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Radiographic Image Analysis, Exams of Radiography

A.T. Still University of Health Sciences (ATSU)Radiography

Radiographic Image Analysis Radiographic Image Analysis

Typology: Exams

2023/2024

Available from 06/23/2024

CarlyBlair
CarlyBlair 🇺🇸

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Radiographic Image Analysis
Parts of a scaphoid -
distal scaphoid
waist of scaphoid and proximal scaphoid
normal CXR criteria -
clavicles show 1 inch above apices
sternal ends equidistant
trachea in midline
entire lungs - apices to costophrenic/cardiophrenic angles
sharp outlines of heart and diaphragm
shadows of ribs and t-spine through the heart
pulmonary markings seen
scapulae outside of lung field
good breathing - 10 posterior ribs seen
ABDOMEN ERECT AP -
no rotation - spinous processes in the midline, alae of ilium symmetric, ischial spines of the
pelvis symmetric
abdominal wall and flank visible
diaphragm without motion - expiration
Abdomen supine AP -
no rotation - spinous processes in the midline, alae of ilium symmetric, ischial spines of the
pelvis symmetric
abdominal wall and flank visible
pubic symph included and the bladder
Abdomen Left Lateral Decubitus -
no rotation - spinous processes in the midline, alae of ilium symmetric, ischial spines of the
pelvis symmetric
abdominal wall and flank visible
diaphragm without motion - expiration
* right side down: when fluid is suspected
* right side up: when air is suspected
Lateral soft tissue neck -
superimposed zygapophyseal joints and mandibular rami
air-filled airway from pharynx to proximal trachea
AP soft tissue neck -
air filled trachea from pharynx to proximal trachea
no rotation - spinous process equidistant to the pedicles and aligned with the midline of the cervical
bodies
pf3
pf4
pf5

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Radiographic Image Analysis

Parts of a scaphoid - distal scaphoid waist of scaphoid and proximal scaphoid normal CXR criteria - clavicles show 1 inch above apices sternal ends equidistant trachea in midline entire lungs - apices to costophrenic/cardiophrenic angles sharp outlines of heart and diaphragm shadows of ribs and t-spine through the heart pulmonary markings seen scapulae outside of lung field good breathing - 10 posterior ribs seen ABDOMEN ERECT AP - no rotation - spinous processes in the midline, alae of ilium symmetric, ischial spines of the pelvis symmetric abdominal wall and flank visible diaphragm without motion - expiration Abdomen supine AP - no rotation - spinous processes in the midline, alae of ilium symmetric, ischial spines of the pelvis symmetric abdominal wall and flank visible pubic symph included and the bladder Abdomen Left Lateral Decubitus - no rotation - spinous processes in the midline, alae of ilium symmetric, ischial spines of the pelvis symmetric abdominal wall and flank visible diaphragm without motion - expiration

  • right side down: when fluid is suspected
  • right side up: when air is suspected Lateral soft tissue neck - superimposed zygapophyseal joints and mandibular rami air-filled airway from pharynx to proximal trachea AP soft tissue neck - air filled trachea from pharynx to proximal trachea no rotation - spinous process equidistant to the pedicles and aligned with the midline of the cervical bodies

how do you fix lateral ankle? -

  1. dorsiflex foot
  2. check for rotation - fibula more posterior/ foot externally rotated (medial dome anterior) so bring patient's heel back
  3. check for tilt - fibula more proximal to talus/knee lifted up (lateral dome higher than medial) so bring patient's knee down
  4. check if you have the 5th MTP base and soft tissue for collimation how to fix lateral elbow? - Wrist relationship - radial head and coronoid process should be superimposed (coronoid distal = wrist depressed) Humerus relationship - capitulum/radial head superior = humerus depressed (radial head completely superimposed on ulna = lower the proximal humerus; medial epicondyle superior + posterior) how to fix tibia/fibula? - Lateral: if fibula over tibia - insufficient rotation externally AP: if fibula over tibia - leg is externally turned how to fix lateral knee rotation and tilt? -
  5. ensure knee is flexed 30 degrees
  6. Assess rotation - adductor tubercle anterior (medial)/fibula too posterior = leg externally rotated - roll the patient back/internally rotate foot
  • Adductor tubercle (medial) too posterior/fibula too anterior and superimposing tibia = leg internally turned - turn the patient more or externally rotate foot
  1. Assess tilt - medial condyle is superior - angle less (excessive cephalic angulation) *** medial condyle sits lower than lateral (Angle cephalic for mediolateral and caudal for lateromedial knee)
  2. collimation - include patella and the fibular head how to fix oblique knees? - External - half of patella in profile laterally and the fibula completely superimposed by the tibia (if not superimposed - externally rotate more) internal - patella on the femur (slightly more medial) and proximal tibiofibular joint open (if not open - internally oblique more) how to fix tangential patellas? - if inferior and superior aspects of patella not superimposed - the knee is flexed more than needed. Bend less. if tibial tuberosity is superimposing the patellofemoral joint space - the knee is not flexed enough. bend more. how to fix AP and lateral femurs? - AP
  3. include ASIS down (femoral head, obturator foramen, pelvic brim, femoral shaft and head)
  4. turn leg in to place greater trochanter in profile (unless contraindicated by trauma/pain/fracture)
  • if lesser trochanter in profile the leg was externally rotated (lesser should NOT be seen on a true AP) Lateral
  • greater tubercle superimposed by humerus
  • acromion superimposing the humeral head
  • scapular neck and spine on the inferior aspect where is the radial tuberosity located and the greater tubercle of the shoulder? - greater tubercle = the thumb - when thumb moves out/lateral (true anatomic position) greater trochanter is in profile radial tuberosity is on the medial side - follows the palm (anterior on lateral elbow when the wrist is lateral ) image criteria for glenoid view? -
    • tip of coracoid process superimposing the humeral head
  • scapular neck superimposed anteroposteriorly
  • glenohumeral joint open how do you fix the glenoid cavity xray? -
    • if over-obliqued the glenoid and scapular neck will be on the thorax
  • if under-obliqued the glenoid cavity will not be open and the scapular neck will not be superimposed IMAGE = needs to be obliqued more criteria for the scapular Y view? -
    • scapular body - medial and lateral borders superimposed on the humerus
  • acromion process in profile laterally (lateral Y)
  • coracoid process in profile medially (medial Y) what does the scapular Y view show? - dislocation - anterior or posterior Anterior dislocation = humeral head out of place and within the thorax/superimposed by ribs Posterior dislocation = humeral head out of place and away from the ribs/thorax how do you fix scapular Y views? - superior angle above clavicle - patient hunched superior angle below the clavicle - patient leaning back lateral border still lateral - insufficient obliquity (lateral border is thicker) medial border (thinner) is lateral - over obliqued = scapula and humerus getting superimposed by the thorax
  • Always collimate but include coracoid process medially how to fix chest lateral image? - find the gastric bubble (left side) and compare that hemidiaphragm with the other.
  • if gastric bubble anterior - left side is more anterior If PA/AP chest is given and no gastric bubble can be found then use that to see if the hemidiaphragm is higher than the other Breathing: entire heart curve should be visible and up to T10 inspiration
  • use hemidiaphragm to check for MCP tilt as well describe stryker notch and ways to fix it? -
    • coracoid process in the middle free from superimposition of the humeral head
  • posterolateral humeral head in profile laterally
  • angle 10 degrees cephalic
  • shows hillsach's defects (angle will ensure coracoid is free of superimposition of the glenoid) how do you fix lateral feet? -
    1. head of metatarsals superimposed
  1. talar domes superimposed
  2. collimation: include whole foot + soft tissue and tib/fib
  3. ensure dorsiflexion is evident
  • if 5th MTP seen - bring knee up + dorsiflex what to include on c-spine AP? - mastoid tip down to T intervertebral disk spaces are open skull and mandible aligned - C3 visible and in the center of the field spinous processes in the middle
  • if intervertebral disk space is closed = angle more cephalad what is included in the lateral c-spine view? - sella turcica (EAM) down to T2 if possible include airway for trauma cases to assess and measure movement in c-spine bodies If C7-T1 space not seen - a swimmers view (with a 5-7 degree caudal angulation may be required)
  • usually the first trauma view what must be included on the odontoid (open-mouth AP) view of the c-spine? - occlusal plane perpendicular and lined up - upper incisors, mastoid air cells and the base of the skull shows the entire odontoid free of superimposition mouth open wide occipitoatlantal joint C1 lateral mass on each side of the peg C2 spinous process and vertebral body visible Atlantoaxial joint space (C1-C2) *** in trauma cases ensure there is no rotation of odontoid - may indicate large-scale fracture how to fix the odontoid? -
    1. Assess rotation: if the space between odontoid (C2) and lateral mass (C1) is equidistant or not
  • turn head towards the narrower side
  1. Assess occlusal plane - if teeth over peg - raise the chin up if base over peg - tuck chin down
  2. ensure all the anatomy is present - repeat with wider mouth
  • Fuchs method may be used in trauma cases what are the 3 lines that are assessed in c-spine traumas? -
    1. anterior spinal line - line in front of vertebrae and posterior to prevertebral fat stripe/trachea
  1. posterior spinal line - line posterior to posterior arch
  2. spinolaminar line - line between the laminas/articular pillars

10 degree caudal angulation to see it without foreshortening and without pubic symph superimposition - center midline to ASIS and symph coccyx aligned with the symph to show no rotation

  • to fix: if symph is over the coccyx = insufficient caudal angulation How do you fix oblique ribs and what should be included? - Upper = 1-8 ribs - inspiration Lower = 8-12 ribs - expiration Anterior ribs = PA Posterior ribs = AP OBLIQUES: RPO = shows right posterior ribs LPO = shows left posterior ribs LAO = shows right anterior ribs RAO = shows left anterior ribs