Finals Rad Procedures

Which humeral epicondyle is larger and more prominent?

Medial Epicondyle

Which side of the proximal forearm is the lateral aspect?

Radial Head

How is the arm and hand positioned in an AP Humerus Projection?

Extend and abduct the arm and supinate the hand

How are the epicondyles positioned in relation to the IR

Parallel to the IR

How do you know that an AP humerus image is a true AP?

Greater tubercles are seen in profile laterally

What epicondyle is visible on an AP Projection of the humerus

Medial and Lateral Epicondyles

How do you know a lateral projection of the humerus is a true lateral?

Lesser tubercle seen in profile medially

What epicondyles are visible in a lateral projection of the humerus?

Medial and Lateral Epicondyles superimposed

When positioning for the proximal humerus, where should the CR be directed?

Perp to surgical neck

What is the breathing instruction given for a transthoracic lateral humerus projection?

Orthostatic Breathing

Where is the CR directed in an AP Shoulder Projection

1” inferior to the coracoid process

How do you position the hand and arm for a lateral internal rotation shoulder projection

Pronate the hand, abduct and internally rotate the arm

How are the epicondyles positioned in relation to the IR on a lateral shoulder internal rotation projection?

Perpendicular to the IR

Where is the CR directed for a lateral shoulder internal rotation projection?

1" inferior to the coracoid process

Where do you center for the glenoid cavity or Grashey method?

Scapulohumeral joint

How much rotation is required in order to place the affected glenoid cavity perpendicular to the IR?

35-45 degrees towards the affected side

What does the Neer method demonstrate?

Demonstrates the coracoacromial arch for the supraspinatus outlet region for possible shoulder impingement

How much caudal angle is used for the Neer method?

10-15 degrees

What does the Lawrence method demonstrate?

Degenerative conditions: osteoarthritis, osteoporosis
Hill-Sachs defect with an exaggerated external rotation

How is the CR centered for the Lawrence method?

Medially 25-30 degrees to the humeral head

Which end of the clavicle has a flat, downward curve and articulates with the acromion process of the scapula to form which joint?

Lateral, acromial end forms the acromioclavicular joint

How is the opposite side to the acromial end of the clavicle shaped and what is it called? What does this end articulate with and what joint does it form?

Medial, sternal end. Triangular and broader. Articulates with the manubrium of the sternum creating the sternoclavicular joint

What is the lateral angle of the scapula also known as?

Head of the Scapula

What is the fossa called on the anterior surface of the scapula?

Subscapular fossa

What is another name for the glenohumeral joint?

Scapulohumeral joint

For the axial clavicle projection, what direction is the angle and to what degree?

Cephalad 15-30 degrees

For the axial projection of the clavicle, when would you angle less?

Angle less for a hypersthenic patient with thick shoulders

When imaging bilateral AC joints, where should the CR be directed?

1” above the jugular notch

What is another name for the bilateral projection of the AC joints?

Pearson Method

For the bilateral AC joint projection, where should the 8-10 lb weights be placed?

Placed on wrists and not held in hands

How do you position the patient in an AP Scapula Projection?

Abduct arm 90 degrees and supinate hand

Where is the CR perpendicular to for the AP Scapula projection?

Mid Scapula

Where should the IR be placed for the AP Scapula Projection?

Top of IR 2" above shoulder and lateral edge of IR 2" from the lateral margin of the rib cage

What breathing technique is employed with an AP Scapula Projection?

Orthostatic Breathing

Which dislocation of the humeral head is more common?

Anterior

Where is the humeral head visualized when it is anteriorly dislocated?

Seen inferior to the coracoid process

What is the movement type of the scapulohumeral joint?

Ball and Socket or Spheroidal

What is the movement type of the sternoclavicular joint?

Plane or Gliding

What is the movement type of the acromioclavicular joint?

Plane or Gliding

Which is an injury of the anteroinferior aspect of the glenoid labrum which may result in an avulsion fracture?

Bankart Lesion

Which is a compression fracture of the articular surface of the posterolateral aspect of the humeral head?

Hill Sachs defect

True/False: The use of automatic exposure control (AEC) is not recommended for the AP projection of the scapula.

True

What projection of the proximal shoulder will demonstrate the lesser tubercle in profile?

Internal rotation

The angle of the head and neck in relation to the femoral body is?

15-20 degrees anterior

The ilium makes up what part and how much of the acetabulum?

Superior 2/5ths

The ischium makes up what part and how much of the acetabulum?

Inferior and posterior 2/5ths

The pubic bone makes up what part and how much of the acetabulum?

Inferior and anterior 1/5th

What is the largest foramen in the body?

Obturator foramen

What are the three ways of locating the femoral neck?

• Find the midpoint of a line between the ASIS and pubic symphysis, the femoral neck is 1 1/2" from this midpoint. The femoral head is 2" from this midpoint.
  

• 1-2" medial and 3-4" distal from the ASIS
  

• Locate greater trochanter, on same plane of the greater trochanter and pubic symphysis

In order to place the femoral neck parallel to the IR and in a true AP projection, the leg must be rotated in what direction and to what degree?

Internally 15-20 degrees

How do you position the leg for the AP proximal femur projection?

Ensure no rotation of the pelvis, separate the legs and feet and internally rotate the affected leg 15-20 degrees

Where is the CR directed for the AP proximal femur projection?

Perp to femoral neck

What anatomy should be visualized for an AP proximal femur projection?

Proximal 1/3 of the femur, acetabulum, ischium, ilium, and any orthopedic appliance in its entirety

How do you know the femur has been properly positioned in the AP proximal femur projection?

The greater trochanter, femoral head and neck should be in full profile without foreshortening. Lesser trochanter should not be projected beyond the medial border

How is the lower leg positioned for the AP projection of the distal femur?

Rotate leg internally 5 degrees for a true AP of the knee

Where should the lower margin of the IR be placed? (AP Distal Femur Proj)

2" below the knee joint

In regard to the patella and fibular head, how do you know that the lower leg has been properly positioned in an AP distal femur projection?

The outline of the patella is slightly toward the medial side of the femur and the medial half of the fibular head should be superimposed by the tibia

Which side of the x-ray tube is the higher intensity side and why?

Cathode since the anode absorbs some of the beam

If using a portrait 14x17, where is the upper edge of the IR placed in a lateral proximal femur projection?

At the level of the ASIS

Is the mid-femur positioned near the anterior or posterior aspect of the thigh?

Nearer to the anterior aspect

How do you know that the proximal femur has been properly placed in a lateral position?

The greater trochanter is superimposed by the neck and femur, the lesser trochanter is slightly visible on the medial side and a minimum of 1" above the hip joint is seen

Where should the lower margin of the IR be placed for the lateral mid-distal femur projection?

Approx 2" below the knee joint

How are the legs positioned in an AP pelvis projection?

Separate legs/feet and internally rotate the entire lower limbs 15-20 degrees

Where is the CR directed for an AP pelvis projection?

Midway between the level of the ASIS and the pubic symphysis (about 2" inferior to the ASIS)

Before rotating the leg for an AP pelvis projection, what must be considered?

Fractures

How much is the femur abducted in order to visualize the femoral neck elongated on a frog-leg projection?

20-30 degrees for femoral neck

How should the IR be placed in a Danelius-Miller trauma hip projection?

Place the IR in the crease above the iliac crest and adjust it so that it is parallel to the femoral neck

Where is the CR directed for the Danelius-Miller method?

Perp to IR and to the femoral neck

What is the Clements-Nakayama method and why is it performed?

Performed when a patient has limited movement in both lower limbs and the infer superior Danielius-miller method cannot be performed

The brim of the pelvis divides the pelvic area into what two cavities?

The greater and lesser pelvis

Which cavity of the pelvis is considered the false pelvis?

The area superior to the pelvic brim, the greater pelvis

Which cavity of the pelvis is completely surrounded by bony structures and forms the birth canal?

The area inferior to the pelvic brim, the lesser pelvis

Where is the inlet of the true pelvis

The pelvic brim

Where is the outlet of the true pelvis? How is it defined?

The triangle shape created from the tip of the coccyx to the two ischial tuberosities

Is the inlet or outlet of the pelvis considered the superior aperture?

The inlet

Which pelvis is wider from side to side, male or female?

Females

Which pelvis has less flared iliac wings, male or female?

Male

Which pelvis is deeper from front to back, male or female?

Male

What is the angle of the CR and how is it directed for the AP axial outlet projection of the pelvis?

Cephalad 20-35 degrees males, 30-45 degrees for a female

Where is the CR directed for the AP axial outlet projection of the pelvis?

1-2" distal to the superior border of the pubic symphysis

What is the CR angle and where is it directed for the AP axial inlet projection of the pelvis?

40 degrees caudad and directed at the level of the ASIS

For the PO acetabulum projection, what anatomy is the CR directed to?

Femoral Head

For the acetabulum projections, to what degree is the patient rotated?

45 degrees PO

If the affected side is down for an acetabulum projection, how do you locate the femoral head?

Locate the downside ASIS, then go 2" distal and 2" medial

If the affected side is up for an acetabulum projection, how do you locate the femoral head?

Locate the upside ASIS, then go directly 2" distal

What is demonstrated on an acetabulum projection if the CR is on the upside?

Anterior ilio pubic column
Posterior rim of the acetabulum
Open obturator foramen

What is demonstrated on an acetabulum projection if the CR is on the downside?

Posterior ilio ischial column
Anterior rim of the acetabulum
Open iliac wing

What classification, mobility type, and movement type are the sacroiliac joints?

Synovial, amphiarthrodial, limited

What classification, mobility type, and movement type are the hip joints?

Synovial, diarthrodial, spherodial

What classification, mobility type, and movement type is the symphysis pubis?

Cartilaginous, amphiarthrodial, limited

What classification, mobility type, and movement type are the unions of the acetabulum?

Cartilaginous, synarthrodial, immovable

What clinical indication is a congenital condition where a dislocated hip is present at birth?

Developmental dysplasia of the hip

What clinical indication is the most common type of ischemic necrosis? Typically involves one hip with a femoral head and neck not receiving adequate blood supply. Seen in 5-10 yr olds. Limp is the first clinical sign. Radiographically demonstrates a flat femoral head.

Legg-Calve-Perthes Disease

What clinical indication is a disorder of adolescents in which the growth plate is damaged and the femoral head moves with respect to the rest of the femur, The head of the femur stays in the cup of the hip joint while the rest of the femur is shifted. Occurs in 10-16 yr olds during rapid growth.

Slipped Capital Femoral Epiphysis

How much do you rotate an upright patient for an RAO sternum projection?

15-20 degrees

Where do you place the IR for an RAO sternum projection?

Upper portion of IR 1 ½ inches above jugular notch

Where is the CR directed to for an RAO sternum projection?

Perpendicular at the center of the sternum 1" left of the midline

Should AEC be utilized for an RAO sternum projection?

No, use orthostatic breathing

If your patient is supine, which oblique position should they be placed in for an RAO sternum projection?

LPO

If your patient is a trauma and can not be rotated, how might you obtain an image of the RAO sternum?

Angle 15-20 degrees across the patient’s right side (grid landscape)