1 to 1- Projectional skills - Adaptive radiography

Question 1

The patient is unable to turn their wrist for the lateral projection, so you have undertaken a horizontal beam lateral with the patient in the PA position. The IR is positioned on the radial aspect of the wrist.
You produce the image shown.

For 2 marks, would you repeat this image and explain your answer????
For 6 marks, if you were to repeat what actions would you take to correct the image shown.

28 year old female
X-ray left wrist
Polytrauma patient
Fracture radius and ulna; follow up post external fixation and k-wire
?position

The patient is unable to turn her arm for the lateral projection, so you have undertaken a horizontal beam lateral with the patient in the PA position.
The IR is positioned on the radial aspect of the wrist.

Answer 1

Yes (1 mark)
The radial and ulnar styloid processes are not superimposed; therefore, the exact degree of any displacement cannot be assessed (1 mark)

No (1 mark)
Image demonstrates degree of fracture healing. Displacement will have been assessed on post-op images (1 mark)

For 6 marks if you were to repeat what actions would you take?
The ulnar styloid is projected posterior to the radial styloid (1 mark)
The tube needs a 5° angle (1 mark) anterior (1 mark)
This will project the ulnar styloid anteriorly superimposing it over the radial styloid (1 mark)

The centring point is too proximal leading to the radio-carpal joint not being demonstrated in profile (1 mark).
The metacarpals and distal external fixation are not included in the image (1 mark).
Therefore centring could be moved distally 3cm (1 mark) and collimation adjusted to included MC heads and proximal external fixation (1 mark)

Question 2

Rotation of the patient
If your patient is rotated/tilted:
Anatomy in the “upper” half of the patient shifts with the rotation
Anatomy on the “lower” half of the patient shifts against the rotation
The further an object is from the centre of rotation, the more it moves

Angling the tube to project anatomy
You will always project the anatomy that is furthest away from the IR more than anatomy that is near the IR

Answer 2

Note slide

Question 3

You produce the lateral shown

For 2 marks, would you repeat this image. Justify your answer.
For 4 marks, if you were to repeat what actions would you take to correct the image shown.
Explain your answers.
You should assume that the patient is able to rotate their leg.

19 year old male
X-ray left knee
Football injury; direct blow to knee leading to hyperextension
? fracture

Answer 3

Yes (1 mark)
The lateral and medial condyles are not superimposed; therefore the tibial plateau and anterior condylar border are not fully demonstrated (1 mark)

No (1 mark)
Though the lateral and medial condyles are not superimposed, any trauma pathology would be demonstrated (1 mark)

The lateral condyle is projected posterior to the medial (1 mark)
The patient’s leg should be internally rotated (1 mark) 10° (1 mark) to superimpose the condyles (1 mark)

Question 4

Facial bones x-ray
Petrous ridge is sitting within the maxillary sinus
Therefore the OMBL is not at 45° to the horizontal
Raise the head 10°
OR
Apply a 10° caudal angle
This will project the petrous ridge (posterior) below the sinus (anterior)

Answer 4

Petrous ridge is sitting within the maxillary sinus
Therefore the OMBL is not at 45° to the horizontal
Raise the head 10°
OR
Apply a 10° caudal angle
This will project the petrous ridge (posterior) below the sinus (anterior)

Question 5

Ankle x-ray
Fibula is superimposed over talus and tibia
Internal rotation will separate – 15°
OR
A 15° lateral/external angle will project the fibula (slightly anterior) laterally from the talus (slightly posterior)

Answer 5

Fibula is superimposed over talus and tibia
Internal rotation will separate – 15°
OR
A 15° lateral/external angle will project the fibula (slightly anterior) laterally from the talus (slightly posterior)

Question 6

Wrist x-ray
Radius is projected anterior to the ulna
Externally rotate 5° to bring the radius posteriorly
OR
Angle 5° posteriorly to project the radius (lateral) posteriorly to the ulna (medial)

Answer 6

Radius is projected anterior to the ulna
Externally rotate 5° to bring the radius posteriorly
OR
Angle 5° posteriorly to project the radius (lateral) posteriorly to the ulna (medial)

Question 7

“Bum & cherry” technique

Lateral knee
If the condyles look like a bum then you need to internally rotate the knee, as you are externally rotated (INTO THE BUM)

If the condyles look like a cherry you need to externally rotate the knee, as you are internally rotated (OUT OF THE CHERRY)

Answer 7

“Bum & cherry” technique

Lateral knee
If the condyles look like a bum then you need to internally rotate the knee, as you are externally rotated (INTO THE BUM)

If the condyles look like a cherry you need to externally rotate the knee, as you are internally rotated (OUT OF THE CHERRY)