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DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Skull Radiography: Additional Projections CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Skull Radiography: Additional Projections using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Skull Radiography: Additional Projections maxilla[2];upper jaws FUNCTIONS OF THE SKULL the structure of skull and bone make it Skull Radiography: Additional Projections The skull is the bony structure that form the head in vertebrate, protecting the brain and supporting the facial features.it consist two main parts which are cranial bones and facial bones which forms the structure of the face Cranial bones; These bones protect the brain. They are 8 cranial bones: Frontal bone: form the forehead and upper part of the eye socket. Parietal bones(2): form the top and upper sides of the skull Occipital bone: form the back and the base of the skull and contain formen magnum where the spinal cord enter the skull. Temporal bone (2): found below the parietal bones; They house structure of the ears. Sphenoid Bones : found at the base of the skull in front of the temporal bones. Help form the eye socket. Ethmoid bones: form part of nasal cavity and eye socket. maxilla[2];upper jaws Mandible; lower jaws, the only movable bones of the skull Zygomatic bones; cheekbones Nasal bones; bridge of nose Palatine bones; forms the back of the hard plate Lacrimal bones; small bones forming party of the eye socket Inferior nasal conchae[2];party of the nasal cavity structure Vomer; form the part of nasal septum 2.Facial bones Skull Radiography: Additional Projections These bones are joined together by sutures, which are immovable joints that fuse the bones tightly. This structure helps protect the brain and forms a rigid framework for the chewing, facial expression and other function FUNCTIONS OF THE SKULL Protection of the brain Support for sensory organs Attachment of muscle Shape and structure of the head Respiratory and airway function. … The skulls complex structure plays a central role in protection delicate tissues and facilitating essential bodily function. ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Skull CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Skull using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic SKULL RADIOGRAPHIC ANATOMY CRANIAL BONES FLOOR Joint of the cranium ( sutures) sutures cranial Bones—PA Axial Caldwell Projection −15˚ caudad (Fig. 11.21) A. Supraorbital margin of the right orbit Cranial Bones—AP Axial Projection (Fig. 11.22) Cranial Bones—Lateral Projection (Fig. 11.23) Anatomy: Terminologies : Landmarks: Glabella: A bony prominence just above the nasion. Lines: Skull PLANES: Preparation of the Skull: Preparation of the patient Useful accessories Positioning: CRANIUM Occipito-frontal Centre: – vertically, in the mid-line, 5 cms (2ins) below the radiographic base line. Position of patient and image receptor Direction and location of the X-ray beam OF OF10°↓, OF15°↓, OF20°↓: Essential image characteristics Essential image characteristics (cont.) (Figs 8.11a–8.11c) Radiological considerations Common faults and solutions Lateral erect (Figs 8.9a–8.9c) Direction and location of the X-ray beam Notes Lateral: The knee of the unaffected side is flexed and rest on the table. Fronto-occipital (Figs 8.12a–8.12c) FO10°↑, FO15°↑, FO20°↑: Occipito-frontal 20⁰ caudad Position of the patient 30⁰ fronto-occipital (Towne’s view) Half axial, fronto-occipital 30° caudal (Towne’s projection) Essential image characteristics (Fig. 8.13b) Accident Technique Fronto-occipital maxilla[2];upper jaws FUNCTIONS OF THE SKULL RADIOGRAPHY OF THE SKULL SKULL RADIOGRAPHIC ANATOMY Skull As with other body parts, radiography of the skull requires a good understanding o all related anatomy. The anatomy o the skull is very complex, and specific attention to detail is required of the technologist. The skull, or bony skeleton of the head, rests on the superior end o the vertebral column and is divided into two main sets o bones—8 cranial bones and 14 facial bones CRANIAL BONES The eight bones of the cranium are divided into the calvarium (skullcap) and the floor. Each of these two areas primarily consists o our bones. Calvarium (Skullcap) Frontal Right parietal Left parietal Occipital FLOOR Right temporal Left temporal Sphenoid Ethmoid Joint of the cranium ( sutures) Adult Cranium The articulations or joints o the cranium are called sutures and are classified as fibrous joints. In an adult, these are immovable and there fore are synarthrodial-type joints. sutures INFANT Anterior Fontanel Posterior Fontanel Right sphenoid Fontanel Left sphenoid fontanel Right mastoid fontanel Left mastoid fontanel ADULT Bregma Lambda Right pterion Left pterion Right asterion Left asterion cranial Bones—PA Axial Caldwell Projection −15˚ caudad (Fig. 11.21) A. Supraorbital margin of the right orbit B. Crista galli of ethmoid C. Sagittal suture (posterior skull) D. Lambdoidal suture (posterior skull) E. Petrous ridge Cranial Bones—AP Axial Projection (Fig. 11.22) A. Dorsum sellae of sphenoid B. Posterior clinoid processes C. Petrous ridge or petrous pyramid D. Parietal bone E. Occipital bone F. Foramen magnum Cranial Bones—Lateral Projection (Fig. 11.23) A. EAM B. Mastoid portion o temporal bone C. Occipital bone D. Lambdoidal suture E. Clivus F. Dorsum sellae G. Posterior clinoid processes H. Anterior clinoid processes I. Vertex o cranium J. Coronal suture K. Frontal bone L. Orbital plates M. Cribriform plate N. Sella turcica O. Body o sphenoid (sphenoid sinus) P. Petrous portion o temporal bone Anatomy: The skull is composed of 22 bones composing of the cranium (vault and base) and facial bones. It forms a protective covering of the brain. The floor of the cranium is divided into anterior, middle and posterior cranial fossae. Terminologies : The radiography of the skull is carried out with reference to visible or palpable landmarks and recognized lines and planes of the skull. Landmarks: Outer canthus of the eye: This is where the upper and lower eyelids meet laterally. Infra-orbital points: This is the lowest point of the inferior orbital margin. Nasion: This is the infronto-nasal articulation. Glabella: A bony prominence just above the nasion. Vertex: this is the highest point of the skull in the Median sagittal plane. External- occipital protuberance (inion): This is a bony prominence on the occipital bone. External auditory meatus: This is the opening into the external Auditory canal. Lines: Interorbital (interpupillary) line: Is a line joining the center of two orbits or the center of two pupils when the eyes are looking straight forward. This is straight angles to the median sagittal plane. Infraorbital line: This joins two infra-orbital points. Anthropological base line: This passes from the infra-orbital point to the upper border of the external auditory meatus. Skull Auricular line: This line is perpendicular to anthropological base line and passing through the center of the external auditory meatus. It is in a coronal plane. Orbito-meatal base line: This extends from the outer canthus of the eye to the center of the external auditory meatus. The line is about 10⁰ to the anthropological base line. PLANES: Median sagittal plane: Divides the skull into right and left halves. Landmarks of this plane are the nasion anteriorly and the external occipital protuberance (inion) posteriorly. Orbito-meatal plane: This contains the two orbito-meatal basal lines and is of an angle of 10 degrees to the anthropological plane. Anthropological plane(Frankfurter line): Is a horizontal plane containing the two anthropological basal lines and infra-orbital line. Skull Coronal planes: Are at right angles to the median sagittal plane and divide the head into an anterior part and posterior part. Auricular plane: Is perpendicular to the anthropological plane and passes through the center of the two external auditory meatuses. It is one of the coronal planes. Radiographic anatomy Preparation of the Skull: All radio-opaque materials should be removed when examining the skull. Materials such as ear-rings, hair grips, zip fasters, spectacles etc. Preparation of the patient Before undertaking skull radiography, the following specific considerations should be made: Ensure that all metal objects are removed from the patient, e.g. hair clips and hairpins. Bunches of hair often produce artifacts and thus should be untied. If the area of interest includes the mouth, then false teeth containing metal and metal dental bridges should be removed. The patient should be provided with a clear explanation

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Skeletal Development, Fractures and Disease CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Skeletal Development, Fractures and Disease using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Diseases affecting skeletal system Bone growth and development (the primary ossification centre) The secondary ossification centre (epiphysis) The apophysis The diaphysis and metaphysis The growing bone Longtitudinal and circumferential growth of bone Appearance of secondary ossification centre Secondary centres around the elbow Determination of bone age Anatomy of long bones Spine anatomy MRI picture of the lumbar spine Shoulder anatomy Elbow anatomy Wrist anatomy Hand anatomy Skeletal system Bone growth, development, anatomy, types of fractures and fracture healing Diseases affecting skeletal system Congenital or developmental Traumatic Infective Bone tumours Metabolic/Systemic diseases Arthritis/ Joint diseases Plain X-rays remain the main imaging modality in skeletal disorders. Two views are obtained, usually at right angles to each other. Bone growth and development (the primary ossification centre) Bones develop and grow through primary and secondary ossification centres. Virtually all primary centres are present at birth. The part of bone ossified from the primary centre is called the diaphysis. In long bones the diaphysis forms most of the shaft. The secondary ossification centre (epiphysis) Secondary ossification centres develop later in growing bones, most appear after birth. The secondary centre at the end of a long bone is termed the epiphysis. The epiphysis is separated from the shaft of the bone by the epiphyseal growth plate. The apophysis An apophysis is another type of ossification centre, which forms a protrusion from the growing bone. One example is the tibial tuberosity. The diaphysis and metaphysis The diaphysis and metaphysis are covered by periosteum and the articular surface of the epiphysis is covered by articular cartilage. The metaphysis is that part of the bone between the diaphysis and the growth plate. The growing bone Name the various parts of This bone. Define the words Primary and second Ossification centre, epiphysis, Metaphysis, diaphysis, apophysis, Periosteum, cartilage Longtitudinal and circumferential growth of bone Longitudinal bone growth occurs at the metaphysis and periosteal activity along the diaphysis contributes to circumferential growth. Appearance of secondary ossification centre It is sometimes important to know the age at which various secondary ossification centres appear. The most complex ones are at the elbow and can be remembered by the pneumonic “CRITOE” Secondary centres around the elbow C = capitellum R = radius I = internal epicondyle T = trochlear O = olecronon E = eternal epicondyle C – 2yrs R – 5yrs I – 5yrs T – 10yrs O – 10yrs E – 13yrs Determination of bone age Bone age is determined by X-ray of one hand and wrist. The development of the carpal bones and phalangeal epiphyses are compared to a set standard for sex and age. Girls mature faster than boys. Anatomy of long bones Identify the parts Labeled a-h, what are long, short flat, sesamoid bones/ Spine anatomy How many bones make up each region of the spine?identify the parts labeled A-G. What are posterior elements?what is theUnique articulation found in the cervical spine?what is the uncovertebral joint? What is the main determinant of vertebral stability?what are the 4 main ligaments which contribute to vertebral stability?what is th eposterior ligament complex? How many cervical nerves are there? Where do they exit form? How many lumbar roots are there and where do they exit from? Spine: learn these parts MRI picture of the lumbar spine Identify the parts of the spine labeled A-G Shoulder anatomy Which bones comprise the shoulder girdle? What are The parts of the scapular? Is the coracoid process Anterior or posterior?is the acromion anterior or posterior What 3ligaments comprise the acromioclavicular joint? What 3 structures comprise the shoulder joint? Describe The glenohumeral joint.describe the rotator cuff.name the Muscles of the rotator cuff.where is the subacromial bursa? Shoulder anatomy Elbow anatomy What bones articulate at the elbow? How do the ulna And humerus articulate? How do the radius and humerus articulate? What are the key anatomical Relationships in the elbow Wrist anatomy Learn these bones Hand anatomy What are the parts of the of a metacarpal? What are the joints in the hand called? In terms of joints, how is the thumb unique/ ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Radiographic Techniques&Procedures CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Radiographic Techniques&Procedures using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic RADIOGRAPHIC TECHNIQUES&PROCEDURES Definitions of terms Radiography is the process of taking radiographs to assist in medical diagnosis and treatment. BASIC PRINCIPLES OF RADIOGRAPHY Undertaking(During) the examination: Post-examination and aftercare: PREPARATION FOR THE EXAMINATION PREPARATION OF THE X-RAY ROOM PREPARATION OF THE PATIENT • Understand the risk versus benefit. PATIENT CARE DURING EXAMINATION • Check the pregnancy status of the patient. RADIOGRAPHIC PROCEDURE Image quality 6. Optimum definition – can you see the detail of the relevant anatomy/structures, i.e. is it sharp? GENERAL PRINCIPLES OF RADIOGRAPHY OF THE SKELETAL SYSTEM INDICATIONS FOR SKELETAL SYSTEM RADIOGRAPHY RADIOGRAPHIC TECHNIQUES&PROCEDURES BMI Definitions of terms Medical Imaging is the technique and process of creating visual representations of the interior of a body for clinical analysis and medical intervention and some function of the organs and tissues Radiographic techniques and procedures are the protocols used by the Radiographer to produce radiographic image. Radiography is the process of taking radiographs to assist in medical diagnosis and treatment. Radiograph is the end product of the radiography in visible radiographic image. Radiographer are medical professionals who specialize in the imaging of human anatomy for the diagnosis and treatment of the pathology Radiographic Techniques&Procedures Projections/ views, these are used in defining the direction of the rays passing through the body e.g AP, PA, Lateral, Oblique. BASIC PRINCIPLES OF RADIOGRAPHY The radiographer has a duty of care to the patient and must treat them with respect and ensure their dignity is maintained. It is essential that the radiographer establishes a rapport with the patient and carers. The radiographer must introduce themselves to the patient/carer and inform them of their role in the examination. They must make sure the request form is for the patient being examined and that the clinical details and history are accurate. Radiographic Techniques&Procedures There are 3 stages to undertaking an X-ray examination, preparation, the radiographic procedure itself and follow up from the examination undertaken. Preparation for the examination: The request form. The X-ray room. The patient, including consent for the examination and identity checks. Three P(s) must be observed during patient preparations physical, psychological and physiological preparations. Undertaking(During) the examination: Patient care. Radiographic procedure. Radiation protection Post-examination and aftercare: Image quality. Patient aspects. Imaging informatics. PREPARATION FOR THE EXAMINATION The request form Ensure the examination requested is authorised and signed with a suitable rationale. Make sure the request card has a justifiable clinical reason for the X-ray, e.g. history of injury and pain in knee joint. Any examination using X-rays must affect the management of the patient. Check the protocol for the examination. Make sure you know which projections are required, e.g. AP and Lateral of the knee. PREPARATION OF THE X-RAY ROOM Make sure the X-ray room is clean, safe and tidy, ensure that the floor is clear and the X-ray tube is not in a position where the patient can walk into it. Set a preliminary exposure for the examination, i.e. X-ray tube focus size, mAs and kV. Have any accessory equipment available, e.g. foam pads. PREPARATION OF THE PATIENT Patient’s full name, date of birth and address. Correct examination requested and reason for the X-ray. Is the patient fit and ambulant or have any physical needs? If applicable ensure the patient is undressed and dress them in a radiolucent gown. The patient is asked: If they understand the nature of the examination and if they have any questions prior to proceeding. For verbal permission to proceed with the examination. For written consent if an examination incurs a higher risk, e.g. angiography • Understand the risk versus benefit. Understand the nature of the examination and why it is being performed. Understand the consequences of not having the examination. Be able to make and communicate an informed decision. PATIENT CARE DURING EXAMINATION At the commencement of the examination introduce yourself to the patient and ask permission to take the X-ray. If the patient has been prepared for the examination, check they have followed the instructions, e.g. undressed appropriately and in a gown, nil by mouth or any other preparation. • Check the pregnancy status of the patient. Check for the patient’s infection status, to prevent cross infection by appropriate methods. Visibly clean hands in front of the patient before you start the procedure. Patient identity. RADIOGRAPHIC PROCEDURE The patient is positioned accurately in relation to the examination being undertaken. The X-ray tube is positioned and centred to the patient and image receptor. The beam is collimated to the area of interest. Appropriate radiation protection is carried out. An anatomical marker is correctly applied to the image receptor Radiographers and other staff/carers stand behind the lead glass protective control screen and exposure undertaken after the exposure factors confirmed on control panel. POST-EXAMINATION AND AFTERCARE Immediately following image acquisition the image will be reviewed to ensure it is of diagnostic quality; the patient will be managed and be given instructions as to what to do next and the examination will be completed in terms of the imaging information of the X-ray procedure. Image quality The image is reviewed using the ‘10-point plan’: Patient identification. Area of interest is included. Markers and legends. Correct projection. Correct exposure indicator 6. Optimum definition – can you see the detail of the relevant anatomy/structures, i.e. is it sharp? Collimation is restricted to the area of interest. Are there any artefacts and are they obscuring anatomy? Any need for repeat radiographs or further projections. Anatomical variations and pathological appearances GENERAL PRINCIPLES OF RADIOGRAPHY OF THE SKELETAL SYSTEM Two views should be taken at the right angle to each other At least one joint should be included in limbs radiography Immobilizing the pt The easiest and less projection should be done first INDICATIONS FOR SKELETAL SYSTEM RADIOGRAPHY TRAUMA PATHOLOGICAL CONDITIONS FORENSIC

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Radiographic Techniques Of The Lower Limb CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Radiographic Techniques Of The Lower Limb using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic FOOT (POSTIONING TERMINOLOGY) Radiographic Techniques Of The Lower Limb Ankle extension: of the ankle joint occurs when the plantar surface of the foot is moved in an inferior direction. Basic projections DORSI-PLANTAR DIRECTION AND LOCATION OF THE X-RAY BEAM DORSI-PLANTAR OBLIQUE LATERAL Position of patient and image receptor LATERAL – ERECT (WEIGHT-BEARING) TOES ANKLE ANTERO-POSTERIOR (AP) – MORTISE PROJECTION LATERAL (MEDIO-LATERAL) CALCANEUM AXIAL TIBIA AND FIBULA ANTERO-POSTERIOR RADIOGRAPHIC TECHNIQUES OF THE LOWER LIMB FOOT (POSTIONING TERMINOLOGY) Dorsal surface: the superior surface of the foot is known as the dorsal surface and slopes downwards, at a variable angle, from the ankle to the toes and from medial to lateral. Plantar aspect: the inferior surface of the foot is known as the plantar aspect. Medial aspect: the surface nearer the midline of the body is the medial aspect. Lateral aspect: the surface further from the midline of the body is the lateral aspect . Radiographic Techniques Of The Lower Limb Medial rotation: the lower limb is rotated inwards, so that the anterior surface faces medially. This will produce internal rotation of the hip joint. Lateral rotation: the lower limb is rotated outwards, so that the anterior surface faces laterally. This will produce external rotation of the hip joint. Ankle flexion: of the ankle joint occurs when the dorsal surface of the foot is moved in a superior direction. Ankle extension: of the ankle joint occurs when the plantar surface of the foot is moved in an inferior direction. Inversion: inversion of the foot occurs when the plantar surface of the foot is turned to face medially – with the limb extended. Eversion: eversion of the foot occurs when the plantar surface of the foot is turned to face laterally – with the limb extended. Flexion of the knee joint: the degree of flexion of the knee joint relates to the angle between the axis of the tibia when the knee is extended and the angle of the axis of the tibia when the knee is flexed. Basic projections Two projections are routinely taken, a dorsi-plantar (DP) a DP oblique DORSI-PLANTAR Position of patient and image receptor The patient is seated on the X-ray table, supported if necessary, with the hip and knee flexed. The plantar aspect of the foot is placed on the image receptor and the lower leg is supported in the vertical position by the other knee. The receptor can be raised by 15° to aid positioning, with a vertical central beam. This will improve the visualization of the tarsal and tarso-metatarsal joints. DIRECTION AND LOCATION OF THE X-RAY BEAM The collimated central beam is centred over the cuboid– navicular joint midway between the palpable navicular tuberosity and the tuberosity of the 5th metatarsal. The X-ray tube is angled 15° cranially when the receptor is parallel to the table. Alternatively, the X-ray beam is vertical if the receptor is raised by 15°. DORSI-PLANTAR OBLIQUE Position of patient and image receptor From the basic DP position, the affected limb is leaned medially, bringing the plantar surface of the foot to approximately 30–45° to the image receptor. A non-opaque angled pad is placed under the foot to maintain the position, with the opposite limb acting as a support. DIRECTION AND LOCATION OF THE X-RAY BEAM The collimated central beam is directed over the cuboid–navicular joint. LATERAL This is used in addition to the routine DP projection to locate a foreign body. It may also be used to demonstrate a fracture or dislocation of the tarsal bones, or base of metatarsal fractures or dislocation. Position of patient and image receptor From the DP position, the leg is rotated outwards to bring the lateral aspect of the foot in contact with the receptor. A pad is placed under the knee for support. The position of the foot is adjusted slightly to bring the plantar aspect perpendicular to the receptor. DIRECTION AND LOCATION OF THE X-RAY BEAM The collimated central beam is centred over the navicular-cuneiform joint if the whole foot is to be examined. LATERAL – ERECT (WEIGHT-BEARING) This projection is used to demonstrate the condition of the longitudinal arches of the foot, usually in pes planus (flat feet). Both feet are examined for comparison. It is important that the full weight of the patient is placed on the feet, to allow an accurate evaluation of the effect of normal weight on the longitudinal arch and bony alignment. Position of patient and image receptor The patient stands on a low platform with the receptor placed vertically between the feet. The feet are brought close together. The weight of the patient’s body is distributed equally. DIRECTION AND LOCATION OF THE X-RAY BEAM The collimated central beam is centred to the tubercle of the 5th metatarsal. TOES Basic projections It is common practice to obtain two projections, a DP and a DPO. A lateral projection is taken for fractures of the phalanges of the hallux (great toe) such as hyperflexion avulsion fractures of the distal phalanx, which could be missed on an oblique projection. DORSI-PLANTAR Position of patient and image receptor The patient is seated on the X-ray table, supported if necessary, with hips and knees flexed. The plantar aspect of the affected foot is placed on thereceptor. A CR cassette may be raised by 15°. DIRECTION AND LOCATION OF THE X-RAY BEAM The collimated central beam is directed over the 3rdmetatarso-phalangeal joint (MTPJ). DORSI-PLANTAR OBLIQUE Position of patient and image receptor From the basic DP position, the affected limb is allowed to lean medially to bring the plantar surface of the foot approximately 45° to the receptor. A 45°e non-opaque pad is placed under the side of the foot for support, with the opposite

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Radiographic Technique CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Radiographic Technique using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic RADIOGRAPHIC TECHNIQUE Objectives 1.Radiography 1.Medical radiography has two branches these are;1; diagnostic radiography(diagnostic) 6.Radiographer is a person train in radiography he /she is skilled in performing radiographic procedures Terminology applicable to radiography Anterior aspect: that seen when viewing the patient from the front. Superior top or the upper part Planes of the body PROJECTION/VIEWS APPLIED IN RADIOGRAPHY Basic view(or routine) Antero-posterior (A.P) Oblique Centering point(cp) these locate on the body where the central ray will pass PROCEDURES OF RADIOGRAPHY Preparation for the examination Identify the patient: 3. During examination 3.After care (after examination) IDENTIFICATION OF RADIOGRAPH: FILM CRITIQUE: B: In the x-ray room there are four things which can be moved: FACTORS WHICH AFFECT SELECTION OF OPTIMUM EXPOSURE FACTORS ARE: The standard viewing of film (presentation of radiographs): general principles of radiography of the skeletal system: Indications for radiography of the skeletal systems: RADIATION PROTECTION: There are three main purposes to minimize the radiation dose received by both patient, staff and public. TO STAFF: TO PATIENT: RADIOGRAPHIC TECHNIQUE Basic principles of radiography, terms and definitions Objectives At the end of this module the students should be able to DEFINE Radiography radiographic technique Radiographic procedures Medical radiology Radiologist Radiographer Radiograph 1.Radiography Is a science of utilizing radiation Radio-referring to radiation and Graph referring to record making. Radiography is therefore the science of making record by means of radiation This study is divided into two branches; Medical radiography Industrial radiography 1.Medical radiography has two branches these are;1; diagnostic radiography(diagnostic) 2;therapy radiography (treatment) Industrial radiography This specifically for industrial purposes Other applications of radiation are for Security i.e. in the airports and customs Research production centers Radiographic Technique 2.Radiographic technique ;is a procedure where by radiographic film is exposed to a controlled amount of x ray in order to produce anatomical set up to any part of the human body for diagnostic purposes. The normal radiographic anatomy is the same for all human beings .the normal radiograph of part of people must be identical Radiographic Technique 3 .Radiographic procedure; is a way or method used by radiographer to obtain a diagnostic radiograph. As from the time receiving patient, prepared examined and after care. 4.Medical radiology(imaging) The application of sciences of X -ray, ultrasound, MRI,CT to diagnose disease 5.Radiologist;is a medical doctor whose specialist qualification is based in medical imaging 6.Radiographer is a person train in radiography he /she is skilled in performing radiographic procedures He/she is the one assisting the radiologist in medical imaging Radiograph is a visual image produced by x rays on a piece of photographic materials Terminology applicable to radiography In radiographic technique you have to know some common descriptive terms which determine the way a patient is positioned in relation to the film and source of x rays In anatomy and in radiographic technique the human body is described in anatomical position Radiographic Technique Anatomical position this is standard position where by the person is in erect ( standing) such that a part ie when the body is straight the eyes and face directed foward, hands supinated by side o trunk and heels together, feet point forward Aspect indicates a surface view of subject under examination Anterior aspect: that seen when viewing the patient from the front. Posterior (dorsal) aspect: that seen when viewing the patient from the back. Lateral aspect: refers to any view of the patient from the side. The side of the head would therefore be the lateral aspect of the cranium. Medial aspect: refers to the side of a body part closest to the midline, e.g. the inner side of a limb is the medial aspect of that limb. Superior top or the upper part Inferior lower part Cephalic towards the head Caudad toward the feet Proximal near the trunk Distal away from the trunk Planes 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. Median sagittal plane: divides the body into right and left halves. 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. Planes of the body…… 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 APPLIED IN RADIOGRAPHY A projection is described by the direction of the central ray relative to aspects and planes of the body. Refers to various positions patient is placed for examinations in relation to radiation source and recording medium Basic view(or routine) These are views (projections) which give best information as pertaining disease or injury They are international Alternative view Projection which are done when isnt possible to do basic view Supplementary view This projection locates some diseases which can not clearly seen on the basic views. They remove some doubts Antero-posterior (A.P) 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 (P.A) 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 (Lt or Rt) The central ray passes from one side of the body to the other along a coronal and transverse plane. Oblique The central ray passes through the body along a transverse plane at some angle between the median sagittal and coronal planes. 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,

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Radiographic Procedures And Techniques For Upper Limb CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Radiographic Procedures And Techniques For Upper Limb using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Learning objective a. Interpret radiology and imaging request forms for the patients Request Form HAND EQUIPMENT AND ACCESORIES BASIC PROJECTIONS DORSI-PALMAR DIRECTION AND LOCATION OF X-RAY BEAM Essential image characteristics (Figs above ) ANTERIOR OBLIQUE (DP OBLIQUE) DIRECTION AND LOCATION OF THE X-RAY BEAM DP oblique hand LATERAL Essential image characteristics (Fig. above) DORSI-PALMAR BOTH HANDS • The wrists are adjusted so that the radial and ulna styloid processes are equidistant from the image receptor. Essential image characteristics(Figs bove) ANTERO-POSTERIOR OBLIQUE BOTH Radiographic Procedures And Techniques For Upper Limb RADIATION PROTECTION FINGERS DORSI-PALMAR (DP) LATERAL INDEX AND MIDDLE FINGERS LATERAL RING AND LITTLE FINGERS Learning objective Interpret radiology and imaging request forms for the patients Conduct x-ray examinations of the upper and lower axial and appendicular muscular skeletal system Conduct x-ray examinations of the vertebral( cervical Thoracic and lumber) as per radiographic drill Evaluate resultant image for quality check Communicate resultant image to the required destination Apply radiographic drill concept in performing radiography of the axial and appendicular muscular skeletal system a. Interpret radiology and imaging request forms for the patients A radiology request form is a document used by healthcare providers to formally request imaging studies, such as X-rays, MRIs, or CT scans, for a patient. It includes Essential patient information it include, name of the patient, patient hospital reg no, gender, age, LMP, dept/ward Relevant clinical history it may include provisional diagnosis Examination requested, Referring Physician Information Date This form helps ensure that the appropriate imaging is conducted and assists radiologists in understanding the context of the request for accurate interpretation Request Form The radiographer checks the request form to ensure the examination is justified according to: ◾ ionizing radiation regulations; ◾ department protocols, making sure that the form contains all the required details, i.e. patient demographics, examination requested, authorised signature for the examination and rationale for the examination. ◾ An explanation of the examination requested is provided. Conduct x-ray examination of the upper and lower limbs as per radiographic drill HAND ANATOMY The skeleton of the hand includes the bones of the carpus the bones of the metacarpus and the phalanges. EQUIPMENT AND ACCESORIES X-RAY MACHINE IMMOBILAZERS(SAND BAG/FOAM PADS) CASSETTE- 18X24CM/24X30CM ANATOMICAL MARKER PROCESSING UNIT BASIC PROJECTIONS Two projections are routinely taken, a dorsi-palmar (DP) and an anterior oblique (DP oblique) DORSI-PALMAR Position of patient The patient is seated alongside the table with the affected arm nearest to the table. The forearm is pronated and placed on the table with the palmer surface of the hand in contact with the image receptor/cassette. The fingers are separated and extended but relaxed to ensure that they remain in contact with the image receptor/cassette. The wrist is adjusted so that the radial and ulna styloid processes are equidistant from the image receptor. A sandbag is placed over the lower forearm for immobilisation. DIRECTION AND LOCATION OF X-RAY BEAM The collimated vertical beam is centered over the head of the 3rd metacarpal Radiation protection/dose Careful technique and close collimation will assist in reducing the patient dose. Essential image characteristics (Figs above ) The image should demonstrate all the phalanges, including the soft tissue of the fingertips, the carpal and metacarpal bones and the distal end of the radius and ulna. The interphalangeal and metacarpo-phalangeal and carpometacarpal joints should be demonstrated clearly. No rotation of the hand. ANTERIOR OBLIQUE (DP OBLIQUE) Position of patient From the basic postero-anterior position, the hand is externally rotated 45° with the fingers extended. The fingers should be separated slightly and the hand supported on a 45° non-opaque pad. A sandbag is placed over the lower end of the forearm for immobilisation DIRECTION AND LOCATION OF THE X-RAY BEAM The collimated vertical beam is centred over the head of the 5th metacarpal. The tube is then angled so that the central ray passes through the head of the 3rd metacarpal, enabling a reduction in the size of the field. Essential image characteristics (Figs above) The image should demonstrate all the phalanges, including the soft tissue of the fingertips, the carpal and metacarpal bones and the distal end of the radius and ulna. The correct degree of rotation has been achieved when the heads of the 1st and 2nd metacarpals are seen separated whilst those of the 4th and 5th are just superimposed. Over-rotation of the hand DP oblique hand DP oblique hand demonstrating over-rotation. The 3rd, 4th and 5th metacarpals are superimposed. A repeat X-ray is required. LATERAL Position of patient From the postero-anterior (DP) position, the hand is externally rotated 90°. The palm of the hand is perpendicular to the image receptor,with the fingers extended and the thumb abducted and supported parallel to the image receptor on a non-opaque pad. The radial and ulnar styloid processes are superimposed DIRECTION AND LOCATION OF THE X-RAY BEAM The collimated vertical beam is centred over the head of the 2nd metacarpal Essential image characteristics (Fig. above) The image should include the fingertips, including soft tissue,and the radial and ulnar styloid processes. The heads of the metacarpals should be superimposed. The thumb should be demonstrated clearly without superimposition of other structures. DORSI-PALMAR BOTH HANDS Position of patient Ideally, the patient is seated alongside the table. However, if this is not possible due to the patient’s condition, the patient may be seated facing the table. Both forearms are pronated and placed on the table with the palmer surface of the hands in contact with the image receptor. The fingers are separated and extended but relaxed to ensure that they remain in contact with the image receptor • The wrists are adjusted so that the radial and ulna styloid processes are equidistant from the image receptor. A sandbag is

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Radiographic Procedure of the Knee Joint CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Radiographic Procedure of the Knee Joint using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic ANATOMY INDICATION RADIOGRAPHIC EQUIPMENT BY SIMON X-RAY DETECTOR PATIENT PREPARATION BY YUNGE PATIENT POSITION BY ANETH CENTERING POINT BY IBRAHIM CENTRAL RAY DIRECTION BY MWAJUMA SPECIAL FEATURES/COLLIMATION BY CATHERINE RADIATION PROTECTION BY OSCAR AFTER CARE BY KENETHY EVALUATION BY JOHN SPECIAL FEATURES/COLLIMATION BY IBRAHIM RADIOGRAPHIC PROCEDURE OF KNEE JOINT: ANATOMY Joint-Is point where two bones meet. Knee joint- is the complex joint that connect femur to the tibia The example is hinge joint. INDICATION INDICATION-Refers to specific reason or conditions that warrant a treatment related to the knee joint. THOSE INDICATIONS ON THE KNEE JOINT INCLUDES: TRAUMA( causes direct impact like fall, accident) Examples of trauma are ligament tears, dislocation , fractures. PATHOLOGICAL CONDITION:EXAMPLE Arthritis, ligament tear, and osteoarthritis. FOLLOW UP RADIOGRAPHIC EQUIPMENT BY SIMON The essential devices and tools used in radiography to produce image for diagnosis and treatment :The equipment that can be used are: X-ray machine X-rays detectors(Digital and film detectors) X-ray generator Control panel(collimators) Immobilize device Lead shielding material X-RAY MACHINE X-RAY DETECTOR A. Film detector B. Digital detector COLLIMATION Lead shielding material. PATIENT PREPARATION BY YUNGE Patient preparation can be done: PHYSICALLY-The removal of material which can cause art crafts. PSYCHOLOGICALLY-To prepare the patient mindset before, during, and after examination. PHYSIOLOGICALLY-To know the patient background and his or her current situation. PATIENT POSITION BY ANETH During knee x-ray examination the following position are considered. Anteroposterior(AP)-Patient lying supine Lateral position-The knee is flexed at about (20-30) degrees with the patient lying of their side. Oblique-Leg rotated (20-30) degrees internally or externally. ANTEROPOSTERIOR(AP) LATERAL VIEW OBLIQUE VIEW CENTERING POINT BY IBRAHIM Centering point during knee x-ray examination The midpoint of the joint- point between medial and lateral point. The joint between patella and femur(patellofemoral joint) PATELLOFEMORAL CENTRAL RAY DIRECTION BY MWAJUMA For lateral knee x-rays –central ray is directed perpendicular to the film at the medial condyle of the femur. For anterior posterior(AP) knee x-ray-The central ray is directed perpendicular to the film at the midpoint of the knee joint below the patella apex-( tibiopatello joint ) CENTERING RAY SPECIAL FEATURES/COLLIMATION BY CATHERINE Collimation-Is a process of reducing x-ray beam. During knee x-ray examination collimation is essential to minimize radiation exposure and enhance image quality by adjusting the lead aperture of the x-ray tube. EXAMPLES IN: .AP View-From the distal femur to the proximal tibia .Lateral view –Include the femoral condyles and the tibial plateau RADIATION PROTECTION BY OSCAR Radiation protection-The measures to ensure patient and staff safety from radiation exposure. The following are methods/ways for radiation protection: Lead shielding-example use of lead apron. Collimation-Collimate the x-ray beam to the area of interests by using adjusting panels. Distance-Maintain a safe distance from the x-ray source example Focal field distance(FFD) Use of ALARA principle. AFTER CARE BY KENETHY 1.Patient education-provide information for immediate medical attention example increase in swelling 2.Post procedure instruction-Inform the patient about follow up steps or results wait in time EVALUATION BY JOHN 1.Image review-review the x-rays images for clarity and completeness 2.Bone integrity -Look for fractures or signs of osteoporosis(condition of bone to be soft due to lack of calcium) 3.Patellar position-check for signs of dislocation. 4.Assessment of alignment-Evaluate the alignment of a femur ,tibia and fibula for any signs of valgus deformities. ANATOMY Knee joint- is the complex joint that connect femur to the tibia The example is hinge joint. INDICATION Indication may be : TRAUMA( causes direct impact like fall, accident) Examples of trauma are ligament tears, dislocation , fractures. PATHOLOGICAL CONDITION:EXAMPLE Arthritis , gout. FOLLOW UP CENTRAL RAY DIRECTION BY MWAJUMA For lateral knee x-rays –central ray is directed perpendicular to the film at the medial condyle of the femur. For anterior posterior(AP) knee x-ray-The central ray is directed perpendicular to the film at the midpoint of the knee joint( 1cm below the patella apex-tibiopatello joint ) CENTERING POINT SPECIAL FEATURES/COLLIMATION BY IBRAHIM During knee x-ray examination collimation is essential to minimize radiation exposure and enhance image quality 1.AP View-From the distal femur to the proximal tibia 2.Lateral view –Include the femoral condyles and the tibial plateau EVALUATION BY JOHN 1.Image review-review the x-rays images for clarity and completeness 2.Bone intergrity-Look for fractures or signs of osteoporosis(condition of bone to be soft due to lack of calcium) 3.Patellar position-check for signs od dislocation. 4.Assessment of alignment-Evaluate the alignment of a femur ,tibia and fibula for any signs of valgus deformities. ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? 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DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Radiographic Procedure – Axial X Ray CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Radiographic Procedure – Axial X Ray using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic AXIAL SKELETON ANATOMY Radiographic Procedure – Axial X Ray SKULL BONES FACIAL BONES Ribcage Bones Vertebral Column (Back Bone) RADIOGRAPHIC PROCEDURE AXIAL SKELETON ANATOMY The entire human skeleton is made up of axial and appendicular skeletons. A vertebrate’s head and trunk bones constitute the axial skeleton, one of the parts of the skeletal system. Eighty bones comprise this skeleton system and are divided into six parts: the skull, the middle ear’s ossicles, the hyoid bone, the sternum, the rib cage and the vertebral column. Radiographic Procedure – Axial X Ray The axial skeleton constitutes the skull, vertebral column, laryngeal skeleton, and thoracic cage. The girdles and limbs of the appendicular skeleton “append” to the axial skeleton. SKULL BONES The skull comprises two groups of bones: 14 facial bones and 8 cranial bones. The cranial bones support and protect the brain, which forms the top and back of the skull. The following are among the eight cranial bones: Two parietal bones (right and left) Two temporal bones (right and left) One occipital bone One frontal bone One sphenoid bone One ethmoid bone FACIAL BONES The face of the skull is formed of the facial bones, which also serve as the body’s entryway. The 14 facial bones consist of: Two maxilla bones (right and left) Two nasal bones (right and left) Two nasal concha bones (right and left) Two zygomatic bones (right and left) Two palatine bones (right and left) Two lacrimal bones (right and left) One mandible bone One vomer bone Ribcage Bones Our heart, lungs, and other internal organs are protected by the ribcage or thoracic cage. It is attached to the respiratory and arm movement muscles. The ribcage contains the following bones: Breastbone or sternum: This is a flat, long bone running down the centre of our chest. Twenty-four ribs: 12 pairs of ribs. Vertebral Column (Back Bone) There are 24 vertebrae in the spinal column, including the sacrum and tailbone (coccyx). The vertebral column spans from the pelvis to the base of the skull. It is divided into five parts: Seven cervical vertebrae: They form the neck and support the head. Twelve thoracic vertebrae: They form the posterior anchor of the ribcage. Five lumbar vertebrae: Affixed to the back muscles, they bear most of the body weight. One sacrum: The sacrum, a triangle bone, constitutes the pelvic back wall. One coccyx (tailbone): The coccyx, located at the base of the spine, connects to various body muscles ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Radiographic Procedure CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Radiographic Procedure using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic OBJECTIVES Perform under supervision the radiographic examinations of the appendicular and axial skeleton following Radiographic drill. DEFINITIONS AND TERMINOLOGIES ANATOMICAL TERMS PLANE OF THE BODY PROJECTION/VIEWS VIEWS TERMINOLOGY A projection is described by the direction of the central ray relative to aspects and planes of the body. Radiographic Procedure BEAM ANGULATION POSITIONING TERMINOLOGY TERMS RELATED TO BODY MOVEMENT LIMB POSITION Extension: when the angle of the joint increases. GENERAL PRINCIPLE OF RADIOGRAPHIC EXAMINATION INDICATION RADIOGRAPHIC DRILL Radiation protection Equipment care Patient care Common challenges in position Radiographic examination 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