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ANATOMY: IS THE Surface anatomy: is the APPLICATIONS OF...

ANATOMY: IS THE Surface anatomy: is the APPLICATIONS OF SURFACE ANATOMY STUDY OF THE study of the external features of the body. Anatomically: regarding the location HUMAN BODY of structures such as bones, muscles, blood vessels, nerves, lymph nodes, STRUCTURES. Some have everyday names, others are named from the organs and internal organs. which lie underneath. Clinically: for conducting a physical Depressions are known as fossae, (ie Popliteal fossa behind the knee). examination and performing certain Some areas take their names from the most important bone in the region, (ie sternal region lies over the sternum). diagnostic tests. Muscles all have names, and they are sometimes responsible for the name of a region. Presentation Title 3 LANDMARKS OF THE BODY Four Prominent body features techniques Visual (seeing) Constant relationship to adjacent deeper structures exist when Palpation (feeling) Used as a guide to position deep structures examining Percussion (tapping) which are very difficult to ascertain by other clinical methods a patient's Auscultation Bony landmarks: e.g. clavicles, iliac crests, ulnar process…. surface (listening) Soft tissue landmarks: e.g. umbilicus, scars, anatomy. tattoo….. 6 BONY LANDMARK SOFT TISSUE LANDMARKS Constant and predicable relationship to each other Less useful than bony landmarks because of their variability not only to each other but to other bony Form convenient network of landmarks covering most parts of the body prominences (e.g umbilicus Vs vertebra) The position of most structures can be usually described in relation to them Stable: outer canthus Variable: umbilicus SURFACE MARKINGS OF FACE 1 Frontal bone LATERAL ASPECT OF 2 Superciliary arch 3 Supraorbital notch THE HEAD 4 Glabella 1. Frontal 5 Nasion 2. Parietal 6 Maxilla 3. Occipital 7 Nasal bone 4. Anterior fontanelle 8 Zygomatic bone 5. Posterior fontanelle 9 Frontozygomatic suture 6. Greater wing of sphenoid 10 Prominence of cheek 7. Temporal 8. Pterion 11 Zygomatic arch 9. Temporal line 12 Infraorbital foramen 10. Zygomatic artch 13 Mandible 11. Mastoid process 14 Mental foramen 12. Styloid process 13. Glabella Head Lumley, John S.P., MS FRCS DMCC FMAA(HON) FGA, Surface Anatomy, Chapter 2, 8-19 14. External occipital protuberance Anterior aspect of the face: bones1Frontal bone 2Superciliary arch 3Supraorbital notch 4Glabella 5Nasion 6Maxilla 7Nasal bone 8Zygomatic bone 9Frontozygomatic suture 10Prominence of cheek 11Zygomatic arch 12Infraorbital foramen 13Mandible 14Mental... ©2008, Elsevier Limited. Lumley, John S. P.. Surface Anatomy - E-Book : The Anatomical Basis of Clinical Examination, Elsevier Health Sciences, 2008 12 Copyright © 2008 ©2008, Elsevier Limited. All rights reserved. ANTERIOR ASPECT OF LATERAL ASPECT OF NECK NECK 1 Angle of mandible 1 Body of mandible 2 Body of mandible 2 Hyoid bone 3 Ramus of mandible 3 Bifurcation of common carotid artery 4 Temporomandibular joint 5 External acoustic meatus 6 Mastoid process 4 Thyroid cartilage 7 Tip of transverse process of atlas vertebra 5 Cricoid cartilage 8 Clavicle 6 Third and fourth tracheal ring 9 Acromion 10 Acromioclavicular joint 7 Manubrium sterni 12 Trapezius 8 Clavicle 13 Pectoralis major 9 Subclavian artery 14 Deltoid ©2008, Elsevier Limited. Lumley, John S. P.. Surface Anatomy - E-Book : The Anatomical Basis of Clinical Examination, Elsevier Health Sciences, 2008 14 ©2008, Elsevier Limited. Lumley, John S. P.. Surface Anatomy - E-Book : The Anatomical Basis of Clinical Examination, Elsevier Health Sciences, 2008 11 Sternocleidomastoid 15 SURFACE ANATOMY OF THE THORAX THE CLAVICLES Bony Thorax Paired clavicles and the sternal contains and protects structures notch represent the border provides attachments for muscles. between the thorax and the neck. On the superior anterior surface where they extend between the ▪ Vertebrae - 12 thoracic segments base of the neck on the right and ▪ Ribs left sides laterally to the ▪ Clavicles shoulders. ▪ Sternum The first rib can be palpated just inferior to the clavicle https://www.alamy.com/stock-photo/thoracic-cage.html  Sternal notch THE STERNUM Left and right costal margins of the rib cage form the inferior boundary Palpated readily as the midline bony of the thorax. structure in the thorax. Infrasternal angle(costal arch) is The manubrium, the body, and the xiphoid where the costal margins join to process may also be palpated. form an inverted V at the xiphoid process On a thin person, many of the ribs Suprasternal (jugular notch): a depression can be seen. on the superior border of the manubrium of Most of the ribs (with the exception the sternum between the medial ends of the of the first one) can be palpated. clavicles ❖The trachea can be palpated posterior to the notch https://medical-dictionary.thefreedictionary.com/sternum THE STERNUM THE STERNUM Manubrium of the sternum: Sternal angle (angle of Louis) can be superior portion of the felt as an elevation between the manubrium and body. sternum at the same levels as the bodies of the third and Sternal angle is clinically important because it is at the level of the costal fourth thoracic vertebrae and cartilage of the second rib. anterior to the arch of the It is the most reliable landmark of the aorta chest It is often used as a landmark for counting ribs. https://www.chegg.com/ ❑ Midsternal, the middle line Lateral sternal line THE STERNUM of the sternum ❑ Mammary or midclavicular Midsternal line Parasternal line Mammary line line, which runs vertically downward from a point Body of sternum: midportion of the sternum midway between the center of anterior to the heart and the vertebral bodies of T5- the jugular notch and the tip T8 of the acromion ❑ Lateral sternal along the sternal margin Xiphoid process of sternum: inferior portion of the ❑ Parasternal midway between sternum, medial to the seventh costal cartilages (T9- the lateral sternal and the T10) mammary lines Xiphisternal joint: the joint between the xiphoid process and the body of the sternum (the heart lies on the diaphragm deep to this joint) SURFACE LINES  SURFACE LINES ANTERIOR CHEST WALL ❑ Anterior and posterior axillary lines are 1 Clavicle drawn vertically from the corresponding 2 Suprasternal notch axillary folds. 3 Manubrium 4 Sternoclavicular joint 5 Body of sternum ❑ Midaxillary line runs downward from the 6 Xiphoid apex of the axilla. 7 Coracoid process 8 True ribs (1– 7) 9 False ribs (8– 10) 10 Costal cartilages 11 Costal margin ©2008, Elsevier Limited. Lumley, John S. P.. Surface Anatomy - E-Book : The Anatomical Basis of Clinical Examination, Elsevier Health Sciences, 2008 26 SURFACE MARKINGS OF THE CHAMBERS OF THE HEART 1 Right atrium 2 Right auricular appendage 3 Left auricular appendage Scapular line is drawn Vertebra prominens (imp for locating vertically through the inferior angle of the scapula the central ray on PA chest) 4 Anterior atrioventricular (coronary) sulcus seventh cervical vertebra It can be readily palpated on most 5 Right ventricle patients at the base of the neck 6 Left ventricle 7 Apex of heart SURFACE LINES 8 Anterior interventricular sulcus ©2008, Elsevier Limited. Lumley, John S. P.. Surface Anatomy - E-Book : The Anatomical Basis of Clinical Examination, Elsevier Health Sciences, 2008 28 Several important structures pass through the superior thoracic aperture: The trachea THE DIAPHRAGM The oesophagus The thoracic duct The apexes of the lungs Nerves (phrenic nerve, vagus nerve, The diaphragm has three recurrent laryngeal nerves, sympathetic trunks) main openings: Arteries (common carotid arteries, The caval opening subclavian arteries) Veins (internal jugular veins, Oesophageal hiatus brachiocephalic veins, subclavian veins) Lymph nodes and lymphatic vessels The aortic hiatus Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 71917 A tip for remembering the vertebral levels: vena cava has eight letters (T8), oesophagus has ten letters (T10), and aortic hiatus has twelve letters (T12). SUPERIOR THORACIC APERTURE CLINICAL PERSPECTIVE MEDIASTINUM During free breathing the ribs which lie superiorly move in the antero-posterior direction whilst the lower more inferior ribs move laterally. Hence, on clinical examination, good chest expansion should be indicated by increased The mediastinum refers to the central mass of antero-posterior movement in the upper tissue that houses: chest and lateral expansion of the lower chest. Heart great vessels Essentially, during breathing in the diaphragm contracts increasing thoracic oesophagus volume and lowering intra-thoracic pressure, Trachea drawing air into the lungs. Thymus gland When breathing out the diaphragm relaxes, lowering thoracic volume and increasing intra- thoracic pressure forcing air out of the lungs. It is divided into the superior and inferior mediastinum. https://www.youtube.com/watch?v=wc2K1Olt4Q8 MEDIASTINUM MEDIASTINUM Superior mediastinum: The top part, The inferior mediastinum lies below the level located superior to (above) your heart. of the 4th thoracic vertebrae but above the diaphragm and is further subdivided into Anterior mediastinum: The part anterior to the anterior, middle and posterior (in front of) your heart, between your heart compartments. and your sternum (breastbone). Middle mediastinum: The part that contains your heart. In the anterior compartment lies the thymus, the middle compartment the heart, whilst Posterior mediastinum: The part posterior the oesophagus and aorta lie in the posterior to (behind) your heart compartment. What is the Mediastinum? (clevelandclinic.org) ABDOMEN AND PELVIC SURFACE ANATOMY FOUR ABDOMINAL QUADRANTS The two lines intersect and divide the The abdomen is bordered superiorly by the diaphragm and inferiorly by the abdomen into four quadrants (clockwise from the top): superior pelvic aperture (pelvic inlet). right upper quadrant fossa (RUQ) Abdominal surface anatomy can be described when viewed from in front of right lower quadrant fossa (RLQ) the abdomen in 2 ways: left lower quadrant fossa (LLQ) 1. divided into 4 quadrants by single vertical and horizontal imaginary planes left upper quadrant fossa (LUQ) 2. divided into 9 regions by two vertical and two horizontal imaginary planes  NINE ABDOMINAL REGIONS SURFACE LINES Four planes divide the body into The transpyloric plane: nine regions An upper transverse line halfway Two horizontal planes between the jugular notch and (transpyloric & transtubercular) the upper border of the and two sagittal (midclavicular symphysis pubis. planes) Transpyloric plane: passes through the inferior border of the L1 In most cases this plane cuts vertebra through the pylorus, the tips of Transtubercular plane: at the level the ninth costal cartilages and the of the L5 vertebral body lower border of the first lumbar vertebra SURFACE LINES NINE ABDOMINAL REGIONS The transtubercular: A lower transverse line midway between the upper transverse and the upper border of the symphysis pubis It corresponds to the line passing through the iliac tubercles It cuts the body of the fifth lumbar vertebra Two sagittal planes are indicated on the surface by a right and a left lateral line drawn vertically through points halfway between the anterior superior iliac spines and the middle line https://quizlet.com/gb/551423034/abdominal-regions-organs-diagram/ Heart MCL Borders of the heart Lungs Left lateral border – mid clavicular sagittal plane Inferior border - T9 vertebral level Apex of lungs = T1 vertebral level Right lateral border – Sagittal plane of the right Inferior border of lungs spinous process At rest – T9 Superior border – Vertebral level T5 – sternal angle Inspiration – T10/T11 Expiration – T8 Valves Medial border of lungs – sagittal plane of L & R spinous process T9 Tricuspid – mid sagittal plane, T7 vertebra level Mitral - Sagittal plane of left transverse process, T7 vertebral level Aortic valve – Right of mid sagittal plane, T6 vertebral level Diaphragm Pulmonary valve – sagittal plane of Left transverse process, T6 At rest – domes = level T9 vertebral level At rest – lateral angles = level L2/L3 or LCM Inspiration – domes = T10/T11 Expiration – domes = T8 Posterior aspect – At rest – T10 Inspiration – T12 Expiration – T9 https://upload.wikimedia.org/wikipedia/commons/6/6b/Surface_anatomy_of_the_heart.png (hint [CPR]: Xiphoid T10 – sternal notch T2. Mid point (2-10)/2+2=T6) https://www.biodigital.com/  Stomach/Duodenum Jejunum Jejunum - The superior portion of the Small bowel Fundus – Directly inferior to the diaphragm on the left side The coils of the jejunum are situated on the left side,in the left lumbar and iliac Greater curvature – Sweeping curve from Fundus, inferiorly regions, and in the left half of the umbilical region. and oblique to level L2, then superior to L1 meeting the duodenum Can vary position from patient to patient quite markedly Lesser Curvature – Sweeping from Fundus inferiorly and obliquely Usual area to level L1 meeting the Superior boundary – L2 duodenum Lateral boundary – Ascending and descending colon Inferior region – L5 Duodenum – Superior L1 Middle – Sagittal plane of R transverse process Inferior – L2 becoming the Jejunum https://www.researchgate.net/publication/261840965/figure/fig2/AS:21421381 4427663@1428083961765/Computed-tomography-shows-diffuse-gastric-wall- thickening-suggesting-Borrmann-4-gastric.png MCL MCL Ileum https://www.biodigital.com Kidney Ileum - The inferior portion of the Small bowel The coils of the ileum lie toward the right in the right lumbar and iliac regions, in the right half of the umbilical region, and in the hypogastric region; a portion of the ileum is within the pelvis. Can vary position from patient to patient quite markedly Usual area Superior boundary – L5 Lateral boundary – Ascending and descending colon Inferior region – Bladder/Uterus Left kidney Superior pole – T12 Pelvis of kidney – L1 Lower pole – L2 Right kidney Superior pole – L1 Pelvis of kidney – L2 lower pole – L3 Medial borders – sagittal plane of transverse process Lateral Borders – Mid clavicular line https://web.stanford.edu/dept/radiology/radiologysite/images/Med%20students%2014,%20kidney/Module-kidney_cap-717443252-5-1-.png Pancreas Pancreas head – Nestled by the duodenum Spleen Level L2 Pancreas body – Sweeps superior and oblique to T12 Spleen – in the upper left quadrant of the abdomen Pancreas tail – Continues superior and oblique T11 – T12 (pancreas tail “points” to the Spleen) Superior border – directly inferior to the diaphragm Its body extends along the transpyloric line, the bulk of it lying above Lateral Border – lateral wall of the abdomen this line to the tail which is in the left hypochondriac region slightly to Inferior border – Level of T12 the left of the lateral line and above the transpyloric line Medial border – Sits “near” the upper pole of the L kidney Pancreas body and tail is posterior to the body of the stomach Citation: Canlas KR, Branch MS. Role of endoscopic retrograde cholangiopancreatography in acute pancreatitis. World J Gastroenterol 2007; 13(47): 6314-6320 URL: https://www.researchgate.net/profile/Mohammad-Zulkarnaen/publication/6156118/figure/fig1/AS:394729935130630@1471122358566/CT-abdomen-showing-an-enlarged-spleen-with- https://www.wjgnet.com/1007-9327/full/v13/i47/6314.htm multiple-hypodense-lesions-of-various-sizes.png  MCL Liver What is a medical image? Superior border – directly inferior to the diaphragm At rest – T9 Inspiration – T10/T11 Expiration – T8 Left lateral border – left mid clavicular sagittal plane Right lateral border – Right side of the upper right border of X,Y coordinates the abdomen Inferior border – LCM, level L2/L3 Oblique inferior border – Curves from LCM to L2, then from L2 Each defined area = picture element (PIXEL) towards MCL superior/oblique Add Z dimension = VOXEL Each pixel has a value https://math.stackexchange.com/questions/4499937/pixels-to- coordinates https://www.biodigital.com 4 https://www.researchgate.net/publication/301334677/figure/fig14/AS:485987131367437@1492879769767/nitial-coronal-CT-showing-normal-appearance-of-bowel-and-liver-metastasis.png Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Digital Imaging: Matrix 512 x 512 Digital image is a layout of rows and columns of boxes or cells [NxN] (or more usual in medical imaging [MxN]) called matrix Each box, or cell, is called pixel Pixel resolution = no. of pixels mm-1 Spatial resolution (SR)= ½ pixel resolution = lpmm-1 No. of pixels in image → ↑SR → ↑mass storage 16 x 16 https://www.ledpulse.com/blog-posts/from-pixel-to-voxel-a-dimensional-leap 6 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Matrix Matrix and Image Quality http://www.sprawls.org/resources/DICHAR/module.htm http://www.sprawls.org/resources/DICHAR/module.htm 8 9 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F.  Spatial Resolution Digital Imaging :Dynamic Range 8 bit 256 G Each pixel has a number. This number is represented in the image as a shade of grey The ability of a system to display shades of grey is called the dynamic range Dynamic range is determined by a number of bits (= 2b, b is bits). E.g. 10 bits system has a dynamic range of 210 or 1024. i.e. the system is able to display 1024 shades 1 bit https://www.radiologycafe.com/radiology-trainees/frcr-physics-notes/ct-image-quality (degree) of grey between the white and black 2G Charles Sturt University 13 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Digital Imaging: Matrix 104 95 132 105 108 110 144 142 100 106 109 116 145 145 143 100 106 99 120 146 143 144 100 106 100 125 146 146 147 105 105 130 152 151 100 132 151 http://www.sprawls.org/resources/DICHAR/module.htm 16 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. (Seeram, 11/2017)Seeram, E. (2017). CT at a Glance. [[VitalSource Bookshelf version]]. Retrieved from vbk://9781118660898 https://www.dielp.com/dielp-ctvsmri.html 17 18 Charles Sturt University Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. (Seeram, 11/2017)Seeram, E. (2017). CT at a Glance. [[VitalSource Bookshelf version]]. Retrieved from (Seeram, 11/2017)Seeram, E. (2017). CT at a Glance. [[VitalSource Bookshelf version]]. Retrieved from vbk://9781118660898 vbk://9781118660898 19 20 Charles Sturt University Charles Sturt University (Seeram, 11/2017)Seeram, E. (2017). CT at a Glance. [[VitalSource Bookshelf version]]. Retrieved from vbk://9781118660898 Window Width and Level – WW/WL (AKA Window Centre and Level- WW/WC) 21 22 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. WW/WL OR W/C Level is the same as centre Up to decrease brightness (window level goes up) Down to increase brightness (window level goes down) Left to increase contrast (window width shrinks) Right to decrease contrast (window width expands) 23 MRS121 Clare Singh 24 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F.  Commonly used terms in this area PACS implementation of a picture archiving and communication system in a Khaleel, H.H., Rahmat, R.O., Zamrin, D.M., 2018. Components and prototype application. Reports in Medical Imaging Volume 12, 1–8.. PACS DICOM RIS HIS Picture Digital Imaging Radiology Hospital archiving and and Information Information communication Communication System System system in Medicine doi:10.2147/rmi.s179268 MRS121 Clare Singh 25 26 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. PACS – Old Versus New http://www.xraycopyservice.com/digital.htmlt https://freelandsystems.com/explore/explore-more/archiving/ MRS204 RIS and PACS 27 MRS204 RIS and PACS 28 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. PACS Workflow Study Size hkg98a/alma991013264170702357 https://primo.csu.edu.au/permalink/61CSU_INST/1 Access via Acquisition (modality) Archive and Secure storage network Workstations for viewing 29 30 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F.  DICOM RIS Contains image and associated data Full of sensitive information Requires a specific viewer International standard to transmitting, storing, retrieving, processing, printing and viewing medical images 31 33 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. https://www.medavis.com/medavis-ris-radiology-information-system/ Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. HIS https://www.openbriefing.com/AsxDownload.aspx?pdfUrl=Report%2FComNews%2F20180903%2F02018095.pdf https://mscissaratu.wordpress.com/2017/02/24/hospital-information-systems-his-introduction/ MRS204 RIS and PACS 34 35 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Huang, H. K. (2019). PACS-based multimedia imaging informatics : basic principles and applications (Third Radiologist Reporting Workstation edition. ed.). Wiley. RIS Worklist PACS Images hkg98a/alma991013264170702357 https://primo.csu.edu.au/permalink/61CSU_INST/1 Access via 36 https://www.itnonline.com/article/choosing-teleradiology-company MRS204 RIS and PACS 37 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F.  Integration Increased efficiency Security risk Safer environment Confidentiality Communication Requires power Reduces cost Potential for storage failure Paperless Potential for human error Information sharing Technical glitches Improved access $$$$$$$ https://www.arpansa.gov.au/sites/default/files/r20_11703_arir_-_annual_summary_report_2019_final_.pdf 38 39 Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Charles Sturt University - TEQSA Provider Identification: PRV12018 (Australian University). CRICOS Provider: 00005F. Examples of Security Risk Deep learning to alter medical images https://www.healthcareitnews.com/news/new-hacking-group-targeting healthcare-infects-mri-x-ray-machine https://www.afr.com/politics/federal/law-firm-x-ray-provider-hit-by-cyber-attacks-20210217-p573bm https://www.washingtonpost.com/technology/2019/04/03/ho