Image Critique

Question 1

AP Humerus

Answer 1

Positioning: Patient upright or supine; arm extended with palm facing forward. Ensure humeral epicondyles are parallel to the IR.
Rotation Check:
Mediolateral: Greater and lesser tubercles should be visible in profile; rotation is indicated if the greater tubercle is obscured or if the lesser tubercle appears prominently.
Superior/Inferior: Misalignment of shoulder and elbow joints indicates off-level positioning.
Collimation: Top of the IR should include the shoulder joint, with the lower edge capturing the elbow.
Evaluation: The greater tubercle should be in profile laterally, epicondyles parallel to the IR, with the entire humerus, shoulder, and elbow joints included.

Question 2

Lateromedial or Mediolateral Humerus

Answer 2

Positioning: Patient upright with the humerus in a true lateral position; ensure epicondyles are perpendicular to the IR.
Rotation Check:
Mediolateral: Epicondyles should be fully superimposed; if visible as two separate profiles, rotation or obliquity is present.
Superior/Inferior: The shoulder and elbow joints should align vertically; any angulation indicates rotation.
Collimation: Shoulder joint down to the elbow, ensuring soft tissue on each side.
Evaluation: Superimposed epicondyles with minimal soft tissue overlap; both joints visible.

Question 3

Lateral Humerus (Recumbent Rotational Lateral)

Answer 3

Positioning: Patient supine, arm abducted and rotated until epicondyles are perpendicular to IR.
Rotation Check:
Mediolateral: Epicondyles appear offset if rotation is present; adjust until epicondyles are superimposed.
Superior/Inferior: Ensure the shoulder and elbow joints align horizontally on the IR.
Collimation: Include both shoulder and elbow, allowing for lateral soft tissue.
Evaluation: Epicondyles should be superimposed and centered, shoulder and elbow joints fully visualized.

Question 4

Lateral Mid and Distal Humerus (Trauma)

Answer 4

Positioning: With the elbow flexed, place the distal humerus in a lateral view without disturbing the upper arm.
Rotation Check:
Mediolateral: Check for double contours along the epicondyles, which indicates improper rotation.
Superior/Inferior: If one end appears elevated, adjust until the humerus is horizontally level.
Collimation: Focus on the mid-to-distal humerus and elbow joint.
Evaluation: The epicondyles should be superimposed, clear bone detail should be visible, and soft tissue well-defined.

Question 5

AP Pelvis

Answer 5

Positioning: Patient supine, legs rotated 15-20° internally to align femoral necks.
Rotation Check:
Mediolateral: Asymmetrical iliac wings or obturator foramina suggest rotation.
Superior/Inferior: Misalignment of iliac crests indicates superior or inferior tilt.
Collimation: Top edge above the iliac crest, lower edge at proximal femora.
Evaluation: Symmetrical iliac wings and obturator foramina, entire pelvis, and both proximal femora visible.

Question 6

AP Hip

Answer 6

Positioning: Patient supine, affected leg internally rotated 15-20°.
Rotation Check:
Mediolateral: Greater trochanter in profile, minimal lesser trochanter visibility.
Superior/Inferior: Femoral neck foreshortening suggests improper tilt.
Collimation: Hip joint and proximal femur, centered to the hip.
Evaluation: Clear hip joint, femoral neck without foreshortening, trochanters visible.

Question 7

Rolled Lateral Hip

Answer 7

Positioning: Patient rotated toward the affected side, with leg flexed and knee turned outward.
Rotation Check:
Mediolateral: Lesser trochanter visibility changes; adjust until minimal visibility is achieved.
Superior/Inferior: Head of femur should be horizontally aligned with the acetabulum.
Collimation: Entire hip joint and upper femur.
Evaluation: Hip joint visible, femoral neck and trochanters in profile.

Question 8

AP Open Mouth (Odontoid)

Answer 8

Positioning: Align upper incisors with the base of the skull.
Rotation Check:
Mediolateral: Dens and lateral masses should be symmetric; if shifted, adjust head rotation.
Superior/Inferior: Occlusion by teeth or skull indicates incorrect head tilt.
Collimation: Focused to C1-C2 region.
Evaluation: Dens fully visible and centered, lateral masses of C1 symmetric

Question 9

AP Axial Cervical Spine

Answer 9

Positioning: Patient supine or upright, with chin slightly elevated; CR angled 15-20° cephalad toward C4.
Rotation Check:
Mediolateral: Spinous processes should be centered along the vertebral bodies.
Superior/Inferior: Open intervertebral spaces confirm correct angulation.
Collimation: From C3 to T2.
Evaluation:
Correct Angulation: Vertebral alignment with open intervertebral spaces and centered spinous processes.
Too Large Angle: Intervertebral spaces may appear closed, with foreshortening of the vertebral bodies, indicating excessive angulation.
Too Small Angle: Overlapping of vertebral bodies, with closed intervertebral spaces, indicating insufficient angulation.

Question 10

PA 45° Oblique Cervical Spine

Answer 10

Positioning: Patient at a 45° oblique angle with CR directed at C4 and angled 15° caudad.
Rotation Check:
Mediolateral: Open intervertebral foramina on the side of interest.
Superior/Inferior: Closed foramina indicate incorrect CR angle.
Collimation: Covering C1 to C7.
Evaluation:
Correct Angulation: Clear intervertebral foramina and lateral soft tissue structures visible on the side of interest.
Too Large Angle: Intervertebral foramina on the side of interest may appear closed or poorly defined, possibly leading to overlapping of vertebral bodies.
Too Small Angle: Lack of visibility of foramina, with the lateral masses of the vertebrae appearing distorted.

Question 11

Lateral Cervical Spine

Answer 11

Positioning: Patient’s chin elevated to prevent jaw overlap.
Rotation Check:
Mediolateral: Zygapophyseal joints should superimpose; double borders indicate rotation.
Superior/Inferior: Vertebrae overlap if misaligned vertically.
Collimation: C1 through C7.
Evaluation: Open intervertebral spaces, zygapophyseal joints aligned.

Question 12

AP Thoracic Spine

Answer 12

Positioning: Patient supine, centered to T7.
Rotation Check:
Mediolateral: Shifted spinous processes; they should be aligned to midline.
Superior/Inferior: Disk spaces appear uneven if angulation is incorrect.
Collimation: C7 to L1.
Evaluation: Clear vertebral bodies, disk spaces open.

Question 13

Lateral Thoracic Spine

Answer 13

Positioning: Arms raised, centered to T7.
Rotation Check:
Mediolateral: Ribs superimposed; if not, adjust to achieve rib overlap.
Superior/Inferior: Misaligned vertebral bodies suggest incorrect height.
Collimation: T3 to L1.
Evaluation: Open intervertebral spaces, ribs superimposed.

Question 14

AP Abdomen (KUB)

Answer 14

Positioning: Supine, centered at iliac crests.
Rotation Check:
Mediolateral: Asymmetrical iliac wings or shifted spinous processes.
Superior/Inferior: Pubic symphysis should be centered.
Collimation: Diaphragm to pubic symphysis.
Evaluation: Symmetrical iliac wings, all abdominal organs visible.

Question 15

AP Lumbar Spine

Answer 15

Positioning: Supine, knees bent to reduce lordosis.
Rotation Check:
Mediolateral: Pedicles and spinous processes should be symmetric.
Superior/Inferior: Disk spaces should be uniform.
Collimation: T12 to sacrum.
Evaluation: Clear vertebral alignment, open disk spaces.

Question 16

Lateral Lumbar Spine

Answer 16

Positioning: Lateral with knees flexed.
Rotation Check:
Mediolateral: Rib or zygapophyseal joint misalignment suggests off-rotation.
Superior/Inferior: Disk spaces closed if spine is angled.
Collimation: T12 to sacrum.
Evaluation: Superimposed vertebral bodies, clear intervertebral spaces.

Question 17

Lateral L5-S1 (Spot View)

Answer 17

Positioning: Patient in a true lateral position; CR angled 5-8° caudad to open the L5-S1 joint space.
Rotation Check:
Mediolateral: Superimposed margins at L5-S1.
Superior/Inferior: Vertebral bodies should align without overlap; correct angulation opens the joint space.
Collimation: Focused on the L5-S1 region only.
Evaluation:
Correct Angulation: Clear L5-S1 joint space, with superimposed posterior borders of the vertebral bodies.
Too Large Angle: The joint space may appear widened or distorted, and the L5-S1 junction may be obscured due to excessive separation.
Too Small Angle: The joint space will likely appear closed or overlapping of the L5 and S1 vertebrae, indicating insufficient angulation to visualize the area properly.