CRT04103 Radiographic Techniques and Procedures

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Barium Enema CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Barium Enema using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Definition Indications notes Barium Enema Contraindications General contraindication Equipment used Other accessories Patient Preparation Contrast medium used and supplies SUPLIES Trolley set up Preparation of the patient Methods of performing Ba. enema Procedure/technique protocol Films taken/position(INDIVIDUAL) GENERAL SPOTS FILMS What to look for Can you see pre sacral space(retrorectal space) Some of the condition associate with retro rectal space < or > Can we sing radiology song? Quiz 3 BARIUM ENEMA Definition Indication Contraindications Equipment used Contrast media used Describe technique of barium enema Adverse effects After care of the patient What to look for(normal barium anema) Definition Barium enema is a special radiological procedure of the large intestines following retrograde injection of sulfate contrast (barium sulphate) through anus done under fluoroscopy. Its for evaluation of anatomy, physiology and pathology of cecum, colon(ascending,transverse colon, descending colon ,sigmoid colon),rectum and anus. Indications Unexplained change in bowel habits investigation of non-specific abdominal pain Abdominal mass Melena (dark feces due to blood) Suspected ulcerative colitis Suspected Diverticulum Suspected Polyps Suspected Intussusception Suspected volvulus Suspected Neoplasm( colorectal cancer) Suspected Strictures Hirschsprung's disease failed colonoscopy notes If a tight stricture is demonstrated, run a small volume of barium proximally to define the upper margin for other wise barium may impact Hirschsprung's disease (HD Barium Enema is a form of megacolon that occurs when part or all of the large intestine or antecedent parts of the gastrointestinal tract have no ganglion cells and therefore cannot function. During normal prenatal development, cells from the neural crest migrate into the large intestine (colon) to form the networks of nerves called the myenteric plexus (Auerbach plexus) (between the smooth muscle layers of the gastrointestinal tract wall) and the submucosal plexus (Meissner plexus) (within the submucosa of the gastrointestinal tract wall). In Hirschsprung's disease, the migration is not complete and part of the colon lacks these nerve bodies that regulate the activity of the colon. Contraindications Absolute: Toxic mega colon Pseudomembranous colitis Suspected bowel perforation Rectal or colonic biopsy within the past 5 days Relative: Partial obstruction recent barium meal (wait 7 – 10 days) Pt. frailty General contraindication Acute appendicitis Perforation Pregnancy Severe diarrhea Incomplete bowel preparation Rectal biopsy within the last 5 days. Equipment used Fluoroscopy Unit Other accessories cassettes, Anatomical markers rt or lt. Foot rest Hand grips shoulder support Lead aprons, gloves thyroid shield Patient Preparation As per barium meal… Plain abdominal film look for Obstruction Megacolon Calcification Bowel preparation Contrast medium used and supplies 1000 – 1500ml of 115% w/v barium sulphate suspension 500ml for double contrast plus air SUPLIES Enema container (1lt on its stand and tubing system with y or T shaped the way glass connector and suitable) Rector catheter Higginson's syringe Bed pan Lubricant KY gel Plenty of towel Sticking plaster Gloves Clamp Jug of water Kidney dish Enema tray Makingtosh Trolley set up please make follow up at the department.. Preparation of the patient As per barium meal.. In some cases enema wash out is advised Methods of performing Ba. enema Single contrast enema: Refer t exceptional in barium meal Double contrast enema: Method of choice to demonstrate mucosal pattern. Procedure/technique DOUBLE CONTRAST protocol Pour 500mls of the suspension into an enema bag, run barium from the enema bag into the plastic tubing to expel the air and finally clamp the tubing. Place the patient on his left, lubricate the enema tip(the rectal catheter),and insert gently into the patient rectum. Protocol….. Connections are made to the barium receiver and the hand pump for injection of air. Unclamp the tubing and allow barium to flow by gravity or by gently squeezing the enema bag The infusion of barium released via rectum and the progress is screening, Then Patient lies prone as the barium reaches to the hepatic flexures ,the infusion is terminated. Protocol….. When the bag is empty of barium or reaches to the hepatic flexures,….. Now the air is gently pumped into the bowel, forcing the column of barium round towards the caecum and producing double contrast effect The insufflating of air is at the rate of not more than one puff per second. Protocol….. From prone position the patient is rolled into the left side and over into an RAO position so that the barium coats the bowel mucosa. Then spots films are taken;… Films taken/position(INDIVIDUAL) FILM / POSITION PURPOSE/ REGION DEMONSTRATED Left lateral, prone, RAO,LPO Rectum and sigmoid colon LAO open out the splenic flexures RAO open out the heaptic flexures RIGHT LATERAL the rectum RAO, RPO (table horizontal) Caecal pole GENERAL SPOTS FILMS left lateral/RT lateral—–RECTUM sigmoid, descending colon, splenic flexures— LAO transverse colon/hepatic flexures—–RAO ascending colon and cecum——-SUPINE whole large bowel———-PRONE Rotate the patient back into LPO position take images of hepatic flexure Rotate the pt into RPO position. Take spot image of splenic flexure Pliz continue to read table tilting with their degrees as well as parts demonstrated…… NOTES post evacuation film is not taken routinely but if taken may allow improvement assessment of the cecum, when other film has failed OR to asses amount of barium expelled After care, Adverse effects, Complications as per previous study What to look for NORMAL BARIUM ENEMA Can you see pre sacral space(retrorectal space) Normal 1-2 cm Some of the condition associate with retro rectal space < or > Chondroma Proctitis Prostatic enlargement Lipomatosis Ca rectum Obesity Tumor of the sacrum Thrombosis of the IVC Granulomatous colitis Can we sing radiology song? ok lets sing together Quiz 3 What are preparation of the patient prior to the barium enema examination What are 5 advantages of taking preliminary film prior to the barium study examination What is Chrohn’s Disease? What is toxic megacolon? ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Barium follow through CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Barium follow through using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Definition Applied anatomy Indications Contraindications Equipment used Other accessories Patient Preparation Contrast medium used Trolley set up Procedure/technique Position summary Other techniques Radiation Protection Radiographic anatomy After care Are you happy? BARIUM FOLLOW THROUGH Definition Indication Contraindications Describe technique of barium meal follow through Adverse effects After care of the patient Normal radiological anatomy Side check up Definition Barium follow through is a special contrast radiological procedure of lower portion of the stomach, the duodenum, small intestine and a portion of the caecum following ingestion of sulfate contrast (barium sulphate) done under fluoroscopy. Its for evaluation of anatomy and physiology and of the lower portion of the stomach, the duodenum, small intestine and a portion of the caecum Series of film are taken at intervals as the column of barium travels through the intestine until it reaches the caecum. Study of small intestines only is small bowel series. If combined with upper GI series, it`s small bowel follow through. Applied anatomy Has 3 parts; duodenum, jejunum and ileum Duodenum is 1st part, shortest, widest and most fixed portion. Primarily in RUQ, also extends into LUQ where it joins the jejunum at duodenojejunal flexure. C-shaped. Internal lining of descending and horizontal portions have tight circular folds with numerous villi resulting in a `feathery` appearance when filled with barium. Jejunum 2nd part, primarily located to the left of midline in LUQ and LLQ. Makes 2/5 of small intestines. Has circular folds as well. Ileum, primarily in RUQ, RLQ and LLQ, is the longest portion (3/5 of small intestines). Terminal ileum joins large intestine at ileocecal valve in RLQ. Has no circular folds. Appear as smooth with fewer indentations hence less feathery. Indications Abdominal pain(persistent) Diarrhea Anemia (?intestinal bleeding) Abdominal mass Mal-absorption syndrome Suspected diverticular(Mekels diverticulum ) Inflammatory bowel disease.. Investigations of transit time Suspected Partial obstruction Suspected Strictures Contraindications Complete bowel obstruction Perforation Obstruction(partial complete) Post operative Pregnancy Suspected perforation Suspected of tracheoesophageal fistula Hypersensitive to barium Equipment used 1.conventonal fluoroscopy Image intensifier Spot film device Television fluoroscopy Fluoroscopic couch Other accessories cassettes, Anatomical markers rt or lt. Foot rest Hand grips shoulder support Lead aprons, gloves thyroid shield Patient Preparation As per barium meal… Plain abdominal film look for Obstruction Megacolon Calcification Bowel preparation Contrast medium used Dosage:E-z paque 100% W/V 300ml of low density usually in 10-15 min increments or 300ml at once. Or 150 ml if performed immediately after barium meal. Cold water is used in preparation of the suspension to stimulate gastric emptying and reduce transit time. In children 3-4mil/kg is suitable volume Where barium is contraindicated non ionic water soluble contrast media have bee shown to be satisfactory alternative Trolley set up As for barium swallow…please make follow up at the department Procedure/technique Barium follow through is a single contrast study The aim is to deliver a single column of barium into small bowel This is archived by lying the patient on the rt side after barium has been ingested(metoclopramide is used to enhance gastric emptying) Time of ingestion of CM is noted Position Prone PA films of the abdomen are taken every 20 min during first hour, Until the barium reached to the terminal ileum, Prone position is used because the presure on the abdomen helps to separate loops of the small bowell Sport films of terminal ileum are taken supine a compression pad is used to displace any overlying loops of small bowel that are obscured by terminal ileum. 1st radiograph taken either 15min or 20min after ingestion of CM. It requires high centering to include diaphragm (stomach). summary PA 30min, most Ba in stomach, duodenum and jejunum. PA 1hr, most Ba in jejunum. PA 2hrs, most barium in ileum and proximal colon. Oblique, erect and trendelenburg positions may also be used Other techniques Pneumocolon technique Enteroclysis..read pliiz Radiation Protection As per previous study Radiographic anatomy NORMAL SMALL-BOWEL BARIUM STUDIES Side check up what comes to your mind when doing bmft Transit time Continuous column Contour changes After care As per previous study Questions Are you happy? happy Ok be happy ← 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 Barium Meal CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Barium Meal using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Definition Indications Contraindications Equipment used Other accessories Preparation of the patient 1 Preparation of the patient 2 Contrast medium used Trolley set up Procedure/technique double contrast Spot films taken RAO supine area of concentration Barium Meal Other imaging modalities Radiation protection Complications After care Adverse effects Quiz 2 BARIUM MEAL Definition Indication Contraindications Describe technique of barium meal Adverse effects After care of the patient Normal radiological anatomy (area of concentration) Definition Barium meal is a special contrast radiological procedure of the lower 1/3 of esophagus, stomach, duodenum following ingestion of sulfate contrast (barium sulphate) done under fluoroscopy. Its for evaluation of anatomy and physiology and of the lower 1/3 esophagus, stomach, duodenum. smoking should be avoided since it increase gastric motility. Indications Dyspepsia Un explained Weight loss Upper abdominal mass Gastro intestinal hemorrhage Assessment of site of perforation Gastric volvulus Bezoar Gastric diverticulum Suspected gastric ulcer/duodenal Hiatus hernia Reflux esophagitis Pain full swallowing Heart burn Dysphagia odynophagia retrostenal pain Contraindications Complete bowel obstruction Perforation Obstruction(partial complete) Post operative Pregnancy Suspected perforation Suspected of tracheoesophageal fistula Hypersensitive to barium Equipment used 1.conventonal fluoroscopy Image intensifier Spot film device Television fluoroscopy Fluoroscopic couch Other accessories cassettes, Anatomical markers rt or lt. Foot rest Hand grips shoulder support Lead aprons, gloves thyroid shield Preparation of the patient 1 Patient identification 4 cheek pregnancy test Consent form should be signed. Patient is nil by mouth 6-8hrs before examination . 3p Smooth Muscle relaxant (antispasmodic),buscopan(Hyoscine) should be given. Preliminary film A control film is advised. Explain the whole procedure to the patient Preparation of the patient 2 Before a barium meal examination is performed, the duodenum needs to be empty to allow clear visualization of structures. A patient may be given a laxative for bowel preparation before the procedure to ensure the small bowel is empty at the time of the examination, which is usually performed on an empty stomach. The patient is first asked to change into a hospital gown and remove all jewellery, dentures, glasses, metal objects and clothing as these items can interfere with imaging. the barium contrast liquid is given to the patient to drink. Contrast medium used 135ml Barium sulphate suspension 250% w/v of more high density barium suspension Effervescent agent(carbex granules), Eno® For double contrast Trolley set up As for barium swallow…please make follow up at the department.. Procedure/technique Can be either single contrast or double contrast Method of choice characterization for double contrast to demonstrate the mucosa pattern.(mostly advised) Single contrast exceptional Children since it usually not necessary to demonstrate the mucosa pattern Very ill patient to demonstrate gross pathology only To precede small bowel series Assessment of gastric peristalsis Post-pyloroplasty double contrast A gas producing agent is swallowed The patient is then drinks the barium while lying on left side, supported elbow(this position prevents the barium from reaching the duodenum too quickly and so obscuring the greater curve of the stomach. The patient is then lies supine and slightly on the rt side to bring the barium up against gastro esophageal junction(this maneuver is scanned t check for the reflux, which may be reveled by asking the patient to cough.) An iv injection of smooth muscle relaxant buscopan 20mg is given The patient is asked to roll onto rt side and quickly over in a complete circle to end in RAO (LPO) position.(this roll is performed to coat the gastric mucosa with barium, good coating has been achieved if areae gastriae in the antrum are visible. Spot films taken FILMS DEMOSTRATES SUPINE RAO………ANTRUM&GREATER CURVE SUPINE…………..ANTRUM &BODY SUPINE LAO……LESSER CURVE SUPINE LEFT LATERAL………FUNDUS PRONE………………DUODENAL LOOP PRONE,RAO,SUPINE,LAO..DUODENAL CAP SERIES ERECT RAO,LAO………FUNDUS Radiographic anatomy RAO Anatomy Demonstrated: • Entire stomach and C-loop of duodenum are visible. prone lateral supine Alternative AP Trendelenburg, A partial Trendelenburg (head down) position may be necessary to fill the fundus on a thin asthenic patient . A full Trendelenburg angulation facilitates the demonstration of hiatal hernia. (Install shoulder brace for patient safety.) Mucosal pattern area of concentration abnormal anatomy Barium Meal gastric ulcer on the lesser curve showing as an out pouching of barium. Radiating folds can also be seen converging towards the ulcer crater. ulcers areae gastrica. Gastritis Enlarged Area gastricea in a patient with H.pylori Gastritis. Perforated peptic ulcer Pyloric stenosis. Other imaging modalities Read……. Radiation protection Minimize the fluoroscopic time and current Collimate the x ray beam Shield should be used to sensitive organs Complications Aspiration of barium Barium impaction &large bowel obstruction Barium induced appendicitis Leakage of barium from unsuspected perforation Constipation After care Patient is informed about possibility of constipation there fore is advised plenty of water/fluids and take mild laxatives Aspiration of barium is gradually clearly by the body but if there is immediate reaction the patient is treated accordingly Ensure patient understand the procedure for receiving better results Adverse effects Side effect of drug used. Mild-moderate-severe Do We Know For Sure: Multidisciplinary Approach Quiz 2 List 5 indication of barium meal? With aid of diagram explain the parts of duodenum. Mention 5 condition in which single contrast can be used What is odynophagia ← 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 Barium swallow CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Barium swallow using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Contents Definition Anatomy Indications Contraindications Equipment used Other accessories Preparation of the patient Contrast recap …. Contrast medium used Notes Trolley set up Procedure/technique Technique prone Rapid series Radiographic anatomy Normal hypopharynx after a mouthful of barium has been swallowed. Radiation protection Complications Adverse effects After care quiz Barium swallow Contents Definition Indication Contraindications Describe technique of barium swallow Adverse effects After care of the patient Normal radiological anatomy Definition Barium swallow is a special contrast radiological procedure of upper GIT(pharynx and esophagus)following ingestion of sulfate contrast done under fluoroscopy. Its for evaluation of anatomy and physiology of the pharynx and esophagus Barium swallow is done virtually always done in conjunction with barium meal Anatomy Recap…………………. Subdivision Indications Dysphagia Esophagitis Assessment of tracheoesophageal fistula Assessment of site of perforation Assessment of esophageal carcinoma Assessment of gastro esophageal reflux disease Assessment of achalasia Assessment of foreign bodies Assessment of gastro esophageal varices Assessment of gastro esophageal diverticular Assessment of motility disorder Assessment of hiatus hernia Assessment of generalized epigastric pain Contraindications Obstruction(partial complete) Post operative Pregnancy Suspected perforation Suspected of tracheoesophageal fistula Hypersensitive to barium Equipment used 1.conventonal fluoroscopy Image intensifier Spot film device Television fluoroscopy Fluoroscopic couch Other accessories cassettes, Anatomical markers rt or lt. Foot rest Hand grips shoulder support Lead aprons, gloves thyroid shield Preparation of the patient Patient identification 4 cheek pregnancy test Consert form should be signed. Patient is nil by mouth 6-8hrs before examination . 3p Contrast recap …. CM are Diagnostic agents used in radiology to; Enhance or create visual contrast in an image between the organ, vessel or tract in which they are present and the surrounding tissues in the body Contrast medium used Barium sulphate 300g with 100 ml Thick barium is used It is more difficult to swallow but suited for use in the esophagus because it descend slowly and tend to the mucosal lining Gastrographin E-Z HD 250%/100l or( more as required ) LOCM(appro 350 mg/ml) Notes For suspected of tracheoesophageal fistula use barium in children For suspected of perforation use water soluble I.e. gastrographin should not be used for investigation of tracheoesophageal fistula or when aspiration is possibility Barium should not be used when perforation is suspected Trolley set up Top shelf jug of water Clean glasses 2 Barium Spoons Tissue paper Straw Lower shelf Emergency drugs ADRENALINE Procedure/technique Preliminary film A control film is advised.. single Contrast or double contrast For double contrast. mucosa relief mucosa pattern…valsavre maneuver is advised mucosa submucosa muscularis mucosa(internal) muscularis external serosa Effervescent agent(carbex granules) Technique 1.the patient is in erect RPO position to throw the esophagus clear to the spine An ample mouth full of barium is swallowed and spot film of the upper and lower esophagus are taken For esophageal varices the prone position RAO..is taken as they will be more distended prone Demonstrate peristaltic activity of esophagus Clear gastroesopgeal junction notes Always start with meal followed by swallow or enema followed by meal Rapid series Basic views PA or AP oblique to clear off the spine PA or AP Lateral ribs must be superimposed The examination is concluded by further spot radiographs of the stomach Radiographic anatomy Normal Barium swallow Normal hypopharynx after a mouthful of barium has been swallowed. The large white arrow indicates a valleculum, and the lower white arrow points to the inferior recess of the pyriform sinus. Arrowheads mark the aryepiglottic folds. Circumvallate papillae (black arrows). Note: There are a number of dental fillings. Radiation protection Minimize the fluoroscopic time and current Collimate the x ray beam Shield should be used to sensitive organs Complications aspiration of barium mixture Leakage of barium from unsuspected perforation Constipation Adverse effects Mild moderate and severe After care Patient is informed about possibility of constipation there fore is advised plenty of water/fluids and take mild laxatives Aspiration of barium is gradually clearly by the body but if there is immediate reaction the patient is treated accordingly Ensure patient understand the procedure for receiving better results quiz With the aid of diagram draw radiographic anatomy of the pharynx and esophagus indicate the view(s) which that diagram is taken Mention constrictors of esophagus Describe the technique of barium swallow What are contrast medium used for barium swallow Classify contrast medium ← 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 Chest Radiography CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Chest Radiography using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic CHEST RADIOGRAPHIC ANATOMY Chest Radiography a, superior vena cava Cardiothoracic ratio PATIENT POSITION WHY ERECT POSITION WHY PA VIEW WHY RESPIRATION Postero-anterior – erect Position of patient and cassette Direction and centering of the X-ray beam Essential image characteristics Expiration technique CHEST LATERAL Direction and centring of the X-ray beam Radiological considerations Position of patient and cassette – AP RADIOLOGICAL CONSIDERATION Antero-posterior – supine NOTE AIR GAP TECHNIQUE CHEST RADIOGRAPHY CHEST RADIOGRAPHIC ANATOMY The lungs lie within the thoracic cavity on either side of the mediastinum, separated from the abdomen by the diaphragm. The right lung is larger than the left due to the inclination of the heart to the left side. In normal radiographs of the thorax, some lung tissue is obscured by the ribs, clavicles and, to a certain extent, the heart, and also by the diaphragm and upper abdominal organs in the postero-anterior projection. Chest Radiography The right lung is divided into upper, middle and lower lobes, and the left lung is divided into upper and lower lobes. The fissures that separate the lobes can be demonstrated in various projections of the thorax, when the plane of each fissure is parallel to the beam. Chest Radiography On a postero-anterior radiograph, however, the main lobes overlap, so that for descriptive purposes the lungs are divided into three zones separated by imaginary horizontal lines. Chest Radiography The upper zone is above the anterior end of the second ribs, the mid-zone is between the second and fourth ribs anteriorly, and the lower zone is below the level of the fourth ribs. Chest Radiography On a lateral radiograph, where horizontal and oblique fissures are visible, upper, middle and lower lobes can be defined separately. Chest Radiography On a postero-anterior radiograph, a horizontal fissure separating the upper and middle lobes may be seen extending from the right hilum to the level of the right sixth rib laterally. Chest Radiography An accessory lobe called the azygos lobe is sometimes seen in the right upper zone as a result of aberrant embryological migration of the azygos vein to the normal medial position. Chest Radiography The trachea is seen centrally as a radiolucent air-filled structure in the upper thorax, which divides at the level of the fourth thoracic vertebra into the right and left main bronchi. The right main bronchus is wider, shorter and more vertical than the left, and as a result inhaled foreign bodies are more likely to pass into the right bronchial tree. Chest Radiography The main bronchi enter the hila, beyond which they divide into bronchi, bronchioles and, finally, alveolar air spaces, each getting progressively smaller. Chest Radiography As these passages are filled with air, they do not appear on a normal radiograph of the thorax, since the surrounding lung is also air-filled. If the parenchyma is consolidated, however, an air-filled bronchogram is shown. The hila regions appear as regions. Chest Radiography The hilar regions appear as regions of increased radio-opacity and are formed mainly by the main branches of the pulmonary arteries. The lung markings that spread out from the hilar regions are branches of these pulmonary arteries, and are seen diminishing in size as they pass distally from the hilar regions. Chest Radiography The right dome of the diaphragm lies higher than the left, due mainly to the presence of the liver on the right. The cost-phrenic angles and lateral chest walls should be defined clearly. HEART a, superior vena cava b, ascending thoracic aorta c, right atrium d, inferior vena cava e, left subclavian vein f, aortic knuckle g, main pulmonary artery h, left ventricle. Cardiothoracic ratio The size of the heart is estimated from the postero-anterior radiograph of the chest by calculating the CRT. This is the ratio between the maximum transverse diameter of the heart and the maximum width of the thorax above the costophrenic angles, measured from the inner edges of the ribs. In adults, the normal CRT is maximally 0.5. In children, however, the CRT is usually greater. Chest Radiography The aortic knuckle is shown as a rounded protrusion slightly to the left of the vertebrae and above the heart shadow. The prominence of the aortic knuckle depends upon the degree of dilation or unfolding of the aorta and the presence (or absence) of cardiac disease. It also alters shape as a result of deformities in the thorax, intrinsic abnormalities and with old age. Calcification in the arch, when present, is demonstrated as curvilinear opacities. PATIENT POSITION Basic Postero-anterior – erect Alternative Antero-posterior – erect Antero-posterior – supine Antero-posterior – semi-erect Supplementary Lateral Postero-anterior – expiration Apices Lateral – upper anterior region Decubitus with horizontal beam Tomography PATIENT POSITION The choice of erect or decubitus technique is governed primarily by the condition of the patient, with the majority of patients positioned erect. Very ill patients and patients who are immobile are X-rayed in the supine or semi-erect position WHY ERECT POSITION control of respiration is more satisfactory, Due to gravity effect on the abdominal organs allows for the disclosure of the maximum area of lung tissue, fluid levels are defined more easily with the use of a horizontal central ray. WHY PA VIEW Heart size : In a PA projection, the heart is closer to the digital detector/ image receptor so magnification is reduced Scapula: Its easier to move the scapula out of lung field Radiation dose: A PA projection reduces the amount of radiation that reaches the radiosensitive organs in the front of the body eg breast. Respiration: standing up for PA projection makes respiration more effective and anterior ribs are better defined. Patient comfort: patients can lean on the detector for support, which makes them more comfortable Fluid levels : A horizontal central beam make it easier to see

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Contrast Media CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Contrast Media using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Contrast Media Objectives Definitions: Contrast media Importance of Contrast media Four basic densities on Radiograph Why use contrast agents Requirements of a contrast agent (2) Ideal Properties of CM Ideal Properties: High osmolar agents ( hypertonic) contain more solutes than there are in the cells. Low Osmolar CM Effects of Osmolality iii) Electron density & RCM Methods of administration of CM Routing of Contrast Media Classification of Contrast Media (a) Positive Contrast Agents (b) Negative Contrast Agents History of Contrast Media Early Contrast Media: 1905-20 Historical Development Early contrast Media: 1920s Early contrast Media: 1928 Aromatic cpds: Development of Iodinated Pyridines Improvements Further Improvements Iodinated Benzoic Acids ANION six-carbon bonded hexagon called benzene ring Diatrizoate (1954) Diatrizoate Basic features of a good CM Diatrizoate toxicity Review ionic effects – Toxicity Triiodobenzoic Acid Derivatives (i) Monomeric ICM (ii) Monomeric NICM New Advances Development of Non ionic CM Toxic effects: NICM (iii) Dimeric ICM Ionic Dimers also Exist (iv) Dimeric NICM Further development of NICM Disadvantages of NICM Commonly used preparations Barium Sulphate CM Barium Complications Adverse reactions TYPES OF IODINATED CONTRAST AGENTS: Ultrasound & MRI CM Gadolinium based Contrast media Gadolinium-Based contrast Ultrasound Contrast Agents Enteric contrast Iodinated Contrast Media Adverse effects of CM Adverse effects of contrast media Risk factors Pharmaceutical aspects of CM Preparation: Contrast Media & Contrast Reactions Objectives Define contrast media Outline Ideal properties of RCM Describe the historical development of RCM Classify contrast media Describe adverse effects of CM Outline drugs use in management of ADR of CM Definitions: Contrast media CM are Diagnostic agents used in radiology to; Enhance or create visual contrast in an image between the organ, vessel or tract in which they are present and the surrounding tissues in the body Importance of Contrast media Enable to visualise certain anatomical structures or physiological functions within the human body when the imaging techniques on their own cannot provide this information. Importance of Contrast media Instilling contrast changes, absorption characteristics of the area Alters subject contrast and density differences Enhancing density differences within an area will improve visibility Four basic densities on Radiograph Air Soft tissues Fatty tissues Calcified structures Soft tissues have same absorptive capacity and cannot be distinguished Why use contrast agents Different tissues within the body attenuate the beam of x-rays to different degrees. The degree of attenuation of an x-ray beam can be varied, especially as the number of electrons encountered during the beams path can vary. Fundamentally the number of electrons in the path of the beam is dependent upon: The thickness of the object being studied. The density of the object being studied. The number of electrons per atom of the element (Z). Requirements of a contrast agent (2) The agent should have rapid elimination. The agent should not be carcinogenic. The agent should have a viscosity appropriate to the patient when introduced. The agent should cause minimal distress to the patient when introduced. The agent should be cost-effective. Ideal Properties of CM Provides maximum opacity to X-rays; is biologically inert; has high water solubility; is chemically stable; selectively excreted; has a low viscosity; exerts minimal osmotic effects; is safe (minimal or no toxicity); is not expensive Easy to administer Non-floculating (allow the organ to be properly demonstrated) Ideal Properties: Osmolarity Homeostasis: body’s ability to maintain a stable internal condition. Osmolarity: A measure of the total number of particles in solution per kg of H2O. the key to understanding IV contrast differences The characteristic of contrast media MOST responsible for adverse reactions. High osmolar agents ( hypertonic) contain more solutes than there are in the cells. Solutions of this type are given to patients who have edema because of fluid retention. High osmolar contrast agents draw fluid out of the cells and cause dehydration. Hypaque 60, Cysto Conray, High Osmolar CM Low Osmolar CM Low osmolar agents (hypotonic) contain fewer solutes (more water) than the cell. These solutions are infused slowly into a dehydrated patient to rehydrate. Low osmolar contrast agents also draw fluid out of the cells but to a lesser degree. Omnipaque, Isoview, Optiray. Effects of Osmolality Increase can cause fluid overload Patients with renal failure Patients with cardiac problems – altered pumping ability shortness of breath crackles in lungs decrease in O2 saturations anxiety and tachynpnea wet cough sweating Effects of Osmolality Calcium binding in cells & tissues Increase osmolarity increases calcium binding Therefore, can cause heart irregularities arrhythmias Bradycardia Rigidity of red blood cells RBCs need space to move through blood vessels Ideal Properties: ii) Viscosity Friction: Size of molecule Concentration of molecule Heating reduces viscosity allows for rapid injection iii) Electron density & RCM CM are opaque to X rays Do not allow x-rays to pass through them Have a high electron density Repelling x rays (moving electrons) Most heavy metals Are electron dense but Too toxic to be used clinically Iodine is electron dense & safe Hence most CM contain iodine Methods of administration of CM Orally. Rectally. Intra-venously – (injection / infusion). Mechanically – Filling of a body cavity or potential space., Intra-vaginally Intra-thecally Intra-arterially Routing of Contrast Media Direct Barium studies Myelography Angiography Arthrography Indirect Intravenous Pyelogram (IVP) Oral Cholecystogram (OCG) Routes of administration Classification of Contrast Media Classification based on physical properties (i) Negative CM Gaseous substances : N20, CO2, Inert gases low atomic number and specific weight Absorb X-rays to a lesser extent than the surrounding body structures (ii) Positive CM All substances which, because of their higher specific weight and atomic number Absorb Xrays to a greater extent than body tissues Classification of Contrast Media (iii) Double contrast agents Incorporates the use of both positive & negative contrast media. eg during a double contrast Barium enema examination. Co2 + BaSo4 = Double Contrast Classification

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Coronal Uterine Anatomy and Imaging CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Coronal Uterine Anatomy and Imaging using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Coronal uterine anatomy. Figure 17-3 Sagittal transabdominal image of the uterus demonstrating posterior to Figure 17-5 Sagittal endovaginal image of the endometrium demonstrating the Uterine Size and Shape Uterine Positions anteversion Retroverted Congenital Uterine Anomalies TECHNIQUE AND POSITIONING Positioning: UTERINE PATHOLOGY Uterine Leiomyoma also referred to as a fibroid or uterine myoma SONOGRAPHIC FINDINGS OF LEIOMYOSARCOMA Nabothian Cyst PATHOLOGY OF THE CERVIX 4. Ovaries Function of ovaries Normal image of ovaries Ovarian cyst Benign Ovarian Disease Corpus Luteum Cysts (Corpus Luteal Cysts) SONOGRAPHIC FINDINGS Parovarian Cysts Cystic Teratoma (Dermoid) Thecoma Granulosa cell tumor. Longitudinal image of a 3-year-old girl suffering Fibroma SONOGRAPHIC FINDINGS OF ENDOMETRIOMAS CLINICAL FINDINGS OF A MUCINOUS CYSTADENOMA SONOGRAPHIC APPEARANCE OF SEROUS Krukenberg Tumor Dysgerminoma Endometrioid Tumor (Endometrioid Carcinoma) Hydrosalpinx MENOPAUSE CLINICAL FINDINGS OF ENDOMETRIAL HYPERPLASIA Endometrial Polyps PELVIC INFLAMMATORY DISEASE CLINICAL FINDINGS OF CHRONIC PELVIC INFLAMMATORY DISEASE Pelvic Inflammatory Disease and the Fallopian Tubes Tubo-ovarian Complex and Tubo-ovarian Abscess CAUSES OF FEMALE INFERTILITY POLYCYSTIC OVARY SYNDROME Tubal Causes of Infertility Asherman Syndrome and Infertility Ovarian Hyperstimulation Syndrome SONOGRAPHIC FINDINGS OF OVARIAN HYPERSTIMULATION Coronal Uterine Anatomy and Imaging NYAMAGANA HOSPITAL REFFERENCE Coronal uterine anatomy. The uterine wall consists of three layers >The outermost layer is referred to as the serosal layer or perimetrium, which is continuous with the fascia of the pelvis. > The middle layer is the myometrium or muscular layer,which constitutes the bulk of the uterine tissue, providing the area where contractile motion occurs. >The inner mucosal layer of the uterus is referred to as the endometrium. The endometrium can be further divided into a deep or basal layer and a superficial or functional layer Figure 17-3 Sagittal transabdominal image of the uterus demonstrating posterior to the distended urinary bladder (F), the uterine fundus (A), uterine corpus (B), uterine isthmus (C), cervix (D), and vagina (E) Figure 17-3 Figure 17-4 Endovaginal transverse image of the uterus demonstrating the myometrium (A), the endometrium (B), and the serosa (C). Figure 17-4 Figure 17-5 Sagittal endovaginal image of the endometrium demonstrating the outermost basal layer (A), the innermost echogenic stripe of the uterine cavity (B), and the functional layer (C) Figure 17-5 The thickness of the basal layer is typically consistent, although minimal changes may occur throughout the menstrual cycle. The functional layer of the endometrium is the component that is shed during menstruation; thus, the thickness of the functional layer of endometrium will vary during the menstrual cycle as a result of hormonal stimulation. The endometrial cavity, also referred to as the uterine cavity, is located between the two functional layers of the endometrium. This cavity is contiguous with the lumen of the fallopian tubes laterally, and the cervix inferiorly. Uterine Size and Shape The size and shape of the uterus depends on the age of the patient, parity, and the presence of pathology or congenital anomalies that may alter its contour The uterus is a hallow muscular walled, pear-shaped organ, flattened antero posteriorly. it lies in the pelvic cavity between the urinary bladder and rectum. uterus is about 7.5cm long, 5cm wide a its walls are about 2.5cm thick(7.5×5×2.5 ). Its weight is from 3o-40gms.Uterus has three parts which are fundus, body and cervix . fundus is the dome-shaped part of the uterus above the openings of the fallopian tubes. Body is the main part occurs b/w the fundus and internal os of the cervix. Cervix is also known as the neck of the uterus and occurs b/w the body of the uterus and vagina at the external os.structurally uterus has three layers/coverings which are perimetrium (outer most layer) ,myometrium (middle layer) and endometrium (innermost layer)of the uterus. Uterine Positions The uterine position within the pelvis is variable, The normal position of the uterus is considered to be Anteversion or anteflexion. Anteversion is the uterine position in which the body tilts forward or anteriorly, forming a 90-degree angle with the vagina. Anteflexion of the uterus is the position in which the uterine body folds forward, possibly coming in contact with the cervix. Retroversion of the uterus is the position in which the uterine body tilts backward or posteriorly, without a bend where the cervix and body meet. Retroflexion is the uterine position that results in the uterine body tilting backward and actually coming in contact with the cervix. anteversion retroversion retroflexion antflexion Retroverted antiverted Congenital Uterine Anomalies Abicornuate uterus, also referred to as bicornis unicollis, is a common uterineanomaly that is present when the endometrium divides into two endometrial cavities with one cervix, with a prominent concavity noted in the outline of the uterine fundus. The unicornuate uterus is present when the uterus has only one horn The subseptate uterus, which is characterized by an incomplete septum, has a normal uterine contour with an endometrium that branches into two horns. The arcuate uterus is a subtle variant in which the endometrium has a concave contour at the uterine fundus. The uterus didelphys is complete duplication of the vagina, cervix, and uterus The septate uterus, which is also describes a uterus that has two complete separate uterine cavities separated by an anteroposterior septum TECHNIQUE AND POSITIONING Preparation Transabdominal imaging of the female pelvis requires the patient to have afull bladder. Patients are typically required to drink 32 ounces of water before the examination. Whether the bladder is retrofilled via a Foley catheter or filled it must be distended adequately to visualize the entire uterus and adnexa This practice will provide an acoustic window via the bladder and also displace bowel from the field of view. NOTE Transivaginal does not requre full bladder TECHNIQUES Sonography can be performed using transabdominal endovaginal,also referred to as transvaginal, techniques. Positioning: patient lie supine or lithotomy position for transivaginal technique TYPES OF PROBE

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Elbow CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Elbow using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic INRODUCTION Elbow Note 1.LATERAL Direction and Centring of X-ray Beam Essential Image Characteristics Notes 2.Antero-posterior Direction and Centering of X-ray Beam MODIFIED TECHNIQUE ELBOW These are ; 1.Antero-posterior – partial flexion a.Antero-posterior – forearm in Direction and location of X-ray beam b.Antero-posterior – upper arm in 2.Antero-posterior – full flexion a.Axial – upper arm in contact b.Axial – forearm in contact Lateral head of radius Position of patient and image receptor Proximal radio-ulnar joint – oblique Ulnar groove – axial Radiological considerations ELBOW INRODUCTION Optimum projections of the elbow joint are obtained when the upper arm is in the same plane as the forearm. For many examinations, the patient will be seated at the table with the shoulder lowered, so that the upper arm, elbow and forearm are on the same horizontal level. Elbow To gain the patient’s confidence, the lateral projection is taken first, because the patient will find it easier to adopt this position. The humerus must be rotated through 90° to make sure that two projections at right-angles are obtained of the humerus as well as the ulna and radius. Alternatively, if the limb cannot be moved, two projections at right-angles to each other can be taken by keeping the limb in the same position and moving the tube through 90° between projections. If the patient cannot extend the elbow fully, modified positioning is necessary for the antero-posterior projection. Note Special care should be taken with a child suspected of having a supracondylar fracture of the humerus. Modified projections must be obtained without moving the arm from the collar and cuff that should be used to immobilize the arm. 1.LATERAL Position of Patient and Image Receptor The patient is seated alongside the table, with the affected side nearest to the table. The elbow is flexed to 90 degrees and the palm of the hand is rotated so that it is at 90 degrees to the tabletop. The shoulder is lowered so that it is at the same height as the elbow and wrist, such that the medial aspect of the entire arm is in contact with the tabletop. The image receptor is placed under the patient’s elbow, with its centre to the elbow joint. The limb is immobilized using sandbags. Direction and Centring of X-ray Beam The vertical central ray is centered over the lateral epicondyle of the humerus. Essential Image Characteristics The central ray must pass through the joint space at 90 degrees to the humerus, i.e. the epicondyles should be superimposed. The image should demonstrate the distal third of humerus and the proximal third of the radius and ulna. Notes Care should be taken when a supracondylar fracture of the humerus is suspected. In such cases, no attempt should be made to extend the elbow joint, and a modified technique must be employed RADIOGRAPHIC ANATOMY -LATERAL 2.Antero-posterior Position of Patient and Image Receptor The patient is seated alongside the table with the affected arm nearest to the table. The arm is extended fully, such that the posterior aspect of the entire limb is in contact with the tabletop and the palm of the hand is facing upwards. The image receptor is positioned under the elbow joint. The arm is adjusted such that the medial and lateral epicondyles are equidistant from the image receptor. The limb is immobilized using sandbags. Direction and Centering of X-ray Beam The vertical central ray is centered through the joint space 2.5 cm distal to the point midway between the medial and lateral epicondyles of the humerus. Essential Image Characteristics The central ray must pass through the joint space at 90 degrees to the humerus to provide a satisfactory view of the joint space. The image should demonstrate the distal third of humerus and the proximal third of the radius and ulna. RADIOGRAPHIC ANATOMY-AP Notes When the patient is unable to extend the elbow to 90 degrees, a modified technique is used for the antero-posterior projection. If the limb cannot be moved, two projections at right-angles to each other can be taken by keeping the limb in the same position and rotating the X-ray tube through 90 degrees. MODIFIED TECHNIQUE ELBOW These projections may be useful in cases of trauma when the patient is unable to extend the elbow joint. These are ; Forearm in contact with image receptor fosuspected radial head and olecranon fractures. Upper arm in contact with image receptor for suspectedsupracondylar fractures. Axial projection when the patient cannot extend their arm to any extent. 1.Antero-posterior – partial flexion Adaptation of technique If the patient is unable to extend the elbow fully, the positioning for the AP projection may be modified. For a general survey of the elbow, or if the main area of interest is the proximal end of the radius and ulna, then the posterior aspect of the forearm should be in contact with the image detector. If the main area of interest is the distal end of the humerus, however, then the posterior aspect of the humerus should be in contact with the image detector. If the elbow is immobilized in the fully flexed position, then an axial projection must be used instead of the AP projection. Notes In both of the above cases, some superimposition of the bones will occur. However, gross injury and general alignment can be demonstrated. a.Antero-posterior – forearm in contact Position of patient and image receptor The patient is seated alongside the table, with the affected side nearest to the table. The posterior aspect of the forearm is placed on the table, with the palm of the hand facing upwards. The image receptor is placed under the forearm, with its centre under the elbow joint. The arm is adjusted such that the medial and lateral epicondyles of the humerus are

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Radiographic Landmarks In Chest Radiography CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Radiographic Landmarks In Chest Radiography using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic INTRODUCTION Radiographic Landmarks in Chest Radiography Spine: The vertebral column, visible along the posterior aspect of the chest Soft Tissue Landmarks Diaphragm Upper Chest Radiographic Landmarks Middle Chest Radiographic Landmarks Lower Chest Radiographic Landmarks RADIOGRAPHIC LANDMARKS IN CHEST RADIOGRAPHY INTRODUCTION KEY TERMINOLOGIES Radiographic landmarks: refer to specific anatomical features or bony structures visible on X-rays that are used for identification, assessment, and measurement purpose. These landmarks help clinicians identify and locate important structures such as the heart, lungs, diaphragm, and ribs. Landmarks also assist in identifying abnormalities, such as tumors, fluid accumulation, and fractures. Chest radiography: a commonly used diagnostic imaging technique to assess the lungs, heart, airways, and surrounding structures. Radiographic Landmarks in Chest Radiography Bony Landmarks Clavicles The clavicles (collarbones) are visible in most chest radiographs and act as important reference points for assessing patient positioning and rotation Ribs The bony cage protecting the chest, useful for identifying fractures or abnormalities. Rib contour and symmetry help assess lung expansion and the presence of fractures or deformities. Spine: The vertebral column, visible along the posterior aspect of the chest Scapulae: Shoulder blades should be out of the field of view, any overlapping shadows could obscure lung structures. Sternum: The breastbone, which can be obscured by other midline structures. Soft Tissue Landmarks Heart The cardiac silhouette, located in the mediastinum, is a prominent landmark. The heart's silhouette should be evaluated for signs of cardiomegaly (enlarged heart). Aortic Knuckle A prominence caused by the aortic arch, visible on the left border of the mediastinum. Pulmonary Vessels The arteries and veins that carry blood to and from the lungs, visible as branching structures in the lung fields. Diaphragm The muscle separating the chest and abdomen, its contours are visible on the radiograph. Diaphragmatic shape and position are assessed for signs of elevation or flattening. Trachea The windpipe, visible as a midline structure, branching into the right and left main bronchi at the carina The position of the trachea should be midline, and deviation may indicate pathology. Lungs The organs responsible for gas exchange, visualized as areas of lower density compared to surrounding tissues. Upper Chest Radiographic Landmarks Apices of the Lungs The apices (top portions) of the lungs are visible in a proper PA chest X-ray. Scapulae Middle Chest Radiographic Landmarks Carina The carina is the point where the trachea bifurcates into the left and right bronchi. Hilum The areas where the bronchi, pulmonary vessels, and nerves enter the lungs The hilum contains the bronchi, pulmonary vessels, and lymph nodes and should be symmetrical on both sides. Heart Borders The left and right heart borders are important for evaluating heart size and detecting abnormalities such as fluid retention. Lower Chest Radiographic Landmarks Diaphragms The diaphragm's position is crucial; a normal diaphragm has a concave shape. Flattening may indicate hyperinflation (e.g., in COPD). Costophrenic Angles These angles, located at the junction of the diaphragm and ribcage, should be sharp and clear. Blunting may suggest pleural effusion. Zones in the chest radiograph Trachea Clavicles scapulae Thank you for listening NEXT 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 Fingers CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Fingers using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic FINGERS Clinical indications BASIC PROJECTION/VIEWS Dorsi-palmar (DP)- postero-anterior Direction and location of X-ray beam Essential image characteristics Radiological considerations Lateral- index and middle fingers Thumb Lateral Antero-posterior (AP) Postero-anterior foreign body Note FINGERS SESSION: 04 Clinical indications Fractures and dislocations of the distal, middle, and proximal phalanges; distal metacarpal; and associated joints Pathologic processes, such as osteoporosis and osteoarthritis BASIC PROJECTION/VIEWS Two projections are routinely taken, a postero-anterior a lateral. The adjacent finger is routinely imaged unless the injury is very localized, e.g. a crush injury to the distal phalanx. Each image is acquired using an 18cm × 24 cm Dorsi-palmar (DP)- postero-anterior Position of patient and image receptor The patient is positioned seated alongside the table as for a postero-anterior projection of the hand. The forearm is pronated with the anterior (palmer) aspect of the finger(s) in contact with the image receptor. The finger(s) are extended and separated. A sandbag may be placed across the dorsal surface of the wrist for immobilization. Direction and location of X-ray beam The collimated vertical beam is centered over the proximal interphalangeal joint of the affected and adjacent finger PA OF SECOND DIGIT PA OF FOURTH DIGIT Essential image characteristics The image should include the fingertips, including soft tissue, and distal 3rd of the metacarpal bone(s). It is necessary to include adjacent finger(s), i.e. the 2nd and 3rd or 4th and 5th to aid in identifying the relevant anatomy. If this is the case, then care should be taken to avoid superimposition, particularly in the lateral projection, by fully extending one finger and partly flexing the other. PA OF THE FOURTH FINGER Radiological considerations The image should include the fingertip and the distal 3rd of the metacarpal bone. Lateral- index and middle fingers Position of patient and image receptor The patient is seated alongside the table with the arm abducted and medially rotated to bring the lateral aspect of the index finger into contact with the image detector. The raised forearm is supported. The index finger is fully extended and the middle finger slightly flexed to avoid superimposition. The middle finger is supported on a non-opaque pad. The remaining fingers are fully flexed into the palm of the hand and held there by the thumb. Direction and location of X-ray beam The collimated vertical central ray is centred over the proximal interphalangeal joint of the affected finger. Essential image characteristics The image should include the fingertip and the distal 3rd of the metacarpal bone. Thumb Basic projections/VIEWS Two projections are routinely taken, a lateral an antero-posterior. Occasionally a postero-anterior may be undertaken if the patient is unable to get into position because of a painful fracture 18 × 24 CM CASSETES Lateral Position of patient and image receptor The patient is seated alongside the table with the arm abducted, the elbow flexed and the anterior aspect of the forearm resting on the table. The thumb is flexed slightly and the palm of the hand is placed on the image receptor. The palm of the hand is raised slightly with the fingers partially flexed and may be supported on a non-opaque pad, such that the lateral aspect of the thumb is in contact with the image receptor. Direction and location of X-ray beam The collimated vertical beam is centered over the 1st MCPJ. Essential image characteristics The image should include the fingertip and the distal 1/3 of the metacarpal bone. Where there is a possibility of injury to the base of the 1st metacarpal, the carpo-metacarpal joint must be included on the image. Antero-posterior (AP) Position of patient and image receptor The patient is seated facing away from the table with the arm extended backwards and medially rotated at the shoulder. The hand may be slightly rotated to ensure that the 2nd, 3rd and 4rth metacarpals are not superimposed on the base of the 1st metacarpal. The patient leans forward, lowering the shoulder so that the 1st metacarpal is parallel to the tabletop. The image receptor is placed under the wrist and thumb and oriented to the long axis of the metacarpal. Direction and location of X-ray beam The collimated vertical central ray is centred over the 1st MCPJ. Postero-anterior foreign body Position of patient and image receptor With the hand in the postero-anterior position, the palm of the hand is rotated through 90° to bring the medial aspect of the hand in contact with the table and the palm vertical. The image receptor is placed under the hand and wrist, with its long axis along the line of the thumb. The fingers are extended and the hand is rotated slightly forwards until the anterior aspect of the thumb is parallel to the image receptor. The thumb is supported in position on a non-opaque pad. Direction and location of X-ray beam The collimated vertical beam is centered over the base of the 1st metacarpal. Note The use of the postero-anterior projection maintains the relationship of the adjacent bones, i.e. the radius and ulna, which is essential in cases of suspected foreign body in the thenar eminence. When undertaking a PA projection there is an increased object to detector distance. This will lead to magnification of the image and any associated unsharpness. To prevent this, increase the focus receptor distance (ffd). Radiological considerations Fracture of the base of the 1st metacarpal through the joint surface may be associated with dislocation due to the pull of the abductor and extensor tendons of the thumb. This is known as Bennett’s fracture and may cause functional impairment and early degenerative disease if not corrected. In contrast, a fracture that does not transgress the articular surface does not dislocate and does not have the same significance (Rolando fracture). ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW