Radiographic Image Analysis

Front cover
Radiographic Image Analysis
Copyright page
Dedication
Reviewer List
Preface
This Edition
Acknowledgments
Table of Contents
1 Image Analysis Guidelines
Outline
Objectives
Key Terms
Why Image Analysis?
Terminology
Characteristics of the Optimal Image
Displaying Images
Computed Radiography Image Receptor and Patient Orientation.
Direct-Indirect Capture Digital Radiography.
Adjusting for Poor Display.
Contrast Mask
Display Stations
Image Analysis Form
Demographic Requirements
Computed Radiography.
Direct-Indirect Capture Digital Radiography.
Marking Projections
Using the Collimator Guide for Marker Placement with Computed Radiography.
Marker Placement with Digital Radiography.
Post-Exam Annotation.
Anatomic Structure Requirements and Placement
Computed Radiography.
Digital Radiography.
Long Bones.
Collimation
Rotating Collimator Head.
Overcollimation.
Anatomic Relationships
Positioning Routines and Understanding the Reason for the Procedure.
Correlating the Anatomic Relationships and Positioning Procedures.
Identifying Anatomic Structures.
Off-Centering.
Angled Central Ray.
Magnification.
Elongation.
Foreshortening.
Distinguishing Between Structures of Similar Shape and Size.
Determining the Degree of Patient Obliquity.
Determining the Degree of Extremity Flexion.
Demonstrating Joint Spaces and Fracture Lines.
Steps for Repositioning the Patient for Repeat Projections
Steps for Repositioning the Central Ray for Repeat Projections
Sharpness of the Recorded Details
Focal Spot Size.
Distances.
Motion.
Double Exposure.
Spatial Resolution.
Radiation Protection
Effective Communication.
Immobilization Devices.
Source-Skin Distance.
Pregnancy.
Gonadal Shielding.
Gonadal Shielding in the AP Projection for Female Patients.
Gonadal Shielding in the AP Projection for Male Patients
Gonadal Shielding in the Lateral Projection for Male and Female Patients.
Shielding of Radiosensitive Cells Not Within the Primary Beam.
Collimation.
Exposure Factors to Minimize Patient Exposure.
Automatic Exposure Control Backup Timer.
Avoiding Dose Creep.
Anatomic Artifacts.
Personnel and Family Members in Room During Exposure.
2 Digital Imaging Guidelines
Outline
Objectives
Key Terms
Digital Radiography
Image (Data) Acquisition
Computed Radiography.
Direct-Indirect Radiography.
Histogram Formation
Automatic Rescaling
Exposure Indicators
Histogram Analysis Errors
Part Selection from Workstation Menu.
Central Ray Centering.
Collimation.
Scatter Radiation Control.
Clearly Defining the Volume of Interest (for Computed Radiography Only).
Coverage of 30% (for Computed Radiography Only).
Multiple Projections on One Image Receptor (for Computed Radiography Only).
Background Radiation Fogging (for Computed Radiography Only).
Image Receptor Exposure
Identifying Underexposure.
Determining the Technical Adjustment for Underexposure
Subject Contrast.
Adjusting kV for Inadequate Contrast Resolution.
Adjusting for Quantum Noise.
Identifying Overexposure.
Other Exposure-Related Factors
Scatter Radiation.
Grids.
Source-Image Receptor Distance.
Object-Image Receptor Distance.
Collimation.
Anode Heel Effect.
Additive and Destructive Patient Conditions.
Automatic Exposure Control.
Correcting Poor Automatic Exposure Control Images.
Contrast Resolution
Bit Depth and Dynamic Range.
Post-Processing
Windowing.
Contrast Masking.
Choosing Alternative Procedural Algorithms (Lookup Table) to Modify Image.
Artifacts
Anatomic Artifact.
External Artifact.
Internal Artifact.
Grid Cutoff Artifact.
Aliasing or Moiré Artifact.
Phantom Image Artifact.
Scatter and Background Fogging.
Back of Cassette Toward Source During Exposure.
Phosphor Plate–Handling Artifact.
Digital System Artifact.
Postprocedure Requirements
Defining Image Acceptability.
Fulfillment of Exam Indication.
Special Imaging Situations
Mobile and Trauma Imaging.
Guidelines for Aligning Contrast Resolution, Part, and Image Receptor
Lateral Projections.
Oblique Projections.
Alignment of Contrast Resolution and Part versus Contrast Resolution and Image Receptor.
Imaging Long Bones.
Pediatric Imaging
Technical Considerations.
Clothing Artifacts.
Obese Patients
Technical Considerations.
Scatter Radiation Control.
Focal Spot Size.
Automatic Exposure Control.
Reference
3 Chest and Abdomen
Outline
Objectives
Key Terms
Image Analysis Guidelines
Chest
Technical Data.
Source-to-IR Distance (SID).
Vascular Lung Markings.
Ventilated Patient.
Lung Conditions Affecting Vascular Lung Marking Visualization
Pneumothorax and Pneumectomy.
Pleural Effusion.
Free Intraperitoneal Air.
Chest Devices, Tubes, Lines and Catheters.
Tracheostomy.
Endotracheal Tube.
Pleural Drainage Tube.
Central Venous Catheter.
Pulmonary Arterial Catheter (Swan-Ganz Catheter).
Umbilical Artery Catheter.
Umbilical Vein Catheter.
Pacemaker.
Automatic Implantable Cardioverter Defibrillator.
External Monitoring Tubes and Lines.
Chest: PA Projection
Special Positioning Situations Dealing With Breasts
Large Pendulous Breasts.
Nipple Shadows.
Singular Mastectomy.
Augmentation Mammoplasty.
Body Habitus and IR Placement.
Midcoronal Plane Positioning and Rotation.
Identifying Rotation.
Distinguishing Scoliosis from Rotation.
Clavicles.
Scapulae.
Midcoronal Plane Tilting.
Identifying Midcoronal Plane Tilting.
Distinguishing Midcoronal Plane Tilting from Poor Shoulder Depression.
Lung Aeration.
Identifying Poor Lung Aeration.
Expiration Chest.
PA Chest Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Chest: Lateral Projection (Left Lateral Position)
Anteroinferior Lung and Heart Visualization.
Midcoronal Plane Positioning and Rotation.
Distinguishing the Right and Left Lungs.
Identifying Rotation.
Distinguishing Scoliosis from Rotation.
Midsagittal Plane Positioning and Hemidiaphragm Visualization.
Right Versus Left Lateral Chest Projection.
Arm Positioning and Anterior Lung Visualization.
Maximum Lung Aeration.
Identifying the Eleventh Thoracic Vertebra.
Lateral Chest Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Chest: AP Projection (Supine or with Portable X-Ray Unit)
Demographic and Positioning Data.
Heart Magnification and SID.
AP Versus PA Projection.
Body Habitus and IR Placement.
Side-to-Side CR Alignment.
Identifying Side-to-Side CR Alignment with IR.
Cephalic-Caudal CR Alignment.
Identifying Poor CR and Midcoronal Plane Alignment.
Spinal Kyphosis.
Supine Patient.
Clavicle.
Scapulae.
Lung Aeration.
AP Chest (Portable) Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Chest: AP or PA Projection (Right or Left Lateral Decubitus Position)
Positioning to Demonstrate Air or Fluid Levels.
Cart Pad Artifact.
Body Habitus and IR Cassette Placement.
Midcoronal Plane Positioning and Rotation
Using the Cervical Vertebrae to Distinguish between the AP and PA Projections.
Identifying Rotation.
Midcoronal Plane Tilting.
Scapulae.
Lung Aeration.
Decubitus Chest Analysis Practice
Analysis.
Correction.
Chest: AP Axial Projection (Lordotic Position)
Clavicle and Ribs.
Determining the Degree of CR Angulation for Method 2.
Identifying Inadequate Midcoronal Plane and CR Angulation.
Rotation.
Scapulae.
AP Lordotic Chest Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Chest: PA Oblique Projection (Right and Left Anterior Oblique Positions)
Accuracy of Obliquity.
Obliquity to Visualize the Heart.
Repositioning for Improper Patient Obliquity.
AP Oblique Chest Projections.
Midcoronal Plane Tilting.
Arm Position.
PA Oblique Chest Analysis Practice
Analysis.
Correction.
Pediatric Chest
Lung Development.
Chest Shape and Size.
Neonate and Infant Chest: AP Projection
Chest Rotation
Positioning Patient to Prevent Rotation.
Identifying Chest Rotation Caused by Poor Patient Positioning.
Side-to-Side CR Alignment to Prevent Rotation.
Identifying Chest Rotation Caused by Poor IR or Side-to-Side CR Alignment.
CR and IR Alignment (Perpendicular or Cephalic Angle).
Alternate CR and IR Alignment.
Chin Position.
Appearance of Lungs and Aeration.
Identifying Poor Lung Aeration.
Neonate and Infant AP Chest Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Child Chest: PA and AP (Portable) Projections
Child Chest PA and AP (Portable) Chest Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Neonate and Infant Chest: Cross-Table Lateral Projection (Left Lateral Position)
Cross-Table Versus Overhead Lateral.
Posterior Rib Superimposition.
Identifying Right and Left Lungs.
Arms.
Chin.
Respiration.
Child Chest: Lateral Projection (Left Lateral Position)
Child Lateral Chest Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Neonate and Infant Chest: AP Projection (Right or Left Lateral Decubitus Position)
Midcoronal Plane Positioning and Rotation.
Preventing Artifact Lines in Lung Field.
Midsagittal Plane Tilting.
Chin and Arm Positioning.
CR and IR Alignment.
Alternate Patient and IR Alignment.
Neonate and Infant AP Decubitus Chest Analysis Practice
Analysis.
Correction.
Child Chest: AP and PA Projection (Right or Left Lateral Decubitus Position)
Child AP-PA (Lateral Decubitus) Chest Analysis Practice
Analysis.
Correction.
Abdomen
Technical Data.
Subject Contrast and Brightness.
Locating the Psoas Major Muscles and Kidneys.
Adjusting Technical Data for Patient Conditions
Bowel Gas.
Ascites, Obesity, Bowel Obstruction, or Soft Tissue Masses.
Pendulous Breasts.
Abdominal Lines, Devices, Tubes, and Catheters.
Nasogastric Tubes.
Spinal Stimulator Implant.
Free Intraperitoneal Air.
Variations in Positioning Procedure Due to Body Habitus.
Abdomen: AP Projection (Supine and Upright)
Abdominal Body Habitus
Hypersthenic.
Asthenic.
Sthenic.
Obese.
Body Habitus and IR Size and Placement Variations.
Supine Hypersthenic Patient.
Upright Hypersthenic Patient.
Supine Obese Patient.
Upright Obese Patient.
Midcoronal Plane Positioning and Rotation.
Distinguishing Abdominal Rotation from Scoliosis.
Respiration.
AEC Chamber and Respiration.
AP Abdomen Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Abdomen: AP Projection (Left Lateral Decubitus Position)
IR Size and Direction
Hypersthenic and Obese Patient.
Demonstrating Intraperitoneal Air.
Patients with Wide Hips.
Midcoronal Plane Positioning and Rotation
Detecting Abdominal Rotation.
Using a Wedge-Compensating Filter to Obtain Uniform Density.
Respiration.
AP (Left Lateral Decubitus) Abdomen Analysis Practice
Analysis.
Correction.
Pediatric Abdomen
Neonate and Infant Abdomen: AP Projection (Supine)
Lumbar Vertebrae Alignment with IR.
Midcoronal Plane and Rotation.
Respiration.
Ventilated Patient.
Neonate and Infant: AP Abdominal Analysis
Analysis.
Correction.
Analysis.
Correction.
Child Abdomen: AP Projection (Supine and Upright)
Child AP Abdominal Analysis Practice
Analysis.
Correction.
Neonate and Infant Abdomen: AP Projection (Left Lateral Decubitus Position)
Demonstrating Intraperitoneal Air.
Midcoronal Plane Positioning and Rotation.
Neonate and Infant AP (Left Lateral Decubitus) Abdominal Analysis Practice
Analysis.
Correction.
Child Abdomen: AP Projection (Left Lateral Decubitus Position)
Child AP (Left Lateral Decubitus) Abdomen Analysis Practice
Analysis.
Correction.
4 Upper Extremity
Outline
Objectives
Key Terms
Image Analysis Guidelines
Technical Data.
Finger: PA Projection
Phalangeal Soft Tissue Width and Midshaft Concavity.
Joint Spaces and Phalanges.
Positioning the Unextendable Finger.
PA Finger Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Finger: PA Oblique Projection
Phalangeal Soft Tissue Width and Midshaft Concavity.
Alternate Second Finger Positioning.
Soft Tissue Overlap.
Joint Space and Phalanges.
PA Oblique Finger Analysis Practice
Analysis.
Correction.
Finger: Lateral Projection
Phalangeal Midshaft Concavity.
Adjacent Finger Overlap.
Finger Fractures.
Lateral Finger Analysis Practice
Analysis.
Correction.
Thumb: AP Projection
Phalangeal and Metacarpal Midshaft Concavity and Soft Tissue Width.
Joint Spaces and Phalanges.
Palmar Soft Tissue.
Thumb and Collimator Alignment.
Alternate PA Thumb Projection.
AP Thumb Analysis Practice
Analysis.
Correction.
Thumb: Lateral Projection
Phalanx and Metacarpal Midshaft Concavity.
Joint Spaces and Phalangeal.
Thumb Abduction.
Lateral Thumb Analysis Practice
Analysis.
Correction.
Thumb: PA Oblique Projection
Soft Tissue Width and Phalangeal and Metacarpal Midshaft Concavity.
Joint Space, Phalangeal and Metacarpal.
Longitudinal Thumb Alignment.
PA Oblique Thumb Analysis Practice
Analysis.
Correction.
Hand: PA Projection
Soft Tissue Width and Phalangeal and Metacarpal Midshaft Concavity.
Joints Spaces, Phalanges, and Metacarpals.
Thumb and Hand Closeness.
Special Condition
Pediatric Bone Age Assessment.
PA Hand Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Hand: PA Oblique Projection (Lateral Rotation)
Metacarpal Spacing.
Soft Tissue Overlap.
Joint Spaces and Phalanges.
Thumb Positioning.
PA Oblique Hand Analysis Practice
Analysis.
Correction.
Hand: “Fan” Lateral Projection (Lateromedial)
Metacarpal Superimposition.
Fanned Fingers.
Lateral Hand in Extension.
Lateral Hand in Flexion.
Lateral Hand Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Wrist: PA Projection
Scaphoid Fat Stripe.
Ulnar Styloid.
Radial Styloid, Radioulnar Articulation and MC Bases.
Distal Radius and Radioscaphoid and Radiolunate Joints.
Identifying the Posterior and Anterior Distal Radial Margins.
Positioning the Patient with a Thick Proximal Forearm.
Positioning the Forearm to Demonstrate Open Radioscaphoid and Radiolunate Joints.
CM Joint Spaces and Scaphoid Visualization.
Identifying Causes of Obscured CM Joint Spaces.
Third MC and Midforearm Alignment.
Demonstrating Joint Mobility.
CR Centering.
PA Wrist Image Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Wrist: PA Oblique Projection (Lateral Rotation)
Ulnar Styloid.
Alignment of Third MC and Midforearm.
Distal Radius and Radioscaphoid and Radiolunate Joints.
Positioning Patient with Thick Proximal Forearm or to Demonstrate Open Radioscaphoid and Radiolunate Joints.
Second CM and Scaphotrapezial Joint Spaces.
Trapezoid, Trapezium, and Trapeziotrapezoidal Joint Space.
Identifying Insufficient or Excessive Wrist Obliquity.
PA Oblique Wrist Analysis Practice
Analysis.
Correction.
Wrist: Lateral Projection (Lateromedial)
Pronator Fat Stripe.
Ulnar Styloid.
Elbow and Humerus Positioning.
Anterior Alignment of the Distal Scaphoid and Pisiform.
Distal Alignment of the Distal Scaphoid and Pisiform.
Positioning Patient with Thick Proximal Forearm.
Metacarpals and Thumb Alignment with the Forearm.
Lateral Projections Taken for Wrist Joint Mobility.
Thumb Positioning and Trapezium Visualization.
CR Centering.
Alternate Mediolateral Wrist Projection.
Lateral Wrist Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Wrist: Ulnar Deviation, PA Axial Projection (Scaphoid)
Scaphotrapezium and Scaphotrapezoidal Joint Spaces.
Scaphoid and Scaphocapitate and Scapholunate Joint Spaces.
Compensating for Inadequate Ulnar Deviation.
Medial Wrist Rotation upon Ulnar Deviation.
Radioscaphoid Joint Space.
Positioning Patient with Thick Proximal Forearm.
CR Angulation.
Adjusting CR Angulation to Align with Fracture.
Collimation.
PA Axial (Scaphoid) Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Wrist: Carpal Canal (Tunnel) (Tangential, Inferosuperior Projection)
Carpal Canal Visualization.
Pisiform and Hamulus Process.
Forearm: AP Projection
Wrist and Distal Forearm Positioning.
Radial Tuberosity.
Humerus and Elbow Positioning.
Ulnar Styloid.
Elbow Flexion.
CR Centering and Openness of Wrist and Elbow Joint Spaces
Distal Forearm.
Proximal Forearm.
Positioning for Fracture
Distal Forearm.
Proximal Forearm.
Including Wrist and Elbow.
AP Forearm Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Forearm: Lateral Projection (Lateromedial)
Soft Tissue Structures.
Wrist and Distal Forearm Positioning
Radius and Ulna Alignment.
Radial Tuberosity.
Humerus and Elbow Positioning.
CR Centering and Openness of Elbow Joint Space.
Effect of Muscular or Thick Forearm.
Positioning for Fracture.
Lateral Forearm Analysis Practice
Analysis.
Correction.
Elbow: AP Projection
Humeral Epicondyles and Radial Head and Ulna Relationship.
Radial Tuberosity.
Elbow Flexion.
Positioning for the Flexed Elbow.
CR Centering.
AP Elbow Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Elbow: AP Oblique Projections (Medial and Lateral Rotation)
Humeral Epicondyles
Medial Oblique (Internal Rotation).
Lateral Oblique (External Rotation).
Elbow Flexion.
Positioning for the Flexed Elbow.
Elbow Joint Spaces
CR Centering.
AP Oblique Elbow Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Elbow: Lateral Projection (Lateromedial)
Elbow Soft Tissue Structures.
Elbow Flexion and Fat Pad Visualization.
Humeral Epicondyles.
Proximal Humerus Mispositioning.
Distal Forearm Mispositioniong.
Radial Tuberosity.
Positioning for Radial Head Fractures.
Lateral Elbow Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Elbow: Axiolateral Elbow Projection (Coyle Method)
Humerus and CR Angulation.
Elbow Flexion and CR Alignment.
Forearm.
Wrist and Hand.
Axiolateral Elbow (Coyle Method) Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Humerus: AP Projection
Humeral Epicondyles.
Positioning for Humeral Fracture.
Field Size and Collimation.
Humerus: Lateral Projection (Lateromedial and Mediolateral)
Mediolateral versus Lateromedial Projections.
Positioning for Humeral Fracture.
Distal Humeral Fracture.
Proximal Humeral Fracture.
Alternate Transthoracic Lateral Humerus Projection.
Lateral Humeral Analysis Practice
Analysis.
Correction.
5 Shoulder
Outline
Objectives
Key Terms
Image Analysis Guidelines
Technical Data.
Shoulder: AP Projection
Shoulder Movements
Supine versus Upright.
Midcoronal Plane Positioning and Shoulder Rotation.
Midcoronal Plane Tilting.
Kyphotic Patients.
Humerus Positioning
Humeral Epicondyles.
AP Shoulder Projections Taken for Mobility.
Humeral Fractures.
Shoulder Dislocations.
AP Shoulder Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Shoulder: Inferosuperior Axial Projection (Lawrence Method)
Humeral Abduction and CR Alignment.
Humerus Positioning
Humeral Fracture or Shoulder Dislocation.
Humerus Foreshortening.
Humerus Rotation.
Lesser Tubercle in Profile.
Posterolateral Humeral Head in Profile.
Coracoid Process and Base.
Including the Posterior Surface.
Including the Medial Coracoid.
Inferosuperior Axial Shoulder Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Glenoid Cavity: AP Oblique Projection (Grashey Method)
Midcoronal Plane Positioning and Shoulder Rotation.
Midcoronal Plane Tilting.
Kyphotic Patient.
Shoulder Protraction.
Recumbent Position.
AP Oblique Shoulder Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Scapular Y: PA Oblique Projection
Midcoronal Plane Positioning and Shoulder Rotation.
Midcoronal Plane.
Kyphotic Patient.
Dislocated Shoulder and Proximal Humeral Fracture.
Detecting Shoulder Dislocation.
Detecting Proximal Humeral Fracture.
AP Oblique Projection
AP Oblique Projection for the Recumbent Patient.
PA Oblique (Scapular Y) Shoulder Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Proximal Humerus: AP Axial Projection (Stryker “Notch” Method)
Midcoronal Plane Positioning and Shoulder Rotation.
Humerus and Humeral Head Positioning.
Poor Midcoronal Plane Positioning or CR Angulation.
Humeral Abduction.
Distal Humeral Tilting.
AP Axial (Stryker Notch) Shoulder Analysis Practice
Analysis.
Correction.
Supraspinatus “Outlet”: Tangential Projection (Neer Method)
Arm Position and Shoulder Obliquity.
Using Palpable Structures to Determine Accurate Obliquity.
Midcoronal Plane and CR Alignment.
Tangential (Outlet) Shoulder Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Clavicle: AP Projection
Midcoronal Plane Positioning and Clavicle Rotation.
Midcoronal Plane Tilting.
AP Clavicle Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Clavicle: AP Axial Projection (Lordotic Position)
Midcoronal Plane Positioning and Clavicle Rotation.
CR Angulation.
Acromioclavicular (AC) Joint: AP Projection
Exam Indication.
Midcoronal Plane Positioning and Clavicle Rotation.
Midcoronal Plane Tilting.
Kyphotic Patient.
CR Centering.
Exam Variations
AP Axial Projection (Alexander Method).
Bilateral AC Joint Projection.
Scapula: AP Projection
Humeral Abduction.
Shoulder Retraction.
Midcoronal Plane Tilting.
Kyphotic Patient.
Respiration.
Exam Variations
Breathing Technique.
Positioning for Trauma.
AP Scapular Analysis Practice
Analysis.
Correction.
Scapula: Lateral Projection (Lateromedial or Mediolateral)
Humerus Positioning.
Midcoronal Plane Positioning and Scapular Obliquity.
Detecting Inaccurate Obliquity.
Lateral Scapular Analysis Practice
Analysis.
Correction.
6 Lower Extremity
Outline
Objectives
Key Terms
Image Analysis Guidelines
Technical Data.
Toe: AP Axial Projection
Phalangeal Midshaft Concavity and Soft Tissue Width.
Joint Spaces and Phalanges.
CR Angulation for Nonextendable Toes.
AP Axial Toe Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Toe: AP Oblique Projection
Phalangeal Midshaft Concavity and Soft Tissue Width.
Rotation Accuracy.
Joint Spaces and Phalanges.
CR Angulation for Nonextendable Toes.
Bony and Soft Tissue Overlap.
AP Oblique Toe Analysis Practice
Analysis.
Correction.
Toe: Lateral Projection (Mediolateral and Lateromedial)
Phalanx Concavity and Condyle Superimposition.
Bony and Soft Tissue Overlap.
Lateral Toe Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Foot: AP Axial Projection (Dorsoplantar)
Metatarsal, Cuneiform, and Talar and Calcaneal Spacing
Medial Arch and Rotation.
Weight-Bearing AP.
Tarsometatarsal and Navicular-Cuneiform Joint Spaces
Determining CR Angulation.
Ankle Flexion.
Weight-Bearing AP.
Locating the Base of the Third Metatarsal.
AP Axial Foot Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Foot: AP Oblique Projection (Medial Rotation)
Cuboid-Cuneiform and Intermetatarsal Joints
Determining Degree of Obliquity.
Inadequate Obliquity.
Ankle Flexion.
AP Oblique Foot Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Foot: Lateral Projection (Mediolateral and Lateromedial)
Anterior Pretalar and Posterior Pericapsular Fat Pads.
Foot Dorsiflexion.
Foot Dorsiflexion.
Proximal Alignment of Talar Domes
Talar Domes.
Lower Leg Positioning.
Repositioning for Poor Lower Leg Positioning.
Weight-Bearing Lateromedial Foot.
Weight-Bearing Mediolateral Foot.
Anterior and Posterior Alignment of Talar Domes
Foot Positioning.
Using the Tibia and Fibula Relationship to Reposition.
Weight-Bearing Lateromedial Projection.
Lateral Foot Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Calcaneus: Axial Projection (Plantodorsal)
Talocalcaneal Joint Space and Calcaneal Tuberosity
Foot Positioning.
Compensating for Dorsiflexion.
Compensating for Planter Flexion.
Rotation and Tilting.
Axial Calcaneal Analysis Practice
Analysis.
Correction.
Calcaneus: Lateral Projection (Mediolateral)
Foot Dorsiflexion.
Talar Dome Alignment
Lower Leg Positioning.
Repositioning for Poor Lower Leg Positioning.
Foot Positioning.
Using the Tibia and Fibula Relationship to Reposition.
Lateral Calcaneal Analysis Practice
Analysis.
Correction.
Ankle: AP Projection
Medial Mortise.
Ruptured Ligament Variation.
Rotation.
Tibiotalar Joint Space.
Evaluating the Openness of the Tibiotalar Joint.
Effect of Foot Positioning on Tibiotalar Joint Visualization.
AP Ankle Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Ankle: AP Oblique Projection (Medial Rotation)
15- to 20-Degree AP Oblique (Mortise).
Repositioning for Inadequate Rotation.
Foot Inversion verus Ankle Rotation.
45-Degree AP Oblique.
Identifying Inadequate Rotation.
Tibiotalar Joint Space.
Evaluating the Openness of the Tibiotalar Joint.
Calcaneus.
AP Oblique Ankle Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Ankle: Lateral Projection (Mediolateral)
Demonstrating the Anterior Pretalar and Posterior Pericapsular Fat Pads.
Foot Dorsiflexion.
Medial and Lateral Talar Domes
Proximal Alignment.
Anterior and Posterior Alignment.
Including the Fifth Metatarsal Base.
Lateral Ankle Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Lower Leg: AP Projection
Anatomic Position versus AP Projections of the Ankle and Knee.
Positioning for Fracture.
Rotation.
Knee and Ankle Joint Spaces.
Leg and IR Placement.
AP Lower Leg Analysis Practice
Analysis.
Correction.
Lower Leg: Lateral Projection (Mediolateral)
Variation from the True Lateral Knee and Ankle Projections.
Positioning for Fracture.
Rotation.
Leg and IR Placement.
Lateral Lower Leg Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Knee: AP Projection
Femoral Epicondyle, and Tibia and Fibular Head Relationship
Rotation.
Patella and Intercondylar Fossa Demonstration
Effect of Knee Flexion.
Patellar Subluxation.
Intercondylar Fossa Visualization with Knee Flexion.
Nonextendable Knee.
Joint Space and Condylar Margins.
CR Alignment with Tibial Plateau in the Supine Position.
Joint Space Narrowing.
Adjusting for Poor CR Angulation.
AP Knee Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Knee: AP Oblique Projection (Medial and Lateral Rotation)
Knee Joint.
Adjusting for Poor CR Angulation.
Rotation
Medial (Internal) Oblique Position.
Lateral (External) Oblique Position.
AP Oblique Knee Analysis Practice
Analysis.
Correction.
Knee: Lateral Projection (Mediolateral)
Patellofemoral Joint and Patella Position
Knee Flexion and Joint Effusion Visualization.
Positioning for Fracture.
Knee Joint Space.
Determining Degree of CR Angulation.
Distinguishing Lateral and Medial Condyles.
Adjusting for Poor CR Angulation.
Anterior and Posterior Alignment of Femoral Condyles.
Alternate Positioning Method.
Knee Rotation.
Knee Flexion.
Supine (Cross-Table) Lateromedial Knee Projection
Distal Alignment of Femoral Condyles.
Anterior and Posterior Alignment of Femoral Condyles.
Lateral Knee Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Intercondylar Fossa: PA Axial Projection (Holmblad Method)
Proximal Intercondylar Fossa Surface and Patella.
Repositioning for Poor Femur Positioning.
Knee Joint and Tibial Plateau.
Repositioning for Poor Foot Positioning.
Medial and Lateral Surfaces of the Intercondylar Fossa
Femoral Inclination.
Foot Rotation.
PA Axial Knee Analysis Practice
Analysis.
Correction.
Intercondylar Fossa: AP Axial Projection (Béclère Method)
Proximal Intercondylar Fossa Surface.
Knee Joint and Tibial Plateau.
The Medial and the Lateral Intercondylar Fossa Surfaces.
Knee Magnification.
Patella and Patellofemoral Joint: Tangential Projection (Merchant Method)
Scatter Radiation Control.
Axial Viewer.
Superior Position of Patellae, Femoral Condyles, and Intercondylar Sulci
Rotation.
Patellar Subluxation.
Joint Space Visualization
Anterior Thigh Soft Tissue Projecting into Joint Space.
Patellae and Tibial Tuberosities in Joint Space.
Positioning for Large Calves.
Light Field Silhouette Indicates Accurate Positioning.
Tangential (Merchant) Patella Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Femur: AP Projection
Distal Femur
Epicondyles and Femoral Condyle Shape.
Positioning for Fracture.
Femoral Shaft Overlap.
Proximal Femur
Pelvis Rotation.
Femoral Neck and Trochanters.
Positioning for Fracture.
Soft Tissue.
AP Femur Analysis Practice
Analysis.
Correction.
Femur: Lateral Projection (Mediolateral)
Femoral Condyles
Anterior and Posterior Femoral Condyle Alignment.
Positioning for Fracture.
Femoral Shaft Overlap.
Proximal Femur
Greater and Lesser Trochanter.
Effect of Femur Abduction.
Midfemur and Grid Midline Alignment.
Positioning for Fracture.
Lateral Femur Image Analysis Practice
Analysis.
Correction.
7 Pelvis, Hip, and Sacroiliac Joints
Outline
Objectives
Key Terms
Image Analysis Guidelines
Technical Data.
Pelvis: AP Projection
Fat Planes.
Differences Between Male and Female Pelves.
Pelvis Rotation.
Femoral Neck and Greater and Lesser Trochanter Visualization.
Detecting Poor Leg Positioning.
Positioning for Femoral Neck or Proximal Femoral Fracture or Hip Dislocation.
CR Centering for Analysis of Hip Joint Mobility.
AP Pelvis Analysis Practice
Analysis.
Correction.
Pelvis: AP Frog-Leg Projection (Modified Cleaves Method)
Pelvis Rotation.
Lesser and Greater Trochanter Visualization.
Identifying Poor Knee and Hip Flexion.
Femoral Neck and Greater Trochanter Visualization.
Importance of Symmetrical Femoral Abduction.
AP Frog-Leg Pelvis Analysis Practice
Analysis.
Correction.
Hip: AP Projection
Pelvis Rotation.
Identifying Rotation.
Femoral Neck.
Identifying Poor Leg Rotation.
Positioning for Dislocated Hip, or Fractured Femoral Neck or Proximal Femur.
CR Centering
Localizing the Femoral Head and Neck.
Including Orthopedic Apparatuses.
AP Hip Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Hip: AP Frog-Leg (Mediolateral) Projection (Modified Cleaves Method)
Pelvis Rotation.
Lauenstein and Hickey Methods.
Lesser and Greater Trochanter.
Poor Knee and Hip Flexion.
Femoral Neck and Greater Trochanter Visualization.
Poor Leg Abduction.
AP Frog-Leg Hip Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Hip: Axiolateral (Inferosuperior) Projection (Danelius-Miller Method)
Unaffected Leg Position.
Femoral Neck Visualization and Greater and Lesser Trochanter Alignment.
Effect of CR and Femoral Neck Misalignment.
Lesser and Greater Trochanter.
Identifying Poor Leg Rotation.
Hip Dislocation or Fractured Femoral Neck or Proximal Femur.
Including Acetabulum and Femoral Head.
Obese Patient.
CR Centering
Including Orthopedic Apparatuses.
Axiolateral Analysis Practice
Analysis.
Correction.
Sacroiliac (SI) Joints: AP Axial Projection
Median Sacral Crest and Symphysis Pubis and Sacrum and Pelvic Brim Alignment.
Detecting Sacroiliac Joint Rotation.
Visualizing the Sacroiliac Joints Without Distortion.
Adjusting CR Angulation for Patient Variations.
Identifying Poor CR Angulation.
Sacral Alignment and CR Centering.
AP Axial SI Joint Analysis Practice
Analysis.
Correction.
Sacroiliac Joints: AP Oblique Projection Left and Right Posterior Oblique Positions
Alternate Marking.
Ilium and Sacrum.
AP Oblique SI Joint Analysis Practice
Analysis.
Correction.
8 Cervical and Thoracic Vertebrae
Outline
Objectives
Key Terms
Image Analysis Guidelines
Technical Data.
Cervical Vertebrae: AP Axial Projection
Rotation.
CR and Intervertebral Disk Alignment.
Upright versus Supine Position.
Kyphotic Patient.
Effect of CR Misalignment.
Occipital Base and Mandibular Mentum Positioning.
Effect of Occiput-Mentum Mispositioning.
Cervical Column and Exposure Field Alignment.
Trauma.
AP Cervical Vertebrae Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Cervical Atlas and Axis: AP Projection (Open-Mouth Position)
Rotation.
Detecting Direction of Rotation.
Upper Incisor, Occipital Base, and CR Positioning.
Positioning for Trauma.
AP Cervical Atlas and Axis Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Cervical Vertebrae: Lateral Projection
Prevertebral Fat Stripe Visualization.
Rotation.
Head Positioning.
Effect of Mandibular Rotation and Elevation on C1 and C2 Visualization.
Detecting Lateral Head and Shoulder Tilting That Causes Lateral Cervical Flexion.
Cervical Column and Exposure Field Alignment.
Lateral Flexion and Extension Projections to Evaluate AP Cervical Vertebral Mobility.
Importance of Including the Clivus.
Demonstration of C7 and T1 Vertebrae.
In Trauma or Recumbency.
Lateral Cervicothoracic Projection (Twining Method).
Trauma.
Lateral Cervical Vertebrae Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Cervical Vertebrae: PA or AP Axial Oblique Projection (Anterior and Posterior Oblique Positions)
Midcoronal Plane Rotation.
Effect of Incorrect Rotation.
CR and Intervertebral Disk Space Alignment.
Identifying Inaccurate Vertebral Column Alignment with the IR and CR Angulation.
Positioning for Kyphosis.
Interpupillary Line Positioning.
Detecting Poor Interpupillary Line Positioning.
Head Positioning.
Trauma.
PA Axial Oblique Cervical Vertebrae Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Cervicothoracic Vertebrae: Lateral Projection (Twining Method; Swimmer’s Technique)
Exam Indication.
Rotation.
IPL and Midsagittal Plane Positioning.
Trauma.
Identifying C7.
Lateral Cervicothoracic Vertebrae Analysis Practice
Analysis.
Correction.
Thoracic Vertebrae: AP Projection
Obtaining Uniform Brightness Across Thoracic Vertebrae
Anode Heel Effect.
Expiration Versus Inspiration.
Rotation.
Distinguishing Rotation From Scoliosis.
CR and Intervertebral Disk Space Alignment.
Positioning for Kyphosis.
AP Thoracic Vertebrae Analysis Practice
Analysis.
Correction.
Thoracic Vertebrae: Lateral Projection
Breathing Technique.
Rotation.
Distinguishing Rotation From Scoliosis.
CR Intervertebral Disk Space Alignment.
Scoliotic Patient.
Locating T7.
Verifying Inclusion of All Thoracic Vertebrae.
Lateral Cervicothoracic (Twining Method) Projection.
Lateral Thoracic Vertebrae Analysis Practice
Analysis.
Correction.
9 Lumbar, Sacral, and Coccygeal Vertebrae
Outline
Objectives
Key Term
Image Analysis Guidelines
Technical Data.
Lumbar Vertebrae: AP Projection
Psoas Muscle Demonstration.
Rotation.
Distinguishing Rotation From Scoliosis.
CR Alignment with Intervertebral Disk Spaces.
Effect of Lordotic Curvature.
AP Lumbar Analysis Practice
Analysis.
Correction.
Lumbar Vertebrae: AP Oblique Projection (Right and Left Posterior Oblique Positions)
AP or PA Projection.
Rotation.
Scottie Dogs and Accurate Lumbar Obliquity.
Identifying Poor Obliquity.
AP Oblique Lumbar Analysis Practice
Analysis.
Correction.
Lumbar Vertebrae: Lateral Projection
Rotation
Effect of Rotation.
Detecting Rotation.
CR Alignment with Intervertebral Disk Spaces.
Scoliotic Patient.
Evaluating AP Mobility of Lumbar Vertebrae.
Lumbar Vertebrae and IR Center Alignment.
Supplementary Projection of the L5-S1 Lumbar Region.
Gonadal Shielding.
Lateral Lumbar Vertebrae Analysis Practice
Analysis.
Correction.
L5-S1 Lumbosacral Junction: Lateral Projection
Rotation.
Central Ray and L5-SI Disk Space Alignment.
Detecting Lateral Lumbar Flexion.
Adjusting for the Sagging Vertebral Column.
Scoliotic Patient.
Lateral L5-S1 Analysis Practice
Analysis.
Correction.
Sacrum
Sacrum: AP Axial Projection
Emptying Bladder and Rectum.
Rotation.
CR and Sacral Alignment.
Effect of CR and Sacral Misalignment.
AP Sacrum Analysis Practice
Analysis.
Correction.
Sacrum: Lateral Projection
Rotation.
CR and L5-S1 Disk Space and Sacral Alignment
Detecting Lateral Lumbar Flexion.
Adjusting for the Sagging Vertebral Column.
Lateral Sacrum Analysis Practice
Analysis.
Correction.
Coccyx: AP Axial Projection
Emptying Bladder and Rectum.
Rotation.
CR and Coccyx Alignment.
AP Coccyx Analysis Practice
Analysis.
Correction.
Coccyx: Lateral Projection
Rotation.
CR and Vertebral Column
Detecting Lateral Lumbar Flexion.
Adjusting for the Sagging Vertebral Column.
Collimation.
10 Sternum and Ribs
Outline
Objectives
Sternum
Image Analysis Guidelines
Technical Data.
Sternum: PA Oblique Projection (Right Anterior Oblique Position)
Why the RAO Position?
Blurring Overlying Sternal Structures.
Patient Obliquity.
Determining the Required Obliquity.
Evaluating Accuracy of Obliquity.
Field Size.
Sternum: Lateral Projection
Positioning for Homogeneous Brightness.
Reducing Scatter Radiation.
Rotation.
Respiration.
Humerus Positioning.
The Supine Patient.
Source-Image Distance.
Ribs
Ribs: AP or PA Projection (Above or Below Diaphragm)
Soft Tissue Structures of Interest.
AP versus PA Projection.
Rotation.
Scoliosis versus Rotation.
Respiration.
Locating the Inferior Scapula to Center the CR in a PA Projection and Remove Scapula from Exposure Field.
CR Positioning When Both Sides of the Rib Are Examined on One Projection.
AP/PA Rib Projection Analysis Practice
Analysis.
Correction.
Ribs: AP Oblique Projection (Right and Left Posterior Oblique Positions)
Controlling Magnification.
Patient Obliquity.
Respiration.
AP/PA Oblique Rib Projection Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
11 Cranium, Facial Bones, and Paranasal Sinuses
Outline
Objectives
Key Terms
Image Analysis Guidelines
Technical Data.
Cranial Positioning Lines.
Trauma Cranial Imaging (Cervical Vertebral Injuries Precaution).
Cranium and Mandible: PA or AP Projection
Head Rotation.
Orbitomeatal Line and IR Alignment.
Adjusting CR for Poor OML Alignment.
Detecting Poor OML Alignment.
Trauma AP Projection.
Correcting the CR Angulation for a Trauma AP Projection.
Mandible: Jaw Position.
Head Tilting and Midsagittal Plane Alignment.
PA or AP Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Analysis.
Correction.
Cranium, Facial Bones, and Sinuses: PA or AP Axial Projection (Caldwell Method)
Head Rotation.
OML and IR Alignment.
Adjusting the CR for Poor OML Alignment.
Detecting Poor OML and CR Alignment.
CR Angulation for a Trauma AP Axial (Caldwell) Projection.
Correcting the CR Angulation for a Trauma AP Axial (Caldwell) Projection.
PA/AP Axial Analysis Practice
Analysis.
Correction.
Analysis.
Correction.
Cranium and Mandible: AP Axial Projection (Towne Method)
Head Rotation.
OML and Midsagittal Plane Alignment
Cranium and Petromastoid Portion.
Mandible.
Poor OML Alignment.
Adjusting for Poor OML Alignment and Determining CR Angulation for Trauma Patients.
Head Tilting and Rotation.
AP Axial (Towne) Analysis Practice
Analysis.
Correction.
Cranium, Facial Bones, Nasal Bones, and Sinuses: Lateral Projection
Air-Fluid Levels in Sinus Cavities.
Head Rotation.
Positioning for Trauma.
Detecting Head Rotation.
Head Tilting.
Lateral Projection Analysis Practice
Analysis.
Correction.
Cranium, Mandible, and Sinuses: Submentovertex Projection (Schueller Method)
IOML and IR Alignment.
Effect of Mispositioning IOML.
Head Tilting.
Head Rotation.
SMV Projection Analysis Practice
Analysis.
Correction.
Facial Bones and Sinuses: Parietoacanthial and Acanthioparietal Projection (Waters Method)
Demonstrating Air-Fluid Levels.
Head Rotation.
MML and IR Alignment.
Detecting Poor MML Positioning.
Adjusting the CR for Poor MML Alignment.
Correcting the CR Angulation for Poor MML Alignment.
Modified Waters Method.
Parietoacanthial and Acanthioparietal Projection Analysis Practice
Analysis.
Correction.
12 Digestive System
Outline
Objectives
Key Terms
Image Analysis Guidelines
Technical Data.
Using the AEC for Double-Contrast Examinations.
Pendulous Breasts.
Peristaltic Activity and Exposure Times.
Body Habitus Positioning Variations.
Hypersthenic.
Asthenic.
Sthenic.
Respiration.
Esophagram: Upper GI System
Upper GI Preparation Procedure
Esophagram Preparation.
Stomach and Duodenum Preparation.
Contrast Medium.
Esophagram: PA Oblique Projection (RAO Position)
Body Obliquity.
Inaccurate Patient Rotation.
Esophagram: Lateral Projection
Rotation.
Detecting Thorax Rotation.
Esophagram: PA Projection
Rotation.
Detecting Rotation.
Stomach and Duodenum
Contrast Medium.
Single Contrast.
Double Contrast.
Stomach and Duodenum: PA Oblique Projection (RAO Position)
Patient Obliquity.
Stomach and Duodenum: PA Projection
Patient Obliquity.
Detecting Rotation.
Stomach and Duodenum: Lateral Projection (Right Lateral Position)
Rotation.
Detecting Rotation.
Stomach and Duodenum: AP Oblique Projection (LAO Position)
Patient Obliquity.
Stomach and Duodenum: AP Projection
Patient Obliquity.
Detecting Rotation.
Small Intestine
Preparation Procedure
Small Intestine Preparation.
Contrast Medium.
Variations in Positioning Procedure Because of Body Habitus.
Supine Hypersthenic Patient.
Supine Obese Patient.
Small Intestine: PA Projection
CR Centering for Early Versus Later Series Projections.
Rotation.
Detecting Abdominal Rotation.
Large Intestine
Preparation Procedure
Large Intestine Preparation.
Good Double-Contrast Lower Intestinal Filling.
Barium Pools.
Poor Double Contrast.
Large Intestine: PA or AP Projection
Detecting Abdominal Rotation.
PA Projection.
AP Projection.
Large Intestine (Rectum): Lateral Projection
Rotation.
Large Intestine: AP or PA Projection (Lateral Decubitus Position)
IR Size and Direction for Hypersthenic and Obese Patients.
Rotation.
PA Decubitus Projection.
AP Decubitus Projection.
Large Intestine: PA Oblique Projection (RAO Position)
Patient Obliquity.
Detecting Inadequate Obliquity.
Large Intestine: PA Oblique Projection (LAO Position)
Patient Obliquity.
Detecting Inadequate Obliquity.
Large Intestine: PA Axial Projection and PA Axial Oblique Projection (RAO Position)
PA Axial: Rotation.
PA Axial Oblique Projection (RAO Position): Patient Obliquity.
Detecting Inadequate Obliquity.
CR Angulation.
Detecting Inadequate CR Angulation.
Bibliography
Glossary
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X