NTA Level 4 Semester One

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 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 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 Spinal Trauma and Radiographic Assessment CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Spinal Trauma and Radiographic Assessment using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic Spinal trauma: general considerations Spinal trauma: cervical spine Spinal trauma: cervical: reading a film Spinal trauma cervical: 4 parallel lines Spinal trauma cervical:important measurements Spinal trauma cervical : mechanisms Spinal trauma cervical; common injuries Spinal trauma cervical :extension injuries Spinal trauma: unstable cervical fractures Jefferson # Hangman’s # Flexion teardrop Clay shoveler’s # Unilateral locked facets Bilateral locked facets Anterior subluxation Thoracic spine trauma Chance # Spinal fracture -dislocation Spinal trauma: general considerations C7 is the most frequently Common sites of # are CI-C2, C5-C6, T10-12 In most spinal trauma, spinal cord damage occurs at time of injury AP, lateral views CT to clarify #s, MRI for soft tissue injury The spine Spinal trauma: cervical spine Cross-table lateral view, AP and open moth for odontoid, may also do Swimmers, Examine the cross table lateral first, before doing other views to avoid moving pt, if the lateral is normal, then do the rest of the series When no # is seen on all views and pain is present, do flexion and extension laterals CT clarifies the injuries Spinal trauma: cervical: reading a film All 7 vertebrae should be shown Check thickness of retropharyngeal space Asses the 4 parallel lines for discontinuity or step-off Examine the atlantodental interval ( distance from anterior arch of C1 to odontoid process of C2 Scrutinize disc space for narrowing or widening Spinal trauma cervical: 4 parallel lines Anterior vertebral line Posterior vertebral line Spinolaminar line Posterior spinous line ODONTOID PROCESS OF C2 SHOULD ALIGN WITH THE CLIVUS Anatomy of the cervical spine showing the 4 lines Spinal trauma cervical:important measurements Thickness of soft tissue plane anterior to C1-C3 < 5mm Thickness of soft tissue plane anterior to C4-C7 <20 mm Width of atlantodental interval < 3mm in adults and <5 mm in children (if wider impies torn transverse ligament) Spinal trauma cervical : mechanisms Hyperflextion Hyperextension compression Spinal trauma cervical; common injuries Subluxation Locked facets (unilateral or bilateral) Odontoid fractures Wedge fractures Clay- shoveler’s # Teardrop # Spinal trauma cervical :extension injuries C1 posterior arch Hangmans # Extension teardrop# Jefferson’s #( this is extension –compression) Spinal trauma: unstable cervical fractures Bilateral locked facets Odontoid # type 2 Teardrop Hangmans Jefferson Burst # Odontoid fractures Jefferson # Commpression # Bony ring of C1 Lateral mass is split, transverse lig. Is torn Axial force See displaced lateral mass of C1 beyond lateral margins of C2 Hangman’s # Traumatic spondylolisthesis of axis’ Hypersextension injury See bilatral pars interarticulatis #s of C2 See anterior dislocation of C2 body See antero-inferior avulsion # associated with a torn anterior longt. Lig. Prevertebral soft tissue shadow Hangmans # Flexion teardrop Severe flexion as when diving into shallow water Posterior lig. Disruption and anterior compression # of the vertebral body This is the most severe and unstable # of all spinal #s See anterior vertebral body avulsion resebling a tear drop See posterior vertebral body subluxation see # of spinous process See prevertebaral heamatoma associated with tear of ant.longtd. Lig Seen cord compression from fragments Flexion teardrop Clay shoveler’s # # of a spinous process often seen C6-T1 See spinous process #best seen on lateral view Ghost sign (double spinous process of C6 or C7 due to displaced fractures spinous process Unilateral locked facets Rotation injury of cervical spine resulting into tear of apophyseal joint ligaments and facet joint disclocation, making them lock See widening of the disc space (“Bow tie” or “ Bat wing” appearance of the locked facets Bilateral locked facets Due to extreme hyperflexion Complete anterior dislocation of the vertebral body High risk of cord injury See complete anterior dislocation of vertebrae Disrupted post.lontd. Lig an detachment of ant. Longtd.lig Bow tie or bats wing appearance of locked facets Anterior subluxation Disruption of post. Longtd. Lig complex from hyperextension May be stable or unstable Do basic views, plus flexion and extension views See fanning or widening of interspinous distance Anterior displacement of vertebral body Thoracic spine trauma # classified into compression (caused by anterior or lateral flexion) and burst (caused by axial loading or acute flexion) Compression # appears as wedging of the vertebral body. It is typically stable # Burst # (#lines extend throught the vertebral body to involve at times the post elements. Fragments in the vertebral canal cause cord compression. See a communited vertebrae, look for fragments in canal, widened interpeduncular distances Chance # Trabsverse splitting of the vertebral body and post elements All the columns, ant, mid and post of the spine are involved Neurological defects occur if there is associated disclocation Associated with abdominal organ injury Common in MVI when using a lap belt only Spinal fracture -dislocation Compression, distraction, and rotation injury Extremely unstable associated with neurological and abdominal organ damage ← 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 Standard Operating Procedures for Radiology Room Preparation CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Standard Operating Procedures for Radiology Room Preparation using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic What is standard operating procedures Important of SOPs Standard Operating Procedures for Radiology Room Preparation What can occur when SPOs are not followed Responsibilities Performing equipment cleaning E.g. of steps of cleaning mashine Room Cleaning Important of performing cleaning 4. Compliance with Health Standards Performing Equipment Tube Warming and Calibration Importance of Tube Warming and Calibration in Radiology Equipment Calibration Tube Warming Procedures Steps for Warming X-ray Tubes: Gradually Increase Exposure: Equipment Calibration Procedures Special Considerations for Tube Warming and Calibration Importance of Checking Equipment Knobs for Functional Performance Types of Knobs and Controls on Radiology Equipment Steps for Checking Equipment Knobs for Functional Performance Functional Testing of Knobs Test Each Knob's Response CONT… Calibration of Knob Function (If Required) Preventive Maintenance for Knobs and Controls Importance of Checking Electrical Gadgets and Plugs Steps for Checking Electrical Gadgets and Plugs for Connectivity and Functionality Troubleshooting Electrical Connectivity Issues Safety Considerations for Handling Electrical Gadgets Standard operation procedures for room preparation in preparing radiology and imaging room for patient investigation What is standard operating procedures is a set of step-by step instructions or guideline the explains how to perform specific task Creating Standard Operating Procedures (SOPs) for room preparation in a radiology and imaging department is essential for ensuring patient safety, equipment functionality, and overall efficiency. Important of SOPs Standard Operating Procedures (SOPs) are crucial for several reasons: Consistency: SOPs ensure that tasks are performed consistently across an organization, leading to uniform quality and results. Efficiency: By providing clear instructions, SOPs streamline processes, reducing time spent on training and minimizing errors. Compliance: They help organizations adhere to regulatory requirements and industry standards, ensuring legal compliance and reducing the risk of penalties. Safety: SOPs establish safety protocols, protecting employees and reducing workplace hazards. Standard Operating Procedures for Radiology Room Preparation Training Tool: They serve as valuable resources for onboarding new employees, providing a clear framework for job responsibilities. Accountability: SOPs define roles and responsibilities, making it easier to hold team members accountable for their tasks. Quality Control: They help maintain high standards of quality by providing a benchmark for performance evaluation. Continuous Improvement: SOPs can be regularly reviewed and updated to incorporate feedback and improve processes over time. What can occur when SPOs are not followed Inconsistent Quality: Variability in processes can lead to inconsistent product or service quality, damaging reputation and customer trust. Increased Errors: Without clear guidelines, employees may make mistakes more frequently, resulting in rework, waste, and potential safety hazards. Compliance Issues: Failing to adhere to SOPs can lead to violations of regulatory requirements, risking legal repercussions and fines. Safety Risks: Ignoring safety protocols can increase the likelihood of accidents and injuries in the workplace. Standard Operating Procedures for Radiology Room Preparation Decreased Efficiency: Lack of standardized processes can result in confusion and inefficiency, slowing down operations and increasing costs. Poor Training Outcomes: New employees may struggle to learn their roles without established procedures, leading to longer onboarding times and reduced productivity. Accountability Challenges: Without SOPs, it can be difficult to determine responsibility for mistakes, leading to conflicts and decreased morale. Diminished Continuous Improvement: Neglecting SOPs can hinder the organization's ability to gather data and feedback for process improvements. Responsibilities Radiology Technologists: Responsible for preparing the room and ensuring all equipment is functioning properly. Radiology Assistants: Assist in room preparation and maintenance of cleanliness. Radiology head of department: Ensure compliance with SOPs and provide training. Performing equipment cleaning Cleaning radiology equipment is crucial for maintaining hygiene, safety, and optimal performance. Here’s a step-by-step guide tailored for radiology settings: Before performing equipment you must consider Read Manufacturer Instructions Always check the equipment’s manual for specific cleaning recommendations Before cleaning make sure the equipment is turned off and do cleaning process eg wiping, dusting etc Make sure you dispose waste according to local regulations. Document Cleaning it can be a checklist containing ,cleaning activities, date, time, and person responsible. E.g. of steps of cleaning mashine Moisten some cotton wool with a solution and gently wipe the screen surface Wipe the equipment free of soap or cleaner with fresh cotton wool Wipe to dry Record date of cleaning Room Cleaning Initial Cleaning: Remove any used materials from the previous patient. Dispose of waste in designated containers. Disinfection: Wipe down all surfaces, including tables, control panels, and equipment handles, with approved disinfectants. Pay special attention to high-touch areas. Floor Cleaning: Sweep and mop the floor as necessary to maintain cleanliness Important of performing cleaning Preventing Damage Accumulated substances can damage sensitive components. Regular cleaning prevents corrosion and other forms of deterioration. Also can extend the lifespan of radiology equipment Infection Control Radiology equipment often comes into contact with patients, making it a potential source of infection. Regular cleaning helps reduce the risk of cross-contamination and the spread of pathogens. Professionalism A clean environment reflects professionalism and attention to detail, which can enhance patient trust and satisfaction. 4. Compliance with Health Standards Meets hospital hygiene policies, radiation safety regulations, and accreditation requirements. Helps avoid legal and regulatory issues. Patient Safety and Confidence A clean environment reassures patients and improves their comfort and trust. Minimizes exposure to contaminants, especially for immunocompromised patients. Performing Equipment Tube Warming and Calibration Performing Equipment Tube Warming and Calibration should be done as per manufacture instruction Tube warming is the process of allowing a tube (such as an X-ray tube, vacuum tube, or fluid-carrying tube) to gradually reach its normal operating temperature before full operation. Calibration is the process of adjusting and verifying an instrument’s measurements by comparing them against a known standard Importance of Tube Warming and Calibration in Radiology Tube Warming Prevents Damage to X-ray Tubes X-ray tubes in diagnostic imaging systems (especially high-output systems)

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE The Vertebral Column CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study The Vertebral Column using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic 1.UNDERLINED ANATOMY The Vertebral Column Vertebral levels Angle of mandible 2-3 CV Radiation protection CERVICAL VERTEBRAE Preparation of the patient Basic views Antero-posterior – first ,second and 3rd Position of patient and cassette Direction and centring of the X-ray beam Antero-posterior third to seventh Axial – upper cervical vertebra Direction and centering of the X-ray beam Lateral supine Addition view Oblique projections are requested mainly to supplement the basic projections in cases of trauma. Cervico-thoracic vertebrae(Lateral swimmers’) THORACIC VERTEBRAE AP Position of patient and cassette The anode heel effect can also be exploited by positioning the anode cranially and the cathode caudally. Heel effect LUMBAR VERTEBRAE LUMBO-SACRAL JUNCTION Lateral Antero-posterior SACRUM COCCYX THE VERTEBRAL COLUMN 1.UNDERLINED ANATOMY The vertebral column consist of 33 vertebrae, 7cervical ,12 thoracic, 5 lumbar ,5 sacral and 4 coccygeal The coccygeal segments in some cases are three fused together and form a triangular bone. The vertebrae in each region show variation from basic pattern. Each region demands its own technique to demonstrate it. When dealing with radiographic technique of the vertebral column, the following terminologies should be remembered; Kyphosis-abnormal backward bending of the spine Lordosis -abnormal forward bending of the spine Scoliosis-abnormal lateral bending of the spine The Vertebral Column Most of the examination in the vertebral column need a Bucky or stationary grid except the lateral view of the cervical spine. Arrested respiration for this examination of this region is necessary After routine examination of part of the vertebral column, the doctor may request a coned view of particular vertebrae At least three to five vertebrae should be be covered in coned view views Vertebral levels Some useful landmarks Angle of mandible 2-3 CV Sternal notch 2-3 DV Sternal angle 4-5 DV Xiphisternal junction 9-4DV Lower coastal margin 3-4 LV Umbilicus 3-4 LV Iliac crest 4 LV ASIS 2 sacral Symphysis pubis-1st piece of coccyx Radiation protection With the exception of lumbo-sacral region and sacrum in female patients, it is always possible to protect the gonads from direct radiation by accurate conning and lead rubber placed over the gonad area The ten day rule should be observed for female patients of child bearing age. Note; the vertebral column of a child may be shown almost completely on one film. demonstration CERVICAL VERTEBRAE The cervical spine is convex forwards. The seven cervical vertebrae show marked differences from each other, particularly the first(atlas)which has an anterior arch instead of vertebral body,into which first the odontoid peg of the second CV (AXIS). In the AP view, the upper CV is obscured by the jaws and occiput . But they can be demonstrated if this view is taken with patients mouth open. Preparation of the patient Remove dentures, hairpins and neck and ear ornaments.. The patients should undress and given the x -ray gown Basic views AP (CV 1-3) AP ( CV 3-7) Lateral view Antero-posterior – first ,second and 3rd cervical vertebrae (open mouth) Position of patient and cassette The patient lies supine on the Bucky table or, if erect positioning is preferred, sits or stands with the posterior aspect of the head and shoulders against the vertical Bucky. The medial sagittal plane is adjusted to coincide with the midline of the cassette, such that it is at right-angles to the cassette. The neck is extended, if possible, such that a line joining the tip of the mastoid process and the inferior border of the upper incisors is at right-angles to the cassette. This will superimpose the upper incisors and the occipital bone, thus allowing clear visualization of the area of interest. The cassette is centered at the level of the mastoid process Direction and centring of the X-ray beam Direct the perpendicular central ray along the midline to the center of the open mouth. If the patient is unable to flex the neck and attain the position described above, then the beam must be angled, typically five to ten degrees cranially or caudally, to superimpose the upper incisors on the occipital bone. The cassette position will have to be altered slightly to allow the image to be centered after beam angulation. Antero-posterior third to seventh vertebrae Position of patient and cassette The patient lies supine on the Bucky table or, if erect positioning is preferred, sits or stands with the posterior aspect of the head and shoulders against the vertical Bucky. The median sagittal plane is adjusted to be at right-angles to the cassette and to coincide with the midline of the table or Bucky. The neck is extended (if the patient’s condition will allow) so that the lower part of the jaw is cleared from the upper cervical vertebra. The cassette is positioned in the Bucky to coincide with the central ray. The Bucky tray will require some cranial displacement if the tube is angled. Direction and centring of the X-ray beam A 5–15-degree cranial angulation is employed, such that the inferior border of the symphysis menti is superimposed over the occipital bone. The beam is centered in the midline towards a point just below the prominence of the thyroid cartilage through the fifth cervical vertebra. Axial – upper cervical vertebra This is a useful projection if the odontoid peg cannot be demonstrated using the open mouth projection. Remember that the neck must not be flexed in acute injuries. Position of patient and cassette The patient lies supine on the Bucky table, with the median sagittal plane coincident with the midline of the table and at right-angles to the cassette. The neck is extended so that that the orbito-meatal baseline is at 45 degrees to the tabletop. The head is then immobilized. The cassette is displaced cranially so that its centre coincides with the central ray. Direction and centering of

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Vertebral Column CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Vertebral Column using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic USEFUL LANDMARKS The inferior angle of the scapula indicates the level of T7 when the arms are placed by the side. The lower costal margin indicates L3 and is located easily. The anterior and posterior iliac spines lie at the level of the second sacral vertebra. CERVICAL SPINE LATERAL VIEW • To aid immobilization, the patient should stand with the feet Direction and centering of the X-ray beam Essential image characteristics Position of patient and cassette Vertebral Column LATERAL THORACIC SPINE • The arms should be raised well above the head. • The trabecular of the vertebrae should be clearly visible, demonstrating an absence of movement unsharpness. 1.UNDERLINED ANATOMY Vertebral levels Angle of mandible 2-3 CV Radiation protection CERVICAL VERTEBRAE Preparation of the patient Basic views Antero-posterior – first ,second and 3rd Direction and centring of the X-ray beam Antero-posterior third to seventh Axial – upper cervical vertebra Lateral supine Addition view Oblique projections are requested mainly to supplement the basic projections in cases of trauma. Cervico-thoracic vertebrae(Lateral swimmers’) Thoracic vertebrae AP Position of patient and cassette The anode heel effect can also be exploited by positioning the anode cranially and the cathode caudally. Heel effect Lumbar vertebrae Lumbo-sacral junction Antero-posterior Sacrum Lateral Coccyx RADIOGRAPHIC PROCEDURE OF THE VERTEBRAL COLUMN USEFUL LANDMARKS The easily palpated tip of the mastoid process indicates the level of C1. The spinous process of C7 produces a visible protuberance on the posterior aspect of the inferior part of the neck. Below this, the spinous process of the thoracic spine can be palpated. NB: the thoracic spinous processes are directed steeply downwards, so their palpable tips will be adjacent to the vertebral body below. The inferior angle of the scapula indicates the level of T7 when the arms are placed by the side. The sternal notch lies at the junction between T2 and T3. T4 is indicated by the sternal angle with T9 corresponding to the xiphisternal joint, although the size of this structure is variable. The lower costal margin indicates L3 and is located easily. This is a very useful aid to positioning in spinal radiography. A line joining the most superior parts of the iliac crests indicates the level of L4, whilst the tubercle of the iliac crest discloses the location of L5. The anterior and posterior The anterior and posterior iliac spines lie at the level of the second sacral vertebra. The coccyx can be palpated between the buttocks and lies at the level of the symphysis pubis. CERVICAL SPINE LATERAL VIEW Position of patient and cassette The patient stands or sits with either shoulder against the cassette. The median sagittal plane should be adjusted such that it is parallel with the cassette. The head should be flexed or extended such that the angle of the mandible is not superimposed over the upper anterior cervical vertebra or the occipital bone does not obscure the posterior arch of the atlas. • To aid immobilization, the patient should stand with the feet slightly apart and with the shoulder resting against the cassette stand. In order to demonstrate the lower cervical vertebra, the shoulders should be depressed, This can be achieved by asking the patient to relax their shoulders downwards. The process can be aided by asking the patient to hold a weight in each hand (if they are capable) and making the exposure on arrested expiration. Direction and centering of the X-ray beam The horizontal central ray is centred to a point vertically below the mastoid process at the level of the prominence of the thyroid cartilage. Essential image characteristics The whole of the cervical spine should be included, from the atlanto-occipital joints to the top of the first thoracic vertebra. The mandible or occipital bone does not obscure any part of the upper vertebra. Angles of the mandible and the lateral portions of the floor of the posterior cranial fossa should be superimposed. Soft tissues of the neck should be included. The contrast should produce densities sufficient to demonstrate soft tissue and bony detail. Position of patient and cassette The patient is positioned supine on the X-ray table, with the median sagittal plane perpendicular to the tabletop and coincident with the midline of the Bucky. The upper edge of a cassette, which should be at least 40 cm long for an adult, should be at a level just below the prominence of the thyroid cartilage to ensure that the upper thoracic vertebrae are included. Vertebral Column Make exposure on arrested inspiration. This will cause the diaphragm to move down over the upper lumbar vertebra, thus reducing the chance of a large density difference appearing on the image from superimposition of the lungs. Direction and centering of the X-ray beam Direct the central ray at right-angles to the cassette and towards a point 2.5 cm below the sternal angle. Collimate tightly to the spine. Essential image characteristics The image should include the vertebrae from C7 to L1. The image density should be sufficient to demonstrate bony detail for the upper as well as the thoracic lower vertebrae. LATERAL THORACIC SPINE Usually undertaken with the patient in the lateral decubitus position on the X-ray table, although this projection can also be performed erect. The median sagittal plane should be parallel to the cassette and the midline of the axilla coincident with the midline of the table or Bucky. • The arms should be raised well above the head. The head can be supported with a pillow, and pads may be placed between the knees for the patient’s comfort. The upper edge of the cassette should be at least 40 cm in length and and should be positioned 3–4 cm above the spinous process of C7. Direction and centering of the X-ray beam The

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER ONE Wrist Joint CRT04103 · Radiographic Techniques and Procedures START READING NOTES Study Wrist Joint using the sections below. Use the topic navigation to continue through Radiographic Techniques and Procedures. Contents of This Topic WRIST JOINT WRIST POSTERO-ANTERIOR Direction and Centering of X-ray Beam Essential Image Characteristics Notes; LATERAL Note Scaphoid For scaphoid fractures, three or more projections may be taken: A; SCAPHOID – POSTERO-ANTERIOR B;SCAPHOID – ANTERIOR OBLIQUE Direction and Centring of X-ray Beam C;SCAPHOID – POSTERIOR OBLIQUE D.SCAPHOID POSTERO-ANTERIOR – Radiological Considerations E. Scaphoid – Lateral Direction and location of the X-ray beam Carpal tunnel Axial – method 1 Direction and location of X-ray beam Axial – method 2 (Fig. 2.17b) WRIST JOINT Mdu RADIOGRAPHIC ANATOMY WRIST Basic Projection POSTERO-ANTERIOR LATERAL POSTERO-ANTERIOR Position of Patient and Image Receptor The patient is seated alongside the table, with the affected side nearest to the table. The elbow joint is flexed to 90 degrees and the arm is abducted, such that the anterior aspect of the forearm and the palm of the hand rests on the image receptor. If the mobility of the patient permits, the shoulder joint should be at the same height as the forearm. The wrist joint is placed central to the image receptor and adjusted to include the lower part of the radius and ulna and the proximal two-thirds of the metacarpals. The fingers are flexed slightly to bring the anterior aspect of the wrist into contact with the image receptor. The wrist joint is adjusted to ensure that the radial and ulnar styloid processes are equidistant from the image receptor. The forearm is immobilized using a sandbag. Direction and Centering of X-ray Beam The vertical central ray is centred to a point midway between the radial and ulnar styloid processes. Essential Image Characteristics The image should demonstrate the proximal two-thirds of the metacarpals, the carpal bones, and the distal third of the radius and ulna. There should be no rotation of the wrist joint. Notes; When the image is undertaken for a scaphoid view the wrist should be in ulnar deviation. LATERAL Position of Patient and Image Receptor The patient is seated alongside the table, with the affected side nearest to the table. The elbow joint is extended to bring the medial aspect of the forearm, wrist and hand into contact with the table. The wrist joint is positioned to include the lower part of the radius and ulna and the proximal two-thirds of the metacarpals on the image receptor. The hand is rotated externally slightly further to ensure that the radial and styloid processes are superimposed. The forearm is immobilized using a sandbag. Direction and Centering of X-ray Beam The vertical central ray is centered over the styloid process of the radius Note If the elbow is extended rather than at right-angles it is often easier to rotate the wrist into a lateral position. CAPAL BONES Scaphoid Imaging of the carpal bones is most commonly undertaken to demonstrate the scaphoid. For suspected scaphoid fractures, three or more projections may be taken The projections may also be used to demonstrate other carpal bones; For scaphoid fractures, three or more projections may be taken: A carpal fracture is a break of one of the eight small bones of the carpus. These bones are the scaphoid, lunate, capitate, triquetrum, hamate, pisiform, trapezium, and trapezoid. Fractures of the other carpal bones do occur but the scaphoid is accountable for 60–70% of fractures of the carpal bones. A; SCAPHOID – POSTERO-ANTERIOR WITH ULNAR DEVIATION Position of patient and image receptor The patient is seated alongside the table with the affected side nearest the table. The arm is extended across the table with the elbow flexed and the forearm pronated. If possible, the shoulder, elbow and wrist should be at the level of the tabletop. The wrist is positioned over the centre of the image receptor and the hand is adducted (ulnar deviation). Ensure that the radial and ulnar styloid processes are equidistant from the image receptor. The hand and lower forearm are immobilized using sandbags.. Direction and Centering of X-ray Beam The vertical central ray is centred midwa between the radial and ulnar styloid processes. Essential Image Characteristics The image should include the distal end of the radius and ulna and the proximal end of the metacarpals. The joint space around the scaphoid should be demonstrated clearly. B;SCAPHOID – ANTERIOR OBLIQUE WITH ULNAR DEVIATION Position of Patient and Image Receptor From the postero-anterior position, the hand and wrist are rotated 45 degrees externally and placed central over an image receptor. The hand should remain adducted in ulnar deviation. The hand is supported in position, with a non-opaque pad placed under the thumb. The forearm is immobilized using a sandbag. Direction and Centring of X-ray Beam The vertical central ray is centred midway between the radial and ulnar styloid processes. Essential Image Characteristics The image should include the distal end of the radius and ulna and the proximal end of the metacarpals. The scaphoid should be seen clearly, with its long axis parallel to the image receptor RADIOGRAPHIC ANATOMY WITH ULNA DEVIATION C;SCAPHOID – POSTERIOR OBLIQUE Position of Patient and Image Receptor From the anterior oblique position, the hand and wrist are rotated externally through 90 degrees, such that the posterior aspect of the hand and wrist are at 45 degrees to the image receptor. The wrist is then supported on a 45-degree no- opaque foam pad. The forearm is immobilized using a sandbag. Direction and Centering of X-ray Beam The vertical central ray is centred over the styloid process of the ulna. Essential Image Characteristics The image should include the distal end of the radius and ulna and the proximal end of the metacarpals. The pisiform should be seen clearly in profile situated anterior to the triquetral. The long axis of the scaphoid should be seen perpendicular to the image receptor D.SCAPHOID POSTERO-ANTERIOR – ULNAR DEVIATION AND 30-DEGREE CRANIAL ANGLE The