XRAY Prep (2025)

14/07/2025

📸 Merrill’s Monday: Lateral Cervical Spine – Keep It Straight, Keep It Sharp!

The lateral C-spine is one of the most informative views we take — it gives a clear look at vertebral alignment, soft tissues, and disc spaces.

👤 Patient Positioning:
• Erect position, either standing or sitting
• Shoulders depressed as much as possible (arms hanging, weights if needed)
• Slightly extend the chin to avoid mandible superimposing anterior vertebrae
• True lateral – no rotation!
• SID: 180 cm (72”) with a horizontal beam
• CR centered to C4

📏 Evaluation Criteria:
✅ C1 to at least T1 visible (dorsum sella to upper T1)
✅ Mandibular rami should be superimposed or nearly superimposed
✅ Zygapophyseal joints open
✅ Pedicles superimposed — indicating no rotation
✅ Open intervertebral disc spaces
✅ No superimposition of the mandible over the cervical vertebrae
✅ Exclude orbits from collimation
✅ Optimal density to see both bony trabeculation and soft tissues (anterior cervical line!)

11/07/2025

🚨 Last Chance! 🚨

Today is the final day to register for the CAMRT national certification exam happening on September 15 & 16, 2025! If you're planning to challenge the exam this fall, this is your official reminder to lock in your spot before it's too late. 🗓️

Once you're registered, it's time to get serious about prep — and that's where XrayPrep.com comes in.

Our platform is built specifically for CAMRT students, with:
✔️ Hundreds of practice questions
✔️ Tailored content based on your learning needs
✔️ Access on both the app and website — study wherever you are!

Thousands of students across Canada have used XrayPrep to build confidence and pass their exam — now it’s your turn.

✅ Register for the exam
✅ Sign up at XrayPrep.com
✅ Let’s get you exam-ready 💪

09/07/2025

🦴 Wisdom Wednesday – P is for Paget’s Disease 🦴
Did you know that bones can actually grow too much and too poorly at the same time?

Paget’s Disease is a chronic condition that causes bones to become enlarged and weakened. It disrupts the normal cycle of bone remodeling, leading to structurally abnormal bone that’s more prone to fractures and deformities.

📸 Radiographic Findings May Include:
• Coarsened trabecular patterns
• Bony enlargement
• Cortical thickening
• “Cotton wool” appearance in the skull
• Bowing of long bones

Most commonly affects:
➡️ Pelvis
➡️ Femur
➡️ Skull
➡️ Spine
➡️ Tibia

🧠 Fun Fact: Paget’s may be asymptomatic for years and often discovered incidentally on X-ray.

💬 Seen Paget’s on a clinical image? Tell us where you spotted it and what tipped you off.

07/07/2025

📸 Merrill’s Monday: AP Open Mouth – Say AHH for the Dens!

Today’s spotlight is on the AP Projection (Open Mouth) – crucial for evaluating the C1-C2 articulation and the dens.

👤 Patient Positioning:
• Supine or erect with the midsagittal plane perpendicular to the IR
• Ask the patient to open their mouth as wide as possible
• Align the occlusal plane (lower edge of upper incisors to mastoid tip) perpendicular to the IR
• Center the CR perpendicular through the midpoint of the open mouth

📏 Evaluation Criteria:
✅ Dens (odontoid), atlas (C1), axis (C2) clearly visible
✅ Atlantoaxial joints open
✅ No rotation or tilt:
• Mandibular rami equidistant to dens
• Lateral masses of C1 symmetric
• C2 spinous process in midline
✅ Superimposed upper incisors and skull base (ensures proper neck flexion)
✅ Tongue not shadowing the upper cervical vertebrae
✅ Open mouth wide enough for clear visualization
✅ Collimation: From just below the EAMs to include C1/C2 and side-to-side to include transverse processes
✅ Optimal density for bone detail and soft tissue visibility

💡 Pro tip: Always double-check alignment — even a small head tilt can throw off this view and mimic a fracture.

04/07/2025

📸 Freaky Friday: Pneumoperitoneum Edition

Take a good look at this upright chest X-ray... do you see it? 👀
➡️ That crisp black line beneath the diaphragm (see arrow) isn't normal — it's free air in the abdominal cavity. This is called pneumoperitoneum, and it usually means one thing: perforation of a hollow organ like the stomach or bowel. 🚨

🩻 Why is this freaky?
Air should never be free-floating under the diaphragm. It’s a classic surgical emergency — often from a perforated ulcer, diverticulum, or trauma.

🔎 Radiographic signs to look for:

Free air under the diaphragm on upright CXR

Rigler’s sign (on abdominal films): both sides of the bowel wall visible

Clear diaphragm outline with lucency beneath it

💡 Tech tip: Always take an upright or left lateral decubitus abdominal X-ray when a bowel perforation is suspected. Supine may miss it!

This is a radiology red flag that you don’t want to miss.
Would you have caught it? Drop a 🫣 if this gave you pause!

02/07/2025

🧠 Wisdom Wednesday – O is for Osteogenesis Imperfecta
aka "Brittle Bone Disease" 🦴💥
⁣
Osteogenesis Imperfecta (OI) is a genetic connective tissue disorder caused by a defect in type I collagen production — leading to bones that fracture very easily, often with minimal or no trauma.

👶 Commonly diagnosed in infancy or early childhood, but mild forms may go unnoticed until later.

📸 Radiographic Features:
• Multiple fractures at various stages of healing
• Thin cortices and osteopenia
• Bowing of long bones
• Wormian bones in the skull
• Possible basilar invagination
• May be associated with scoliosis

🧬 Key Clinical Signs:
• Blue sclera 👁
• Hearing loss
• Dental issues (dentinogenesis imperfecta)
• Family history of fractures

⚠️ Pro Tip: Always assess for non-accidental trauma, but remember — a pattern of fractures with the above signs might point to OI, especially in pediatrics.

30/06/2025

📸 Merrill’s Monday: AP Axial C-Spine
Let’s dive into the AP Axial Projection of the Cervical Spine – a must-know for spine imaging!

👤 Patient Positioning:
• Supine or upright with the back against the IR
• Extend the chin so the occlusal plane is perpendicular to the IR
• Angle the CR 15°–20° cephalad
• Center at the level of C4

📏 Evaluation Criteria:
✅ C3–T2 clearly visible (if C3 is obscured, repeat the image)
✅ Mandible & base of skull should superimpose C1–C2
• Chin too high? Skull base projects over upper C-spine
• Chin too low? Mandible body projects over upper C-spine
✅ Open intervertebral disc spaces (indicates correct tube angulation)
✅ No rotation:
• Spinous processes centered
• Mandibular angles and mastoids symmetric
✅ Collimation: Mentum to jugular notch (lengthwise); include transverse processes (especially wide at C7)
✅ Optimal density: Crisp bone detail + visible soft tissue

💡 Pro tip: Proper chin extension is key — not too much, not too little. Just right for that textbook AP axial shot!

25/06/2025

🧠 Wisdom Wednesday – N is for Noise

In medical imaging, Noise refers to random variations in image signal that reduce image quality and can obscure diagnostic detail.

🌀 What causes noise?

Low mAs (not enough X-ray photons reaching the detector)

High-speed imaging with limited exposure

Digital image processing limitations

📉 More noise = lower signal-to-noise ratio (SNR)
📈 Higher SNR = clearer, more diagnostic images

💡 Pro tip: Boosting mAs can reduce noise — but always balance it with patient dose. Smart technique = clear image + ALARA compliance.

Have you ever had to repeat an image due to excessive noise? Comment below with your troubleshooting approach 👇

23/06/2025

📘 Merrill’s Monday – Internal Oblique Elbow

Time to dive into that medial rotation magic — the internal oblique view of the elbow:

🧍‍♂️ Positioning:

Patient seated, arm fully extended
Humerus and forearm in the same plane
Entire arm rotated medially 45°
Hand pronated
Epicondyles at 45° to the IR

CR: Perpendicular to the elbow joint

📸 Evaluation Criteria:
✅ Coronoid process, trochlear notch, and medial trochlea in profile
✅ Trochlear–coronoid articulation open
✅ Radial head and neck superimposed on ulna (~¾ overlap with 45° oblique)
✅ Clear trabecular detail and soft tissue visibility
✅ Collimation includes the radial tuberosity and ≤¼ of the humerus

20/06/2025

🩻 Freaky Friday Case – When the Rod Takes a Detour… 😬

Take a long look at this post-op tib/fib X-ray — and yes, your eyes aren’t deceiving you. That intramedullary nail has done a full U-turn at the ankle and punched straight through the cortex.

This was meant to stabilize the tibia. Instead? It’s now a hardware fail turned surgical nightmare.

❓ What do you think the plan of action will be to fix this?
(Asking all students, techs, and ortho fans – comment your take!)

👎 Complications likely include:

Malalignment

Soft tissue injury

Need for hardware removal and re-fixation

Possibly external fixation depending on bone and tissue status

Drop your thoughts 👇
Would you catch this on a busy shift?

18/06/2025

🧠 Wisdom Wednesday – M is for Magnification

Magnification in radiography refers to the enlargement of structures on an image compared to their actual size — and understanding it is key to producing accurate, diagnostic images.

🔍 What causes magnification?

Increased object-to-image distance (OID)

Decreased source-to-image distance (SID)

The closer the body part is to the image receptor, the less magnified and more accurate it will appear.

📌 Example: In a PA chest, the heart is closer to the detector, minimizing magnification. That’s why PA is preferred over AP, especially in cardiac assessment.

💡 Radiographic Tip:
Want less distortion? Keep your OID low and your SID high.

16/06/2025

📘 Merrill’s Monday – AP Elbow

Let’s line up the essentials for your AP elbow projection:

🧍‍♂️ Positioning:

-Patient seated with arm fully extended
-Humerus and forearm in the same horizontal plane
-Hand supinated to avoid forearm rotation
-Epicondyles parallel to the IR

CR: Perpendicular to the elbow joint

📸 Evaluation Criteria:
✅ Radial head, neck, and tuberosity slightly superimposed over the proximal ulna (~1/8 of radial head overlaps)
✅ Open elbow joint, centered on the image
✅ No rotation of humeral epicondyles
✅ Sharp bony detail with visible trabeculation & soft tissue
✅ Collimation includes the radial tuberosity and no more than ¼ of the humerus

📏 Tip: Symmetry of the epicondyles = no rotation. Double-check before you shoot!

XRAY Prep