Study Question Answers
CHAPTER 01: GUIDELINES FOR IMAGE ANALYSIS
D. 1 and 3
1. A. Projection is accurately displayed. E. 4
B. Demographic information (patient and facility F. 4
name, time, date) is visualized G. 1 and 5
C. Correct marker(s) in the appropriate position H. 1 and 5
without superimposing the VOI I. 1 and 5
D. Desired anatomic structures are in the exposure J. 1 and 5
filed and in accurate alignment with each other K. 6
E. Maximum spatial resolution L. 1
F. Radiation protection practices were accurately M. 1
used during the exposure
G. Image histogram was accurately produced with- 11. A. The AP knee projection is accurately displayed.
out errors. The marker is correct, and it is accurately dis-
H. Adequate exposure reached the IR based on played as if hanging from the patient’s hip.
ideal EI. B. The marker is reversed, indicating that the
I. Contrast resolution identifies the subject contrast. projection needs to be flipped horizontally. The
J. Noise is minimal (including scatter and prevent- image is accurately displayed by the fingertip.
able artifacts). C. The marker is reversed, indicating that the
projection needs to be flipped horizontally. The
2. A. Midcoronal image is accurately displayed as if the patient
B. Anterior were in an upright position.
C. Posterior D. Forearm projections should be displayed as if
D. Superior hanging by the fingertips and not the elbow. The
E. Inferior image is horizontally displayed correctly, as indi-
F. Anterosuperior cated by the correctness of the marker.
G. Posteroinferior E. Lateral feet projections should be displayed as if
hanging from the patient’s hip. The projection
3. Anterolateral should be moved 90 degrees counterclockwise.
The marker is also reversed and should be correct
4. Posteromedial for a lateral foot projection. The projection should
be flipped horizontally.
5. Anterosuperior F. The marker is reversed and should be correct for
AP oblique projections. The projection should be
6. Mediolateral flipped horizontally, with the left marker posi-
tioned on the viewer’s right side. The projection
7. A. Midsagittal is accurately displayed as if the patient were in an
B. Lateral upright position.
C. Medial
D. Inferolateral 12. Left
E. Superolateral
13. True
8. A. Proximal
B. Distal 14. False
9. A. Source–object distance 15. A. Facility’s name
B. Object–image receptor distance B. Patient’s name
C. Source–image receptor distance C. Patient’s age or birth date
D. Patient’s hospital identification number
10. A. 1 and 3 E. Date of examination
B. 2 F. Time of examination
C. 1
e1
Copyright © 2025, Elsevier Inc. All Rights Reserved. Study Question Answers
,16. A. Right 22.
B. Laterally, adjacent to the patient’s right side
17. A. Right
B. Anteriorly or posteriorly to the torso, but posteri-
orly can be obscured by scatter
18. A. The marker is situated too medially, superim-
posing the VOI. It should remain within the
collimated field but be moved as far laterally as
possible.
B. The marker is situated at the midsagittal plane. It
should be placed on the left side of the vertebral
column as far laterally as possible while staying
within the collimated field.
C. The marker is superimposed on the VOI. Move
the marker as far laterally as possible while stay-
ing within the collimated field.
D. The marker is placed to the right of the vertebral 23. Mark the side that is positioned closer to the IR and
column. It should be placed on the left side of the place a face-up marker laterally adjacent to that side.
vertebral column as far laterally as possible while
staying within the collimated field. 24. Annotate the marker next to the original during
E. The marker is only partially demonstrated. The postprocessing for digital systems.
marker shoulder be placed completely within the
collimated field. Annotate an R marker adjacent 25. A. Decrease
to the original marker without covering up the B. Increase
original marker. C. Decrease
19. A. Lead 26. A. Long axis
B. Radiopaque B. CR
C. 0.5 – 1 inches (1.25 – 2.5 cm)
20. Closer to
27. True
21.
28. False
29. Needed to prevent the off-centered joint(s) from
being projected off the IR when they are projected
in the direction of the diverged x-ray beams that are
used to record them.
30. The ankle joint has been projected off the IR, and
more of the distal femur is included than needed. The
lower leg was not centered correctly on the IR. Pal-
pate the joints to determine accurate centering.
31. Make an imaginary X diagonally connecting the
corners of the collimated field. The center of the X
indicates where the CR was centered. The CR was
centered to the T9-T10 intervertebral disk space.
32. A. Larger
B. The x-ray beams continue to diverge as they
move through the patient to the IR.
e2
Study Question Answers Copyright © 2025, Elsevier Inc. All Rights Reserved.
,33. False 37. A.
34. A. Too much of the patient’s abdominal structures
have been included, and the lateral collimation
borders are not within 1⁄2 inch (1.25 cm) of the
skin line. The superior aspect of the chest is not
included. The CR is centered too inferiorly to
collimate tightly.
B. The posterior and superior collimation borders
are within 1⁄2 inch (1.25 cm) of the skin line, but
the anterior and inferior borders are too wide.
The CR is centered too anteroinferiorly to colli-
mate tightly.
C. The CR was centered anterior to the foot instead
of on the tarsal bones, and the foot was aligned
diagonally instead of with the long axis of the
exposure field, preventing the collimation bor-
ders from being within 1⁄2 inch (1.25 cm) from
B.
the skin line.
D. The CR was centered to the upper cervical verte-
brae region instead of to the center of the skull,
preventing the shoulder and cervical vertebrae
from being collimated off the projection, and the
collimation borders are not within 1⁄2 inch (1.25
cm) of the skull skin line.
35. A. A
B. B
C. The clavicular projection A demonstrates grid
cutoff, which occurs when the CR and grid are
not properly aligned.
36. A. It would superimpose it.
B. (1) Proximal
(2) No
(3) Because letter A is farther from the IR, it will
be projected further proximally than letter B. 38. A. The SC joints would be projected to the right of
C. (1) Distally the vertebral column.
(2) Letter A would be projected even more B. The SC joints are currently at the level of the third
distally. thoracic vertebrae. The 10-degree cephalic angle
D. Possibly superimposed over it or positioned only would project the SC joints superior to this position.
slightly distal or proximal to it depending on the C. The answers would be the same, although the
SID used. The placement would vary depending amount of movement to the right for A and supe-
on the SID because the angle used to record A and riorly for B would be less because the x-rays
B could be perpendicular or proximal if a short recording the structures would be less diverged.
SID was used and caudal if a long SIS was used. D. The answers would be the same, although the
amount of movement would be less because
the heart shadow is not as far away from the
IR as the SC joints are.
39. A. Parallel
B. Perpendicular
40. A. Foreshortening
B. Elongation
C. Elongation
e3
Copyright © 2025, Elsevier Inc. All Rights Reserved. Study Question Answers
, 41. A. Magnification: Proportional magnification of the 49. A. Fully extend the patient’s finger.
proximal, distal, and midshaft of the humerus B. Align the CR parallel with the IP joint or per-
B. Foreshortening: The proximal humerus was pendicular to the phalange of interest. For this
placed farther from the IR as demonstrated by the examination, the CR would have needed to be
increased magnification of the proximal humerus angled proximally until it was parallel with the
when compared with the distal humerus. joint of interest.
C. Elongation: The distal humerus was placed far-
ther from the IR as demonstrated by the increased 50. A. Farther from
magnification of the distal humerus when com- B. Closer to
pared with the proximal humerus.
51. A. Internally rotate the hand 0.5 inch (1.25 cm).
42. Image 2 B. Direct the CR anteriorly to move the second meta-
carpal toward the fifth MC. Because the physical
43. Image 2 distance between the second and fifth MCs is
2.5 inches (0.6 cm) and a 5-degree angle will
44. A. Use known structures that surround the identical move the second MC 0.5 inch (1.25 cm) for this
structures. amount of physical separation, and the amount
B. Use surrounding bony projections. of mispositioning is off by 1 inch (2.5 cm), a
C. Identify expected magnification. 10-degree angle should be placed on the CR.
45. A. Adjust the patient half the distance demonstrated 52. A. Externally rotate the leg 1 inch (2.5 cm).
between the two structures that should be super- B. Direct the CR anteriorly to move the medial con-
imposed. dyle toward the lateral condyle. Because the phys-
B. Adjust the patient the entire distance between the ical distance between the condyles is approxi-
structures that should be superimposed. mately 21⁄2 inches (6.25 cm), a 5-degree angle
will move the medial condyle 0.5 inch (1.25 cm)
46. A. 0 for this amount of physical separation, and the
B. 68 condyles are mispositioned by 2 inches (5 cm), a
C. 45 20-degree angle should be placed on the CR.
D. 23
E. 90 53. A. Internally rotate the leg 0.125 inch (0.3 cm).
B. Direct the CR posteriorly to move the medial
47. A. 45 talar dome toward the lateral dome. Because the
B. 45 physical distance between the talar domes is
C. 30 1 inch (2.5 cm), a 5-degree angle will move the
D. 105 medial condyle 0.125 inch (0.3 cm) for this
amount of physical separation, and the domes are
48. mispositioned by 0.25 inch (0.6 cm), a 10-degree
angle should be placed on the CR.
54. True
55. False
56. A. Spatial frequency
B. Amount of space (distance)
57. True
58. False
59. DR system B
60. AP hip projection because it uses a smaller IR than
an AP pelvis and a smaller IR has higher resolution.
61. False
62. Small/smaller
e4
Study Question Answers Copyright © 2025, Elsevier Inc. All Rights Reserved.
CHAPTER 01: GUIDELINES FOR IMAGE ANALYSIS
D. 1 and 3
1. A. Projection is accurately displayed. E. 4
B. Demographic information (patient and facility F. 4
name, time, date) is visualized G. 1 and 5
C. Correct marker(s) in the appropriate position H. 1 and 5
without superimposing the VOI I. 1 and 5
D. Desired anatomic structures are in the exposure J. 1 and 5
filed and in accurate alignment with each other K. 6
E. Maximum spatial resolution L. 1
F. Radiation protection practices were accurately M. 1
used during the exposure
G. Image histogram was accurately produced with- 11. A. The AP knee projection is accurately displayed.
out errors. The marker is correct, and it is accurately dis-
H. Adequate exposure reached the IR based on played as if hanging from the patient’s hip.
ideal EI. B. The marker is reversed, indicating that the
I. Contrast resolution identifies the subject contrast. projection needs to be flipped horizontally. The
J. Noise is minimal (including scatter and prevent- image is accurately displayed by the fingertip.
able artifacts). C. The marker is reversed, indicating that the
projection needs to be flipped horizontally. The
2. A. Midcoronal image is accurately displayed as if the patient
B. Anterior were in an upright position.
C. Posterior D. Forearm projections should be displayed as if
D. Superior hanging by the fingertips and not the elbow. The
E. Inferior image is horizontally displayed correctly, as indi-
F. Anterosuperior cated by the correctness of the marker.
G. Posteroinferior E. Lateral feet projections should be displayed as if
hanging from the patient’s hip. The projection
3. Anterolateral should be moved 90 degrees counterclockwise.
The marker is also reversed and should be correct
4. Posteromedial for a lateral foot projection. The projection should
be flipped horizontally.
5. Anterosuperior F. The marker is reversed and should be correct for
AP oblique projections. The projection should be
6. Mediolateral flipped horizontally, with the left marker posi-
tioned on the viewer’s right side. The projection
7. A. Midsagittal is accurately displayed as if the patient were in an
B. Lateral upright position.
C. Medial
D. Inferolateral 12. Left
E. Superolateral
13. True
8. A. Proximal
B. Distal 14. False
9. A. Source–object distance 15. A. Facility’s name
B. Object–image receptor distance B. Patient’s name
C. Source–image receptor distance C. Patient’s age or birth date
D. Patient’s hospital identification number
10. A. 1 and 3 E. Date of examination
B. 2 F. Time of examination
C. 1
e1
Copyright © 2025, Elsevier Inc. All Rights Reserved. Study Question Answers
,16. A. Right 22.
B. Laterally, adjacent to the patient’s right side
17. A. Right
B. Anteriorly or posteriorly to the torso, but posteri-
orly can be obscured by scatter
18. A. The marker is situated too medially, superim-
posing the VOI. It should remain within the
collimated field but be moved as far laterally as
possible.
B. The marker is situated at the midsagittal plane. It
should be placed on the left side of the vertebral
column as far laterally as possible while staying
within the collimated field.
C. The marker is superimposed on the VOI. Move
the marker as far laterally as possible while stay-
ing within the collimated field.
D. The marker is placed to the right of the vertebral 23. Mark the side that is positioned closer to the IR and
column. It should be placed on the left side of the place a face-up marker laterally adjacent to that side.
vertebral column as far laterally as possible while
staying within the collimated field. 24. Annotate the marker next to the original during
E. The marker is only partially demonstrated. The postprocessing for digital systems.
marker shoulder be placed completely within the
collimated field. Annotate an R marker adjacent 25. A. Decrease
to the original marker without covering up the B. Increase
original marker. C. Decrease
19. A. Lead 26. A. Long axis
B. Radiopaque B. CR
C. 0.5 – 1 inches (1.25 – 2.5 cm)
20. Closer to
27. True
21.
28. False
29. Needed to prevent the off-centered joint(s) from
being projected off the IR when they are projected
in the direction of the diverged x-ray beams that are
used to record them.
30. The ankle joint has been projected off the IR, and
more of the distal femur is included than needed. The
lower leg was not centered correctly on the IR. Pal-
pate the joints to determine accurate centering.
31. Make an imaginary X diagonally connecting the
corners of the collimated field. The center of the X
indicates where the CR was centered. The CR was
centered to the T9-T10 intervertebral disk space.
32. A. Larger
B. The x-ray beams continue to diverge as they
move through the patient to the IR.
e2
Study Question Answers Copyright © 2025, Elsevier Inc. All Rights Reserved.
,33. False 37. A.
34. A. Too much of the patient’s abdominal structures
have been included, and the lateral collimation
borders are not within 1⁄2 inch (1.25 cm) of the
skin line. The superior aspect of the chest is not
included. The CR is centered too inferiorly to
collimate tightly.
B. The posterior and superior collimation borders
are within 1⁄2 inch (1.25 cm) of the skin line, but
the anterior and inferior borders are too wide.
The CR is centered too anteroinferiorly to colli-
mate tightly.
C. The CR was centered anterior to the foot instead
of on the tarsal bones, and the foot was aligned
diagonally instead of with the long axis of the
exposure field, preventing the collimation bor-
ders from being within 1⁄2 inch (1.25 cm) from
B.
the skin line.
D. The CR was centered to the upper cervical verte-
brae region instead of to the center of the skull,
preventing the shoulder and cervical vertebrae
from being collimated off the projection, and the
collimation borders are not within 1⁄2 inch (1.25
cm) of the skull skin line.
35. A. A
B. B
C. The clavicular projection A demonstrates grid
cutoff, which occurs when the CR and grid are
not properly aligned.
36. A. It would superimpose it.
B. (1) Proximal
(2) No
(3) Because letter A is farther from the IR, it will
be projected further proximally than letter B. 38. A. The SC joints would be projected to the right of
C. (1) Distally the vertebral column.
(2) Letter A would be projected even more B. The SC joints are currently at the level of the third
distally. thoracic vertebrae. The 10-degree cephalic angle
D. Possibly superimposed over it or positioned only would project the SC joints superior to this position.
slightly distal or proximal to it depending on the C. The answers would be the same, although the
SID used. The placement would vary depending amount of movement to the right for A and supe-
on the SID because the angle used to record A and riorly for B would be less because the x-rays
B could be perpendicular or proximal if a short recording the structures would be less diverged.
SID was used and caudal if a long SIS was used. D. The answers would be the same, although the
amount of movement would be less because
the heart shadow is not as far away from the
IR as the SC joints are.
39. A. Parallel
B. Perpendicular
40. A. Foreshortening
B. Elongation
C. Elongation
e3
Copyright © 2025, Elsevier Inc. All Rights Reserved. Study Question Answers
, 41. A. Magnification: Proportional magnification of the 49. A. Fully extend the patient’s finger.
proximal, distal, and midshaft of the humerus B. Align the CR parallel with the IP joint or per-
B. Foreshortening: The proximal humerus was pendicular to the phalange of interest. For this
placed farther from the IR as demonstrated by the examination, the CR would have needed to be
increased magnification of the proximal humerus angled proximally until it was parallel with the
when compared with the distal humerus. joint of interest.
C. Elongation: The distal humerus was placed far-
ther from the IR as demonstrated by the increased 50. A. Farther from
magnification of the distal humerus when com- B. Closer to
pared with the proximal humerus.
51. A. Internally rotate the hand 0.5 inch (1.25 cm).
42. Image 2 B. Direct the CR anteriorly to move the second meta-
carpal toward the fifth MC. Because the physical
43. Image 2 distance between the second and fifth MCs is
2.5 inches (0.6 cm) and a 5-degree angle will
44. A. Use known structures that surround the identical move the second MC 0.5 inch (1.25 cm) for this
structures. amount of physical separation, and the amount
B. Use surrounding bony projections. of mispositioning is off by 1 inch (2.5 cm), a
C. Identify expected magnification. 10-degree angle should be placed on the CR.
45. A. Adjust the patient half the distance demonstrated 52. A. Externally rotate the leg 1 inch (2.5 cm).
between the two structures that should be super- B. Direct the CR anteriorly to move the medial con-
imposed. dyle toward the lateral condyle. Because the phys-
B. Adjust the patient the entire distance between the ical distance between the condyles is approxi-
structures that should be superimposed. mately 21⁄2 inches (6.25 cm), a 5-degree angle
will move the medial condyle 0.5 inch (1.25 cm)
46. A. 0 for this amount of physical separation, and the
B. 68 condyles are mispositioned by 2 inches (5 cm), a
C. 45 20-degree angle should be placed on the CR.
D. 23
E. 90 53. A. Internally rotate the leg 0.125 inch (0.3 cm).
B. Direct the CR posteriorly to move the medial
47. A. 45 talar dome toward the lateral dome. Because the
B. 45 physical distance between the talar domes is
C. 30 1 inch (2.5 cm), a 5-degree angle will move the
D. 105 medial condyle 0.125 inch (0.3 cm) for this
amount of physical separation, and the domes are
48. mispositioned by 0.25 inch (0.6 cm), a 10-degree
angle should be placed on the CR.
54. True
55. False
56. A. Spatial frequency
B. Amount of space (distance)
57. True
58. False
59. DR system B
60. AP hip projection because it uses a smaller IR than
an AP pelvis and a smaller IR has higher resolution.
61. False
62. Small/smaller
e4
Study Question Answers Copyright © 2025, Elsevier Inc. All Rights Reserved.
