-carpal area for a PA wrist projection. This ensures
optimal visualization of the carpal bones and radiocarpal joint space .
9. Which projection best demonstrates the scaphoid without superimposition?
• A) PA hand
• B) PA wrist with ulnar deviation
• C) Lateral wrist
• D) AP forearm
Answer: B
Rationale: The PA wrist with ulnar deviation (Stecher method) best demonstrates the scaphoid
without superimposition. Ulnar deviation elongates the scaphoid and projects it free from
overlapping carpal bones .
10. The "fingers" (digits 2-5) each contain how many phalanges?
• A) 2
• B) 3
• C) 4
, 4
• D) 5
Answer: B
Rationale: Each of the four fingers (digits 2-5) has three phalanges: proximal, middle, and distal. The
thumb (digit 1) has only two phalanges .
11. What is the evaluation criteria for a PA hand radiograph?
• A) Carpal bones only visualized
• B) Entire hand from distal phalanges to distal radius and ulna
• C) Only metacarpals visible
• D) Only phalanges visible
Answer: B
Rationale: The entire hand from the distal phalanges to the distal radius and ulna should be
visualized with proper positioning. This ensures complete anatomical coverage for diagnostic
evaluation .
12. In a lateral wrist projection, which structures are superimposed?
• A) Radius and ulna
• B) Scaphoid and lunate
• C) Trapezium and trapezoid
• D) Capitate and hamate
Answer: B
Rationale: In a true lateral wrist, the scaphoid and lunate are superimposed with the radius. Proper
superimposition indicates correct positioning .
13. What is the position of the thumb in a PA hand projection?
• A) Extended straight
• B) Flexed inward
• C) Oblique
• D) Posterior
Answer: C
Rationale: In a PA hand projection, the thumb is placed in an oblique position to demonstrate it
without superimposition from the other digits .
The Complete Meaghan Piretti Radiographic
Positioning & Procedures Certification Practice Exam:
200 ARRT-Style Multiple-Choice Questions with
Detailed Answers, Clinical Rationales, and
Comprehensive Study Notes for Registry Success
SECTION 1: UPPER EXTREMITY PROCEDURES
1. Where are the sesamoid bones located in the hand?
• A) Lateral aspect of the 5th metacarpal
• B) Anterior (palmar) surface of the first metacarpal head (thumb)
• C) Dorsal side of the 2nd metacarpal
• D) Between each phalanx
Answer: B
Rationale: The sesamoid bones are found on the anterior (palmar) surface of the first metacarpal
head (thumb). These small, round bones are embedded within tendons and help reduce friction and
protect the tendon from excessive wear .
2. How many phalanges and joints does the thumb have?
• A) Three phalanges, two joints
• B) Two phalanges, one joint
• C) Two phalanges, two joints
• D) Three phalanges, three joints
Answer: C
Rationale: The thumb has two phalanges (proximal and distal) and two joints (MCP and IP), unlike
fingers 2-5, which have three phalanges and three joints .
3. List the carpal bones in the proximal row from lateral to medial.
• A) Trapezium, Trapezoid, Capitate, Hamate
• B) Scaphoid, Lunate, Triquetrum, Pisiform
• C) Scaphoid, Capitate, Hamate, Pisiform
• D) Lunate, Triquetrum, Pisiform, Hamate
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Answer: B
Rationale: The proximal row of carpal bones consists of the scaphoid, lunate, triquetrum, and
pisiform. The distal row consists of the trapezium, trapezoid, capitate, and hamate .
4. Which carpal bone is most commonly fractured?
• A) Lunate
• B) Scaphoid
• C) Triquetrum
• D) Pisiform
Answer: B
Rationale: The scaphoid is the most commonly fractured carpal bone, typically resulting from a fall
on an outstretched hand (FOOSH). Due to its tenuous blood supply, scaphoid fractures carry a risk of
avascular necrosis .
5. What is the recommended SID for hand and wrist radiography?
• A) 40 inches (100 cm)
• B) 44 inches (112 cm)
• C) 72 inches (183 cm)
• D) 56 inches (142 cm)
Answer: A
Rationale: The standard SID for hand and wrist radiography is 40 inches (100 cm). This distance
provides optimal magnification and spatial resolution for extremity imaging .
6. A "Stecher Method" is used to demonstrate which structure?
• A) Carpal tunnel
• B) Scaphoid
• C) Wrist joint
• D) Thumb
Answer: B
Rationale: The Stecher method is a projection used specifically to demonstrate the scaphoid with
the hand in ulnar deviation. This positioning elongates the scaphoid and projects it free of
superimposition from adjacent carpal bones .
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7. What is the recommended degree of wrist flexion for a carpal tunnel (Gaynor-Hart) view?
• A) 30 degrees
• B) 45 degrees
• C) 90 degrees
• D) 120 degrees
Answer: C
Rationale: The Gaynor-Hart method requires the wrist to be flexed approximately 90 degrees to
demonstrate the carpal tunnel. This tangential projection visualizes the carpal canal and its
contents .
8. Where is the central ray directed for a PA wrist projection?
• A) Capitate
• B) Mid-carpal area
• C) Radial styloid
• D) Ulnar styloid
Answer: B
Rationale: The central ray is directed to the mid-carpal area for a PA wrist projection. This ensures
optimal visualization of the carpal bones and radiocarpal joint space .
9. Which projection best demonstrates the scaphoid without superimposition?
• A) PA hand
• B) PA wrist with ulnar deviation
• C) Lateral wrist
• D) AP forearm
Answer: B
Rationale: The PA wrist with ulnar deviation (Stecher method) best demonstrates the scaphoid
without superimposition. Ulnar deviation elongates the scaphoid and projects it free from
overlapping carpal bones .
10. The "fingers" (digits 2-5) each contain how many phalanges?
• A) 2
• B) 3
• C) 4
, 4
• D) 5
Answer: B
Rationale: Each of the four fingers (digits 2-5) has three phalanges: proximal, middle, and distal. The
thumb (digit 1) has only two phalanges .
11. What is the evaluation criteria for a PA hand radiograph?
• A) Carpal bones only visualized
• B) Entire hand from distal phalanges to distal radius and ulna
• C) Only metacarpals visible
• D) Only phalanges visible
Answer: B
Rationale: The entire hand from the distal phalanges to the distal radius and ulna should be
visualized with proper positioning. This ensures complete anatomical coverage for diagnostic
evaluation .
12. In a lateral wrist projection, which structures are superimposed?
• A) Radius and ulna
• B) Scaphoid and lunate
• C) Trapezium and trapezoid
• D) Capitate and hamate
Answer: B
Rationale: In a true lateral wrist, the scaphoid and lunate are superimposed with the radius. Proper
superimposition indicates correct positioning .
13. What is the position of the thumb in a PA hand projection?
• A) Extended straight
• B) Flexed inward
• C) Oblique
• D) Posterior
Answer: C
Rationale: In a PA hand projection, the thumb is placed in an oblique position to demonstrate it
without superimposition from the other digits .
