Imaging Procedures

Quiz on 17th

Count posterior ribs, need at least 10 on PA chest

Get all artifacts out of the way of the patient

High kvp 110-125

High mA, short exposure time. Reduces chance of motionDo erect= Diaphragm can move up and down, Air and fluid levels, engorgement and hyperemia can be monitored (Distend or swollen with blood)

9/8

Chest positiong. Make sure no rotation or obstructions

Equal distance on top and bottom of lungs from end of image

7-8 inches below vertebral prominens= center ray for x ray to t7

T7 3-4 inches below jugular notch

Pediatric do AP supine mammilary line

Chest projections below:

PA, Lateral. Special AP supine or semierect

lateral decubitus

Ap lordotic

Chest anatomy and positiong. 2 powerpoints quiz on 17th

Do quiz me’s

9/10

Abdomen

Quiz on chest anatomy and positioning 9/17

Study T and C positioning of certain points and x rays

Bony structures- lumbar spine, sacrum, coccyx, pelvis, femur

two psoas mucles- should be seen on either side of lumbar

Diaphragm= separates abdominal cavity from thoracic

Diaphragm openings= inferior vena cava hiatus vein, aortic hiatus, esophageal hiatus

6 steps of digestive system

Accessory organs

Stomach-small intestines (duodenum, jejunum, ileum)-large intestines

Duodenum, ducts with billiary tree

Billiary tree connects to descending duodenum

Large intestines begin right lower quadrant=cecum-ascending colon-transverse colon-descending colon-sigmoid-rectum

ileocecal valve

Appendix=wormlike structure

Pancreas=behind stomach

Head of pancreas sits in C loop of abdomen (romance of the abdomen)

Helps produces insulin and digestive juices (endocrine and exocrine system)

Liver=largest solid organ. produces bile to break down fats (emulsification)

Gallbladder= stores bile, concentrates bile, contracts / releases bile when the horomone CCK released

Cholelithiasis one or more gallstones

Spleen= behind stomach, part of lymphatic system makes white blood cells

2 kidneys. right is lower than left bc liver pushes down

Ureters, bladder, urethra

Adrenal glands on top of kidneys

Peritoneum (parietal and visceral) Abdomen lining. Membrane contains most abdomen organs

Mesentery holds small intestines to posterior wall

Omentum= lesser / greater. biggest and smallest curve on side of stomach. connects stomach to organs

Lesser connects to liver. Greater connects to transverse colon

Mesocolon= ascending, transverse, descending, sigmoid. peritoneum attaches to posterior abdom. wall

Ascites=too much fluid in abdominal cavity

Fatty apron

2 parts of peritoneal cavity. Major portion(greater sac) Smaller (lesser sac). Lesser is little part by stomac

Intra peritoneal, retro peritoneal, infraperitoneal

Intraperitoneal= 9 organs in it. Mnemonic to remember it

Little girls speak softly just in case they sing

Retroperitoneal 9 or 10

Kids use any pants dirty and dumpy under mud

Infraperitoneal 3 organs

Love your rectum

What organs sit in each of 4 quadrants

Transverse plane l4/l5

7RUQ, 6LUQ, 5RLQ, 3LLQ

right colic (hepatic) flexure

left splenic flexure

9/15

4 quadrants, 9 regions

Vertical planes= right, left lateral planes/mid clavicular planes

halfway between midsaggital plane and asis

Horozontal/transverse planes= transpyloric (top) and transtubercular plane (bottom)

xiphoid=t9t10

inferior costal margin l2l3

iliac crest l4l5

Anterior superior iliac spine s1s2 (ASIS)

greater trochanter. same level as symphysis pubis

around 70-85 kvp for abdomen

short exposure time, mAs changes with thickness

see psoas muscles

transverse processes coming off of vertebra sides

routine has KUB kidneys, ureter, bladder

Special pa prone, lateral decub ap

ap erect

dorsal decubitus

abdome 40 sid, recommend grid, supine, arms at side away from body, can bend legs, center iliac crest

left lateral decubitus preferred. lay on side for at least 5 min to let gases settle

center 2 inches above iliac crest if they want to include diaphragm

straight lines in bowel are air-fluid levels

Level 1 comps

erect AP abdomen

review bowels

Acute abdomen series list of ordered images

Abdomen anatomy and positioning tuesday

tuesday before autumn break is midterm

CHAPTER 4

9/17 and 9/22 and 9/24

phalanges/ phalynx 14 (proximal, middle distal), metacarpals 5, carpals 8, 27 bones in each hand

2-5 digits have three phalanges. digit 1 has 2

tip of finger called tuft

thumb=pollex

phalynx has base, body, head

metacarpals=anterior part has concave shape. posterior part is convex

sesmoid bone- small bone in tendon or muscle near a joint

1 digit joints=interphalngeal, metacarpophalangeal, carpometacarpal (listed outside to in) IP, MCP, CMC

2-5 digits distal interphalangeal, proximal interphalangeal, metacarpophalangeal (DIP,PIP,MCPand CMC

Norgaard method (ball catcher) for rheumatoid arthritis and fx at base of 5th metacarpal. Internally rotated 45 degrees. CR at level of 5th MCP joint. Ask if it should be bent or straight

Fan lateral=OK symbol CR 2nd mcp joint

Good hand image has bony tribeculi

9/24

Wrist and forearm

Radius points=Ulnar notch, styloid notch, radial tubercle

Ulna points=olecranan

Ch 4 is finger-elbow

8 carpals 4 in proximal row, 4 distal row

Proximal row=starting thumb side= scaphoid, lunate, Triquetrum, pisiform

Scaphoid is most frequently fractured, biggest is proximal row

Distal row thumb side over= trapezium, trapezoid, capitate, hamate

Capite means large bone _largest of all carpals

Hamulus, hamate, hooklike

Steve left the party to take carol home

Carpal Sulcus visualizes pisiform and hamulus best

Ulnar collateral ligament

Radial collateral ligament

Scaphoid fat stripe, pronator fat stripe

What ulnar deviation views best, what radial deviation views best

Wrist fxs=Barton, colles, smith

Cast conversion chart

SM to MED plaster cast increase 5-7 kvp. LG increase 8-10. Fiberglass 3-4 kvp

Wrist has pa, pa obl and lateral

PA has CR at midcarpal area

OBL is rotated 45 degrees

LATkarate chop.Should see captain riding the duck Capitate.Scaphoid in background.body of ducklunate

PA and PA axial scaphoid angle 10-15 degrees proximal with ulnar deviation

PA scaphoid= hand elevated and ulnar deviation 20 DEGREE SPONGE

Carpal canal tangenital Gaynor Hart Method= internally rotate 10 degrees. CR angled 25-30 degrees proximal. Center 1 inch distal to base of third metacarpal. Pisiform and hamulus process should be separated and visible

Forearm=styloid process, ulnar notch ON RADIUS, head of ulna

Styloid process sticks out both bones distal side

Radial tuberosity, bump on proximal, medial side of radius

Radial head at elbow, Ulnar head at wrist

Olecranon process= tip of elbow

Coronoid tubercle=bump on ulna medial proximal side

Trochlear notch (semilunar)

Study lateral view of elbow

9/29

Forearm AP and Lateral

Lateral=bend 90 degrees, thumb up

views 90 degrees from each other=orthogonal

Parts of elbow

names of humeral condyles

parts of distal humerous

epicondyles on humeous, medial and lateral

Fossas of humerous, radial and coronoid fossa, olecranon fossa

Threeconcentric arcs=trochlearsulcus(spool of trochlea), Ridges ofcapitulum and trochlea,trochlear notc

And semilunar notch

Trochlea, coronoid tubercle, capitulum, lateral epicondyle, coronoid process

proximal radioulnar joint

scaphoid vs pronator view of wrist

posterior fat pad, anterior fat pad, supinator fat pad

Scaphoid fat stripe, pronated fat stripe

AP should have radius and ulna slightly superimposed

Oblique completely superimposes, Lateral oblique Separates

Osteomyelitis, Bursitis, osteopetrosis, osteoporosis

Shoulder and extremity on the same plane

AP, Alternate AP-partial flexion (2 views)

AP= make sure epicondyles are equal. Mid elbow joint CR ¾ inch distal to midpoint of epicondyles

Capitulum on top of radial head

Radial tuberosity

Olecranon process location vs trochlea

Tubercle vs coronoid process location

Lateral (external) AP oblique projection elbow best view what

Supinate hand and rotate laterally 45 degrees. Rad and ulna should be separated

Tuberosity-radail protrusion towards ulna on neck

Medial internal AP oblique=visualizes coronoid process of ulna and trochlea

Lateromedial elbow view=elbow flexed 90 degrees and hand in lateral position

1 ½ inches medial from olecranon process to find mid elbow joint

Trauma axial lateral (coyle method) Axiial lateromedial and Axial mediolateral

Axial Lateromedial Coronoid process best visualized 90 degrees elbow flexion

axial Mediolateral elbow flexed only 80 degrees

QUIZ CH 4 (fingers through elbows)

Do quiz me’s. Finish clinical papers. Study fingers-elbows

Proximal humerous called head

Anatomic neck top, surgical neck bottom

Greater tubercle (tuberosity) vs major

Deltoid tuberosity

Scapulohumeral joint, glenohumeral, shoulder joint all the same

elbow joint different

Neutral rotation=humerous is naturally in oblique angle

External rotation=humerous in true AP

Internal rotation=humerous in lateral position

Routine projections=AP and lateral

True AP shows greater tubercle on lateral side

Lateromedial and mediolateral

Latero=back to IR, internally rotate arm at the side

Medio=Pt obl looking at IR, move elbow back to expose humerous

Special projections=

horozontal beam lateral=laying down crossfire

Transthoracic lateral=goes through body to hit humerous against IR

If pt cant drop shoulder enough, angle 10-15 degrees cephalad

Orthostatic breaths=take short shallow breaths while staying still

AP neutral humerous=as is, no rotation

10/6

Glenoid fossa

subscapularis fosssa

Acromion

Infraspinous fossa, supraspinous fossa

Greater tubercle out if hand is externally rotated

Lesser tubercle seen if internally rotated

If neither, its natural

coracoid process

Lawrence method=stretch arm out 90 degrees, rotate head away, 25-30 degrees medially. If they cant extend arm to 90 degrees, angle 15-20 degrees medially

Exaggerating hand during a projection (bring arm out and rotate externally) will show hill sachs defect

10/08

Grashey method=cr at scapulohumeral joint with affected shoulder against board

Superoinferior axillary view=arm out to side bent. 5-15 degrees distal

Y view is shoulder against IR facing the board according to textbook 45-60 degrees

NEER method=PA, angle 10-15 caudal. Shows corocromial arch. pt 45-60 degrees oblique

Lateral scapula=45=60 degrees . let arm by side, other arm reach across to opposite shoulder

BIG DIFFERENCE=difference between different Y-views-have to move arm out or stay still

AP axial clavicle=15-30 degrees

THIN PT IS 25-30 degrees. THICK PTS IS 15-20

AP AXIAL= clavicle is above scapula and 2nd and 3rd rib

AP axial clavicle=angle caudad

AP ANGLE CEPHALAD

PA ANGLE CAUDAL

AC view=cr at 1 inch above jugular notch for bilateral

Unilateral is 1 inch below affected ac joint

10/20

Toes and feet

14 phalanges in each foot

5 metatarsals

7 tarsals

Big toe is hallux

Tarsals=come to colorado the next 3 christmases

3 cuneiforms=close to metatarsals

Navicular behind those

Cuboid

Calcaneus=os calcis=largest, strong,tuberosity,bone spurs=achilles tendon on x ray,lat and med process

Peroneal trochlea on lateral side, sustentaculum

Subtalar joint (talocalcaneal joint)Anterior, middle, articular surface

Calcaneal sulcus

Talus(astrogalus) 2nd largest

Has sinus tarsi=opening with ligaments

4 talus articulations

Navicular(sometimes interchanged with scaphoid)

5 articulations

Cuboid=proximal to 4th and 5th metatarsals, 5 articulations

tibial and fibular sesamoid bones=imbedded into tendons

Transverse and longitudinal lines

MTP joint

TMTjoint

Intertarsal joints

Dorsum/dorsum pedis AP

PA plantodorsal

Inversion (varus)

Eversion (valgus)

Gout=uric acid in blood=common in 1st MTP

Joint effusions=fluid in joint cavity

10-15 degrees toward calcaneus for toe x ray

3rd digit in foot is rotated medially on oblique

2 times more soft tissue on one side and concavity if obliqued correctly

CR for lateral toes are pip joints

Lateromedial projection 1-3

Mediolateral for 4-5th toes

Sesamoid-tangenital view=15-20 degrees angle with toess pressed on IR. tube perpendicular

Alternative sesamoid projection, toes pointed up

Routine views AP OBL and LAT

10/22

Foot

angle 5-15 degrees

CR base of 3rd metatarsal

Medial OBL-30-40 degrees internally, NO ANGLE

Sometims LAT OBL 30 degrees

LAT OBL for space between 1 and 2 metatarsals and for 1 and 2 cuneiforms and navicular as well

LAT-CR medial cuniform, same as base of 3 metatarsal

Lisfranc injury-injury on bridge of foot

Longitudinal injury for foot

Weight bearing AP-angle 15 degrees

LAT weight bearing-

Tallus=astrogalus

ANKLE AND CALCANEUS

Tibial plafond

LAT and MED malleolus

Mortise

Ankle vs mortise joint

Tibia, fibla and tallus=ankle joint

Mortise position internally rotate 15 degrees

Calcaneal plantodorsal axial-laying supine foot out, angle 40 degrees from vertical, CR base of 3third metatarsal, foot 90 degrees

Calcaneus axial projection-plantodorsal, Dorsoplantar axial=prone, elevate ankles, bottom of foot against IR, angle 40

Weight bearing dorsoplantar view (Coalition view)-angle 45 degrees

10/27 Ankle continued

AP mortise-internally rotate 15-20 degrees. foot in natural position, CR between malleoli shows full joint

Lateral ankle (mediolateral) Laying recumbent, flex affected limb 45 deg. dorsiflex. CR med. Malleolis

Oblique view-tibia and fibula unsuperimposed

Stress views=inversion and eversion, tech is pulling

Mortise=standing, internally rotate 15 degrees

Lower leg

Intercondylar eminensce, tibial spine, medial and lateral intercondylar tubercles

Tibial plafond and tibial plateu

Tibial tuberosity is the attachment site for the patellar tendon/ligament

Fibula-styloid process is top part

Osteomyelitis

10/29

Patella

Front rough back smooth

When leg is extended, patella has more movement

PA, LAT, Tangential (merchant, inferosuperior, settegast and hobbs (not on registry))

PA 5 degree internal rotation, CR mid popliteal crease lying down

Lateral flex knee 5-10 degrees. CR mid patellofemoral joint. Lying down

Merchant SID 48-72, Knee flexed 40 degrees. Angle 30 deg. caudal. Sitting. Bilateral. Board 12 inches below knee

Settegast-seated or prone, 90 degree flexed knee, angle 15-20 cephalic

Knee

Pattelar surface aka intercondylar sulcusaka trochlear grooves

Popliteal surface

Knee joint aka femorotibial joint

Patellofemoral

Proximal tibfib joint

Quadriceps femoris tendon

Patellar ligament/tendon

If you see adductor tubercle, lat knee is under rotated

Base (top) and apex (bottom) of patella

AP, OBL, LAT knee