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Radiographic Projections & Positions
QUESTIONS ANSWERSThe term defined as the path of central ray as it exits the x-ray tube and goes through the patient to the IR is called a what?
Projection
During this projection a perpendicular central ray enters the anterior body surface and exits the posterior body surface is known as what projection?
Anteroposterior-AP
During this projection a perpendicular central ray enters the posterior body and exiting the anterior body surface.
Posteroanterior-PA
During this projection, there is longitudinal angulation of the central ray with the long axis of the body or a specific body part.
Axial projection
This term refers to all projections in which the longitudinal angulation between the central ray and the long axis of the body part is 10 degrees or more.
Axial
Occasionally the central ray is directed toward the outer margin of a curved body surface to profile a body part just under the surface and project it free of superimposition during this projection.
Tangential
During this projection, a perpendicular central ray enters one side of the body or body part, passes transversely along the coronal plane and exits on the opposite side.
Lateral projection
During this projection, the central ray enters the body or body part from a side angle following an oblique plane.
Oblique projection
If the central ray enters the anterior surface and exits the opposite posterior surface, it is known as what projection?
AP oblique projection
If it enters the posterior surface and exits anteriorly, it is known as what projection? PA oblique projection
The overall posture of the patient or the general body position is termed as what? Position
Erect or marked by a vertical position. Upright
Upright position in which the patient is sitting or stool. Seated
Lying on the back Supine
Lying face down Prone
Supine position with the head tilted downward Tredelenburg's position
Supine position with the head higher than the feet. Fowler's position
General term referring to lying down in any position. Recumbent
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A recumbent position with the patient lying on the left anterior side (semiprone) with the left leg extended and the right knee and thigh partially flexed.
Sim's position
A supine position with the knees and hip flexed and thighs abducted and rotated externally, supported by ankle supports.
Lithotomy position
This position refers to the side of the patient that is placed closest to the IR. Lateral position
This position is achieved when the entire body or body part is rotated so that the coronal plane is not parallel with the radiographic table or IR.
Oblique position
Term used to indicate that the patient is lying down and that the central ray is horizontal and parallel with the floor
Decubitus position
This position is achieved by having the patient lean backward while in the upright body position so that the shoulders are in contact with the IR.
Lordotic position
This term is used to describe the body part as seen by the IR. View
This term describes the specific radiographic projection that the individual developed. Method
Terms & Positioning
QUESTIONS ANSWERSThe lowest level of structuaral organization of the human body is the:
Chemical Level
Four basic types of tisues in the body: Epithelial, Connective, Muscular, Nervous
The 10 systems of the human body: Skeletal, Circulatory, Digestive, Respiratory, Urinary, Reproductive, Nervous, Muscular, Endocrine, Integumentary
Eliminates solid waste from the body Digestive System
Regulates fluid and electrolyte balance and volume Urinary System
Maintains posture Muscular System
Regulates body activities with electical impulses Nervous System
Regulates body activities through various hormones Endocrine System
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Eliminates carbon dioxide from the blood Respiratory System
Receives stimuli, such as temperature, pressure, and pain Integumentary System
Reproduces the organism Reproductive System
Helps regulate body temperature Circulatory System
Supports and protects many soft tissues of the body Skeletal System
True or False: One of the six functions of the circulatory system is to protect against disease
True
This body system regulates body temperature: Integumentary System
What is the largest organ system in the body? Integumentary System
List the two divisions of the human skeleton Appendicular and Axial
True or False: The adult skeleton system contains 256 bones. False (206)
True or False: The scapula is part of the axial skeleton. False (appendicular skeleton)
True or False: The skull is part of the axial skeleton. True
True of False: The pelvis is part of the appendicular skeleton. True
List the four classifications of bones Long Bones, Short Bones, Flat Bones, Irregular Bones
The outer coveringof a long bone, which is composed of a dense, fibrous membrane, is called what?
Periosteum
Which aspect of long bones is responsible for the production of red blood cells?
Medullary Aspect
Which aspect of the long bone is essential for bone growth, repair, and nutrition?
Periosteum
Identify primary and secondary growth centers for long bones Primary growth center: the body (diaphysis) Secondary growth center: epiphyses
True of False: Epiphyseal fusion of the long bones is complete by the age of 16 year
False (25 years)
What is the wIder portion of a long bone in which bone growth in length occurs
Metaphysis
What are the three functional classifications of joints? Synarthrosis, Amphiarthrosis, Diathrosis
What are the three structual classifications of joints? Fibrous, Connective, Synovial
First carpometacarpal of thumb Synovial Joint
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Roots around teeth Fibrous Joint
Proximal radioulnar joint Synovial Joint
Skull sutures Fibrous Joint
Epiphyses Cartilaginous JoinT
Interphalangeal joints Synovial Joints
Distal tibiofibular joint Fibrous Joint
Intervertebral disk space Cartilaginous Joint
Symphysis pubis Cartilaginous Joint
Hip Joint Synovial Joint
What are the seven types of movement for synovial joints? Plane(Gliding) Ginglymus(Hinge) Trochoid(Pivot) Ellipsoid(Condylar) Seller(Saddle) Spheroidal(Ball and Socket) Bicondylar
First carpometacarpal joint Sellar
Elbow joint Ginglymus
Shoulder blade Spheroidal
Intercarpal joint Plane
Wrist joint Ellipsoidal
Temporomandibular joint Bicondylar
First and secnond cervical vertebra joint Trochoidal
Distal radioulnar joint Trochoidal
Second interphalangeal joint Ginglymus
Ankle joint Sellar
Knee joint Bicondylar
Third metacarpophalangeal joint Ellipsoidal
What is an image of a patient's anatomic parts as porduced by the actions of x-rays on an imager receptor?
Radiograph
What is the aspect of an x-ray beam that has the least divergence?
Central Ray
Upright position with the arms abducted, palms forward, and Anatomic Position
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head and feet directed straight ahead
Vertical plane that divides the body into equal right and left parts
Mid-Sagittal Plane
the vertical plane that divides the body into equal anterior and posterior parts
Mid-Coronal Plane
A plane taken at right angels along any point of the longitudinal axis of the body
Transverse/Axial Plane
True or False: The base plane of the skull is a plane located between the infraorbital margin of the orbit and the superior margin of the external auditory meatus.
True
True or False: The Frankfort horizontal plane is also referred to as the midcoronal plane.
False
The direction or path of the central ray defines the following positions term
Projection
The positioning term that describes the general and specific body position is:
Position
True or False: Oblique and lateral positions are described according to the side ofthe body closest to the image receptor
True
True or False: Decubitus positions always use a horizontal x-ray beam
True
What is the name of the position in which the body is turned 90 degrees from a true anteriorposterior(AP) or posterioanterior(PA) projection
Lateral Position
A patient is erect with the back to the image receptor. The left side of the body is turned 45 degrees toward the image receptor. What is this Position?
Left Posterior Oblique(LPO)
A patient is recumbent facing the image receptor. The right side of the body is turned 15 degrees toward the image receptor. What is this position?
Right Anterior Oblique(RAO)
The patient is lying on his back. The x-ray beam is directed horizontally and enters the right side of the body and exits the left side of the body. An image receptor is placed against the left side of the patient. Which specific position has been used?
Dorsal Decubitus(Left Lateral)
The patient is erect with the right side of the body against the image receptor. The x-ray beam enters the left side and exits the right side of the body. What position has been preformed?
Right Lateral
A patient is lying on the left side of a cart. The x-ray beam is Left Lateral Decubitus(PA)
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directed horizontally and enters the posterior surface and exits the anterior aspect of the body. The image receptor is against the anterior surface. Which specific position has been perform
Palm of the hand Palmar
Lying on the back facing upward Supine
An upright position Erect
Lying down in any position Recumbent
Front half of the patient Anterior
Top or anterior surface of the foot Dorsum Pedis
Position in which head is higher than the feet Fowlers
Posterior aspect of the foot Plantar
Position in which the head is lower than the feet Trendelenburg
Back half of the patient Posterior
What is the name of the projection in which the central way enters the anterior surface and exits the posterior surface
Anteriorposterior
A projection using a CR angle of 10 percent or more directed parallel along the long axis of hte body or body part is
Axial Projection
The specific position that demonstrates the apices of teh lungs, without superimposition of the clavicles
Apical Lordotic
True or False: Radiographic "view" is not a correct positioning term in the United States
True
True or False: The term varus describes the bending of a port outward
False(inward, toward midline)
Anteroposterior Projection
Prone Position
Trendelenburg Position
Left posterior oblique Position
Left lateral chest Position
Mediolateral ankle Projection
Tangential Projection
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Lordotic Position
Inferosuperior acial Projection
Left lateral decubitus Position
Opposites
Flexion Extension
Ulnar Deviation Radial Deviation
Dorsiflexion Plantarflexion
Eversion Inversion
Lateral(external) Rotation Medial (internal) Rotation
Abduction Adduction
Supination Pronation
Retraction Protraction
Depression Elevation
Near the source or beginning Proximal
On the opposite side Contralateral
Toward the center Medial
Toward the head end of the body Cephalad or Superior
Away from the source or beginning Distal
Outside or outward Exterior
On the same side Ipsilateral
Near the skin surface Superficial
Away from the head end Caudad or Inferior
Farther from the skin surface Deep
Moving or thrusting the jaw forward form the normal position is an example of
Protraction
To turn or bend the wrist toward the radius side is called Radial Deviation
Which two types of information should be imprinted on every radiographic image?
Patient Name and Date, and Anatomic Side Markers
True or False: a technologist has the right to refuse to perform False
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an examination on a patient whom he or she finds offensive.
True or False: A technologist is responsible for the professional decisions he or she makes during care of a patient.
True
True or False: The technologist is responsible for communicating with the patient to obtain pertinent clincal information.
True
True or False: The technologist is expected to provide a preliminary interpretation of radiographic findings to the referring physician.
False
True or False: The technologist must reveal confidential information pertaining to a patient who is less than 18 years of age to the patient or guardian.
False
What two are rules/principles for determining positioning routines as they relate to the maximum number of projections required in a basic routine?
A minimum of two projections 90 degrees from each other, and a minimum of three projections when the joints are in the prime interest area
What is the minimum number of projections for the: Foot Three
What is the minimum number of projections for the: Chest Two
What is the minimum number of projections for the: Wrist Three
What is the minimum number of projections for the: Tibia/Fibula
Two
What is the minimum number of projections for the: Humerus Two
What is the minimum number of projections for the: Fifth Toe Three
What is the minimum number of projections for the: Postreduction of wrist
Two
What is the minimum number of projections for the: Left Hip Two
What is the minimum number of projections for the: Knee Three
What is the minimum number of projections for the: Pelvis(non-hip injury)
One
A young child enters the emergency room with a fractured forearm. After one projection is completed that confirms a fracture, the child refuses to move the forearm for any additional projections. What is the minimum number of projections needed?
Two
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If additional projections are required for a routine forearm series, what should the technologist do with the young patient?
Rather than move the forearm for a second projection, place the IR and x-ray tube as needed for the second projections 90 degrees from the first projection.
The physical localization of topographic landmarks on a patient is called:
Palpation
Which two landmarks may not be palpated because of institutional policy?
Ischial Tuberosity, and Symphysis Pubis
True or False: Always place a radiograph for viewing as teh IR "sees" the patient. The patients left is to the viewer's left on an AP projection)
False, the patients left is to the viewers right on an AP projection
True or false: Most CT and MRI images are viewed so that the patient's right is to the viewer's left.
True
The radiographic anolog(film) image is composed of ________ on a polyester base.
Metallic Silver
What are the four image quality factors of a radiograph? Density, Spatial Resolution, Contrast, Exposure Latitude
The range of exposure over which a film produces an acceptable image
Exposure Latitude
Which specific exposure factor controls the quality or pentrationg ability of the x-ray beam?
Kilovoltage(kVp)
Exposure time is usually expressed in units of Milliseconds(ms)
The amount of blackness seen on a prcessed radiograph is called
Density
The primary controlling factor for the overall blackness on a radiograph is
mAs
If the distance between the x-ray tube and IR is increased from 40 to 80 inches, what specific effect will it have on the radiographic density, if other fractors are not changed?
Decrease density to 25%
Which term is used to describe a radiograph that has too little density?
Under Exposure
Doubling the mAs will result in _______ the denisty of the IR image
Doubling
True or False: kV must be altered to chance the radiographic density on the IR
False, mAs will change the density, kVp will change the contrast
When analog images, using manual technique settings, are 25% to 30%
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underexposed or overexposed, a minimum chance in mAs of ________ is required to make a visible difference in the radiographic density
According to the anode heel effect, the x-ray beam is less intense at the(anode or cathode) end of the x-ray tube
Anode
To best use the anode heel effect, the thicker part of the anatomic structure should be place under the (anode or cathode) end of the x-ray tube
Cathode
What device or method (other than the anode heel effect)may be used to compensate for the anatomic part thickness difference and prduce an acceptable density of the IR image
Compensating Filters
What are three common types of compensating filters Wedge Filter, Trough Filter, Boomerang Filter
Which type of compensationg filter is used commonly for AP projections of the thorasic spine?
Wedge Filter
Which type of compensating filter permits soft tissue and obny detail of the shoulder to be equally visualized?
Boomerang Filter
A radiograph produced using conventional analog cassettes resulted in too little density. The origanal exposure was 5 mAs. What mAs is needed to correct the density(density needs to be doubled)
10 mAs
The difference in density on adjacent areas of the radiograph defines
Radiographic Contrast
What is the primary controlling factor for radiographic contrast
kVp
What are the two scales of radiographic contrast, and identify which is classified as high contrast and which is low contrast.
Long Scale Contrast(low contrast), Short Scale Contrast(high contrast)
Which scale of contrast is produced with a 110-kV technique Long Scale Contrast(low contrast)
True or False: A 50-kV technique produces a high contrast image
True
True of False: A low-contrast image demonstrastes more shades of gray on the radiograph
True
Which of the following sets of exposures factors will result in the least patient exposure and produce long-scale contrast on a PA chest (50 kV, 800 mAs or 110 kV, to mAs)
110 kV at 10 mAs
A radiograph of a hand is underexposed. The original technique used was 55kV with 2.5 mAs. Keeping the mAs and
8 - 10kV
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increasing the kV what would the new kV be to double density?
If an anoatomic part measures greater than _____cm a grid must be used
10cm
Identify the type of grid cuttoff that is created: The central ray (CR)and face of grid are not perpendicular
Off-Level Grid Cutoff
Identify the type of grid cuttoff that is created: The SID is set beyond the focal range of the grid
Off-Focused Grid Cutoff
Identify the type of grid cuttoff that is created: The back of the grid is facing the x-ray tube
Upside Down Grid Cutoff
The recorded sharpness of structures of objects on the radiograph defines
Spatial Resolution/Definiton
The lack of visible sharpness is Blur/Unsharpness
What are the three geometric factors that control or influence image resolution
Focal Spot Size, Source Image Receptor Distance(SID), Object Image Receptor Distance(OID)
The term that describes the unsharp edges of the projected image
Penumbra
True or False: The use of a small focal spot will entirely eliminate the problem identified in teh previous question
False
The greatest contributor to image unsharpness as related to positioning
Motion
Body Movement
QUESTIONS ANSWERSMovement of a part away from the central axis of the body or body part. abduction
Movement of part toward the central axis of the body or body part. adduction
Straightening of a joint; when both elements of the joint are in the anatomic position; the normal position of a joint.
extension
Act of bending a joint; the opposite of extension. flexion
Forced or excessive extension of a limb or joints. hyperextension
Forced over flexion of a limb or joint. hyperflexion
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Outward turning of the foot at the ankle. eversion
Inward turning of the foot at the ankle. inversion
Rotation of the forearm so that the palm is down. pronate
Rotation of the forearm so that palm is up (in the anatomic position). supinate
Turning or rotating of the body or body part around its axis. rotate
Circular movement of a limb. circumduction
Tipping or slanting a body part slightly; in relation to the long axis of the body. tilt
A turning away from the regular standard or course. deviation
Body Habitus/Regions
QUESTIONS ANSWERSName the 3 superior body regions. Right Hypochondrium, Epigastrium, Left
Hypochondrium
Name the 3 middle body regions Right Lateral, Umbilical, Left Lateral
Name the 3 inferior body regions. Right Inguinal, Hypogastrium, Left Inguinal
What organs are found in the Right Hypochondrium region? Gallbladder, Liver
What organs are found in the Left Hypochondrium region? Spleen, Stomach
What organs are found in the Right Inguinal region? Appendix
What organs are found in the Hypogastrium region? Bladder, Rectum
What conditions are likely in the Left Inguinal region? Gas pains
What conditions can occur in the Epigastrium region? Heartburn, Ulcer
What organs can be found in the Right Lateral Region? Ascending colon, Kidney
What organs can be found in the Left Lateral Region? Descending colon, Kidney
Name the 4 Quadrants. Left Upper Quandrant, Left Lower Quandrant, Right Lower Quadrant, Right Upper Quadrant
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What organs are in the LUQ? Stomach, Spleen, Pancreas
What organs are located in the RLQ? Appendix, Cecum, Colon
What organs are located in the RUQ? Gallbladder, Liver, Intestines, Kidney
What organs can be found in the LLQ? Descending colon, Intestines
Name the 4 types of Body Habitus. Asthenic, Hypersthenic, Hyposthenic, and Sthenic
Which body habitus has the highest rate of occurrence? Sthenic at 50%.
Which body habitus has the lowest rate of occurrence? Hypersthenic at 5%
Which body habitus belongs to frail individuals? Asthenic
Asthenic Body Habitus occurs about ___% 10%
Which body habitus is the most difficult to classify? Hyposthenic
This body habitus represents 10% of the population, gallbladder is low and nearer the midline, stomach is low and medial. This is the ________ body habitus.
Asthenic
Define body habitus. Common variations in the shape of the human body.
Body habitus affects the location of which organs? Gallbladder, Stomach, Heart, Lungs, Diaphragm
In which body habitus is the heart nearly vertical at midline? Asthenic
Which body habitus represents 10% of the population, the gallbladder is low and nearer to midline and the stomach is low and medial?
Asthenic
Which body habitus representing 5% of the population, has a high gallbladder, and a high, transverse stomach?
Hypersthenic
What is the percentage of occurrence for hyposthenic body habitus?
35%
What is the stomach and gallbladder position for sthenic? Stomach: high/upper left; Gallbladder: center on right
What is the stomach and gallbladder position for asthenic? Stomach: Low/medial; Gallbladder: low/near midline
What is the stomach and gallbladder position for hypersthenic? Stomach: High/transverse/in middle; Gallbladder: High & outside
Sthenic organ placement. Stomach: high & left; colon: even spread;
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GB: centered right side
Hyposthenic organ placement. No change.
Asthenic organ placement. Stomach: low & medial in pelvis; colon: low; GB: Low & near midline
Hypersthenic organ placement. Stomach: High & middle; Colon: frames abdomen; GB: High & outside.
Skeletal Landmarks
C1 MASTOID TIP
C2 - C3 GONION
C3 - C4 HYOID
C5 THYROID
C7 VERTEBRA PROMINENS
T1 APPROXIMATELY 2" ABOVE JUGULAR NOTCH
T2 - T3 JUGULAR NOTCH
T4 - T5 STERNAL ANGLE
T7 INFERIOR ANGLES OF SCAPULA
T9 - T10 XIPHOID PROCESS
L2 - L3 LUMBAR PUNCTURE
L4 - L5 ILIAC CREST
S1 - S2 ASIS
PUBIC SYMPHYSIS/GREATER TROCHANTERS COCCYX
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Lower Extremities
QUESTIONS ANSWERSThe pelvic girdle consists of 2 hip bones
The Pelvis consists of both hip bones, sacrum, coccyx
The hip is made up of the ilium, ischium, and pubic bone
What is the area between the greater and lesser trochanter called on the ANTERIOR aspect of the proximal femur
intertrochanteric line
What is the area between the greater and lesser trochanter called on the POSTERIOR aspect of the proximal femur
intertrochanteric crest
A true AP of the hip require how much rotation? 15-20 degree internal rotation
kV for the AP Pelvis, AP Hip, and Lateral Hip is 75-85kV
Center for the AP Pelvis is centered 2" inferior to level of ASIS (crest 1.5" below top of IR)
How are you doing? EXCELLENT!
What size IR for a AP Pelvis? 14x17 CW
T/F Lesser trochanters of the femur is included in the AP Pelvis
True
How do you detect rotation for Pelvis?
The superior ramus is part of the pubis
The inferior ramus is part of the Ischium
The Judet method demonstrates the Acetabulum
Center for AP hip (with hardware) 1-2" distal to neck or femur (all of hardware must be demonstrated)
Lateral of the hip is also called Frog or Modified Cleaves or Lauenstein method
Trauma Hip most often used is called Danelius-Miller or Cross-table lateral or Axiolateral (inferiorsuperior)
The modified axiolateral trauma hip when both hips can't be moved. is called
Clements-Nakayama method
How much should the femur be abducted for the Cleaves method for the hip?
40-45degrees
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How much should the femur be abducted for the Lauenstein method for the hip?
40-45 degrees (with knee flexed 90degrees)
Where is the CR placed for a unilateral frog-leg projection
mid femoral neck
The AP axial outlet projection for the pelvis requires the CR to be ______for females and _______ for males
20-35 and males 30-45degrees
The AP inlet projection for the pelvic ring requires the CR angle to be
40deg caudad
A male pelvis has an ______ angle while a female pelvis has a ________
less than 90 degrees acute, female greater than 90 degrees obtuse
Three differences in a female and male pelvis are males have narrower , deeper and less flared, angle of the pubic arch is less than 90deg, shape of the inlet is more narrower and more oval or heart shape
What are some important positioning landmarks for the pelvis
iliac crest, ASIS, greater trochanter, symphysis pubis, ischial Tuberosity
The pelvis is separated into ______ superior to the inlet and ________pelvis is a cavity that is surrounded by bony structures that is of great importance during birthing process
greater false pelvis, lesser true pelvis forms birthing canal
If the femoral neck is foreshortened and the lesser trochanters are in profile medially on a radiograph what is probable cause for positioning
external rotation of the leg and foot
When taking a patient history for a hip x-ray it is important to ask about a prosthesis or any hip surgery for what two reasons
so you can position patient without injuring site, and to make sure you center lower to include all hardware
What pathology is best demonstrated with the judet method
acetabular fractures
Where is the CR placed for a unilateral frog-leg projection
mid femoral neck
The ankle joint is formed by what three bones tibia, fibula, talus
A 15deg internal rotated AP oblique projection is called the
mortise projection
The mortise position demonstrates the joint and should have even space over entire _____
talar surface
What does the mortise joint do for the body helps stabilize weight
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What is the difference between the AP mortise and AP oblique ankle projections for positioning
internal rotation for mortise is 15-20deg and the ankle is internal rotation of 45deg
On a true AP of the ankle what is not demonstrated
entire three part joint space of the ankle mortise
The ankle is what type of joint with what type of movement
synovial joint, sellar or saddle type and movement is flexion and extension
Which malleolus is longer and is an extension of the fibula
lateral malleolus
What are the stress views of the ankle important shows lack of support, from fractures or tears of ligaments
Before doing a stress view of the ankle what should be ruled out
make sure there is no fracture
What are the two joints are on the tibia proximal and distal tibiofibular joints
What structures are seen in the AP Ankle? 1/3 of tib/fib, ½ of metatarsals, ankle joint with the medial and upper portion of the joint open.
Name the 3 Ankle positions (routine) AP, AP oblique with medial rotation, Lateral
Positioning for the AP ankle Center to ankle joint, foot dorsiflexed.
Positioning for the AP mortise with medial rotation
15-20 degrees medial rotation, centered to ankle. (demonstrates ankle mortise)
How do you accurately position for the AP w/ medial rotation?
rotate medially until the malleoli are parallel (equidistant) to the IR. Rotate the whole leg NOT just the ankle or foot.
What is the visual difference between and AP and AP Mortise?
the joint space on the lateral side of the Mortise will be open. In the AP the Fib is superimposed over part of the talus.
What is the (rarely used) AP oblique with 45degree medial rotation for?
to show tib/fib joint space.
Identify rotation on Lateral ankle talar domes should be superimposed, lateral malleolus superimposed over posterior half of tibia.
What are Inversion/Eversion view of the Ankle for?
stress views that are used to demonstrate ligament damage.
What do you do to fit the Tib/Fib on a 14x17? Try it diagonally, then try increasing the SID (44-48in)
T/F There should be partial superimposition of the Tib and Fib at both proximal AND distal ends?
TRUE
You are _____? ON FIRE! Someone call 9-1-1!
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Describe positioning for the Lateral TIB/FIB Mediolateral, flex knee to 45 degrees, center midshaft and include both joints. May increase SID.
Identify rotation for the Lateral TIB/FIB Rotation indicated by condyles of femur and ankle joint. Condyles should be superimposed and the proximal head of FIB superimposed by TIB, distal FIB superimposed over posterior half of TIB.
Identify rotation for AP TIB/FIB evaluate relationship of the fibula to tibia. Lat. Rot. – fib shifts toward or under tib, obscuring medial mortise. Med. Rot – head of fib draws from beneath tib.
.
Name the tarsals of the foot Calcaneus, Cuboid, Cuniforms (1 medial, 2 intermediate, 3 lateral), Navicular, Talus
How many Tarsals are there? Seven 7
The heel bone is called Calcaneus
The Calcaneus is a Tarsal True
Where would you find Sesamoid Bones in the foot?
embedded in tendons, near joints, plantar surface
How many bones in the foot? 14 (phalanges), 5 (metatarsals), 7 (tarsals). 26 total bones.
Name the arches of the foot Longitundinal Arch (Lateral and Medial sides of foot) Transverse arch (across the foot)
Describe the Longitudinal arch of the foot Comprised of lateral and medial, most of the arch is on the medial side and in the mid aspect of the foot
Describe the Transverse arch of the foot primary located along the plantar surface of the distal tarsals and TMT joints. Made up mostly of the cuniforms and cuboid (especially 2nd and 3rd cuniforms).
Dorsiflexion is when the foot is raised cephalad
Plantar Flexion is when the foot is extended away from the body (pressing the gas pedal)
Inversion (varus) of the foot is when the bottom of the foot is faced medially
Eversion (valgus) of the foot is when the bottom of the foot is faced laterally
Technical factors for the foot 40in SID, 50-70kV, short exp. time, grid if >10cm
Name the Foot positions AP axial, AP oblique, Lateral
Name the Toes positions AP axial, AP oblique, Lateral
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Name the Calcaneus positions Axial and Lateral
CR angle for AP axial Toes 15 degrees cephalic
Centering for AP axial Toes MTP joint
Film size for AP axial Toes 8x10 or 10x12 (depends on projections done and if AP axial FOOT is done as a projection)
Special projection for sesamoid bones tangential of toes – dorsiflex foot 15-20degrees from vertical, CR perpendicular to IR and centered tangentially to posterior of 1st MTP
alternative lateral for the foot lateromedial- outside of the foot, CR mid-cuneiform base of 3rd MT
special projection for the foot to show longitudinal arches
AP & lateral weight-bearing CR 15deg posterior to base of MT
Name the Calcaneus projections and centering point
Axial Plantodorsal –dorsiflexed, CR 40deg cephalic at base of 3rd MT Lateral-Mediolateral- CR 1in inferior to medial malleolus
what is gout? form of arthritis, uric acid deposits destuct joint space
Does Lisfranc joint injury requires a decrease or increase in technique
increase to penetrate tarsal region
joint effusions are signs of fracture,dislocation,soft tissue damage
what type of joints are IP joints hinge (flexion and extension)
what type of joints are TMT,intertarsal plane or gliding (limited movement)
what type of joints are MTP ellipsoidal or condyloid, (4 movements)
the calcaneal sulcus and a depression on the Talus form an opening for ligaments to pass through in the middle of the subtalar joint called?
sinus tarsi
three articular facets appear at the subtalar or talocalcaneal joint with the Talus through which the weight of the body is transmitted to the ground in an erect position
posterior, anterior and middle articular
what does the sustentaculum do? provides medial support for weight bearing subtalar or talocalcaneal joint
.
in what projection is the tuberosity on the 5th MT demonstrated
oblique-medial of the foot
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what is a common trauma site for the foot that provides attachment of a tendon
tuberosity of the 5th MT
weight of the body is transmitted by this bone through the important ankle and talocalcaneal joints
TALUS
what type of joint is the ankle synovial-sellar type w/flexion and extension
Longest and strongest bone femur
Four major ligaments for the knee joint posterior cruciate, anterior cruciate, fibular collateral, tibial collateral
Name three knee positions that are tunnel projections
BeClere, camp Coventry, homblad
Name two tangential knee projections merchant and sunrise
A distinguishing difference between the lateral and medial condyle is the presence of _____________
adductor tubercle on the posterior side of the medial condyle that receives the tendon of the adductor muscle
What do all tunnel views demonstrate intercondylar fossa
How do you position a patient for the camp-coventry method
patient supine, flex knee 40-50degrees, CR to knee joint or popliteal depression, CR perpendicular to tib/fib, 40 SID.
What two tunnel projections are PA holmblad and camp Coventry
What one tunnel view requires the CR to be perpendicular to the IR
Homblad method
The settegast method also called the inferosuperior projection requires the knees to be flexed __________ deg and the CR angle __________ to the lower legs
40-45d, 10-15d
The joints at each end of the femur are a frequent source of pathology when trauma occurs because why
The entire weight of the body is transferred through the femur and associated joints
What do the medial and lateral condyles of the femur articulate with
the tibia
Why must the CR angle for a lateral knee be 5-7 degrees cephalad
the medial femoral condyle extends lower than the lateral femoral condyle when the femoral shaft is vertical
The medial and lateral epicondyles are attachments for what
the medial and lateral collateral ligaments
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What is the largest sesamoid bone in the body the patella
When the leg is extended the patella is where superior to the patellar surface
When the leg is flexed the patella is where downward over the patellar surface
Where is the apex of the patella located along the inferior border
Where is the base of the patella located the superior border
Does the patella articulate with the tibia no! only with the femur
Where is the femorotibial joint located between the two condyles of the femur and the condyles of the tibia
What is the femorotibial joint classified as a synovial joint, bicondylar and diarthrodial that allows flexion and extension
Where is the patellofemoral joint located where the patella articulates with the anterior surface of the distal femur
What is the patellofemoral joint classified as synovial , SELLAR (saddle)
What is the largest joint space of the human body cavity of the knee joint
What is the knee joint the knee joint is synovial type enclosed in an articular capsule or bursa
What are the medial and lateral menisci fibrocartilage disks between the articular facets of the tibia and the femoral condyles
What projection shows the articular facets in profile
AP knee
Where do you center for an AP knee parallel to the tibial plateau
Why are the femoral condyles superimposed but never completely
because of magnification
What is the same for all tunnels of the knee CR perpendicular to tib/fib and demonstrates intercondylar fossa
Why is a PA patella preferred over an AP less OID
What is demonstrated on an AP proximal femur lesser trochanter superimposed and the greater trochanter in profile
What is demonstrated on an AP Distal femur epicondyles parallel to IR
What is demonstrated on a Lateral proximal femur
lesser trochanter in profile and the greater trochanter is superiposed
What is demonstrated on a lateral distal femur condyles are in line with long axis of femur for no
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rotation
Beclere method (ap axial) for tunnel knee requires _____degree knee flexion, CR angle of ____ degrees and the CR centered _______
40-45, 40-45 cephalad, ½ inched distal to apex of patella
Holmblad method (pa axial) for tunnel knee requires ______degree knee flexion, and the CR angle of ______degrees.
60-70 degree knee flexion and no angle on CR (perp to IR)
Camp Coventry method (pa axial) for tunnel of knee requires _____degree knee flexion, and CR angle of ______ degrees.
60-70 degree knee flexion and 40-50 degree caudad angle on CR
Do you rotate the knee for a true AP? yup, 5 degree internal rotation of anterior knee will align interepicondylar line parallel to plane of IR.
How much should you flex the knee for a Lateral-Mediolateral Knee projection?
5-10 degrees additional flexion may cause separation of a fracture (p.253)
Define Baker Cyst When an excess of knee joint fluid is compressed by the body weight between the bones of the knee joint, it can become trapped and separate from the joint to form the fluid-filled sac in the posterior knee.
The cavity in the hipbone that articulates with the femoral head is called the
acetabulum
The hip bone consists of what three parts? Ischium, Pubic bone, and Ilium
The ilium and sacrum articulates at the _________ joint
Iliosacral
The junction of what 2 bones forms the obturator foramen of the pelvis?
Ischium and Pubic bone
Name the bones that make up the pelvic girdle Right and Left Hip bones
Name the bones that make up the pelvis in an adult
Sacrum, Coccyx, Right and Left Hip
The prominent ridge extending between the trochanters at the base of the neck on the posterior surface of the femur is the
intertrochanteric crest
Name one or more structures that may be helpful in order to evaluate rotation on an AP pelvis radiograph (not proximal femur)
Symetry of the Obturator formina or Ischial spines, and alignment of the Coccyx and Pubis symphisis.
How much do you medially rotate the feet and lower limbs to place the femoral necks parallel with the plane of the IR on an AP projection of
15-20 degrees
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the pelvis?
What position, projection or method is useful in diagnosing fractures of the acetabulum?
Judet (axiolateral)
What is the projection of the Modified Cleaves often called?
Frog leg
Do you see the lesser trochanter with the Modified Cleaves method?
Yes
What projection/position of the hip best demonstrates the greater trochanter in profile?
AP hip/pelvis
The angulation of the tube for the axiolateral projection (Danelius-Miller Method) is angled perpendicular to what structure? (not the film)
Femoral Neck (and IR)
Where is the central directed for the unilateral frog-leg?
Femoral Neck
The largest sesamoid bone in the body is the patella
The tube angle for the Camp Coventry method for the PA axial (knee) is
40 degrees
In order to better visualize the joint space in the AP projection of the knee on a large patient, the central ray should be angled how many degrees and in what direction?
3-5 degrees cephalic
In the Be'clere position the patient is placed (supine, prone, or lateral)?
Supine
The centering point for the AP of the knee is 1/2" distal from apex of Patella
This acts as a shock absorber in the knee Meniscus
In the AP projection of the proximal femur, the foot should usually be slightly rotated internally ________ degrees.
15-20
Which projection of the patella provides sharper recorded detail, AP or PA?
PA
What is the name of the prominence on the posterior aspect of the femur that forms the popliteal surface?
Linea Aspera
What is the protrusion on the anterior side of the proximal tibia called where the patellar ligament
tibial tuberosity
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inserts
When looking at a lateral ankle radiograph, how do you determine if it is rotated
the talar domes should be superimposed and there should be superimposition of the posterior tibia
Is the sustentaculum tali on the medial or lateral side of the calcaneus
medial
The lateral malleolus is part of this bone fibula
The fibula articulates with the condyles of the femur (T or F?)
False
When doing an oblique ankle that is for the mortise, how much do you rotate the leg and in which direction
15-20 degrees medial rotation
Describe how to position a tib/fib for an AP condyles should be parallel to IR and foot should be AP
Where is the centering point on an AP projection of the ankle
ankle joint
If an x-ray of the toes are requested, how much do you angle your tube on the AP axial projection to open the joint spaces
15 degrees
If an x-ray of the foot is requested, how much do you angle your tube for an AP projection which opens the joint spaces
10 degrees
On an AP oblique projection of the foot, which oblique and how many degrees obliquity is most often performed
30 degrees medial oblique
When doing an AP oblique projection of the foot which rotation best demonstrates the sinus tarsi
medial rotation
Where is the central ray directed for the lateral first toe
IP
Where is the central ray directed for the AP foot base of the 3rd metatarsal
To obtain an axial projection of the calcaneus, the number of the degrees the central ray is angled____ when the long axis of the foot is perpendicular to the plane of the IR
40 degrees
For AP of the toes, the toes/foot are ________ to the IR and the CR is at the ____ Joint?
PARALLEL and MTP Joint
For AB Oblique of the toes, knees are flexed, foot on IR with toes INTERNALLY rotated are
30" to 45* Oblique = CR to MTP Joint
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_______ to the IR with CR TO ____ joint.
For the lateral view of the big toe, the foot should always be in what position
LATERAL
Where is the CR Directed for an AP Dorsoplantar of the foot?
CR is angled 10* POSTERIORLY toward the heel ot BASE of the 3RD Metatarsal
For and AP OBLIQUE of the foot how many degrees to the IR ?
30*
For the AP OBLQUE of the foot the CR to the BASE is at?
the 3rd Metatarsal
For a lateral view of the foot how should it be positioned?
Mediolateral
For the AXIAL PLANTODORSAL position of the foot and calcaneus (the heel) be positioned to the IR?
Perpendicular to the IR
In the AXEAL PLANTODORSAL position the CR should be angled how many degrees
40* Cephalad toward the id calcaneus
What does CEPHALD mean? Toward the head
What position should the leg be in a lateral (mediolateral) position
Knee Flexed-Leg rotated externally until lateral side of foot is against the IR - Ankle is flexed 90*
For and AP OBLIQUE Mortise how far do you rotate the ankle?
15* - 20* Oblique
For an AP OBLIQUE how far do you rotate the ankle
45* oblique to IR
When positioning the lower leg the 14"x17" is placed how?
Diagonally
In the AP of the lower leg the lower leg and knee should be _______ to the IR?
PARALLEL
When positioning the knee in the AP View the CR angled should be _____ * cephalad to 1/2" distal to apex of patella
5*
For a lateral knee the knee should be flexed ____* to ____ *, leg should be rotated _____ until femoral condyle and patella are ____ to IR
- 20* TO 30* = Externally = PERPENDICULAR to IR
For the lateral knee the CR is _____* to _____* cephald to _____" distal to medial epicondyle
5* to 1* = 1"
1
How many degrees is the knee flexed for the TUNNEL VIEW?
Prone with Knee Flexed 40-50* to IR
How many degrees for a SUNRISE VIEW? 80*
For the Patella the CR angle is? 15* to 20* Cephalad to APEX of the Patella
What is ASIS? Anterior Superior Iliac Spine
When positioning the femur the 14" x 17" should be placed __________ with TOP OF IR at level of _______ for PROXIMAL VIEWS
LONGITUDINALLY - ASIS
When positioning the femur the 14'x17' should be placed ________ with the BOTTOM of the IR ________ below knee joint for a distal view
Longitudinally - 1" to 2"
For a LATERAL PROXIMAL VIEW the patient is turned _______ on side, knees flexed _______ with legs rotated ________ until lateral?
PARTIALLY on side - 30"-45" - Rotated EXTERNALLY -
For a LATERAL DISTAL VIEW the patient is turned on side with ________ leg crossed over affected leg, knee is flexed ____* with femoral condyles and patella _______ to the IR
UNAFFECTED LEG - 30*-45* = PERPENDICULAR
When using the bucky to position the hip a 10" x 12" is placed ____________ with TOP OF IR at level of ASIS
Longitudinally
For an AP Positioning of the hip leg is fully extended with foot and leg rotated ________ *
Internally 15
Name the irregular bones OXCOXAE - SACRUM - COCCYX
The tarsal are what type of bones Short Bones
The phalanges and metatarsals are classified as what type of bones?
Long Bones
The tibia and fibula are classified as what type of bones
Long Bones
The femur is considered what type of a bone Long Bone
What type of movement does all PHANGEAL JOINTS provide
Hinge Movement
The MTP Joints allow for what type of movement Hinge Movement
The ANKLE (MORTISE) Joint allows for what type of movement
Hinge Movement
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The Patella femoral allows for what type of movement?
Gliding Movement
The hip joint allows for what type of movement Circumduction
How many bones are there in the foot? 26
How many phalanges (toes) are there in the foot 14
There are ________ tarsals in the foot 7
The FEMUR extends from the _____ to the ____ Hip to the Knee
The proximal end of the femur contains what? The head - neck & greater and lesser trochanters
The distal end contains the ______ & _____ with a U-shaped notch. This notch lets what pass through?
Medial and the Lateral Condyles = Blood vessels and nerves
The 1st digit (big toe) contains ____ phalanges 2
What are name of the phalanges found in the big toe?
Proximal and Distal Phalanx
The foot contians 2 _______ bones near the 1st metatarsal phalangeal joint
Sesamoid Bone
What are the 3 bones in the Proximal Row of the foot
Navicualr - Talus - Calcaneous (heel0
What are the 2 bones that make up the lower leg Tibia and Fibula
On what disc is the Fibula found Lateral Side
The tibia is the larger weight bearing bone located on the MEDIAL Side
True
Where are the TIBIAL SPINES located Anterior Tibia
The tibial tuberosity is a raised area on Anterior Tibia
The distal tibia contains ____________? Medial Maleolus
The proximal end contains the ______ and _______ process
Head and Styloid
The POINTAL INFERIOR border is called the? APEX
The ROUNDED SUPERIOR border is called the Base
The bones that make up the pelvic girdle are the? Right and Left OS COXAE (HIPS)
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The hip bones is made up of 3 fused bones ..what are they?
Ilium, Ishium and Pubis
The Pelvis includes the _______ and ______? Pelic Girdle, Sacruml, Coccyx
The ilium has a curved upper portion called the? Iliac Crest
The ilium has a bondy projection called the ASIS Anterior Superior Iliac Spine
In each Os Coxae there are 2 large openings called the ______ _________ which allows for the passage of NERVES and BLOOD VESSELS to the legs
Obturator Foramen
How many IP Joints does the big toe have 1 IP
Digits 2 - 5 have both PIP (Proximal Interphalangeal) and Distal (DIP) Interphalangeal Joints
True
The ankle mortise joint seperates the Tibia from the Lateral Malleolus
FALSE
The Meniscus acts as a ________ helping to cushion the knee joint.
shock absorber
EC - What are the 2 c-shaped disks between the femoral condyles and the tibial plateaus called
Meniscus
EC - The medial and laterial condyles have a Ushaped notch that seperates them and it is called a ________. Blood vessels and nerves pass through this notch
Inter Condylar Fossa
Toes (Lateral) Perpendicular, entering IP joint of big toe
Foot (AP Axial) 10 degrees toward heel, entering base of third metatarsal
Calcaneus (Lateral) Perpendicular to calcaneus. Center 1" distal to medial malleolus.
Calcaneus (Axial) Plantodorsal 40 degrees cephalic to base of 3rd metatarsal
Ankle (AP Oblique) Medial Rotation Perpendicular entering ankle joint midway between malleoli
Ankle (Lateral) Lateromedial Perpendicular through ankle joint, entering 1/2" superior to lateral malleolus
Sesamoids (Tangential) Perpendicular and tangential to 1st metatarsal joint
Knee (AP) Weight-Bearing Horizontal and perpendicular, entering 1/2" below patella
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apex
Knee (Lateral) Mediolateral To knee joint 1" distal to medial epicondyle at angle of 5 - 7 degrees cephalic
Patella (Lateral) Mediolateral Perpendicular, entering knee at midpatellofemoral joint
Patella (Tangential) Merchant Method Perpendicular with 40 degree knee flex. Angle CR 30 degrees caudal.
Patella (PA) Perpendicular to midpopliteal, exiting patella
Patella and Patellofemoral Joint (Tangential) Settegast Method
Perpendicular to perpendicular joint. If not, CR angle will be 15 - 20 degrees
Patella and Patellofemoral Joint (Tangential) Hughston Method
Angled 45 degrees cephalic and directed through patellofemoral joint
Intercondylar Fossa (PA Axial) Camp-Coventry Perpendicular and centered to knee joint. Angled 40 degrees when knee flexed 40 degrees or angled 50 degrees when knee is 50 degrees
Hip (AP) Line up at ASIS. Go distal 2" and center between ASIS and pubic symphysis.
Hip (Modified Axiolateral) Clements - Nakayama Directed 15 degrees posteriorly and aligned perpendicular to femoral neck
Hip (Axiolateral) Danelius-Miller Perpendicular to long axis of femoral neck.
Hip (Lateral) Mediolateral (Lauenstein) Perpendicular through hip joint. Lauenstein: midway bet. ASIS and Pubic symphysis
Hip (Lateral) Mediolateral (Hickey) Perpendicular through hip joint. Hickey: Cephalic angle is 20 - 25 degrees
Acetabulum (AP Oblique) Judet Method Perpendicular, entering pubic symphysis
Anterior Pelvic Bones (AP Axial) Outlet - Taylor Method
Male: Directed 20 - 35 degrees cephalic and centered to a point 2" distal to superior border of pubic symphysis.
Anterior Pelvic Bones (AP Axial) Outlet - Taylor Method
Female: Directed 30 - 45 degrees cephalic and centered to point 2" distal to upper border of pubic symphysis.
Anterior Pelvic Bones (Superoinferior Axial) Inlet - Bridgeman Method
Directed 40 degrees caudal, entering at level of ASIS
SI Joints (AP Oblique) Perpendicular, entering 1" medial to elevated ASIS
SI Joints (PA Oblique) (RAO/LAO) Perpendicular, 1" medial to ASIS
Pelvis (Lateral) Perpendicular to a point at the level just above greater
1
trochanter
Femoral Necks (AP Oblique) Modified Cleaves Perpendicular, entering at level 1" superior to pubic symphysis
Femoral Necks (AP) Modified Cleaves Directly to femoral neck
What is the position of part for the Lateral Femur (with the knee included)?
Distal Femur- draw the patient's uppermost limb forward, true lateral position, and adjust the position of the Bucky tray so that the IR projects approximately 2 inches beyond the knee to be included.
What is the position of part for the Lateral Femur (with the hip included)?
For the proximal femur, place the top of the IR at the level of the ASIS. Adjust the pelvis so that it is rolled 10 to 15 degrees from the lateral position to prevent superimposition.
What is the central ray for the Lateral Femur?
Perpendicular to the midfemur and the center of the IR
What is the structures shown for the Lateral Femur?
The lateral projection of 3/4ths of the femur and adjacent joint. If needed, use two IRs for the entire adult femur.
What is the evaluation criteria for the Lateral Femur?
A 2nd radiograph for the other end of femur is recommended,Any orthopedic,Trabecular detail on the femoral body, With the knee- Superimposed anterior surface of the femoral condyles, Patella in profile, opposite thigh, greater trochanter not prominent.
Added evaluation criteria for the Lateral Femur?
Patients with the conditions should be examined in the supine position by placing the IR vertically along the medial or lateral aspect of the thigh and knee and the directing the central ray horizontally.
Position of patient for the AP Femur? Supine, pelvis is not rotated
Position of part for the AP Femur? Center the IR midline, when patient is too tall include the entire femur, include the joint closest to the area of interest.
Position of part for the AP Femur (with hip included)?
Proximal femur-which must include the hip joint, place the top of the IR a the level of the ASIS. Rotate limb internally 10to15 degrees to place the femoral neck in profile.
Structures shown and evaluation criteria for the AP femur?
Projection of the femur, including the knee joint and/or the hip. Femoral neck not foreshortened on the proximal femur.
What is the position of the patient for the Tangential Projection(Settegast Method)?
Supine or Prone. Use an even, slow flexion to tolerate pain. Place IR transversely under the knee and center to joint space b/t the patella and the femoral condyles.
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What is the central ray for the Tangential Projection for the Patella?
Perpendicular to the joint space between the patella and the femoral condyles when joint is perp. The angulation is 15-20degress when space is not perp.
What is the evaluation criteria for the Tangential Settegast?
Patella in profile, open patellofemoral artic., Surfaces of the femoral condyles, soft tissue, and bony detail of patella and femoral condyles
What is the SID for Tangential Projection Merchant Method?
6 feet, to reduce magnification
What is the position of part for Tangential Projection (Merchant Method)?
Adjust the angle of knee flexion to 40 degrees, may varies 30to90 to demonstrate patellofemoral disorders, Place IR perpendicular to the central ray 1 ft distal to patellae,
What is the structure shown for a Tangential projection(Merchant Method)?
The right angle alignment of the IR and the central ray, the patellae are seen as nondistorded, albeit slightly magnified images.
What is the evaluation criteria for the Tangential projection(Merchant Method)?
Patellae in profile, Femoral condyles, and intercondylar sulcus, Open patellofemoral articulations.
What lateral projection is the Patella? Mediolateral
What is the position or patient and part for the Lateral Patella?
Lateral Remcumbent, Flex affected knee approx. 5-10(Increasing flexion reduces patellofemoral joint; adjust knee in lateral position so epicondyles are superimposed, center IR to patella
What is the CR for the Lateral Patella? Perpendicular to the IR entering the knee at the midpatellofemoral joint. Collimate to the patellar area.
Evaluation Criteria for the Lateral Patella? Knee flexed 5-10, open patellofemoral space, patella in lateral, close collimation
What is the IR Size for the PA Projection for the Patella?
8x10 in lengthwise
What is the position of part for the PA Patella?
Center the IR to the Patella, Adjust the leg to place patella parallel with IR, usually requires that the heel be rotated 5-10 degrees laterally.
What is the CR for the PA Patella? Perpendicular to the midpopliteral area exiting the Patella, Collimate close to the patellar area.
What is the structures shown for the PA Patella?
The PA projection of the patella provides sharper recorded detail than in the AP projection because of the close object to image receptor distance.
What is the position of patient in the PA Axial (Camp-Coventry) for the
Place the patient in prone, and do not rotate.
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Intercondylar Fossa?
Position of Part for the Camp-Coventry? Flex the knee to either 40-50 and rest foot on support, Center the upper half of the IR to the knee joint the central ray angulation projects the joint to the center of the IR. Adjust leg so knee has no medial or lateral rotation.
CR for the Camp-Coventry? Perpendicular to the long axis of the lower leg and centered to the knee joint. Angled 40 degrees when the knee is flexed 40 degrees and 50 degrees when the knee is flexed 50 degrees.
Structures shown for the Camp-Coventry? Axial image shows unobstructed projection of the intercondyloid fossa and the medial and lateral intercondylar tubercles of the intercondylar eminence.
What are the four parts of the lower limb? 1. Hip2. Leg3. Thigh4. Hip
How many bones are in the foot? 26 Bones Total14 Phalanges5 Metatarsals7 Tarsals
What are the Forefoot, Midfoot, and Hindfoot and what do they contain?
Forefoot- The metatarsals and toesMidfoot- Five tarsals, cuneiforms, navicular, and cuboidHindfoot- Talus and Calcaneus
What is the largest and strongest tarsal bone?
Calcaneus
What does the talus articulates with? Tibia, Fibula, Calcaneus, and Navicular
What does the Trochlear surface articulate with?
Tibia and connects with the foot to the leg.
Where is the cuboid bone located? The cuboid bone lies on the lateral side of the foot between the calcaneus and the fourth and fifth metatarsals.
Where is the navicular bone located? The navicular bone lies on the medial side of the foot between the talus and the three cuneiforms.
What does the leg contain? Tibia and Fibula
What is the sharp projection between the two surfaces of the the tibal plateaus?
The intercondylar eminence
What is the distal end of the tibia and its medial surface is prolonged into a large process?
Medial malleolus
What is the apex? The apex is the lateorposterior aspect of the head that is the conic projection
What is the enlarged distal end of the fibula?
Lateral malleolus
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Where does the lateral malleolus lie? Axially, the lateral malleolus lies approximally 15-20 degrees more posterior than the medial malleolus
What is the largest, strongest, and most heaviest bone in the body
Fibula, convex anteriorly and slants medially from 5to15 degrees.
What is the patella? The patella is the largest and most constant sesamoid bone in the body. That is flat, triangular anterior surface of the femur
Where is the apex located? Directed inferiorly lies 1/2 inch above the knee joint
What are the three positions for the Intercondylar Fossa PA Axial (Holmblad Method)?
1. Standing w/knee of interest in flexed & resting on a stool at the side of the table 2. Standing at side of table w/affected knee flexed & placed in contact w/IR. 3. Kneeling on table w/affected knee over IR. (Patient leans over table for support)
What is the position of part for the Intercondylar Fossa PA Axial (Holmblad Method)?
Flex knee 70 from full extension (20 difference from the CR)
What is the Position of part for the AP Oblique Knee (Medial)?
Medially rotated the limb, ate elevate the hip of the affected side enough to rotate the limb 45.
What is the Central Ray for AP Oblique Knee both Lateral and Medial Rotation?
Directed 1/2 inferior to patellar apex. The angle is variable, depending on measurement between the ASIS & table:<19cm = 3-5 degrees caudad19-24cm = 0 degrees>24cm= 3-5 degrees cephalad
What is the position of part for the AP Oblique Knee Lateral?
If necessary, elevate the hip of the unaffected side enough to rotate the affected limb. Center IR 1/2 below the apex of the patella. Externally rotate the limb 45 degrees
What is the Central Ray for the AP Weight Bearing Knees?
Ask the patient to stand straight w/knees fully extended. Center the IR 1/2 below the apices of the patellae.
What is the position of part for the Knee Lateral?
A flexion of 20-30 is usually preferred bc this position relaxes the muscles & shows the max. volume of the joint cavity. To prevent fragment separation in new or unhealed patellar fractures, the knee should not be flexed more than 10.
What is the Central Ray for the Knee Lateral?
Directed to the knee joint 1in distal to the medial epicondyles at an angle of 5-7 cephalad.
What is the Central Ray for the PA Knee? Directed at an angle of 5-7 caudad to exit a point 1/2 inferior to the patellar apex. B/C the tib/fib are slightly inclined, the CR will be parallel w/the tibial plateau
What is the position of part for the AP Oblique Leg?
Rotate the limb 45 degrees medially or laterally. For the medial rotation ensure that the leg is turned inward and not just the foot.
What is the position of part for the Lateral Adjust rotation of the body to place the patella perpendicular to
1
Leg? IR and ensure that a line drawn thru the femoral condyles are perpendicular. ALT: When pt cannot be turned from supine position, the lateral projection may be taken cross-table.
What is the position of part for the Ankle AP Oblique?
Place plantar surface of foot in vertical position & laterally rotate leg and foot 45 degrees.
What is the position of part for the Ankle Mortise Joint (AP Oblique)?
Grasp distal femur area w/one hand and foot w/the other. Assist pt by internally rotating the entire leg and foot together 15-20 degrees until the intermalleolar plane is parallel w/IR.
Foot, Ankle & Leg
QUESTIONS ANSWERSFOOT 26 BONES
14 PHALANGES BONES OF TOE
5 METATRSALS BONES OF INSTEP
7 TARSALS BONES OF ANKLE
WALKING, SUPPORTING BODY WEIGHT
THINGS FOOT DOES
FOREFOOT METATARSALS AND TOES
midfoot 5 tarsals
hindfoot talus and calcaneous
midfoot cuniforms, navicular, cuboid
longitudinal and transverse arches shock absorber that distributes body weight in all directions
superior side of foot dorsum
inferior side of foot plantar surface
big (great) toe medial toe only two phalanx distal and proximal NO MIDDLE
metatarsals body and two ends base and head, FIVE HEADS FORM BASE OF FOOT
1st metatarsal shortest and thickest
2nd metatarsal longest
1
base of 5th metatarsal prominent tuberosity common site for fractures
7 tarsals in foot Calcaneuos,talus, navicular,cuboid, medial cuneiform,intermediate cuneiform, lateral cuneiform.
begining at the medial side of the foot the cuneiforms are described as
medial, intermediate, lateral.
the calcaneous largest and strongest tarsal (os Calsis)
calcaneous angle 30 degrees
posterior and inferior parts of the calcaneous attach to
the Achilles tendon
the talus second largest tarsal bone
talus articulates with four bones( tibia, fibula, calcaneous, and navicular.
cuboid lateral side3 of the foot between calcaneous and 4th and 5th metatarsals
navicular between talus and three cuneiforms
cuniforms central and medial aspect of the foot between the navicular , first second and third metatarsals
medial cuneiform largest
the intermediadte cunieform smallest
7 tarsal pneumonic CHUBBY ( calcaneous) TWISTED (Talus) Never (Navicular) Could (cuboid) CHA (Cunieform-medial) CHA ( cunieform -intermediate) CHA (cunieform-lateral)
sesamoid bones beneath the head of the first metatarsal embedded w/in the tendons (common site of fracture)
Leg tibia and fibula
tibia second largest bone in body medial side weight bearing bone
fibula lateral side of leg bears no weight
tbia makes up most of the mortise and articulates with the talus
femur longest, strongest and heaviest bone in body
when femur is vertical the medial condyle is lower than the lateral
because the lateral epicondyle on the femur is lower
the central ray is angled 5m to 7 degrees cephalad to open the joint
the superior portion of the femur the acetabulum of the hip joint
1
articulates with
patella knee cap
Ankle Tibia & Fibula
QUESTIONS ANSWERSThe ankle joint is formed by what three bones
tibia, fibula, talus
A 15deg internal rotated AP oblique projection is called the
mortise projection
The mortise position demonstrates the joint and should have even space over entire
talar surface
What does the mortise joint do for the body
helps stabilize weight
What is the difference between the AP mortise and AP oblique ankle projections for positioning
internal rotation for mortise is 15-20deg and the ankle is internal rotation of 45deg
On a true AP of the ankle what is not demonstrated
entire three part joint space of the ankle mortise
The ankle is what type of joint with what type of movement
synovial joint, sellar or saddle type and movement is flexion and extension
Which malleolus is longer and is an extension of the fibula
lateral malleolus
What are the stress views of the ankle important
shows lack of support, from fractures or tears of ligaments
Before doing a stress view of the ankle what should be ruled out
make sure there is no fracture
What are the two joints are on the tibia proximal and distal tibiofibular joints
Name the 3 Ankle positions (routine) AP, AP oblique with medial rotation, Lateral
Positioning for the AP ankle Center to ankle joint, foot dorsiflexed.
Positioning for the AP with medial rotation
15-20 degrees medial rotation, centered to ankle. (demonstrates ankle mortise)
1
How do you accurately position for the AP w/ medial rotation?
rotate medially until the malleoli are parallel (equidistant) to the IR. Rotate the whole leg NOT just the ankle or foot.
What is the visual difference between and AP and AP Mortise?
the joint space on the lateral side of the Mortise will be open. In the AP the Fib is superimposed over part of the talus.
What is the (rarely used) AP oblique with 45degree medial rotation for?
to show tib/fib joint space.
Identify rotation on Lateral ankle talar domes should be superimposed, lateral malleolus superimposed over posterior half of tibia.
What are Inversion/Eversion view of the Ankle for?
stress views that are used to demonstrate ligament damage.
What do you do to fit the Tib/Fib on a 14x17?
Try it diagonally, then try increasing the SID (44-48in)
T/F There should be partial superimposition of the Tib and Fib at both proximal AND distal ends?
TRUE
.
Describe positioning for the Lateral TIB/FIB
Mediolateral, flex knee to 45 degrees, center midshaft and include both joints. May increase SID.
Identify rotation for the Lateral TIB/FIB Rotation indicated by condyles of femur and ankle joint. Condyles should be superimposed and the proximal head of FIB superimposed by TIB, distal FIB superimposed over posterior half of TIB.
Identify rotation for AP TIB/FIB evaluate relationship of the fibula to tibia. Lat. Rot. – fib shifts toward or under tib, obscuring medial mortise. Med. Rot – head of fib draws from beneath tib.
.
AP stress views for the ankle evaluate what?
Stability of the mortise joint
What anatomy overlaps on an AP ankle? the distal tibia and fibula overlap eachother and the talus
What is the anterior tubercle? An expanded process at the distal anterior and lateral tibia that articulates with the superolateral talus and partially overlaps the fibula anteriorly
What is the tibial plafond? The distal tibial joint surface that forms the roof of the ankle.
What does a true lateral of the ankle require?
The lateral malleolus to be about 1 cm posterior to the medial malleolus.
1
T/F? The tibia is the weight bearing bone of the body.
True
The distal tibiofibular joint is classified as what type of joint?
Fibrous joint and is amphiarthrodial (slightly moveable) of the syndesmosis type.
The proximal tibiofibular joint is classified as what type of joint?
Synovial joint and is diarthrodial (freely moveable) and is plane (gliding) type
Where is the fibula located? Laterally and posteriorly to the tibia.
What does an AP ankle need to demonstrate?
Slight superimposition of the talus and lateral malleolus and slight superimposition of the distal tibia and fibula.
T/F The entire mortise joint is open on an AP oblique ankle with medial rotation (mortise).
True
T/F The intermalleolar line is perpendicular to the IR on a Mortise projection.
False. The intermalleolar line is parallel to the IR.
What is demonstrated on a AP oblique ankle with 45 degree rotation?
The distal tibiofibular joint is open and is in profile.
T/F The intermalleolar line is perpendicular to the IR on a Mortise projection.
False. The intermalleolar line is parallel to the IR.
What is demonstrated on a AP oblique ankle with 45 degree rotation?
The distal tibiofibular joint is open and is in profile.
What needs to be visualized on a lateral ankle?
The entire talus and calcaneus, lateral malleolus superimposed over posterior half of tibia and talar domes are superimposed
What do you look for on inversion/eversion ankle projections?
ligament attachments
T/F An AP tib/fib is done bucky. False. AP tib/fib is done table top
Knee and Femur
QUESTIONS ANSWERSLongest and strongest bone femur
Four major ligaments for the knee joint posterior cruciate, anterior cruciate, fibular collateral,
1
tibial collateral
Name three knee positions that are tunnel projections
BeClere, camp Coventry, homblad
Name two tangential knee projections merchant and sunrise
A distinguishing difference between the lateral and medial condyle is the presence of _____________
adductor tubercle on the posterior side of the medial condyle that receives the tendon of the adductor muscle
What do all tunnel views demonstrate intercondylar fossa
How do you position a patient for the camp-coventry method
patient supine, flex knee 40-50degrees, CR to knee joint or popliteal depression, CR perpendicular to tib/fib, 40 SID.
What two tunnel projections are PA holmblad and camp Coventry
What one tunnel view requires the CR to be perpendicular to the IR
Homblad method
The settegast method also called the inferosuperior projection requires the knees to be flexed __________ deg and the CR angle __________ to the lower legs
40-45d, 10-15d
The joints at each end of the femur are a frequent source of pathology when trauma occurs because why
The entire weight of the body is transferred through the femur and associated joints
What do the medial and lateral condyles of the femur articulate with
the tibia
Why must the CR angle for a lateral knee be 5-7 degrees cephalad
the medial femoral condyle extends lower than the lateral femoral condyle when the femoral shaft is vertical
The medial and lateral epicondyles are attachments for what
the medial and lateral collateral ligaments
What is the largest sesmoid bone in the body the patella
When the leg is extended the patella is where superior to the patellar surface
When the leg is flexed the patella is where downward over the patellar surface
Where is the apex of the patella located along the inferior border
Where is the base of the patella located the superior border
Does the patella articulate with the tibia no! only with the femur
Where is the femorotibial joint located between the two condyles of the femur and the condyles of
1
the tibia
What is the femorotibial joint classified as a synovial joint, bicondylar and diarthrodial that allows flexion and extension (and gliding and rotational with knee partially flexed)
Where is the patellofemoral joint located where the patella articulates with the anterior surface of the distal femur
What is the patellofemoral joint classified as a synovial joint, sellar/saddle and diarthrodial
What is the largest joint space of the human body cavity of the knee joint
What is the knee joint the knee joint is synovial type enclosed in an articular capsule or bursa
What are the medial and lateral menisci fibrocartilage disks between the articular facets of the tibia and the femoral condyles
What projection shows the articular facets in profile
AP knee
Where do you center for an AP knee parallel to the tibial plateau
Why are the femoral condyles superimposed but never completely
because of magnification
What is the same for all tunnels of the knee CR perpendicular to tib/fib and demonstrates intercondylar fossa
Why is a PA patella preferred over an AP less OID
What is demonstrated on an AP proximal femur lesser trochanter superimposed and the greater trochanter in profile
What is demonstrated on an AP Distal femur epicondyles parallel to IR
What is demonstrated on a Lateral proximal femur
lesser trochanter in profile and the greater trochanter is superiposed
What is demonstrated on a lateral distal femur condyles are in line with long axis of femur for no rotation
Beclere method (ap axial) for tunnel knee requires _____degree knee flexion, CR angle of ____ degrees and the CR centered _______
40-45, 40-45 cephalad, ½ inched distal to apex of patella
Holmblad method (pa axial) for tunnel knee requires ______degree knee flexion, and the CR angle of ______degrees.
60-70 degree knee flexion and no angle on CR (perp to IR)
1
Camp Coventry method (pa axial) for tunnel of knee requires _____degree knee flexion, and CR angle of ______ degrees.
60-70 degree knee flexion and 40-50 degree caudad angle on CR
Do you rotate the knee for a true AP? yup, 5 degree internal rotation of anterior knee will align interepicondylar line parallel to plane of IR.
How much should you flex the knee for a Lateral-Mediolateral patella projection?
5-10 degrees additional flexion may cause separation of a fracture (p.253)
Define Baker Cyst When an excess of knee joint fluid is compressed by the body weight between the bones of the knee joint, it can become trapped and separate from the joint to form the fluid-filled sac in the posterior knee.
The largest sesamoid bone in the body is the patella
The tube angle for the Camp Coventry method for the PA axial (knee) is
40 degrees
In order to better visualize the joint space in the AP projection of the knee on a large patient, the central ray should be angled how many degrees and in what direction?
3-5 degrees cephalic
In the Be'clere position the patient is placed (supine, prone, or lateral)?
Supine
The centering point for the AP of the knee is 1/2" distal from apex of Patella
This acts as a shock absorber in the knee Meniscus
In the AP projection of the proximal femur, the foot should usually be slightly rotated internally ________ degrees.
15-20
Which projection of the patella provides sharper recorded detail, AP or PA?
PA
What is the name of the prominence on the posterior aspect of the femur that forms the popliteal surface?
Linea Aspera
Patella Anatomy
What joints make up the knee? patellofemoral, femorotibial
1
Where does the ligamentum patellae attach? tibial tuberosity
At what age does the patella form? 3-5 years of age
How do the femoral condyles sit in relation to each other?
the medial condyle sits 5-7 degrees more inferior
What ligaments stabilize the knee joint? posterior cruciate, anterior cruciate, tibial collateral, fibular collateral.
What are the attachment points for the posterior cruciate ligament?
medial condyle, posterior intercondylar area
What are the attachment points for the anterior cruciate ligament?
lateral condyle, anterior intercondylar area
ACL anterior cruciate ligament
PCL posterior cruciate ligament
What are the attachment points for the tibial collateral ligament?
medial femoral condyle, medial tibial condyle
What are the attachment points for the fibular collateral ligament?
lateral femoral condyle, lateral fibular head
What angle do the tibial plateaus sit at? they slope posteriorly 10-20 degrees
How is the femur normally situated in the body? it slants medially 5-15 degrees
What type of bone is the patella? sesamoid
What is the name for the sesamoid bone occasionally found behind the knee?
flabella
Where does the patella form? in the quadriceps femoris muscle
What is the name of the surface the patella articulates with on the femur?
patellar surface
Where does the patellar apex lie in relation to the knee joint space?
½ inch superior
Upper Extremities
QUESTIONS ANSWERSkV for AP or AP Axial Clavicle 65-75kV
1
Centering for Clavicle perpendicular to mid clavicle
kV for AP or Lateral Scapula 70-80kV
AP Axial of Clavicle, the CR is angled _____?
15-30 degrees cephalad
Bilateral AC joints require what two positions?
with and without 5-8lbs of weights
Name the three angles of the Scapula Superior, Inferior, and Lateral angles
Name the two fossa on the Dorsal Scapula Supraspinous and Infraspinous Fossa
The two views of the Scapula AP and Lateral
Criteria for good Scapula image entire scapula, lateral border free of ribs and lungs, optimal exposure factors
SID for Scapula and Clavicle 40 inches
SID for AC Joints 72 inches
Centering for AC Joints 1 inch above Jugular Notch
True/False: Bilat. AC joints require markers- R, L, with, without
TRUE
True/False: Bilat. AC Joints can be done WITHOUT a grid
TRUE
Name the 3 arm positions that can be used for a lateral scapula
behind back, across chest, over head.
True/False: Humerus should be superimposed over the scapula
FALSE
Name Criteria for lateral Scapula entire scapula,in profile,separated from ribs, humerous not superimposed over area of interest.
True/False: Respiration is not important for a AP Scapula
False - Should be slow respiration
True/False: Respiration is not important for a Lateral Scapula
False - Should be suspended respiration
Name the Trauma Shoulder positions AP neutral rotation, Transthoracic lateral or the Scapular Y view
Name the Routine Shoulder positions AP with external and internal rotation
Another name for Inferosuperior axial (Shoulder)
Lawrence method
1
Another name for Superoinferior axial (Shoulder)
Hobbs modification
Another name for Posterior Oblique- glenoid cavity (Shoulder)
Grashey method
Another name for Tangential projection - intertubercal groove(Shoulder)
Fisk modification
Another name for Transthoracic lateral (Shoulder)
Lawrence method
Routine positions for the Humerus are: AP and Lateral
Trauma positions for the Humerus are: Lateral for distal Humerus, Transthoracic lateral for proximal Humerus, Y-view for proximal Humerus
Criteria for good AP Humerus entire Humerus, Greater tubercle in profile, epicondyles in profile, exposure factors.
Criteria for good Lateral Humerus entire Humerus, Lesser tubercle in profile, epicondyles are superimposed, exp. factors.
Type of joint: Scapulohumeral Spheroidal (ball and socket)
Type of joint: Sternoclavicular Plane (gliding)
Type of joint: Acromioclavicular Plane (gliding)
Describe epicondyles and tubercles with Shoulder AP External rotation
Epicondyles are parallel to IR, Greater tub in profile laterally, Lesser tub anterior
Describe epicondyles and tubercles with Shoulder AP Internal rotation
Epicondyles are perpendicular to IR, Greater tub anterior, Lesser tub in profile medially
Centering point for AP shoulder? 1" inferior of Coracoid process (Scapulohumeral joint)
Where is the Coranoid Process? The proximal end of the Ulna, articulates with the Trochlea of the Humerus
Where is the Coracoid Process? Superior border of Scapula and inferior to the Distal end of the Clavicle
What carpal bone articulates with the radius?
Scaphoid
What carpal bone articulates with the radius and the capitate?
Lunate
Which carpal bone is proximal to the first metacarpal (thumb)?
Trapezium
Which carpal bone is proximal to the 2nd Trapezoid
1
metacarpal?
Which carpal bone is proximal to the 3rd metacarpal?
Capitate
Which carpal bone is proximal to the 4th and 5th metacarpal?
Hamate
The metacarpals are concave on the anterior and convex on the posterior.
True
The wrist joint is an ellipsoidal joint which is the most freely moveable of synovial joints.
True
What is the joint called where the radius articulates with the scaphoid and the lunate?
radiocarpal joint
What is the average range of kV for the fingers hand and wrist?
50-65 kV
Where do you center for a PA hand and an oblique hand?
3rd MCP
Where do you center for a lateral of the hand?
2nd MCP
What is another name for the Norgaard Method and what is it used to diagnose?
Ball Catcher's Position - diagnoses rheumatoid arthritis
Where do you center for a PA and oblique wrist?
mid carpal area
Where do you center for a lateral wrist? Perpendicular to wrist joint
How much of a CR angle is used for the Stecher Method (Scaphoid)?
20 degrees up hand centered over the scaphoid
Where do you center on the thumb? At 1st MCP joint
What position is used for an oblique of the thumb?
PA hand
What needs to be demonstrated on an exam of the thumb?
Entire thumb including the 1st MCP
Where do you center for the 2nd-5th digits? PIP joint
The radial head is proximal/near the elbow on the lateral or thumb side.
True
The ulnar head is distal/near the wrist on True
1
the medial side.
When does the radius cross over the ulna? during pronation
When do the radius and ulna show no superimposition?
external rotation (oblique with lateral rotation)
What does a true lateral show? The proximal head and neck of the radius, the radial tuberosity, and the trochlear notch.
Does the forearm need to show both joints? YES
What exam shows the coronoid process free of superimposition?
AP oblique (medial rotation)
Acute flexion is also called? Jones method
Technical factors for the Shoulder? (kV/mAs)
Medium kV (70-80) High mA/low exposure time
The lesser tuberosity of the humerus is seen in profile with the arm in ________ .
Internal rotation
Which part of the scapula does the humerus articulate with?
glenoid fossa
To demonstrate the shoulder and upper humerus in anatomical position, the arm should be rotated __________
Externally
The AP internal rotation of the shoulder places the humerus _______ in the position
Lateral
What is the centering point for AP shoulder WITH external rotation?
1" inferior of the coracoid process
Which shoulder position shows the lesser tubercle in profile?
AP with internal rotation
Another name for inferosuperior, axial projection of the shoulder is?
Lawrence method
In the inferiosuperior, axial projection of the shoulder, the ______ tubercle is in profile
Lesser
The AP shoulder with neutral rotation is done for?
Trauma
When doing the humerus how many, and which joints are demonstrated?
2, Scapulohumeral and elbow joint (includes humeralulna, humeralradial, and proximal radioulnar joints.)
When doing a dislocated shoulder exam, AP shoulder with neutral rotation and the Y view
1
what positions would be performed?
What is the centering point for a transthoracic lateral of the humerus?
surgical neck
What is the Grashey method and how much is the patient rotated?
AP oblique of the shoulder, 35degrees toward the affected side
What is the position of the scapula when doing a Y view?
Lateral
The Grashey method is used to demonstrate?
profile of the glenoid cavity
For the oblique of the Hand, what do you use to measure your rotation and what is the degree?
The styloid processes should be at a 45degree angle
Why are the fingers parallel to the IR and not bent in a hand exam?
to show joint spaces
What should you do with the fingers in a wrist projection?
curl them, to move the carpals closer to the IR
What is the name of the furthest lateral carpal on the proximal row?
Schapoid
Name the carpals in order, proximal row first.
Schaphoid, Lunate, Triquetrium, Pisiform, Trapezium, Trapazoid, Capitate, Hamate
Ok Hotshot, what are the OLD names the carpals in order ?
Navicular, Semilunar, Triangular, Pisiform, Greater Multiangular, Lesser Multiangular, Os magnum, Unciform
WOW, you are good! Yeah, I know you know.
In the anatomical position, what is it called when the hand is moved medially, but the arm is kept straight?
Ulnar deviation
R______ A_______ is a common pathology that hand and wrist exams are ordered for.
Rhumatoid Artharitis
How many bones are in the hand? 27
How many bones in the Phalanges? 14
How many carpals? 8
What kind of joint is the 1st MCP? Sellar (saddle)
What kind of joint is the DIP? Ginglymus (hinge)
What kind of joint are the intercarpals? Plane (Gliding)
1
What kind of joint is the Wrist (carpal to ulna and radius)?
Ellipsoid (condyloid)
What ind of joint is the proximal and distal radioulnar joints?
Trochoid (pivot)
What kinda of joint is the elbow? Ginglymus (hinge)
kV AP hand? 50-60
kV Lateral hand? 55
kV Oblique hand 55-65
kV wrist and trauma wrist? 55-65 and 50-70
Define Subluxion partial dislocation
Define Sprain rupture or tearing of ligaments
Define Contusion bruise without fracture
Define Greenstick incomplete fracture
fx means? fracture
Baseball mallet fx is? fx of distal phalynx
Boxer's fx is? broken knuckle
Name the fat pads of the elbow anterior fat pad, posterior fat pad, supinator fat stripe.
To obtain a lateral forearm: Thumb side must be up & forearm & humerus must be in the same plane
To clearly see the olecranon process in profile, which position should be used?
AP Oblique w/medial rotation
For some soft tissue injuries the lateral elbow is only flexed:
30-35 degrees
The proximal radioulnar joint is considered a:
pivot joint and is diarthrodial
For a lateral view of the elbow to be accurate, what should be superimposed?
epicondyles of the humerus
For a trauma elbow, how many AP projections should be taken
2
Which projection of the elbow AP projection;acute flexion
1
superimposes the forearm and the humerus?
Are both joints usually visualized when taking a forearm on an 11 x 14?
YES
Which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid & trapezium bones?
radial collateral ligament
The two important fat stripes around the wrist joint are:
scaphoid fat stripe & pronator fat stripe
Pathology revealed in a AP forearm? Fractures, dislocations,and pathologic processes such as osteomyelitis or arthritis.
Describe Positioning for an AP forearm Entire limb in the same planeShoulder at table levelAlign and centre forearm to long axis of IRSupinate hand (2nd to 5th metacarpal heads against IR)Elbow fully extendedCheck the humeral epicondyles are equidistant from the IR
A forearm film is hung from which end? from the fingers...or wrist end.
A shoulder is hung from which end? from the shoulder.
You are _______ Amazing!
Rotation of the forearm is shown by ? separation of ulna and radius(lat. rot.) or MORE THAN SLIGHT superimposition (med. rot.) or pronation- if radius is rotated across ulna (hand not supinated)
Name wrist fat pads? scaphoid fat stripe and pronator fat stripe
Name Elbow fat pads? Anterior fat pad, posterior fat pad, supinator fat stripe.
Define Bursitis Inflammation of the bursae (fluid filled sacs that enclose joints)
Define Osteroarthritis degenerative joint disease
Define Osteoporosis reduction in quantity of bone or atrophy of skeletal tissue
Define Rheumatoid Arthritis systemic chronic inflammation of connective tissue.
Detect rotation on AP thumb or fingers by? should be symmetric concave sides of phalanges and equal soft tissue.
Detect rotation of AP hand. should be symmetric concavity of sides of metacarpals and phalanges 2 thru 5.
Detect rotation of Oblique hand true 45degree oblique will have some overlap of 3rd, 4th, and 5th metacarpal head only.
1
Detect rotation for lateral hand radius and ulna should be superimposed. metacarpals should also be superimposed.
Detect rotation AP wrist should be equal concavity of proximal metacarpals and near equal distance between proximal carpals.
Detect rotation of Lateral wrist true lateral ulnar head will be superimposed over distal radius 2-5 metacarpals aligned and superimposed.
Detect rotation for AP Forearm should be humeral epicondyles in profile. radial head, neck, and tuberosity slightly superimposed by ulna.
Detect rotation for Lateral Forearm head of ulna and radius SHOULD be superimposed and humeral epicondyles should be superimposed.
the wrist joint is also called the radiocarpal joint
ellipsoidal joints move in how many directions
4
cast conversions fiberglass-^25-30%ma or kV^3-4, sm to dry- ^mas 50-60% or kV^5-7, heavy or wet- ^mas 100% or kV ^8-10
CR for carpal canal-tangential inferiorsuperior projection for carpal tunnel syndrome
25-30deg 1 inch distal to base of third metacarpal
How many phalanges are there? 14
The largest carpal bone is what? Capitate
Which carpal bone has a "HOOK LIKE" process? Hamate
Which carpal bone is MOON SHAPED Lunate
How many carpal bones are in the wrist? 8
The ULNA is located on what dies of the forearm Medical (Pinky Side)
The Proximal end of the radius contains what? Radial Head, Neck and tuberosity
The Olecranon Fossa is located on? Posterior/Anterior Humerous
The greater and lesser tubercles are located on the what? Proximal End of the humerous
The shoulder girdle consist of what? Scapula and Clavicle
Which of the following is NOT one of the scapula borders?
Superior - Medial - Lateral
The shoulder joint is formed by the articulation of the head of the humerous and _____ of the scapula?
Glenoid Cavity
1
The medial end of the clavical is called the what? Sternal End
THERE WILL BE MATCHING - KNOW LONG-SHORT-FLAT BONES (there will be no irregular bones)
Know the LONG - SHORT - FLAT BONES
The Phalanges Bones are what? Long Bones
The Carpal Bones are what? Short Bones
The Radial and Ulna Bones are what? Long Bones
The Metecarpals bones are what? Long Bones
The Scapula are what? Flat Bones
The Clavical Bones are what? Long Bones
The Phalanges (fingers) are called what kind of joint? Interphalangeal Joint
All of the Interphalangeal joints allow for what movement?
Hinge Movement
The Metacarpal Phalangeal Joints allow for what movement?
Circumduction Movement
The radiocarpal joint allows for what movement? Circumduction Movement
Flexion and Extenion of the Elbow Joint allows for what movement?
Hinge Movement
The Proximal RadialUlnar joint allows for what movement?
Rotational Movement
The Shoulder joint allows for what type of movement? Circumduction Movement
The AC (acromioclavicular) joint and the SC (sternoclavicular) joint allows for what movement?
Gliding Movement
What part of the hand has only 1 Interphalangeal (IP) The THUMP (IP)
What digits Numbers have both PROXIMAL (PIP) and Distal (DIP)
Digits 2 thru
In the LATERAL PROJECTION of the thumb the CR is directed to what ?
MCP1
For a PA Projection of the hand should be in what position?
LATERAL POSITION
Where is the CR (Central Ray) directed for a PA of the 5th Digit
PIP Joint
For the lateral of the 2nd digit what projection should you Medial Lateral
1
obtain?
(T/F) A medial lateral projection is the correct xray for the 4th digit?
FALSE (Lateral is correct)
The correct degree of a PA Oblique of the 3rd digit is? 45*
For a LATERAL HAND the fingers should be what? (Karate Chop position) Fingers should be extended and superimposed-with thumb extended
(T/F) For a PA Projection of the hand it is PARRELL to the IR?
TRUE
Where is the CR drected for a LATERAL Hand? 2nd MCP Joint
The hand should be rotated ____ to obtain an OBLIQUE Position
EXTERNALLY
For a LATERAL Wrist the CR should be directed to the Middle of what?
Mid carpals
For a PA Projection of the wrist the hand is? Pronated and forms a slight fist. Parallel to the cassette
For a PA Projection of the SCAFOID?
The CR is directed how many degrees toward the elbow? 20*
(T-F) The CR should be angled 25* to 30* toward the palm for a tangential view of the wrists?
TRUE
To include the wrist and elbow joint for an adult the IR should be placed how?
Diagnally
For a LATERAL FOREARM the elbow should be flexed how many degrees?
90*
For a LATERAL FOREARM what projection should you obtain?
Lateral Medial
What position or projection of the elbow demonstrates the radial head/neck of superimpostion
AP External Oblique
What AP Projection of the elbow epicondyle should be_______ to the IR
Parallel
T/F = For the LATERAL Elbow the CR should be directed to the Medial Epicondyle?
FALSE (should be LATERAL)
For an AP Humerous Projection a 14" x 17" should be placed ____________ with the top of the IR __________ above the shoulders
1) Longitudinally 2) 1.5" to 2"
1
For a lateral humerous the hand should be placed on the what?
HIP
Which position of projection demostrates the greater tubercle in profile laterally
AP with External Rotation
What position or projection is used to demonstrate "OPEN" joint space with Glenoid Humerous Joints?
AB Oblique (GRASHEY) Glenohumeral View
Where should the CR be directed for AP Shoulder with External Rotation?
CR 1" Medial and inferior to corticoid process/IR
T/F = A Transthoracic Lateral Shoulder Exam requires a breathing technique
TRUE
For an AP or PA Oblique Scapular of the Shoulder the body is rotated how many degrees?
45*-60*
When X-Raying the Clavical and the AP Projection you can free from superimposition of the shoulder by angling the CR?
15-30 Cephalad to Mid Clavical
Where should the CR be directed for an AP Clavical? Mid Clavical
T/F= For an AP Scapula the humerous should be abducted 90* away from the body with the hand supinated. (Sworn for Trial)
TRUE
For and AP Projection of the lateral scapula the arm should be placed in what position?
Across the chest or behind the back
For AP Projection of an AC Joints should be done with a patient?
Standing or Erect
Is an AP Projection of an AC Joint done WITH or WITHOUT weights to demonstrate ligament damamge?
DONE WITH WEIGHTS
What degenrative joint disease is commonly seen on images of the hand and wrist?
Arthritis
T/F= A COLLES Frature of the wrist occurs when a person falls and extends their hand to break their fall
True
The MOST COMMON Elbow fracture occurs where? At the RADIAL HEAD/NECK
Page 9/10 ID Picture of DISLOCATED SHOULDER DISLOCATED SHOULDER
Which Carpal Bone most frequently fractured? Navicular or Scapula
What joint has the greatest range of movement in the body?
SHOULDER
What is another name for the AP Oblique? Grashey
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What type of fracture usually visualizes as a fracture of the 4th or 5th Metacarpal
BOXERS (Common fracture seen in the hand)
Where is the CR directed on all finger radiographs?
PIP
Which projection (not routine) will show the joint interfaces better?
AP
What is the main difference in CR placement between the thumb vs the finger?
MCPJ
Why is there a difference in cr placement between finger and thumb?
No middle phalanx
WHAT ADVANTAGES OR DISADVANTAGES TO DOING A PA OR AP PROJECTION OF THE THUMB?
PA HAS MORE OID BUT IS MORE COMFORTABLE TO PT. AP HAS LESS OID BUT IS HARDER FOR PT TO ACHIEVE
where is the cr directed for a pa projection of a hand>
3rd mcp
where is the cr directed for an oblique projection of the hand?
3rd mcp
where is the cr projection for a lateral projection of the hand?
2nd mcp
how many degrees is the hand oblique? 45
what projection does the lateral position of the hand have?
lateral to medial
what are the variations of positioning a lateral hand? Why are they done?
fan lateral, and lateral-medial finger involvement, fx location mc
how is the pt positioned? seated @ the end of the table
What SID do you use on hand? 40 in sid
what is a bone age film done for adn how do you do it?
bone ossification, lt PA hand
what projection will demonstrate rheudoid arthritis? How do you do it?
Norgaard/Ballcatchers Midpoint between both hands, Cr 2 3rd MCP
Name all the bones in the wrist scaphoid, lunate, triquetrium, pisiform, trapezium, trapazoid,
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capitate, hamate
How do you tell the difference between a PA projection adn a PA oblique of a wrist?
PA oblique- 3-5th MC heads overlap Well diminstrated trapezoid and distal scaphoid
On a lateral wirst, how is the hand, thumb, forearm and elbow positioned?
Perpendicular to IR, elbow @ 90 degrees
If the radiologist wanted to see the pisiform in prodile, what projection would show that?
AP oblique
Where does the CR go for all wrist radiographs?
midcarpal
to decrease the distance between the carpal bones and the film on the PA projection, what can be done?
Arch hand @ MCPJ
Why does the navicular/scaphoid bone have a separate routine?
Common fx site
What is the routine discussed in class for scaphoid?
Ulnar diviation and stetcher (axial)
What will happen to the scaphoid by diviating the wrist 45 degrees toward the ulna?
Corrects foreshortening, elongates the scaphoid
Where is the Cr directed on the PA projection of the scaphoid?
perpendicular to scaphoid
What does the term axial mean? How does it relate to the scaphoid routine?
more than 10 degree angle
Why would we angle the CR on the PA axial projection? How much and which direction?
Clear deliniation of scaphoid, 20 degree caudad (toward elbow)
What do you do with your SID when you angle the CR? Why?
decrease your distance 1 in for every 5 degree, keep oid
radiolgraphically, describe how to tell the difference betweem the PA projection with 45 degree ulnar diviation and the PA axial?
Axial- scaphoid projected without self superimposition
What does the term tangential mean? How does it relate to the Carpal Tunnel routine?
Skimming, you want to just skim the carpals
Describe how to do the inferosuperior Hyperextend, CR at the radiostyloid process
1
projection of the carpals tunnel?
Where it the Cr directed on a carpal tunnel view? which way it angled, how much?
radiolstyloid, 25-30 degrees, reduce tube 5-6 inches
Describe how to do the superoinferior projection on a carpal tunnel view?
dorsoflex and lean forward
What is the only bone to be see free from superimposition on carpal tunnel views?
pisiform
What is the routine for forearm Ap and Lateral
Where is the Cr directed for a forearm? midpoint to elbow
radiologically, what anatomy must be included on both forearm projections?
ulna and radium, both elbow and wrist joint
How is the hand positioned for an AP projection of the wrist? What happens if the hand is not positioned correctly?
Supinate, radius nad ulna will cross
How is the lateral wrist positioning done? elbow @ 90 degrees, thumb up, epicondyles perp to IR
When an imaginary line is drawn between the humeral epicondyles and it is parallel to the film, what projection of the elbow will you have?
AP
What is the line that is perp to the film, and what projection will you have in an elbow?
Lat
where does the cr go on an ap projection of the elbow>
Midpoint of the elbow
How many degrees do you rotate for a lat/med oblique of the elbow?
45
How is acute flexion of the elbow done? Elbow fleced, humerus on IR
Why is the angled lateral (axiolateral) projection of the elbow done? How is it done? How is the CR angled? Which direction?
Trama view, 45 degree angle toward/away from
how many exposures must be done to see the entire circumference of the radial head?
4, PA, Ap, oblique (lat and med)
what are the Fat pads of the arm? Supinator, anterior and posterior
1
What is the humerus routine? Ap and Lateral
what breathing instructions do you give the patient? Why?
Shallow or suspended breathing, blurr motion lines, or decrease motion
To get and AP projection, what must you do with the humeral epicondyles? Lateral?
Ap: parallel to IR, Lat:Perp to IR
Where is the CR directed on a humerus? midhumerus
What anatomic structure will be seen clearly on the humeral head on the AP projection? Lateral?
Ap: greater trochanter, Lat: lesser trochanter
When would you need to perform a tranthoracic lateral projection of the humerus?
trauma
How it a transthoracic donr? film size? Affected arm? Unaffected arm? Cr? Breathing instructions?
Affected arm against IR, Cr through surgical neck, midcoronal plane. Unaffected are up out of the way. Affected arm against the buckie. 14x17 IR
Lateral Forearm evaluation wrist and distal humerus, superimposed radius and ulna, elbow flexed 90 degrees
Pa wrist evaluation: carpals, distal rad and ulna, prox. mc. no rotation, Radial and ulnar joint spaces open. No excessive flexion to obscure mc or digits.
Pa hand eval: no rotation of hand. = concavity of mc and phalanges. = amount of soft tissue. =distance between mc heads. open mcp and ipj. Slight separation w/ soft tissue overlap. All anatomy distal to radius and ulna
Lat Wrist eval lat projection of mc, c,distal radius and ulna. Ant/post. displacement of fractures. superimposed distal radius, ulna and mc
Oblique Hand eval min. overlap of 3rd-4th, 4th-5th mc shafts. Slight overlap of mc heads and bases. Separation of 2nd and 3rd mc. Open mcp and ipj. Digits separated w/ no overlap of soft tissue. All anatomy distal to ulna and radius. Soft tissue and bony trabiculae
Lat hand eval true lat. Superimposition of phalanges, mc and distal rad and ulna and extended digits. Thumb of superimposition. Each bone outlined through superimposed shadows of other mc
Norgaard eval both hands from carpal area to tip of digits. Mc free of superimposition. Useful level of density over heads of mc
AP elbow eval Rad head, neck and tuberosity slightly superimposed over prox
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ulna. Elbow joint centered
Ap oblique (med) elbow coronoid in profile, trochlea . Elongated med humeral epicondyle. Ulna superimposed by rad head and neck. Olecranon process in fossa. Soft tissue and bony trabiculae
Ap oblique (lat) elbow rad head, neck, tuberosity projected free of ulna, capitulum. Open elbow joint. Soft tissue and bony trabiculae
PA digits eval no rotation, concavity of phalangeal shafts. = amount of soft tissue, open ip and mcpj
Lat elbow eval open elbow joint. Elbow flexed 90 degrees. Superimposed humeral epicondyle. Radial tuberosity facing anterior, radial head partially superimposing coronoid porcedd. Olecranon in profile. Bony trabiculae adn soft tissue
Ulnar Deviation Eval no rotation, extreme ulnar deviation, scaphoid w adjacent articulations
Ap Forearm eval wrist distal to radius slightly superimposition of rad head, neck adn tuberosity. Partially open elbow. No elongation or foreshortening. = distance between wrist and elbow
PA oblique aval Carpals on lat wrist, trapezium and distal scaphoid shown. Distal rad, ulna, carpals and Mc open trapizotrapzoid and scaphotrapezial joint. Slightly overlap of distal rad. Space between 3rd-4th and 4th-5th mc shafts
AP Thumb eval no rotation, =concavity of phalangea and MC shafts. Open IP adn MCPJ spaces
PA thumb eval No rotation, =concavity of phalanges adn mc shafts. Open IP adn MCPJ spaces
Oblique thumb eval Proper rotation of phalanges, soft tissue and 1st MC. Area from distal tip to trapezium. open Ip adn MCPJ, soft tissue and bony trabiculae
Ap Humerus eval Elbow and shoulder joint. Max. visability of epicondyle w/o rotation. Humeral head and greater tunercle inprofile. outline of lesser tubercle between humeral head and greater tubecle. No great variation in density of prox and distal humerus
Lat Humerus eval Elbow and shoulder joint superimposed epicondyles. lesser tubercle in profile. Greater tubercle superimposed over humeral head. No variation of density between prox and distal humerus
Lat digits eval entire digit true lat. concave ant. surface of phalanges. No rotation. open ipj, no obstruction of porx phalanx or mcpj
Lat thumb 1st digit in true lat position. Concave ant surface of prox phalanx.
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No rotation. open ip and mcpj. Soft tissue and bony trabiculae
Clavicle/Scapula
QUESTIONS ANSWERSWhat type of bone is the clavicle? long bone
Where does the clavicle lie in the body? just above the first rib
What is the function of the clavicle? serves as a fulcrum for arm movements
What type of bone is the scapula? a flat bone
Where does the scapula lie in the body? superoposterior thorax between the 2nd and 7th ribs
Alternate name for the anterior surface of the scapula? costal
Where does the subscapularis muscle attach? subscapular fossa
Where does the anterior serratus muscle attach? the medial border of the anterior surface
Alternate name for the posterior surface of the scapula dorsal
What is the origin of the supraspinatus muscle? supraspinous fossa
What is the alternate name for the medial border of the scapula? vertebral
What is the alternate name for the lateral border of the scapula? axillary
Which tubercle on the humeral head is more anterior? lesser tubercle
The lesser tubercle serves as an insertion point for: the subscapular muscle
Which tubercle of the humeral head is on the lateral aspect? greater tubercle
What are the 2 names for the area between the greater and lesser tubercles of the humeral head?
intertubercular or bicipital groove
How is the greater tubercle of the humeral head situated? It slopes posteriorly 25 degrees
Name the 3 muscle attachments of the greater tubercle of the humeral head
supraspinatus, infraspinatus, teres minor
scapulohumeral joint type ball and socket
acromioclavicular joint type gliding
1
sternoclavicular joint type double gliding
what forms the sternoclavicular joint? cartilage of the first rib, manubrium, medial facet
Wrist and Hand
QUESTIONS ANSWERSWhat are the views in the standard wrist series? 1.PA wrist 2.Medial Oblique Wrist 3.Lateral
Wrist
In the PA wrist what 2 carpal bones overlap? trapezium and trapezoid
***Avascular Necrosis of Lunate (aka Kienbock Disease) is associated with which Ulnar Variance (positive or negative)?
It's associated with Negative Ulnar Variance
T/F there is overlap b/w the trapezium and the trapezoid in a medial oblique view?
false, there is no overlap in medial oblique wrist, just the PA wrist
75% of fractures in the wrist is in which bone? Scaphoid, Trapezius is 2nd
Which carpal is the the most proximal bone? Lunate
In a Lateral Wrist view, which 3 bones should form a straight line?
the 3rd metacarpal, capitate, and lunate
Which carpal bone(s)is the 1st to appear? Capitate and Hamate
In the wrist, what is potentially not visualized or displaced following trauma?
Pronator Quadratus Fat Stripe
List 2 accessory views of the wrist? 1.PA wrist with ulnar deviation 2.Carpal tunnel projection
What are the 3 arcs of Carpal alignment? 1.Along proximal aspect of proximal row 2.along distal aspect of proximal row 3.along proximal aspect of distal row
***The joint spaces b/w the carpal bones should not exceed ____mm?
2mm
The distal radio-ulna joint space should not exceed ____mm?
2mm
What two carpal bones are most commonly fused? Lunate and Triquetrum
1
Normally the ulna should be no more than ____mm shorter than the radius?
1-2mm
***What is it called when there is delayed growth of medial distal radius?
Madelung's Deformity
***T/F "Bayonnette" appearance is a xray finding, whereas Madelung's Deformity is a clinical sign of delayed growth of medial-distal radius?
False bayoneette = clinical sign, Madelung's Deformity is the xray finding
There is a Madelung's Deformity when the carpal angle is greater than _____ degrees?
greater tan 117 degrees
Anatomy & Positioning of the Upper Extremities & Shoulder
QUESTIONS ANSWERSHow many phalanges are there? 14
The largest carpal bone is what? Capitate
Which carpal bone has a "HOOK LIKE" process? Hamate
Which carpal bone is MOON SHAPED Lunate
How many carpal bones are in the wrist? 8
The ULNA is located on what dies of the forearm Medical (Pinky Side)
The Proximal end of the radius contains what? Radial Head, Neck and tuberosity
The Olecranon Fossa is located on? Posterior/Anterior Humerous
The greater and lesser tubercles are located on the what? Proximal End of the humerous
The shoulder girdle consist of what? Scapula and Clavicle
Which of the following is NOT one of the scapula borders? Superior - Medial - Lateral
The shoulder joint is formed by the articulation of the head of the humerous and _____ of the scapula?
Glenoid Cavity
The medial end of the clavicle is called the what? Sternal End
THERE WILL BE MATCHING - KNOW LONG-SHORT-FLAT BONES (there will be no irregular bones)
Know the LONG - SHORT - FLAT BONES
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The Phalanges Bones are what? Long Bones
The Carpal Bones are what? Short Bones
The Radial and Ulna Bones are what? Long Bones
The Metecarpals bones are what? Long Bones
The Scapula are what? Flat Bones
The Clavicle Bones are what? Long Bones
The Phalanges (fingers) are called what kind of joint? Interphalangeal Joint
All of the Interphalangeal joints allow for what movement? Hinge Movement
The Metacarpal Phalangeal Joints allow for what movement? Circumduction Movement
The radiocarpal joint allows for what movement? Circumduction Movement
Flexion and Extension of the Elbow Joint allows for what movement?
Hinge Movement
The Proximal RadialUlnar joint allows for what movement? Rotational Movement
The Shoulder joint allows for what type of movement? Circumduction Movement
The AC (acromioclavicular) joint and the SC (sternoclavicular) joint allows for what movement?
Gliding Movement
What part of the hand has only 1 Interphalangeal (IP) The THUMP (IP)
What digits Numbers have both PROXIMAL (PIP) and Distal (DIP)
Digits 2 thru
In the LATERAL PROJECTION of the thumb the CR is directed to what ?
MCP1
For a PA Projection of the hand should be in what position? LATERAL POSITION
Where is the CR (Central Ray) directed for a PA of the 5th Digit
PIP Joint
For the lateral of the 2nd digit what projection should you obtain?
Medial Lateral
(T/F) A medial lateral projection is the correct x-ray for the 4th digit?
FALSE (Lateral is correct)
The correct degree of a PA Oblique of the 3rd digit is? 45*
For a LATERAL HAND the fingers should be what? (Karate Chop position) Fingers should be extended and superimposed-with thumb
1
extended
(T/F) For a PA Projection of the hand it is PARRELL to the IR?
TRUE
Where is the CR directed for a LATERAL Hand? 2nd MCP Joint
The hand should be rotated ____ to obtain an OBLIQUE Position
EXTERNALLY
For a LATERAL Wrist the CR should be directed to the Middle of what?
Mid carpals
For a PA Projection of the wrist the hand is? Pronated and forms a slight fist. Parallel to the cassette
For a PA Projection of the SCAFOID?
The CR is directed how many degrees toward the elbow? 20*
(T-F) The CR should be angled 25* to 30* toward the palm for a tangential view of the wrists?
TRUE
To include the wrist and elbow joint for an adult the IR should be placed how?
Diagonally
For a LATERAL FOREARM the elbow should be flexed how many degrees?
90*
For a LATERAL FOREARM what projection should you obtain?
Lateral Medial
What position or projection of the elbow demonstrates the radial head/neck of superimpostion
AP External Oblique
What AP Projection of the elbow epicondyle should be_______ to the IR
Parallel
T/F = For the LATERAL Elbow the CR should be directed to the Medial Epicondyle?
FALSE (should be LATERAL)
For an AP Humerus Projection a 14" x 17" should be placed ____________ with the top of the IR __________ above the shoulders
1) Longitudinally 2) 1.5" to 2"
For a lateral humerus the hand should be placed on the what?
HIP
Which position of projection demonstrates the greater tubercle in profile laterally
AP with External Rotation
1
What position or projection is used to demonstrate "OPEN" joint space with Glenoid Humerous Joints?
AB Oblique (GRASHEY) Glenohumeral View
Where should the CR be directed for AP Shoulder with External Rotation?
CR 1" Medial and inferior to corticoid process/IR
T/F = A Transthoracic Lateral Shoulder Exam requires a breathing technique
TRUE
For an AP or PA Oblique Scapular of the Shoulder the body is rotated how many degrees?
45*-60*
When X-Raying the Clavicle and the AP Projection you can free from superimposition of the shoulder by angling the CR?
15-30 Cephalad to Mid Clavicle
Where should the CR be directed for an AP Clavicle? Mid Clavicle
T/F= For an AP Scapula the humerus should be abducted 90* away from the body with the hand supinated. (Sworn for Trial)
TRUE
For and AP Projection of the lateral scapula the arm should be placed in what position?
Across the chest or behind the back
For AP Projection of an AC Joints should be done with a patient?
Standing or Erect
Is an AP Projection of an AC Joint done WITH or WITHOUT weights to demonstrate ligament damage?
DONE WITH WEIGHTS
What degenerative joint disease is commonly seen on images of the hand and wrist?
Arthritis
T/F= A COLLES Fracture of the wrist occurs when a person falls and extends their hand to break their fall
True
The MOST COMMON Elbow fracture occurs where? At the RADIAL HEAD/NECK
Page 9/10 ID Picture of DISLOCATED SHOULDER DISLOCATED SHOULDER
Which Carpal Bone most frequently fractured? Navicular or Scapula
What joint has the greatest range of movement in the body? SHOULDER
What is another name for the AP Oblique? Grashey
What type of fracture usually visualizes as a fracture of the 4th or 5th Metacarpal
BOXERS (Common fracture seen in the hand)
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Humerus and Shoulder Girdle
QUESTIONS ANSWERSScapulohumeral Spheroidal or ball and socket(greater
freedom of movement)
Sternoclavicular Plane or Gliding
Acromioclavicular Plane or Gliding
Which of the following Humeral Structures is most distal? Lesser Tubercle
What is another term for the mid area of the costal surface of the scapula?
Subscapular Fossa
Which of the following scapular structures is most posterior? Acromion
What is the classification for the scapulohumeral joint? Spheroidal
An injury of the anterioinferior aspect of the glenoid labrum is termed?
Bankart Lesion
Which of the following AP proximal shoulder projections will demo the lesser tubercle in profile?
Internal rotation
Which of the following projections will best demo a possible Hills-Sachs defect?
N/A
How much is the body rotation for a posterior oblique position?-Grashey Method
35-45 degrees
What anatomy of the shoulder is best demo'd with a Tangential Projection?-Fisk Modification
Glenoid Cavity
How much should the CR be angled for an AP axial projection of the clavicle on an asthenic PT?
N/A
The use of AEC is not recommended for the AP projection of the Scapula. T or F?
N/A
The shoulder girdle consists of ____, ____, and _____. Proximal Humerus, Scapula, and Clavicle.
The 3 aspects of the Clavicle are the? Sternal Extremity, Body(shaft), and Acromial Extremity.
Do females or males have thicker or more curvy in shape Clavicles? Male
The 3 angles of the Scapula include? Lateral Angle, Superior Angle, and Inferior Angle
Anterior Side of the Scapula is referred to as? Costal Surface
1
Anatomic Name for Armpit? Axilla
2 Fossae located on the posterior Scapula? Infraspinous Fossa and Supraspinous Fossa
All joints of the shoulder girdle are classified as being? Synovial (Diarthrodial)
Scapulohumeral-joint classification Spheroidal
Sternoclavicular-joint classification Plane
Acromioclavicular-joint classification Plane
Greater Tubercle Proximal Humerus
Coracoid Process Scapula
Crest of Spine Scapula
Coronoid Process Not part of the shoulder girdle
Acromial Extremity Clavicle
Intertubercular Groove Proximal Humerus
Condylar Process Not part of shoulder girdle
Surgical Neck Proximal Humerus
At what angle should the affected arm be abducted from the body for the Inferosuperior Axial Projection?
90 degrees
Proximal Humerus Rotation if the Greater Tubercle is profiled laterally
External Rotation
Proximal Humerus Rotation if the Humeral Epicondlyes angled 45 degrees the the IR
Neutral Rotation
Proximal Humerus Rotation if the Epicondyles are perpendicular to the IR
Internal Rotation
Proximal Humerus Rotation if there is supination of the hand External Rotation
Proximal Humerus Rotation if the palm of hand is against thigh Neutral Rotation
Proximal Humerus Rotation if Epicondyles are parallel to the IR External Rotation
Proximal Humerus Rotation if Lesser Tubercle is profiled medially Internal Rotation
Proximal Humerus Rotation if Proximal Humerus is in a lateral Position
Internal Rotation
Proximal Humerus in position for an AP projection External Rotation
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T or F: The use of a grid is not required for shoulders that measure less than 10 cm
TRUE
T or F: Low mA with short exposure times should be used for adult shoulder studies?
FALSE
T or F: Large focal spot setting should be selected for most adult shoulder studies?
FALSE
T or F: A high speed screen IR is recommended for shoulder studies when using a grid?
TRUE
T or F: The gonadal dose for most shoulder projections is .1 mrad or less.
TRUE
T or F: The use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections?
TRUE
kV range to be used for a shoulder series on the average adult? 70 to 80 kV
If physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?
Parent or Guardian
T or F: CT arthography of the shoulder joint requires the use of iodinated contrast media injected into the joint?
TRUE
T or F: Nuclear Medicine bone scans can demo signs of osteomyelitis and cellulitis?
TRUE
T or F: Ultrasound can provide a functional (dynamic) evaluation of joint movement that MRI cannot.
TRUE
Compression between the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch?
Impingement Syndrome
Injury of the anterioinferior glenoid labrum? Bankart Lesion
Inflammatory condition of the tendon? Tendonitis
Superior Displacement of the Distal Clavicle? Acromioclavicular Joint Dislocation
Compression fracture of the articular surface of the humeral head? Hills-Sachs Defect
Traumatic injury to one or more of the supportive muscles of the shoulder girdle?
Rotator Cuff Tear
Atrophy of Skeletal Tissue? Osteoporosis
Subacromial Spurs Impingement Syndrome
Fluid Filled Joint Space Bursitis
Thin bony cortex Osteoporosis
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Abnormal widening of acromioclavicular joint space Acromioclavicular joint seperation
What structure is not part of the proximal humerus? A. Lesser tubercle B. Glenoid process C. Intertubercular groove D. Anatomical neck Answer is B. Glenoid process
Which term describes the medial end of the clavicle? Sternal extremity
True or False. The female clavicle is usually shorter and less curved than the male.
True
The anterior surface of the scapula is referred to as: Costal surface
What is the name of the large fossa found within the anterior surface of the scapula?
Subscapular fossa
True or False. All of the joints of the shoulder girdle are diartrodial.
True
Which one of the following joints is considered to have spheroidal type of movement?
A. Acromioclavicular joints B. Sternoclavicular joints C. bicipital joints D. Scapulohumeral joints Answer is D. Scapulohumeral joint
Which rotation of the humerus will result in a lateral position of the proximal humerus?
Internal rotation (epicondyle perpendicular to the film).
Which AP projection of the shoulder and proximal humerus is created by placing the affected palm of the hand against the thigh?
Neutral rotation
True or False. The erect tangential projection for the intertubecular groove results in about twice the skin dose compared to the same projection taken with the patient supine because of the shorter SOD with the erect position.
True
Which one of the following shoulder positions is considered a trauma projection? (Can be performed safely for a possible fracture or dislocation)
Apical oblique
How much medial CR angle is required for the inferosuperior axiolateral pojection?
25 to 30 degrees
What additional maneuver must be aded to the inferosuperior axiolateral projection to best demonstrate a possible Hill-Sachs
Increase external rotation of the affected
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defect? arm
Which one of the following shoulder projections best demonstrates the scapulohumeral joint space?
AP oblique
True or False. The inferosuperior projection of the shoulder demonstrates the acromion process of the shoulder to be located most superiorly (anteriorly).
False
True or False. For a Grashey projection of the shoulder, the CR is centered to the scapulohumeral joint.
True
How much CR angulation is required for the supine version of the tangential projection for the intertubecular (bicipital) groove?
10 to 15 degrees.
Which ionization chamber for the AEC should be used for a tangential projection for biciptial groove?
A. Center chamber B. both outside chambers C. Left chamber D. None of the above Answer is none of the above
What projection should be performed using a breathing technique?
AP scapula
How much CR angulation should be used for a scapular Y projection?
No CR angle should be used
Where is the CR centered for a transthoracic lateral projection? level of the surgical neck
True or False. The proper name method for the AP oblique projection is the Lawrence method.
False. It is the grashey method
An AP apical oblique projection for an anteriorly dislocated scapulohumeral joint will project the humerus _____ to glenoid cavity.
Inferiorly
Which projection of the shoulder requires that the patient be rotated approximately 60 degrees toward the cassette for a PA position?
Lateral scapula
How much CR angulation is recommended for an asthenic patient for an AP axial projection of the clavicle?
30 degrees
Where is the CR centered for an AC joint projection on a single 14 x 17 cassette?
1 inch above jugular notch
A radiograph of an AP oblique projection reveals that the anterior and posterior rims of the glenoid process are not superimposed. What modifications should produce a more acceptable image?
Increase obliquity of the body
A transthoracic lateral projection reveals difficulty visualizing the proximal humerus due to the ribs and lung markings.
Use a breathing technique
1
Exposure used 75 kVp, 30 mAs, 40 in SID, grid, suspended respiration. What change will improve the quality of the image?
An AP projection of the proximal humerus reveals that the greater tubercle is profiled laterally. What change will improve this image for a repeat exposure?
Positioning is acceptable; don't repeat it.
An AP clavicle reveals that the sternal extremity is partially collimated off. What should the technician do?
Repeat the AP projection and collimate correctly
An anterior oblique scapular Y position reveals that the scapula is slightly oblique. The axillary border of the scapula is determined to be more lateral as compared with the vertebral border. What modification should be made for the repeat exposure?
Increase obliquity of thorax
A radiologist orders AP rotation projections for patient with arthritic condition of right shoulder, as well as an inferosuperior axiolateral projection. The patient cannot abduct arm. What other projecions will demonstrate scapulohumeral joint space?
AP oblique
A patient comes to ER with possible right AC joint separation. A right clavicle and AC joint exam is ordered. The clavicle is taken first and a small linear fracture of the midshaft of the clavicle is discovered. What should the tech do in this situation?
Consult with the ER physician before continuing with the AC joint study.
A patient in ER with severe shoulder pain & history of chronic dislocation of the shoulder. Radiologist wants tech to take an AP shoulder, neutral rotation & a 2nd projection to demonstrate signs of Hill-sachs defect. What other projection will show this?
Neer Method
A patient enters ER with multiple injuries. The physician is concerned about a dislocation of the left proximal humerus. The patient is unable to stand. What routine is advisable to best demonstrate this condition?
Limited AP and recumbent AP scapular Y projection
A patient enters ER with a possible AC joint separation. The patient is paraplegic, therefore the study can't be done erect. Which one of the following routines would be performed to diagnose this condition?
Non-weight and weight bearing type projections performed recumbent by pulling down on shoulders.
A patient in ER has possible bony defect/fracture of mid-wing area of the scapula. The patient is able to stand. In addition to the routine AP scapula projection, which one of the following factors should be applied to best demonstrate the involved area?
Have patient reach across the chest and grasp opposite shoulder for a lateral scapula.
True or False. The recommended SID for AC joints is 72 in True
True or False. The Hill-Sachs defect is a fracture of the articular surface of the glenoid cavity.
False, humeral head
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True or False. The arm should be abducted about 45 degree for an AP scapula.
False, 90 degree
True of False. The thyroid dose for a transthoracic lateral and inferosuperior axiolateral shoulder projection are both relatively low, under 10 mrad.
False, 86 mrad thoracic, 0 mrad infero
True or False. The thyroid dose on an AP projection of the AC joints is relatively low (less than 10 mrad) if correct collimation is used.
False
True or False. A posterior dislocation of the shoulder occurs about as frequently as an anterior dislocation.
False
True or False. AP with 0 degree CR angle and AP axial with 15 to 30 degree CR cephalic angle are both common basic or routine projections for the clavicles in a majority of US hospitals.
True
AP Projection-Exteranal Rotation: Shoulder (nontrauma) is also called?
AP proximal humerus
AP Projection-Internal Rotation: Shoulder (nontrauma) is also called?
Lateral Proximal Humerus
Inferosuperior Axial Projection: Shoulder (nontrauma) is also called?
Lawrence Method
Superoinferior PA Transaxillary Projection: Shoulder (nontrauma) is also called?
Hobbs Modification
Inferosuperior Axial Projection: Shoulder (nontrauma) is also called?
Clements Modification
Posterior Oblique Position-Glenoid Cavity: Shoulder (nontrauma) is also called?
Grashey Method
Tangential Projection-Intertubecular (Bicipital) Groove: Shoulder (nontrauma) is also called?
Fisk Modification
Transthoracic Lateral Projection: Proximal Humerus (Trauma) is also called?
Lawrence Method
Tangential Projection-Supraspinatus Outlet: Shoulder (Trauma) is also called?
Neer Method
AP Apical Oblique Axial Projection: Shoulder (Trauma) is also called?
Garth Method
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Bony Thorax, Sternum, Ribs, SC joints
QUESTIONS ANSWERSThe bony thorax is formed by what parts of the thoracic cavity?
Sternum, 12 Ribs, and 12 thoracic vertebrae
What are the spaces in between each rib called? Intercostal space
Which joint of the rib articulates with the vertebra? Costovertebral Joint
What part of the rib articulates with the Transverse Process of the Thoracic vertebrae?
Tubercle
How are the anterior ends of the ribs situated in comparison to the posterior ends?
3 to 5 inches lower
Which body habitus will the diaphragm be at the highest level in the body?
Hyperstenic
Which projections are essential to demonstrate the sternum?
Oblique, lateral
How much should the body be rotated for a PA Oblique projection of the sternum?
15 to 20 degrees
What breathing instructions are preferred for an oblique sternum?
Breathing technique
On trauma patients, which position is preferred for imaging the oblique sternum?
AP LPO
What is the preferred SID for an oblique projection of the sternum?
30 inches
Which projection of the sternum utilizes the heart shadow?
PA RAO
How much above the jugular notch should the IR be positioned for the oblique and lateral sternum?
1 1/2 inches
The respiratory movement of the diaphragm averages how many inches between deep inspiration and deep expiration?
1 1/2 inches
How many ribs are considered to be true ribs? 7
How many ribs are considered to be false ribs? 5
What are the last two ribs called? floating ribs
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Which body habitus is the diaphragm at the lowest position in the body?
Hypostenic
The 12 costovertebral joints of the ribs are considered what type?
Synovial-Gliding
Which ribs are attached directly to the sternum? 1-7
How is the 8th through the 10th rib attached? By the costal cartilage of the 7th rib
Name the typical parts of a rib. Head,neck,body,and tubercle
What structures are on the head of the ribs for articulation with the vertebrae?
Facet
Which ribs attach directly to the sternum? 1-7
What are the 3 main parts of the sternum? Manubrium, body, xiphoid process
What is the name of the indentation on the manubrium called?
Jugular notch
What is the average length of the sternum as a whole? 6 inches
Which ribs are considered to be false ribs? 8-12
What is the name of the joints that are the only points of articulation in the upper limbs and the trunk?
Sternoclavicular joints(SC)
What is the SID for a lateral sternum? 72 inches
What is the degree of obliquity for PA SC joints? 10-15 degrees
Which SC joint is better visualized on an oblique projection?
The SC joint closest to the IR
Where is the CR directed for SC joints? T3
How should the patients head be positioned for a PA SC joint x-ray?
Rest head on chin, midsagittal plane should be vertical
Where should the CR be directed for an oblique SC joint? At the level of T2-T3(3in distal to the Vertebral Prominens),and 1 to 2 in lateral from MSP
How should the arms be placed for an upright lateral sternum?
Hands locked behind the back
What are the breathing instructions for the lateral sternum?
Suspend respiration upon deep inspiration
In which position does the diaphragm descend to its lowest level?
The upright position
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Which position is best to visualize the upper ribs? Upright, seated or standing
How are the patients hands positioned on upright ribs? Hands against the hips with palms faced outwards
What are the breathing instructions for the upper ribs? Suspend at full inspiration
Where is the CR directed for upper anterior ribs? At the level of T7
How much light should be above the shoulders for upper ribs, if the positioning is correct?
Approximately 1 1/2 in above the shoulders(jugular notch)
What is the SID for any projection of ribs? 40 inches
Where should the CR be directed for an AP projection of the ribs?
T7(3-4 in below jugular notch)
What are the breathing instructions for the lower ribs? Suspend respiration upon expiration
Why should the patient suspend respiration upon expiration for lower ribs?
Elevate the diaphragm to visualize the lower ribs more clearly
How many degrees is the patient rotated for an oblique rib xray?
45 degrees
What PA projection is the same as an AP LPO? PA RAO
Where should the film be positioned for AP or PA lower ribs?
The bottom of the film at the top of the Iliac Crest
Where should the arm of affected side of the ribs be positioned?
Raise the arm enough to get the scapula away from the ribs
What position shows the left ribs cleared of the heart and its shadow?
LAO or RPO
If the affected side of the ribs are away from the film, what position is the patient in?
PA Oblique,RAO or LAO
If the affected side of the ribs are towards the film, what position is the patient in?
AP Oblique, LPO or RPO
Where should the CR be directed for the AP or Oblique projections of the ribs?
Mid way between the spine and the lateral margin of the thorax
In what projection can the axillary portion of the ribs best be seen?
Oblique
What is the main function of the bony thorax? serve as an expandable, bellows like chamber, wherein the interior capacity expands and contracts during
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inspiration and expiration.
What does the bony thorax consist of? Sternum, Thoracic Vertebra, and the 12 pairs of ribs.
Is the Sternum projected Aneriorly or Posteriorly? Anteriorly
Is the Thoracic vertebra projected Anteriorly or Posteriorly?
Posteriorly
Where is the most common site for a bone marrow biopsy?
Sternum
An AP or PA projection of the sternum demonstrates the thoracic spine minimally. True/False
Fales: it projects the sternum minimally.
What are the three segments of the sternum? Manubrium (upper portion), Body (middle portion), and Xiphoid Process (most inferior)
What is the length of the Manubrium? 2in. (5cm)
What is the length of the Body? 4in. (10cm)
The four segments of the Body beings during puberty and is not completed until what age?
25
What is the Xiphoid Process composed of and when does it totally ossify?
cartilage; 40yrs.
What another name for the palpable jugular notch? suprasternal or manubrial notch
The Jugular Notch is at what level? T2-T3
What is the Sternal Angle? where the lower end of the manubrium joins the body of the sternum.
The Sternal Angle is an easily palpated landmark that can be used to locate other structures of the bony thorax. True/False
True
What is the level of the Sternal Angle? T4-T5
What is the level of the Xiphoid Process? T9-T10
Where is the level for the Inferior Rib (costal) angle?
L2-L3
What is the Sternoclavicular Joint? where each clavicle articulates with the manubrium laterally at the clavicular notch on each side.
What is the only bony connection between each shoulder girdle and the bony thorax?
Sternoclavicular Joint.
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What connects directly to the sternum? clavicles and the cartilages of the first seven pairs of ribs
The anterior ribs untire directly with the sternum. True/False
False: they unite to the sternum via a short piece of cartilage called costocartilage
What is Costocartilage? the short piece of cartilage that attaches the ribs to the sternum.
Where does the first costocartilage connect to? manubrium
Where does the second costocartilage connect to? sternum at the level of the sternal angle
Where do the third through the seventh costocartilages connect directly to?
body of the sternum
Which ribs posses costocartilage but are connected at the 7th costocartilage, which then connects to the sternum?
8,9,10
Which ribs are considered false ribs? last five pairs of ribs (8,9,10,11,12)
What’s another name for the posterior end of a rib? vertebral end
What’s another name for the anterior end of a rib? sternal end
What does the Head of the rib articulate with? one or two thoracic vertebral bodies as well as the neck of the rib
What does the Tubercle of the rib articulate with? the transverse process of of a vertebra and allows for attachment of a ligament
What is the Costal Groove? contains blood vessels and nerves
The vertebral end of a typical rib is 3-5in higher than the anterior/sternal end. True/False
True
What does the lower inside margin of each rib protect?
an artery, a vein, and a nerve
Where is the bony thorax its widest (in diameter)? lateral margins of the 8th or 9th ribs
Rib Compositions
QUESTIONS ANSWERSFunction of the bony thorax to protect the heart and lungs, support the walls of the pleural cavity,
support the diaphragm during inspiration and allow for change in
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volume with respiration.
what forms the bony thorax? sternum, 12 pair of ribs, 12 thoracic vertebrae
how long is the sternum? 6”
what type of bone is the sternum? flat bone
purpose of the sternum support the clavicle and superior manubrial angles, and provides attachment for the 1st 7 pair of ribs.
Name the 3 parts that make up the sternum
manubrium, body, xiphoid process
What is special about the xiphoid process?
it doesn’t ossify until late in life
The xiphoid process can serve as a landmark for what internal structures?
the superior border of the liver and inferior border of the heart
The costal cartilage is made up of what?
hyaline cartilage
Alternate names for the sternal body corpus or gladiolus
How long is the body of the sternum? 4”
T10 is a landmark for what soft tissue anatomy?
superior border of the liver and inferior border of the heart.
How does the location of sternal angle change when the patient is supine?
it moves superiorly
What runs through the costal grove? arteries, veins and nerves
Which ribs attach directly to the sternum?
1-7
How do the ribs move with inspiration?
the anterior ribs move anteriorly, superiorly and laterally
How do the ribs move with expiration?
the anterior ribs move posteriorly, inferiorly and medially
How are the ribs situated in the body? they slant anterior and inferiorly 3-5 inches.
True ribs 1-7
False ribs 8-12
Floating ribs 11-12
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Parts of a rib (1-10) head, neck, tubercle, body.
Parts of a rib (11-12) head, tubercle (without facet), body.
What makes up the SC joints? sternal extremity of the clavicle and clavicular notches of the manubrium.
What makes up the costovertebral joints?
head of the rib and demifacets of 2 adjacent vertebrae
What makes up the costotransverse joint?
tubercle of a rib and transverse process of a vertebra
Bony Thorax
QUESTIONS ANSWERSwhat forms the bony thorax -sternum -12 pairs of ribs -12 thoracic vertebrae
is the posterior of the bony thorax longer or shorter than the front
longer
how long is the sternum 6" long
what is the purpose of the sternum -attachment for costal cartilages of first seven pairs of ribs at lateral borders -forms SC joints -supports clavicles at manubrial angles
what are the three parts of the sternum -manubrium(most superior) -body(gladiolus) -xiphoid process(most inferior)(ensiform)[top at T9 and tip at T10]
-quadrilateral in shape -widest portion of sternum -jugular notch at superior border *palpable landmark *lies at T2-T3 interspace -has a clavicular notch where sternoclavicular joints are
manubrium
which ribs are considered true ribs 1st seven
-longest portion of sternum(about 4") -joined to another portion of sternum to create sternal angle -sternal angle is palpable and lies at T4-T5 -provides attachment for costal cartilage of first seven ribs at lateral border
Body of sternum
-most distal portion of sternum -often deviates from midline -useful landmark -tip lies over T10
xiphoid process
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and body lies over T9
pectus excavum funnel chest/caved chest/cereal chest
pectus carinatum pigeon chest/bulges out/extra bone
how many pairs of ribs to we have -12(may increase with presence of a cervical or lumbar rib)*number corresponds to thoracic vertebrae to which it attaches
what classification of bone are the ribs flat
anterior ends of ribs lie higher or lower than posterior ends
lower
what plane do the ribs sit in oblique
intercostal space is made up of what intercostal muscle(important during respiration)
ribs vary in _____ and _____ -length -width (increase in length from 1-7, then decrease from 8-12)
which ribs are false ribs 8-12
which ribs are floating 11 and 12
tubercle of rib articulates with _____ transverse process
head of rib articulates with ______ vertebral body
what are the 2 extremities of ribs vertebral and sternal
typical rib consist of ? -head -neck -tubercle -body -costal angle(lots of nerves sit here)
costovertebral joint head of rib and facet of vertebrae
costotransverse joint tubercle of rib and transverse process
costochondral between anterior extremities and costal cartilage
sternoclavicular joint classification synovial/gliding.freely moveable
costovertebral: 1st-12th classification synovial/gliding/freely moveable
costotransverse: 1st-10th classification synovial/gliding/freely moveable
costochodral: 1st-10th classification cartilaginous/synchondroses/immovable
sternocostal: 1st rib classification cartilaginous/synchoroses/immovable
sternocostal: 2nd-7th classification synovial/gliding/freely moveable
interchodral: 6th-9th classification synovial/gliding/freely moveable
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interchondral: 9th-10th classification fibrous/syndesmoses/slightly moveable
manubriosternal classification cartilaginous/symphysis/slightly moveable
xiphisternal classification cartilaginous/synchondroses/immoveable
what is flail chest when the body of the sternum separates from the manubrium
Chest Anatomy, Techniques, Positioning
QUESTIONS ANSWERSwhat are the systems of the thoracic cavity
*cardiovascular system *respiratory system *digestive system *endocrine glands *nervous system *lymphatics
what are the three chambers of the thoracic cavity
*right pleural cavity or space *left pleural cavity or space *pericardium
superior thoracic aperture opening at the top of the ribcage
inferior thoracic aperture opening the base of the ribcage, bordered by the diaphragm
pneumothorax air in pleural cavity
hemathroax blood in pleural cavity
pleural effusion fluid in pleural cavity
empyema pus in pleural cavity
visceral pleura surrounds lungs *no nerve endings
parietal pleura surrounds visceral pleura and is in contact with parietal wall (there is a serous layer between the two layers that prevents friction)
what two structures make up the pleura
*visceral pleura *parietal pleura
what are the vessels that supply the lungs with blood (dual blood supply)
*bronchial artery *pulmonary artery
what structures make up the mediastinum
*heart *aorta *svc *esophagus *thymus *trachea
thymus *primary control of lymphatic system *produces thymosin *develops
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immune system
what three structures pass through the diaphragm
*aorta *svc *esophagus
what are the structures that make up the respiratory system
*nasal cavities *pharynx *larynx *trachea *bronchi *two lungs
glottis opening to trachea, between vocal cords
what are the four sets of sinuses *frontal *ethmoidal *sphenoidal *maxillary
nasal conchae bones of the nasal cavity that act as a turbine to cool or warm body temp.
what does the pharynx consist of *nasopharynx *oropharynx *laryngopharynx
nasopharynx behind nasal cavity and consist of: *hard palate(maxilla) *soft palate *uvula *tonsils and adenoids *auditory tubes
oropharynx behind oral cavity, extends to hyoid bone
laryngopharynx from C3-C6
epiglottis flap that prevents food from going into trachea, by forming a seal when swallowing and opens up to take air into trachea when breathing
thyroid cartilage two fused platelike structures of cartilage that form anterior wall of the larynx
in what order does the air flow through the structures of the lungs
trachea bifurcates at the carina-->primary bronchi-->secondary bronchi-->tertiary bronchi-->primary brochioles-->terminal brochioles-->alveolar duct-->alveoli
contains silia to clean the air, as well as cooling and heating air that enters
mucous membrane
cricoid cartilage simple ring of cartilage(the only complete ring around the trachea), attachment for muscles
vocal cords mucous membrane, vibrate to help phonate sound
trachea hollow tube that sits midline and measures 1/2 inch in diameter, 4 1/2 inches long. the posterior aspect is flat.
carina last cartilage that surrounds trachea
how many primary bronchi 1 on each side, the bronchi on the right is shorter and more transverse than the left bronchi
how many secondary brochi 3 on the right and 2 on the left
how many tertiary bronchi 10 on the right and 8 on the left
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what are the divisions of the brochi *primary bronchi *secondary(lobar)bronchi *tertiary(segmental)bronchi *primary bronchioles *terminal bronchioles
what is the functional unit of the lungs alveoli- the respiratory zone *where oxygen and carbon dioxide are exhanged(there are millions of alveoli in each lung)
what is the anatomy of the alveoli *alveolar ducts *alveolar sacs *alveoli
pulmonary arteries carry deoxygenated blood from the heart to the lungs
pulmonary veins carry oxygen rich blood to the left atrium
lungs organs of respiration
parenchyma spongy elastic material that the lungs are made of
apex top pointed portion of the lungs
base inferior, broad portion of the lungs that boarders the diaphragm
costophrenic angles bottom lateral angles of the lungs
cardiophrenic angles bottom medial angles of the lungs
hilum indention on medial portion of lungs, that allows vessels to enter and exit
cardiac notch indentation in the lung where the heart sits
costal surface of lungs in contact with ribs
diaphragmatic surface of lungs touches diaphragm
mediastinal surface of lungs touches mediastinum
how many fissures are there in each lung
*2 in the right lung *1 in the left lung
how are the fissures of the lungs positioned
*horizontal *oblique
lingula region of left lung that would be the middle lobe if there were a second fissure in that lung
inspiration lungs fill with air and get longer, diaphragm moves down
expiration lungs get shorter as air is pushed out, diaphragm moves up
ageniesis unformed lung
hypoplasia under developed lungs
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cysts hollow cavities filled with fluid
bronchoesphageal fistula abnormal communication between the bronchi and esophagus
tracheotomy surgical procedure to open a direct airway into the trachea
lobectomy surgical removal a lung lobe
pneumonectomy surgical removal of a lung
segmental resection removal of part of lobe or segment
thoracoplasty removal of part of ribs(required for lung removal
thoracentesis removal of fluid or air from thoracic cavity
bronchography radiographic exam of bronchiole tree
atelactesis collapsed lung
bronchitis inflamation of the bronchi
laryngitis inflamation of the larynx
pneumonitis inflamation of lung tissue(pneumonia)
bronchopneumonia inflamation of part of the lobe and bronchi
lobar pneumonia infection of single lobe of lung
pleurisy inflamation of the pleura
COPD -chronic obstructive pulmonary disease *pathological obstruction of air flow
emphysema aveoli lose elasticity and are unable to complete gas exchange, causing unusually long and dark lungs
empyema pus in plural cavity
what procedural guidelines should followed when setting a pt up for an exam
*patient prep *general patient position *IR size *SID *ID markers *radiation protection *patient instructions
what should be done to prepare a patient for a procedure
*remove all artifacts from anatomy of interest *secure all pt belongings *obtain pertinent patient hx
what patient hx questions should we ask before a chest xray
*any chest pain *location of pain *hx of chest or heart problems/surgeries *pain level *smoker? *shortness of breath *onset of symptoms *if exam is preop, what for?
how should the patients general *ambulatory patients- do upright *nonambulatory patients- do sitting
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position be determined up when possible. if it is not possible to sit patient up, decubitis can be performed
what factors should be considered for IR selection
*body habitus *use smallest IR that will demonstrate anatomy *collimate
what is the SID recommendation for chest radiography
longer SID to show true size of the heart
what are the ID markers that should be included in your images
*right or left markers and all other required markers should be included in final image
what radiation protection measures should always be taken
*shield patients *colimate *use optimal technique factors (high kVp/low mAs)
patient instructions should include what
*explanation and demonstration of positions when possible *respiration instructions *exposures should be made after second deep inspiration
in some instances two seperate radiographs may be taken, one on inspiration and one on expiration. why is this done
to demonstrate: *pneumothorax *diaphragm movement *presence of foreign body *atelectasis
what are the essential chest projections
*PA *lateral *PA oblique *AP oblique *AP *AP axial
position for PA chest *upright, if possible *facing IR with MSP centered *MSP perpendicular and MCP parallel to IR *weight equally distributed on both feet *top of IR 1.5" to 2" above shoulders *depress shoulders into same transverse plane *roll shoulders forward
what is the path of the central ray for a PA chest
*perpendicular to the center of the IR *CR enters at T7 and MSP
what is the technique for PA chest *105-120 kVp *two outer AEC cells should be selected(1 & 3) *exposure should be made at the end of second full inspiration
what can you look for on your image that will show that your patients lungs have fully expanded during inspiration
*10 posterior ribs can be visualized within the lungs above diaphragm on an adult *8 on a child
tension pneumothorax spontaneous pneumothorax
position for lateral chest *upright if possible *IR 1.5" to 2" above shoulders *MSP parallel and MCP perpendicular to the IR *shoulder in contact with board *extend arms over head, flex elbows, and rest forearms on head
what is the path of the central ray for a lateral chest
*directed perpendicular to the IR *enters at level of T7 and MCP
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what is the technique for a lateral chest
*105-120 kVp *center AEC cell selected(2) *exposure should be made after second full inspiration
position for PA oblique chest *upright or recumbent *45-degree LAO or RAO *top of IR 1.5" to 2" above vertebra prominens *arms positioned out of collimated field
what is the path of the central ray for a PA oblique chest
*perpendicular to the IR *enters at level of T7
what is the technique for a PA oblique chest
*105-120 kVp, two outer cells of AEC are selected(1 & #) *exposure made after second full inspiration
position for AP oblique chest *upright or recumbent *45-degree LPO or RPO *shoulders in same transverse plane *arms out of field
what is the path of the central ray for an AP oblique chest
*perpendicular to IR *enters 3" below jugular notch
what is the technique for AP oblique chest
*105-120 kVp, two outer AEC cells are selected(1 & 3) *exposure made after second fall inspiration
position for AP chest *supine or sitting up *center MSP to IR *top of IR 1.5" to 2" above shoulders *roll shoulder forward if patient is able *shoulders in same transverse plane
what is the path of the central ray for AP chest
*perpendicular to long axis of sternum and center of IR *enters 3" below jugular notch
what is the technique for AP chest *manual(high mA, low time)- use of grid if patient is larger than 12cm *exposure made after second full inspiration
position for lordotic chest *upright, facing tube *about 1 foot in front of grid *top of IR placed 3" above shoulders when patient in lordotic position *MSP centered to midline of grid *assist pt to lean backward until shoulders rest on grid
what is the path of the central ray for a lordotic chest
*perpendicular to IR *enters MSP at midsternum(T7)
what is the technique use for lordotic chest
*105-120 kVp, two outer AEC cells selected(1 & 3) *exposure made after second full inspiration
AP/PA(projection) lateral decubitus chest position
*to demonstrate fluid levels patient should be positioned on affected side *to demonstrate free air patient should be positioned on unaffected side *elevate body 5 to 8 cm if lying on affected side *no rotation *arms over head *chest against grid
for lateral decubitus, how long should patient be in position before exposure to obtain an optimal image
5 minutes
what is the path of the central ray for lateral decubitus chest
*horizontal to floor and perpendicular to IR *enters MSP at 3" below jugular notch for AP, T7 for PA *exposure made on second full
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inspiration
Lateral(projection) Ventral or Dorsal decubitus chest positions
*prone or supine *body elevated 2" to 3" *no rotation *affected side against grid device *arms above head *top of IR at level of thyroid
what is the path of the central ray for a ventral or dorsal chest
*horizontal to the floor and perpendicular to the IR *enters at level of MCP, 3" to 4" below jugular notch for dorsal, T7 for ventral
what is the technique used for ventral or dorsal decubitus chest
*105-120 kVp, center AEC cell is selected(2) *exposure made after second full inspiration
what should be visible in a PA chest image
*entire lung fields from apices to costophrenic angles *no rotation *trachea in midline *scapulae out of lung fields *10 posterior ribs visible above diaphragm *heart and diaphragm outlines sharp *ribs and t-spine visible in heart shadow *lung mrkn
what should be visible in a Lateral chest
*superimposition of ribs posterior to vertebral column *arm or its soft tissue not seen in lung field *long axis of lungs vertical without forward or backward leaning *lateral sternum *Costophrenic angles and apices *pentration of lungs and heart
what should be visible in a lateral chest...contd
*open thoracic intervertebral disk spaces and foramina, except in pt with scoliosis *sharp outlines of heart and diaphragm *hilum in center
what should be visible in a PA oblique chest
*both lungs seen in their entirety *air-filled trachea *visible ID markers *heart and mediastinal structures within lung field of elevated side in 45-degree obliques *maximum area of right lung seen on LAO *maximum area of left lung seen on RAO
what should be visible on an AP olblique chest
*both lungs seen in their entirety *air filled trachea *visible ID markers *lung fields and mediastinal structures *maximum area of left lung seen on LPO *maximum area of right lung seen on RPO
what should be visible on an AP chest *medial portion of clavicles equidistant from vertebral column *trachea in midline *clavicles lying more horizontal and obscuring more of apices than in PA *equal distance from vertebral column to lateral border of ribs on each side
what should be visible on an AP chest contd.
*ribs and thoracic vertebra vesible through heart shadow *entire lung fields from apices to angles *pleural markings visible
what should be visible on Lordotic chest
*clavicles lying superior to apices *sternal ends of clavicles equidistant from vertebral column *apices and lungs in their entirety *clavicles horizontal with medial ends overlapping first or second ribs *ribs distorted and almost superimposed
what should be visible in an AP/PA(projection) lateral decubitus chest
*no rotation *Entire affected side demonstrated *apices *proper ID to indicate decubitus performed *arms not visible in anatomy of interest
what should be visible on a *entire lungs *no rotation *arms not seen in upper lungs *proper
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Lateral(projection) ventral or dorsal Decubitus chest
markers to indicate decubitus performed *T7 in center of IR
Surface Landmarks
QUESTIONS ANSWERSC1 landmark Mastoid tip
C2, C3 landmark Gonion
C3, C4 Landmark Hyoid bone
C5 Landmark Thyroid cartilage
C7, T1 Landmark Vertebra prominens
T1 landmark 2" above jugular notch
T2, T3 landmark Level of jugular notch
T4, T5 landmark level of sternal angle
T7 landmark level of inferior angles of scapulae
T9, T10 landmark level of xyphoid process
L2, L3 landmark level of inferior costal margin
L4, L5 Landmark Level of superiormost aspect of iliac crests
S1, S2 landmark Level of anterior superior iliac spine ASIS
Coccyx landmark level of pubic symphysis and greater trochanters
Spine
How many cervical vertebrae are there? How many Lumbar vertebrae are there?
1) 7 Cervical Vertebrae 2) 5 Lumbar Vertebrae
Which 2 Vertebrae have a lordotic curve and bulge anteriorly? Cervical and Lumbar
Which 2 Vertebrae have a kyphotic curve and bulge posteriorly? Thoracic and Sacrum
1
The circular opening between the body and vertebral arch is called the _____ ______?
Vertebral Foramen
The _____ ______ are the ridges of bone that can be easily felt under a person’s skin?
Spinous Process - C7
T/F - Vertebrae have 2 Superior and 2 Inferior articulating process that project from the vertebral arch.
TRUE
Which of the following features are unique to the cervical? 1 & 3 = Spinous Process & Foramina
The spinous process of C2 - C6 are ______, meaning they are split into 2 posterior projections.
BIFID
C7 has a long spinous process that projects posteriorly called the _______.
Vertebral Prominens
On what vertebrae are the lateral masses located? C1
The ODONTOID process is part of what bone? C2 - Axis
C2 has a projection called what? Odontoid Process
T/F - The spinous processes of the Thoracic Vertebrae are long and slender, projecting sharply inferior?
True
Which characteristics describes the sacrum? ALL 3 = Triangular, Shovel Shaped, 5 Fused Vertebrae
The INFERIOR portion of the sacrum is called what? APEX
The SUPERIOR portion of the sacrum is called what? BASE
The base has a prominent ridge of bone that projects ANTERIORLY called the _____________.
Promontory
The sacrum has how many sacral foramina? 8
T/F - The sacrum and coccyx is part of the pelvic girdle TRUE
T/F - The coccyx (or tailbone) is a small, triangular bone formed by the fusion of 3-5 vertebrae
TRUE
The inferior portion of the coccyx is called ________? APEX
Classifications of bone shapes: Cervical-Thoracic-Lumbar-Sacrum-Coccyx
ALL IRREGULAR BONES
The outer part of the intervertebral disk is called __________ made of a thick tough cartilage.
Annulus Fibrosus
Which of the following is the soft semigelatinous material part of Nucleous Pulposus
1
what?
The what are located between the articular processes of stacked vertebrae
Zygapophyseal Joints
The anterior edge of the upper sacrum is the what? Promonitary
The ___________ are located between the sacrum and each ilium of the coccyx
Sacroiliac (S1) Joints
(EC) ________ refers to the anterior displacement of 1 vertebrae on another
Spondylolisthesis
EC = Which view demonstrates the C7/C1 Vertebrae when not visualized on routine lateral projection.
Lateral Cervicothoracic = Swimmers
C1 is AKA ATLAS
C2 is AKA AXIS
_________ is spinal arthritis. Spondylosis
______ _______ occurs in bones weakened by diseases. Compression Fractures
_____ ______ is one of the most common types of spinal injury d/t a fall, lifting, twisiting or other impart
Disk Herniation
For an AP/PA view of the entire spine the CR enters at the level of the _______ ________.
Xiphoid Process
An AP/PA view of the entire spine demonstrates ________. Scoliosis
Intervertebral Joints have a ______ movements. Gliding Movement
Zygapophyseal Joints have a _______ movement. Gliding Movement
The positioning landmark for the MASTOID TIP is? C1
The positioning landmark for the Thyroid Cartilage Upper border of C4
The positioning landmark of the Top of the Shoulders C7
The positioning landmark of the Jugular Notch is? Between the T2, T3 and Supborder of the manubrium
The positioning landmark of the Inferior Angle of the Scapula T7
The positioning landmark of the Xiphoid Process T10, Bottom of Sternum
The positioning landmark of the Iliac Crest Between L4 AND L5
The SID should be __________" for a lateral cervical spine? 72"
For an AP axial of the Cervical Spine the CR should be angled 15 degrees cephalad
1
______* ____________
For an AP axial of the cervical spine the CR should be directed toward _____________ cartilage.
Thyroid
For and AP OPEN MOUTH of a cervical spine, it demonstrates the ____________
Zygopophyseal joints between C1 & C2
For a lateral view of the cervical spine the head, neck and body should be ______ to the IR.
Parallel
For a lateral view of the cervical spine the CR is directed toward the ______ cartilage and passes through the ________.
Thyroid - Mastoid Tip
What view is done to demonstrate range of motion and intersegmental stability of vertebrae?
Flexion & Extension Lateral
For a PA Oblique for a cervical spine how many degrees should the body be rotated?
45*
RAO Demonstrates _____________ intervertebral foramina. Right
LAO Demonstrates ____ for a PA Oblique of a Cervical Spine LEFT
RPO Demonstrates ___________ intervertebral foramina? Left
LPO Demonstrates ___________ for an AP Oblique of a cervical spine Right
For an AP Thoracic view the IR should be placed with _______ of IR ______ " above the shoulders.
Top = 1"
For an AP View of the Thoracic Spine the CR should be directed to _____ at the mid _____
T7 = Sternum
Which technique is used for a lateral view of the thoracic spine and at what exposure time?
Breathing Technique - 3-4 Sec
T/F - For an AP View of the lumbar spine the patient should be lying on their back (supine) with knees flexed?
TRUE
For an AP view of the Lumbar Spine, the CR should be directed to ______ at level of ____ ____.
L4 = Iliac Crest
For a lateral view of the lumbar spine the CR should be directed to the ______ at the level of the _____ _____.
L4 = Iliac Crest
For a L5/S1 coned down spot view of the lumbar spine the CR is angled ______ * _______.
5* - 8* = Caudal
How is the body rotated for an AP Oblique view for the lumbar spine. 45* = LPO or RPO
1
RPO Demonstrates _____________ Zygopophyseal joints and Scotty dog.
RIGHT
LPO Demonstrates ________ for an AP Oblique of the lumbar spine LEFT
For an AP View of the sacrum the CR is angled _____ * _______. 15* = Cephalad
For an AP View of the Coccyx the CR is angled _______ * _____. 10* - Caudal
For a lateral view of the coccyx the CR is directed to the mid _____ and enters _____" posterior and ______" inferior to ASIS.
Coccyx 3.5" and 2 "
For an AP View of the S1 joint the CR is angled _____* for males and _____* for females ______.
30* - 35* - Cephalad
For an Oblique view for the S1 Joint the body is rotated ______ * LPO or RPO
25*-30*
For a LATERAL AP OPEN MOUTH the SID is what? 72"
The Central Angle for the AP AXIAL is what? 15* Cephalad
The IR for the AP AXIAL is pointing where? Thyroid Cartilage
Why is the AP open mouth performed? To demonstrate the ZYGAPOPPHYSEAL JOINTS between C1 and C2
For a lateral cervical spine what body part is parrallel to the IR?
HEAD - NECK - AND BODY (MID SAGITTAL PLANE)
For the LATERAL CERVICAL SPINE the CR should be centered where?
CR to the THYROID CARTILAGE passes through the mastoid tip
EX - What is another name for C1 ATLAS
EX - What is another name for C2 Axis
In the Lateral Cervicothorasic AKA - Swimmers is done what?
Demonstrates the C7/T1 Vertebrae when not visualized on routine lateral projection
What veiw is done to demonstrate RANGE of MOTION and Intersegemental stability of vertebrae
FLEXION and EXTENSION LATERAL
C-spine, T-spine and Part of Lumbosacral
QUESTIONS ANSWERS
1
What is another word for the dens? odontoid
What method of the AP dens is used when the open mouth method excludes the upper half of dens?
Fuchs Method
Where does the CR enter on the open mouth method of the atlas and axis?
middle of mouth
Where is IR situated for the open mouth projection? level of axis
What is respiration for the open mouth method of Atlas and Axis?
phonate,ahhhh
Which projection of the upper C-spine checks for lateral displacement?
Atlas and Axis Open Mouth
What should you do if the patient cannot open their mouth for the open mouth method of atlas and axis?
use tomography
T/F you can always find a way to image the AP atlas and Axis with patient positioning.
False, not if patient has a deep head or a long mandible
CR entering point for an AP Axial C-spine through C4 (thyroid cartilage)
CR angle for the AP Axial Cspine 15-20° cephalad
Why do you extend the chin on the AP Axial Cspine? prevents superimposition of mandible and midcervical vertebrae
Where is IR centered for the AP Axial Cspine? C4
Vertebral structures shown for AP Axial CSpine lower 5 Cspine and upper 2-3 Tspine
What type of spaces are demonstrated on the AP Axial Cspine?
interpediculate spaces
Are intervertebral disk spaces shown on the AP Axial Cspine? yes
How is CR positioned on the lateral Cspine? horizontal and perpendicular
What level does the CR go into for the lateral Cspine? C4
Which magnified shoulder outline (closest/farthest) is projected below the lower Cspine when the lateral Cspine projection is performed correctly?
farthest
How many inches above the EAM is the IR when performing a Lateral Cspine?
1 inch
What two things should be done to depress the shoulders for a lateral Cspine?
1.fullexpiration, 2.use sandbags to weigh them down
Structures shown on a Lateral Cspine intervertebral disk spaces, articular pillars,
1
lower 5 zygapophyseal joints, spinous processes, If shoulders are depressed: you may see C7 (sometimes T1-T2)
How does the CR enter for the Lateral Cspine Hyperflexion/Hyperextension exam AND wo what level?
horizontal and perpendicular ; C4
How many inches above the EAM is the IR positioned for a Latera Cspine Hyperflexion/Hyperextension exam?
2 inches
What is head position for hyperflexion? dropped forward; chin drawn to chest
What is head position for hyperextension? head lifted back; chin elevated
What is the main reason for taking a Lateral Cspine Hyperflexion/Hyperextension exam?
to show movement/non movement abilities
For Lateral Cspine Hyperflexion exam, what are structures shown?
spinous processes elevated and widely separated, mandible is vertical, all 7 vertebrae
For Lateral Cspine Hyperextension exam, what are structures shown?*8spinous processes are depressed, horizontal mandible, all 7 vertebrae
CR angle for the AP Axial Oblique Cspine intervertebral foramina RPO/LPO?
15-20°cephalad
Why is CR angle for the AP Axial Oblique Cspine intervertebral foramina RPO/LPO 15-20° cephalad?
In order to coincide with the angle of foramina (same reason for the CR angle for the PA Axial Oblique Cspine intervertebral foramina RAO/LAO being angled 15-20°caudad)
To compensate for CR angulation of the AP Axial Oblique Cspine intervertebral foramina RPO/LPO exam, where is the IR positioned?
1 inch above the thyroid cartilage
To compensate for CR angulation of the PA Axial Oblique Cspine intervertebral foramina RAO/LAO exam, where is the IR positioned?
1 inch below thyroid cartilage
Where is IR centered for the AP Axial Oblique Cspine intervertebral foramina RPO/LPO?
to C3 which rests 1 inch above thyroid cartilage
Where is IR centered for the PA Axial Oblique Cspine intervertebral foramina RAO/LAO?
to C5 which rests 1 inch below the thyroid cartilage
What is the degree of obliquity for both AP and PA Axial Oblique Cspine intervertebral foramina exams?
45°
Why is the chin protruded for the AP and PA Axial Oblique tp prevent superimpositioning of mandible
1
Cspine intervertebral foramina exams? with upper cspine.
On the PA Axial Oblique Cspine intervertebral foramina exam, are the foramina opening perpendicular or parallel with the IR?
Parallel
AP and PA Axial Oblique Cspine intervertebral foramina exams: Which shows intervertebral foramina and pedicles FARTHEST from the IR?
AP Axial Oblique Cspine intervertebral foramina exam
AP and PA Axial Oblique Cspine intervertebral foramina exams: Which shows intervertebral foramina and pedicles CLOSEST to the IR?
Pa Axial Oblique Cspine intervertebral foramina exam
AP and PA Axial Oblique Cspine intervertebral foramina exam: Which shows the occipital bone NOT overlapping the axis?
Pa Axial Oblique Cspine intervertebral foramina exam
Chewing method ottonello method for AP Cspine
Where is IR location for the AP Cspine Ottonello Method? in the bucky tray
Where is IR centered for the AP Cpsine Ottonello Method? C4
Why use the AP Cpsine Ottonello Method? to blur the mandibular shadow which demonstrates the underlying atlas and axis (occipital bone will not overlap axis, either)
Patient position and technique importance for the AP Cpsine Ottonello Method
low mAs, long exposure (at least 1 second), head immobilized, chewing motion
CR centering for Lateral Cervicothoracical Vertebrae Swimmer’s Technique
to C7-T1 interspace
When doing the Lateral Cervicothoracical Vertebrae Swimmer’s Technique, and the shoulder away from the IR is well depressed, how is CR positioned?
perpendicularly (to C7-T1 interspace) no angle is necessary
When doing the Lateral Cervicothoracical Vertebrae Swimmer’s Technique, and the shoulder away from the IR cannot be depressed or is immobile, how is CR positioned?
3-5° caudad
If you want to see the intervertebral disk spaces and the patient has broad shoulders or a non-elevated lower Tspine on a Lateral Cervicothoracical Vertebrae Swimmer’s Technique, how is the CR positioned to compensate?
5-15°cephalad
Is a grid necessary for the Lateral Cervicothoracical Vertebrae Swimmer’s Technique?
yes
C7-T1 interspace corresponds to 2 inches above jugular notch
1
Give 2 reasons why is the Lateral Cervicothoracical Vertebrae Swimmer’s Technique may be used instead of the Lateral Cspine exam:
1)when shoulder imposition cannot be avoided, 2)when upper thoracic lateral region needs to be viewed
Even though both options are acceptable: For the Lateral Cervicothoracical Vertebrae Swimmer’s Technique, is it recommended to move the humeral head anteriorly or posteriorly?
anteriorly
Why is it important that the head remains in true lateral for the Lateral Cervicothoracical Vertebrae Swimmer’s Technique?
to prevent rotation of cervical vertebrae
T/F: The AP Thoracic Vertebrae is a lot like a CXR. true
CR position and entering point for the AP Thoracic Vertebrae perpendicular to IR halfway between the jugular notch and the xiphoid process
Where is the top of the IR for the AP Thoracic Vertebrae? 1 ½-2 inches above shoulder (T7 near center of image)
What should you do to the hips of a supine patient when taking and exam of the AP Thoracic Vertebrae and why?
flex to vertical position; to reduce kyphosis
Structures shown for the AP Thoracic Vertebrae intervertebral disk spaces, transverse processes, costovertebral articulations, better look at ribs, shoulder, diaphragm, and lungs and all 12 Tspine because of larger IR size (35x43)
What type of pillow would you give a patient when supine and performing a AP Thoracic Vertebrae exam and why?
Thin pillow (or none at all, really); to keep from accentuating thoracic kyophosis
Supine patient: What is done to the feet and how are the thighs positioned on the AP Thoracic Vertebrae exam and why?
Vertical thighs, feet immobilized with sandbags; to reduce kyphosis
T/F: The AP Thoracic Vertebrae will greatly improve with use of a grid/filter
true
What is patient position for the Lateral Tspine? left(recommended) lateral recumbent or upright
T/F what is done to the gown in a Lateral Tspine exam to better expose vertebral column?
open back of gown
What type of pillow should be used on a Lateral Tspine to keep vertebral column horizontal?
firm pillow
Where is the superior edge of the 35x43 or (18x43) IR placed on a Lateral Tspine?
1 ½ to 2 inches above relaxed shoulders
On the Lateral Tspine: What anatomy is centered to the posterior half of thorax; T7
1
midline of the grid and at what level?
What vertebra corresponds to the scapula? T7
How can the ribs be elevated enough to clear the intervertebral foramina on the Lateral Tspine?
put patients arms to right angle to long axis of body
Lateral Tspine: What is preferred method to compensate for vertebral column not being horizontal when patient is recumbent?
elevate upper or lower thoracic region with radiolucent support
Lateral Tspine: What is another way to compensate for vertebral column not being horizontal when patient is recumbent (instead of using radiolucent support to elevate upper/lower thoracic region)?
CR angulation 10° cephalad for women and 15° cephalad for men.
Why do you tell the patient to breath for the Lateral Tspine exam?
to obliterate the ribs
During the Lateral Tspine exam, why do we angle the CR cephalad 15° on males instead of 10° like on the female?
men have broader shoulders
Why might the upper vertebrae in the Lateral Tspine NOT be shown?
because of overlapping shoulders
T/F T1 to T3 will not be well visualized on the Lateral Tspine exam.
true
Does the Lateral Tspine have a wide or narrow latitude of exposure?
wide
What recommended projections demonstrate the Thoracic Zygapophyseal joints?
PA/AP oblique projections
On the Thoracic Zygapophyseal exam, which oblique position shows the joints farthest from the IR?
AP
On the Thoracic Zygapophyseal exam, which oblique position shows the joints closest to the IR?
PA
What is the degree of obliquity for the oblique Thoracic Zygapophyseal exam?
70°
Where is top of IR on the oblique Thoracic Zygapophyseal exam; where is IR centered?
1 ½ to 2 inches above shoulders; T7
On the AP oblique Thoracic Zygapophyseal exam, why is the arm adjacent to the grid brought forward?
to avoid humeral superimposition on the thoracic vertebrae.
What is the degree of obliquity with the recumbent Thoracic Zygapophyseal exam?
70°
1
Where is top of IR on the recumbent Thoracic Zygapophyseal exam; where is IR centered?
1 ½ to 2 inches above shoulders; T7
T/F a compression band may be needed when performing the recumbent Thoracic Zygapophyseal exam.
true
Where does the CR enter or exit when performing the recumbent Thoracic Zygapophyseal exam?
level of T7
T/F The number of joints shown on the recumbent Thoracic Zygapophyseal exam depends on the thoracic curve
true
When patients have accentuated kyphosis, what need to be done on the recumbent Thoracic Zygapophyseal exam in order to show joints at proximal and distal ends? Use a greater degree of rotation
What structure is NOT shown on the recumbent Thoracic Zygapophyseal exam and why?:
inferior articular process of T12 (b/c of 45°angle)
On the AP/PA Lumbar-Lumbosacral Vertebrae exam, what three things are part of patient prep?
evacuation of gas, feces, and urine.
Which projection is more commonly used on the AP/PA Lumbar-Lumbosacral Vertebrae exam?
AP
How do you reduce the lordotic curve on the recumbent AP Lumbar-Lumbosacral Vertebrae exam?
flex knees and hips to put back flat against table.
Which projection places the intervertebral disk spaces at an angle closely paralleling the beam divergence on the AP/PA Lumbar-Lumbosacral Vertebrae exam ?
PA
Which projection reduces patient dose when referring to the AP/PA Lumbar-Lumbosacral Vertebrae exam?
PA
Which projection is more commonly used for upright studies of the lumbar and lumbosacral spine?
PA Lumbar-Lumbosacral Vertebrae Projection
What SID is used on the AP/PA Lumbar-Lumbosacral Vertebrae exam in order to reduce distortion, completely open intervertebral disk spaces, and improve overall quality of exam?
48 in SID
What do you do on a AP/PA Lumbar-Lumbosacral Vertebrae exam if the patient has excrusciating pain?
upright
IR size and centering for lumbar spine and sacrum together 35x43 centered at iliac crest
IR size and centering for lumbar spine only 30x35 centered 1 ½ inches above iliac crest
Where is CR for lumbosacral projection? perpendicular to the L4 (iliac crest)
1
Where is CR for lumbar section only? 1 ½ in above iliac crests (L3)
The lumbosacral disk space of the last lumbar segment is not shown well in which projection?
AP Lumbar-Lumbosacral Vertebrae exam
Structures shown for the AP/PA Lumbar-Lumbosacral Vertebrae exam:
lower thoracic vertebrae to the sacrum, beam collimated to lateral margin of psoas muscles, open intervertebral joints
For the Lateral Lumbar-lumbosacral exam, does patient lay on right or left side?
depends…they lay on the AFFECTED side
As a preferred method, where does radiolucent support go on the Lateral Lumbar-lumbosacral exam to make it horizontal?
under lower thorax
With a 35-43 IR on a Lateral Lumbar-lumbosacral exam, center it to --
iliac crest (L4)
Iliac crest corresponds to what vertebra? L4
With a 30-35 IR on a Lateral Lumbar-lumbosacral exam, center it to --
1 ½ in above iliac crest
Where is CR directed for the Lateral Lumbar-lumbosacral exam? 1 ½ in above iliac crest with a 30-35 IR and iliac crest (L4) with a 35-43 IR
Lateral Lumbar-lumbosacral exam :When lumbar spine cannot be adjusted to a horizontal plane because of the lumbar angle or the breadth of the pelvis, how much and which direction do you angle the CR for a woman? And for a man?
CAUDAD 8° females (if they have wide pelvis), and 5° males.
Structures shown for the Lateral Lumbar-lumbosacral exam: lumbosacral junction, spinous processes, profile image of intervertebral foramina of L1-L4.
On the Lateral Lumbar-lumbosacral exam, which R&L intervertebral foramina are not visualized because of their oblique direction?
L5
What is the patient position for the Lateral L5-S1 Lumbosacral Junction exam?
lateral recumbent
What should be done to hips for the Lateral L5-S1 Lumbosacral Junction exam?
hips should be fully extended
On the Lateral L5-S1 Lumbosacral Junction exam, which is the more preferred method of positiong the vertebral column to a horizontal plane: angling the CR or using radiolucent
radiolucent support.
1
support?
Lateral L5-S1 Lumbosacral Junction exam CR is on a ___ plane, ___ in. posterior to ASIS and ___ in. inferior to the iliac crests
coronal, 2, 1 ½
Lateral L5-S1 Lumbosacral Junction exam: if radiolucent support will not provide a horizontal position, angle the CR:
CAUDALLY 5° for males and 8° for females OR use the imaginary interilliac line.
Vertebrae shown on the Lateral L5-S1 Lumbosacral Junction exam:
all of L5 and the upper sacrum
The Lumbar Zygapophyseal joints form an angle of ___-___ degrees
30-60° to the midsagittal plane but can vary from patient to patient
To demonstrate joints closest to the IR on the Lumbar Zygapophyseal joint Exam, turn patient toward affected side ___ degrees
45
On the Lumbar Zygapophyseal joint Exam, the lumbar spine lies in a longitudinal plane that passes ___ in. medial to the ELEVATED ASIS
2
What is the degree of obliquity on the Lumbar Zygapophyseal joint Exam in order to demonstrate the L5-S1 zygapophyseal joint and articular process?
60
On the Lumbar Zygapophyseal joint Exam, and 45 °oblique body position will demonstrate the majority of ___-___ zygapophyseal joint spaces.
L3-S1
CR for the lumbar region of the Lumbar Zygapophyseal joint Exam, the CR enters
2 inches medial to ELEVATED ASIS and 1 ½ in above iliac crest
CR for 5th zygapophyseal joint on the Lumbar Zygapophyseal joint Exam is
2 inches medial to elevated ASIS and up to a point midway between the iliac crest and the ASIS
T/F on the Lumbar Zygapophyseal joint Exam, both sides are examined for comparison
true
On the Lumbar Zygapophyseal joint Exam, the articular processes being demonstrated are the ones ___ to/from IR?
closest
Obliquity for the Lumbar Zygapophyseal joint Exam 45°
Does the Lumbar Zygapophyseal joint Exam show the Scottie Dog?
yes
Structures shown on the Lumbar Zygapophyseal joint Exam: lower tspine to sacrum, zyga joints closest to IR, too much rotation-pedicle posterior, not
1
enough rotation-pedicle is anterior
The PA Oblique Lumbar Zygapophyseal joint Exam shows the zyga joints ___ to/from IR
farthest
Obliquity for the PA Oblique Lumbar Zygapophyseal joint Exam:
45-60°
C-spine
QUESTIONS ANSWERS
What is atypical about C1? it is ring like with no body and a short spinous process
Alternate name of C1 atlas
What divides that anterior and posterior arch of C1? Transverse atlantal ligament
Which portion of the ring of C1 receives the dens? anterior portion
Alternate name of C2 axis
Alternate name for the dens odontoid
What is the function of the dens? allows for pivot movement
Alternate name for C7 vertebra prominens
What passes through the transverse foramina of the C-spine? vertebral artery and vein, and spinal nerves
How do the zygapophyseal joints of the C-spine lie? at right angles to the MSP
How do the intervertebral foramina of the C-spine lie? they angle 45 degrees anteriorly and 15 degrees inferiorly
What projection must be done to view the intervertebral foramina of the C-spine?
45 degree oblique – AP side up, PA side down
A 45 degree RAO C-spine will demonstrate which IV foramina?
right
A 45 degree LAO C-spine will demonstrate which IV foramina?
left
A 45 degree RPO C-spine will demonstrate which IV foramina?
left
1
A 45 degree LPO C-spine will demonstrate which IV foramina?
right
What projection must be done to view the zygapophyseal joints of the C-spine?
lateral
T-spine
QUESTIONS ANSWERSWhat is the term for the inner part of an intervertebral disk?
nucleus pulposus
What is the term for the outer part of an intervertebral disk?
annulus fibrosus
What is a “slipped disk”? when the nucleus pulposus protrudes into the spinal canal, pressing on a nerve.
What causes Spina bifida? the lamina fail to fuse which may cause the spinal cord to protrude from the back
What points on each vertebrae articulate with those below and above?
the facets of the superior and inferior articular processes
What is the name for the joint where a vertebrae articulates with the one above or below?
zygapophyseal or interarticular facet joints
Which thoracic vertebrae have whole facets? T1( superior border), T10-T12 (superior border)
how do the spinous processes of T5-T9 lie? they sit at the level of the interspace for the vertebra below
How are the zygapophyseal joints of the T-spine situated?
they open and angle anteriorly 15-20 degrees from the MCP, creating angle of 70-75 degrees to the MSP
What degree of patient rotation is necessary to open the zygapophyseal joint spaces?
70-75 degrees
How do the intervertebral foramina lie in the T-spine?
true lateral – perpendicular toe the MSP
Name the 4 curves of the spine cervical, thoracic, lumbar and pelvic
Which curves are convex anteriorly? cervical and lumbar
Name the lordotic curves of the spine cervical and lumbar
Which curves are concave anteriorly? thoracic and pelvic
1
Name the kyphotic curves of the spine thoracic and pelvic
What are primary curves of the spine? thoracic and pelvic curves are present at birth
Functions of the vertebral column protect the spinal cord, support the trunk, support the skull and muscle attachment.
Intervertebral joint types cartilaginous symphysis
Zygapophyseal joint types synovial gliding
Costovertebral joint types synovial gliding
Costotransverse joint types synovial gliding
.
Where does the diaphragm lie in hypersthenic patients?
higher in the abdomen
How is the diaphragm situated in hyposthenic patients?
it sits lower in the abdomen
Which rib is thickest? 1st
Which rib is thinnest? 12
How much does a rib move with respiration? 1 ½ inches
Will the ribs move more or less with respiration changes for hypersthenic patients?
less
Will the ribs move more or less with respiration changes for hyposthenic patients?
more
How should the affected rib be placed in relation to the IR?
parallel
What kind of technique should be used? low kVP for a short scale of contrast
Which vertebrae have whole facets and where? T1 (superior), T10-T12 (superior)
Which demifacets are found on T1? inferior
Which vertebrae have demifacets both superiorly and inferiorly?
T2-T8
Where can a demifacet be found on T9? superiorly
What positioning is done for the anterior ribs? PA
What is the CR entry point for ribs? entering T7
1
What projection is done for posterior ribs? AP
Where should the IR be positioned for ribs below the diaphragm?
crosswise, BOF at the iliac crests
To show the right axillary ribs, what position is used?
RPO or LAO
To show the left axillary ribs, what position is used?
LPO or RAO
For AP oblique ribs, how is the affected side positioned?
“down”
For PA oblique ribs, how is the affected side positioned?
“away”
L-spine
QUESTIONS ANSWERSstructures shown for L-spine obliques articular process and zygapophseal joints of side down
the pedicle is seen anterior on the body for an oblique L-spine, meaning:
the patient is under rotated
if the pedicle is posterior on the body for an oblique L-spine, the patient is:
over-rotated
What projection must be done to view the intervertebral foramina of the L-spine?
lateral
What projection must be done to view the zygaopohyseal joints of the L-spine?
30-60 degree oblique – AP side down, PA side up
A 45 degree RAO L-spine will demonstrate which zygapophyseal joints?
left
A 45 degree RPO L-spine will demonstrate which zygapophyseal joints?
right
A 45 degree LPO L-spine will demonstrate which zygapophyseal joints?
left
A 45 degree LAO L-spine will demonstrate which zygapophyseal joints?
right
1
How are the zygapophyseal joints of L1-L2 oriented on average?
15 degrees to the MSP
How are the zygapophyseal joints of L2-L3 oriented on average?
30 degrees to the MSP
How does the orientation of the transverse processes of the lumbar vertebrae change?
they lie laterally on the superior vertebrae, and slightly superiorly on the inferior vertebrae
The lamina between the superior and inferior articular process is called:
pars interarticularis
How are the zygapophyseal joints of the L-spine situated?
angles posteriorly 30-60 degrees from the MSP
Lumbar, sacrum, and coccyx
QUESTIONS ANSWERSWhat is the CR directed on an AP L-Spine? Center the CR at the Iliac Crest(L4), center to the
Midsagittal plane of the patient
Where is the IR directed for an oblique L-spine? 2 in medial to the elevated ASIS and 1 1/2 in above the Iliac Crest
How many degrees is the patient rotated for the oblique L-Spine?
45 degrees
When the patient is in the correct 45 degree oblique position for the lumbar spine, what appearance do the lumbar vertebra take on?
A Scottie Dog appearance
Where is the IR directed for the lateral L-Spine? Perpendicular to the level of the Iliac Crest(L4)
What breathing instructions are suggested for all L-Spine projections EXCEPT l5-s1 Spot film?
Suspend breathing at the end of expiration
What part of the lumbar vertebra in the oblique position, is the "Ears" of the Scottie Dog?
Superior Articular Process
What part of the lumbar vertebra in the oblique position, is the "Nose" of the Scottie Dog?
Transverse Process
What part of the lumbar vertebra in the oblique position, is the "Eye" of the Scottie Dog?
Pedicle
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What part of the lumbar vertebra in the oblique position is the "Neck" of the Scottie Dog?
Pars Interarticularis
What part of the lumbar vertebra in the oblique position, is the "body" of the Scottie Dog?
Lamina
What part of the lumbar vertebra in the oblique position, is the "Front Legs" of the Scottie Dog?
Inferior Articular Process
Which zygapophyseal joint is most visualized on the radiograph?
The zygapophyseal joint closest to the film
If the pedicle is too posterior on the vertebral body of the lumbar oblique film, the body was rotated ___________?
Too much
If the pedicle is too anterior on the vertebral body of the lumbar oblique film, the body was rotated __________?
Not enough
What is another name for the AP Axial Projection of the Lumbosacral Junction and SI Joints?
Ferguson Method
Where should the CR be directed in the AP Axial(Ferguson) Projection?
About 1 1/2 in superior to the pubic symphysis and at the midsagittal plane of the patient
What degree of angulation and in what direction, for men, is suggested on the AP Axial Projection?
30 degree Cephalad
What degree of angulation and in what direction, for women, is suggested on the AP Axial Projection?
35 degrees Cephalad
Where is the CR directed on the L5-S1 projection? Center to the Coronal Plane, 2 in posterior to the ASIS and 1 1/2 in inferior to the ASIS
When the spine is not in a true lateral position on the L5-S1 projection, The CR can be angled ______ degrees _______ for men.
5, Caudad
When the spine is not in a true lateral position on the L5-S1 projection, The CR can be angled ______ degrees _______ for women.
8, Caudad
How many degrees is the patient elevated on an oblique SI Joint projection?
25 to 30 degrees and to the midsagittal plane
Where is the CR directed for the oblique SI Joint Projection?
1 in medial to the ASIS
Where is the CR directed on an AP Sacrum? 2 in superior to the pubic symphysis, and to the
1
midsagittal plane
What degree and in which direction is the CR directed on the AP Sacrum?
15 degree, Cephalad and to the midsagittal plane
Where is the CR directed for an AP Coccyx Projection?
2 in superior to the pubic symphysis and to the midsagittal plane
What degree and in which direction is the CR directed for an AP Coccyx?
10 degrees, Caudad
Where is the CR directed on a lateral Sacrum? Perpendicular and directed to the level of the ASIS and approximately 3 1/2 in to 4 in posterior. This centering should work on most patients.
Where is the CR directed on a lateral Coccyx? Perpendicular and directed to the level of the ASIS and approximately 3 1/2 in to 4 in posterior and 2 in inferior. This centering should work for most patients.
Vertebral Column
QUESTIONS ANSWERSAP projection of dens is also known as what? Fuchs method
IR for AP Fuchs 8 x 10" (18 x 24 cm) ↔
Patient position for AP Fuchs supine w/ chin extended (MML near ⊥ to tabletop)
Location of IR for AP Fuchs Center IR @ tips of mastoid processes
CR for AP Fuchs ⊥ to IR just distal to chin tip
Area of interest for AP Fuchs Dens w/in foramen magnum
PA projection of dens is also known as what? Judd method
Patient position for PA Judd prone w/ chin extended (MML near ⊥ to tabletop)
IR for PA Judd 8 x 10" (18 x 24 cm) ↔
Location of IR for PA Judd ⊥ to MML @ inferior tip of mandible
CR for PA Judd ‖ to MML 1" (2.5 cm) inferoposterior to mastoid tips & ∠s of mandible; ∠ as needed
Area of interest for PA Judd Dens w/in foramen magnum
Respiration for AP Fuchs Suspend
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Respiration for PA Judd Suspend
AP projection of atlas & axis is also known as what? Open mouth technique
IR for AP open mouth 8 x 10" (18 x 24 cm)
Patient position for AP open mouth supine
Location of IR for AP open mouth IR CTR @ C2; occlusal plane ⊥ to IR
CR for AP open mouth ⊥ @ midpoint of open mouth
Respiration for AP open mouth Phonate "ah" upon exposure
Area of interest for AP open mouth C1 & C2 through open mouth
IR for AP axial C-spine 8 x 10" (18 x 24 cm) ↕
Patient position for AP axial C-spine supine or upright
Location of IR for AP axial C-spine CTR IR @ C4 w/ occlusal plane ⊥ to IR
CR for AP axial C-spine 15-20° cephalad @ C4
Respiration for AP axial C-spine Suspend
Area of interest for AP axial C-spine C3- T2/3; ? C-ribs
SID for AP open mouth 30" (76 cm) to ↑ view of odontoid area
True or false? AP Fuchs should not be attempted if fx or degenerative disease of upper cervical region is suspected.
True
Lateral projection of C-spine is also known as what? Grandy method
IR for lateral C-spine, Grandy method 8 x 10" (18 x 24 cm) ↕
SID for lateral C-spine, Grandy method 60- 72" SID due to ↑ OID; helps show C7
Patient position for lateral C-spine, Grandy method seated or standing, midsagittal plane ‖ to IR; Ⓡ or Ⓛ position
Location of IR for lateral C-spine, Grandy method CTR coronal plane that passes thru mastoid tips to IR midline
CR for lateral C-spine, Grandy method ⊥ @ C4; shoulder FARTHEST from IR proj ↓ lower c-spine
Area of interest for lateral C-spine, Grandy method C3-C7 Zygapophyseal joints
Respiration for lateral C-spine, Grandy method Suspend @ expiration ∴ ↓ shoulders
1
True or false? Sandbags can be attached to each of patient's wrists in lateral C-spine, Grandy method?
True
True or false? Lateral C-spine, hyperflexion or hyperextension can be performed as long as patient as sufficient support.
False; only attempt once C-spine pathology or fx has been r/o.
Area of interest for lateral C-spine, hyperflexion & hyperextension
Motility of C-spine; includes intervertebral disks & zygapophyseal joints
Location of spinous processes in lateral C-spine, hyperflexion
elevated & widely separated
Location of spinous processes in lateral C-spine, hyperextension
depressed in close appoximation
IR for lateral C-spine, hyperflexion & hyperextension 24 x 30 cm ↕
Patient position for lateral C-spine, hyperflexion & hyperextension
seated or standing; chin dropped or chin extended; Ⓡ or Ⓛ position
CR for lateral C-spine, hyperflexion & hyperextension
⊥ @ C4
Location of IR for lateral C-spine, hyperflexion & hyperextension
IR CTR @ C4 & top 2" (5 cm) ↑ EAM
Respiration for lateral C-spine, hyperflexion & hyperextension
Suspend
SID for lateral C-spine, hyperflexion & hyperextension
60- 72" SID due to ↑ OID; helps show C7
EAM External acoustic meatus
MML Mentomeatal line
Occlusal plane line from the lower edge of the upper incisors to the tip of the mastoid process
SID for AP axial oblique C-spine, RPO & LPO 60- 72" SID due to ↑ OID
Area of interest for AP axial oblique C-spine, RPO & LPO
Cervical intervertebral foramina; C2/C3- C7/T1
IR for AP axial oblique C-spine, RPO & LPO 8 x 10" (18 x 24 cm) ↕
Patient position for AP axial oblique C-spine, RPO & LPO
supine or upright* (seated or standing); elevate/protrude chin
Body rotation for AP axial oblique C-spine, RPO & 45° ∠
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LPO
Location of IR for AP axial oblique C-spine, RPO & LPO
IR CTR to body of C3
1" (2.5 cm) ↑ to the most prominent point of the thyroid cartilage
C3
CR for AP axial oblique C-spine, RPO & LPO 15- 20° cephalad @ C4; w/ ∠ of foramina
Respiration for AP axial oblique C-spine, RPO & LPO
Suspend
Side of interest for AP axial oblique C-spine, RPO & LPO
side FARTHEST from IR
True or false? Hyperflexion & hyperextension of AP oblique C-spine is performed to demonstrate fx, obscure dislocations & subluxations of the articular processes.
True
IR for PA axial oblique C-spine, RAO & LAO 8 x 10" (18 x 24 cm) ↕
SID for PA axial oblique C-spine, RAO & LAO 60- 72" SID due to ↑ OID
Patient position for PA axial oblique C-spine, RAO & LAO
prone or upright* (seated or standing); chin elevated & protruded
Location of IR for PA axial oblique C-spine, RAO & LAO
CTR IR @ C5
Body rotation for PA axial oblique C-spine, RAO & LAO
45° ∠ ∴ foramina openings ‖ w/ IR
Respiration for PA axial oblique C-spine, RAO & LAO
Suspend
CR for PA axial oblique C-spine, RAO & LAO 15- 20° caudal @ C4; w/ ∠ of foramina
Side of interest for PA axial oblique C-spine, RAO & LAO
side CLOSEST to IR
Area of interest for PA axial oblique C-spine, RAO & LAO
Intervertebral foramina & pedicles
What is the Lateral projection of the cervicothoracic region also known as?
"Swimmer's" technique
IR for Lateral Swimmer's 24 x 30 cm ↕
Patient position for Lateral Swimmer's recumbent or upright
Area of interest for Lateral Swimmer's cervicothoracic vertebrae between shoulders
1
Location of IR for Lateral Swimmer's CTR IR @ C7-T1, 2" (5 cm) ↑ jugular notch
CR for Lateral Swimmer's ⊥ to C7-T1 or 3-5° caudal when unable to ↓ shoulder
Respiration for Lateral Swimmer's Suspend; breathing tech if pt able & can be immobilized
2" (5 cm) ↑ jugular notch C7-T1 interspace
IR for AP T-spine 35 x 43 cm (14" x 17") or 18 x 43 cm ↕
Location of IR for AP T-spine Top of IR 1½- 2" (3.8- 5 cm) ↑ shoulders ∴ T7 in CTR of image
Position of patient for AP T-spine supine or upright
CR for AP T-spine ⊥ to IR @ ½ btwn jugular notch & xiphoid process
Respiration for AP T-spine Shallow breaths; or suspend @ expiration
Area of interest for AP T-spine T1-T12 w/ uniform density
IR for Lateral T-spine, Ⓡ or Ⓛ 35 x 43 cm (14" x 17") or 18 x 43 cm ↕
Area of interest for Lateral T-spine, Ⓡ or Ⓛ thoracic vertebral bodies & intervertebral foramina
Location of IR for Lateral T-spine Ⓡ or Ⓛ Top of IR 1½- 2" (3.8- 5 cm) ↑ shoulders ∴ T7 in CTR of image
inferior ∠ of scapulae T7
Patient position for Lateral T-spine, Ⓡ or Ⓛ lateral recumbent (Ⓡ or Ⓛ* position), upright
CR for Lateral T-spine, Ⓡ or Ⓛ ⊥ @ T7; 10 cephalad for ♀ & 15 cephalad for ♂ to T7 if vertebral column not elevated
Respiration for Lateral T-spine, Ⓡ or Ⓛ Normal breathing or suspend @ expiration
Area of interest for AP/PA (opt) L-spine Lumbar vertebrae: bodies, IV disk spaces, laminae, spinous & transverse processes. w/larger IR also shows abd viscera & air/gas patterns
SID for AP/PA L-spine 48" (122 cm); ↓ distortion, opens intervertebral joint spaces ↑, & and ↑ quality of exam
IR for AP/PA L-spine 35 x 43 cm (14 x 17") for lumbosacral spine; or 30 x 35 cm (12 x 14") for L-spine only
Patient position for AP/PA L-spine recumbent or upright
Location of IR for AP/PA L-spine L-spine & sacrum: CTR IR @ L4; L-spine only: 1½"
1
(3.8 cm) ↑ iliac crest @ L3
CR of IR for AP/PA L-spine For L-S exam: ⊥ @ L4; For Lumbar exam: ⊥ & 1½" (3.8 cm) ↑ L3
Respiration for AP/PA L-spine Suspend @ expiration
Level of iliac crests L4
IR for Lateral Lumbar & Lumbosacral vertebrae 35 x 43 cm (14 x 17") for lumbosacral spine; or 30 x 35 cm (12 x 14") for L-spine only
Patient position for lateral lumbar & lumbosacral vertebrae
upright or recumbent (same as AP/PA), lying ON AFFECTED side
Location of IR for Lateral Lumbar & Lumbosacral vertebrae
L-spine & sacrum: CTR IR @ L4; L-spine only: 1½" (3.8 cm) ↑ iliac crest @ L3
CR for Lateral Lumbar & Lumbosacral vertebrae For L-S exam: ⊥ @ L4; For Lumbar exam: ⊥ & 1½" (3.8 cm) ↑ L3
Respiration for Lateral Lumbar & Lumbosacral vertebrae
Suspend @ expiration
Area of interest for Lateral Lumbar & Lumbosacral vertebrae
L-vertebrae; intervertebral foramina of L1-L4
IR for Lateral L5-S1 8 x 10" (18 x 24 cm)
Location of IR for Lateral L5-S1 CTR on coronal plane 2" (5 cm) posterior to ASIS & 1½" (3.8 cm) ↓ to the iliac crest
Patient position for Lateral L5-S1 lateral recumbent
CR for Lateral L5-S1 ‖ w/ interiliac line; or if spine not horizontal 5° caudal for ♂ & 8° caudal for ♀
Respiration for Lateral L5-S1 Suspend
provides a standardized & accurate reference point from which to CTR the L5-S1 junction
ASIS
Area of interest for Lateral L5-S1 Lateral lumbosacral junction; L4- L5, and upper sacrum
imaginary line between both iliac crests interiliac plane
What are AP or PA axial projection of L-S jct & SI joints also known as?
Ferguson method
IR for AP/PA axial L5-S1/SI joints 8 x 10" (18 x 24 cm) or 24 x 30 cm ↕
Location of IR for AP/PA axial L5-S1/SI joints IR ctr to CR
1
Patient position for AP/PA axial L5-S1/SI joints supine (PA axial, prone)
CR for AP/PA axial L5-S1/SI joints 30° cephalad ♂ & 35° ♀; 1½" (3.8 cm) ↑ to pubic symphysis (30-35° caudal @ L4 for PA axial)
Respiration for AP/PA axial L5-S1/SI joints Suspend
Area of interest for AP/PA axial L5-S1/SI joints Lumbosacral joint & both SI joints
CR Variation for PA axial L5-S1/SI joints (Meese) ⊥ & CTR to ASIS @ 2" (5 cm) distal to spinous process of L5
IR for AP oblique Zygapophyseal joints, RPO & LPO 35 x 43 cm (14 x 17") or 30 x 35 cm ↕; 8 x 10" (18 x 24") for the last zygapophyseal joint
Location of IR for AP oblique Zygapophyseal joints, RPO & LPO
IR ctr to CR
Patient position for AP oblique Zygapophyseal joints, RPO & LPO
recumbent or upright; affected side closest to IR
Respiration for AP oblique Zygapophyseal joints, RPO & LPO
Suspend @ expiration
CR for AP oblique Zygapophyseal joints, RPO & LPO
For lumbar region, 2" (5 cm) medial to ↑ ASIS & 1½" (3.8 cm) ↑ iliac crest @ L3; For 5th Z-joint, 2" (5 cm) medial to ↑ ASIS & ½way btwn ASIS and iliac crest.
Area of interest for AP oblique Zygapophyseal joints, RPO & LPO
Zygapophyseal joints & articular processes of side closes to IR
plane of the zygapophyseal joints 30-60° to the MS plane in most patients; varies
Side of interest for AP oblique Zygapophyseal joints, RPO & LPO
side closest to IR
Body rotation for AP oblique Zygapophyseal joints, RPO & LPO
45°, but can be up to 60° to show L5-S1 Z-joint
Show when pt properly positioned or AP oblique of L-spine/ Z-joints
"Scottie dogs"
IR for PA oblique Z-joint projection, RAO & LAO 35 x 43 cm (14 x 17") or 30 x 35 cm ↕; 8 x 10" (18 x 24") for the last zygapophyseal joint
Location of IR for PA oblique Z-joint projection, RAO & LAO
IR ctr @ L3
Patient position for PA oblique Z-joint projection, RAO & LAO
upright or recumbent prone*; also semisupine
1
CR for PA oblique Z-joint projection, RAO & LAO ⊥ to L3, 2" (5cm) lateral to palpable spinous process
Respiration for PA oblique Z-joint projection, RAO & LAO
Suspend @ expiration
Area of interest for PA oblique Z-joint projection, RAO & LAO
Zygapophyseal joints (esp 5th) & articular processes of side farthest from IR
Side of interest for PA oblique Z-joint projection, RAO & LAO
joints FARTHEST from IR
Body rotation for PA oblique Z-joint projection, RAO & LAO
45°, but can be up to 60° to show L5-S1 Z-joint
IR for PA projection, lumbar intervertebral disks, weight bearing method, Ⓡ or Ⓛ bending
35 x 43 cm (14" x 17") ↕
What is PA projection, lumbar intervertebral disks, also known as?
Weight-bearing method; Ⓡ or Ⓛ bending
Patient position for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending
standing
CR for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending
⊥ to L3; 15-20° caudad or thru L4/L5 or L5-S1 if area of interest
Respiration for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending
Suspend
Location of IR for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending
IR CTR @ L3
Area of interest for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending
mobility of intervertebral joints; localize to site of lesion in pts w/ disk protrusion
True or false? AP L-spine bending is preferred over PA L-spine bending for comfort of patient.
False; PA pref'd due to ↓ pt rad
IR for AP projection, L-spine Ⓡ or Ⓛ bending 24 x 30 cm (10 x 12") or 35 x 43 cm (14" x 17") ↕
Patient position for AP projection, L-spine Ⓡ or Ⓛ bending
supine
Location of IR for AP projection, L-spine Ⓡ or Ⓛ bending
IR CTR to CR
Respiration for AP projection, L-spine Ⓡ or Ⓛ bending
Suspend
1
CR for AP projection, L-spine Ⓡ or Ⓛ bending ⊥ to L3
Area of interest for AP projection, L-spine Ⓡ or Ⓛ bending
max Ⓡ or Ⓛ lat flex; early scoliosis; motion of spinal fusion; localize herniated disk
IR for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension
35 x 43 cm (14" x 17") ↕
Patient position for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension
lateral recumbent; 1st knees fwd & 2nd lean thorax bkwd
Location of IR for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension
IR CTR @ spinal fusion
Respiration for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension
Suspend
CR for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension
⊥ to spinal fusion area or L3
Area of interest for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension
motion in spinal fusion area, or localize herniated disk
prep for sacrum & coccyx exams bowel free of gas & fecal material; bladder empty
IR for AP or PA axial Sacrum 24 x 30 cm (10 x 12")
IR for AP or PA axial Coccyx 8 x 10" (18 x 24 cm)
Location of IR for AP or PA axial Sacrum IR CTR to CR
Location of IR for AP or PA axial Coccyx IR CTR to CR
Patient position for AP axial Sacrum or Coccyx supine
Patient position for PA axial Sacrum or Coccyx prone
Respiration for AP or PA axial Sacrum or Coccyx Suspend
CR for AP axial Sacrum 15° cephalad @ 2" ↑ to pubic symphysis
CR for PA axial Sacrum 15° caudad @ sacral curve
CR for AP axial Coccyx 10° caudad @ 2" ↑ to pubic symphysis
CR for PA axial Coccyx 10° cephalad @ coccyx
Area of interest for AP or PA axial Sacrum & Coccyx Sacrum or Coccyx free of superimposition
True or false? Females can be shielded for sacrum & coccyx x-rays.
False
IR for Lateral projection of sacrum, Ⓡ or Ⓛ 24 x 30 cm (10 x 12")
1
IR for Lateral projection of coccyx, Ⓡ or Ⓛ 8 x 10" (18 x 24 cm ↕)
Area of interest for Lateral projection of sacrum & coccyx, Ⓡ or Ⓛ
lateral sacrum & coccyx
Location of IR for Lateral sacrum & coccyx, Ⓡ or Ⓛ IR CTR to CR w/ sacrum or coccyx to midline of grid
CR for Lateral sacrum, Ⓡ or Ⓛ ⊥ to ASIS level @ point 3½" (9 cm) posterior
CR for Lateral coccyx, Ⓡ or Ⓛ ⊥ toward point 3½" (9 cm) posterior to ASIS & 2" (5 cm) ↓
Respiration fof Lateral sacrum & coccyx Suspend
What is AP/PA* scoliosis series also known as? Ferguson method
IR for PA projection of thoracolumbar spine, scoliosis series, Ferguson method
14 x 36" (35 x 90 cm) or 14 x 17" (35 x 43 cm) ↕
Position of patient for PA thoracolumbar spine, scoliosis series, Ferguson method
seated or standing
Location of IR for PA thoracolumbar spine, scoliosis series, Ferguson method
Bottom of IR 1" (2.5 cm) ↓ to iliac crests
CR for PA thoracolumbar spine, scoliosis series, Ferguson method
⊥ to midpoint of IR
True or False? Patient support or compression bands are NOT to be used in PA thoracolumbar, Ferguson method radiographs.
True
Respiration for PA thoracolumbar spine, scoliosis series, Ferguson method
Suspend
How many radiographs are taken for PA thoracolumbar spine, scoliosis series, Ferguson method
2; 1st normal seated/standing & 2nd w/ hip or foot elevated
Area of interest for PA thoracolumbar spine, scoliosis series, Ferguson method
comparison to distinguish deforming or primary curve from compensatory curve in patients w/ scoliosis
Skull and Facial Anatomy
QUESTIONS ANSWERSHow many bones make up the cranium? 8
How many bones make up the face? 14
1
Which skull suture is found between the frontal and parietal bone? coronal
What skull bones contain sinuses? ethmoid, frontal, spheniod
The zygomatic arches are part of which bone? temporal
The largest and most dense bone in the face is? mandible
Which skull type is narrow from side to side? dolicocephalic
In a typically shaped head, the petrous pyramids project anteriorly and medially at what angle?
47 degrees
The superior aspect of the sphenoid bone contains a deep depression that contains the:
pituitary gland
The large aperture in the occipital bone contains two large openings that allow blood vessels and nerves to pass through. These two openings are called:
jugular foramen
The thickest and densest portion of bone in the cranium is the: petrous portion of the temporal bone
What type of joint is the TMJ? synnovial-hinge and gliding
How many bones make up the skull? 22
The smallest facial bone is the: lacrimal
Sutures in the skull are classified as what types of joints? synarthrosis
In general, anatomic structures in a person with a dolicocephalic skull would lie how in relationship to the IOML as compared to the mesocephalic skull?`
lower
Skull Anatomy
QUESTIONS ANSWERSList the eight cranial bones. R/L parietal bones, Frontal bone, Occipital
bone, R/L temporal bones, sphenoid, ethmoid
List the 14 facial bones. R/L nasal, R/L lacrimal, R/L maxillary, R/L palantine, mandible, vomver, R/L nasal conchae, R/L zygomatic
List the four main sutures in the skull. coronal, sagittal, lambdeoidal, squamosal
1
Junction of the parietal bone, squamosal suture and the greater wing of the sphenoid.
Pterion
Junction of coronal and sagittal sutures. Bregma
What are the three regions of the base of the skull (cranial floor)?
anterior, middle, posterior cranial fossas
What bone is the cribiform plate located on? Ethmoid bone
Lambda Junction of sagittal and lambdoidal suture
What bone is the sella turcica located on? Sphenoid bone
Asterion Junction of the occipital bone, parietal bone and mastoid portion of the temporal bone.
Perpendicular plate is located on the ______. ethmoid bone
What bone contains the pterygoid processes? Sphenoid bone
Supraorbital forament Hole located on frontal bone; above the orbits
Raised rounded portion found on frontal bone. Frontal eminence
Raised portion located between the cribiform plate and found on the ethmoid bone.
crista gali
AKA eyebrow supracilliary arches
Forament rotendum foramen located on sphenoid bone
What are the two types of cranial bones? calvaria and floor
Which bones are located in the calvaria? 4 bones -frontal, occipital, R/L parietal
Which bones are located in the floor? 4 - ethmoid, sphenoid, occipital, R/L temporal
How many total bones are located in the skull? 22
What are the six aspects of the skull? frontal (anterior), lateral (2), posterior (occipital), vertex (crown), basal (inferior surface)
Which suture is the only paired one? squamosal suture
What are the four foramen found in the sphenoid bone? foramen rotundem, foramen ovale, foramen lacerum, foramen spinosum
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What are the most dense portions of the skull? petrous portions
Largest foramen in the skull. foramen magnum
Soft spongy tissue between compact bone. diploe
Areas of incomplete ossification in infant skulls. Fontanels
A typical skull is termed ________. Mesocephalic
Be able to locate the following: glabella, inner canthus, outer canthus, nasion, infraorbital margin, acantion, gonion, mental point, EAM, Auricular point, Tope of ear attachment
Look at diagram
Smooth elevation between the superciliary carches is the ________.
glabella
Rounded elevation on the frontal bone. frontal eminence
Opening for nerves and blood vessels found in the center of the supraorbital margin.
supraorbital foramen
Nasion midpoint of the frontonasal suture
Horizontal portion of the ethmoid bone cribiform plate
Thick conical process arising from the cribiform plate. cristi gali
Perpendicular plate vertical portion of the ethmoid bone
Air cells in ethmoid contained within the labyrinths; aka ethmoidal sinuses
Scroll shaped processes projecting inferiorly from labyrinths superior and inferior nasal conchae
What bones does the ethmoid bone articulate with? frontal and sphenoid
What bones does the frontal bone articulate with? r/l parietal, sphenoid, and ethmoid bones
How many parietal bones are there? two
Prominent bulge on parietal bone parietal eminence
Which bones do the parietal bones articulate with? frontal, temporal, occipital, sphenoid, opposite parietal
Irregularly wedged shaped bone that resembles a bat with wings.
Sphenoid bone
The sphenoid bone consists of : two greater wings, two lesser wings, body, two pterygoid processes
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Superior surface of sphenoid contains a deep depression called the ______.
sella turcica
Which portion of the skull is measured due to it being the widest point of the head?
parietal eminence
What gland sits in the sella turcica? pituitary gland
The sella turcica is bound anteriorly by the ________ and posteriorly by the _____.
tuberculum sellae and dorsum sellae
Where is the posterior clinoid processes located? Located on the dorsum sellae
Slanted area posterior and inferior to dorsum sellae. clivus
The _____ _____ extends across the anterior portion of the tuberculum sellae.
optic groove
Opening of the optic canal. optic foramen
Comes off of the lesser wings and tuberculum sellae. anterior clinoid process
Bone located at the posteroinferior part of the skull. occipital bone
Where is the pons supported? In the clivus
What are the four parts of the occipital bones? squama, two occipital condyles, basilar portion
Prominent process located between the squama and the foramen magnum externally.
external occipital protuberance
What is another term used instead of external occipital protuberance?
inion
The occipital condyles articulate with the ____. atlas of the cervical spine
Found at the anterior ends of condyles and transmit the hypoglossal nerves.
hypoglossal canals
With what bones does the occipital bone articulate with? r/l parietal, r/l temporal, sphenoid and atlas of c spine
Which portion of the temporal bones contains the organs of hearing and balance?
petromastoid portion
Thin upper portion of the temporal bone squamous portion
The ________ process of the temporal bone articulates with the zygomatic bone of the face.
zygomatic process
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The mandibular fossa receives the condyle of the mandible to form the ______.
TMJ; temporomandibular joint
Skull & Cranium Positioning
QUESTIONS ANSWERSWhat is the routine for skull? Townes, Right Lateral, Left Lateral, PA(SMV @
POI & TLI)
In the Townes (AP Axial), the patient is placed ______ with the ______ perpendicular.
Supine, IOML
The central ray is angled ____ degrees _____ in the Townes AP axial of the skull.
37; caudal
Where does the central ray enter in the Townes AP axial of the skull?
Enters approx. 2-21/2" above the glabella
The CR exits the _____ _____ in the Townes skull. foramen magnum
What is being demonstrated in the Townes skull. Dorsum sellae and posterior clinoid processes visible within foramen magnum, occipital bone, poserior portion of parietal bones
What view is being described: Patient prone, head rested on forehead and nose. OML and MSP perpendicular. CR perpendicular through nasion.
PA
What line is also known as the radiographic baseline? OML - orbitomeatal line
OML is the abbreviation of _______ _____. orbitomeatal line
What is demonstrated in the PA skull. Frontal bone, petrous ridges filling the orbits, crista galli, ethmoid sinus, dorsum sellae
If the patient is unable to do PA skull, what can be done?
AP skull
I the patient is unable to be placed in AP axial Townes, what can be done?
PA Haas method
IOML infraorbitomeatal line
In this projection the mandibular rami, orbital roofs, mastoids, EAM, TMJ's are superimposed, Dorsum sellae is viewed, sella turcica seen in profile.
Right/Left lateral
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In the cross table lateral what is best demonstrated? sphenoid sinus effusion which is indicative of a basilar skull fracture
In the right/left lateral, the patient is prone, the MSP is ____, IOML is _____, and the IPL is ______.
horizontal, parallel, perpendicular
The CR enters ______. Perpendicular to 2" superior to the EAM
How would your CR enter if the main purpose was to examine the sella turcica in the right/left lateral?
CR enter 3/4" superior and 3/4" anterior to the EAM
EAM external auditory meatus
CR perpendicular to IOML through sella turcica3/4" anterior to EAM and entering between angles of mandible. What view is being described?
SMV
SMV is also known as?? Schuller method or submentovertical projection
Describe the positioning for the SMV of skull. Patient supine or upright. Center MSP to film. Extend neck as far back as possible and rest head on vertex. MSP perpendicular. IOML parallel
What is demonstrated in the SMV skull. Superimposition of mandibular symphysis over anterior frontal bone, sphenoidal sinuses, cranial base, foramen ovale and spinosum
If the SMV is contraindicated by the patients condition, what should be done?
VSM (verticosubmental projection)
.
Which specific positioning error is present if the mandibular rami are not superimposed on a lateral skull radiograph?
Rotation
Which specific positioning error(s) is/are present if the Petrous Ridges are projected higher in the orbits then expected for a 15 degree axial projection. What is the positioning error if there's lack of symmetry of the Petrous ridges?
Excessive flexion at the neck, or too much angle on CR. Rotation.
Where will the Petrous Ridges be projected with a 15 degree PA axial (Caldwell) projection on the cranium.
In the lower 3rd of the orbits.
Where is the CR centered for a lateral of the Sella Turcica? What will be demonstrated to tell if I've centered the CR correctly?
3/4" anterior & 3/4 superior to EAM. Will demonstrate the anterior & posterior Clinoid process with no divergence.
Which skull projection best demonstrates the Sella Turcica in profile?
Lateral skull.
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Which imaging modality is usually performed on neonates with a possible intracranial hemmorhage?
Ultrasound
What are the 5 most common errors made during skull radiography? Which 2 of those are the most common?
Rotation, Tilt, Excessive Flexion, Excessive Extension, Incorrect CR angulation. Rotation & Tilt are the most common.
Which skull projection best demonstrates the Clivus in profile?
Lateral
Which focal spot is used for skull projections? Small focal spot.
What is used as the primary control of rotation for a true lateral skull? What is used as 2ndry?
Aligning Mid Sagittal Plane parallel to the IR is primary. The Glabella and Inion should be equal distance to the IR.
What is the primary control of tilt for a lateral skull? Aligning the Interpupillary line perpendicular to the IR is the primary.
What positioning lines can be used to position skull directly in the center of the IR for a lateral skull?
Aligning the IOML parallel to the transverse axis of the IR
What is the general centering point for the CR on a lateral skull?
CR centered 45 degrees anterosuperior 1" from TEA (diagonal).
What can be used to assess for rotation on a lateral skull radiograph?
The posterior edge of the Rt & Lt mandibular rami should be superimposed.
What can be used to asses for tilt on a lateral skull radiograph?
The Rt & Lt orbital plates on the horizontal portion of the frontal bone should be superimposed. If there's scissor effect, there's tilt.
Why must a patient be cleared from a X-table lateral C-spine prior to performing a x-table lateral skull?
Because the patient's head must be lifted up to place a sponge underneath the patient's head for the x-table lateral skull.
For the PA Axial (Caldwell) method, how much and which direction should the CR be angled? Where should it be centered?
CR angled 15 degrees caudad to the OML. The CR should exit at the Nasion.
What can be used to assess that patient is in the correct position for a PA (caldwell) Axial Skull projection? What's used to assess for rotation?
Face flat to IR with head flexed. Check that OML is perpendicular to the IR. Align MId Sagittal Plane perpendicular to IR. The Mastoid Tips should be equidistant to determine rotation. The ankles can be tugged to line the patient up.
What alternate projection can be used on a trauma/unconscious patient instead of a PA Axial (Caldwell) skull? How much and which direction is the CR angled? Where is it centered?
The Reverse Caldwell. AP Axial skull. The CR is angled 15 degrees cephalic to the OML and centered at the Nasion.
What can be assessed on the PA Axial (Caldwell) and The Petrous Pyramids should be projected into the
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AP Axial (Reverse Caldwell) radiograph's to be sure the patient and CR is in the correct position? What can be done to correct it?
lower 1/3 of the orbits. CR angle may be too little, or too much. Or the OML may not be truly perpendicular to the IR.
What is used to assess for rotation on the PA Axial (Caldwell or AP Axial (Reverse Caldwell) radiograph's?
Equal distance from mid lateral orbital margins to lateral wall of cranium on each side to assess for rotation.
When using a 30 degree caudad angle for the AP axial (Towne Method) projection of the skull, which positioning line should be perpendicular to the IR? Which cranial bone is best demonstrated with the Towne Method?
The OML (OrbitoMeatal Line). The Occipital bone.
What is a fracture that may produce an air-fluid level in the sphenoid sinus?
Basal Skull Fracture
What is a destructive lesion with irregular margins? Osteolytic Neoplasm
What is another name for a "PIng Pong" fracture? Depressed skull fracture
What is a tumor that may produce erosion of the Sella Turcica?
Pituitary Adenoma
What's another name for Osteitis Deformans? Paget's Disease
What's the name for a tumor that originates in the bone marrow?
Multiple Myeloma
Does Paget's disease require an increase in exposure factors?
Yes
On a properly positioned AP Axial (Towne's Method) projection, where should the Dorsum Sellae be placed into the middle aspect of?
Foramen Magnum
If the patient cannot flex their neck to bring the OML perpendicular to the IR, what positioning line can the technologist bring perpendicular to the IR and how much CR angle?
The IOML can be perpendicular and the CR angle can be 37 degrees caudad instead of 30 degrees caudad.
Where is the CR centered for a lateral skull? Where is the CR centered for a lateral projection of the Sellae Turcica?
2" superior to the EAM, halfway between the Frontal Eminence and the Inion, or $5 degrees anterosuperior (diagonal) from the TEA. For the Sella Turcica the CR should be centered 3/4" anterosuperior to the EAM.
Which skull positioning line is placed parallel to the IR for the SMV projection?
The IOML
What CR angle must be maintained for the AP Axial (Towne's Method) projection? How much angle should
30 degrees caudad to the OML? 37 degrees caudad.Center to the mid sagittal plane 2 1/2 "
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be used when positioning the IOML perpendicular to the IR? Where is the centering for the Towne's? Which part should the CR traverse through?
superior to the Glabella, or 1 1/2" superior to the Superciliary Arch. Through the Sellae Turcica (3/4" anterosuperior to EAM)
What is the Haas Method (WHich projection and CR angle)? Which level should the CR exit at?
A PA axial skull with the CR angled 25-30 degrees cephalic. CR should exit 1 1/2" superior to the Nasion.
Facial Bones
QUESTIONS ANSWERShow many bones make up the skull 8 cranial bones & 14 facial bones
what are the facial bones 2maxillae/maxillary,2zygomagtic,2lacrimal,nasal,inferior nasal conchae,2palatine,1vomer,1mandible
what is the largest facial bone mandible bone
what is the largest moveable bone maxillae/maxillary bone
each maxilla assists in the formation of 3 cavities
mouth, nasal cavity, one orbit
each maxilla consists of what a body & 4 processes projecting from the body
the body of each maxilla is located where
centrally located portion that lies laterally to the nose.
what are the four process of the maxilla
frontal process,zygomatic process,alveolar process,palatine process
the body of each maxillary bone contains a large air filled cavity known as a
mazillary sinus
the palatine process can only be demonstrated
on an inferior veiw of the 2 maxillae
what forms the anterior portion of the roof of the mouth called the hard/bony palate
the 2 palatine process
Facial Positioning
QUESTIONS ANSWERSWhere is the CR centered for a lateral projection of the Facial Bones?
Perpendicular and entering the lateral surface of the zygomatic bone, halfway between the outer canthus
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and the EAM
Which line is Parallel to the transverse plane of the IR for a lateral projection of the Facial Bones?
IOML
What does the Lateral projection of the Facial Bones show?
All facial bones in their entirety with the zygomatic bone in the center
What other name does the Parietoacanthial Projection have?
Waters Method
Where is the CR directed for a Waters method? Exits the Acanthion
What is the degree of angle the OML forms with the plane of the IR when doing a Waters view?
37 degrees
What line will be almost perpendicular to the plane of the IR when doing a Waters view?
MML
Which plane is perpendicular to the IR for a Waters view?
MSP
Where should the IR be centered for a Waters view? Acanthion
What structures will be seen on a Waters projection of the Facial Bones?
Petrous ridges projected immediately below the Maxillary Sinuses, Maxillary Sinuses, Orbits, Zygomatic Arches and Maxilla
What part of the patients head will be placed on the IR for a Waters view?
Chin
When doing a Modified Waters, the OML is adjusted to form an angle of ______ degrees with the plane of the IR?
55
Where are the Petrous Ridges projected on a Modified Waters View?
Just below the inferior border of the Orbits, midway through the Maxillary Sinuses
What does the Modified Waters demonstrate better than the original Waters?
Blow out fractures
What line is perpendicular to the IR for a Reverse Waters view?
MML
When is the Reverse Waters view done? Trauma, or when the patient can not set up or turn over on their stomach
What is the degree of angulation of the CR for a Reverse Waters view?
0, Perpendicular
When would you angle the CR for a Reverse Waters view?
Trauma
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Where does the CR exit on a Caldwell projection of the Facial Bones?
Nasion
What is the degree of angulation of the CR and in what direction for the Caldwell Facial Bones projection?
15 degrees, Caudad
On a Lateral projection of Nasal Bones, what line is parallel to the transverse plane of the IR?
IOML
What line is perpendicular to the plane of the IR for Lateral Nasal Bones?
IP
Where does the CR enter on a Lateral view of the Nasal Bones?
Perpendicular to the bridge of the nose and at a point 1/2 in distal to the Nasion
Why do both Laterals for Nasal Bones? Comparasion
Where does the CR enter on an SMV projection of the Zygomatic Arches?
Perpendicular to the IOML and entering the MSP of the throat approx. 1 in posterior to the Outer Canthi
How do you position the patients head for an SMV of the Zygomatic Arches?
Hyperextend neck completely so that the IOML is nearly parallel to the IR; Vertex of skull is placed on IR
What structures will be shown on the SMV projection of the Zygomatic Arches?
Both Zygomatic Arches free of overlying structures; Symetric without foreshortening with no rotation
What types of film can be used to image the nasal bones?
Occlusal and Regular film
What projections of the Zygomatic Arches will demonstrate both arches on the same film?
AP Axial(modified townes) and SMV
What projection of the Zygomatic arches is similar to the Tangential projection?
SMV
What line is parallel to the IR on a Tangential projection of the Zygomatic arches?
IOML
What degree is the MSP of the patients head rotated and in what direction, for the tangential projection?
15 degrees towards the affected side
What direction is the top of the patients head tilted and how many degrees, for the Tangential projection?
Away from the side being examined, 15 degrees
Where is the CR directed for the Tangential projection of the Zygomatic arches?
Perpendicular to the IOML and centered to the Zygomatic arch at a point approximately 1in posterior to the outer canthus
What is the main reason a Tangential projection is done Depressed fractures of the arch or flat cheekbones
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for the Zygomatic arches?
When doing an AP Axial projection of the Zygomatic arches, what line is perpendicular to the IR?
OML
Where is the CR directed for a Modified Townes projection of the Zygomatic arches?
Glabella
What is the degree of angulation for the Zygomatic arches if the IOML is used and in what direction for the Townes method?
37 degrees, Caudad
What part of the patients face is touching the IR for a PA projection of the Mandibular Rami?
Nose and Forehead
What line will be perpendicular to the IR for a PA projection of the Rami?
OML
Where is the CR directed for a PA projection of the Rami?
Exit the Acanthion
What projection of the mandubilar rami is angled 20-25 degrees cephalad and exits the acanthion?
PA Axial projection of mandibular rami
In the PA Axial projection of the mandibular rami, what line is perpendicular to the IR?
OML
In the PA projection of the mandibular body, where is the CR directed?
Perpendicular to the level of the lips
What line is perpendicular to the IR on a PA mandibular body projection?
AML
On a PA Axial projection of the mandibular body, what is the degree of angle and in which direction does the CR enter?
30 degrees, cephalad
Where is the CR directed on the PA axial mandibular body projection?
Midway between the TMJ's
What line is perpendicular to the IR on the PA Axial mandibular body projection?
AML
On an Axiolateral oblique projection of the mandible,the head is in a _________ position and the _______ line is perpendicular to the IR.
Lateral, IP
What part of the mandible is parallel with the transverse axis of the IR on an Axiolateral Oblique?
The mandibular body
The CR is directed _____ degrees, __________ to pass through the mandibular region of interest on all
25, cephalad
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mandibular axiolateral images.
For an Axiolateral Oblique of the mandibulal ramus, the head is to be in what position?
True lateral
For an Axiolateral Oblique of the manbilular body, the head is in what position?
Laterally and rotated 30 degrees towards the IR
For an Axiolateral Oblique of the Mandibular symphysis, the head is in what position?
Laterally and rotated 45 degrees towards the IR
What projection of the mandible shows the neck the best?
Axiolateral Oblique
Where does the CR enter on an SMV projection of the mandible?
Centered between the angles of the mandible
On an AP Axial projection of the TMJ'S, what direction and to what degree is CR angled?
35 degrees, caudad
Where is the CR directed on an AP Axial projection of the TMJ's?
Midway between the TMJ's and 3 in above the nasion
What line is perpendicular to the IR on an AP Axial of the TMJ's?
OML
On an Axiolateral of the TMJ'S, the MSP is ________, and the IP is __________ to the IR.
Parallel, perpendicular
Where does the CR enter on an Axiolateral projection of the TMJ's?
1/2 in anterior to the EAM, and 2 in superior to the upside EAM
What position is the head in for the Axiolateral TMJ? Lateral
In an Axiolateral Oblique of the TMJ's, the CR is directed in what direction and what angle?
Caudad, 15 degrees
The ______ is parallel with the transverse plane of the IR, on an Oblique TMJ.
AML
The MSP of the head is rotated _____ degrees towards the IR on the Oblique TMJ.
15
The CR is centered ____ in anterior to the EAM for the Oblique TMJ's.
1/2
The CR is directed _____degrees _______, exiting the TMJ closest to the IR and enters _____inches superior to the ______.
15, Caudad, 1 1/2, EAM
What projections of the mandibular rami will show medial or lateral displacement of fractures?
PA, PA Axial
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Waters, Caldwell, Lateral
QUESTIONS ANSWERSFor a lateral projection of the facial bones, the IR is centered to the: zygomatic bone
What baseline is placed parallel to the transverse axis of the IR for a lateral projection of the facial bones?
infraorbitomeatal
For a lateral projection of the facial bones the CR will enter the: halfway between the outer canthus and the EAM
The lateral projection clearly demonstrates the: all facial bones in their entirety
For the Waters method, the orbitomeatal line is placed at what angle to the IR?
37 degrees
Where is the CR for the parietoacanthial projection of the facial bones? acanthion
Which facial bones are clearly demonstrated in the parietoacanthial (Waters) projection?
orbits, maxillae, zygomatic arches
The parietoacanthiomeatal of the facial bones is often modified so there is less angulation of the facial bones, the orbitomeatal line is adjusted to what angle?
55 degrees
What baseline is placed perpendicular to the IR for the acanthioparietal projection of the facial bones?
mentomeatal line
Trauma patients may arrive in the department with their ahead mobilized, a reverse waters can be performed by adjusting the CR to be parallel to the:
mentomeatal line
The CR angulation for the Waters method is: 0
In the parietoacanthial projection, the orbital floor should be: perpendicular to the IR and parallel to the CR
The parietoacanthial projection requires the CR to exit the: acanthion
To correct positioning for a situation where the petrous pyramids are projected in the maxillary sinuses for a parietoacanthial projection a technologist should:
extend the chin
The best single projection for facial bones is: parietoacanthial (Water)
The best projection for orbital fractures is the: Modified Waters
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Mastoid, Outer, Middle & Inner Ear
QUESTIONS ANSWERSWhat are the 3 aspects of the Temporal bone? Which aspect of the Temporal bone is considered the densest?
Squamous portion, Mastoid portion & Petrous portion. The Petrous portion is the densest.
Which structure makes up the cartilaginous, external ear?
The Auricle or Pinna
How long is the average External Acoustic Meatus (EAM)?
2.5 cm (1")
Which small membrane marks the beginning of the middle ear?
Tympanic membrane (eardrum)
What is the collective term for the small bones of the inner ear?
Auditory Ossicles
Which structure allows for communication between the nasopharynx & middle ear? What is the major function of this structure?
Eustachian tube (auditory tube. To equalize atmospheric pressure within the middle ear.
What are the 3 auditory ossicles? Malleus (hammer), Incus (anvil), Stapes (stirrups)
What is the name of the thin plate of bone that separates the mastoid air cells from the brain?
Tegman Tympani
Which one of the auditory ossicles pick up sound vibrations from the tympanic membrane?
Malleus (hammer)
Which structure serves as an opening between the mastoid portion of the temporal bone & the middle ear?
Aditus
Which one of the auditory ossicles is considered to be the smallest?
Stapes (stirrups)
Which one of the auditory ossicles resembles a pre-molar tooth?
Incus (anvil)
What is the name of the small membrane that connects the middle to the inner ear? What is it located between?
Oval Window (Vestibular window). Between the Stapes & Vestibule (central portion of bony labyrinth.
Which two sensory functions occur within the inner ear?
Hearing & equilibrium
What is the name of the small membrane that will move outward to transmit impulses to the auditory nerve, thus creating the sense of hearing? Where is structure.
Round window (Cochlear window). At the base of the cochlea.
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Is the cochlea a closed system relating to the sense of hearing? Why?
Yes. Because of its connection to the stapes through the oval window.
How will the doctor diagnose a cholesteatoma, or neuroma?
If the height of the Internal Auditory Canal (IAC) isn't consistent. A neuroma will erode the bone in the IAC.
What are the 3 semi circular canals? What portion of the bony labyrinth do they come off? What senses do the semi circular canals relate to?
The posterior semi circular canal, lateral semi circular canal & superior semi circular canal. Off the Vestibule. To a sense of direction or equilibrium (balance).
What are the 3 parts of the Osseous (bony) labyrinth? The cochlea, vestibule & Semi circular canals.
What are the 2 main parts that the internal ear is divided into?
Osseous (bony labyrinth) & Membranous labyrinth.
Where is the Membranous labyrinth located? What is it lined with? Where does the fluid come from?
Inside the osseous labyrinth (in the cochlea). With fluid & membranous lining that transmit sound. from the endolymph duct.
What passes through the Internal Acoustic Meatus (IAM)?
Auditory nerve & blood vessels.
Which of the middle ear structures is most lateral? The Malleus (hammer).
What is the opening between the Epitympanic recess & the Mastoid portion of the temporal bone?
The aditus.
Which auditory ossicle attaches to the oval window? Stapes (stirrups)
What is a benign, cyst-like mass of the middle ear? Cholesteatoma
What are the 3 main parts of the middle ear? Tympanic membrane (eardrum), Auditory ossicles & the Tympanic cavity.
What are the 2 parts of the tympanic cavity divided into? Where are they.
Tympanic cavity proper is inferior & epitympanic recess (attic) is superior. They are located in the middle ear.
Where is the Drum Crest or Spur located? Attached to the tympanic membrane that separates the external acoustic meatus from epitympanic recess (attic)
For Stenver's view, what will semi circular canals appear as? Which 3 points should be on the IR? How is patient's head rotated? How much & which direction is CR angled? Where is CR centered? How does the affected petrous ridge position relate to the IR?
As a star. The forehead, nose & cheek. IOML perpendicular to front of IR, skull rotated 45 degrees from lateral. CR angled 12 degrees cephalic. Along the IOML & on the anterior aspect of the sideburns. The affected petrous ridge will be parallel to IR.
What is the Schuller method for the demonstrating Patient skull positioned in a true lateral (affected side
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Mastoids? on IR) with CR angled 25 degrees caudad centered 1" posterior to the EAM.
What is the Law method for demonstrating the Mastoids? What does it do to the ossicles & mastoid air cells?
Patients skull rotated 15 degrees from lateral nose down, with the CR centered 1" posterior to EAM on side down. It elongates the ossicles & mastoid air cells.
Which projection puts the Mastoid tip (process) in profile?
Stenver's projection.
What is the Owen method? Head is rotated 30 degrees (nose up) from lateral & a 30 degree caudad CR angle exiting at the Mastoid side down.
What is the Meyer method? What does it demonstrate?
head rotated 45 degrees with a 45 degree CR angle. Demonstrates the chain of connection between the ossicles.
Which projection will demonstrate petrous ridges at to the mid-orbital level? How much CR angle is used?
Modified PA caldwell with a 10 degree caudad angle to OML.
What is the large chamber within the mastoid portion that connects to the aditus?
The antrum
What is an Arcelin method for the petromastoid region?
A reverse Stenver's. Patient's head rotated 45 degrees, CR 12 degrees caudad centered 1" anterior & superior to TEA on side up
Sinuses
QUESTIONS ANSWERSWhat are the views for Sinuses? Lateral, Caldwell, Waters, SMV
In the views of sinuses, the patient is always _______ and the CR is __________.
upright, horizontal
Describe the patient’s position in the Lateral Sinuses.
Patient is upright in an RAO or LAO with te head turned lateral
What line(s) are parallel and which line(s) are perpendicular?
MSP and IOML are parallel, IPL is perpendicular
What is the entrance point of the central ray for lateral sinuses?
perpendicular, entering 1/2 - 1" posterior to outer canthus
What is demonstrated in Lateral Sinuses? All four sinus groups, superimposed orbital roofs, mandibular
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rami, sinuses clearly visible, air/fluid levels, no rotation of sellla turcica
Which group of sinuses are primarily seen? sphenoid
What SID is used for the lateral sinuses? When is the SID changed?
40" SID except when for pre-op it should be done 72" SID
If patient is unable to sit upright for lateral sinuses, what can be done to show air/fluid levels?
cross-table lateral
What kVp do we use for skull work? 65-75 kVp
Describe the patients position for the Caldwell Sinuses?
Upright, OML perpendicular and then lift chin up so that the OML is 15 degrees from perpendicular
The central ray exits the ______ in the Caldwell Sinuses.
nasion
What is the angle of the CR in the Caldwell Sinuses?
There is no angle. The CR is perpendicular.
What is demonstrated in the Caldwell Sinuses?
Frontal sinuses above the frontonasal suture, ethmoid sinuses above the petrous ridges, Petrous ridges in lower 1/3 of orbit, lateral borders of skull equal, close collimation
What is another name for the Waters sinuses view?
parietoacanthial projection
Describe the patients position in the Waters sinus view?
Patent is upright with chin extended. MML perpendicular.
The OML forms a ________ to film in the Waters sinus view.
37 degree angle
The central ray exits at the ______. acanthion
Petrous pyramids inferior to floor of maxillary sinuses, maxillary sinuses ar demonstrated in what view of the sinuses?
Waters
SMV stands for ________. submentovertical
Describe the patients position for the SMV sinuses.
Patient is upright with neck extended back to place the crown of head on IR.
What line is parellel to the film? IOML
In the SMV sinuses, the CR enters _______ to the ______ throught the _______.
perpendicular, IOML, Sella turcica
If an SMV sinuses is not able to be done, what Open mouth Waters
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other method can be done?
What is best demonstrated in the SMV sinuses?
sphenoidal and ethmoidal air cells
What is demonstrated in the SMV sinuses? sphenoidal and ethmoidal air cells, anterior frontal bone superimposed by mandibular symphysis, mandibular condyles anterior to petrous pyramids, no rotation
Orbits
QUESTIONS ANSWERSWhat are the projections done for orbits? Waters, Lateral of affected side, PA Axial, Rhese PA
bilateral
In the Waters orbits, the OML is perpendicular and the MML forms a 37 degree angle to the table. T or F
False, the MML is perpendicular and the OML forms a 37 degree angle to the IR
What is the main reason for doing a Waters with the orbits?
To see a blow out fracture
Describe the patient’s position in the Waters orbits? Patient is prone or upright, chin in table
Central ray is _______ and exits the _______ in the Waters orbits.
Perpendicular; acanthion
In the Waters orbits the petrous ridges are located where?
Located below the maxillary sinuses
In the Lateral orbits, which side do we do? We do the affected side
Describe patients position and positioning lines used in Lateral orbits projection.
Pt. is semi-prone with affected side against film; IPL perpendicular, MSP paralle, IOML parallel
In the Lateral orbits the central ray is ______. perpendicular through the outer canthus of the affected side
What is demonstrated in the Lateral orbits? Orbital roofs superimposed
PA axial orbits: Describe central ray direction and exit or entrance point.
Central ray is angled 20-25 degrees caudal (30 degrees merrils) and exits at the level of the inferior margin of the orbit
Describe patients position for the PA axial orbits. patient is prone or upright, Forehead and nose resting on table, OML perpendicular, MSP perpendicular
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In the PA axial orbits the petrous ridges are located ______.
below the superior orbital fissures
What is most importantly demonstrated in the PA axial orbits?
Orbits free of superimposition by the petrous ridges
Which method is used to demonstrate the optic foramen in inferior lateral corner of orbit side down and outer rim of side up?
Rhese PA parieto orbital oblique
In the PA Rhese the patient is prone and the head is rotated so MSP forms a _____ from the IR.
53 degree angle from IR
What is the central ray direction and entrance point in the Rhese PA orbits?
perpendicular through the inner canthus side up
In the Waters Orbits, what is demonstrated? petrous ridges below the maxillary sinuses, blowout orbital fractures, no rotation
Nasal Bones
QUESTIONS ANSWERSWhat is the routine for nasal bones? Caldwell, Waters, Hard lateral, Soft Lateral
What is another name for the Waters nasal bones? parietoacantial
In this view the patient is placed prone with the chin resting on the table. OML forms a 37 degree angle to film.
Waters
The CR in the _______ is angled 15 degrees caudal, exiting the nasion.
Caldwell nasal bones
In the Waters nasal bones the CR is _______. Perpendicular and exiting the acantion
Describe the position for the Caldwell nasal bones. Patient is prone with forehead and nose touching table. OML perpendicular.
What is the difference between a hard and soft lateral nasal bones.
hard is done with AEC while the soft is table top with a manual hand technique
Describe patients position for hard/soft lateral nasal bones. Patient is prone, supine pr cross-table, IPL perpendicular
What is demonstrated in the hard lateral nasal bones? frontonasal region
What is demonstrated in the soft lateral nasal bones? Soft tissue frontaonasal region, nasal bones, nasion and acanthion
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Which side is done in the hard/soft lateral? only the affected side
Mandible
QUESTIONS ANSWERSWhat projections are done for the mandible? PA, PA Axial, Axiolateral oblique bilateral
In the PA mandible, what is the position of the patient? Patient is prone or upright
The ___ and ___ are perpendicular to the IR in the PA mandible.
OML, MSP
Where does the CR exit in the PA mandible? exits the acanthion
Mandibular body and rami, medial or lateral displacement of the fragments in fractures of the rami are demonstrated in what view of the mandible?
PA
CR is angled 20-25 degrees cephalad and exits the acanthion is the description of the central ray in what view of the mandible?
PA Axial
Patient position for PA Axial. Patient is prone or upright, OML is perpendicular, MSP perpendicular
What is demonstrated in the PA Axial mandible? Mandibular body and rami symmetric, condylar processes, entire mandible
In what view do we see the entire mandible (mentum to condyle) and no overlap of the mandibular body by the opposite side of the mandible?
Axiolateral Oblique
Describe the patient’s position for the Axiolateral Oblique of the mandible.
The patient is semi-prone or supine or upright. Adjust head so that the broad surface of the mandibular body is parallel to the plane of the IR
Mastoids
QUESTIONS ANSWERSWhat are the views for Mastoids? Townes, Laws (R/L), Stenvers (Posterior Profile
R/L), Arcelin (Anterior Profile R/L)
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In the Townes mastoids, what lines are used for positiong?
OML or IOML, MSP
Whatis the patients position in the Townes Mastoids? patient is supine or upright
The OML/IOML is _______ to the IR in the Townes mastoids.
perpendicular 30 degrees for OML, perpendicular 37 degrees for IOML
The central ray is angle ______ degrees _____ if using the OML in the Townes mastoids.
30, caudad
How much do you angle using the IOML line in the Townes mastoids? Which direction?
37, caudad
Enters at the hairline (approx. 2 1/2" sup. to nasion)passing through the EAM's is the description of the central ray entrance for what view of the Mastoids?
Townes
What is demonstrated in he Townes mastoids? Petrosa above the base of the skull, Dorsum sella (posterior clinoid process) seen witin the shadow of the foramen magnum
What is another name for the Laws view for the mastoids?
axial lateral oblique
Describe the patient’s position in the Laws mastoids view.
Patient is prone or uprigt.Patient is placed in a lateral position and skull is rotated 15 degrees towards the table (toward nose)
In the Laws view of the mastoids, what is the CR entrance?
Angled 15 degrees caudal entering appprox. 2" superior and 2" posteriorto EAM (toward toes)
Where does the CR exit in the Laws mastoids? exits 1" inferior to the mastoid tip
What is mainly demonstrated in the Laws view of the mastoids?
mastoid air cells
What is demonstrated in the Laws view of the mastoids?
mastoid air cells (side down), opposite mastoid not superimposing byt lying inferior and slightly anterior to mastoid of interest, auricle of ear not superimposing mastoid, superimposition of internal and externl auditory meati, TMJ visible
Which side do we image in the Laws mastoids view? both
In the Stenver's view the patient is placed supine with their head rotated 45 degrees away from side being examined. T or F
False - the patient is prone with their forehead,nose and zygoma restng on the table (3 point landing)
I the Stenvers view of the mastoids the MSP forms a ____ degree angle to the plane of the film. The IOML
45, parallel
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is _____ to the film.
Describe the CR entrance and exit in the Stenver's view of mastoids.
CR is angled 12 degrees cephalad and enters approx. 3-4" posterior and 1/2" inferior to the EAM of side up; CR exits anteior to the EAM to side down
Mastoid rocess (tip) in profile below the margin of the cranium (side down), petroa of interest parallel with the plane of the film, profile of petromastoid portion closest to the IR, collimation to petrosa/mastoid region. Demon. in what view of mastoids?
Stenvers
Describe the patients position in the Arcelin view of mastiods?
Patient is supine, Head is rotated 45 degrees away from side being examined
IOML is parallel to plane of the IR in the Arcelin view. T or F
True
CR is angled 10 degrees cauded enterng approx. 1" anterior and 3/4" superior to EAM. Which view of mastoids?
Arcelin (anterior profile)
What views are done to see the tip of the mastoids best?
Stenvers (posterior profile) and Arcelin (anterior profile)
What is demostrated in the Acelin view of mastoids? petromastid portion of side arthest from IR; mastoid process in profile below margin of cranium, collimation of petrosa and mastoid region
The affected side is imaged in the arcelin view of mastoids?
false - we do both sides right and left
TMJ's
QUESTIONS ANSWERSWhat views are done for the TMJ's? PA Axial, Laws (R/L open mouth),Laws (R/L
closed mouth)
In the PA Axial the patient is placed in what position? Prone with their forehead and nose on the table, mouth open
In the PA Axial, the ___ is perpendicular. OML
Desribe the CR entrance in the PA Axial. CR is angled 25 degrees cephalad through the level of the TMJ's
What is demonstrated in the PA Axial? Condyar processes and rami with no rotation
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Patient prone or upright in RAO or LAO. Head lateral then rotate 15 degrees towards table. Descibes what view of TMJ's.
Laws
What lines are used for patient positioning? IPL perpendicular, MSP parallel, AML parallel
In the Laws TMJ's the CR is angled __ degrees ______, exits through the TMJ closest to the film (3/4" su. to EAM side up)
15, caudad
TMJ articulation clearly visualized on side down, condyles ad necks. Which view demonstrates this?
Laws
What is the main difference between what is demonstrated in the Laws open mouth and Laws closed mouth?
Condyle lying in mandibular fossa in closed mouth; condyle lying inferior to articular tubercle in open mouth
What does AML stand for? acanthiomeatal line
