Radiographic Procedure

RADIOGRAPHIC PROCEDURE

OBJECTIVES

At the end of this module students should be able to:

Describe indications for requesting radiography of the appendicular skeletal and axial skeleton.

Describe the common terms used in Radiography Procedures.

Explain the anatomical position and projections used in Radiography of the appendicular skeleton and axial skeleton.

Describe the body planes as used in Radiography.

Describe the body movements and anatomical terms and projections used in various patient positions.

Explain all the general principles associated with a radiographic examination including preparation, positioning, exposure considerations, focal film distance and image assessment.

Perform under supervision the radiographic examinations of the appendicular and axial skeleton following Radiographic drill.

Perform under supervision the radiographic examinations of the appendicular and axial skeleton following Radiographic drill.

Identify the positioning aids and accessories used in a radiographic examinations Describe the Radiation protection and safety measures when conducting Radiographic examinations Explain the common difficulties encountered in different conditions and pathologies in Radiography of the appendicular skeleton and axial skeleton Describe Radiographs evaluation and various views Discuss the presentation of radiographs Identify radiographic patterns as they appears in various radiographic images

DEFINITIONS AND TERMINOLOGIES

• Definition of common terms as used in Radiography and imaging:
• Radiographer,
• Radiography,
• Radiograph,
• Radiologist and
• Medical imaging.
• Radiographic procedures

Radiographic Protocols

ANATOMICAL TERMS

Anatomical position : In the anatomical position, the body is upright, directly facing the observer, feet flat and directed forward. The upper limbs are at the body’s sides with the palms facing forward.

PLANE OF THE BODY

Three planes of the body are used extensively for descriptions of positioning both in plain-film imaging and in cross-sectional imaging techniques.

• The planes described are mutually at right angles to each other:
• Median sagittal plane: divides the body into right and left halves.

NB: Any plane that is parallel to this but divides the body into unequal right and left portions is known simply as a sagittal plane or parasagittal plane.

• Coronal plane: divides the body into an anterior part and a posterior part.
• Transverse or axial plane: divides the body into a superior part and an inferior part

PROJECTION/VIEWS

• Anterior,
• Posterior
• Lateral,
• Superior,
• Inferior,
• Proximal,
• Distal,
• Medial,
• Caudal,

Cephalic

VIEWS TERMINOLOGY

• Views:
• AP,
• PA,
• Lateral,
• Oblique,
• Dorsal palmar,

dorsal planter

A projection is described by the direction of the central ray relative to aspects and planes of the body.

Antero-posterior The central ray is incident on the anterior aspect, passes along or parallel to the median sagittal plane, and emerges from the posterior aspect of the body.

Postero-anterior The central ray is incident on the posterior aspect, passes along or parallel to the median sagittal plane, and emerges from the anterior aspect of the body Lateral The central ray passes from one side of the body to the other along a coronal and transverse plane. The projection is called a right lateral if the central ray enters the body on the left side and passes through to the image receptor positioned on the right side

Radiographic Procedure

Oblique The central ray passes through the body along a transverse plane at some angle between the median sagittal and coronal planes. For this projection, the patient is usually positioned with the median sagittal plane at some angle between zero and 90 degrees to the cassette, with the central ray at right-angles to the cassette.

Anterior oblique The central ray enters the posterior aspect, passes along a transverse plane at some angle to the median sagittal plane, and emerges from the anterior aspect.

Posterior oblique The central ray enters the anterior aspect, passes along a transverse plane at some angle to the median sagittal plane, and emerges from the posterior aspect

BEAM ANGULATION

Radiographic projections are often modified by directing the central ray at some angle to a transverse plane, i.e. either caudally (angled towards the feet) or cranially/cephalic angulation (angled towards the head).

The projection is then described as, for example, a lateral 20-degree caudad or a lateral 15-degree cephala

POSITIONING TERMINOLOGY

This describes how the patient is positioned for the various radiographic examination projections Erect: the projection is taken with the patient sitting or standing. In the erect position, the patient may be standing or sitting:

• with the posterior aspect against the cassette; or
• with the anterior aspect against the cassette; or

with the right or left side against the cassette.

Radiographic Procedure

Decubitus: the patient is lying down. In the decubitus position, the patient may be lying in any of the following positions:

• Supine (dorsal decubitus): lying on the back.
• Prone (ventral decubitus): lying face-down.
• Lateral decubitus: lying on the side.
• Right lateral decubitus – lying on the right side.

Left lateral decubitus – lying on the left side.

Semi-recumbent: reclining, part way between supine and sitting erect, with the posterior aspect of the trunk against the cassette.

TERMS RELATED TO BODY MOVEMENT

• Flexion
• Extension
• Adduction
• Abduction

Circumduction Etc.

LIMB POSITION

• Positioning for limb radiography may include: •

This a describe the aspect of the limb in contact with the cassette;

The direction of rotation of the limb in relation to the anatomical position, e.g. medial (internal) rotation towards the midline, or lateral (external) rotation away from the midline;

• the final angle to the cassette of a line joining two imaginary landmarks; • the movements, and degree of movement, of the various joints concerned.

Extension: when the angle of the joint increases.

• Flexion: when the angle of the joint decreases.
• Abduction: refers to a movement away from the midline.

Adduction: refers to a movement towards the midline.

Rotation: movement of the body part around its own axis, e.g. medial (internal) rotation towards the midline, or lateral (external) rotation away from the midline.

Pronation: movement of the hand and forearm in which the palm is moved from facing anteriorly (as per anatomical position) to posteriorly.

Supination is the reverse of this. Other movement terms applied to specific body parts are described in the diagrams.

GENERAL PRINCIPLE OF RADIOGRAPHIC EXAMINATION

• Views/projections – At least two views must be taken
• FFD(SFD), FOD (SID), OFD to be observed
• Inclusion of at least one joint of every Radiograph of Limbs
• Immobilization. device
• Foam pads
• Sandbags
• Compression bands
• Pillows
• The easiest/less painful views done first
• Observe radiation protection.

ANATOMICAL POSITION

LLD

SEMI RECUMBANT

INDICATION

• Common indications for requesting skeletal radiography;
• Trauma
• Skeletal survey
• Forensic cases
• Pathological

Follow up

RADIOGRAPHIC DRILL

• Radiographic drill of various examinations
• Understanding the radiographic request form
• Understanding the medical terminology
• Preparation of the Room and Equipment
• Radiographer patient contact
• Preparation of the patient
• Positioning of patients

Equipment manipulation

Radiation protection

• Patient safety precautions and protection
• Staff radiation protection

Public radiation protection

RADIATION PROTECTION

• for Staff
• For Patient and

For Public

Positioning of patient-eg sitting beside the X-ray table, Patient side to side with the x-ray table-to avoid direct exposure to lower limbs/gonads.

Views-PA instead of AP (in Skull radiography-to protect eye lenses and thyroid glands irradiation) Collimation-limitation of x-ray beam size Application of ALARA principle

Application of TDS factor (Time, Distance and Shielding)- Time of Exposure, Emphasis on Gonad shield, Shielding using Aprons, lead rubber sheets etc.

Equipment care

• Before examination
• During examination

After examination

Patient care

• Before the examination
• During examination
• After the examination

Resultant radiograph quality

Common challenges in position

• In positioning of some parts for extra ordinary heavy patients (Gigantic patients)
• Infants and Children
• Elderly patients
• Patients with severe injuries
• Pediatric patients

Patients in POP, Splints etc.

Other conditions the patient may present eg.patients with rickets, scoliosis, kyphosis, Kyphoscoliosis.

Radiographic examination

• Indications,
• equipment required,
• Patient preparation,
• patient positioning,
• Centering points,
• direction of central ray,
• special features,
• exposure factors tabulation and performance of the examination,
• supplementary views to demonstrate some structures according to pathology and

evaluation of the images.