Rad anaphy Notes

Anatomy & Physiology for Radiologic Technology

Course Description

This unit covers types of bones, bone tissue, the axial skeleton, the appendicular skeleton, and joints. It primarily focuses on the anatomic and physiologic functions of bones and their appearance in X-ray images (radiographs).

Course Objectives

At the end of this course, students will be able to:

• Identify major components of the skeletal system and describe their functions.
• Describe different types of bones and provide an example of each.
• Describe the process of bone repair.
• Identify different types of fractures.
• Locate and identify bones that comprise the axial and appendicular skeleton.
• Locate and identify bones of the skull and major skull landmarks.
• Locate and identify bones of the thoracic cage.
• Locate and identify bones, major bony landmarks, and ligaments of the vertebral column.
• Identify and describe different joint types and their functions.
• Explain how ligaments reinforce joints and contribute to movement.
• Describe how joints can degenerate with age.
• Identify bone structures on a radiograph.
• Describe bone appearances in different radiographic positions.
• Identify pathology or abnormalities on radiographic images.

General Anatomy

Cells of the Human Body

The human body consists of various cells, including brain cells, liver cells, muscle cells, blood cells, and intestinal cells.

Anatomy & Physiology

• Anatomy: The study, classification, and description of the structure and organs of the human body.
• Physiology: The study of the processes and functions of the body, or how body parts work.

Structural Organizations

The structural organization of the body, from lowest to highest level:

1. Chemical Level: Atoms joined to form molecules.
2. Cellular Level: Molecules are organized to form cells.

Chemical Composition of the Human Body

The human body comprises various chemical elements and compounds. Approximate percentages include:

• Water: $62 \%$
• Oxygen: $65 \%$
• Carbon: $18 \%$
• Hydrogen: $9.5 \%$
• Nitrogen: $3.2 \%$
• Calcium: $1.5 \%$
• Phosphorus: $1.2 \%$
• Potassium: $0.4 \%$
• Sulfur: $0.2 \%$
• Sodium: $0.2 \%$
• Chlorine: $0.2 \%$
• Magnesium: $0.1 \%$
• Other: $>1 \%$
• Protein: $15 \%$
• Fat: $16 \%$
• Carbohydrate: $6 \%$

Cells

A cell is the basic structural and functional unit of all living tissue, containing components like the nucleus, cytoplasm, nucleolus, endoplasmic reticulum, mitochondria, ribosome, and cell membrane.

Tissues

The human body is made up of four basic tissues:

1. Epithelial tissue
2. Connective tissue
3. Muscular tissue
4. Nervous tissue

• Epithelial Tissue: Covers internal and external body surfaces, including linings of vessels and organs.
• Connective Tissue: Supportive tissues that bind together and support various structures; includes areolar, adipose, fibrous, osseous tissue, blood, and hyaline cartilage.
• Muscular Tissue: Makes up the substance of a muscle; includes skeletal, smooth, and cardiac muscle.
• Nervous Tissue: Makes up the substance of nerves and nerve centers, composed of dendrites, cell bodies, axons, Schwann cells, myelin sheaths, nodes of Ranvier, and axon terminals.

Organs

An organ is a number of tissues working together to perform a specialized function (e.g., eye, brain, tooth, heart, lung, liver, stomach, kidney, skin, bowels).

Body Systems

A system consists of a group or association of organs that have a similar or common function.

Levels of Human Structural Organization

The levels of human structural organization are:

1. Atoms
2. Molecules
3. Cells
4. Tissues
5. Organs
6. System
7. Organism/Human Body

Skeletal System

The skeletal system provides support, gives the body shape, allows movement, makes blood cells, protects organs, and stores minerals.

Functions of the Skeletal System

• Supports and protects soft tissues.
• Allows movement through interaction with muscles (leverage system).
• Produces blood cells.
• Stores calcium.

Structures of Bones

Bone anatomy includes:

• Compact bone
• Spongy bone
• Periosteum
• Endosteum
• Trabeculae
• Red marrow
• Yellow marrow
• Blood vessels
• Nerve vessels

Main Parts of the Skeletal System

The Skeletal system is composed of:

• Bones
• Ligaments
• Tendons
• Joints

Composition

The adult skeletal system comprises 206 bones.

Axial and Appendicular Skeleton

• Appendicular Skeleton: Includes shoulder girdles (clavicles, scapula), upper limbs (humerus, ulna, radius, carpals, metacarpals, phalanges), pelvic girdle (hip bones), and lower limbs (femur, tibia, fibula, patella, tarsals, metatarsals, phalanges).
  *shoulder girdles: clavicles (2), scapula (2)
  *Upper limbs: humerus (2), ulna (2), radius (2), carpals (16), metacarpals (10), phalanges (28)
  *Pelvic girdle: Hip bones (2)
  *Lower limbs: Femur (2), tibia (2), fibula (2), patella (2), tarsals (14), metatarsals (10), phalanges (28)
• Axial Skeleton: Includes the skull (cranium, facial bones), hyoid bone, auditory ossicles, vertebral column (cervical, thoracic, lumbar, sacral, coccyx), and thorax (sternum, ribs).
  *Skull: Cranium (8), facial bones (14)
  *Hyoid: 1
  *Auditory ossicles: 6
  *Vertebral column: Cervical (7), thoracic (12), lumbar (5), sacral (1), coccyx (1)
  *Thorax: Sternum (1), ribs (24)

Skeletal Anatomy Details

Appendicular Skeleton

Shoulder Girdle

• Clavicles
• Scapula

Upper Limbs

• Humerus:
  • Greater tubercle
  • Anatomical neck
  • Head
  • Intertubercular groove
  • Surgical neck
  • Lesser tubercle
  • Deltoid tuberosity
  • Olecranon fossa
  • Lateral epicondyle
  • Capitulum
  • Coronoid fossa
  • Medial epicondyle
  • Trochlea
• Radius:
  • Head
  • Neck
  • Radial tuberosity
  • Styloid process
• Ulna:
  • Olecranon process
  • Trochlear notch
  • Coronoid process
  • Radial notch
  • Ulnar tuberosity
  • Styloid process
• Carpals: 8 bones
• Metacarpals: 5 bones
• Phalanges: 14 bones

Lower Limbs

• Femur:
  • Head
  • Neck
  • Greater trochanter
  • Lesser trochanter
  • Body (shaft)
  • Lateral condyle
  • Medial condyle
  • Fovea Capitis
• Tibia:
  • Lateral condyle
  • Medial condyle
  • Intercondylar eminence
  • Tibial tuberosity
  • Medial malleolus
• Fibula:
  • Head
  • Lateral malleolus
• Patella
• Tarsals: 7 bones (calcaneus, talus, navicular, cuboid, medial cuneiform, intermediate cuneiform, lateral cuneiform)
• Metatarsals: 5 bones
• Phalanges: 14 bones (proximal, intermediate, distal)

Pelvic Girdles

• Hip Bones:
  • Ilium:
    • Iliac crest
    • Iliac spine
  • Ischium
    • Ischial spine
    • Ischial tuberosity
  • Pubis
  • Acetabulum
  • Obturator foramen

Axial Skeleton

Skull

• Cranial Bones: Frontal, parietal (2), temporal (2), occipital, sphenoid, ethmoid.
• Facial Bones: Nasal (2), lacrimal (2), palatine (2), inferior nasal concha (2), zygomatic (2), maxilla (2), mandible, vomer.

Hyoid Bone / Auditory Ossicles

• Hyoid Bone
• Auditory Ossicles (malleus, incus, stapes)

Vertebral Column

• Vertebrae:
  • Cervical (7)
  • Thoracic (12)
  • Lumbar (5)
  • Sacrum (5, fused)
  • Coccyx (4, fused)

Thorax

• Sternum
  • Manubrium
  • Body
  • Xiphoid process
• Ribs (24)
  • True ribs (1-7)
  • False ribs (8-12)
  • Floating ribs (11, 12)

Classification of Bones

Bones are classified by shape:

• Long bones
• Short bones
• Flat bones
• Irregular bones
• Sesamoid bones

Development of Bones

• Ossification: The process by which bones form.
• Embryonic skeleton consists of fibrous membranes and hyaline cartilage.

Bone Formation Types

• Intramembranous Ossification: Bone replaces membranes. Occurs in the cortex of tubular and flat bones; bones of the skull (calvarium): facial bones. Contributes to increase in bone thickness, Participates in the remodeling process throughout life.
• Endochondral Ossification: Bone replaces cartilage. Occurs at the primary and secondary ossification centers. All tubular and fat bones: vertebrae: base of the skul, the ethmoid medial and lateral ends of the clavicles Stops after skeletal maturity Contributes to increase in bone length., Highly organized transformation of cartilage to bone.

Primary & Secondary Centers of Endochondral Ossification

• Diaphysis: Primary center of ossification in growing bones (mid-body area).
• Epiphysis: Secondary center of ossification that appears near the ends of the limbs of long bones.

Bone Growth

Bone growth involves the bone collar, primary ossification center, hyaline cartilage, periosteum, epiphyseal plate, secondary ossification center, articular cartilage, blood vessels, spongy bone, medullary cavity and compact bone.

Parts of a Long Bone

• Epiphysis
• Diaphysis
• Compact bone
• Spongy bone
• Articular cartilage
• Cancellous bone
• Epiphyseal plate
• Marrow cavity
• Periosteum
• Head
• Shaft

Body Systems

The human body is a structural and functional unit made up of 10 lesser units called systems:

• Skeletal
• Reproductive
• Circulatory
• Nervous
• Digestive
• Muscular
• Respiratory
• Endocrine
• Urinary
• Integumentary

System Functions

• Skeletal System: Supports and protects soft tissues, allows movement, produces blood cells, stores calcium.
• Circulatory System: Distributes oxygen and nutrients, carries cell waste, transports water, electrolytes, hormones, and enzymes, protects against disease, prevents hemorrhage, regulates body temperature.
• Digestive System: Prepares food for absorption, eliminates solid waste.
• Respiratory System: Supplies oxygen, eliminates carbon dioxide, regulates acid-base balance.
• Urinary System: Regulates blood composition, eliminates waste, regulates fluid and electrolyte balance, maintains acid-base balance.
• Reproductive System: Produces offspring.
• Nervous System: Regulates body activities with electrical impulses.
• Muscular System: Allows movement, maintains posture, produces heat.
• Endocrine System: Regulates bodily activities through hormones.
• Integumentary System: Regulates body temperature, protects against microbial invasion and radiation damage, eliminates waste, receives stimuli, synthesizes vitamins and biochemicals.

Positioning Terminology

Anatomical Directional Terms

• Superior
• Inferior
• Anterior (ventral)
• Posterior (dorsal)
• Medial
• Lateral
• Proximal
• Distal

Body Planes

• Sagittal plane
• Coronal plane
• Oblique plane

Radiographic Principles

ALARA Principle

As Low As Reasonably Achievable

Radiographic Positioning

The study of patient positioning to demonstrate specific body parts on image receptors (IR).

General Terms

• Radiograph: An image produced by X-rays on an image receptor.
• Image Receptor (IR): The device that captures the radiographic image (film/screen cassettes or digital acquisition devices).
• Central Ray (CR): The center-most portion of the X-ray beam emitted from the X-ray tube.
• ALARA: minimizing radiation exposure.

Radiographic Examination

Involves:

• Positioning of body part and alignment with the IR and CR.
• Selection of radiation protection measures.
• Selection of exposure factors.
• Patient instructions.

Anatomical Position

Standing upright, head and eyes directed straight ahead, upper limbs at the sides, palms facing forward, thumbs pointing away from body, lower limbs parallel, and feet flat on the ground and facing forward.

Body Planes, Sections, and Lines

• Sagittal Plane: Divides the body into right and left parts.
• Coronal Plane: Divides the body into anterior and posterior parts.
• Horizontal (Transverse/Axial) Plane: Divides the body into superior and inferior portions.
• Longitudinal Sections: Sagittal, coronal, and oblique.
• Transverse/Axial Sections: Cross-sections at right angles to the longitudinal axis.

Planes and Landmarks of the Skull

• Base Plane: Connects infraorbital margins to the superior margins of the EAM (Frankfort horizontal plane).
• Occlusal Plane: Formed by the biting surfaces of the upper and lower teeth with jaws closed.

9 Regions of the Abdomen

1. Right Hypochondriac Region
2. Epigastric Region
3. Left Hypochondriac Region
4. Right Lumbar Region
5. Umbilical Region
6. Left Lumbar Region
7. Right Illiac Region
8. Hypogastric Region
9. Left Illiac Region

4 Quadrants of the Abdomen

1. Right Upper Quadrant (RUQ)
2. Left Upper Quadrant (LUQ)
3. Right Lower Quadrant (RLQ)
4. Left Lower Quadrant (LLQ)

Body Surfaces and Parts

• Posterior: Back part of the body.
• Anterior: Front part of the body.

Surfaces of the Hand and Feet

• Plantar: Sole of the foot.
• Palmar: Palm of the hand.
• Dorsal:
  • Foot: Top (anterior) surface.
  • Hand: Back (posterior) aspect.

Common Projection Terminology

• Posteroanterior (PA): CR enters the posterior surface and exits the anterior surface.
• Anteroposterior (AP): CR enters the anterior surface and exits the posterior surface.
• Oblique Projection: Rotated either medial or lateral.

Lateral Projection

Refers to the side of a body part, described by the path of the CR (mediolateral or lateromedial).

General Body Positions

• Supine
• Prone
• Erect
• Lithotomy
• Trendelenburg
• Fowler's
• Right Lateral Recumbent
• Left Lateral Recumbent
• Sims' Position

Specific Body Positions

• Lateral (Right or Left)
• RAO/LAO and RPO/LPO positions

Decubitus vs. Recumbent

• Decubitus: Lying down; used to detect air-fluid levels.
  • Ventral decubitus
  • Dorsal decubitus
  • Left lateral decubitus
• Recumbent: Lying down in any position (supine, prone, lateral, or oblique).

Relationship Terms

• Medially (medial): Toward the center / median plane.
• Laterally (lateral): Away from the center / median plane.
• Proximal: Near the source.
• Distal: Away from the source.
• Cephalad (cranially): CR directed towards the head.
• Caudad (caudally): CR directed towards the feet.

Terms Related to Movement

• Flexion: Decreases the angle of the joint.
• Extension: Increases the angle of the joint.
• Eversion: Outward stress movement of the foot.
• Inversion: Inward stress movement of the foot.
• Varus: Bending of the part outward.
• Valgus: Bending of a part inward.

Arthrology (Joints)

Joints are classified by function and structure.

Functional Classification

• Synarthrosis: Immovable
• Amphiarthrosis: Slightly movable
• Diarthrosis: Freely movable

Structural Classification

• Fibrous Joints

  • Syndesmoses
  • Suture
  • Gomphosis

• Cartilaginous Joints

  • Symphysis
  • Synchondrosis

• Synovial Joints

Types of Synovial Joints

• Ginglymus (Hinge) joints
• Trochoid (Pivot) joints
• Ellipsoid (Condyloid) joints
• Sellar (Saddle) joints
• Spheroidal (Ball and socket) joints
• Bicondylar joints
• Gliding joint

Bone Fracture Basics

Types of Fractures

• Open Fracture- A fracture in which the bone breaks through the skin and can be seen outside the leg.
• Closed Fracture: A fracture that does not break the skin.
• Complete Fracture: A complete break of the bone causing it to be separated into two or more pieces.
• Stable Fracture: The broken ends of the bone line up and have not moved out of place.
• Displaced Fracture: There is a gap between the broken ends of the bone.
• Transverse fractures: Are breaks that are in a straight line across the bone
• Spiral Fracture
• Greenstick Fracture: This is a partial fracture that occurs mostly in children. The bone bends and breaks but does not separate into two separate pieces..
• Stress Fracture: Also called hairline fractures. Stress fractures are often caused by repetitive motions such as
• Compression Fracture: When bones are crushed it is called a compression fracture. Osteoporosis is the most common cause of compression fractures.
• Oblique Fracture: Is when the break is diagonal across the bone. Oblique fractures may be the result of a sharp blow that comes from an angle due to a fall or other trauma.
• Impacted Fracture: An impacted fracture occurs when the broken ends of the bone are driven together.
• Segmental Fracture: The same bone is fractured in two places, leaving a “floating” segment of bone between the two breaks.
• Comminuted Fracture: A comminuted fracture is one in which the bone is broken into 3 or more pieces.
• Avulsion Fracture: Fracture occurs when a fragment is pulled off the bone by a tendon or ligament.

TREATMENT/PROCEDURE/MATERIALS FOR BONE FRACTURE

• Mono Axial Screw
• GPC
• Bone Screws
• Locking plate
• Locking screws
• Triangle Square Buttress Thread
• Poly Axial Screw
• Malleolar Screw
• Herbert Screw
• Cortical Screw
• Cancellous Screw
• Buttress Square Triangle Dynamic Plate
• Compression screws
• Closed fracture with severe soft-tissue injury, joint-bridging external fixator
• Bandages/Sling

PROSTHETIC/PROSTHESES/ARTIFICIAL

Open Reduction VS. Closed Reduction

Stages of Healing Bones

• Fracture

• Hematoma

• External Callus

• Internal Callus

• Ruptural blood

• New blood

• Consolidated fracture

• Spongy trabecular

• Stage

  • Hematoma formation
  • Callus formation
  • Bony callus formation

STEPS IN REPAIR OF BONE FRACTURE

1. Formation of fracture hematoma. Blood vessels crossing the fracture line are broken. As blood leaks from the torn ends of the vessels, a mass of blood (usually clotted) forms around the site of the fracture. This mass of blood, called a fracture hematoma, usually forms 6 to 8 hours
2. Because the circulation of blood stops at the site where the fracture hematoma forms, nearby bone cells die. Swelling and inflammation occur in response to dead bone cells, producing additional cellular debris. Phagocytes (neutrophils and macrophages) and osteoclasts begin to remove the dead or damaged tissue in and around the fracture hematoma. Thi t l t t l k

SKELETAL MATURATION

As a rule primary centers appear before birth and the secondary centers after birth. A typical long bone ossifies in three parts, the two ends from secondary centers and the intervening shaft from a primary center.

AXIAL SKELETON

• SKULL
• LARYNGEAL SKELETON
• VERTEBRAL COLUMN
• THORACIC CAGE

SKULL

• Skull ge
• Zygomatic
• Maxilla
• Nasal
• Lacrimal
• Mandible
• Frontal bone
• Glabella
• Coronal suture
• Supraorbital margin
• Nasal bone
• Temporal bone
• Intraorbital margin
• Zygomatic bone
• Perpendicular plate of ethmoid bone
• Vamer
• Nasal cavity
• Nasal septum
• Maxilla
• Alveolar processes
• Body of mandible
• Superior orbital fissure
• Supraorbital foramen
• Orbital plate of frontal bone
• Parietal bone
• Sphenoid bone
• Lacrimal bone
• Middle nasal concha
• Intraorbital foramen
• Inferior nasal concha
• Anterior nasal spine
• Oblique line of mandible
• Mandibular symphysis
• Mental foramen
• Genu

MANDIBLE

FACIAL BONES

• Nasal
• Lacrimal
• Palatine
• Inferior Nasal
• Zygomatic
• Maxilla
• Mandible
• Vomer

ORBITS

ORBITSFRONTAL

• Sphenoid
• Lacrimal
• Ethmoid
• Maxilla

SKULL

Landmarks
Landmark
Glabella

• Nasion
• Acanthion
• Symphysis Menti
• Gonion
• Inion
• External Auditory Meatus (EAM)

Lines/Plane of the Skull used in
Positioning of the skull
Interpupillary line** line*
Infraorbitomeatal line
Supraorbitomeatal line
Canthomeatal line
Acanthiometal line
RADIOGRAPHIC ANATOMY Radiographic
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