Image Analysis Final (central rays) Flashcards
CR: Digits 2-5
perpendicular to PIP joint of affected digit
CR thumb/first digit:
perpendicular to MCP joint
CR for PA and oblique hand:
perpendicular to the 3rd MCP joint
CR for lateral hand:
perpendicular to the 2nd MCP joint
CR for wrist
perpendicular to midcarpal area
what is best demonstrated on a PA oblique wrist:
trapezium and distal half of scaphoid
what is best demonstrated on AP oblique wrist?
pisiform
CR for AP and Lateral forearm:
perpendicular to the midpoint of the forearm
why is AP forearm is done over PA?
pronation of hand crosses radius over ulna at the proximal third and rotates the humerus medially creating an oblique – AP keeps them separated
CR for AP elbow?
perpendicular to elbow joint
What is best demonstrated on the lateral elbow?
olecranon process
CR for AP medial oblique elbow:
perpendicular to elbow joint
what is best demonstrated on AP Medial oblique elbow?
coronoid process
CR for AP Lateral Oblique elbow:
perpendicular to elbow joint
what is best demonstrated on AP Lateral Oblique Elbow?
radial head and neck
CR AP and Lateral humerus:
perpendicular to the mid-portion of the humerus and the center of the IR
CR for AP External SHoulder:
perpendicular 1 inch inferior to coracoid process
Hand placement for AP External shoulder?
supinate the hand
what is best demonstrated on the AP external shoulder?
greater tubercle
CR for AP internal shoulder:
perpendicular 1 inch inferior to coracoid process
hand placement for AP internal shoulder
back of hand on hip
what’s best demonstrated on an AP internal shoulder?
lesser tubercle
CR for Transthoracic Lateral Shoulder
perpendicular to the IR entering the MCP at the level of the surgical neck
Placement of affected arm in a Transthoracic Lateral Shoulder
By side
Placement of unaffected arm in a Transthoracic Lateral Shoulder
Raise it and rest forearm on head and elevate shoulders as much as possible
CR for Axillary Shoulder (Inferosuperior)
horizontally through the axilla to the region of AC articulation – medial angulation of CR depends on degree of abduction of arm (15-30)
What is the lesser tubercle placement in Axillary Shoulder(inferosuperior)
in profile and directed anteriorly
CR for bilateral AP AC joints:
perpendicular to the midline of the body at the level of the AC joints for a single projection
CR for AP Axial AC joints:
Directed to the coracoid process at a cephalic angle of 15 degrees
CR for AP Clavicle:
perpendicular to midshaft of the clavicle
CR for AP Axial Clavicle:
15 degrees cephalic enter the midshaft of the clavicle
What is the purpose of angulation for AP Axial Clavicle?
To project the clavicle off the scapula and ribs
CR for AP scapula
perpendicular to mid-scapular area at a point approximately 2 inches inferior to the coracoid process
Where is the affected arm placed for a AP scapula?
Abduct the arm to a right angle with body, flex the elbow, and support the hand in a comfortable position
CR for lateral scapula:
perpendicular to the mid-medial border of the protruding scapula
What makes up the “Y” in the lateral scapula?
Acromion, coracoid process, and body of scapula
CR for AP Axial Toes
15 degrees posteriorly through 3rd MTP joint
CR for AP oblique Toes:
Perpendicular and entering the third MTP joint
CR for Lateral Toes:
entering IP joint for great toe or proximal IP joint for lesser toes
CR for AP or AP Axial Foot
10 degrees toward the heel entering the base of 3rd metatarsal
or
entering base of third metatarsal
CR for lateral foot
perpendicular to the base of third metatarsal
CR for AP medial Oblique Foot
base of third metatarsal
Degree of obliquity for AP Medial Oblique Foot
30 degrees
AP Medial Oblique Foot critique for correct rotation
if more than 30 degrees the lateral cuneiform tends to be thrown over other cuneiforms – cuboid in profile
CR for Axial Calcaneus
cephalic angle of 40 degrees to the long axis of the foot entering the base of the third metatarsal
CR for lateral calcaneus
1 inch distal to medial malleolus – subtalar joint
CR AP ankle
perpendicular through the ankle joint at a point midway between the malleoli
CR Lateral Ankle:
perpendicular to the ankle joint entering the medial malleolus
CR for AP medial oblique ankle:
perpendicular to the ankle joint entering midway between malleoli
AP medial oblique ankle critique to check rotation
distal ends of the tibia and fibula shown and tibiofibular articulation should be shown
CR AP and Lateral Lower Leg
perpendicular to the center of the leg
CR AP knee
5 degrees cephalic 1/2 inch inferior to the patellar apex
CR Lateral Knee
5-7 cephalic 1 inch distal to medial epicondyle
CR AP medial oblique knee
1/2 inch inferior to the patellar apex
Patient position for intercondylar fossa (camp Coventry)
prone – patient knee to a 40-50 degree angle
CR of intercondylar fossa (camp Coventry)
perpendicular to the long axis of the lower leg and centered to the knee joint – angle 40 degrees when knee is 40 degrees
CR for tangential patella (settegast method)
perpendicular to the joint space between the patella and the removal condyles when the joint is perpendicular – angle 15-20 degrees
CR for AP Femur
perpendicular to the mid-femur
what is the purpose of rotating limb internally 15-20 degrees on a AP Femur?
places femoral neck in profile
CR for lateral femur
perpendicular to the mid-femur
CR for AP Pelvis:
2 inches inferior to ASIS and 2 inches superior to pubic symphysis
how to check for proper lower limb rotation in AP pelvis?
if femoral necks parallel with plane of image receptor
CR for AP Hip:
perpendicular to femoral neck
AP Hip, hip localization technique:
left thumb on ASIS, second finger is on superior margin of pubic symphysis. CR is positioned 1.5 inches distal to center of line drawn between ASIS and pubic symphysis
CR for lateral frog hip
perpendicular through the hip joint (midway between ASIS and pubic symphysis)
Greater tubercle position in lateral frog hip
greater trochanter overlaps femoral neck
CR Axiolateral Hip
perpendicular to long axis of the femoral neck
Relationship of femoral neck and IR in Axiolateral Hip
parallel
CR AP open mouth
perpendicular to center of IR and entering the midpoint of open mouth
Position of mouth for AP Open Mouth
open mouth as wide as possible, adjust head so that a line from the low edge of the upper incisors to the tip of the mastoid process is perpendicular to IR
AP Open Mouth SID and why:
30 inch to increase the field of view of the odontoid area
AP Axial Cervical CR
15-20 degrees cephalic through C4
which vertebra must be see on AP Axial Cervical
C3-T2
what is demonstrated on the AP Axial Cervical
the lower 5 cervical bodies, upper 2 or 3 thoracic bodies, the interpediculate spaces, the superimposed transverse and articular processes and the intervertebral disk spaces
CR lateral cervical
horizontal and perpendicular to C4
SID for lateral cervical and why
60-72” increased object to IR distance to show C7
what is best demonstrated on lateral cervical
spinous processes and cervical bodies and interspaces, open zygapophyseal joints
CR posterior oblique cervical
C4 at a cephalic angle of 15-20 degrees
marker placement for posterior oblique cervical
mark down side – opposite from what is demonstrated
best demonstrated on posterior oblique cervical
intervertebral foramina and pedicles farthest from the IR an oblique projection of bodies
CR for anterior oblique cervical
C4 at an angle of 15-20 degrees caudal
marker placement on Anterior Oblique Cervical
mark down side – same side of what’s demonstrated
what’s best demonstrated on anterior oblique cervical
intervertebral foramina and pedicles closest to the IR and an oblique projection of the bodies
CR AP thoracic
halfway between the jugular notch and xiphoid process (T7)
Respiration for AP thoracic
suspend at end of full expiration
CR for lateral thoracic
perpendicular to level of T7
lateral thoracic respiration
breathing technique
best demonstrated on lateral thoracic
lateral projection of thoracic bodies, interspaces, intervertebral foramina, and lower spinous processes
which thoracic vertebra are visualized on lateral thoracic spine and why?
lower 9 because T1-T3 are superimposed by shoulders
CR swimmers
caudal 3-5 degrees direct to C7-T1 interspace
swimmers respiration
suspend, breathing technique
CR AP lumbar spine
perpendicular to IR at level of iliac crests
best demonstrated on AP lumbar
lumbar bodies intervertebral disk spaces, interpediculate spaces, laminae, and spinous and transverse processes
CR lateral lumbar
perpendicular to level of the crest enters MCP
best demonstrated on lateral lumbar
lumbar bodies and their interspaces, the spinous processes, and the lumbosacral junction
CR posterior oblique lumbar
2 inches medial to elevate ASIS and 1 1/2 inches above iliac crest
best demonstrated on posterior oblique lumbar
oblique projection of the lumbar or lumbosacral spine or both showing the articular process on the side closest to the IR
Scotty dog ear
superior articular process
scotty dog eye
pedicle
scotty dog neck/collar
pars interarticularis
scotty dog nose
transverse process
scotty dog front leg
inferior articular process
CR L5-S1 Spot
5-8 caudal center on coronal plane 2 inch posterior to ASIS and 1 1/2 inches inferior to iliac crest
CR AP Sacrum
15 cephalic at 2 inches superior to pubic symphysis
CR AP coccyx
10 caudal 2 inches superior to pubic symphysis
CR lateral sacrum and coccyx
perpendicular and directed to level of ASIS and to a point 3 1/2 inches posterior
Lateral Sacrum and Coccyx IR placement
top of film at crests
CR AP Axial SI joints
30-35 cephalic enters 1 1/2 inches superior to pubic symphysis on MSP
CR posterior oblique SI joint:
perpendicular entering 1 inch medial to elevated ASIS
Degree of obliquity of posterior oblique SI joint
25-30
which SI joint is demonstrated on the posterior oblique SI joint?
upside
CR for AP and Lateral Esophagus
IR is at the level of the mouth – level of T5-T6
CR RAO Esophagus
Top of IR is at the level of mouth (level of T5-T6)
degree of obliquity for RAO esophagus:
35-40 degrees
Purpose of obliquing patient for RAO esophagus
places esophagus between the vertebra and the heart
CR for PA UGI
1-2 inch above the lower rib margin at the level of L1-L2
where contrast will be on a double-contrast study for PA UGI?
body, duodenal bulb, and pylorus
CR RAO UGI:
1-2 inches above lower rib margin level of L1-L2
Degree of obliquity RAO UGI:
40-70 degrees
what is demonstrated to RAO UGI:
stomach, duodenal bulb, duodenal loop, pyloric canal
CR lateral UGI
level of L1-2 for recumbent (1-2 inches above lower rib margin) level of L3 for upright
CR AP UGI
level midway between the xiphoid process and lower rib margin
in AP UGI where barium will be on double-contrast study
fundus
CR for PA BE
enter the midline of the body at the level of the iliac crests
where is barium situated in colon in PA BE?
transverse colon
CR PA Axial Sigmoid BE
30-40 caudal to enter midline of body at the lvel of ASIS
best demonstrated on PA Axial Sigmoid BE
rectrosigmoid area of colon
CR PA Oblique RAO BE
1-2 inches lateral to midline of the body on the elevate side at level of iliac crest
degree of obliquity for PA Oblique (RAO) BE
35-45
best demonstrated PA Oblique (RAO) BE
right colic flexure, ascending colon, and the sigmoid colon
CR PA oblique (LAO) BE
perpendicular to IR and entering approximately 1-2 inches lateral to midline of the body on the elevated side at the level of iliac crest
degree of obliquity for PA oblique (LAO) BE
35-45
Best demonstrated on PA oblique LAO BE
left colic flexure and the descending portion of the colon
CR left lateral rectum
enter MCP at level of ASIS
best demonstrated on left lateral rectum
rectum and distal sigmoid portion
CR AP BE
enter midline of body at the level of iliac crest
where barium lies on double-contrast AP BE
flexures
CR AP Axial Sigmoid BE
30-40 cephalic enter midline of body approximately 2 inches below ASIS
best demonstrated AP Axial Sigmoid BE
rectrosigmoid area of colon
CR Right lateral decubitus BE
horizontal and perpendicular to enter the midline of the body at the level of the iliac crests
best demonstrated on right lateral decubitus BE
“UP” medial side of the ascending colon and lateral side of descending colon when colon is inflated with air
CR left lateral decubitus BE
horizontal and perpendicular to the IR to enter the midline of the body at the level of iliac crests
best demonstrated on left lateral decubitus BE
“up” lateral side of the ascending colon and the medial side of the descending colon when the colon is inflated with air
CR cross table lateral (ventral decub) BE
horizontal and perpendicular to the IR to enter MCP of the body at the level of the iliac crests
bets demonstrated cross table lateral (ventral decub) BE
“up” posterior portions of colon
– only on double contrast
CR PA Skull
exit nasion
PA Skull best demonstrates
frontal bone
PA Skull OML
perpendicular
PA Skull petrous ridges
filling the orbits
CR PA Axial Skull (Caldwell)
15 degree caudal exit nasion
PA Axial Skull (Caldwell) best demonstrated
frontal bone
PA Axial Skull Caldwell OML
perpendicular
PA Axial Skull Caldwell Petrous Ridges
lower third of orbit
CR lateral skull
perpendicular entering 2 inches superior to EAM
in lateral skull which lines are parallel with long axis of IR
IOML and MSP
Lateral Skull IPL
perpendicular
CR AP Axial Skull(Townes)
Directed through the foramen magnum at a caudal angle of 30 degrees to OML or 37 degrees to IOML. Enters approximately 2 1/2 inches above the glabella and passes through the level of the EAM
AP Axial Skull Townes best demonstrates
occipital bone
CR lateral facial bones
halfway between the outer canthus and EAM
What facial bones are demonstrated on lateral facial bones
All facial bones
CR for Parietoacanthial (waters)
perpendicular to exit acanthion
Parietoacanthial Waters OML
37 degree angle
Parietoacanthial Waters which line is perpendicular to IR
MML and MSP
CR lateral nasal bones
perpendicular to the bridge of the nose at a point 1/2 inch distal to nasion
which side is demonstrated on lateral nasal bones
side nearest film
lateral nasal bones done TT or bucky
TT
CR SMV for zygomatic arches
perpendicular to the IOML and entering MSP of throat approximately 1 inch posterior to outer canthus
SMV for zygomatic arches IOML
parallel
SMV for zygomatic arches MSP
perpendicular
CR Lateral Sinuses
horizontal entering the patient’s head 1/2 to 1 inch posterior to outer canthus
Lateral sinus IPL
perpendicular to IR
Lateral Sinus MSP
parallel to IR
Lateral Sinus IOML
parallel to transverse plane of IR
What sinuses are demonstrated on Lateral Sinuses
all
what sinuses are demonstrated on Caldwell Sinuses?
frontal, sphenoid, maxillary
what sinus I best demonstrated in Caldwell sinuses?
frontal
location of petrous ridges in waters sinuses?
below the floor of the maxillary sinus
sinuses demonstrated in waters sinus
maxillary sinus, ethmoid sinus, frontal
which sinus is best demonstrated in waters sinus?
maxillary sinus
CR for PA mandible
perpendicular to exit acanthion
in PA mandible what is in contact with the grid
patients forehead and nose
CR PA Axial Mandible
20-25 cephalic exits acanthion
CR Axiolateral Oblique Mandible
20-25 cephalic enters approximately 2” distal gonion of upside
chin placement of axiolateral oblique mandible
extend until body is parallel with IR plane
CR AP Axial TMJ
35 caudal midway between TMJs entering a point 3 inches above nasion
What 2 exposures are made for AP axial TMJ
open and closed mouth
Axiolateral TMJ CR
25-30 caudal enters 1/2” anterior and 2” superior to upside EAM, exits through TMJ
what side is against IR for Axiolateral TMJ
affected side
what is demonstrated on Axiolateral TMJ
condyles and neck of mandible
CR Rhese
exits down orbit
In Rhese what parts touching grid
nose, cheek, and chin
What positioning line is perpendicular to IR in Rhese?
AML
what is demonstrated in Rhese?
optic foramen in lower outer quadrant of orbit
