HSMI 1314 Medical Imaging Procedure PDF

AHMI HSMI 1313: RADIOGRAPHIC 1314: Medical IMAGING Imaging Procedure: Chest, BonyCHEST PROCEDURE: ThoraxAND and Abdomen ABDOMEN RADIOGRAPHIC POSITIONING OF THE BONY THORAX...

AHMI HSMI 1313: RADIOGRAPHIC 1314: Medical IMAGING Imaging Procedure: Chest, BonyCHEST PROCEDURE: ThoraxAND and Abdomen ABDOMEN RADIOGRAPHIC POSITIONING OF THE BONY THORAX 1  BONY THORAX STERNUM S T E R N O C L AV I C U L A R J O I N T S RIBS 2  SUMMARY OF PROJECTION FOR BONY THORAX STERNUM (BASIC) RAO LATERAL SC JOINTS (BASIC) PA ANTERIOR OBLIQUES RIBS (BASIC) AP (posterior ribs) PA (anterior ribs) Axillary Ribs (anterior or posterior oblique) Unilateral rib study (AP/PA) 3  ANATOMY Bony Thorax Sternum anteriorly Thoracic vertebrae posteriorly 12 pairs of ribs 4  STERNUM Thin, narrow, flat bone Manubrium Body Xiphoid process 5  PALPABLE LANDMARKS Jugular notch/suprasternal/ manubrial notch: T2/T3 level Sternal angle: T4/T5 level Xiphoid tip: T9/T10 Inferior rib angle/lower coastal margin: L2/L3 6  ARTICULATION Sternoclavicular articulation Bony connection between shoulder girdle and bony thorax Sternal rib articulations Costocartilages: connect anterior ribs to sternum 7  RIBS Numbered according to the thoracic vertebrae 1-7ribs: true ribs: attached directly to sternum by its own costocartilages 8-12: false ribs 8-10: costocartilages attached to 7th costocartilage 11&12: floating ribs: no costocartilage 8  TYPICAL RIB On radiograph: posterior end always superior than the anterior end 9  RIB CAGE 5th rib shaded: to show downward angulation of the ribs 1st rib: short and broad, most vertical 2nd-7th: getting longer 8th and onwards: getting shorter 12th: short Widest diameter: lateral margins of 8th and 9th ribs 10 ARTICULATION OF BONY THORAX (ANTERIOR) A. Costochondral union/junction B. Sternoclavicular joint C. Sternocostal joint of first rib: no motion (synartrodial joint) D. Sternocostal joint of fourth rib: synovial joint allow gliding motion(diarthrodial joint)2nd-7th ribs E. Interchondral joint: diarthrodial joint 11 ARTICULATION OF BONY THORAX (POSTERIOR) 12  CLINICAL INDICATIONS Fracture : disruption of bone Congenital anomalies: pectus carinatum (pigeon chest) or pectus excavatum (funnel chest) Metastases a : transfer of a cancerous lesion from one area to another : osteolytic, osteoblastic, combination of both Osteomyelitis : inflammation of bone due to pyogenic infection Osteopetrosis : increased density of atypically soft bone Osteoporosis : loss of bone density Paget’s disease : thick, soft bone marked by bowing and fractures Tumour : chondrosarcoma, Multiple myeloma SUMMARY OF CLINICAL INDICATIONS 14 STERNUM 15  CONSIDERATIONS In radiographs appreciation of sternum problematic due: Superimposition of spine and heart (how to overcome this? Rotation of patient / angulations of tube) The cartilaginous nature of the sternum  DEGREE OF ROTATION Depend on size of thoracic cavity 17  WHY RAO? RAO superimposes the heart shadow over the sternum. Air filled lungs more radio density then heart shadow. Positioning the sternum in the heart shadow ensures homogenous darkness across the entire sternum.  EXPOSURE FACTORS 70kV recommended for sthenic patient Breathing technique Shallow breathing: blur vascular lung marking Low kV (65 +or – 5) range Low mA Long exposure time (3-4 s) SID: minimum is 40 inches (100 cm) 19 STERNUM- RAO 20  STERNUM- RAO If cannot be done in  NOTE  The amount of required obliquity can also be RAO, do LPO instead. determine by placing one hand on the sternum & the CR angle 15-20 deg other on the spinous process. These two points are across the RT side, to not superimposed as viewed from x-ray tube. project the sternum 21 laterally. RADIOGRAPHIC IMAGE- RAO STERNUM 22 STERNUM- LATERAL Pt. Position Erect/lateral recumbent Part Position Erect: standing/seated with shoulders & arms drawn back. Recumbent: pt supine, arms by the side, shoulder drawn back. Top of IR 1.5”(4cm) above jugular notch. Long axis of sternum align to midline of grid True lateral; no rotation 23 STERNUM- LATERAL  CR Perpendicular to IR Center to mid-sternum, midway between jugular notch & xiphoid process. SID 150-180, reduce magnification of sternum IR 24X30cm  Respiration Suspend respiration on inspiration.  Exposure Factors 70-75kV Higher mAs 24 RADIOGRAPHIC IMAGE- LATERAL STERNUM 25 STERNOCLAVICULAR JOINT 26  SC JOINT-PA PROJECTION  Pt. Position Prone, pillow under head, arms beside head,  Part Position Aligned MSP to CR No rotation of shoulders Center IR to CR (3” distal to vertebral prominence)  CR CR perpendicular, centered at level of T2/3, or 3” below vertebra prominence. SID 100cm 27  SC JOINT-PA PROJECTION Respiration Suspend on expiration for uniform density IR & Exposure Factor 18x24 cm 60-70kV Moving or stationary grid 28 RADIOGRAPHIC IMAGE SC JOINT- PA PROJECTION 29  SC JOINT- RAO/LAO  Pt. Position Prone with slightly rotated (10 to 15deg) of thorax; upside arm above head; downside behind pt.  Part Position With pt rotated 10 to 15deg; align and center spinous process 3 to 5 cm lateral (toward upside) to RAO-right of downside CR & midline of IR LAO- left of downside 30  SC JOINT- RAO/LAO  CR  Perpendicular to level of T2/3 (7.5 cm distal to vertebra prominence) and 3 to 5 cm lateral (towards upside) to MSP  SID 100cm Respiration Suspend on expiration IR & Exposure Factor 18x24 cm 60-70kV Moving or stationary grid 31 RADIOGRAPHIC IMAGE SC JOINT- RAO/LAO 32 RIBS 33  CONSIDERATIONS Important clinical history Nature of the trauma or patient complaint Location of the rib pain Whether patient has been coughing up blood Need to determine whether patient can stand or not. 34 ABOVE OR BELOW DIAPHRAGM 35  DETERMINE PROJECTION The projection should: Place the ROI closest to image receptor Rotate spine away from the area of interest E.g. 1: Trauma to left posterior rib Posterior rib: AP Left posterior oblique: move spine toward right side away from left side E.g. 2: Trauma to right anterior rib? 36  CHEST RADIOGRAPHS PA and lateral chest To rule out any injury to lung E.g: pneumothorax, hemothorax, etc 37  POST. RIBS – AP PROJECTION DONE IN ABOVE (CR T7) OR BELOW DIAPHRAGM (CR T10) Pt. Position Erect for above diaphragm; supine for below diaphragm Part Position Aligned MSP to CR & midline of IR Rotate shoulder anteriorly Chin raised No rotation of pelvis & thorax 38  POST. RIBS – AP PROJECTION CR Above diaphragm:3-4” below jugular notch. Top of IR 1.5” above shoulder. Below diaphragm: to level of midway between xiphoid process and lower rib cage (bottom of IR at Iliac crest) Respiration Inspiration for ABOVE Expiration for BELOW IR & Exposure Factor 35X43 cm; crosswise Above diaphragm: 65-75kV Below diaphragm: 75-85kV 39 RADIOGRAPHIC IMAGE- AP RIBS 40  ANT. RIBS- PA PROJECTION Pt. Position Erect with arms downside Part Position Align MSP to CR & IR Shoulder rotated anteriorly to remove scapula from lung field No pelvis& thorax rotation CR Perpendicular to IR, centered to T7 (7-8 inch/18cm-20 cm below vertebra prominence) Top of IR 1.5” above shoulders. SID 100cm 41  ANT. RIBS- PA PROJECTION Respiration Suspend respiration on inspiration IR & Exposure Factor 35x43 cm; crosswise 65-75kV Moving or stationary grid 42 RADIOGRAPHIC IMAGE- PA RIBS 43 UNILATERAL RIB STUDY 44 RADIOGRAPHIC IMAGE 45  POSTERIOR OR ANTERIOR OBLIQUE POSITIONS: RIBS Posterior-lateral injury: posterior oblique position (affected side towards IR) Anterior-lateral injury: anterior oblique position (affected side away from IR) Patient Position Erect (Above Diaphgram) Supine (Below Diaphragm) Part Position Rotate pt. 45 deg posterior or anterior oblique with affected side towards IR for posterior oblique and away from IR for anterior oblique Raise elevated side arm above head, and extend opposite arm down and behind patient away from thorax Support body with positioning block Align a plane of thorax midway between spine and the lateral margin of thorax on the side of interest to CR and midline of grid. 46  POSTERIOR OR ANTERIOR OBLIQUE POSITIONS: RIBS CR Perpendicular to IR Centered midway between spine and lateral margin of thorax Above diaphragm:3-4” below jugular notch. Top of IR 1.5” above shoulder. Below diaphragm: to level of midway between xiphoid process and lower rib cage (bottom of IR at Iliac crest) 47 48 RADIOGRAPHIC IMAGES 49 50  REFERENCES Bontrager, K.L. and Lampignano, J.P (2013) Textbook of Radiographic Positioning and Related Anatomy (8th Ed) St.Louis, Missouri: Mosby Inc. Note that all images and copy paste are from the above book. 51