Bontrager's Textbook of Radiographic Positioning and Related Anatomy

Front Cover
Bontrager's Textbook of Radiographic Positioning and Related Anatomy
Copyright Page
Acknowledgments and Dedication
Contributors
Contributors to Past Editions
Reviewers
Preface
Purpose and Goal of the Ninth Edition
Methodology
New to This Latest Edition
Ancillaries
Workbook
Evolve Instructor Resources
Handbook
Mosby’s Radiography Online
How to Use the Positioning Pages
Table Of Contents
1 Terminology, Positioning, and Imaging Principles
Contents
Part One ■ Terminology and Positioning
General, Systemic, and Skeletal Anatomy and Arthrology
General Anatomy
Structural Organization
Cells
Tissues
Organs
System
Organism
Systemic Anatomy
Body Systems
Skeletal System
Circulatory System
Digestive System
Respiratory System
Urinary System
Reproductive System
Nervous System
Muscular System
Endocrine System
Integumentary System
Skeletal Anatomy
Osteology
Axial Skeleton
Appendicular Skeleton
Sesamoid Bones
Classification of Bones
Long Bones
Composition
Short Bones
Flat Bones
Irregular Bones
Development of Bones
Blood Cell Production
Bone Formation
Intramembranous Ossification
Endochondral Ossification
Primary and Secondary Centers of Endochondral Ossification (Fig. 1.21)
Radiograph Demonstrating Bone Growth
Arthrology (Joints)
Classification of Joints
Functional
Structural
Fibrous Joints
1. Syndesmoses1
2. Sutures
3. Gomphoses
Cartilaginous Joints
1. Symphyses
2. Synchondroses
Synovial Joints
Movement Types of Synovial Joints
1. Plane (gliding) joints
2. Ginglymus (hinge) joints
3. Pivot (trochoid) joints
4. Ellipsoid (condylar) joints
5. Saddle (sellar) joints
6. Ball and socket (spheroidal) joints
7. Bicondylar joints3
Body Habitus
Impact of Body Habitus on Radiographic Positioning
Positioning Terminology
General Terms
Radiographic Examination or Procedure
Anatomic Position
Viewing Radiographs
Body Planes, Sections, and Lines (Fig. 1.39)
Plane: Straight Line Surface Connecting Two Points
Sagittal Plane
Coronal Plane
Horizontal (Axial) Plane
Oblique Plane
Sectional Image of Body Part
Longitudinal Sections—Sagittal, Coronal, and Oblique
Transverse or Axial Sections (Cross-Sections)
Sagittal, Coronal, and Axial Images
Planes of the Skull (Fig. 1.44)
Base Plane of Skull
Occlusal Plane
Body Surfaces and Parts
Terms for the Back and Front Portions of the Body (Fig. 1.45)
Posterior or Dorsal
Anterior or Ventral
Terms for Surfaces of the Hands and Feet
Plantar
Dorsal
Foot
Hand
Palmar
Radiographic Projections
Common Projection Terms
Posteroanterior (PA) Projection
Anteroposterior (AP) Projection
AP Oblique Projection
PA Oblique Projection
Mediolateral and Lateromedial Projections
Body Positions
General Body Positions
Specific Body Positions
Lateral Position
Oblique Position5
Left and Right Posterior Oblique (LPO and RPO) Positions
Right and Left Anterior Oblique (RAO and LAO) Positions
Decubitus (Decub) Position
Right or Left Lateral Decubitus Position—AP or PA Projection
Dorsal Decubitus Position—Left or Right Lateral
Ventral Decubitus Position—Right or Left Lateral
Additional Special Use Projection Terms
Axial Projection
Inferosuperior and Superoinferior Axial Projections
Tangential Projection
Examples
AP Axial Projection—Lordotic Position
Transthoracic Lateral Projection (Right Lateral Position)
Dorsoplantar and Plantodorsal Projections
Parietoacanthial and Acanthioparietal Projections
Submentovertical (SMV) and Verticosubmental (VSM) Projections
Relationship Terms
Medial Versus Lateral
Examples
Proximal Versus Distal
Examples
Cephalad Versus Caudad
Interior (Internal, Inside) Versus Exterior (External, Outer)
Superficial Versus Deep
Example
Ipsilateral Versus Contralateral
Example
Terms Related to Movement
Flexion Versus Extension
Hyperextension
Abnormal Hyperextension
Normal Flexion and Hyperextension of Spine
Normal Hyperextension of Wrist
Acute Flexion of Wrist
Ulnar Deviation Versus Radial Deviation of Wrist
Dorsiflexion Versus Plantar Flexion of Foot and Ankle
Dorsiflexion of Foot
Plantar Flexion of Foot
Eversion Versus Inversion
Valgus Versus Varus1
Medial (Internal) Rotation Versus Lateral (External) Rotation
Abduction Versus Adduction
Supination Versus Pronation
Protraction Versus Retraction
Example
Elevation Versus Depression
Example
Circumduction
Rotation Versus Tilt
Summary of Potentially Misused Positioning Terms
Position
Projection
View
Positioning Principles
Evaluation Criteria
Evaluation Criteria Format
Image Markers and Patient Identification
Patient Identification and Date (Film-Screen Cassette [ANALOG] Systems)
Digital Systems
Anatomic Side Marker
Additional Markers or Identification
Professional Ethics and Patient Care
Essential Projections
Routine Projections
Special Projections
General Principles for Determining Positioning Routines
Minimum of Two Projections (90° From Each Other)
1. Superimposition of anatomic structures
2. Localization of lesions or foreign bodies
Example
3. Determination of alignment of fractures
Minimum of Three Projections When Joints Are in Area of Interest
Exceptions to Rules
Palpation of Topographic Positioning Landmarks
Palpation
Image Receptor (IR) Alignment
Viewing Radiographic Images
Viewing CT or MRI Images
Part Two ■ Imaging Principles
Image Quality in Film-Screen (Analog) Radiography
Analog Images
Exposure Factors for Analog (Film-Screen) Imaging
Image Quality Factors
Density
Definition
Controlling Factors
Adjusting Analog Image Density
Density and Anode Heel Effect
Compensating Filters
Summary of Density Factors
Contrast
Definition
Adjusting Analog Image Contrast
Controlling Factors
Grids
Correct Use of Grids
1. Off-center grid
Exception: decubitus—short dimension (SD)—type linear grids:
2. Off-level grid
3. Off-focus grid
4. Upside-down focused grid
Summary of Contrast Factors
Spatial Resolution
Controlling Factors
Geometric Factors
Film-Screen System
Motion
Difference between voluntary and involuntary motion
Summary of Spatial Resolution Factors
Distortion
X-Ray Beam Divergence
Controlling Factors
1. SID
Minimum 40-inch (or 102-cm) SID
2. OID
3. Object image receptor alignment
Effect of improper object IR alignment
4. Central ray alignment
CR angle
Summary of Factors That May Affect Distortion
Image Quality in Digital Radiography
Digital Images
Exposure Factors for Digital Imaging
Image Quality Factors
Brightness
Controlling Factors
Contrast Resolution
Controlling Factors
Pixels and Bit Depth
Pixel Size
Scatter Radiation Control
Spatial Resolution
Controlling Factors
Distortion
Controlling Factors
Exposure Indicator
Deviation Index
Controlling Factors
Noise
Signal-to-Noise Ratio (SNR)
High SNR
Low SNR
Postprocessing
Postprocessing and Exposure Indicator Range
Postprocessing Options
Applications of Digital Technology
Digital Imaging Systems
Computed Radiography (CR) (Photostimulable Storage Phosphor Plate-PSP)
Technologist Workstation
Image Archiving
Application of CR Digital Systems
Collimation
Accurate Centering of Part and IR
Use of Lead Masks
Use of Grids
Exposure Factors
Evaluation of Exposure Indicator
Direct Radiography (DR) (Flat-Panel Detector With Thin-Film Transistor)
Advantages of DR Systems
Application of DR-Based Systems
Image Receptor Sizes and Orientation
Picture Archiving and Communication System (PACS)
Advantages of PACS
Digital Imaging Glossary of Terms
Part Three ■ Radiation Protection
Radiation Units
Traditional and SI Units
Dose Limits
Personnel Monitoring
ALARA
Pregnant Technologists
Radiographic Patient Dose
Patient Protection in Radiography
Minimum Repeat Radiographs
Correct Filtration
Accurate Collimation
Collimation and Tissue Dose
Positive Beam Limitation (PBL)
Manual Collimation
Collimation Rule
Specific Area Shielding
Shadow Shields
Contact Shields
Male
Female
Summary of Rules for Specific-Area Shielding
Pregnant Patient
Optimum Speed
Minimize Patient Dose by Selecting Projections and Exposure Factors With Least Patient Dose
Radiation Safety Practices
Fluoroscopic Patient Dose
Dose Area Product (DAP)
Skin Injury
Dose Reduction Techniques During Fluoroscopy
Scattered Radiation
Radiation Protection Practices During Fluoroscopy
Image Wisely
2 Chest
Contents
Radiographic Anatomy
Chest
Bony Thorax
Topographic Positioning Landmarks
Vertebra Prominens (Seventh Cervical Vertebra)
Jugular Notch (Manubrial or Suprasternal Notch)
Xiphoid Process (Tip)
Respiratory System
Pharynx
Esophagus
Four Parts of the Respiratory System
Larynx (Voice Box)
Sectional image of larynx
Trachea
Thyroid gland
Parathyroid glands
Thymus gland
Radiographs
Sectional image of the trachea
Branches of aortic arch
Right and Left Bronchi
Secondary bronchi, lobes, and alveoli
Sectional image of bronchi and lungs
Lungs
Sectional drawing of lungs and heart
Sectional image
PA Chest Radiograph
Parts of Lungs
Lateral Chest View
Mediastinum
Thymus Gland
Heart and Great Vessels
Trachea and Esophagus
Radiographic Positioning
Body Habitus
Breathing Movements
Degree of Inspiration
Positioning Considerations
Radiation Protection
Repeat Exposures
Collimation
Lead Shielding
Backscatter Protection
Technical Factors
Kilovoltage
Exposure Time and Milliamperage (mAs–Milliampere Seconds)
Placement of Image Markers
Pediatric Applications
Supine Versus Erect
Technical Factors
Geriatric Applications
CR Centering
Technical Factors
Instructions and Patient Handling
Obese Patient Considerations
Breathing Instructions
Hold Breath on Second Inspiration
Inspiration and Expiration
Erect Chest Radiographs
PA 72-inch (183-cm) source image receptor distance
Evaluation Criteria
PA Chest Positioning
True PA, No Rotation
Extending the Chin
Minimizing Breast Shadows
Lateral Chest Positioning
Side Closest to IR
True Lateral, No Rotation or Tilt
Direction of Rotation
No Tilt
Arms Raised High
CR Location
CR Chest-Positioning Method
Vertebra Prominens (PA Chest)
Exceptions
Jugular Notch (AP Chest)
Lung Dimensions and IR Placement
PA Chest
AP Chest
Collimation Guidelines
Digital Imaging Considerations
Alternative Modalities and Procedures
Conventional Tomography and CT
Sonography
Nuclear Medicine
MRI
Clinical Indications
Chest Pathology, Conditions, and Trauma5
Routine and Special Projections
Routine and Special Projections
PA Projection: Chest
Ambulatory Patient
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Projection: Chest
On Stretcher if Patient Cannot Stand
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Chest
Ambulatory Patient
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Alternative Lateral Positions: Chest
With Wheelchair or Cart if Patient Cannot Stand
Clinical Indications
Technical Factors
Shielding
Patient Position on Cart
Patient Position in Wheelchair
Part Position
CR
Recommended Collimation
Respiration
AP Projection: Chest
Supine or Semierect (in Department or as Bedside Portable)
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Decubitus Position (AP Projection): Chest
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Alternative Positioning
AP Lordotic Projection: Chest
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Alternative Lordotic Projection
Anterior Oblique Positions—RAO and LAO: Chest
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Exception
Posterior Oblique Positions—RPO and LPO: Chest
Clinical Indications
Technical Factors
Shielding
Patient Position (Erect)
Patient Position (Recumbent)
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Upper Airway
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Note on Centering and Exposure for Neck Region
Centering and Exposure for Distal Larynx and Trachea Region
AP Projection: Upper Airway
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Note on Exposure
Centering for Upper Airway and Trachea
Radiographs for Critique
3 Abdomen
Contents
Radiographic Anatomy
Abdominal Radiography
Acute Abdominal Series
Abdominal Muscles
Abdominal Organ Systems
Digestive System
Oral Cavity, Pharynx, and Esophagus
Stomach and Small and Large Intestines
Stomach
Small Intestine
Duodenum (A)
Jejunum and ileum (B and C)
Radiograph of Stomach and Small Intestine
Large Intestine
Spleen
Accessory Digestive Organs
Pancreas
Liver
Gallbladder
Cholelithiasis
CT Sectional Images
Urinary System
Excretory or Intravenous Urogram
Sectional Image
Abdominal Cavity
Peritoneum
Mesentery
Omentum
Mesocolon
Greater Sac and Lesser Sac
Retroperitoneal and Infraperitoneal Organs
Retroperitoneal Organs
Infraperitoneal Organs
Intraperitoneal Organs
Male Versus Female Peritoneal Enclosures
Quadrants and Regions
Four Abdominal Quadrants
Nine Abdominal Regions
Names of Regions
Topographic Landmarks
Seven Landmarks of the Abdomen
Radiographic Positioning
Patient Preparation
General Positioning Considerations
Breathing Instructions
Image Markers
Radiation Protection
Repeat Exposures
Close Collimation
Gonadal Shielding
Pregnancy Protection
Exposure Factors
Special Patient Considerations
Pediatric Applications
Geriatric Applications
Obese Patient Considerations
Digital Imaging Considerations
Alternative Modalities
CT and MRI
Sonography
Nuclear Medicine
Clinical Indications
Routine and Special Projections
Routine and Special Projections
AP Projection—Supine Position: Abdomen
KUB
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Projection—Prone Position: Abdomen
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Decubitus Position (AP Projection): Abdomen
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection—Erect Position: Abdomen
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Dorsal Decubitus Position (Right or Left Lateral): Abdomen
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Abdomen
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Acute Abdominal Series: Acute Abdomen
(1) AP Supine, (2) Erect (or Lateral Decubitus) Abdomen, (3) PA Chest
Departmental Routine
Specific Clinical Indications for Acute Abdominal Series
Positional Guidelines
Patient and Part Positioning
Breathing Instructions
CR
Radiographs for Critique
4 Upper Limb
Contents
Radiographic Anatomy
Upper Limb
Hand and Wrist
Phalanges—Fingers and Thumb (Digits)
Metacarpals (Palm)
Joints of the Hand
Thumb (First Digit)
Fingers (Second Through Fifth Digits)
MPJ and CMC Joints
Review Exercise With Radiographs
Carpals (Wrist)
Proximal Row
Distal Row
Carpal Sulcus (Canal or Tangential Projection)
Summary Chart of Carpal Terminology
Review Exercise With Radiographs
Forearm—Radius and Ulna
Radius and Ulna
Proximal Ulna
Distal Humerus
True Lateral Elbow
Review Exercise With Radiographs
Classification of Joints
Hand and Wrist
Interphalangeal Joints
Metacarpophalangeal Joints
Carpometacarpal Joints
Intercarpal Joints
Wrist Joint
Wrist Ligaments
Elbow Joint
Wrist Joint Movement Terminology
Ulnar Deviation
Radial Deviation
Forearm Rotational Movements
Summary
Elbow Rotational Movements
Importance of Visualizing Fat Pads
Wrist Joint
Elbow Joint
Summary
Radiographic Positioning
General Positioning Considerations
Lead Shielding
Distance
Multiple Exposures per Imaging Plate
Special Patient Considerations
Trauma Patients
Pediatric Applications
Geriatric Applications
Exposure Factors
Image Receptors
Increase Exposure With Cast
Collimation, General Positioning, and Markers
Correct Centering
Digital Imaging Considerations
Exposure Factors
Alternative Modalities and Procedures
Arthrography
CT and MRI
Nuclear Medicine
Clinical Indications
Malignant bone tumors
Benign bone or cartilaginous tumors (chondromas)
Routine and Special Projections
Routine and Special Projections
PA Projection: Fingers
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
PA Oblique Projection—Medial or Lateral Rotation: Fingers
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Optional Medial Oblique
Lateromedial or Mediolateral Projections: Fingers
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Projection: Thumb
Clinical Indications
Technical Factors
Shielding
Patient Position—AP
Part Position—AP
Exception—PA (Only if Patient Cannot Position for Previous AP)
CR
Recommended Collimation
PA Oblique Projection—Medial Rotation: Thumb
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateral Position: Thumb
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Axial Projection (Modified Robert’s Method)5: Thumb
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
PA Stress Thumb Projection
Folio Method8
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
PA Projection: Hand
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
PA Oblique Projection: Hand
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Exception
“Fan” Lateral—Lateromedial Projection: Hand
Clinical Indications
Technical Factors
Compensation Filter
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateral in Extension and Flexion—Lateromedial Projections: Hand
Alternatives to Fan Lateral
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Oblique Bilateral Projection: Hand
Norgaard Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
PA (AP) Projection: Wrist
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Alternative AP
PA Oblique Projection—Lateral Rotation: Wrist
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateromedial Projection: Wrist
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
PA and PA Axial Scaphoid—With Ulnar Deviation: Wrist
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
PA Scaphoid—Hand Elevated and Ulnar Deviation: Wrist
Modified Stecher Method10
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
Alternative Method
CR
Recommended Collimation
PA Projection—Radial Deviation: Wrist
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Carpal Canal (Tunnel)—Tangential, Inferosuperior Projection: Wrist
Gaynor-Hart Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Alternative Imaging
Carpal Bridge—Tangential Projection: Wrist
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Projection: Forearm
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateromedial Projection: Forearm
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Projection: Elbow
Elbow Fully Extended
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Projection—Alternate Partial Flexion: Elbow
When Elbow Cannot Be Fully Extended
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Acute Flexion Projections: Elbow
AP Projections of Elbow in Acute Flexion
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Oblique Projection—Lateral (External) Rotation: Elbow
Clinical Indications
Lateral (External Rotation) Oblique
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Oblique Projection—Medial (Internal) Rotation: Elbow
Clinical Indications
Medial (Internal Rotation) Oblique
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateromedial Projection: Elbow
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Trauma Axial Lateromedial and Mediolateral Projections: Elbow
Coyle Method13
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position 1—Radial Head–Axial Lateromedial Projection
Part Position 2—Coronoid Process–Axial Mediolateral Projection
Recommended Collimation
Radial Head—Lateromedial Projections: Elbow
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Radiographs for Critique
5 Humerus and Shoulder Girdle
Contents
Radiographic Anatomy
Upper Limb (Extremity)
Humerus
Proximal Humerus
Anatomy of Proximal Humerus on Radiograph
Shoulder Girdle
Clavicle
Radiograph of the Clavicle
Scapula
Anterior View
Posterior View
Lateral View
Review Exercise With Radiographs
AP Projection
Lateral Projection
Proximal Humerus and Scapula
Inferosuperior Axial Projection
Classification of Joints
Classification
Mobility Type
Movement Type
Radiographic Positioning
Proximal Humerus Rotation
Radiographs of Proximal Humerus
External Rotation
Internal Rotation
Neutral Rotation
Positioning and Exposure Considerations
Technical Considerations
Average Adult Humerus and Shoulder
Radiation Protection
Gonadal Shielding
Shielding of Thyroid, Lungs, and Breasts
Special Patient Considerations
Pediatric Applications
Geriatric Applications
Obese Patient Considerations
Digital Imaging Considerations
Alternative Modalities and Procedures
Arthrography
CT and MRI
Nuclear Medicine
Sonography
Clinical Indications
Routine, Alternate, and Special Projections
Routine and Special Projections
AP Projection: Humerus
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Rotational Lateral—Lateromedial or Mediolateral Projections: Humerus
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
CR
Recommended Collimation
Respiration
Trauma Horizontal Beam Lateral—Lateromedial Projection: Mid-to-Distal Humerus
Distal Humerus
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
CR
Recommended Collimation
Respiration
Transthoracic Lateral Projection: Humerus (Trauma)
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection—External Rotation: Shoulder (Nontrauma)
AP Proximal Humerus
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection—Internal Rotation: Shoulder (Nontrauma)
Lateral Proximal Humerus
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Inferosuperior Axial Projection: Shoulder (Nontrauma)
Lawrence Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Transaxillary Projection: Shoulder (Nontrauma)
Hobbs Modification
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Inferosuperior Axial Projection: Shoulder (Nontrauma)
Clements Modification7
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Oblique Projection—Glenoid Cavity: Shoulder (Nontrauma)
Grashey Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Apical AP Axial Projection: Shoulder8
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Tangential Projection—Intertubercular (Bicipital) Sulcus: Shoulder (Nontrauma)
Fisk Modification
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
Erect (Fisk Modification)
Supine
CR
Recommended Collimation
Respiration
AP Projection—Neutral Rotation: Shoulder (Trauma)
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Transthoracic Lateral Projection: Proximal Humerus (Trauma)
Lawrence Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Oblique Projection—Scapular Y Lateral: Shoulder (Trauma)
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Tangential Projection—Supraspinatus Outlet: Shoulder (Trauma)
Neer Method9
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Apical Oblique Axial Projection: Shoulder (Trauma)
Garth Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP and AP Axial Projections: Clavicle
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
AP
AP Axial
Recommended Collimation
Respiration
Alternative PA
AP Projection (Pearson Method): AC Joints
Bilateral With and Without Weights
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Weights
Alternative AP Axial Projection (Alexander Method)
Alternative Supine Position
AP Projection: Scapula
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Scapula
Patient Erect
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Scapula
Patient Recumbent
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Radiographs for Critique
6 Lower Limb
Contents
Radiographic Anatomy
Distal Lower Limb
Foot
Phalanges—Toes (Digits)
Metatarsals
Joints of Phalanges (Digits) and Metatarsals
Joints of digits
Joints of metatarsals
Sesamoid bones
Tarsals
Calcaneus
Articulations
Talus
Articulations
Navicular
Articulations
Cuneiforms
Articulations
Cuboid
Articulations
Arches of Foot
Longitudinal Arch
Transverse Arch
Ankle Joint
Frontal View
Lateral View
Axial View
Joint Structure
Review Exercise With Radiographs
Lateral Left Foot (Fig. 6.13)
Oblique Right Foot (Fig. 6.14)
AP Mortise View Right Ankle (Fig. 6.15)
Lateral Right Ankle (Fig. 6.16)
Lower Leg—Tibia and Fibula
Tibia
Proximal Extremity
Body
Distal Extremity
Fibula
Midfemur and Distal Femur—Anterior View
Midfemur and Distal Femur—Posterior View
Distal Femur and Patella (Lateral View)
Distal Femur and Patella (Axial View)
Patella
Knee Joint
Proximal Tibiofibular Joint and Major Knee Ligaments
Synovial Membrane and Cavity
Menisci (Articular Disks)
Knee Trauma
Review Exercise With Radiographs
AP Lower Leg (Fig. 6.29)
Lateral Lower Leg (Fig. 6.30)
AP Knee (Fig. 6.31)
Lateral Knee (Fig. 6.32)
Lateral Knee (Fig. 6.33)
Tangential Projection (Patellofemoral Joint) (Fig. 6.34)
Classification of Joints
Surfaces and Projections of the Foot
Surfaces
Projections
Motions of the Foot and Ankle
Radiographic Positioning
Positioning Considerations
Distance
Shielding
Collimation
General Positioning
Correct Centering
Multiple Exposures Per Imaging Plate
Exposure Factors
Image Receptors
Grids
Special Patient Considerations
Pediatric Applications
Geriatric Applications
Obese Patient Considerations
Placement of Markers and Patient Identification Information
Increase Exposure With Cast
Digital Imaging Considerations
Alternative Modalities and Procedures
Arthrography
CT
MRI
Bone Densitometry
Nuclear Medicine
Clinical Indications
Routine, Alternate, and Special Projections
Routine and Special Projections
AP Projection: Toes
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Computed Radiography or Digital Radiography
AP Oblique Projection—Medial or Lateral Rotation: Toes
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Computed Radiography or Digital Radiography
Lateral—Mediolateral or Lateromedial Projections: Toes
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
CR
Recommended Collimation
Computed Radiography or Digital Radiography
Tangential Projection: Toes—Sesamoids
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Alternative Projection
AP Projection: Foot
Dorsoplantar Projection
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Computed Radiography or Digital Radiography
AP Oblique Projection—Medial Rotation: Foot
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Optional Lateral Oblique (Fig. 6.60)
Lateral—Mediolateral or Lateromedial Projections: Foot
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position (Mediolateral Projection)
CR
Recommended Collimation
Digital Imaging Systems
Alternative Lateromedial Projection
AP Weight-Bearing Projections: Foot
Clinical Indications
Technical Factors
Shielding
AP
CR
Recommended Collimation
Lateral Weight-Bearing Projections: Foot
Lateral
CR
Recommended Collimation
Plantodorsal (Axial) Projection: Calcaneus
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Digital Imaging Systems
Lateral—Mediolateral Projection: Calcaneus
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Digital Imaging Systems
AP Projection: Ankle
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Digital Imaging Systems
AP Mortise Projection—15° to 20° Medial Rotation: Ankle
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Digital Imaging Systems
AP Oblique Projection—45° Medial Rotation: Ankle
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Digital Imaging Systems
Lateral—Mediolateral (or Lateromedial) Projection: Ankle
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position (Mediolateral Projection)
CR
Recommended Collimation
Digital Imaging Systems
Alternative Lateromedial Projection
AP Stress Projections: Ankle
Inversion and Eversion Positions
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Digital Imaging Systems
AP Projection: Lower Leg (Tibia and Fibula)
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Alternative Follow-Up Examination Routine
Lateral—Mediolateral Projection: Lower Leg (Tibia and Fibula)
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Alternative Follow-Up Examination Routine
Horizontal Beam (Cross-Table) Lateral
AP Projection: Knee
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Oblique Projection—Medial (Internal) Rotation: Knee
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Oblique Projection—Lateral (External) Rotation: Knee
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateral—Mediolateral Projection: Knee
Clinical Indications
Technical Factors
Shielding
Patient Position
Lateral Recumbent Projection
Horizontal Beam Projection
Part Position
CR
Recommended Collimation
AP Weight-Bearing Bilateral Knee Projection: Knee
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
CR
Recommended Collimation
Alternative PA
PA Axial Weight-Bearing Bilateral Knee Projection: Knee
Rosenberg Method
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
CR
Recommended Collimation
Alternative Unilateral Projection
PA and AP Axial Projections (“Tunnel Views”): Intercondylar Fossa
Camp Coventry Method, Holmblad Method (and Variations), and Béclere Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
1. Prone (Camp Coventry Method) (Fig. 6.118)
2. Kneeling (Holmblad Method) (Fig. 6.119)
3. Partially Standing, Straddling Table (Holmblad Variation)
4. Partially Standing, Affected Leg on Stool or Chair (Holmblad Variation) (Figs. 6.122 and 6.123)
CR
Recommended Collimation
AP Axial Projection: Knee—Intercondylar Fossa
Béclere Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
PA Projection: Patella and Patellofemoral Joint
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateral—Mediolateral Projection: Patella
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Tangential—Axial or Sunrise/Skyline Projection: Patella
Merchant Bilateral Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Tangential—Axial or Sunrise/Skyline Projections: Patella
Inferosuperior, Hughston, and Settegast Methods
Summary
Technical Factors
Inferosuperior Projection
CR
Hughston Method7
CR
Settegast Method
CR
Superoinferior Sitting Tangential Method: Patella
Hobbs Modification
CR
Radiographs for Critique
7 Femur and Pelvic Girdle
Contents
Radiographic Anatomy
Lower Limb (Extremity)
Femur
Proximal Femur
Angles of the Proximal Femur
Pelvis
Hip Bone
Ilium
Positioning Landmarks
Ischium
Positioning Landmarks
Pubis
Positioning Landmark
Summary of Topographic Landmarks
True and False Pelvis
True Pelvis
Birth Canal
Male Versus Female Pelvis Differences2
Male Versus Female Pelvis Radiographs
Review Exercise With Radiographs
Lateral Hip
Classification of Joints (Fig. 7.20)
Sacroiliac Joints (Fig. 7.21)
Symphysis Pubis
Union of Acetabulum
Hip Joint
Radiographic Positioning
Positioning Considerations
Location of Head and Neck
Appearance of Proximal Femur in Anatomic Position
Internal Rotation of Leg
Evidence of Hip Fracture
Summary: Effect of Lower Limb Rotation
Shielding Guidelines
Male Shielding
Female Shielding
Exposure Factors and Patient Dose
Special Patient Considerations
Pediatric Applications
Geriatric Applications
Obese Patient Considerations
Digital Imaging Considerations
Alternative Modalities
Computed Tomography
Magnetic Resonance Imaging
Sonography (Ultrasound)
Nuclear Medicine
Clinical Indications
Routine and Special Projections
Routine and Special Projections
AP Projection: Femur—Mid- and Distal
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateral—Mediolateral or Lateromedial Projections: Femur—Mid- and Distal
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
Lateral Recumbent (Fig. 7.39)
Trauma Lateromedial Projection (Fig. 7.40)
CR
Recommended Collimation
Lateral—Mediolateral Projection: Femur—Mid- and Proximal
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
AP Pelvis Projection (Bilateral Hips): Pelvis
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Bilateral Frog-Leg Projection: Pelvis
Modified Cleaves Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial Outlet Projection3 (for Anterior-Inferior Pelvic Bones): Pelvis
Taylor Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial Inlet Projection4: Pelvis
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Collimation
Respiration
Posterior Oblique PROJECTION: Pelvis—Acetabulum
Judet Method
Clinical Indications
Technical Factors
Shielding
Patient Position—Posterior Oblique Positions
Part Position
CR
Recommended Collimation
Respiration
PA Axial Oblique Projection—Acetabulum
Teufel Method
Clinical Indications
Technical Factors
Shielding
Patient Position—Axial Oblique Positions
Part Position
CR
Recommended Collimation
Respiration
AP Unilateral Hip Projection: Hip and Proximal Femur
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Axiolateral Inferosuperior Projection—TRAUMA: Hip and Proximal Femur
Danelius-Miller Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position (Figs. 7.68 and 7.69)
CR
Recommended Collimation
Respiration
Unilateral Frog-Leg Projection—Mediolateral: Hip and Proximal Femur
Modified Cleaves Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position (Fig. 7.71)
Recommended Collimation
Respiration
Modified Axiolateral Projection—Possible Trauma: Hip and Proximal Femur
Clements-Nakayama Method5
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Radiographs for Critique
8 Cervical and Thoracic Spine
Contents
Radiographic Anatomy
Vertebral Column
Spinal canal
Spinal cord
Intervertebral disks
Sections of Vertebral Column
Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae
Sacrum and coccyx
Vertebral Column Curvatures
Lordosis
Kyphosis
Scoliosis
Typical Vertebral Anatomy
(1) Body
(2) Vertebral Arch
Superior Perspective
Lateral Perspective
Summary
(3) Joints in the Vertebral Column
Intervertebral Joints
Zygapophyseal Joints
Costal Joints
(4) Intervertebral Foramina
(5) Intervertebral Disk
Characteristics of Cervical Vertebrae
Superior Perspective
Lateral Perspective
Cervical Zygapophyseal Joints
Cervical Intervertebral Foramina
Atlas (C1)
Axis (C2)
Relationship of C1 and C2
Characteristics of Thoracic Vertebrae
Rib Articulations
Costovertebral Joints
Costotransverse Joints
Superior and Lateral Perspectives
Lateral Oblique Perspective
Thoracic Zygapophyseal Joints
Thoracic Intervertebral Foramina
Unique C1-C2 Joint Classifications
Anatomy Review With Radiographic Images
AP Cervical Spine Image
Lateral Cervical Spine Image
Oblique (RPO) Cervical Spine Image
AP and Lateral Thoracic Spine Image
AP Thoracic Spine Image (Fig. 8.28)
Lateral Thoracic Spine (Fig. 8.29)
Intervertebral Foramina Versus Zygapophyseal Joints
Cervical Spine Skeleton
Cervical Spine Radiographs
Thoracic Spine Skeleton
Thoracic Spine Radiographs
Radiographic Positioning
Topographic Landmarks
Cervical Landmarks
Sternum and Thoracic Spine Landmarks
Positioning and Technical Considerations
Erect versus Recumbent
Patient Radiation Protection
Technical and Image Quality Factors
Exposure Factors
Focal Spot Size
Compensating Strategies
SID
Scatter Radiation
Part-IR Alignment
Special Patient Considerations
Pediatric Applications
Geriatric Applications
Communication
Safety
Patient Handling and Comfort
Technical Factors
Obese Patient Considerations
Digital Imaging Considerations
Alternative Modalities and Procedures
Myelography
Computed Tomography
Magnetic Resonance Imaging
Nuclear Medicine
Clinical Indications
Routine and Special Projections
Routine and Special Projections
AP Open Mouth Projection (C1 and C2): Cervical Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine or Erect Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial Projection: Cervical Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine or Erect Position
Part Position
CR
Recommended Collimation
Respiration
Anterior and Posterior Oblique Positions: Cervical Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Erect or Recumbent Position
Part Position
CR
Anterior Oblique (RAO, LAO)
Posterior Oblique (RPO, LPO)
Recommended Collimation
Respiration
Lateral Position (Erect): Cervical Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Lateral Position
Part Position
CR
Recommended Collimation
Respiration
Lateral, Horizontal Beam—Trauma: Cervical Spine
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Cervicothoracic (Swimmer’s) Lateral Position: Cervical Spine
C5-T3 Region
Clinical Indications
Technical Factors
Shielding
Patient Position—Erect or Recumbent Position
Part Position
CR
Recommended Collimation
Respiration
Optional Breathing Technique
Lateral Positions—Hyperflexion and Hyperextension: Cervical Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Erect Lateral Position
Part Position
CR
Recommended Collimation
Respiration
AP or PA Projection for C1-C2 (Odontoid process–dens): Cervical Spine
Fuchs Method (AP) or Judd Method (PA)
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
AP (Fuchs Method)
PA (Judd Method)
Recommended Collimation
Respiration
AP “Wagging Jaw” Projection: Cervical Spine
Ottonello Method
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial Projection—Vertebral Arch (Pillars): Cervical Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection: Thoracic Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Recumbent and Erect Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Thoracic Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Lateral Recumbent or Erect Position
Part Position
CR
Recommended Collimation
Respiration
Anterior or Posterior Oblique Position: Thoracic Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Oblique Anterior or Posterior Recumbent or Erect Positions
Part Position
Posterior Oblique Position (Recumbent)
Anterior Oblique Position (Recumbent)
Erect Anterior Oblique Position
CR
Recommended Collimation
Respiration
Radiographs for Critique
9 Lumbar Spine, Sacrum, and Coccyx
Contents
Radiographic Anatomy
Lumbar Vertebrae
Lateral and Superior Perspectives
Intervertebral Foramina
Zygapophyseal Joints
Posterior and Anterior Perspectives
Sacrum
Anterior Perspective
Lateral Perspective
Posterior Sacrum
Coccyx
Anterior Coccyx
Posterior Coccyx
Lateral Sacrum and Coccyx Radiograph
Anatomy Review
Superoinferior Projection
Lateral Position
AP Projection
Lateral Lumbosacral Spine
AP Lumbosacral Spine
Oblique Lumbar Vertebrae
Appearance of “Scottie Dog”
Oblique Lumbar Radiograph
Classification of Joints
Zygapophyseal (Apophyseal) Joints
Intervertebral Joints
Intervertebral Foramina Versus Zygapophyseal Joints
Intervertebral Foramina—Lateral Lumbar Spine
Zygapophyseal Joints—Oblique Lumbar Spine
Posterior Oblique
Anterior Oblique
Radiographic Positioning
Topographic Landmarks
Lower Spine Landmarks
Positioning Considerations
Patient Radiation Protection
Patient Position
PA Versus AP Projections
Exposure Factors
Lead Masking on Tabletop
SID
Part-IR Alignment
Special Patient Considerations
Pediatric Applications
Patient Motion and Safety
Communication
Immobilization
Technical Factors
Geriatric Applications
Communication and Comfort
Technical Factors
Obese Patient Considerations
Digital Imaging Considerations
Alternative Modalities and Procedures
Computed Tomography
Magnetic Resonance Imaging
Nuclear Medicine Technology
Bone Densitometry
Myelography
Clinical Indications
Routine and Special Positioning
Routine and Special Projections
AP (or PA) Projection: Lumbar Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine Position
Part Position
CR
Recommended Collimation
Respiration
Posterior (or Anterior) Oblique Positions: Lumbar Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Posterior or Anterior Oblique Positions
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Lumbar Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Lateral Position
Part Position
CR
Recommended Collimation
Respiration
Lateral L5-S1 Position: Lumbar Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Lateral Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial L5-S1 Projection: Lumbar Spine
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine Position
Part Position
CR
Recommended Collimation
Respiration
PA Projection: Scoliosis Series
Clinical Indications
Technical Factors
Shielding
Patient Position—Erect and Recumbent Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position (ERECT): Scoliosis Series
Clinical Indications
Technical Factors
Shielding
Patient Position—Erect Lateral Position
Part Position
CR
Recommended Collimation
Respiration
PA Projection (Ferguson Method): Scoliosis Series
Clinical Indications
Technical Factors
Shielding
Patient Position—Erect
Part Position
CR
Recommended Collimation
Respiration
PA (AP) Projection—Right and Left Bending: Scoliosis Series
Clinical Indications
Technical Factors
Shielding
Patient Position—Erect or Recumbent Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Positions—Hyperextension and Hyperflexion: Spinal Fusion Series
Clinical Indications
Technical Factors
Shielding
Patient Position—Recumbent Lateral Position
Part Position
Hyperflexion
Hyperextension
CR
Recommended Collimation
Respiration
AP Axial Projection: Sacrum
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial Projection: Coccyx
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Sacrum and Coccyx
Clinical Indications
Technical Factors
Shielding
Patient Position—Lateral Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Coccyx
Clinical Indications
Technical Factors
Shielding
Patient Position—Lateral Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial Projection: Sacroiliac Joints
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine Position
Part Position
CR
Recommended Collimation
Respiration
Posterior Oblique Positions (LPO and RPO): Sacroiliac Joints
Clinical Indications
Technical Factors
Shielding
Patient Position—Supine Position
Part Position
CR
Recommended Collimation
Respiration
Radiographs for Critique
10 Bony Thorax—Sternum and Ribs
Contents
Radiographic Anatomy
Bony Thorax
Sternum
Palpable Landmarks
Sternoclavicular Articulation
Sternal Rib Articulations
Ribs
Summary
Typical Rib
Inferior View
Posterior View
Rib Cage
Articulations of Bony Thorax
Anterior Articulations
Posterior Articulations
Radiographic Positioning
Positioning Considerations for the Sternum
Exposure Factors
Source Image Receptor Distance (SID)
Positioning Considerations for the Ribs
Above or Below Diaphragm
SID
Above Diaphragm
Below Diaphragm
Recommended Projections
Marking the Site of Injury
Chest Radiography
Special Patient Considerations
Pediatric Applications
Communication
Immobilization
Exposure Factors
Collimation
Geriatric Applications
Communication and Comfort
Exposure Factors
Obese Patient Considerations
Digital Imaging Considerations
Alternative Modalities and Procedures
Computed Tomography
Nuclear Medicine
Clinical Indications
Routine and Special Projections
Routine and Special Projections
RAO Position: Sternum
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position—R or L Lateral: Sternum
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
Erect
Lateral Recumbent
CR
Recommended Collimation
Respiration
PA Projection: Sternoclavicular Joints
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Anterior Oblique Positions—RAO and LAO: Sternoclavicular Joints
Images of the Right and Left Joints Are Obtained
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection: Bilateral Posterior Ribs
Above or Below Diaphragm
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Above Diaphragm
Below Diaphragm
Recommended Collimation
Respiration
PA Projection: Bilateral Anterior Ribs
Above Diaphragm
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Erect and Lateral Chest Study
AP Projection: Unilateral Rib Study: Posterior Ribs
Above or Below Diaphragm
Ribs
Technical Factors
Shielding
Patient Position
Part Position
CR
Above diaphragm
Below diaphragm
Recommended Collimation
Respiration
Posterior or Anterior Oblique Positions: Axillary Ribs
Above or Below Diaphragm
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Above diaphragm
Below diaphragm
Recommended Collimation
Respiration
Radiographs for Critique
11 Cranium, Facial Bones, and Paranasal Sinuses
Contents
Radiographic Anatomy
Skull
Cranial Bones
Calvarium (Skullcap)
Floor
Frontal Bone
Squamous or vertical portion
Orbital or horizontal portion
Articulations
Parietal Bones
Articulations
Occipital Bone
Articulations
Temporal Bones
Lateral view
Frontal cutaway view
Superior view
Articulations
Sphenoid Bone
Superior view
Oblique view
Sella turcica—lateral view
Articulations
Ethmoid Bone
Articulations
Cranium—Sagittal View
Joints of the Cranium—Sutures
Adult Cranium
Infant Cranium
Fontanels
Sutural, or Wormian, Bones
Anatomy Review With Radiographs
Cranial Bones—PA Axial Caldwell Projection −15˚ caudad (Fig. 11.21)
Cranial Bones—AP Axial Projection (Fig. 11.22)
Cranial Bones—Lateral Projection (Fig. 11.23)
Anatomy of Organs of Hearing and Equilibrium
External Ear
Middle Ear
CT of Temporal Bone
Eustachian Tube
Internal Acoustic Meatus
Mastoids
Auditory Ossicles
Auditory Ossicles—Frontal and Lateral View
Internal Ear
Osseous (Bony) Labyrinth
Semicircular Canals
“Windows” of Internal Ear
Anatomy Review With Radiographs
Axiolateral Projection (Fig. 11.35)
Posterior Profile Position (Fig. 11.36)
Facial Bones
Facial Bones
Right and Left Maxillary Bones
Lateral View of Left Maxilla
Frontal View
Hard Palate (Inferior Surface)
Articulations
Right and Left Zygomatic Bones
Articulations
Right and Left Nasal and Lacrimal Bones
Lacrimal Bones
Nasal Bones
Articulations
Lacrimal
Nasal
Right and Left Inferior Nasal Conchae
Sectional Drawing
Inferior Nasal Conchae
Right and Left Palatine Bones
Articulations
Inferior nasal conchae
Palatine
Nasal Septum
Vomer
Articulations
Mandible
Lateral View
Frontal View
Ramus
Submentovertical Projection
Temporomandibular Joint
Joint Classifications (Mandible and Skull)
Synovial Joints (Diarthrodial)
Fibrous Joints (Synarthrodial)
TMJ Motion
Radiographs (Open and Closed Mouth)
Paranasal Sinuses
Purpose
Maxillary Sinuses
Frontal Sinuses
Ethmoid Sinuses
Sphenoid Sinuses
Osteomeatal Complex
Radiographs—Paranasal Sinuses
Lateral Position
PA (Caldwell) Projection
Parietoacanthial Transoral Projection (Open-Mouth Waters)
SMV Projection
Orbits
Bony Composition of Orbits
Openings in Posterior Orbit
Anatomy Review
Seven Bones of Left Orbit (Fig. 11.73)
Openings and Structures of Left Orbit (Fig. 11.74)
Parieto-orbital Oblique Projection of Orbits (Fig. 11.75)
Facial Bones—Lateral (Figs. 11.76 and 11.77)
Facial Bones—Parietoacanthial (Waters)
Facial Bones—SMV (Inferior View)
Skull Only (See Fig. 11.80)
Radiograph Only (See Fig. 11.81)
Facial Bones—Frontal View (Fig. 11.82)
Clinical Indications of Cranium
Skull and Cranial Pathology
Temporal Bone Pathology
Clinical Indications of Facial Bones and Paranasal Sinuses
Radiographic Positioning Considerations of Cranium
Skull Morphology (Classifications by Shape and Size)
Mesocephalic Skull
Brachycephalic and Dolichocephalic Skulls
Positioning Considerations Related to Skull Morphology
Cranial Topography (Surface Landmarks)
Body Planes (Fig. 11.88)
Anterior and Lateral View Landmarks (Figs. 11.89 and 11.90)
Ear
Eye
Cranial Positioning Lines (Fig. 11.91)
Skull Positioning Aids
Positioning Considerations
Erect Versus Recumbent
Patient Comfort
Hygiene
Exposure Factors
Paranasal Sinuses
Exposure Factors
Source Image Receptor Distance
Radiation Protection
Patient Shielding
Causes of Positioning Errors
Five Common Positioning Errors
Radiographic Positioning Considerations of Facial Bones and Paranasal Sinuses
Special Projections and Anatomic Relationships
PA Skull Projection
Parietoacanthial (Waters Method) Projection
Special Patient Considerations
Pediatric Applications
Communication
Immobilization
Exposure Factors
Geriatric Applications
Communication and Comfort
Exposure Factors
Obese Patient Considerations
Alternative Modalities
CT
MRI
Sonography
Nuclear Medicine
Routine and Special Projections
Routine and Special Projections
AP Axial Projection: Skull Series
Towne Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position—Right or Left Lateral: Skull Series
Clinical Indications
Trauma Routine
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Axial Projection: Skull Series
15° CR (Caldwell Method) or 25° to 30° CR
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Alternative 25° to 30°
Alternative AP Axial Projection
PA Projection: Skull Series
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Submentovertical (SMV) Projection: Skull Series
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
Supine
Erect
CR
Recommended Collimation
Respiration
PA Axial Projection: Skull Series
Haas Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position—Right or Left Lateral: Facial Bones
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Parietoacanthial Projection: Facial Bones
Waters Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Axial Projection: Facial Bones
Caldwell Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Modified Parietoacanthial Projection: Facial Bones
Modified Waters Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Nasal Bones
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Superoinferior Tangential (Axial) Projection: Nasal Bones
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Submentovertical (SMV) Projection: Zygomatic Arches
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Oblique Inferosuperior (Tangential) Projection: Zygomatic Arches
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial Projection: Zygomatic Arches
Modified Towne Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Parieto-orbital Oblique Projection: Optic Foramina
Rhese Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Axiolateral or Axiolateral Oblique Projection: Mandible
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA or PA Axial Projection: Mandible
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial Projection: Mandible
Towne Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Submentovertical (SMV) Projection: Mandible
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Orthopantomography—Panoramic Tomography: Mandible
Clinical Indications
Technical Factors (Conventional Radiographic Systems)
Unit Preparation
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Digital Orthopantomography
Advantages of Orthopantomography Compared With Conventional Mandible Positioning
AP Axial Projection: TEMPOROMANDIBULAR JOINTS
Modified Towne Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Axiolateral Oblique Projection: TMJ
Modified Law Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Axiolateral Projection: TMJ
Schuller Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position—Right or Left Lateral: Sinuses
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Projection: Sinuses
Caldwell Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Parietoacanthial Projection: Sinuses
Waters Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Submentovertical (SMV) Projection: Sinuses
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Parietoacanthial Transoral Projection: Sinuses
Open-Mouth Waters Method
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Radiographs for Critique—Cranium
Radiographs for Critique—Facial Bones
Radiographs for Critique—Sinuses
12 Biliary Tract and Upper Gastrointestinal System
Contents
Radiographic Anatomy
Liver
Lobes of the Liver
Function of the Liver
Gallbladder and Biliary Ducts
Functions of the Gallbladder
Common Bile Duct
Gallbladder and Biliary Ducts (Lateral View)
Anatomy Review
Radiograph of Gallbladder
Oral Cholecystogram—Historical Review
Medical Sonography
Clinical Indications
Gallbladder and Biliary Duct Radiography
Biliary Calculi (Gallstones)
Cholecystitis
Neoplasms
Biliary Stenosis
Digestive System
Alimentary Canal
Accessory Organs
Functions
Common Radiographic Procedures
Esophagogram or Barium Swallow (Study of Pharynx and Esophagus)
Upper Gastrointestinal Series (Study of Distal Esophagus, Stomach, and Duodenum)
Mouth (Oral Cavity)
Accessory Organs in Oral Cavity
Pharynx
Cavities That Communicate With Pharynx
Deglutition (Swallowing)
Esophagus
Diaphragmatic Openings
Swallowing and Peristalsis
Stomach
Stomach Openings and Curvatures
Stomach Subdivisions
Mucosal Folds Within the Stomach—Rugae
Stomach Position
Air/Gas–Barium Distribution in Stomach
Duodenum
Four Parts of Duodenum
Anatomy Review
Radiograph of Stomach and Duodenum
Digestion
Mechanical Digestion
Chemical Digestion
Digested Substances and Resultant By-Products
Summary
Body Habitus
Hypersthenic Versus Hyposthenic/Asthenic
Hypersthenic
Hyposthenic/Asthenic
Sthenic
Additional Factors
Radiographs of Upper Gastrointestinal Tract Demonstrating Body Types
Radiographic Procedures
Similarities
Contrast Media
Barium Sulfate
Thin Barium
Thick Barium
Contraindications to Barium Sulfate
Double Contrast
Postexamination Elimination (Defecation)
Digital Fluoroscopy
Digital Radiography-Fluoroscopy
Optional Postfluoroscopy “Overhead” Images
Multiple Frame Formatting and Multiple “Original” Films
Cine Loop Capability
Image Enhancement and Manipulation
Worker Protection During Fluoroscopy
Exposure Patterns
Lead Drape Shield
Bucky Slot Shield
Lead Aprons
Cardinal Principles of Radiation Protection
Esophagogram Procedure
Definition and Purpose
Contraindications
Clinical Indications for Esophagogram
Patient and Room Preparation for Esophagogram
General Procedure
Fluoroscopy
Demonstration of Esophageal Reflux
Breathing Exercises
Water Test
Compression Technique
Toe-Touch Maneuver
Postfluoroscopy Imaging
Upper GI Series Procedure
Definition and Purpose
Contraindications
Clinical Indications for Upper GI Series
Patient Preparation for Upper GI Series
Pregnancy Precautions
Room Preparation and Fluoroscopy Procedure
Patient and Table Movements
Postfluoroscopy Routines
Special Patient Considerations
Pediatric Applications
Pediatric Patient Preparation for Upper GI
Barium Preparation
Room Preparation
Geriatric Applications
Obese Patient Considerations
Summary of Positioning Tips for Upper GI Examinations
Clinical History
Body Habitus
Fluoroscopy
High kV and Short Exposure Time
Digital Imaging Considerations
Alternative Modalities and Procedures
CT
MRI
Medical Sonography
Nuclear Medicine
Routine and Special Projections
Routine and Special Projections
RAO Position: Esophagogram
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Position: Esophagogram
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Optional Swimmer’s Lateral Position
AP (PA) Projection: Esophagogram
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Alternative PA
LAO Position: Esophagogram
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
RAO Position: Upper GI Series
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA Projection: Upper GI Series
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Alternate PA Axial
Right Lateral Position: Upper GI Series
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
LPO Position: Upper GI Series
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection: Upper GI Series
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Alternative AP Trendelenburg
13 Lower Gastrointestinal System
Contents
Radiographic Anatomy
Digestive System
Common Radiographic Procedures
Small Bowel Series—Study of Small Intestine
Barium Enema (Lower GI Series, Colon)—Study of Large Intestine
Small Intestine
Duodenum (RUQ and LUQ)
Jejunum (LUQ and LLQ)
Ileum (RLQ and LLQ)
Sectional Differences
Jejunum
Ileum
CT Cross-Sectional Image
Large Intestine
Colon Versus Large Intestine
Cecum
Appendix
Large Intestine—Barium-Filled
Rectum and Anal Canal
Large Versus Small Intestine
Relative Locations of Air and Barium in Large Intestine
Anatomy Review
Small Bowel Radiographs
Barium Enema
Digestive Functions
Digestive Functions of the Intestines
Movements of Digestive Tract
Small Intestine
Large Intestine
Radiographic Procedures
Small Bowel Series
Definition
Purpose
Contraindications
Clinical Indications
Small Bowel Procedures
Contrast Media
Upper GI–Small Bowel Combination
Review of Images
Fluoroscopic Study
Delayed Radiographs
Small Bowel–Only Series
Enteroclysis—Double-Contrast Small Bowel Procedure
Intubation Method—Single-Contrast Study
Patient Preparation
Pregnancy Precautions
Method of Imaging
Barium Enema (Lower GI Series)
Definition
Purpose
Contraindications
Appendicitis
Clinical Indications for Barium Enema
Barium Enema Procedure
Patient Preparation
Contraindications to Laxatives (Cathartics)
Two Classes of Laxatives
Radiographic Room Preparation
Equipment and Supplies
Barium Enema Containers
Enema Tips
Latex Allergies
Contrast Media
Negative-Contrast Agent
Contrast Media Preparation
Procedure Preparation
Sims Position
Preparation for Rectal Tip Insertion
Enema Tip Insertion
Summary of Enema Tip Insertion Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
Step 8
Fluoroscopy Routine
Types of Lower GI Examinations (Procedures)
Single-Contrast Barium Enema Procedure
Double-Contrast Barium Enema Procedure
Two-stage procedure
Single-stage procedure
Spot images (during fluoroscopy)
Digital fluoroscopy
Postfluoroscopy radiographs
Postevacuation radiograph
Evacuative Proctography—Defecography
Definition and purpose
Clinical indications
Special equipment
Contrast media
Applicator
Evacuative Proctogram Procedure
Summary of Evacuative Proctogram Procedure
Colostomy Barium Enema
Clinical Indications and Purpose
Special Supplies for Colostomy Barium Enema
Patient Preparation
Procedure
Summary of Colostomy Barium Enema Procedure
Special Patient Considerations
Pediatric Applications
Small Bowel Series and Barium Enema
Geriatric Applications
Obese Patient Considerations
Digital Imaging Considerations
Alternative Modalities and Procedures
CT
CT Enteroclysis
CT Colonography (CTC)
Patient Preparation
Procedure
Advantages of CT Colonography4
Disadvantages of CT Colonography
Nuclear Medicine
MRI
Sonography
Routine and Special Projections
Routine and Special Projections
PA Projection: Small Bowel Series
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA or AP Projection: Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
RAO Position: Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
LAO Position: Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
LPO and RPO Positions: Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Lateral Rectum Position or Ventral Decubitus Lateral: Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position (Lateral Position)
CR
Recommended Collimation
Respiration
Right Lateral Decubitus Position (AP or PA Projection): Barium Enema—Double Contrast
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Left Lateral Decubitus Position (AP or PA Projection): Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
PA (AP) Projection—Postevacuation: Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Axial or AP Axial Oblique (LPO) Projections: Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
AP Axial
LPO
CR
AP
LPO
Recommended Collimation
Respiration
PA Axial or PA Axial Oblique (RAO) Projections: Barium Enema
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
PA
RAO
CR
PA
RAO
Recommended Collimation
Respiration
14 Urinary System and Venipuncture
Contents
Radiographic Anatomy
Urinary System
Kidneys
Ureters
Urethra
Kidneys
Kidney Orientation
Cross-Sectional View
CT Axial Section
Normal Kidney Location
Kidney Movement
Functions of Urinary System
Renal Blood Vessels
Urine Production
Macroscopic Structure
Ureters
Ureter Size and Points of Constriction
Urinary Bladder
Bladder Functions
Size and Position of the Bladder
Female Pelvic Organs
Female Reproductive Organs
Retroperitoneal and Infraperitoneal Organs
Male Pelvic Organs
Male Reproductive Organs
Anatomy Review
Retrograde Pyelogram
Voiding Cystourethrogram
Computed Tomography Axial Section
Venipuncture
Introduction
Preparation for Administration of Contrast Agents
Bolus Injection
Drip Infusion
Equipment and Supplies
Patient Preparation
Signing Informed Consent Form
Selection of Vein
Ensure Vein and Not an Artery
Type and Size of Needle
Venipuncture Procedure
Step 1: Wash Hands and Put On Gloves (Figs. 14.28 and 14.29)
Step 2: Apply Tourniquet, Select Site, and Cleanse the Site (Figs. 14.30 to 14.33)
Step 3: Initiate Puncture (Figs. 14.34 and 14.35)
Step 4: Confirm Entry and Secure Needle (Figs. 14.38 to 14.41)
Step 5: Prepare and Proceed With Injection (Figs. 14.42 and 14.43)
Step 6: Needle or Catheter Removal (Figs. 14.44 and 14.45)
Summary of Safety Considerations
Radiographic Procedures
Contrast Media and Urography
Introduction to the Intravenous Urogram
Types of Contrast Media
Ionic Organic Iodides
Higher Osmolality and Greater Chance of Reaction
Nonionic Organic Iodide
Lower Osmolality and Less Chance of Reaction
Low-Osmolality Organic Iodide
Common Side Effects
Patient History
Blood Chemistry
Metformin3
Selection and Preparation of Contrast Media
Reactions to Contrast Media
Preparation for Possible Reaction
Premedication Procedure
Categories of Contrast Medium Reactions3
Local Reactions
Systemic Reactions
Excretory Urography—Intravenous Urography (IVU)
Purpose
Contraindications
Glossary of Urinary Pathologic Terms
Clinical Indications
Patient Preparation
Pregnancy Precautions
Preparation of Radiographic Equipment and Supplies
Ureteric Compression
Contraindications to Ureteric Compression
Alternative Trendelenburg
General Intravenous Urography Procedure
Scout Image and Injection
Basic Imaging Routine (Sample Protocol)
Alternatives to Routine Examination
1. Postrelease or “spill” procedure with ureteric compression
2. Erect position for bladder
3. Delayed radiographs
Nephrogram Versus Nephrotomogram
Hypertensive Intravenous Urography
Purpose
Procedure
Retrograde Urography
Purpose
Procedure
Retrograde Cystography
Purpose
Procedure
Voiding Cystourethrography
Purpose
Clinical Indications
Procedure
Retrograde Urethrography
Purpose
Clinical Indications
Procedure
Summary of Urinary System Procedures
Special Patient Considerations
Pediatric Applications
Geriatric Applications
Obese Patient Considerations
Digital Imaging Considerations
Alternative Modalities and Procedures
Computed Tomography
CT Dose Reduction Measures
Sonography (Ultrasound)
Magnetic Resonance Imaging
Nuclear Medicine
Routine and Special Projections
Routine and Special Projections
AP Projection (Scout and Series): Intravenous (Excretory) Urography
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Nephrotomography and Nephrography: Intravenous (Excretory) Urography
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
RPO and LPO Positions: Intravenous (Excretory) Urography
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection: Intravenous (Excretory) Urography
Postvoid
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection: Intravenous (Excretory) Urography
Ureteric Compression
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
AP Projection • LPO and RPO Positions • Lateral Position (Optional): Cystography
Clinical Indications
Technical Factors
Patient and Part Positions
AP
Posterior Oblique
Lateral
CR
AP
Posterior Oblique
Lateral (Optional)
Recommended Collimation
Respiration
RPO (30°) Position—Male • AP Projection—Female: Voiding Cystourethrography
Anatomy Demonstrated
Technical Factors
Shielding
Patient Position
Part Position
Male
Female
CR
Recommended Collimation
Respiration
15 Trauma, Mobile, and Surgical Radiography
Contents
Trauma and Mobile Imaging
Introduction
Skeletal Trauma and Fracture Terminology
Dislocation
Subluxation
Sprain
Contusion
Fracture
Fracture Alignment Terminology
Apposition
Angulation
Types of Fractures
Simple (Closed) Fracture
Compound (Open) Fracture
Incomplete (Partial) Fracture
Complete Fracture
Comminuted Fracture
Impacted Fracture
Specific Named Fractures
Barton Fracture
Baseball (Mallet) Fracture
Bennett Fracture
Boxer Fracture
Colles Fracture
Smith (Reverse Colles) Fracture
Hangman Fracture
Hutchinson (Chauffeur) Fracture
Monteggia (mon-tej′-ah) Fracture
Pott Fracture
Additional Fracture Types
Avulsion Fracture
Blowout and/or Tripod Fracture
Chip Fracture
Compression Fracture
Depressed Fracture (sometimes called a Ping-Pong fracture)
Epiphyseal Fracture
Pathologic Fracture
Stellate Fracture
Stress or Fatigue Fracture (sometimes called a “March” fracture)
Trimalleolar Fracture
Tuft or Burst Fracture
Postfracture Reduction
Closed Reduction
Open Reduction
Mobile X-Ray Equipment
Mobile X-Ray Systems
Battery-Driven, Battery-Operated, Mobile X-Ray Units
Standard Power Source, Capacitor-Discharge, Non-Motor-Driven Units
Digital Imaging Considerations
Positioning Principles for Trauma and Mobile Radiography
Principle 1: Two Projections 90° to Each Other With True CR-Part-IR Alignment
Exception to True Anteroposterior (AP) and Lateral Principle
Exception to CR-Part-IR Alignment
Principle 2: Entire Structure or Trauma Area Included on Image Receptor
Principle 3: Maintain the Safety of the Patient, Health Care Workers, and the Public
Alternative Modalities
Computed Tomography
Sonography
Nuclear Medicine
Angiography and Interventional Procedures
Routine and Special Projections
Routine and Special Projections
Trauma and Mobile Positioning
AP Chest
Clinical Indications
Technical Factors
Patient Position
AP Chest
Part Position
AP Chest
CR
AP Chest
Radiation Safety
Respiration
Lateral Decubitus AP Projection
AP Supine and Decubitus: Abdomen
Clinical Indications
Technical Factors
Patient Position
AP Supine (Fig. 15.33)
Left Lateral Decubitus AP (or PA) Projection (Fig. 15.34)
Part Position
AP Supine
Left Lateral Decubitus AP (or PA) Projection
CR
AP Supine
Left Lateral Decubitus AP (or PA) Projection
Radiation Safety
Respiration
AP Supine and Left Lateral Decubitus AP (or PA) Projection
Dorsal Decubitus, Lateral Position (Fig. 15.35)
Upper Limb
Clinical Indications
Technical Factors
Patient Position
Part Position
CR
Radiation Safety
Upper Limb Positioning Examples
Shoulder
Clinical Indications
Technical Factors
Patient Position
AP Shoulder and Scapular Y Lateral—AP Oblique (Lateromedial Scapula) (Figs. 15.51 and 15.52)
Inferosuperior Axial (Fig. 15.53)
Transthoracic Lateral (Fig. 15.54)
Part Position
AP Shoulder
Scapular Y Lateral—AP Oblique (Lateromedial Scapula)
Inferosuperior Axial
Transthoracic Lateral
CR
AP Shoulder
Scapular Y Lateral—AP Oblique (Lateromedial Scapula)
Inferosuperior Axial
Transthoracic Lateral
Radiation Safety
Respiration
Lower Limb
Clinical Indications
Technical Factors
Patient Position
Part Position
CR
Radiation Safety
Lower Limb Positioning Examples
Pelvis
Clinical Indications
Technical Factors
Patient Position
AP Pelvis
Part Position
AP Pelvis
CR
AP Pelvis
Radiation Safety
Respiration
Hip
Clinical Indications
Technical Factors
Patient Position
AP Hip and Axiolateral-Inferosuperior Hip—Danelius-Miller Method (Figs. 15.69 and 15.70)
Part Position
AP Hip
Axiolateral-Inferosuperior Hip–Danelius—Miller Method
CR
AP Hip
Axiolateral-Inferosuperior Hip—Danelius-Miller Method
Radiation Safety
Respiration
Cervical Spine
Clinical Indications
Technical Factors
Patient Position
Lateral, Horizontal Beam (Fig. 15.71) and Cervicothoracic (Swimmer’s) Lateral (Fig. 15.72)
Part Position
Lateral, Horizontal Beam
Cervicothoracic (Swimmer’s) Lateral
CR
Lateral, Horizontal Beam
Cervicothoracic (Swimmer’s) Lateral
Radiation Safety
Respiration
Thoracic and Lumbar Spine
Clinical Indications
Technical Factors
Patient Position
Lateral Thoracic Spine, Horizontal Beam (Fig. 15.73) and Lateral Lumbar Spine, Horizontal Beam (Fig. 15.74)
Part Position
Lateral Thoracic Spine, Horizontal Beam and Lateral Lumbar Spine, Horizontal Beam
CR
Lateral Thoracic Spine, Horizontal Beam
Lateral Lumbar Spine, Horizontal Beam
Radiation Safety
Respiration
Cranium
Lateral, Horizontal Beam
Clinical Indications
Technical Factors
Patient Position
Part Position
AP Lateral, Horizontal Beam
CR
AP Lateral, Horizontal Beam
Radiation Safety
Respiration
Cranium
AP, AP Axial 15° (Reverse Caldwell Method)
Clinical Indications
Technical Factors
Patient Position
Part Position
AP and AP Axial 15°
CR
AP to Orbitomeatal Line Projection (Fig. 15.77)
AP Axial 15° Reverse Caldwell Method Projection (Fig. 15.78)
Radiation Safety
Respiration
Cranium
AP 30° Axial (Towne Method)
Clinical Indications
Technical Factors
Patient Position
Part Position
AP Axial (Towne Method) Projection
CR
AP Axial (Towne Method) Projection (Fig. 15.79)
Radiation Safety
Respiration
Facial Bones
Lateral, Horizontal Beam
Clinical Indications
Technical Factors
Patient Position
AP Lateral, Horizontal Beam
Part Position
AP Lateral, Horizontal Beam
CR
AP Lateral, Horizontal Beam
Radiation Safety
Respiration
Facial Bones
Acanthioparietal (Reverse Waters Method) and Modified Acanthioparietal (Modified Reverse Waters)
Clinical Indications
Technical Factors
Patient Position
Acanthioparietal (Reverse Waters Method)
Part Position
Acanthioparietal (Reverse Waters Method)
CR
Acanthioparietal (Reverse Waters Method)
Modified Acanthioparietal (Modified Reverse Waters Method)
Radiation Safety
Respiration
Surgical Radiography
Essential Attributes of the Radiologic Technologist in Surgical Radiography
Confidence
Communication
Problem-Solving Skills
Mastery
Surgical Team
Surgeon
Anesthesiologist
Surgical Assistant
Certified Surgical Technologist
Circulator
Scrub
Surgical Radiography Imaging Equipment
Cleaning
Operational Check
Proper Equipment Location
Mobile C-Arm Digital Fluoroscopy Systems
Maneuverability
Display Monitors and Control Cart
Uses of C-Arm
Controls and Operation Modes
Foot Pedal
Image Orientation
O-Arm
Radiation Protection in Surgical Radiography
Staff Radiation Exposure
C-Arm Orientation and Exposure Patterns
Vertical Posteroanterior Projection CR
Horizontal Projection CR
Vertical AP Projection CR
Patient Dose
Summary of Radiation Protection in Surgical Radiography
Time
Use of Intermittent Fluoroscopy
Minimize Boost Exposures
Distance
Vertical Alignment
Minimize Distance Between Anatomy and Image Receptor
Shielding
Protective Lead Aprons
Communication
Coordination of Exposure With Surgical Team
Monitor Personal Dosimetry Report
Surgical Asepsis Principles
Surgical Suite Environment
Imaging Equipment/Personnel and Sterile Fields
C-arm
Image Receptors
Surgical Attire
Scrubs
Scrub Cover
Head Cover
Shoe Covers
Shoes
Masks
Protective Eyewear
Nonsterile Gloves
Surgical Radiographic Procedures
Biliary Tract Procedures
Operative (Immediate) Cholangiography
Overview of Procedure
Equipment Used and Setup
C-arm Digital Fluoroscopic Cholangiography
Mobile Radiographic Cholangiography
Laparoscopic Cholecystectomy
Advantages of Laparoscopy
Summary of Procedures for Operative and Laparoscopic Cholangiography
Images Obtained
Anatomy Demonstrated
Urinary Tract Procedures
Retrograde Urography
Overview of Procedure
Equipment Used and Setup
Summary of Procedure
Anatomy Demonstrated
Orthopedic Procedures
Orthopedic Surgical Terminology and Concepts
Closed Reduction
Open Reduction
Internal Fixation
External Fixation
Intramedullary Fixation
Hip Fractures (Pinning, Open Reduction With Internal Fixation)
Overview of Procedure
Imaging Equipment Used and Setup
Lateral Hip C-Arm Projection
Summary of Procedure
Spinal Procedures
Laminectomy
Overview of Procedure
Equipment Used and Setup
Summary of Procedure
Cervical Procedure (Anterior Approach)
Lumbar Procedure (Posterior Approach)
Anatomy Demonstrated
Thorax Procedures
Pacemaker Insertion
Overview of Procedure
Equipment Used and Setup
Summary of Procedure—Transvenous Approach
Glossary of Surgical Abbreviations, Terminology, and Procedures
16 Pediatric Radiography
Contents
Introduction and Principles
Introduction
Age of Understanding and Cooperation
Pre-Examination Introduction and Child and Parent Evaluation
Introduction of Technologist
Evaluation of Parent’s Role
Immobilization
Other Forms of Immobilization
Wrapping With Sheets or Towels (“Mummifying”)
Bone Development (Ossification)
Child Abuse
Classification
Radiographic Indications
Classic Metaphyseal Lesion
Rib Fractures
Healing Fractures
Radiographic Imaging
Alternative Imaging Modalities
CT
MRI
Sonography
Nuclear Medicine
Radiation Protection and Image Gently
Minimizing Exposure Dose
Gonadal Protection
Parent Protection
Pre-Examination Preparation
Child Preparation
Digital Imaging Considerations
Alternative Modalities
CT
Reducing Pediatric Dose During CT3
Sonography
MRI
Nuclear Medicine
Clinical Indications
Pediatric Chest
Pediatric Skeletal System
Pediatric Abdomen
Routine and Special Projections
Routine and Special Projections
AP and PA Chest Projection: Chest
Clinical Indications
Technical Factors
Shielding
Patient Position—With Patient Supine
Part Position
CR
Recommended Collimation
Respiration
AP and PA Chest Projection: Chest
Erect PA Chest With Pigg-O-Stat
Patient Position—With Patient Erect
CR
Recommended Collimation
Respiration
Lateral Chest Position: Chest
Clinical Indications
Technical Factors
Shielding
Patient Position—With Patient Recumbent
Part Position
CR
Recommended Collimation
Respiration
Lateral Chest Position: Chest
Erect Lateral Chest With Pigg-O-Stat
Patient Position—With Patient Erect
Procedure if Lateral Follows PA Projection
CR
Recommended Collimation
Respiration
AP and Lateral: Upper Limbs
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
AP
Lateral
CR
Recommended Collimation
AP and Lateral: Lower Limbs
Clinical Indications
Technical Factors
Shielding
Patient Position and CR
AP and Lateral
AP and Lateral: Lower Leg AP and Lateral: Foot—Kite Method
Clinical Indications
Technical Factors
Shielding
Patient Position and CR
AP Lower Leg
Lateral Lower Leg
Recommended Collimation
AP and Lateral Foot
AP foot
Lateral foot
Recommended Collimation
Talipes (Congenital Clubfoot)—Kite Method
AP and Lateral: Pelvis and Hips
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
AP
Lateral
CR
Recommended Collimation
Respiration
AP, AP Reverse Caldwell, and AP Towne: Skull
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Lateral Projection: Skull (Head)
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Radiographic Procedures of Pediatric Abdomen
Differences Between Children and Adults
Patient Preparation for Contrast Media Procedures
Upper GI Tract
Lower GI Tract
Contraindications
Newborn to 2 Years
Children 2 to 10 Years
Children Older Than 10 Years to Adult
Intravenous Urogram
Routine and Special Projections
AP Projection (Kub): Abdomen
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
Newborns and Young Infants
Infants and Toddlers
CR
Respiration
AP Erect Projection: Abdomen
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
CR
Respiration
Lateral Decubitus and Dorsal Decubitus: Abdomen
Clinical Indications
Technical Factors
Shielding
Patient and Part Position
Lateral Decubitus
Dorsal and Ventral Decubitus
CR
Respiration
Upper GI Tract Study
Barium Swallow, Upper GI, and Small Bowel Combination Study
Clinical Indications
Room Preparation
Shielding
Barium Preparation
Patient and Parent Preparation
Procedure
Drinking Barium
Fluoroscopy Positioning Sequence
Small Bowel Follow-Through
Postprocedure Instructions
Lower GI Tract Study—Barium Enema
Single-Contrast, Double-Contrast, or Air Enema
Clinical Indications
Contrast Media and Materials-Barium Enema, Single-Contrast
Children Older Than 1 Year
Neonates (Newborn to 1 Year)
All Patients
Contrast Media and Materials—Barium Enema, Double-Contrast
Air Enema
Materials
Room Preparation
Shielding
Patient and Parent Preparation
Procedure
Fluoroscopy and Spot Imaging
After Reduction of Intussusception Following Air or Barium Enema
Postprocedure Tasks
Genitourinary System Study—Voiding Cystourethrogram
Clinical Indications
Technical Factors
Shielding
Genitourinary System Study—Voiding Cystourethrogram (VCUG)
Preparation
Contrast Media and Materials
Room Preparation
Patient and Parent Preparation
Procedure
Postprocedure Tasks
17 Angiography and Interventional Procedures
Contents
Radiographic Anatomy
Introduction
Definition
Divisions or Components of the Circulatory System
Cardiovascular System
Functions
Blood Components
Systemic Circulation
Arteries
Veins
Pulmonary Circulation
General Systemic Circulation
Heart
Coronary Arteries
Coronary Veins
Cerebral Arteries
Blood Supply to Brain
Branches of Aortic Arch
Neck and Head Arteries
External Carotid Artery Branches
Internal Carotid Artery
Anterior Cerebral Artery
Middle Cerebral Artery
Internal Carotid Arteriogram
Vertebrobasilar Arteries
Arterial Circle (Circle of Willis)
Vertebrobasilar Arteriogram
Cerebral Veins
Great Veins of Neck
Dural Venous Sinuses
Cranial Venous System
Thoracic Circulatory System
Thoracic Arteries
Thoracic Veins
Abdominal Circulatory System
Abdominal Arteries
Abdominal Veins
Hepatic Portal System (Hepatoportal System)
Peripheral Circulatory System
Upper Limb Arteries
Upper Limb Veins
Lower Limb Arteries
Lower Limb Veins
Angiographic Procedures
Overview
Angiography Team
Consent and Patient Care Before Procedure
Vessel Access for Contrast MEDIA Injection
Seldinger Technique (Fig. 17.35)
Step 1. Insertion of Compound (Seldinger) Needle
Step 2. Placement of Needle in Lumen of Vessel
Step 3. Insertion of Guidewire
Step 4. Removal of Needle
Step 5. Threading of Catheter to Area of Interest
Step 6. Removal of Guidewire
Angiographic Tray
Contrast MEDIA
Risks and Complications
Postprocedural Care
Special Patient Considerations
Pediatric Applications
Geriatric Applications
Radiation Protection
Contraindications
Angiographic Imaging Equipment
Angiographic Room
Equipment Requirements
Digital Acquisition
Digital Subtraction Angiography
Post-Processing Images
Automatic Electromechanical Contrast Media Injector
Alternative Modalities and Procedures
Computed Tomography
Nuclear Medicine
Sonography
Magnetic Resonance Angiography
Rotational Angiography
3D Rotational Angiography
Alternative Contrast Media: CO2 and Gadolinium
Specific Angiographic Procedures
Cerebral Angiography
Purpose
Clinical Indications
Catheterization
Contrast Media
Imaging
Common Carotid Arteriography
Internal Carotid Arteriography
Thoracic Angiography
Purpose
Clinical Indications
Catheterization
Contrast Media
Imaging
Thoracic Aortogram
Pulmonary Arteriogram
Angiocardiography
Purpose
Clinical Indications
Catheterization
Contrast Media
Imaging
Abdominal Angiography
Purpose
Clinical Indications
Catheterization
Contrast Media
Imaging
Peripheral Angiography
Purpose
Clinical Indications
Catheterization
Contrast Media
Imaging
Lower Limb
Upper Limb
Interventional Imaging Procedures
Definition and Purpose
Vascular Interventional Angiography
Embolization
Uterine Fibroid Embolization
Uterine Artery Embolization
Chemoembolization
Intracranial Endovascular Coil Embolization
Risks and Complications
Examples
Percutaneous Transluminal Angioplasty and Stent Placement
Angioplasty
Stent Placement
Risks and Complications
Stent-Graft Placement
Risks and Complications
IVC Filter
Risks and Complications
Insertion of Venous Access Devices
Risks and Complications
Transjugular Intrahepatic Portosystemic Shunt
Risks and Complications
Thrombolysis and Thrombectomy
Risks and Complications
Infusion Therapy
Extraction of Vascular Foreign Bodies
Risks and Complications
Nonvascular Interventional Procedures
Percutaneous Vertebroplasty and Kyphoplasty
Vertebroplasty
Kyphoplasty
Risks and Complications
Nephrostomy
Percutaneous Biliary Drainage
Percutaneous Abdominal Abscess Drainage
Needle Aspiration
Catheter Drainage
Percutaneous Needle Biopsy
Percutaneous Gastrostomy
Radiofrequency Ablation
18 Computed Tomography
Contents
Radiographic Anatomy
Gross Anatomy of the CNS—Brain and Spinal Cord
Neurons
Divisions of CNS
Summary of Spinal Cord Anatomy
Brain and Spinal Cord Coverings—Meninges
Dura Mater
Arachnoid
Pia Mater
Meningeal Spaces
Epidural Space
Subdural Space
Subarachnoid Space
Three Divisions of Brain
Brainstem
Forebrain
Cerebrum
Five Lobes of Each Cerebral Hemisphere
Cerebral Hemispheres
Cerebral Ventricles
Lateral Ventricles
Third Ventricle
Fourth Ventricle
Superior View of Ventricles
Anterior View of Ventricles
Subarachnoid Cisterns
Cisternal puncture
Thalamus
Hypothalamus
Midbrain and Hindbrain
Pituitary and Pineal Glands
Cerebellum
Gray Matter and White Matter
Summary—White Matter Versus Gray Matter
White Matter
Gray Matter
Cerebral Nuclei (Basal Ganglia)
Brain—Inferior Surface
Cranial Nerves
Orbital Cavity
Orbital Cavities (Superior View)
Visual Pathway
Basic Principles
Basic Principles of CT
Introduction
CT Terminology
Evolution of CT
First-Generation and Second-Generation Scanners
Third-Generation Scanner
Fourth-Generation Scanner
Volume CT Scanners
Advantages
Multislice CT Scanners
Advantages
CT System Components
Gantry
X-Ray Tube
Detector Array
Collimator Assembly
Computer
Operator Console
Networking and Archiving
Image Reconstruction
Volume Element (Voxel)
Attenuation (Differential Absorption) of Each Voxel
Converting 3D Voxels to 2D Pixels
Computed Gray Scale and CT Numbers
Window Width and Window Level (Window Center)
Pitch With Volume Scanners
Image Reconstruction Summary
Clinical Application of CT
CT Versus Conventional Radiography
Patient Communication and Consent
Procedure
Viewing CT Images
Intravenous Contrast Media
Contrast Media and Blood-Brain Barrier
Radiation Dose
Patient Dose
Pediatric CT Scans
Technologist and Personnel Exposure
Cranial CT—Head CT
Introduction
Pathologic Indications
Head CT Procedure
Sectional Anatomy
Axial Sections of Brain
Examples of Pathology
Metastatic Lesion
Subdural Hematoma
Subarachnoid Hemorrhage
Cerebrovascular Accident (Stroke)
Hydrocephalus
Additional CT Procedures
Neck CT
Musculoskeletal CT
Spine CT
Specialized CT Procedures
3D Reconstruction
CT (Virtual) Endoscopy
CT Enteroclysis
CT Angiography
Cardiac CT and Coronary CT Angiography
CT Fluoroscopy
Interventional CT
Percutaneous Biopsy
Percutaneous Abscess Drainage
Terminology
19 Special Radiographic Procedures
Contents
Introduction
Arthrography
Introduction
Knee Arthrography
Purpose
Clinical Indications
Contraindications
Patient Preparation
Imaging Equipment
Accessory Equipment
Contrast Media
Needle Placement and Injection Process
Positioning Routines
Radiographic Routines
Conventional or Digital Fluoroscopic Imaging
Evaluation Criteria
Conventional Radiographic Projections
Evaluation Criteria
Shoulder Arthrography
Purpose
Clinical Indications
Imaging Equipment
Accessory Equipment
Contrast Media
Needle Placement and Injection Process
Positioning and Imaging Sequence
CT and MRI Arthrography
Biliary Duct Procedures
Postoperative (T-Tube or Delayed) Cholangiography
Purpose
Clinical Indications
Residual Calculi
Strictures
Contraindications
Patient Preparation
Imaging Equipment
Accessory Equipment
Contrast Media
Injection Process
Endoscopic Retrograde Cholangiographic Pancreatography
Endoscopy
Purpose
Clinical Indications
Residual Calculi
Strictures
Contraindications
Patient Preparation
Imaging Equipment
Accessory Equipment
Contrast Media
Injection Process
Hysterosalpingography
Introduction
Anatomy
Uterus
Uterine Tubes
Purpose
Clinical Indications
Infertility Assessment
Demonstration of Intrauterine Pathology
Contraindications
Patient Preparation
Imaging Equipment
Accessory and Optional Equipment
Contrast Media
Cannula or Catheter Placement and Injection Process
Positioning
Radiographic Routine
Digital Fluoroscopy or Conventional Imaging
Radiography
Evaluation Criteria
Myelography
Purpose
Clinical Indications
Contraindications
Patient Preparation
Imaging Equipment
Accessory and Optional Equipment
Contrast Media
Dosages
Needle Placement and Injection Process
Positioning
Fluoroscopy or Spot Imaging or Digital Fluoroscopy or Imaging
Radiographic Myelography Positioning (After Fluoroscopy)
Cervical Region
Horizontal Beam Lateral (Figs. 19.35 and 19.36)
Swimmer’s Lateral Horizontal Beam (Figs. 19.37 and 19.38)
Thoracic Region
Right Lateral Decubitus Position—AP or PA Projection With Horizontal Beam (Fig. 19.39)
Left Lateral Decubitus Position—AP or PA Projection With Horizontal Beam (Fig. 19.40)
Right or Left Lateral—Vertical Beam (Fig. 19.41)
Lumbar Region
Semierect Lateral—Horizontal Beam (Figs. 19.42 and 19.43)
Radiographs
Evaluation Criteria (for All Levels of Spinal Column)
CT Myelography
Orthoroentgenography
Purpose
Clinical Indications—Limb Length Discrepancies
Routine and Special Projections
Lower Limb Measurement (Unilateral or Bilateral on Same IR)
Technical Factors
Shielding
Positioning and CR—Unilateral Exposure
AP Hip (Figs. 19.49 and 19.50)
AP Knee (Figs. 19.51 and 19.52)
AP Ankle (Figs. 19.53 and 19.54)
Upper Limb Measurement
Technical Factors
Shielding
Positioning and CR
AP Shoulder (Figs. 19.55 and 19.56)
AP Elbow (Figs. 19.57 and 19.58)
AP Wrist (Figs. 19.59 and 19.60)
Hip-to-Ankle Long Bone Measurement
Technical Factors
Positioning and CR
Evaluation Criteria
Long Bone Measurement on CT (CT Scanogram)
Conventional Tomography
Purpose
Terminology
Imaging Equipment
Control Console
Basic Principles
Fulcrum
Determining Fulcrum Level and Centering
Determining Sectional Thickness (Object Plane Thickness)
20 Diagnostic and Therapeutic Modalities
Contents
Nuclear Medicine
Definition and Introduction
Nuclear Imaging Equipment
Clinical Applications
Bone Scan
Heart (Cardiac) Studies
Lung Scan
Thyroid Uptake Study
Nuclear Medicine Team
Nuclear Medicine Terminology1,2
PET
Definition and Description
Comparison With Nuclear Medicine
Use of Positron Emitters
Positron Emitting Elements
Cyclotron
Anatomic and Functional Image Coregistration
Clinical Applications
Oncology (Study of Tumors)
Cardiology
Coronary Artery Disease
Neurology
Epilepsy
Brain Mapping
Central Nervous System Tumor Imaging
Evaluation of Dementia
Radiation Oncology
Introduction
External Beam Irradiation
Brachytherapy
Proton Therapy
Radiation Oncology Team
Sonography
Definition and Introduction
History and Physical Principles of Ultrasound
A-Mode
B-Mode
M-Mode
Real-Time Imaging
Doppler
Digital Systems
Limitations and Advantages of Sonography in Medical Imaging
Advances in Sonography
Clinical Applications
Abdomen
Obstetrics and Gynecology
Cardiac
Superficial Parts
Vascular Imaging
Musculoskeletal Imaging
Sonography Team Members
Sonography Terminology
Mammography
Breast Cancer
Mammography Quality Standards Act
Anatomy of the Breast
Surface Anatomy
Sagittal Section Anatomy
Methods of Localization
Anterior View Anatomy
Breast Tissue Types
Summary
Breast Classifications
Fibroglandular Breast
Fibrofatty Breast
Fatty Breast
Summary
Radiographic Positioning
Positioning and Technical Considerations
Patient Preparation
Breast Positioning
X-Ray Tube
AEC Chamber Selection
Compression15
Magnification
Patient Dose
Analog (Film-Screen) Mammography
Digital Versus Analog (Film-Screen) Mammography
Digital Mammography
Computed Radiography Mammography
Operating Costs
Telemammography
Archiving and PACS Options
Image Manipulation
Mammography Workstation
Contrast Mammography18
Computer-Aided Detection Systems
Alternative Modalities and Procedures
Sonography (Ultrasound)
Conventional Scanner and Handheld Transducer
Nuclear Medicine
PET Mammography
Breast-Specific Gamma Imaging
MRI
Advantages of MRI
Breast Implants
Disadvantages of MRI
Digital Breast Tomosynthesis
Pathologic Indications
Breast Carcinoma (Cancer)
Cysts
Fibroadenoma
Fibrocystic Changes
Gynecomastia
Intraductal Papilloma
Paget Disease of the Nipple
Mammography Terminology
Routine and Special Projections
Routine and Special Projections
Craniocaudal (CC) Projection: Mammography
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
Positioning Tips
CR
Recommended Collimation
Respiration
Posterior Nipple Line
Mediolateral Oblique (MLO) Projection: Mammography
Superomedial-Inferolateral Oblique
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Recommended Collimation
Respiration
Special Projections (Additional Views): Mammography
Mediolateral (ML) Projection: True Lateral Breast Position
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
Positioning Tips
CR
Recommended Collimation
Respiration
Special Projections (Additional Views): Mammography
Exaggerated Craniocaudal (Laterally) (XCCL) Projection
Clinical Indications
Technical Factors
Shielding
Patient Position
Part Position
CR
Collimation
Respiration
Special Projections (Additional Views): Mammography
Implant Displaced (ID) (Eklund Method)24
Clinical Indications
Eklund Method23
Exception
Manual Exposure Techniques
Radiographs for Critique
Bone Densitometry
Introduction
History
Composition of Bone
Osteoclasts and Osteoblasts
Bone Mineral Content Versus Bone Mineral Density
Purpose
Clinical Risk Factors and Indications
BMD and Fracture Risk
Assessment of Fracture Risk
World Health Organization Diagnostic Criteria for Diagnosis of Osteoporosis
Osteoporosis Management
Estrogen
Mode of Action
SERMs
Mode of Action
Bisphosphonates
Mode of Action
Calcitonin
Mode of Action
Parathyroid Hormone
Mode of Action
Contraindications
Patient Preparation
Major Equipment Methods and Techniques
Dual-Energy X-Ray Absorptiometry
z Score
T Score
Quantitative Computed Tomography
Quantitative Ultrasound
Radiation Safety
Site Selection and Method
Positioning (for DXA)
Spine
Hip
Forearm
Body Habitus
DXA Precision and Accuracy
Accuracy
Vertebral Fracture Assessment
Summary
MRI
Introduction
Comparison With Computed Tomography (CT)
Physical Principles of MRI
Interaction of Nuclei With Magnetic Fields
Precession
Net Magnetization Vector
Resonance
Relaxation
T1 Relaxation
T2 Relaxation
Spin Density
Summary
Magnets
Permanent Magnets
Resistive Magnets
Superconducting Magnets
Flared and Short Bore Design
Open MRI System
Clinical Applications
Contraindications
Patient Preparation
Relieving Patient Anxiety
Patient Monitoring
Summary
Basic Safety Considerations
Projectiles/Missile Effects
Electromechanical Implants
Torque
Tissue Heating
Gradient Magnetic Fields (Time-Varying Magnetic Fields)
Pregnancy
Occupational Hazards
Patient History
Contrast Agents
Appearance of Anatomy
T1-Weighted and T2-Weighted Images
Relaxation Versus Contrast Weighting
Sample MRI Examinations
Brain Imaging
Comparisons With CT
T1-Weighted Images
T2-Weighted Images
Spine Imaging
Comparison With CT
T1-Weighted Images
T2-Weighted Images
Joint and Limb Imaging
T1-Weighted Images
T2-Weighted Images
Abdomen and Pelvis Imaging
T1-Weighted Images
T2-Weighted Images
Physiologic Gating
Functional MRI
Spectroscopy
Diffusion-Weighted Imaging (DWI)
MRI Terminology35
Appendix A Answer Key: Radiographs for Critique
Chapter 2: Chest (p. 104)
PA Chest (Fig. C2.91)
PA Chest (Fig. C2.92)
Lateral Chest (Fig. C2.93)
PA Chest (Fig. C2.94)
Lateral Chest (Fig. C2.95)
Chapter 3: Abdomen (p. 126)
Left Lateral Decubitus Abdomen (Fig. C3.52)
AP Supine Abdomen—KUB (Fig. C3.53)
AP Supine Abdomen—KUB (Fig. C3.54)
AP Erect Abdomen (Fig. C3.55)
Chapter 4: Upper Limb (p. 175)
PA Hand (Fig. C4.160)
Lateral Wrist (Fig. C4.161)
AP Elbow (Fig. C4.162)
PA Wrist With Ulnar Deviation (Fig. C4.163)
PA Forearm—Infant (Fig. C4.164)
Lateral Elbow (Fig. C4.165)
Chapter 5: Humerus and Shoulder Girdle (p. 210)
AP Clavicle (Fig. C5.102)
AP Shoulder—External Rotation (Fig. C5.103)
AP Scapula (Fig. C5.104)
AP Humerus (Fig. C5.105)
Chapter 6: Lower Limb (p. 262)
Bilateral Tangential Patella (Fig. C6.142)
Plantodorsal (Axial) Calcaneus (Fig. C6.143)
AP Mortise Ankle (Fig. C6.144)
AP Lower Limb—Pediatric (Fig. C6.145)
Lateral Knee (Fig. C6.146)
AP Medial Oblique Knee (Fig. C6.147)
Chapter 7: Femur and Pelvic Girdle (p. 289)
AP Pelvis (Fig. C7.77)
AP Pelvis (Fig. C7.78)
Unilateral Frog-Leg Projection (Performed During Cystogram) (Fig. C7.79)
Bilateral Frog-Leg Projection (Fig. C7.80)
Chapter 8: Cervical and Thoracic Spine (p. 323)
AP Open Mouth (C1-C2) (Fig. C8.91)
AP Open Mouth (C1-C2) (Fig. C8.92)
AP Axial Projection (Fig. C8.93)
Right Posterior Oblique Cervical Spine (Fig. C8.94)
Lateral (Trauma) Cervical Spine (Fig. C8.95)
AP Projection—Fuchs Method (For Odontoid Process) (Fig. C8.96)
AP Thoracic Spine (Fig. C8.97)
Chapter 9: Lumbar Spine, Sacrum, and Coccyx (p. 353)
Lateral Lumbar Spine (Fig. C9.83)
Lateral Lumbar Spine (Fig. C9.84)
Lateral L5-S1 (Fig. C9.85)
RPO Lumbar Spine (Fig. C9.86)
AP Lumbar Spine (Fig. C9.87)
LPO Lumbar Spine (Fig. C9.88)
AP Lumbar Spine (Fig. C9.89)
AP Erect Lumbar Spine—Scoliosis Study (Fig. C9.90)
Lateral Lumbar Spine—Scoliosis Study (Fig. C9.91)
Chapter 10: Bony Thorax—Sternum and Ribs (p. 373)
Bilateral Ribs Above Diaphragm (Fig. C10.47)
Oblique Sternum (Fig. C10.48)
Ribs Below Diaphragm (Fig. C10.49)
Lateral Sternum (Fig. C10.50)
Chapter 11 Cranium, Facial Bones, and Paranasal Sinuses (pp. 442-444)
Critique Radiographs of Cranium
Lateral Skull: 4-Year-Old (Fig. C11.201)
Lateral Skull: 54-Year-Old, Post-Traumatic Injury (Fig. C11.202)
AP Axial (Towne) Skull (Fig. C11.203)
AP or PA Skull (Fig. C11.204)
AP or PA Skull (Fig. C11.205)
Critique Radiographs of Facial Bones
Parietoacanthial (Waters) Projection (Fig. C11.206)
SMV Mandible (Fig. C11.207)
Optic Foramina, Parieto-Orbital Oblique—Rhese Method (Fig. C11.208)
Optic Foramina, Parieto-Orbital Oblique—Rhese Method (Fig. C11.209)
Lateral Facial Bones (Fig. C11.210)
Critique Radiographs of Paranasal Sinuses
Parietoacanthial Transoral (Open-Mouth Waters) (Fig. C11.211)
Parietoacanthial (Waters) (Fig. C11.212)
Submentovertical Projection (SMV) (Fig. C11.213)
Lateral Projection (Fig. C11.214)
Chapter 20: Diagnostic and Therapeutic Modalities (p. 767)
Critique Radiographs of the Breast
CC Projection (Fig. C20.79)
MLO Projection (Fig. C20.80)
CC Projection (Fig. C20.81)
MLO Projection (Fig. C20.82)
CC Projection (Fig. C20.83)
CC Projection (Fig. C20.84)
Appendix B Routine and Special Projections
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 20
References
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Interventional Angiography
Chapter 18
Chapter 19
Chapter 20
Additional Resources
Chapter 1
Chapter 8
Chapter 10
Chapter 14
Chapter 18
Chapter 20
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
U
V
W
X
Z