RAD14 Radiographic Positioning and Radiologic Procedures 1 PDF

RAD14: RADIOGRPAHIC inversion / a movement in which the plantar surface (sole) of varus the foot rotates towards the mid-line of the body. POSITIONING AND R...

RAD14: RADIOGRPAHIC inversion / a movement in which the plantar surface (sole) of varus the foot rotates towards the mid-line of the body. POSITIONING AND RADIOLOGIC is a position of the body: lying with the face up, PROCEDURES 1 supine resting in a back BSRT 3 (A.Y. 2024-2025) prone is a position of the body; lying with the face anterior refers to forward or front part of the body or down, (ventral) forward part of an organ erect essentially upright position or vertical posterior refers to back part of a body or organ. (ofe, recumbent lying down either front or back (dorsal) however, that the superior surface of the foot is referred to as the dorsal surface.) sims the knee chest position caudad refers to parts away from the head of the body trendelenburg the body is laid flat on the back with the feet higher than the head cephalad refers to parts toward the head of the body rotation the process of turning around an axis superior. refers to nearer the head or situated above circumduction movement of a part in a circular direction inferior refer to nearer the feet or situated below central peripheral refers to parts at or near the surface, edge, or outside of another body part Anterior Body Landmark medial refers to parts toward the median plane of the abdominal anterior body trunk inferior to ribs body or toward the middle of another body part ribs lateral refers to part away from the median plane of the acromial points of shoulder body or away from the middle of another body part to the right or left antebrachial forearm superficial refers to parts near the skin or surface antecubital anterior surface of elbow deep refers to parts far from the surface axillary armpit distal refers to parts farthest from the point of brachial arm attachment, point of reference, origin, or carpal wrist beginning; away from center of body cervical neck region proximal refers to parts nearer the point of attachment. point coxal hip of reference, origin, or beginning: toward the center of the body crural leg external refer to parts outside an organ or on the outside of deltoid curve of shoulder form by large deltoid muscle the body digital finger / toes internal refer to parts within or on the inside of an organ femoral thigh parietal refers to the wall or lining of a body cavity fibular lateral part of leg visceral refers to the covering of an organ frontal forehead ipsilateral refers to a part or parts on the same side of the inguinal area where thigh meets body nasal nose area contralateral refers to a part or parts on the opposite side of the oral mouth body orbital eye area flexion bending of a part or decreasing the angle of a joints pelvic area overlying the pelvis anteriorly extension straightening of a part or increasing the angle of a pubic genital region joints sternal breastbone area abduction moving a limb away from the centre line or away tarsal ankle area from the origin thoracic chest adduction moving a limb towards from the centre line or umbilical navel towards the midline of the body hyper "beyond " increasing angle of a joints Posterior Body Landmark extention - hyper flexion - "beyond" decreasing angle of a joints calcaneal heel or foot eversion / a movement in which the plantar surface of the cephalic head valgus foot rotates away from the mid-line of the body. femoral thigh  gluteal buttock Abdominal cavity lumbar area between ribs and hip  Peritoneum occipital posterior surface of head  Liver  Gallbladder olecranal posterior surface of elbow  Pancreas popliteal posterior knee area  Spleen sacral area between hips  Stomach  Intestines scapular shoulder blade region  Kidneys sural posterior surface lower leg, the calf  Ureters vertebral area of spine  Major Blood Vessels  Pelvic Porti on: Rectum, Urinary Bladder, and Parts of the Sagittal Plane Reproductive System  Pleural - a sagittal plane divides the entire body or a body part into right and left segments. The plane passes vertically through Quadrants the body from front to back 1. Right Upper Quadrant (RUQ), The Midsagittal Plane 2. Right Lower Quadrant (RLQ), 3. Left Upper Quandrant (LUQ), - is a specific sagittal plane that passes through the midline of 4. Left Lower Quadrant (LLQ) the body and divide it into equal right and left halves Coronal Plane - a coronal plane divides the entire body or a body part into anterior and posterior segment Midcoronal Plane - often referred to as the midaxillary plane is a specific coronal plane that passes through the midline of the body, dividing it into equal anterior and posterior halve. Horizontal Plane - often it is referred to as a transverse or axial plane - plane passes crosswise through the body or a body part at right angles to the longitudinal axis Oblique Plane - an oblique plane is a longitudinal or transverse plane that is at an angle or slant and is not parallel to the sagittal, coronal, or horizontal plane Thoracic Cavity  Lungs  Trachea  Esophagus  Pericardium  Heart and Great Blood Vessels Body habitus directly affects the location of the following:  Heart  Lungs  Diaphragm  Stomach  Colon  Gallbladder  Box 3-2 Primary X-Ray Projections And Body Positions Projections Positions Anteroposterior (AP) General body positions Posteroanterior (PA) Upright Lateral Seated Lateral Projection AP Oblique Supine  For a lateral projection, a perpendicular central ray enters one PA Oblique Prone side of the body or body part, passes transversely along the Axial Recumbent coronal plane, and exits on the opposite side  A left lateral position or right lateral position specifies the side AP Axial Fowler of the body closest to the IR and corresponds with the side PA Axial Trendelenburg exited by the central ray AP Axial Oblique Radiographic body positions Oblique Projection PA Axial Oblique Lateral  During an oblique projection, the central ray enters the body or Axiolateral Right body part from a side angle following an oblique plane. Axiolateral Oblique Oblique o AP oblique projection o PA oblique projection Transthoracic Right posterior oblique (RPO) Craniocaudal Left posterior oblique (LPO) Tangential Right anterior oblique (RAO) Inferosuperior Left anterior oblique (LAO) Superoinferior Decubitus Plantodorsal Right lateral Dorsoplantar Left lateral Lateromedial Ventral Complex Projections Mediolateral Dorsal  For additional clarity, projections may be defined by entrance Submentovertical Lordotic and exit points and by the central ray relationship to the body at the same time. Acanthoparietal o Ex. PA axial projection Parietoacanthial  Axiolateral projections also use angulations of the central ray, Acanthioparietal but the ray enters and exits through lateral surfaces of the entire body or body part. Orbitoparietal True Projections Parieto-orbital  The term true (true AP, true PA, and true lateral) 1 is often Projection used in clinical practice. True is used specifically to indicate that the body part must be placed exactly in the anatomic  The term projection is defined as the path of the central ray as position it exits the x-ray tube and goes through the patient to the IR.  Most projections are defined by entrance and exit points in the body and are based on the anatomic position. o Ex. AP/PA Projection  Projections can also be defined by the relationship formed between the central ray and the body as the central ray passes through the entire body or body part. Examples include axial and tangential projections. In-Profile Anteroposterior Projection  In-profile is an outlined or silhouette view of an anatomic  Perpendicular central ray enters the anterior body surface and structure that has a distinctive shape. The distinctive aspect is exits the posterior body surface. not superimposed. The view is frequently seen from the side. Posteroanterior Projection Position  Perpendicular central ray is shown entering the posterior body The term position is used in two ways in radiology. One way surface and exiting the anterior body surface identifies the overall posture of the patient or the general body position. General Body Positions The following list describes the general body positions. All are commonly used in radiography practice.  upright erect or marked by a vertical position  seated upright position in which the patient is sitting on a chair or stool  recumbent general term referring to lying down in any position, such as dorsal recumbent, ventral recumbent, or lateral recumbent  supine lying on the back  prone lying face down  Trendelenburg position supine position with head tilted downward  Fowler position supine position with head higher than the feet  Sims position recumbent position with the patient lying on the left anterior side (semiprone) with left leg extended and right knee and thigh partially flexed  Lithotomy position supine position with knees and hip flexed and thighs abducted and rotated externally, supported by ankle or knee supports Oblique Position  An oblique radiographic position is achieved when the entire body or body part is rotated so that the coronal plane is not parallel with the radiographic table or IR. Lordotic Position Medical Terminology  The lordotic position is achieved by having the patient lean backward while in the upright body position so that only the shoulders are in contact with the IR.  An angulation forms between the central ray and the long axis of the upper body, producing an AP axial projection. This position is used for visualization of pulmonary apices and clavicles. Note to Educators, Students, and Clinicians  Educators and clinicians are encouraged to use the term projection generally when describing any examination performed.  The word projection is the only term that accurately describes how the body part is being examined.  The term position should be used only when referring to placement of the patient’s body. A correct example is, ―We are going to perform a PA projection of the chest with the patient in the upright position.‖ View  The term view is used to describe the body part as seen by the IR. Use of this term is restricted to the general discussion of a finished radiograph or image  deviation – turning away from the regular standard or course  dorsiflexion – flexion or bending of the foot toward the leg  plantar flexion – flexion or bending of the foot downward toward the sole Oblique Radiographs  Oblique radiographs are obtained when the patient’s body is rotated so that the projection obtained is not frontal, posterior, or lateral.  These radiographs are viewed with the patient’s anatomy placed in the anatomic position. The part to be examined is usually centered on the center point of the IR or at the position where the angulation of the central ray projects it to the center. Source-to-Image Receptor Distance (SID)  Source-to-image receptor distance (SID) is the distance from the anode focal spot inside the x-ray tube to the IR.  SID is an important technical consideration in the production of radiographs of optimal quality. This distance is a critical component of each radiograph because it directly affects magnification of the anatomy on the image, the spatial resolution, and the dose to the patient.  For a few radiographic projections, SID less than 40 inches is desirable.  An IR just large enough to Source-To-Skin Distance cover the region being examined should be used when available. This aids in  The distance between the focal spot of the radiography tube positioning and encourages proper and the skin of the patient is termed the source-to-skin distance collimation. (SSD).  The exception to this rule is  This ditstance affects the dose to the patient and is addressed seen when DR is used with a 17 × 17-inch by the National Council on Radiation Protection (NCRP). (43 × 43-cm) IR integrated with the table. Current NCRP recommendations state that the SSD shall not The radiographer has to collimate exactly be less than 12 inches (30 cm). to the body part size anywhere on the  The software included in the computers of DR systems allows detector.. for shuttering. Shuttering is used in DR to provide a black background around the original collimation edges. This black background eliminates the distracting clear areas and the associated brightness that comes through to the eyes. Many radiographers open the collimator larger than is necessary and use the shuttering software to ―crop-in‖ or mask unwanted peripheral image information and create the appearance of proper collimation. Voluntary Muscles  The voluntary, or skeletal, muscles are composed of striated muscular tissue and are controlled by the central nervous system. These muscles perform the movements of the body initiated by the individual. In radiography, the patient’s body must be positioned in such a way that the skeletal muscles are relaxed. The patient’s comfort level is a good guide in determining the success of the position. Voluntary motion resulting from lack of control is caused by the following: o Nervousness o Discomfort o Excitability o Mental illness o Fear o Age o Breathing  Decreasing the length of exposure time is the best way to control voluntary motion for patients who are unable to cooperate, such as young children, the elderly, and those with mental illness.  Radiolucent positioning sponges and sandbags are commonly used as immobilization devices. o A leg holder is used to stabilize the opposite leg for lateral radiographs of the legs, knee, femur, and hip. o A thin radiolucent mattress, called a table pad, may be placed on the radiographic table to reduce movement related to patient discomfort caused by lying on the hard surface Lead Shielding Lead Markers & Image Receptor Holder 3. Trochoid (Pivot) Joints  formed by a bony, pivot-like process that is surrounded by a ring of ligaments or a bony structure or both.  allows rotational movement around a single axis.  Examples: proximal and distal radioulnar joints of the forearm, which demonstrate this pivot movement during rotation of the hand and wrist. The adult human skeleton is composed of 206 primary 4. Ellipsoid (Condylar) Joints bones. Ligaments unite the bones of the skeleton. Bones provide the  movement occurs primarily in following: one plane and is combined 1. Attachment for muscles with a slight degree of rotation 2. Mechanical basis for movement at an axis at right angles to the 3. Protection of internal organs primary plane of movement. 4. A frame to support the body  rotational movement is limited 5. Storage for calcium, phosphorus, and other salts by associated ligaments and 6. Production of red and white blood cells tendons.  allows primarily four The 206 bones of the body are divided into two main groups: directional movements: flexion  Axial skeleton and extension and abduction and adduction.  Appendicular skeleton  Examples: metacarpophalangeal joints of the fingers, the wrist joint, and the metatarsophalangeal joints of the toes.  The axial skeleton 5. Sellar (Saddle) Joints supports and protects the  Movements —flexion, head and trunk with 80 extension, adduction, bones. abduction, and circumduction.  The best example: first carpometacarpal joint of the thumb. 6. Spheroidal (Ball and Socket) Joints  allows the greatest freedom of motion.  Movements of spheroidal joints include flexion, extension, abduction, adduction, circumduction, and medial and lateral rotation.  Two examples: hip joint and Synovial Joints / Diathrosis / Freely Moveable the shoulder joint. 7. Bicondylar Joints 1. Plane (Gliding) Joints  provide movement in a single  permits the least movement direction.  is a sliding or gliding motion  Two examples: knee between the articulating (formerly classified as surfaces. ginglymus) and the  Examples: intermetacarpal, temporomandibular joint carpometacarpal, and (TMJ). intercarpal joints of the hand and wrist. 2. Ginglymus (Hinge) Joints  The articular surfaces are molded to each other in such a way that they permit flexion and extension movements only.  Examples: interphalangeal joints of fingers and toes and the elbow joint. Hand and Wrist Carpals (Wrist) The 27 bones on each hand and wrist are divided into the following Proximal Row three groups:  Scaphoid 1. Phalanges (fingers and thumb - 14 o a boat-shaped bone. largest bone in the proximal row 2. Metacarpals (palm) - 5 o articulates with the radius proximally. 3. Carpals (wrist) - 8 o most frequently fractured carpal bone Total – 27  Lunate o the second carpal in the proximal row Phalanges – Fingers and Thumb (Digits) o articulates with the radius  Each phalanx consists of three parts:  Triquettum o A distal rounded head, a body (shaft), base o Three articular surfaces o Pyramidal shape Metacarpals (Palm) o Articulation small pisiform  Pisiform  The second group of bones of the hand, which make up the o (pea-shaped) palm, consists of the five metacarpals. o Smallest pf the carpal bones  Each metacarpal is composed of three parts, similar to the o Anterior to the triquetrum phalanges. o Most evident in the carpal sulcus view Distal Row  Trapezium o Proximal to the first metacarpal o Four-sided, irregularly shaped bone  Trapezoid o Smallest bone in the distal row o Four-sided, irregularly shaped bone Joints of the Hand  Interphalangeal (IP) o thumb has only two phalanges  Metacarpophalangeal (MCP) Joint o joint between the fist metacarpal and the proximal phalanx  Fingers (second through fifth digits) o distal interphalangeal (DIP) o proximal interphalangeal (PIP) joint, and, most proximally, the metacarpophalangeal (MCP) joint Metacarpals Carpal Sulcus  metacarpophalangeal (MCP) joints (distal end)  Carpal sulcus – forms concave side to side of the wrist  carpometacarpal (CMC) joints (proximal end)  Flexor retinaculum – strong fibrous band, attaches medially Five metacarpals (MCs) articulate with specific carpals as follows: to the pisiform and hook of hamate  Carpal tunnel – passageway created between the carpal sulcus  First MC with trapezium and flexor retinaculum  Second MC with trapezoid  The median nerve and the flexor tendons pass through the  Third MC with capitate carpal canal.  Fourth and fifth MC with hamate Upper Extremities (From Carl) DIGITS (2nd to 5th)  PP – Part Position  RP – Reference Point PA Projection  CR – Central Ray  SS – Structure Shown  ER – Examination Rationale  ⊥ - Perpendicular  || - Parallel  b/n – between Fracture A break in a bone Simple / Closed Does not break through the skin Fx Compound / Portion of the bone protrudes through the skin  PP: Palmar face down, separate the digits slightly Open Fx  RP: PIP joint Incomplete / Does not traverse through entire bone  CR: Perpendicular Partial Fx Torus/Buckle Fx: buckle in the cortex with no  SS: PA projection of the affected digit complete break  AP Projection: For suspected joint injury Greenstick Fx/Willow Stick/Hickory Stick: fracture is on one side only (commonly in Lateral Projection children) Complete Fx Break is complete & bone is broken into two pieces Transverse Fx: near right angle to long axis of the bone Oblique Fx: at an oblique angle to the bone\ Spiral Fx: bone is twisted apart & spirals around the long axis of bone Comminuted Fx Bone is splintered or crushed (two or more fragments) Impacted Fx One fragment is firmly driven into the other Avulson Fx A fragment of bone is separated or pulled away Dislocation / Bone is displace from a joint Luxation  PP: Rest hand on radial surface (2nd to 3rd digits) & ulnar Subluxation Partial dislocation surface (4th to 5th digits) Rolando Fx Comminuted fx of 1st MCP base  RP: PIP joint Bennett's Fx Transverse fx of 1st MCP bas  CR: Perpendicular Boxer's Fx 4th-5th metacarpal neck fx  SS: Lateral projection of affected digit Colles' Fx / Fx of distal radius w/ posterior/dorsal Dinnerfork / displament PA Oblique Projection Bayonet Smith Fx / Fx of distal radius w/ anterior/palmar Reverse Colles' displacement Barton's Fx Fx of posterior lip of distal radius Baseball / Mallet Fx of distal phalanx Fx Hutchinson's / Intraarticular fx of the radial styloid process Chaeffeur's Fx Monteggia's Fx Fx of proximal half of the ulna with radial head dislocation Nursemaid's / Partial dislocation of the radial head of a child  PP: Hand pronated; lateral rotation (4th & 5th); medial Jerked Elbow rotation (2nd & 3rd)  RP: PIP joint  CR: Perpendicular  SS: PA oblique projection of affected digit  THUMB (1st digit) PA Oblique Projection AP Projection  PP: Hand in slight ulnar deviation; thumb abducted  PP: Hand in extreme internal rotation  RP: 1st MCP joint  RP: 1st MCP joint  CR: Perpendicular  CR: Perpendicular  SS: PA oblique projection of thumb  SS: AP projection of thumb FIRST CARPOMETACARPAL JOINT PA Projection Robert Method (AP Projection)  PP: Shoulder, elbow, & wrist on the same plane (prevent carpal bones elevation & closing 1st CMC joint); arm internally rotated; hand hyperextended; dorsal aspect of thumb against IR  RP: 1st CMC joint  PP: Hand in lateral position: distal surface of hand parallel  CR: to IR o Robert – Perpendicular entering at the first CMC  RP: 1st MCP joint joint.  CR: Perpendicular o Rafert-Long Method – 15° proximally along the  SS: Magnified PA projection of thumb long axis of the thumb and entering the first CMC joint. Lateral Projection o Lewis Method – Angled 10-15° proximally along the long axis of the thumb and entering the first MCP joint.  SS: 1st CMC joint  ER: Bennett’s Fracture; To demonstrate arthritic changes; fractures; 1st CMC joint displacement  Angulation Rationale: To project soft tissue of the hand away from 1st CMC joint; to help open joint spaces Burman Method (AP Projection)  PP: Hand in its natural arched position; palmar surface down  RP: 1st MCP joint  CR: Perpendicular  SS: Lateral projection of the thumb  PP: Hand hyperextended; opposite hand hold the  PP: Hand pronated; palmar surface down, MCP joints at hyperextended hand or bandage loop around first digits; 45° to IR, 45° foam wedge. hand rotated internally; thumb abducted o Interphalangeal joints: use a 45° foam wedge  RP: 1st CMC joint o Joint spaces: elevate the index finger and thumb  CR: 45° toward the elbow (use of radiolucent material & reduces the degree of  SS: Magnified 1st CMC joint foreshortening of phalanges)  ER: To provide a clearer image of 1st CMC than standard o Metacarpals: rotating the patient' hand laterally AP (externally) from the pronated position until the fingertips touch the IR. FIRST METACARPOPHALANGEAL  RP: 3rd MCP joint Folio Method/Skier’s Thumb (PA Projection)  CR: Perpendicular  SS: PA oblique projection of hand  ER: To investigate fractures and pathologic conditions Lane-Kennedy-Kuschner Recommendation (Reverse Oblique Projection)  PP: Hand rotated 45° internally  RP: 3rd MCP joint  CR: Perpendicular  ER: To demonstrate severe metacarpal deformities  PP: Hands rested on medial aspect; distal portion of both fractures thumbs wrap around by a rubber band; thumb in PA plane  RP: between level of MCP of both joints  CR: Perpendicular Kallen Recommendation  SS: 1st CMC joint; bilateral MCP joint, and MCP angles (Tangential Oblique Projection)  ER: Useful diagnosis of ulnar collateral ligament (UCL) rupture.  PP: Hand in PA position, hand rotated 40-45° toward ulnar surface and 40-45° forward, MCP joints flexed 75-80°, HANDS hand dorsum resting on IR PA Projection  RP: MCP joint of interest  CR: Perpendicular  ER: To demonstrate metacarpal fractures Lateral Projection in Extension (Lateromedial, Mediolateral, Fan Lateral)  PP: Hand palmar surface down; spread finger slightly  RP: 3rd MCP joint  CR: Perpendicular  SS: PA oblique projection of the hand  AP Projection: o Hand cannot be extended because of injury and pathologic conditions  PP: o For metacarpal bones and MCP joints o Lateromedial: Hand in lateral position; digits extended; ulnar aspect down PA Oblique Projection o Mediolateral: Radial aspect down o Fan Lateral: (eliminates superimposition of all phalanges)  RP: 2nd MCP joint  CR: Perpendicular  SS: Lateral projection of the hand in extension  ER: To locate foreign bodies and metacarpal fracture displacement  Lewis Method  PP: Hand rotated 5° posteriorly from true position lateral position (removes superimposition of 2nd to 4th metacarpals); thumb extended  RP: Midshaft of 5th metacarpal  CR: Perpendicular  ER: To demonstrate fractures of the 5th metacarpal Lateral Projection in Flexion (Lateromedial)  PP: Hand in natural arch position; digits relaxed  RP: 2nd MCP joint  CR: Perpendicular  SS: Lateral projection of hand in flexion  ER: To demonstrate anterior or posterior displacement in fractures of metacarpals Norgaard Method/Ball-catcher’s Position (AP Oblique Projection)  PP: Hand supinate; medial aspect against IR; 45° sponge support  RP: Between level of 5th MCP joints of both hands  CR: Perpendicular  SS: AP Oblique projection of both hands  ER: To diagnose rheumatoid arthritis