RADIOGRAPHIC POSITIONING AND
RELATED ANATOMY
11TH EDITION
• AUTHOR(S)JOHN P. LAMPIGNANO
TEST BANK
1
Reference
Ch. 1 — Terminology, Positioning, and Imaging Principles —
Positioning Terminology
Question Stem
A patient with suspected anterior rib fractures is to be imaged.
Which projection and patient orientation will best demonstrate
the anterior ribs with minimal cardiac superimposition?
A. AP erect with patient facing tube (AP)
B. PA erect with patient facing detector (PA)
C. Right anterior oblique (RAO) with a 45° rotation toward the
affected side
D. Left posterior oblique (LPO) with a 30° rotation away from
the affected side
,Correct Answer
B
Rationales
Correct: A PA erect projection places the anterior ribs closer to
the detector and moves the heart anteriorly away from the
thorax, reducing cardiac magnification and superimposition
over anterior ribs. This improves visualization of anterior rib
detail.
A incorrect: AP erect projects anterior ribs more magnified and
increases cardiac superimposition because the heart is farther
from the detector.
C incorrect: An oblique may demonstrate rib detail but
introduces overlapping structures and does not specifically
reduce cardiac superimposition as effectively as PA.
D incorrect: A posterior oblique targets posterior rib detail more
than anterior ribs and a 30° rotation is less effective at isolating
anterior rib anatomy.
Teaching Point
PA erect projection places anterior ribs closer to the detector,
reducing heart superimposition.
Citation
Lampignano, J. P. (2024). Textbook of Radiographic Positioning
and Related Anatomy (11th Ed.). Ch. 1.
2
,Reference
Ch. 1 — Terminology, Positioning, and Imaging Principles —
Positioning Terminology
Question Stem
A technologist must perform an AP projection of the pelvis on a
patient who cannot internally rotate the legs. Which positioning
adjustment will most accurately demonstrate the femoral
necks?
A. Externally rotate each leg 10° and increase SID
B. Place legs in neutral and angle the CR 15° toward the feet
(caudad)
C. Internally rotate legs 15°–20° and center at the symphysis
D. Use a bilateral frog-leg (modified cleaves) projection with 45°
abduction
Correct Answer
B
Rationales
Correct: When the patient cannot be internally rotated, angling
the central ray caudad (approximately 15°) compensates for the
femoral neck foreshortening and approximates the relationship
seen with internal rotation.
A incorrect: External rotation worsens foreshortening of the
femoral necks and increasing SID does not correct neck
orientation.
C incorrect: Internal rotation is preferred but the stem states
the patient cannot internally rotate; thus this is not feasible.
, D incorrect: Frog-leg demonstrates the lesser trochanters and
proximal femora but is not an AP pelvic substitution when the
goal is neutral AP visualization of the femoral necks.
Teaching Point
When leg rotation is limited, slight CR angulation can
compensate and reduce femoral neck foreshortening.
Citation
Lampignano, J. P. (2024). Textbook of Radiographic Positioning
and Related Anatomy (11th Ed.). Ch. 1.
3
Reference
Ch. 1 — Terminology, Positioning, and Imaging Principles —
Positioning Principles
Question Stem
During a lateral cervical spine radiograph, the technologist
notes slight rotation of the patient’s head. Which image-
evaluation finding specifically indicates that rotation has
compromised the projection?
A. Intervertebral disk spaces appear open
B. Mandibular rami are superimposed over cervical vertebrae
on one side
C. The spinous processes are midline and symmetric
D. The odontoid process is centered over C2
RELATED ANATOMY
11TH EDITION
• AUTHOR(S)JOHN P. LAMPIGNANO
TEST BANK
1
Reference
Ch. 1 — Terminology, Positioning, and Imaging Principles —
Positioning Terminology
Question Stem
A patient with suspected anterior rib fractures is to be imaged.
Which projection and patient orientation will best demonstrate
the anterior ribs with minimal cardiac superimposition?
A. AP erect with patient facing tube (AP)
B. PA erect with patient facing detector (PA)
C. Right anterior oblique (RAO) with a 45° rotation toward the
affected side
D. Left posterior oblique (LPO) with a 30° rotation away from
the affected side
,Correct Answer
B
Rationales
Correct: A PA erect projection places the anterior ribs closer to
the detector and moves the heart anteriorly away from the
thorax, reducing cardiac magnification and superimposition
over anterior ribs. This improves visualization of anterior rib
detail.
A incorrect: AP erect projects anterior ribs more magnified and
increases cardiac superimposition because the heart is farther
from the detector.
C incorrect: An oblique may demonstrate rib detail but
introduces overlapping structures and does not specifically
reduce cardiac superimposition as effectively as PA.
D incorrect: A posterior oblique targets posterior rib detail more
than anterior ribs and a 30° rotation is less effective at isolating
anterior rib anatomy.
Teaching Point
PA erect projection places anterior ribs closer to the detector,
reducing heart superimposition.
Citation
Lampignano, J. P. (2024). Textbook of Radiographic Positioning
and Related Anatomy (11th Ed.). Ch. 1.
2
,Reference
Ch. 1 — Terminology, Positioning, and Imaging Principles —
Positioning Terminology
Question Stem
A technologist must perform an AP projection of the pelvis on a
patient who cannot internally rotate the legs. Which positioning
adjustment will most accurately demonstrate the femoral
necks?
A. Externally rotate each leg 10° and increase SID
B. Place legs in neutral and angle the CR 15° toward the feet
(caudad)
C. Internally rotate legs 15°–20° and center at the symphysis
D. Use a bilateral frog-leg (modified cleaves) projection with 45°
abduction
Correct Answer
B
Rationales
Correct: When the patient cannot be internally rotated, angling
the central ray caudad (approximately 15°) compensates for the
femoral neck foreshortening and approximates the relationship
seen with internal rotation.
A incorrect: External rotation worsens foreshortening of the
femoral necks and increasing SID does not correct neck
orientation.
C incorrect: Internal rotation is preferred but the stem states
the patient cannot internally rotate; thus this is not feasible.
, D incorrect: Frog-leg demonstrates the lesser trochanters and
proximal femora but is not an AP pelvic substitution when the
goal is neutral AP visualization of the femoral necks.
Teaching Point
When leg rotation is limited, slight CR angulation can
compensate and reduce femoral neck foreshortening.
Citation
Lampignano, J. P. (2024). Textbook of Radiographic Positioning
and Related Anatomy (11th Ed.). Ch. 1.
3
Reference
Ch. 1 — Terminology, Positioning, and Imaging Principles —
Positioning Principles
Question Stem
During a lateral cervical spine radiograph, the technologist
notes slight rotation of the patient’s head. Which image-
evaluation finding specifically indicates that rotation has
compromised the projection?
A. Intervertebral disk spaces appear open
B. Mandibular rami are superimposed over cervical vertebrae
on one side
C. The spinous processes are midline and symmetric
D. The odontoid process is centered over C2
