Chapter_002.pdf

Chapter 2 General Anatomy and Radiographic Positioning Terminology  Outline (1 of 3)  Introduction  General anatomy  Definition of terms  Body planes  Body cavities  Divisions of abdomen  Surface landmarks  Body habitus...

Chapter 2 General Anatomy and Radiographic Positioning Terminology  Outline (1 of 3)  Introduction  General anatomy  Definition of terms  Body planes  Body cavities  Divisions of abdomen  Surface landmarks  Body habitus 2  Outline (2 of 3)  Bone functions  Skeletal divisions  General bone features  Bone development  Classification of bones  Arthrology  Joints  Bone markings and features  Processes and Projections 3  Outline (3 of 3)  Depressions  Fractures  General bone features  Anatomic relationship terms  Radiographic positioning terminology  Essential projections  Positions  Body movement terminology 4  Introduction  Radiographers must possess a thorough knowledge of anatomy and medical terminology  This chapter provides an overview of anatomy and terms related to radiographic positioning 5  General Anatomy  Definitions of terms  Body planes  Body cavities  Divisions of the abdomen  Surface landmarks  Body habitus 6  Definitions of Terms  Anatomy The term applied to the science of the structure of the body  Physiology The study of the function of the body organs  Osteology The detailed study of the body of knowledge relating to the bones of the body 7  Body Planes  Imaginary planes that subdivide the body in reference to anatomic position  Planes “slice” the body in all directions at designated levels  Fundamental planes Sagittal Coronal Horizontal Oblique 8  Sagittal Planes  Pass through vertically from front to back  Divide the body into right and left segments  Midsagittal plane (MSP) is a specific sagittal plane that passes through midline and divides the body into equal right and left halves Top-down perspective of patient's body showing sagittal plane through left shoulder, coronal plane through anterior head, and oblique plane through right shoulder. 9  Coronal Planes  Pass through the body vertically from side to side, dividing the body into anterior and posterior parts  Midcoronal plane (MCP), also called midaxillary plane, is the specific plane that passes through midline and divides the body into equal anterior and posterior Midsagittal plane dividing body equally into right and halves left halves and midcoronal plane dividing body equally into anterior and posterior halves. Sagittal, coronal, and horizontal planes are always at right angles to one another. 10  Horizontal planes  Horizontal planes pass crosswise through the body or body part at right angles to the longitudinal axis Positioned at right angle to sagittal and coronal planes Divides the body into superior and inferior portions Also called transverse, axial, or cross-sectional planes A patient in anatomic position with four planes identified. 11  Oblique Planes  Oblique planes pass through a body part at any angle between the previous three planes  Planes are used in radiographic positioning to center a body part to the IR or CR Top-down perspective of patient's body showing  Planes can also be used sagittal plane through left shoulder, coronal plane through anterior head, and oblique plane to guide projections of the through right shoulder. central ray 12  Special Body Planes Special planes are localized to specific parts or areas of the body Interiliac plane transects the body at the pelvis at the top of the iliac crests (level of L4) Occlusal plane formed by the biting surfaces of the upper and lower teeth with jaws closed 13  Body Cavities  Two great cavities Thoracic cavity Abdominal cavity  Abdominal cavity has no lower partition, but the lower portion is called the pelvic cavity  Often referred to as the abdominopelvic cavity Anterior view of torso showing two great cavities: thoracic and abdominopelvic. 14  Thoracic Cavity  Contains: Pleural membranes Lungs Trachea Esophagus Pericardium Heart and great vessels Anterior view of torso showing two great cavities: thoracic and abdominopelvic. 15  Abdominal Cavity  Contains: Peritoneum Liver Gallbladder Pancreas Spleen Stomach Intestines Kidneys Ureters Anterior view of torso showing two great cavities: thoracic and abdominopelvic. Major blood vessels 16  Pelvic Cavity  Contains: Rectum Urinary bladder Part of the reproductive system Anterior view of torso showing two great cavities: thoracic and abdominopelvic. 17  Divisions of the Abdomen  Bordered superiorly by diaphragm  Bordered inferiorly by superior pelvic aperture (pelvic inlet)  Abdomen divided in two methods Quadrants Regions 18  Quadrants of the Abdomen  Four quadrants Right upper quadrant (RUQ) Right lower quadrant (RLQ) Left upper quadrant (LUQ) Left lower quadrant (LLQ)  Quadrants are useful for Four quadrants of abdomen. describing the location of various abdominal organs 19  Regions of the Abdomen  Abdomen divided into nine regions by four planes: Two horizontal and two vertical (Not used as often as quadrants)  Superior regions Right hypochondrium Epigastrium Left hypochondrium  Middle regions Right lateral Umbilical Left lateral  Inferior regions Right inguinal Hypogastrium Left inguinal 20  Review Question (1 of 3) Which body plane passes through the body from anterior to posterior and divides the body into equal right and left halves? A. Midsagittal B. Midcoronal C. Midaxillary D. Midtransverse 21  Review Question (2 of 3) In which quadrant of the abdomen is the largest portion of the liver located? A. Right upper B. Left upper C. Right lower D. Left lower 22  Review Question (3 of 3) The detailed study of the body of knowledge relating to the bones of the body defines: A. Anatomy B. Arthrology C. Osteology D. Pathology 23  Surface Landmarks (1 of 2)  Most anatomic structures cannot be seen or palpated  To accurately and consistently position, radiographers rely on palpable external landmarks to locate unseen anatomy  These landmarks are accepted averages for most patients and Surface landmarks. (A) Head and neck. (B) Torso. should be used only as guidelines. 24  Surface Landmarks (2 of 2)  See Table 2-1 25  Body Habitus (1 of 3)  Defined as the common variations in the shape of the human body  Four major types of body habitus: Sthenic Hyposthenic Asthenic Hypersthenic  Sthenic and hyposthenic are considered average  Hypersthenic and asthenic are the extremes 26  Body Habitus (2 of 3)  Organs affected by body habitus Heart Lungs Diaphragm Stomach Colon Gallbladder Different trunks are shown for asthenic and hypersthenic habitus, the two extremes. The abdomen is the same length in both patients (diaphragm-to-pubic symphysis). The abdominal organs are in completely different positions. Note high stomach in hypersthenic habitus (green color) and low stomach in asthenic habitus. 27  Body Habitus (3 of 3)  Important in radiography because habitus determines size, shape, and position of organs of the thoracic and abdominal cavities Placement, shape, and size of lungs, heart, and diaphragm in patients with four different body habitus types. (A) Sthenic. (B) Hyposthenic. (C) Asthenic. (D) Hypersthenic. 28  Osteology  Bone functions  Skeletal divisions  General bone features  Bone development  Classification of bones 29  Bone Functions  Attachment for muscles  Mechanical basis for movement  Protection of internal organs  Support frame for body  Storage for calcium, phosphorus, and other salts  Production of red and white blood cells 30  Skeletal Divisions  Total of 206 bones in the body  Divided into two main groups Axial skeleton (80 bones) Appendicular skeleton (126 bones)  Axial skeleton supports and protects the head and trunk  Appendicular skeleton provides means for movement 31  General Bone Features (1 of 2)  Compact bone Strong, dense outer layer  Spongy bone Inner, less dense layer Contains a spiculated network called trabeculae  Trabeculae filled with red and yellow marrow Red marrow produces red and white blood cells Yellow marrow stores fat cells General bone features and anatomic parts 32  General Bone Features (2 of 2)  Medullary cavity Central cavity of long bones Contains trabeculae filled with yellow marrow Red marrow found in ends of long bones  Periosteum Tough, fibrous connective tissue that covers bone, except at articular ends  Endosteum Lines marrow cavity General bone features and anatomic parts 33  Bone Development (1 of 3)  Ossification is the term that applies to the development and formation of bones  Begins in the second month of embryonic life  Two processes: Intermembranous Endochondral 34  Bone Development (2 of 3)  Flat bones are formed by intramembranous ossification  Short, irregular, and long bones are created by endochondral ossification  Endochondral ossification occurs from two distinct centers of Primary and secondary ossification of bone. (A) Primary development ossification of tibia before birth. (B) Secondary ossification, which forms two epiphyses after birth. (C) Primary Full growth into single bone, which occurs by age 21 Secondary years. 35  Bone Development (3 of 3)  Primary ossification begins before birth and forms long central shaft in long bones  Secondary ossification occurs after birth when separate bones begin to develop at both ends of long bones Primary and secondary ossification of bone. (A) Primary ossification of tibia before birth. (B) Secondary Ends are called ossification, which forms two epiphyses after birth. (C) epiphyses Full growth into single bone, which occurs by age 21 years. 36  Classification of Bones (1 of 3)  Classified by shape A. Long B. Short C. Flat D. Irregular E. Sesamoid Bones are classified by shape. (A) Humerus is a long bone. (B) Carpals of the wrist are short bones. (C) Sternum is a flat bone. (D) Vertebra is an irregular bone. (E) Patella is a sesamoid bone. 37  Classification of Bones (2 of 3)  Long bones found only in limbs Consist of body and two enlarged articular ends Examples: femur, humerus and phalanges  Short bones Consist mainly of cancellous bone with a thin outer layer of compact bone Example: carpal and tarsal bones  Flat bones consist of two plates of compact bones Middle layer of cancellous bone called diploë Examples: sternum, cranium and scapula  Irregular bones are peculiarly shaped Examples: vertebrae, pelvic bones and facial bones 38  Classification of Bones (3 of 3)  Sesamoid bones Very small and oval Develop inside and beside tendons Protect the tendon from excessive wear Largest is patella Located: Beneath the first metatarsophalangeal articulation of the foot On the palmar aspect of the thumb at the metacarpophalangeal joint of the hand Can be fractured 39  Review Question (1 of 3) Which of the following is an example of a flat bone? A. Femur B. Radius C. Clavicle D. Scapula 40  Review Question (2 of 3) All of the following are functions of the skeleton, except: A. Attachment for muscles B. Storage for calcium, phosphorus, and other salts C. Production of minerals D. Production of red and white blood cells 41  Review Question (3 of 3) Which of the following can be palpated to locate T7? A. Jugular notch B. Sternal angle C. Inferior angle of the scapula D. Xiphoid process 42  Arthrology  Defined as the study of joints, or articulations, between bones  Classified two ways: Functional Structural 43  Functional Classification  Three subdivisions based on mobility of joint Synarthroses = immovable Amphiarthroses = slightly movable Diarthroses = freely movable 44  Structural Classification  Three distinct groups based on connective tissues Fibrous Cartilaginous Synovial  11 specific types of joints fall within the above broad categories 45  Fibrous Joints (1 of 2)  Do not have a joint cavity  United by various fibrous and connective tissues and ligaments  Strongest joints in the body  Three types Syndesmosis Suture Gomphosis 46  Fibrous Joints (2 of 2)  Syndesmosis Immovable or very slightly movable United by fibrous sheets Example: inferior tibiofibular joint  Suture Immovable joint only in the skull  Gomphosis Examples of three types of fibrous joints. (A) Syndesmosis: Inferior tibiofibular joint. (B) Immovable joint only in Suture: Sutures of skull. (C) Gomphosis: Roots roots of teeth of teeth in alveolus. 47  Cartilaginous Joints (1 of 2)  Do not have a joint cavity  Virtually immovable  Two types: Symphysis Synchondrosis  United by hyaline cartilage or fibrocartilage 48  Cartilaginous Joints (2 of 2)  Symphysis Slightly movable joint Separated by a pad of fibrocartilage Designed for strength and shock absorbency Example: pubic symphysis  Synchondrosis Immovable joint Examples of two types of cartilaginous joints. (A) United by rigid cartilage Symphysis: Pubic symphysis. (B) Synchondrosis: Epiphyseal plate found between epiphysis and Example: epiphyseal diaphysis of growing long bones. plate 49  Synovial Joints (1 of 2)  Permit wide range of motion; freely movable  Complex joints  Enclosed by articular capsule  Many have accessory soft tissues Meniscus - act as shock absorbers Bursae - reduce friction between skin and bones, tendons and bones, and muscles and bones Lateral cutaway view of knee showing distinguishing features of a synovial joint. 50  Synovial Joints (2 of 2)  Six types: Gliding Hinge Pivot Ellipsoid Saddle Ball and socket Examples of six types of synovial joints. (A) Gliding: Intercarpal joints of wrist. (B) Hinge: Elbow joint. (C) Pivot: Atlas and axis of cervical spine (viewed from above). (D) Ellipsoid: Radiocarpal joint of wrist. (E) Saddle: Carpometacarpal joint. (F) Ball and socket: Hip joint. 51  Gliding Joint  Simplest synovial joint  Permit slight movement  Examples: intercarpal and intertarsal joints (A) Gliding: Intercarpal joints of wrist. 52  Hinge Joint  Permits flexion and extension only  Examples: elbow, knee and ankle (B) Hinge: Elbow joint. 53  Pivot Joint  Allows rotation around a single axis  Example: atlantoaxial joint (C1-C2 joint) (C) Pivot: Atlas and axis of cervical spine (viewed from above). 54  Ellipsoid Joint  Allows flexion, extension, abduction, adduction, and circumduction  Example: radiocarpal (wrist) joint (D) Ellipsoid: Radiocarpal joint of wrist. 55  Saddle Joint  Allows movement similar to ellipsoid  Difference is in the shape of the articular surfaces  Example: carpometacarpal joint between trapezium and first metacarpal (E) Saddle: Carpometacarpal joint. 56  Ball-and-Socket Joint  Permits widest range of motion  Examples: hip and shoulder (F) Ball and socket: Hip joint. 57  Review Question (1 of 2) Which of the following joint classifications is slightly movable? A. Amphiarthroses B. Synarthroses C. Diarthroses D. Synovial 58  Review Question (2 of 2) All of the following are types of synovial joints, except: A. Ellipsoid B. Syndesmosis C. Gliding D. Pivot 59  Bone Markings and Features  Processes or projections Extend beyond or project out from the main body of a bone  Depressions Hollow or depressed areas  Fractures A break in bone 60 Processes and Projections (1 of 4)  Condyle Rounded process at an articular end  Coracoid or coronoid Beaklike or crownlike process  Crest Ridgelike process  Epicondyle Projection above a condyle 61 Processes and Projections (2 of 4)  Facet Small, smooth-surfaced articular process  Hamulus Hook-shaped process  Head Expanded end of a long bone  Horn Hornlike process 62 Processes and Projections (3 of 4)  Line Linear elevation; not as prominent as a crest  Malleolus Club-shaped process  Protuberance Projecting prominence  Spine Sharp process 63 Processes and Projections (4 of 4)  Styloid Long, pointed process  Trochanter Either of the two large, rounded, and elevated processes of the proximal femur  Tubercle Small, rounded, and elevated process  Tuberosity Large, rounded, and elevated process 64  Depressions (1 of 2)  Fissure Cleft or deep groove  Foramen Hole in a bone for transmission of vessels and nerves  Fossa Pit, fovea, or hollow space  Groove Shallow linear channel 65  Depressions (2 of 2)  Meatus Tubelike passageway  Notch Indentation in the border of a bone  Sinus Recess, groove, cavity, or hollow space  Sulcus Furrow or trench 66  Fractures (1 of 2)  Closed  Open  Nondisplaced  Displaced 67  Fractures (2 of 2)  Fractures are classified according to the nature of the break.  Common classifications Compression Compound (open) Comminuted Greenstick Impacted Transverse Spiral or oblique Simple Common classifications of fractures.  Many fractures fall into more than one category 68  Review Question (1 of 2) Which of the following is defined as a beaklike or crownlike process? A. Coronoid process B. Condyle C. Epicondyle D. Malleolus 69  Review Question (2 of 2) Which of the following is defined as a hole in a bone for transmission of blood vessels and nerves? A. Fissure B. Groove C. Sinus D. Foramen 70 Anatomic Relationship Terms (1 of 4)  Anterior (ventral) Forward or front part of the body or of a part  Posterior (dorsal) Back part of body or part  Caudad Parts away from the head of the body  Cephalad Parts toward the head 71 Anatomic Relationship Terms (2 of 4)  Superior Nearer the head or situated above  Inferior Nearer the feet or situated below  Central Mid area or main part of an organ  Peripheral At or near the surface, edge, or outside of another body part 72 Anatomic Relationship Terms (3 of 4)  Medial Toward the median plane of the body or toward the middle of a body part  Lateral Away from the median plane or away from the middle of a part  Superficial Near the skin or surface  Deep Far from the surface 73 Anatomic Relationship Terms (4 of 4)  Distal Farthest from the point of attachment or origin  Proximal Nearer to the point of attachment or origin  External Outside the body or part  Internal Inside the body or part Use of common radiology terms proximal and distal 74 Review Question - Use of Location Terms (1 of 2) Identify the structure that is proximal to the wrist. A. Metacarpals B. Phalanges C. Elbow 75 Review Question—Use of Location Terms (2 of 2) Is the ankle (A) proximal or (B) distal to the knee? Is the heart (A) anterior or (B) posterior to the spine? 76  Use of Location Terms Point to the medial surface of your forearm. Is the thumb on the medial or lateral side of the hand? 77 Anatomic Relationship Terms (1 of 2)  Parietal The wall or lining of a body cavity  Visceral The covering of an organ  Ipsilateral Parts on the same side of the body  Contralateral Parts on the opposite side of the body 78 Anatomic Relationship Terms (2 of 2)  Palmar Palm of the hand  Plantar Sole of the foot  Dorsum Anterior, or top, of the foot or the back of the hand 79  Radiographic Positioning Terminology (1 of 3) The most commonly used positioning terms in radiology are: Projection Position View Method 80  Radiographic Positioning Terminology (2 of 3)  Projection Defined as the path of the CR as it exits the x-ray tube, passing through the patient to the IR Identified by the entrance and exit points of the body Based on anatomic position  Position Overall posture of the patient or general body position Also refers to the specific placement of the body or part in relation to the table or IR 81  Radiographic Positioning Terminology (3 of 3)  View Used to describe the body part as seen by the IR Exact opposite of projection, the preferred term in the United States  Method Refers to a specific radiographic projection developed by an individual 82  Essential Projections  AP CR enters the anterior surface and exits the posterior  PA CR enters the posterior surface and exits the anterior  Axial Longitudinal angle of the CR of 10 degrees or more Produced by angling the central ray cephalad or caudad Also achieved by angling the entire body or body part while maintaining the central ray perpendicular to the IR. 83  Review Question— Identify the Projection (1 of 2) A. AP B. PA C. Upright D. Prone 84  Review Question— Identify the Projection (2 of 2) A. AP B. PA C. Lateral D. Supine 85  Essential Projections  Tangential CR directed along the outer margin of a curved body surface  Lateral CR enters one side of the body, passing transversely along the coronal plane  Oblique CR enters from side angle Entrance and exit surfaces still specified (e.g., AP oblique) 86  Review Question— Identify the Projection (1 of 4) A. AP B. PA C. AP axial D. Tangential 87  Review Question— Identify the Projection (2 of 4) A. PA B. PA axial C. Tangential D. Lateral 88  Review Question— Identify the Projection (3 of 4) A. AP B. PA C. Lateral D. Tangential 89  Review Question— Identify the Projection (4 of 4) A. PA B. PA oblique C. AP oblique D. AP 90  Positions (1 of 5)  General body positions Upright—erect or vertical Seated—upright, but sitting on a stool Recumbent—lying down in any position Supine—lying on the back Prone—lying face down 91  Positions (2 of 5)  General body positions Trendelenburg position: supine with the head lower than the feet Fowler position: supine with the head elevated Sims’ position: recumbent with patient lying on left anterior side with left leg extended and right knee and thigh partially flexed 92  Positions (3 of 5)  General body positions Lithotomy position: supine with knees and hips flexed and thighs abducted and Lithotomy position of body. rotated externally, supported by ankle supports Lateral position: named according to the side of the patient that is placed closer to the IR Left lateral radiographic position of chest results in lateral projection 93  Positions (4 of 5)  Oblique position: Body is rotated so that the coronal plane is not parallel with the table or IR Angle of rotation is specific for anatomy of interest Named according to side and surface of body closer to table or IR Abbreviations: RPO, LPO, RAO, and LAO LPO radiographic position of chest results in AP oblique projection 94  Positions (5 of 5)  Decubitus position Recumbent position with a horizontal CR Named according to the body surface on which the patient is lying  Lordotic position Upright position in which the patient is leaning backward 95 Review Question— Identify the Position A. LAO B. RAO C. LPO D. RPO 96  Review Question— Identify the Projection A. AP B. PA C. Lateral D. Decubitus 97 Review Question—Identify the Position A. Right lateral B. Right lateral decubitus C. Left lateral D. Left lateral decubitus 98 Body Movement Terminology (1 of 7)  Abduct or abduction Movement of a part away from the central axis of the body  Adduct or adduction Movement of a part toward the central axis of the body  Extension Straightening of a joint  Flexion Bending of a joint 99 Body Movement Terminology (2 of 7)  Hyperextension Forced or excessive extension  Hyperflexion Forced overflexion  Evert/eversion Outward turning of the foot at the ankle  Invert/inversion Inward turning of the foot at the ankle 100  Body Movement Terminology (3 of 7)  Pronate/pronation Rotation of forearm so that the palm is down  Supinate/supination Rotation of forearm so that the palm is up  Rotate/rotation Turning of the body or part around its axis Rotation of a limb is either medial (toward midline) or lateral (away from midline) 101  Body Movement Terminology (4 of 7)  Circumduction Circular movement of a limb 102  Body Movement Terminology (5 of 7)  Tilt Tipping or slanting a body part slightly Tilt of skull is 15 degrees from long axis 103  Body Movement Terminology (6 of 7)  Deviation A turning away from the regular or standard course Radial deviation of hand (turned to radial side) and ulnar deviation (turned to ulnar side). 104 Body Movement Terminology (7 of 7)  Dorsiflexion Flexion or bending of the foot toward the leg  Plantar flexion Flexion or bending of the foot toward the Foot in dorsiflexion and plantar flexion. sole Note movement is at ankle joint 105