Radiographic Procedures

General Procedural Considerations

I. BODY PLANES

These are imaginary lines used to describe how the body is divided.

Core Planes:

📌 Board tip:
If MSP is not aligned → image will show rotation (asymmetry)

II. BODY HABITUS

👉 This affects:

• Organ position

• Organ shape

• Exposure technique

• Positioning adjustments

The 4 Types (Memorize differences)

💡 Key Board Rationales:

• Stomach position differs → affects contrast studies

• Hypersthenic → horizontal stomach

• Asthenic → vertical “J-shaped” stomach

👉 Exam trick:
If question says “tall, slender patient” → think asthenic → organs LOW

III. SURFACE LANDMARKS

These help you locate internal organs externally

High-Yield Landmarks:

💡 Board rationale:

• Iliac crest = L4 → used in lumbar spine centering

• Sternal angle = T4–T5 → helps locate carina

IV. SKELETAL MOTION TERMINOLOGY

These describe how body parts move (common exam traps)

V. PRELIMINARY STEPS

This is where many situational questions come from.

Step-by-step with rationale:

1. Read request carefully

   • 👉 Prevents wrong exam

   • Board: “Most important first step?” → THIS

2. Prepare room

   • Clean, ready equipment

   • 👉 Prevents delays & contamination

3. Identify patient

   • 👉 Prevents medical errors (legal issue)

4. Remove artifacts

   • Jewelry, hair, clothing

   • 👉 Prevents image artifacts → misdiagnosis

5. Explain procedure

   • 👉 Improves cooperation → less motion

6. Minimum of TWO projections (90° apart)

👉 VERY HIGH YIELD:

• Frontal → LEFT/RIGHT

• Lateral → ANTERIOR/POSTERIOR

✔ Used for:

• Fractures

• Tumors

• Foreign bodies

7. Use smallest IR size

   • 👉 Reduces radiation dose (ALARA principle)

8. Include joints in long bones

   • 👉 Detect spread of injury

9. Adjust exposure factors

   • 👉 Different positions = different densities

10. Proper labeling

• 👉 Legal + diagnostic accuracy

📸 POSITIONING TERMINOLOGY (COMMON EXAM CONFUSION)

Common Positions:

• Supine → lying face up

• Prone → lying face down

• Erect → standing/sitting

• Decubitus → lying with horizontal beam

Obliques:

VI. IMMOBILIZATION & RESPIRATION

Why important?

👉 Motion = blurred image (loss of detail)

Types of Motion:

Key Methods:

• Short exposure time (MOST IMPORTANT)

• Communication

• Sponges, sandbags

• Immobilization devices

Respiration Rules (BOARD FAVORITE)

📌 Special:

• Hypersthenic → 2nd inspiration

VII. MODIFIED & ADDITIONAL PROJECTIONS

Why needed?

• Trauma patients

• Cannot move

• Pathology present

Examples:

• Cross-table lateral
  👉 Used when patient cannot move
  👉 Prevents further injury

• Erect instead of supine
  👉 More comfortable + better visualization (e.g., air-fluid levels)

💡 Board rationale:

• Radiographer must:

  • Adapt positioning

  • NOT independently add projections

  • BUT may recommend to physician

🔥 FINAL BOARD PEARLS (MUST MEMORIZE)

• MSP misalignment = rotation error

• Hypersthenic = organs HIGH

• Asthenic = organs LOW

• 2 projections at 90° = standard

• Chest = inspiration / Abdomen = expiration

• Motion = biggest enemy of image quality

• Distance & positioning save patients in trauma

Imaging Procedures: Anatomy, Positioning, and Pathology

I. THE SKELETAL SYSTEM

🔑 Core Concept

Osteology = study of bones (206 bones in adults)

🧠 Functions of Bones (COMMON BOARD QUESTION)

• Support → framework of the body

• Protection → e.g., skull protects brain

• Movement → muscle attachment (leverage)

• Mineral storage → calcium & phosphorus

• Hematopoiesis → blood cell production (red marrow)

👉 Rationale:
Boards often test function-based reasoning (e.g., “Which structure produces RBCs?” → bone marrow).

🦴 Bone Tissue Types

👉 Rationale:

• Fractures often occur differently depending on bone type

• Cancellous bone = more vascular → heals faster

🧬 Bone Structure (LONG BONES)

• Diaphysis → shaft (primary ossification)

• Epiphysis → ends (secondary ossification)

• Metaphysis → growth region

• Medullary cavity → marrow space

• Periosteum → outer covering (healing + blood supply)

👉 Board Tip:
Epiphyseal plate = growth plate (kids)
→ disappears → becomes epiphyseal line

🦴 JOINT CLASSIFICATION (VERY HIGH-YIELD)

🧠 Types of Synovial Joints (FREQUENTLY TESTED)

👉 Rationale:
If question asks:
“Which joint allows circumduction but not rotation?” → Condyloid

II. APPENDICULAR SKELETON

Includes:

• Upper limbs

• Lower limbs

• Shoulder girdle

• Pelvic girdle

👉 Rationale:
Most radiographic exams = appendicular → very high board weight

A. UPPER EXTREMITY (ANATOMY + POSITIONING + PATHOLOGY)

✋ 1. HAND & FINGERS

Anatomy Summary

• Metacarpals = 5

• Phalanges = 14

  • 3 per finger

  • 2 in thumb

Joints:

• IP joints → hinge (flexion/extension)

• MCP joints → condyloid (more movement)

📸 POSITIONING (HIGH-YIELD TABLE)

👉 Rationale:

• Oblique = best for joints

• Lateral = shows anterior/posterior displacement

⚠ Common Pathologies

• Phalangeal fractures → crush injuries

• Metacarpal fractures → displacement/rotation

• Scaphoid fracture → most important

👉 BOARD TRAP:

• Scaphoid = poor blood supply → nonunion risk

🖐 2. WRIST

Carpal Bones (SUPER HIGH-YIELD)

👉 Lateral → medial:

Proximal row:

• Scaphoid

• Lunate

• Triquetrum

• Pisiform

Distal row:

• Trapezium

• Trapezoid

• Capitate

• Hamate

👉 Mnemonic (optional):
“Some Lovers Try Positions…” 😏

📸 KEY PROJECTIONS

👉 Rationale:

• Ulnar deviation stretches the scaphoid → better seen

⚠ Pathology

• Scaphoid fracture → FOOSH injury

• Carpal tunnel syndrome → median nerve compression

💪 3. FOREARM

Bones:

• Radius (lateral)

• Ulna (medial)

📸 Positioning

👉 Rationale:

• If not supinated → radius & ulna overlap → WRONG image

⚠ Pathology

• Distal radius fracture → VERY COMMON

• Radial head fracture → FOOSH injury

🔗 4. ELBOW (VERY HIGH-YIELD)

Key Structures:

• Capitulum → radius

• Trochlea → ulna

• Olecranon fossa

📸 PROJECTIONS

🧠 FAT PAD SIGN (BOARD FAVORITE)

• Posterior fat pad = ALWAYS abnormal

• Indicates fracture

👉 Rationale:
Even if the fracture is not visible → assume a fracture

💪 5. HUMERUS

Key Landmarks:

• Greater tubercle

• Lesser tubercle

• Surgical neck

⚠ Pathology

• Surgical neck fracture = most common

• Greater tubercle fracture → muscle pull

🦴 6. SHOULDER (VERY HIGH-YIELD)

Joints:

• Glenohumeral (ball & socket)

• AC joint

• SC joint

📸 KEY PROJECTIONS

⚠ Pathology

• Dislocation (most common = anterior)

• Rotator cuff injury

• AC separation

👉 Board Clue:

• Humeral head under coracoid → anterior dislocation

🧠 POSITIONING PRINCIPLES (ULTRA HIGH-YIELD)

ALWAYS REMEMBER:

1. 2 projections minimum (90° apart)

   • Frontal → left/right

   • Lateral → anterior/posterior

👉 Rationale:
Localization of fractures & foreign bodies

2. Remove artifacts

• Jewelry, hair, clothing

👉 Prevents false pathology

3. Immobilization

• Use sponges, sandbags

• Short exposure time

👉 Reduces motion blur

4. Respiration

• Chest → inspiration

• Abdomen → expiration

5. Trauma Rule
   👉 DO NOT MOVE PATIENT — MOVE THE TUBE

⚠ TYPES OF FRACTURES (BOARD FAVORITE)

🧠 FINAL BOARD STRATEGY (IMPORTANT)

If the question is about:

• Joint movement → know joint type

• Projection → know what it shows

• Trauma → choose the safest method

• Image error → think positioning or artifacts

B. LOWER EXTREMITY & PELVIS – STUDY GUIDE

🦶 1. Foot and Toes

🔹 Bones of the Foot

• 7 Tarsals:

  • Calcaneus (heel bone, largest)

  • Talus

  • Navicular

  • Cuboid

  • Medial (1st) cuneiform

  • Intermediate (2nd) cuneiform

  • Lateral (3rd) cuneiform

• 5 Metatarsals

• 14 Phalanges

  • Big toe = 2 phalanges

  • Other toes = 3 each

🔹 Key Articulations

• Talus + calcaneus → Subtalar joint

• Talus + navicular → ankle-foot connection

• Navicular + cuneiforms

• Cuboid + 4th & 5th metatarsals

🔹 Important Notes

• Calcaneus

  • Attachment of the Achilles tendon

  • Has sustentaculum tali

• 5th metatarsal

  • Has tuberosity → prone to fracture

🔹 Common Conditions

• Calcaneal fracture → fall from height

• Stress fractures → metatarsals (often missed early)

• Hallux valgus → bunion (big toe deviates medially)

• Toe fractures → stubbing/crushing injuries

🦶 2. Ankle

🔹 Structure

• Formed by:

  • Talus

  • Distal tibia

  • Distal fibula
    → forms ankle mortise

🔹 Common Injuries

• Fractures:

  • Medial malleolus

  • Lateral malleolus

• Severe injury → instability or arthritis

🦵 3. Lower Leg (Tibia & Fibula)

🔹 Tibia (Medial, weight-bearing)

• From the knee and ankle joints

• Key landmarks:

  • Tibial plateau → articulates with femur

  • Tibial tuberosity → patellar ligament attachment

  • Medial malleolus

🔹 Fibula (Lateral, non-weight-bearing)

• Landmarks:

  • Head → proximal articulation

  • Lateral malleolus → ankle joint

  • Neck → common fracture site

🔹 Clinical Condition

• Osgood–Schlatter disease

  • Painful tibial tuberosity (young active patients)

🦵 4. Knee

🔹 Bones Involved

• Femur

• Tibia

• Patella

🔹 Joints

• Femorotibial

• Femoropatellar

🔹 Structures

• Menisci (medial & lateral)

• Ligaments:

  • ACL

  • PCL

  • Collateral ligaments

🔹 Patella

• Largest sesamoid bone

• Moves during flexion/extension

🔹 Clinical Notes

• Common injuries:

  • Meniscal tears

  • Ligament injuries

• Patellar fractures:

  • Transverse

  • Comminuted

• Bipartite patella

  • Normal variant (can mimic fracture)

🦴 5. Femur

🔹 General

• Longest & strongest bone

🔹 Key Parts

• Head → fits into the acetabulum

• Neck → common fracture site

• Greater & lesser trochanters

• Linea aspera (posterior ridge)

🔹 Clinical Notes

• Femoral neck fracture → very common

• Risk of avascular necrosis if the blood supply is disrupted

🦴 6. Pelvis

🔹 Composition

• 2 hip bones (innominate bones), each made of:

  • Ilium

  • Ischium

  • Pubis

🔹 Key Structures

• Acetabulum → socket for femoral head

• Obturator foramen

• Iliac crest

• Ischial tuberosity

• Pubic symphysis

🔹 Joints

• Sacroiliac joints

• Hip joint

🔹 Male vs Female Pelvis

• Female pelvis:

  • Wider, shallower

  • Larger pelvic outlet

  • Adapted for childbirth

🔹 Clinical Notes

• Pelvic fractures → may damage:

  • Bladder

  • Urethra

🔗 Articulations Summary

• Sacroiliac

• Hip

• Knee

• Tibiofibular (proximal & distal)

• Ankle

• Intertarsal

• Tarsometatarsal

• Metatarsophalangeal

• Interphalangeal

⚠ Common Pathologies

• Osteoporosis

• Osteomyelitis

• Osteoarthritis

• Gout

• Bone metastasis

• Paget’s disease

• Rickets

• Tendonitis

• Bursitis

💥 Types of Fractures (High Yield)

• Simple – no displacement

• Compound – open fracture

• Greenstick – incomplete (children)

• Torus (buckle) – cortex buckled

• Comminuted – many fragments

• Spiral – twisting injury

• Transverse – straight across

• Oblique – angled

• Stress – repetitive force

• Avulsion – tendon pulls bone

• Pathologic – due to disease

🔹 Named Fractures

• Jones → 5th metatarsal

• Pott’s → ankle (tibia + fibula)

• Trimalleolar → ankle (3 malleoli)

📸 Positioning Key Points (Radiography)

• Remove radiopaque objects

• Keep the patient still

• Use the shortest exposure time

• Use shielding

• Many exams:

  • Foot → tabletop

  • Knee → may need grid

  • Hip/pelvis → usually with grid

• Cross-table lateral → if movement contraindicated

III. AXIAL SKELETON

The axial skeleton forms the central axis of the body and includes:

• Skull (facial + cranial bones)

• Vertebral column

• Thorax (sternum + ribs)

👉 Function:

• Supports the body

• Protects vital organs (brain, spinal cord, heart, lungs)

A. VERTEBRAL COLUMN (Spine)

Composition: 33 vertebrae

• 7 Cervical (C1–C7)

• 12 Thoracic (T1–T12)

• 5 Lumbar (L1–L5)

• 5 Sacral (fused)

• 4 Coccygeal (fused)

👉 Key points:

• First 24 vertebrae = movable

• Last 9 = fused (immovable)

• Connected by ligaments + intervertebral discs

• Discs = amphiarthrotic joints (slightly movable)

🌀 SPINAL CURVES

• Cervical & Lumbar → Lordosis (inward curve)

• Thoracic & Sacral → Kyphosis (outward curve)

⚠ Abnormalities:

• Kyphosis = hunchback

• Lordosis = swayback

• Scoliosis = side-to-side curvature

🧩 TYPICAL VERTEBRA STRUCTURE

Each vertebra has:

1. Body

• Weight-bearing part

2. Neural (Vertebral) Arch

👉 surrounds the spinal cord (vertebral foramen)

🧠 NEURAL ARCH (IMPORTANT 🔥)

Composed of:

• 2 Pedicles

• 2 Laminae

Forms:

• Vertebral foramen → passage of spinal cord

🦴 Supports 7 Processes:

• 2 Superior articular processes

• 2 Inferior articular processes

• 2 Transverse processes

• 1 Spinous process

👉 Functions:

• Movement

• Muscle attachment

• Joint formation

🔍 IMPORTANT PARTS EXPLAINED

🟤 Pedicles

• Short, thick projections from vertebral body

• Form sides of vertebral arch

• Have notches → form intervertebral foramina

👉 Intervertebral foramina:

• Passage of spinal nerves

🟤 Laminae

• Extend posteriorly from pedicles

• Join to form spinous process

⚠ Clinical:

• Failure to fuse → spina bifida

🟤 Processes

• Spinous process → palpable, muscle attachment

• Transverse processes → lateral muscle attachment

• Articular processes → form joints (apophyseal joints)

🔄 MOVEMENTS OF SPINE

• Flexion (forward)

• Extension (backward)

• Lateral bending

• Rotation

🧠 CERVICAL SPINE (SPECIAL FEATURES)

C1 (Atlas)

• No body, no spinous process

• Supports skull

• Allows nodding (yes movement)

C2 (Axis)

• Has dens (odontoid process)

• Allows rotation (no movement)

Typical Cervical Vertebra:

• Small

• Transverse foramina (for vertebral artery/vein)

• Bifid spinous process (except C7)

👉 C7 = vertebra prominens (landmark)

⚠ COMMON CONDITIONS

🟡 Whiplash

• Sudden hyperflexion + hyperextension

• Causes:

  • Neck pain

  • Stiffness

  • Headache

  • Numbness

🟡 Osteoarthritis

• Degeneration of cartilage

• Seen in:

  • Spine

  • Knees

  • Hips

👉 X-ray findings:

• Narrow joint spaces

• Bone spurs (osteophytes)

🦴 THORACIC SPINE

• 12 vertebrae

• Articulates with ribs

• Long, downward spinous processes

⚠ Common issue:

• Osteoporosis

  • Bone weakening

  • Compression fractures

🦴 LUMBAR SPINE

• Largest vertebrae

• Supports most body weight

• Short, thick spinous processes

⚠ Common causes of low back pain:

• Herniated disc

• Muscle spasm

• Osteoarthritis

• Trauma

🦴 SACRUM & COCCYX

Sacrum:

• 5 fused vertebrae

• Connects spine to pelvis

Coccyx:

• 4–5 fused vertebrae

• Tailbone

• Easily fractured from falls

B. THORAX

Sternum:

• Manubrium

• Body

• Xiphoid process

Ribs (12 pairs):

• True ribs (1–7) → attach to sternum

• False ribs (8–10) → indirect attachment

• Floating ribs (11–12) → no anterior attachment

🔥 QUICK MEMORY TIP (EXAM!)

👉 Neural Arch = Pedicles + Laminae
👉 7 Processes = 2S, 2I, 2T, 1 Spinous
👉 C1 = nodding, C2 = rotation

C. HEAD AND NECK — SIMPLIFIED REVIEW

🦴 1. Skull Overview

The skull has 2 main parts:

• Cranium (8 bones) → protects the brain

• Facial bones (14 bones) → form the face

🔹 Cranial Bones (8)

• Frontal (1)

• Parietal (2)

• Temporal (2)

• Occipital (1)

• Ethmoid (1)

• Sphenoid (1)

🔹 Facial Bones (14)

• Nasal (2)

• Lacrimal (2)

• Palatine (2)

• Inferior nasal conchae (2)

• Zygomatic (2)

• Maxillae (2)

• Vomer (1)

• Mandible (1) → only movable bone

🧩 2. Skull Sutures (Immovable joints)

• Sagittal → between parietals

• Coronal → frontal + parietals

• Lambdoidal → parietals + occipital

• Squamous → temporal + parietal

📍 Key landmarks:

• Bregma → sagittal + coronal meet

• Lambda → sagittal + lambdoidal meet

• Pterion → weak area (clinical importance!)

🧠 3. Important Cranial Bones (High-Yield)

🔸 Frontal Bone

• Forms forehead

• Contains frontal sinuses

• Landmark: glabella

🔸 Parietal Bones

• Form top (vertex) and sides of skull

🔸 Ethmoid Bone

• Between orbits

• Key parts:

  • Cribriform plate → olfactory nerves

  • Crista galli

  • Perpendicular plate → nasal septum

🔸 Sphenoid Bone (VERY IMPORTANT)

• “Bat-shaped,” central skull base

• Contains:

  • Sella turcica → pituitary gland

  • Optic canal

  • Foramina (rotundum, ovale, spinosum)

🔸 Occipital Bone

• Posterior skull

• Foramen magnum → spinal cord passes

🔸 Temporal Bone

• Contains ear structures

• Key parts:

  • Mastoid process

  • External auditory meatus

  • Mandibular fossa (TMJ)

🙂 4. Facial Bones Highlights

🔹 Maxillae

• Upper jaw

• Contains maxillary sinuses

🔹 Zygomatic Bones

• Cheekbones

🔹 Nasal Bones

• Bridge of nose (common fracture site)

🔹 Mandible (VERY HIGH-YIELD)

• Only movable bone

• Parts:

  • Body

  • Ramus

  • Angle (gonion)

  • TMJ (temporomandibular joint)

⚠ 5. Common Fractures (Exam Favorite)

• Linear → simple crack

• Depressed → pushed inward

• Blowout fracture → orbital floor

• Hangman’s fracture → C2 injury

• Compression fracture → vertebrae

👁 6. Orbits

Formed by 7 bones:

• Frontal, sphenoid, ethmoid, maxilla, palatine, zygomatic, lacrimal

⚠ Weak point: orbital floor → prone to blowout fractures

🦴 7. Paranasal Sinuses (VERY IMPORTANT)

4 paired sinuses:

📌 KEY PRINCIPLE:

• Must be taken erect → to see air-fluid levels

8. Soft Tissue Neck (Upper Airway)

• Views: AP & Lateral

• Used to assess:

  • Adenoids

  • Airway obstruction

📌 Important:

• Taken during slow nasal inspiration
  → to fill airway with air (better contrast)

📸 9. High-Yield Radiographic Views (Quick Recall)

• PA Skull → frontal bone, sinuses

• Caldwell (PA axial) → frontal + ethmoid sinuses

• Towne (AP axial) → occipital bone

• Waters view → maxillary sinuses, orbits ⭐

• Lateral skull → superimposed structures

• SMV (basal) → skull base, foramina

🧠 Quick Memory Tips

• “8 protect, 14 project” → cranial vs facial bones

• Waters = maxillary sinuses best

• Towne = occipital bone

• Sella turcica = pituitary gland

• Mandible = only movable bone

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IV. BODY SYSTEMS

A. RESPIRATORY SYSTEM

1. 🔹 Basic Anatomy & Function

• Main organs: lungs

• Function:

  • Supply oxygen (O₂) to blood

  • Remove carbon dioxide (CO₂)

Lung Structure

• Shape: cone-shaped

  • Apex → top

  • Base → rests on diaphragm

• Entry/exit point: Hilum

  • Bronchi

  • Pulmonary vessels

Right vs Left Lung

👉 Clinical tip:
Foreign bodies usually go to the right lung (because it’s more vertical)

2. 🔹 Pleura & Lung Conditions

• Parietal pleura → lines chest wall

• Visceral pleura → covers lungs

• Pleural cavity → space between them

⚠ Important Conditions

• Pneumothorax → air in pleural space

• Atelectasis → lung collapse

  • Signs:

    • ↑ density

    • Elevated diaphragm

• Pleural effusion → fluid accumulation

• Thoracentesis → removal of air/fluid

3. 🔹 Chest Radiography (VERY HIGH YIELD)

📸 General Principles

• Done ERECT → to see air-fluid levels

• Must include:

  • Apices (top)

  • Costophrenic angles (bottom)

• Proper inspiration = 10 posterior ribs visible

• Use 72-inch SID → reduces heart magnification

4. 🔹 PA Chest Projection (Most Important)

📍 Position

• Patient erect, facing IR

• Shoulders rolled forward

• Hands on hips

🎯 Central Ray

• Perpendicular to T7

👀 Shows

• Lungs + heart + thoracic structures

• Air-filled lungs (on inspiration)

⚠ Key Reminders

• No rotation → check clavicles symmetry

• Good inspiration → 10 ribs

• Scapulae must be out of lung fields

5. 🔹 Lateral Chest Projection

📍 Position

• Left side against IR (preferred)

🎯 Central Ray

• Perpendicular to T7

👀 Best For

• Heart

• Left lung

• Lung fissures

⚠ Check

• Ribs superimposed → no rotation

• Arms raised to avoid obstruction

6. 🔹 Special Chest Views

AP Axial (Lordotic)

• CR: 15–20° cephalad

• Shows:

  • Apices (above clavicles)

👉 Used for:

• TB

• Apical lesions

🛏 Decubitus (Side-Lying)

• Detects:

  • Air or fluid levels

👉 Rules:

• Air suspected → affected side UP

• Fluid suspected → affected side DOWN

7. 🔹 Airway Imaging

• Views: AP + Lateral

• Used for:

  • Foreign body

  • Tumors

  • Obstruction

⚠ Technique

• Exposure on slow inspiration

• Shows air-filled trachea

8. 🔹 Common Pathologies (Know These!)

• Asthma

• Atelectasis

• Bronchitis

• Bronchiectasis

• COPD

• Emphysema

• Pneumonia

• Tuberculosis

• Pneumothorax

• Pleural effusion

• Hemothorax

🩺 Medical Devices Seen in X-ray

• Chest tube

• Endotracheal tube

• ECG leads

• Swan–Ganz catheter

• Central venous line

🔑 SUPER HIGH-YIELD SUMMARY (For Exams)

• Right lung = 3 lobes, left = 2 lobes

• Right bronchus = more vertical → aspiration risk

• PA chest = standard view

• 10 posterior ribs = good inspiration

• Always do chest ERECT

• Decubitus:

  • Air → up

  • Fluid → down

• Lateral chest = heart + left lung best seen

B. BILIARY SYSTEM

🔹 Main Structures

• Biliary tree components:

  • Left & right hepatic ducts

  • Common hepatic duct

  • Cystic duct

  • Common bile duct

  • Gallbladder

👉 Flow of bile:
Liver → Hepatic ducts → Common hepatic duct → + cystic duct → Common bile duct → joins pancreatic duct → enters duodenum (via ampulla of Vater)

🔹 Gallbladder (GB)

• Located under the liver (right side)

• Stores & concentrates bile

⚠ Important Conditions

• Gallstones (cholelithiasis)
  → May pass or get stuck

• Cholecystitis (inflammation)

  • Stone in cystic duct → NO jaundice

  • Stone in common bile duct → WITH jaundice

• “Gallbladder attack”
  → Triggered by fatty food → contraction → pain

🔹 Imaging Procedures

Most are now replaced by ultrasound, but still important:

• OCG (Oral Cholecystography)

• Cholangiography

• T-tube cholangiography

• ERCP (most commonly used today)

👉 All use contrast media

🔹 Key Preparation (OCG)

• Take iodinated tablets night before

• Fat-free meal → prevents GB contraction

🔹 Positioning Highlights (GB)

• Located around 10th–12th ribs (right side)

• Position varies by body type:

  • Hypersthenic → higher & lateral

  • Asthenic → lower & midline

C. DIGESTIVE SYSTEM

🔹 Main Function

• Digestion + absorption of nutrients

🔹 Parts

GI Tract (alimentary canal)

• Esophagus

• Stomach

• Small intestine (duodenum, jejunum, ileum)

• Large intestine (colon)

Accessory organs

• Liver, gallbladder, pancreas

• Salivary glands

🔹 ESOPHAGUS

Function

• Moves food via peristalsis

Common Conditions

• GERD (acid reflux)

• Esophageal varices

• Hiatal hernia

Imaging

• Uses barium swallow

• Best view: RAO position

🔹 STOMACH

Parts

• Cardia

• Fundus

• Body

• Pylorus

Key Concept

• Has folds called rugae

Common Conditions

• Gastritis

• Ulcers

• Hiatal hernia

🔹 SMALL INTESTINE

Parts

• Duodenum (C-shaped, shortest)

• Jejunum

• Ileum

Important Concepts

• The duodenum surrounds the pancreas

• Ends at the ileocecal valve

Condition

• Volvulus → twisting → can cut blood supply ⚠

🔹 LARGE INTESTINE (COLON)

Parts

• Cecum → Ascending → Transverse → Descending → Sigmoid → Rectum

Features

• Haustra (pouches)

• Appendix attached to the cecum

Conditions

• Appendicitis

• Diverticulitis

• Obstruction

• IBS

🔹 CONTRAST MEDIA (VERY IMPORTANT ⚠)

Types

• Barium sulfate

  • Used normally

  • Coats GI tract → shows shape

• Water-soluble iodine

  • Used if perforation is suspected

  • Safer (absorbed by the body)

👉 Key rule:
❌ NEVER use barium if perforation is suspected

🔹 IMAGING PRINCIPLES (HIGH-YIELD)

Abdomen X-ray

• AP supine → general overview (scout image)

• Erect → shows air-fluid levels

• Decubitus → if the patient can’t stand

👉 “3-way abdomen”:

• Supine

• Erect

• Left lateral decubitus

Esophagus Imaging

• Done during swallowing

• Fast exposure (<0.1 sec)

• RAO = best view

Stomach Imaging Positions

• LPO → fundus filled with barium

• RAO → pylorus + duodenum

• Lateral → anterior/posterior walls

Small Bowel Series

• X-rays every 15–30 minutes

• Track barium until the ileocecal valve

Large Intestine (Barium Enema)

Technique:

• Fill with barium → drain → add air
  👉 “Double contrast.”

Purpose:

• Detect polyps, lesions

Key Positions (Colon)

• RAO → ascending colon

• LAO → descending colon

• Decubitus → shows air + barium separation

🔴 IMPORTANT PATHOLOGIES (MEMORIZE)

Biliary

• Cholecystitis

• Cholelithiasis

• Jaundice

Digestive

• Appendicitis

• Diverticulitis

• Hiatal hernia

• Ulcer

• Volvulus

• Crohn’s disease

• Ulcerative colitis

💡 ULTRA-SHORT SUMMARY (EXAM MODE)

• Biliary = bile flow + gallbladder storage

• Gallstones → pain, inflammation, jaundice

• GI tract = digestion pathway

• Barium = standard contrast

• Iodine = for perforation

• RAO = best for the esophagus

• RAO = pylorus & duodenum

• Double contrast = best for colon lesions

• Erect/decubitus = air-fluid levels

D. URINARY SYSTEM

🔹 Main Function

• Filters blood → produces urine → excretes waste

🔹 Main Parts

• Kidneys → produce urine

• Ureters → transport urine

• Bladder → stores urine

• Urethra → releases urine

🔹 KIDNEYS

📍 Location

• Retroperitoneal (behind the abdomen)

• Levels: T12–L3

• The right kidney is lower (because of the liver)

🔹 Movement

• Moves:

  • Down (1–3 inches) when standing

  • During breathing

🔹 Internal Structure

• Cortex → outer (contains glomeruli)

• Medulla → inner (renal pyramids)

• Calyces → renal pelvis → ureter

👉 Urine pathway:
Nephron → calyces → renal pelvis → ureter

🔹 URETERS

• Connect kidneys → bladder

• Move urine via peristalsis

⚠ 3 Normal Constrictions (IMPORTANT)

1. Ureteropelvic junction (UPJ)

2. Pelvic brim

3. Ureterovesical junction (UVJ)

👉 Common sites for kidney stones

⚠ Pathology

• Obstruction → Hydronephrosis (kidney swelling)

🔹 BLADDER

• Stores urine

• Has a triangular area: Trigone

• Process of urination = Micturition

🔹 URETHRA

• Male: 7–8 inches (longer)

• Female: ~1.5 inches (shorter → higher UTI risk)

🔴 RADIOGRAPHY (VERY HIGH-YIELD)

🔹 Main Exam

IVU / IVP (Intravenous Urography)

👉 MOST IMPORTANT

• Contrast injected IV

• Shows function + structure

🔹 Patient Preparation

• Light meal + laxative (night before)

• NPO after midnight

• Empty bladder before exam

🔹 Contrast Media Effects

Normal:

• Warm feeling

• Metallic taste

• Mild nausea

Serious (rare ⚠):

• Allergic reaction

• Respiratory distress

• Anaphylaxis

👉 Non-ionic contrast = safer

🔹 IVU TIMING (SUPER IMPORTANT)

• 30 sec → nephrogram (kidneys visible)

• 1, 3, 5 min → kidney detail

• 10–15 min → KUB images

• 20 min → ureters (often prone)

• Post-void → bladder emptying

🔹 COMPRESSION

• Applied over the ureters
  👉 Keeps contrast in the kidneys longer

🔹 PROJECTIONS (MUST KNOW)

📸 KUB (Kidneys, Ureters, Bladder)

AP SUPINE

• General overview (scout)

• Shows:

  • Kidneys

  • Organs

  • Calcifications

PA

👉 BEST for ureters

• Because the ureters are anterior

OBLIQUE (30°)

• Side UP → kidney shown

• Side DOWN → ureter shown

👉 Example:

• RPO → Left kidney + Right ureter

🔹 BLADDER IMAGING

AP Projection

• Shows bladder (filled or post-void)

Voiding Cystourethrogram (VCUG)

• Shows bladder + urethra during urination

👉 Female:

• Use a 5° caudad angle (to avoid pubic overlap)

🔹 RETROGRADE STUDIES

• Contrast inserted via catheter (NOT IV)

Types:

• Retrograde urogram

• Cystogram

• VCUG

👉 Shows structure only (not function)

🔴 IMPORTANT PATHOLOGIES (MEMORIZE)

• Hydronephrosis → kidney swelling

• Renal calculi (kidney stones)

• Staghorn calculus → large stone shaped like antlers

• Polycystic kidney

• Horseshoe kidney

• Vesicoureteral reflux

• Pyelonephritis (infection)

• Prostatic hypertrophy

E. REPRODUCTIVE SYSTEM

🔹 Hysterosalpingography (HSG)

👉 MOST COMMON imaging for the female reproductive system

🔹 Purpose

• Check:

  • Uterus shape

  • Fallopian tube patency

  • Infertility causes

🔹 Procedure

• Contrast is injected into the uterus

• If normal → flows into fallopian tubes → peritoneal cavity

🔹 Timing

• Done ~10 days after menstruation
  👉 Prevents irradiating the fertilized ovum

🔹 Position

• AP projection

• Center: 2 inches above pubic symphysis

🔴 PATHOLOGY (REPRODUCTIVE)

• Ectopic pregnancy ⚠ (emergency)

• Salpingitis → tube inflammation → infertility

• Endometriosis

• Fibroids (leiomyoma)

• Pelvic inflammatory disease

💡 ULTRA-FAST REVIEW (EXAM MODE)

• Kidneys: T12–L3, right lower

• Ureters: 3 constrictions (stones!)

• IVU = function study

• PA = best for ureters

• Oblique: up = kidney, down = ureter

• VCUG = urination study

• Hydronephrosis = obstruction

• HSG = infertility test

F. CENTRAL NERVOUS SYSTEM (CNS)

1. Overview

• The CNS = brain + spinal cord

• Protected by:

  • Skull (brain)

  • Vertebral column (spinal cord)

• Functions:

  • Sensory perception

  • Integration (thinking, memory)

  • Motor response

Brain Parts

• Cerebrum – the largest, for thinking & voluntary actions

• Cerebellum – balance & coordination

• Brainstem:

  • Midbrain

  • Pons

  • Medulla oblongata (vital functions like breathing)

Spinal Cord

• Extends from the brain to L1 (conus medullaris)

• Below that → cauda equina

• Structure:

  • Inner gray matter (H-shaped)

  • Outer white matter (nerve pathways)

2. Meninges (Protective Layers)

• Pia mater – inner, attached to CNS

• Arachnoid mater – middle layer

• Dura mater – outer, tough layer

Spaces

• Subarachnoid space → contains CSF

• CSF functions:

  • Shock absorber

  • Nutrient transport

3. Key Procedures

Lumbar Puncture

• Done at L3–L4 or L4–L5

• Purpose:

  • Get a CSF sample

  • Inject contrast

Myelography

• Uses contrast in the subarachnoid space

• Detects:

  • Herniated discs

  • Tumors

👉 Most disc herniations:

• L4–L5

• L5–S1

4. Common CNS Conditions

• Herniated nucleus pulposus

• Degenerative disc disease

• Meningitis

• Hydrocephalus

• Parkinson’s disease

• Spondylosis

G. CIRCULATORY SYSTEM

1. Overview

• Components:

  • Heart

  • Blood vessels (arteries, veins, capillaries)

Functions

• Deliver oxygen & nutrients

• Remove waste products

2. Heart Basics

Heart Layers

• Epicardium – outer

• Myocardium – muscle

• Endocardium – inner

Chambers

• Right atrium

• Right ventricle

• Left atrium

• Left ventricle

3. Blood Flow (HIGH-YIELD 💡)

1. Body → Right atrium (via vena cava)

2. → Right ventricle

3. → Lungs (via pulmonary artery)

4. → Left atrium (via pulmonary veins)

5. → Left ventricle

6. → Body (via aorta)

👉 Remember:

• Pulmonary artery = deoxygenated

• Pulmonary vein = oxygenated

4. Key Terms

• Systole – contraction

• Diastole – relaxation

• Pulse – arterial expansion

5. Aorta Divisions

• Ascending aorta

• Aortic arch

• Thoracic aorta

• Abdominal aorta

6. Circulation Types

• Pulmonary circulation
  → Heart ↔ Lungs

• Systemic circulation
  → Heart ↔ Body

7. Imaging & Procedures

Angiography

• Uses contrast to view vessels

• Often uses DSA (Digital Subtraction Angiography)
  → removes bones for clearer vessels

Venogram

• Checks deep vein thrombosis (DVT)

• Contrast injected in the foot veins

8. Common Conditions

• Atherosclerosis

• Hypertension

• Myocardial infarction (heart attack)

• Aneurysm

• Pulmonary embolism

• Congestive heart failure

🔥 QUICK MEMORY TIPS

• CNS = control center (think + move)

• CSF = cushion

• L4–L5 = most common disc problem

• Right heart = lungs | Left heart = body

• Arteries = away, veins = return