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524 Cards in this Set
- Front
- Back
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Diseases of Red Blood Cells
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Hemolytic anemias (
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destruction of the RBC’s) – osteoporosis in the long bones, widened medullary spaces with thinning of the cortex. Skull shows thinning of cortex with hair-on-end appearance.
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Sickle cell anemia – hemoglobin is abnormal; RBC’s crescent-shaped. Radiographs show spine with biconcave indentations superiorly and inferiorly on the vertebral body.
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Megaloblastic anemia – occurs as a result of deficiency of vitamin B12 of folic acid. Results in an overall decrease of RBC’s. Stomach appears tubular with a decrease or absence of rugae.
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Polycythemia – primary (neoplastic) results from hyperplasia of bone marrow, resulting in increased amounts of erythrocytes, granulocytes and platelets. Chest films show prominent vascular markings without cardiomegaly. Secondary (non-neoplastic) elevated hemoglobin concentration. Normal chest film, but skull radiographs show hair-on-end appearance on children with cyanotic heart disease.
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Diseases of White Blood Cells
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Leukemia – neoplastic proliferation of WBC’s. Skeletal radiographs display radiolucent bands at metaphyses on long bones of children (moth-eaten appearance). Commonly shows displacement or obstruction of GI or GU system.
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Lymphoma – neoplasm of lymph system – enlargement of mediastinal lymph nodes produces asymmetry on chest films, polypoid masses in the stomach, or thickening of rugae. Erosion of thoracolumbar spine.
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Infectious mononucleosis – viral infection of the lymph system that produces lymphadenopathy and splenomegaly.
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Bleeding Disorders
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Hemophilia – inability of proper blood coagulation. Increased cloudy densities displayed over soft tissues. Chronic cartilage destruction with joint narrowing.
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Purpura – deficiency of number of platelets. Small bowel shows thickening of mucosal folds, splenomegaly.
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· Facility ID on radiograph. - superiorly to prevent from obscuring a costophrenic angle
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· Rt. or LT marker on correct side so as not to obscure anatomy - laterally upper shoulder region
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· No artifacts such as: undergarments, necklaces and gown snaps
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· Contrast and density adequate to demonstrate: vascular markings (evaluated for changes), pneumothorax (air in pleural cavity), pneumectomy (removal of lung).
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· To demonstrate precise fluid levels, CXR should be taken: patient upright and x-ray beam horizontal. (PA also good for discerning the presence of free intraperitoneal (within abdominal cavity) air beneath the diaphragm.
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· Beam penetration sufficient to demonstrate thoracic vertebrae and posterior ribs through he heart and mediastinal structures. - KV 100 - 130 optimal, Grid to reduce fog.
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· Lung markings, diaphragm, heart borders and bony cortical outlines are sharply defined: no respiration or body movements, least OID and 72” SID to DECREASE magnification of the heart and lung details.
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· CR - seventh thoracic vertebrae. (7.5” inferior to vertebral prominens)
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· Must see: apices, lateral lungs and costophrenic angles
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· Film size: 14x17 Sthenic and asthenic patient put film lengthwise.
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· Upon inspiration lungs expand: 3 dimensions. Transversely, anteroposteriorly and vertically. Vertical will demonstrate greatest expansion, up to 4 inches.
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· True PA, distance from the vertebral column to sternal (medial) ends of the claviculae are equal, air filled trachea is aligned with the vertebral column and small amount of heart shadow is visualized on right side of the patients thoracic vertebrae.
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· Detecting rotation: PA chest – evaluate the distance between the vertebral column and the sternal ends of the claviculea or the sternoclavicular (SC) joints. The SC joint that demonstrates the lesser amount of vertebral column superimposition represents the side of the chest that is positioned farther from the film. The OPPOSITE is true for an AP projection. The side of the chest closer to the film shows the SC joint superimposing the LEAST amount of the vertebral column
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· Distinguishing scoliosis from rotation: compare the distance from the vertebral column to the SC joints and the distance from the costophrenic angles to the lateral soft tissue outline. Equal with scoli, different in a rotated patient
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· Claviculea: same horizontal plane.
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· Midcoronal Plane (pts. upper midcoronal plane is tilted toward the film -the lean in BIG Bellies) vs. Poor shoulder positioning: Decreased lung field superior to the claviculea will be seen with poor shoulder positioning and increased lung field superior will be seen with poor midcoronal positioning.
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· Humeri are abducted away from the chest and scapulae are located outside the lung field.
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· Manubrium is superimposed by the fourth thoracic vertebra with about 1” of the apical lung field visualized above the clavicullae and the lungs and heart are demonstrated without foreshortening. If midcoronal plane is tilted forward, lungs and heart are foreshorted and manubrium at T-5 or lower. If midcoronal plane is tilted backwards, heart and lungs are also forshortened but manubrium is between T1-3.
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· Ten to 11 posterior ribs are seen above the diaphragm for full lung aeration. Inspiration: Do after second full inspiration. Expiration: as few as 9 posterior ribs may be seen and heart shadow is broader and shorter and may be necessary to increase mAs for lung details.
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Left Lateral
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ID, markers and artifacts.
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Grid and kVp – 100 –130.
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Short OID and 72” SID
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CR – T-8 (must include right costophrenic angle) Note; because right costophrenic angle is at long OID and CR is centered superiorly to it, angle is projected inferiorly.
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Film size: 14x17 lengthwise.
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No rotation as demonstrated by: posterior and anterior ribs are nearly superimposed (.5” space), sternum in profile and T vertebra ore open. Rotation will show more space.
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RT vs LT lung: Identify hemi diaphragm. How: 1. Gastric air bubble. ON upright patient, gas in stomach rises to fundus just beneath left hemi diaphragm. If you can see bubble, you know left hemi diaphragm is directly above it. 2. Use heart shadow. Located in left chest cavity and extends anterioinferiorly to left hemi diaphragm, outlining superior heart shadow help you to recognize left lung. So, if left lung is anterior, then heart shadow continues beyond sternum into anterior lung. Most common: left lung to be rotated anteriorly. 3. Follow interior border of heart shadow to left hemi diaphragm. Do only when clearly defined. When inferior heart shadow extends below superior diaphragm then left lung is inferior lung. When rotating, the amount of adjustment should be only half the distance needed because both move simultaneously.
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Scoli vs. rotation – anterior ribs are superimposed but posterior are not depending on severity of scoliosis.
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Lungs are seen without foreshortening with nearly superimposed hemi diaphragms. Broad shoulders and narrow hips – keep hips away from film to maintain parallel midsagital plane. Remember part away from film is magnified more so right lung will be more magnified.
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RT vs. LT lateral- 2 distance differences 1. size of heart shadows and superimposition of hemi diaphragms. For right lateral, right thorax closer to film. Advantage of right – increase in right lung detail.
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Humeral soft tissue should not superimpose anterior lung apices.
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Anterioinferior lung and heart shadow are well defined. If patient seated and leaning foreword, anterior abdominal tissue is compressed so lean slightly backward, esp. obese pt.
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The T-11 is entirely superimposed by lung field. (Can find 11 by finding 12. 12 had last rib attached to it.) Usually diaphragms are seen dividing body of T12.
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AP – supine or portable
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ID, markers (lateral upper shoulder region), artifacts.
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For air-fluid levels, pt upright and x-ray beam horizontal.
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Contrast and density
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See: vascular lung markings, soft tissue outlines of air-filled trachea, heart shadow, cortical outline of posterior and anterior ribs.
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Heart penetration on portable – increase kVp. Especially needed when used to evaluate line placement or other apparatus.
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May use 40-50 “ SID
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CR – T7
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Film size and direction – 14 x 17. If hyperstenic, do crosswise.
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Rotation: Distance from vertebral column to sternal ends or SC joints. (Use this to detect rotation.) are equal, air filled trachea is aligned with vertebral column, sm amount of heart shadow in right side of patient’s vertebrae.
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Claviculea on same horizontal plane.
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Poor shoulder positioning shows DECREASED lung field superior to claviculea, poor CR alignment shows INCRASED lung field superior to claviculea.
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Scapulae are seen within lung field and distal humeri have been abducted out of field.
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Manubrium superimposed T4 with about 1 inch of apices shown above claviculae and posterior ribs show a downward contour. Angling CR caudally projects manubrium superior to fourth vertebrae and makes ribs look vertical. Angling CR cephalically makes ribs look horizontal.
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Kyphosis-looks like CR was caudal and chin may superimpose apical chest. To compensate use 5-10 degree cephalic angle.
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Supine patient-9-10 ribs demonstrated due to compress abdominal organ compression. Take on second inspiration.
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Lateral Decub –primarily to confirm air or fluid
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ID, maker (use arrow on side up and mark correct side) and artifacts. (this include cart pad)
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Contrast and density to see: vascular markings, air or fluid levels within pleural cavity, faintly show thoracic vertebrae and posterior ribs through the heart and mediastinal structures.
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KVp-100 –130 use Grid
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Air-affected side up so air rises to highest leveling cavity. If pneumothorax is suspected, decrease kVp 8 percent
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Fluid: affected side down away from mediastinal structures. If pleural effusion suspected, increase mAs by 35 percent.
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See: lung markings, apices, lateral lungs, costophrenic angles, diaphragm, heart borders amd cortical outlines
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SID-72’ to decrease magnification
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CR-perpendicular at seventh thoracic vertebra. (about 7.5 inches inferior to vertebra prominens for PA and 4.5” inferior to jugular notch for AP
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Film crosswise as lungs can’t fully expand.
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Rotation - Distance from vertebral column to sternal ends or SC joints. (Use this to detect rotation.) are equal, air filled trachea is aligned with vertebral column, sm amount of heart shadow in right side of patient’s vertebrae.
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AP vs. PA – analyze C6 and 7 In AP, no distortion. In PA, distorted, disk spaces closed and spinous processes of vertebra are well visualized
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Arms, mandible and lateral borders of scapulae are outside of lung field and lateral aspect of clavicle is projected upward.
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Manubrium and 3rd or 4th thoracic vertebra are superimposed.
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9-10 posterior ribs are seen above diaphragm
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AP Lordotic
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· ID, markers, artifacts, contrast and density.
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· See: lung markings and bony cortical outlines.
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· CR- midsagittal plane halfway between manubrium and xiphoid process.
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· Lungs will be foreshortened so use tight collimation to prevent unnecessary exposure to other tissue.
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· Claviculae are projected superior to lung apices onto first thoracic vertebra.
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· Posterior and anterior ribs lie horizontally and are nearly superimposed.
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RAO and LAO
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Right and left principal bronchi are at the center of the collimated field. About twice as much lung field in seen on one side of the thoracic vertebra as on the other and SC joints are seen without spinal superimposition indicating that a 45degree obliquity has been obtained.
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RAO demonstrates the left lung, LAO demonstrates the right lung.
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Heart shadow has no spinal superimposition on RAO but does on left so a 60-degree obliquity is needed.
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Abdomen
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ID, correct marker, correct placement (lower corner of film), no artifacts.
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Contrast and density adequate to see: collections of fat that outline psoas muscles and kidneys as well as bony structures of lumbar vertebrae, bony trabecular patterns and cortical outlines of vertebra and pelvis.
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KVp – 70-80 and high ratio grid.
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Psoas muscles originate: first lateral lumbar on each side and go to lesser trochanter.
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If bowel gas: decrease mAs 30 to 50 % or kVp up to 15 % from “normal” technique.
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If ascites (fluid in peritoneal cavity), obesity, bowel obstructions or soft tissue masses: increase mAs 30-50% or kVp 15 %.
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For excessive soft tissue: 2 crosswise films.
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Involuntary motion: use shortest possible exposure time
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Can identify by: sharp bony cortices and blurry gastric and intestinal gases.
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AP –spinous processes are aligned with the midline of vertebral bodies; distance from pedicles to spinous processes is the same on both sides, sacrum centered with symphysis pubis.
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For intraperitoneal air: pt upright for 10-20 minutes before radiograph
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Detecting rotation: see AP. The side with smaller distance between pedicles and spinous processes and TOWARD which the sacrum is rotated is the side of the patient positioned farther from the tabletop and film. Also flatter iliac wing.
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Scoliosis versus rotation: on scoli, middle vertebra may be rotated yet not upper or lower. This can’t happen in rotation.
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Long axis of lumbar is aligned with long axis of the collimated field
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Expiration and diaphragm dome is superior to 11 thoracic vertebra.
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Supine
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CR-L4 (iliac crest for females, 1” inferior to Iliac crest for males)
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Must see: spinous process of the 11th vertebra (kidneys, tip of liver and spleen), lateral body soft tissues, iliac wings and the obturator foramina.
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SID- 40-48”
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Film size and direction: 14x17 lengthwise or 2 14x17 crosswise on hypersthenic patients.
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Shield if 2 films are required on males but not on females cuz shield may obscure info.
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Upright
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CR – L3
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Must see: diaphragm, t-9 lateral body soft tissue and iliac wings.
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Film size and direction: 14x17 lengthwise or 2 14x17 crosswise on hypersthenic patients.
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Left lateral decub – to evaluate peritoneal cavity for intraperitoneal air.
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KVp-70-80 with high ratio grid
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Expiration.
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CR – L3
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Allow 10-20 minutes for: air to move away from soft tissue
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If bowel gas: decrease mAs 30 to 50 % or kVp 15 % from “normal” technique.
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If ascites (fluid in peritoneal cavity), obesity, bowel obstructions or soft tissue masses: increase mAs 30-50% or kVp 15 %.
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May need wedge compensating filter if: pt has excessive abdominal soft tissue.
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Pillow between knees-may help common foreword rotation.
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Must see: cortical outlines of the posterior ribs, lumbar vertebrae and pelvis, gases within the stomach and intestines are sharply defined.
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Why left lateral decub? Because intraperitoneal air migrates to the elevated diaphragm, the left is chosen to position the gastric bubble way from where the intraperitoneal air will migrate.
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Findings for Infectious Diseases
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· Syphillis
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· Gonorrhea
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Syphillis
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· Affects males and females
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· Aortic dilatation and possible calcification
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· Osteomyelitis of long bones and skull
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· Thickened gastric wall causing lumen narrowing
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Gonorrhea
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· Bacterial infection that causes urethral stricture
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· Affects males and females
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· Septic arthritis with articular erosion and joint space narrowing
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Diseases of the Male Reproductive System
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· Benign Prostatic Hyperplasia
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· Carcinoma of the Prostate Gland
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· Undecended Testes
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· Testicular Torsion
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Benign Prostate Hyperplasia
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· General enlargement of the prostate gland
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· Elevation and smooth impression of contrast-filled bladder floor in IVU
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· Distal ureters display “J-shape”
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Carcinoma of Prostate Gland
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· Irregular elevation of contrast-filled bladder floor in IVU
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· Possible obstruction
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Undecended Testes
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· Inguinal or ectopic testicle/s
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· Visualized on US, MRI, or CT
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· Can be carcinogenic
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Testicular Torsion
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· A twisting of the testicle resulting in decreased blood circulation
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· Loss of bloodflow confirmed by doppler US
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Diseases of the Female Reproductive System
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· Pelvic Inflammatory Disease (PID)
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· Ovarian cysts/tumors
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· Dermoid cyst
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· Uterine Fibroid
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· Endometrial Carcinoma
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· Endometriosis
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· Carcinoma of the Cervix
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Pelvic Inflammatory Disease
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· Infection of uterus and fallopian tubes
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· CT shows full extent of disease
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· HSG – nonvisualized fallopian tubes due to obstruction
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Ovarian Cysts/Tumors
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· Cysts diagnosed on ultrasound
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· Cysts smooth structure, sometimes containing fluid
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· Tumors can be diagnosed on KUB’s, US, or CT
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· Tumors irregular in shape
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Dermoid Cyst (teratoma)
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· Germ cell tumor
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· Shows calcifications radiographically
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· Can contain skin, hair, teeth, and fatty tissue
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Uterine Fibroid (leiomyoma)
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· Benign smooth muscle tumors
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· IVU shows lobulated impressions of bladder
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· Most common calcified lesions of the female genital tract
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Endometrial Carcinoma
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· Cancer of the uterine body that can invade posterior wall of the bladder
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· Most common invasive gynecologic neoplasm
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Endometriosis
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· Endometrium outside normal location
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· Tissue undergoes shedding and bleeding during menstruation
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· Can build up outside genital tract
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Carcinoma of the Cervix
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· Second most common form of cancer in women
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Findings for Breast Lesions
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· Breast Carcinoma
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· Benign Breast Disease
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Breast Carcinoma
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· Poorly defined irregular margins with numerous fine, linear strands radiating from the mass (on mammography)
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Benign Breast Disease
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· Fibrocystic breast or single cysts
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Findings for Pregnancy
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· Uterine Pregnancy – implantation of fetus within the uterus
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· Ectopic Pregnancy – fertilization outside the uterus
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Optimal radiographs demonstrate 7 characteristics:
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1. Maximum recorded detail
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2. Perfect patient positioning
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3. Excellent penetration
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4. Contrast
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5. Density
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6. No motion
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7. No removable artifacts
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Never should have to be taken a 3rd time.
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Review terms:
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1. Inferior - structure in relation to another is below
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2. Superior - structure in relation to another is above
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3. Lateral - in relation to another body part is away from the midline. Side being radiographed is adjacent to film. Rt or Lt is side of patient CLOSER to film.
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4. Medial-in relation to another body part is toward the midline of the body
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5. Adduct - extremity is moved toward midline of the body.
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6. Abduct - extremity is moved away from midline of the body.
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7. Cortical outline – outer layer of bone, appears white on image.
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8. Foreshortening – appear shorter on image.
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9. Elongating – appears longer on image.
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10. Size distortion – happens when image becomes magnified.
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11. Shape distortion – misrepresentation of shape of image due to elongation and/or foreshortening.
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Hanging Films
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1. Torso, vertebral, cranial, shoulder and hip – pt standing upright
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2. Finger, wrist, forearm – pt hanging from fingertips
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3. Elbow, humerus – hanging from patient shoulder
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4. Toe, AP and oblique foot – hanging from toes.
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5. Lateral foot, ankle, lower leg and femur – hanging from hip.
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6. Decub chest and abdomen – hang UP side up.
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7. Axiolateral of hip and shoulder – anterior surface UP and posterior surface DOWN.
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8. AP/PA – as if you are facing each other.
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Markers
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1. When AP or posterior oblique, markers appear correct.
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2. Marker on lateral? – side of patient closest to film.
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3. Put markers on cassettes rather that tabletop (distortion, magnification, fog from scatter on film, etc.).
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4. Oblique – on side of patient closest to film.
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5. Lateral X-TBL – marker anterior so doesn’t obscure structures on posterior edge.
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6. Extremities – always mark the lateral border (according to anatomical position).
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Radiographic Critique
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1. Relationship of anatomical structures
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a. Estimate degree extremity is flexed or extended
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b. Remember structure farthest from film is magnified the most
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2. Maximum collimation means seen on all sides (four-sided collimation).
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3. CR placement can be seen by imaginary X on diagonal corners of images.
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4. Extremities – collimate to skin-line.
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5. Are all anatomic structures seen on radiograph?
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6. Radiation protection includes:
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a. Shielding – what are we shielding? ovaries, fallopian tubes, uterus, testes in scrotal sac
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b. Technique (KV)
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c. Others in room
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7. Artifacts: pt hand, sponges, hair clips
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8. Smallest possible film size used
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9. Check for film-screen contact.
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10. If more than 1 image on radiograph -are all aligned in the same direction?
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Overexposure ( too much mAs) Vs Underexposure (too little) – how to tell
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.
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· Look at bony cortical outlines of structures.
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· If UNDEREXPOSED, outlines are visible even though the film is light.
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· If UNDERPENETRATED (kV), little density and cortical outlines of thickest parts can’t be seen.
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· If you can see the outline, even if light, adjust mAs, if not, adjust kVp.
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· NEVER repeat with less than a 30% change in technique.
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· How to know: If you think it is only “a little light – it might pass but I’d feel better if I repeated it.” then adjust 30% mAs. If you say, “ Way too light, must repeat,” adjust to at least twice the original mAs.
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· If using photo timer and is too dark or light, why? Poor patient positioning. Also check density settings on console.
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2 ways to control scatter:
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1. tight collimation
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2. grid
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What has to be photoflashed on film:
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· Facility name
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· Patient name
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· Age/DOB
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· Time and date
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Where should the ID plate (blocker) go?
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Next to narrowest structure
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When film is lengthwise it is either upper RT or lower LT if projection was AP. If it was PA, it will either be in the upper LT or lower RT.
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AP C-spine
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the T1-T2 articulation should be seen on the film
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the mastoid processes should be symmetrical
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the mandible should superimpose the base of the skull and C1 and/or C2
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the intervertebral disk spaces should be clearly demonstrated
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AP open-mouth odontiod
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the entire atlas and axis should be included on the film
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C1 should be in the center of the film
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the lateral masses should be equal distances from the rami of the mandible
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the lower edge of the incisors should be even with the base of the skull
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zygopophyseal joints should be visualized between C1 and C2
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Oblique C-spine
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C1-C7 should be included on the film
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C1 should be demonstrated without superimposition of the occipital bone
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the intervertebral disk spaces should be clearly demonstrated
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the mandible should not be superimposed over the vertebrae
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when doing PA obliques, intervertebral foramina closest from the film is demonstrated
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when doing AP obliques, intervertebral foramina furthest to the film is demonstrated
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Lateral C-spine
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C1 – C7 should be included on the film
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If the C7-T1 disk space is not visualized, perform additional “swimmer’s” view
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zygapophyseal joint spaces, intervertebral disk spaces, and spinous processes of C2-C7 demonstrated
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vertebrae should be free of superimposition of the mandible
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the EAM’s should be superimposed
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Swimmer’s view
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C5-T4 should be included on the film (depending on Radiologist’s preference)
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C7-T1 disk space should be adequately penetrated with proper density
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humeral heads should be separated
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AP T-spine
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vertebral bodies of C7-L1 should be included
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sternoclavicular joints should be symmetrical
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spinous process should align with the middle of the vertebrae
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intervertebral disk spaces should be clearly demonstrated
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Lateral T-spine
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vertebral bodies of T3-L1 should be visualized with adequate penetration and density
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posterior ribs should be superimposed
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intervertebral disk spaces should be clearly demonstrated
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AP pelvis
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Iliac crests, greater and lesser trochanters should be included
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Ilia and hip joints adequately penetrated
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Obturator foramina and iliac crests should be symmetrical in size and shape
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Femoral necks should be free of superimposition by greater trochanters
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Lesser trochanters should be minimally demonstrated or not seen
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AP hip
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The acetabulum, greater and lesser trochanters, and approximately one third of the proximal femur should be seen (you must see the distal portion of any prosthetic device)
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Femoral head and acetabulum adequately penetrated
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Femoral neck centered to the film and seen free of superimposition of the greater trochanter
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Lesser trochanter should be minimally seen or not seen at all
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Frog Leg lateral hip
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The acetabulum, greater and lesser trochanters, and approximately one third of the proximal femur should be seen (you must see the distal portion of any prosthetic device)
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Femoral head and acetabulum adequately penetrated
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Femoral neck centered to the film and seen without unnecessary foreshortening
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Greater trochanter should be superimposed over femoral neck
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Transfemoral lateral (x-tbl)
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Acetabulum, ischial tuberosity, greater and lesser trochanters, and approximately 1/3 of the proximal femur should be included
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Femoral head and acetabulum should be adequately penetrated
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Femoral neck should be demonstrated without any foreshortening or elongation
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Greater and lesser trochanters should be partially superimposed
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AP oblique SI joints
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SI joints, ASIS, and ilium on elevated side should be included
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SI joints should be adequately penetrated
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The joint space of the elevated side should be clearly visible
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AP/PA SI joints
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SI joints, 5th lumbar vertebra, and superior border of symphysis pubis should be included
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SI joints should be adequately penetrated
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AP Lumbar Spine
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Vertebral bodies of T12-L2 should be included
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The iliac crests and SI joints should be symmetrical
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Spinous processes should be visualized in the middle of the vertebral bodies
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Intervertebral disk spaces should be clearly demonstrated
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AP Oblique Lumbar Spine
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Vertebral bodies of T12-L2 should be included
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When RPO and LPO positions are compared, the ilia should be symmetrical
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The right zygapophyseal joints should be visible in the RPO position
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The left zygapophyseal joints should be visible in the LPO position
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Pedicles should be demonstrated in the middle of the vertebral body
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If pedicle is anterior to vertebral body, there is too much rotation
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If pedicle is posterior to vertebral body, there is not enough rotation
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“Scotty Dog” should be visualized
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Lateral Lumbar Spine
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Vertebral bodies of T12-L2 should be included
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L1-L5 should be adequately penetrated
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Intervertebral disk spaces should be clearly demonstrated
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*Note: exposure on expiration will free L1 from superimposition of the lungs
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Lateral “Spot” for L5-S1
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The entire vertebral bodies of L5 and S1 should be included
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Intervertebral disk space between L5 and S1 should be well demonstrated
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*Note: tube angulation may vary depending on body habitus
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If hips are larger than upper abdomen, angle caudal
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If hips are smaller than upper abdomen, angle cephalic
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AP Sacrum
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The L5-S1 disk space and symphysis pubis should be included on the film
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The alea of the sacrum should be symmetrical
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Angle tube perpendicular to sacrum (approximately 15 degrees cephalic)
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AP Coccyx
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The coccyx and approximately 1/3 of the sacrum should be included
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kV should be adjusted to produce a high-contrast image
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The coccyx should appear directly above the symphysis pubis
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Lateral Sacrum/Coccyx
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The L5-S1 disk space and the entire sacrum and coccyx should be included on the film
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The femoral heads should be superimposed
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The sacrum should be clearly visible without overexposure of coccyx (take additional film if needed)
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• Shoulder AP (internal rotation):
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|
• 70-80 kV
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|
• - 10 x 12 crosswise
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• - acromion, surgical neck of humerus, lesser tubercle of humerus, and at least half of clavicle should be seen (depending on Radiologist’s preference) some request SC joint to be on the film.
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• - glenohumeral joint adequately penetrated and visible
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|
• - lesser tubercle demonstrated in profile near the glenoid cavity
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|
Shoulder AP (external rotation):
|
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|
|
• - 10 x 12 crosswise
|
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|
|
• - acromion, surgical neck of humerus, lesser tubercle of humerus, and at least half of clavicle should be seen (depending on Radiologist’s preference)
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|
|
• - glenohumeral joint adequately penetrated and visible
|
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|
|
• - greater tubercle should be demonstrated in profile laterally
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|
Anatomy
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|
• Internal Rotation External Rotation
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Axillary shoulder
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|
(Lawrence method):
|
|
|
|
- glenohumeral joint, acromion process, coracoid process, and surgical neck of humerus should be included on film
|
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|
• - glenohumeral joint adequately penetrated and seen on film
|
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|
• - coracoid process should be seen most anteriorly and acromion process should be visualized through the humeral head
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|
|
• 90 degree humeral abduction; CR should be at a 30 degree angle with the patients body. Decreased arm abduction requires a decreased angle
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“Y” shoulder:
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|
|
• - acromion process, coracoid process, and inferior angle of the scapula should be included on the film
|
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|
• - penetration and density should be sufficient to demonstrate humeral head through the scapula
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• - scapula superimposed over humerus with acromion, coracoid, and body of scapula appearing as a “Y” shape.
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•
|
Note: location of the humeral head inferior to the coracoid process indicates anterior dislocation (anterior is most common); humeral head beneath acromion process indicates posterior dislocation
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Needs to Decrease Rotation
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|
GLENOID CAVITY
|
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|
“GRASHEY METHOD”
|
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|
|
• GRASHEY METHOD
|
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|
|
– CENTERED TO GLENOID CAVITY.
|
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|
|
– ROTATE PATIENT 35 TO 45 DEGRESS POSTERIORLY TOWARDS THE AFFECTED SIDE
|
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|
– WILL DEMONSTRATE OPEN JOINT SPACE BETWEEN GLENOID CAVITY AND HUMERAL HEAD WITH GLENOID CAVITY IN PROFILE.
|
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|
|
• AP Clavicle:
|
|
|
|
• - entire clavicle, sternoclavicular joint, and acromioclavicular joint included on film
|
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|
|
• - penetrated so that lateral clavicle not overexposed, yet medial is clear and visible
|
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|
|
• - medial half of clavicle superimposed over ribs and lung
|
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|
|
• AP Axial Clavicle:
|
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|
|
• - entire clavicle, sternoclavicular joint, and acromioclavicular joint included on film
|
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|
|
• - penetrated so that lateral clavicle not overexposed, yet medial is clear and visible
|
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|
• - most of clavicle should be projected above thorax WITH A 15-30 DEGREE ANGLE CEPHALIC.
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Pt rotated away from affected side
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Patient is rotated towards affected side
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• AP scapula:
|
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|
|
• - entire scapula included on film
|
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|
• - bony trabeculae visualized while lung detail should be blurred
|
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|
• - medial half of scapula superimposed over ribs and lungs
|
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|
• - humerus at 90 degree angle with thorax
|
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|
• Lateral scapula:
|
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|
|
• - acromion process, coracoid process, and inferior angle of the scapula should be included on the film
|
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|
|
• - penetration and density should be sufficient to demonstrate humeral head through the scapula
|
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|
• - vertebral and axillary borders superimposed and body of scapula separated from thorax
|
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|
Acromioclavicular Joints:
|
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|
|
• - Bilateral exposure if possible
|
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|
• - SC joints equidistant from spine (no rotation)
|
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|
|
• - penetrated so that lateral clavicles not overexposed, yet medial clavicles are clear and visible
|
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|
• - should be done upright on expiration
|
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|
• - one exposure with weights and one without weights… and marked appropriately
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