Image Evaluation Criteria Flashcards
How much of the lungs should be shown on a Chest xray?
Entire lungs from the apices to the costophrenic angles
Is there any rotation on any CXR? If there is, which ones?
Only PA/AP Oblique projections
Where should the CR enter on a PA chest?
Should enter at the level of T7 (inferior angle of the scapula)
Are air-fluid levels seen on a AP or PA Chest?
Yes
Where should you adjust the height of the IR on a PA Chest?
the upper border is about 1.5 to 2 inches (3.8 to 5cm) above the relaxed shoulders
Where should you center the midsagittal plane of the pt body to the IR?
MSP is centered midline of the IR
On a PA Chest, the head should be adjusted so that the MSP is _______
vertical
When positioning a pt in a PA Chest, what should be avoided in the image, and part of the purpose in doing this position.
Engorgement of the pulmonary vessels
What should the pt do with their arms in a PA
Chest?
Elbows should be flexed, the back of the hands should be low on the hips below the costophrenic angles
What should the pt do with their shoulders in a PA Chest?
Depress the shoulders and adjust to lie in the same transverse plane. Rotate the shoulders forward so that they both touch the vertical grid device.
In a PA Chest, why do we move the arms in a specific position? What does this do and show in our images?
These movements will position the clavicles below the apices of the lungs
In a PA Chest, why do we move the shoulders forward?
This movement will rotate the scapulae outward and laterally to reduce superimposition of the scapulae with the lungs
In a PA Chest, what would happen if we take an image of a female pt with large breasts? What can we do to correct the image and make it look better?
A female pt with large breasts can superimpose the lower part of the lung field, especially the costophrenic angles.
We should ask the pt to pull the breasts upward and laterally that way be can see the anatomy better but also show if there is any presence of fluid.
In a PA Chest, should there be a full inspiration or expiration? Why is this important?
Exposure is made after the second full inspiration to ensure the maximum expansion of the lungs (shows all of the lungs). Sometimes certain conditions are made present at the end of the full inspiration/expiration.
In a PA Chest, what happens with the lungs when there is maximum expansion?
The lungs expand transversely, anteroposteriorly, and vertically, with the vertical being the greatest dimension.
What should be clearly seen on a PA Chest?
Entire lungs, no rotation, sternal ends of the clavicles equidistant from the vertebral column, trachea visible in the midline, equal distance from the vertebral column to the lateral border of the ribs on each side, proper anterior shoulder rotation - scapula projected outside the lung fields, proper inspiration demonstrated by 10 posterior ribs visible above diaphragm, sharp outlines of heart and diaphragm, faint shadows of ribs and thoracic vertebrae through heart shadow, and pulmonary markings from hilar regions
For a PA & Lateral Chest, what ways can you have the pt positioned?
They can be upright standing (recommended) or upright seated
This could be taken laying down but does not show air-fluid levels and the diaphragm at its lowest position that well
In a Lateral Chest, adjust the position of the pt so that the MSP of the body is ________ with the IR and the adjacent shoulder is touching the grid device.
Parallel
The MCP should be ___________ and ________ to the midline of the grid.
MCP should be perpendicular and centered
What should the pt do with their arms in a Lateral Chest?
The pt should extend their arms directly upward, flex the elbows and with the forearms resting on the head and have them hold that position for the image
In a Lateral Chest, where should you adjust the height of the IR?
Adjust the height of the IR so that the upper border is about 1.5 to 2 inches (3.8 to 5cm) above the shoulders
The MSP must be _______ for the lateral chest projection.
Vertical
In a lateral chest, having the pt lean against the the grid device results in ________ of all thoracic structures.
distortion (foreshortening)
In the lateral chest projection, besides the pt leaning against the grid, what else could the pt do that can result in distortion of structural outlines?
Forward bending
How many breaths should the pt do for a lateral and PA chest projection?
2 breaths, 1 exhalation and 2 inspirations
In the lateral chest projection, is the pt perpendicular or parallel to the center if the IR? How about the CR and the pt?
Perpendicular to the IR, parallel to the CR.
For a Lateral Chest, where should the CR enter?
MCP at the level of T7 or at the inferior aspect of the scapula
For the PA chest, is the pt perpendicular or parallel to the IR? How about the CR and the pt?
Parallel to the IR, perpendicular to the CR
What should be clearly seen on a lateral chest?
Entire lungs, no rotation, arm or soft tissues not overlapping the lung field or any parts of the arms and shoulders blocking the lungs in any way, hila in the approximate center of the radiograph, superimposition of the ribs posterior to the vertebral column, sternum in profile, trachea visible in the midline. long axis of the lung fields shown in vertical position w/o bending, opened thoracic intervertebral joint spaces, sharp outlines of heart/diaphragm, and pulmonary markings
For the AP chest projection, how can the pt be positioned?
If the pt is too ill to sit or stand they can be supine on the table. Upright sitting for pt that have to be in a wheelchair, and pt on a stretcher can be sitting up against the upright IR. Typically they would be upright at the bucky against the grid
For a AP chest, center the _____ of the chest to the IR
MSP
For the AP chest projection, adjust the IR so that the upper border is approximately…..
1.5 to 2 inches (3.8 to 5cm) above the relaxed shoulders
(if they can) what should the pt do with their arms in the AP chest projection?
flex the elbows, pronate the hands and place the hands on the hips to draw the scapulae laterally.
The shoulders (in AP chest) should lie in the same ________ plane
transverse
For the AP chest, is the pt perpendicular or parallel to the IR ? How about the pt and the CR?
Parallel to the IR, CR is perpendicular to the long axis of the sternum
Where should the CR enter in the AP chest projection?
Should enter about 3 inches (7.6cm) below the jugular notch
What should be clearly seen on a AP chest projection?
Entire lungs, no rotation, sternal ends of the clavicles equidistant from the vertebral column, trachea is visible, equal distance from the vertebral column to the lateral border of the ribs, clavicles appear more horizontal than in the PA chest projection, 1 inch between the apices and clavicles, and pulmonary markings
What method is the AP Axial Chest? What is the name of this position? Although this projection is of the chest, what is this specific projection normally imaging for?
Lindblom Method
Lordotic position
This projection is typically for the pulmonary apices
What positions can the pt be in for a AP Axial Chest projection?
Standing upright
What makes the AP Axial different from the AP chest when it comes to pt positioning?
The pt is standing upright, facing the tube and standing approximately 1 foot in front of the vertical grid, leaning back onto the bucky.
For the AP Axial chest, where should the IR be adjusted to?
Adjust the height of the IR so that the upper margin is about 3 inches above the upper border of the shoulders when the pt is adjusted in the lordotic position
For the AP Axial chest projection, you should adjust the pt with the coronal plane of the thorax ___ to ___ degrees from the vertical and MSP centered to the midline of the grid
15 to 20 degrees
For the AP Axial chest projection, is the pt perpendicular or parallel to the IR? How about the pt and the CR?
The pt is parallel to the IR. The pt is perpendicular to the CR
For the AP Axial chest projection, where should the CR enter at?
At the level of the midsternum (3 to 4 inches below the jugular notch)
What should be clearly seen on a AP Axial chest projection?
Pulmonary markings, entire apices and appropriate portion of the lungs, clavicles superior to the apices, sternal ends equidistant from the vertebral column, clavicles lying horizontally with sternal ends overlapping the first/second ribs, and ribs distorted w/ their anterior and posterior portions superimposed
Why do we do a decubitus chest x-ray?
Air-fluid levels are demonstrated the best
How do you know if it is a left or right lateral decubitus?
Whatever side the pt is laying on that is closer to the IR determines whether it is a left or right decubitus
EX: Pt is lying on their left side (which is closer to the IR) so it is a Left Lateral Decubitus
On the Lateral Decubitus, where can you normally see air and fluid?
Air: is demonstrated on the side up
Fluid: is demonstrated on the side down
What should you include for a pediatric chest?
Collimated fields should include mastoid tips to just above the iliac crests
What position is most preferred with pediatric chest x-rays?
Upright
What common restraints are used for a pediatric chest x-ray?
pigg-o-stat
For a Lateral Decubitus, how long should we let the pt lay on their side before taking an exposure? Why do we wait?
We should let the pt lay there for 5 minutes. We have them wait to allow the fluid to settle and air to rise.
(lateral decubitus) if the pt is laying on the affected side to demonstrate fluid, we should elevate the body __ to __ inches on a suitable platform or a firm pad
2 to 3 inches
For a Lateral Decubitus, what should the pt do with their arms?
Extend the arms well above the head, and adjust the thorax in a true lateral position.
(for a lateral decubitus) adjust the IR so that it extends approximately ___ to ___ inches beyond the shoulders
1.5 to 2 inches
(for a lateral decubitus) what is the relation of the IR to the pt? How about the pt and the CR?
The pt is parallel to the IR. The pt and the CR are perpendicular and horizontal
For a lateral decubitus, where should the CR enter the pt?
At a level 3 inches below the jugular notch for the AP and T7 for the PA
What should be clearly seen on a lateral decubitus?
Presence of a side marker and decubitus marker placed clear of anatomy of interest, affected side in its entirety, from apex to costophrenic angles, no rotation, sternal ends of the clavicle equidistant from the spine, pt arms not visible in the field of interest, faintly visible spine and pulmonary markings from the hilar region
What positions can you have the pt in for a lateral ventral or dorsal decubitus projection?
Prone or supine (true prone or supine)
When taking a x-ray of a lateral ventral or dorsal decubitus projection, how many inches should you elevate the pt?
2 to 3 inches
In a lateral ventral or dorsal decubitus projection, are you able to see air-fluid levels?
Yes
For a lateral ventral or dorsal decubitus projection, what should the pt do with their arms?
The pt should extend their arms well above the head, out of the lung field
For a lateral ventral or dorsal decubitus projection, where should the grid device be? How should it be adjusted?
The grid device should be against the affected side and should be adjusted so that the top of the IR extends to the level of the thyroid cartilage
(lateral ventral or dorsal decubitus projection) What is the relation of the pt and the IR? How about the pt and the CR?
The pt is perpendicular to the IR. The pt is horizontal and parallel to the CR
For the lateral ventral or dorsal decubitus projection, where should the CR enter at?
CR should enter at the level of the MCP and 3 to 4 inches below the jugular notch for the dorsal decubitus and at T7 for the ventral decubitus
What should be clearly seen on a lateral ventral or dorsal decubitus projection?
Presence of side and decubitus markers placed clear of anatomy of interest, entire lung field, including posterior and anterior surfaces, upper lung field not obscured by arms, no rotation of the thorax from a true lateral position, T7 in the center of IR, and pulmonary markings
What is the mediastinum?
is the area of the thorax bounded by the sternum anteriorly, the spine posteriorly, and the lungs laterally.
What structures make up the mediastinum?
Heart, great vessels, trachea, esophagus, thymus, lymphatics, nerves, fibrous tissue, and fat
The abdominopelvic cavity consists of what two parts?
(1) a large superior portion, the abdominal cavity and (2) a smaller inferior part, the pelvic cavity
Where does the abdominal cavity extend to/from?
extends from the diaphragm to the superior aspect of the bony pelvis
What does the abdominal cavity contain?
the stomach, small and large intestines, liver, gallbladder, spleen, pancreas, and kidneys.
The pelvic cavity lies within what margins?
margins of the bony pelvis and contains the rectum and sigmoid of the large intestines, the urinary bladder, and the reproductive organs
The abdominopelvic cavity is enclosed in a double-walled submembranous sac called the…
peritoneum
The outer portion of the seromembranous sac is termed the _______ ________, is in close contact with the abdominal wall, the greater (false) pelvic wall, and most of the undersurface of the diaphragm
Parietal peritoneum
The inner portion of the seromembranous sac, known as the ________ ___________, is positioned over or around the contained organs.
visceral peritoneum
What is the term that contains serous fluid?
peritoneal cavity
In a abdominal radiographic image you should be able to visualize what anatomy?
Outlines of the psoas muscles, lower border of the liver, kidneys, ribs and transverse processes of the lumbar vertebrae (and body) along with the diaphragm, T-spine, sacrum/coccyx, stomach, small/large intestines, pancreas, spleen, gallbladder, ureters, bladder, urethra, ASIS, iliac crest, adrenal glands, pubic symphysis, and greater trochanters
What does KUB stand for?
Kidneys, ureter and bladder
What should be clearly seen on a KUB?
Area from the pubic symphysis to the upper abdomen (two pictures may be necessary), centered vertebral column, ribs, pelvis, and hips, equidistant to the edge of image or collimated borders on each side, no rotation, spinous process/transverse process are centered, ischial spines of the pelvis symmetric (if visible), alae or wings of the ilia symmetric, sufficient exposure factors demonstrating: lateral abdominal wall and properitoneal fat layer (flank stripe), psoas muscle, lower liver, kidneys, inferior ribs, diaphragm w/o motion
For a KUB, center the ______ of the body to the midline of the grid device
MSP
For a KUB (supine position) where should you center the IR/collimated field to?
center the IR/collimated field at the level of the iliac crests, and ensure that the pubic symphysis is included
For a KUB (upright position) where should you center the IR/ collimated field to?
2 inches above the level of the iliac crests or high enough to include the diaphragm
(for a KUB) if the bladder is to be included on the upright image where should the IR/colliated field be at?
at the level of the iliac crests
(For a KUB) Where should the IR/collimated field be at if a pt is too tall? (two images would need to be taken)
IR/collimated field is oriented crosswise and is centered 2 to 3 inches above the upper border of the pubic symphysis
For a KUB, is the pt perpendicular or parallel to the IR? How about the pt and the CR?
The pt is parallel to the IR. The pt is perpendicular to the CR
For a KUB, where should the CR enter at?
At the level of the iliac crests for the supine position. Horizontal and 2 inches above the level of the iliac crests to include the diaphragm for the upright position
PA (upright) projection (KUB), center the ________ midline to the midline of the IR
abdominal
For a PA (upright) projection (KUB), where should you center the IR/collimated field to?
2 inches above the level of the iliac crests
For a PA (upright) projection (KUB), adjust the height of the vertical grid device so that the long axis of the IR is centered to the _________
MSP
For a PA (upright) projection (KUB), where should the pt be position/centered to the IR?
level of the iliac crests (a slightly higher centering point, 2 inches above the iliac crests may be necessary to ensure the diaphragm is included)
For a PA (upright) projection (KUB), CR is directed _________ and __________ to the midpoint of the IR
horizontal and perpendicular
For a PA (upright) projection (KUB), what should be clearly seen?
Diaphragm w/o motion, both sides of the abdomen if its too wide, side down when fluid is suspected, side up when free air is suspected, abdominal wall, flank structures, diaphragm, no rotation, spinous process centered, ischial spines of the pelvis symmetrical (if visible), alae or wings of the ilia symmetric, abdominal contents visible w/o contrast media
What is the SID for the AP L-spine projection?
48 inches (might take 40)
For the AP L-spine, why is the SID 48?
to reduce distortion and open the intervertebral disk spaces more completely
For the AP L-spine, center the _____ of the pt body to the midline of the grid
MSP
For the AP L-spine, how should the pts shoulders and hips be adjusted?
the pt shoulders and hips should lie in the same horizontal plane
To show the lumbar and sacrum in AP position we should center the pt to the IR at…..
the level of the iliac crests (L4)
To show the lumbar spine only (in AP) we should center the pt to the IR at…..
1.5 inches above the iliac crests (L3)
For the AP L-spine, is the pt parallel or perpendicular to the IR? How about the pt to the CR?
the pt is parallel to the IR. the pt is perpendicular to the CR
The CR is __________ to the IR at the level of the iliac crests (L4) for a lumbosacral examination or 1.5 inches above the iliac crests for the lumbar spine only
perpendicular
For the AP L-spine, what should be clearly seen?
area from the lower thoracic vertebrae to the sacrum, x-ray beam collimated to the later margin of the psoas muscles, no artifacts across the midabdomen from any elastic in the pt underclothing, no rotation, symmetric vertebrae with spinous process centered to the bodies, sacroiliac joints equidistant from the vertebral column, open intervertebral disk spaces
For the lateral L-spine, what should be clearly seen?
Area from the lower thoracic vertebrae to proximal sacrum for lumbar only, vertebrae aligned down the middle of the image, no rotation, superimposed posterior margins of each vertebral body, nearly superimposed crests of the ilia when the x-ray beam is not angled, spinous processes in profile, opened intervertebral disk spaces and intervertebral foramina (L1-L4)
For the Spot: L5-S1, what should be clearly seen?
Lumbosacral joint in the center of the image, open lumbosacral intervertebral disk space, crests of the ilia closely superimposing each other when the x-ray beam is not angled
For the AP Oblique, what should be clearly seen?
area from the lower thoracic vertebrae to the sacrum, z-joints closest to the IR - open and uniformly visible through the vertebral bodies, (if the joint is not well seen and the pedicle is anterior on the vertebral body, the pt is not rotated enough), (if the joint is not well seen and the pedicle is posterior on the vertebral body, the pt is rotated too much), vertebral column parallel w/ the tabletop so that T12-L1 and L1-L2 intervertebral joint spaces remain open
The cervical and lumbar curves, which are convex anteriorly (goes forward), are called?
Lordotic curves
The thoracic and pelvic curves are concave anteriorly (goes backward or in) and are called?
Kyphotic curves
What is scoliosis?
lateral curvature of the spine (side to side)
A typical vertebra is composed of two pain parts called?
the body and the vertebral arch
The vertebral arch is formed by two ___(1)___ and two ___(2)____ that support four ___(3)____ processes, two ___(4)_____ processes, and one ____(5)___ processes.
(1) pedicles
(2) laminae (lamina)
(3) articular
(4) transverse
(5) spinous
The part of the lamina between the superior and inferior articular processes is called the….
pars interarticularis
How many bodys of the spine can you see (or should see) for the L-spine?
7 bodies - T12, L1-L5, S1
What is the name of the method for the axiolateral projection (of the hip)?
Danelius-miller method
What is the name of the method for the lateral hip projection (mediolateral)?
Lauenstein and Hickey method
What is the name of the method for the tangential projection (Patella and patellofemoral joint)?
Settegast method
What is the name of the method for the tangential projection (Patella and patellofemoral joint)?
Merchant Method
What is the name of the method for the tangential projection (Patella and patellofemoral joint)?
Hughston Method
What is the name of the method for the AP Axial projection (Intercondylar fossa)?
Beclere method
What is the name of the method for the PA Axial projection (Intercondylar fossa)?
Camp-coventry method
What is the name of the method for the PA Axial projection (Intercondylar fossa)?
Holmblad method
What is the name of the method for the transthoracic lateral projection (shoulder)?
Lawrence method
What is the name of the method for the inferosuperior axial projection (shoulder)?
Lawrence method
Rafert ET AL. Modification
What is the name of the method for the inferosuperior axial projection (shoulder)?
West Point Method
For the PA projection of the digits, where does the CR enter?
PIP - Proximal Interphalangeal Joint
For the lateral projection of the digits, where does the CR enter at?
PIP - Proximal Interphalangeal joint
For the oblique projection of the digits, where does the CR enter at?
PIP - Proximal Interphalangeal joint
For the AP/PA, lateral, and oblique projection of the 1st digit (thumb), where does the CR enter at?
MCP - metacarpophalangeal joint
For the PA, lateral, and oblique projection of the hand, where does the CR enter at?
For the AP & oblique, it enters at the third MCP (Metacarpophalangeal joint)
For the lateral, it enters at the second digit of the MCP (metacarpophalangeal joint)
For the PA/AP, lateral, & oblique projection of the wrist, where does the CR enter at?
For the AP/PA it enters midcarpal area
For the Lateral it enters at the wrist joint (radiocarpal joint)
For the Obliques it enters at midcarpal area; just distal to the radius
For the PA Ulnar deviation projection of the wrist, where does the CR enter at? What is the angulation of the CR?
For the ulnar deviation it enters to the scaphoid
CR angulation of 10 to 15 degrees proximally or distally sometimes required for clear delineation
For the AP & lateral projection of the forearm, where does the CR enter at?
For the AP & lateral, the CR enters at midpoint of the forearm
How many degrees should you flex the elbow for a lateral forearm?
90 degrees
For the AP, lateral, & oblique (medial & lateral) projection of the elbow, where does the CR enter at?
For the AP the CR enters at the elbow joint.
For the lateral the CR enters at the elbow joint regardless of its location to the IR.
For the medial/lateral oblique the CR enters at the elbow joint
What should be clearly seen for a “trama” AP elbow projection (partial flexion) (2views)?
Distal humerus w/o rotation or distortion, proximal radius superimposed over the ulna, closed elbow joint, greatly foreshortened proximal forearm
Proximal radius and ulna w/o rotation or distortion, radial head/neck/tuberosity slightly superimposed over the proximal ulna, partially open elbow joint, foreshortened distal humerus
For the AP & lateral projection of the humerus, where does the CR enter at?
Enters midportion of the humerus
For the AP/Lateral humerus projection, where should the height of the IR be to the humerus?
The upper margin of the IR approximately 1 1/2 inches above the level of the humeral head
What bones make up the shoulder girdle?
the clavicle and scapula
Where does the CR enter on a external, internal, & neutral rotation of the shoulder
CR enters 1 inch inferior to the coracoid process
What is the name of the method for the AP oblique projection of the shoulder (glenoid cavity)?
Grashey method
Where does the CR enter on the AP oblique, grashey method of the shoulder?
CR should be at a point 2 inches medial and 2 inches inferior to the superolateral border of the shoulder
How much of an angle should the pt be from the IR in the AP oblique Grashey method projection of the shoulder?
35 to 45 degrees (affected side on the bucky)
Where does the CR enter on the transthoracic lateral projection - lawrence method of the shoulder?
enters MCP at the level of the surgical neck
For the transthoracic lateral projection - lawrence method of the shoulder, what should you do with the CR if the pt cannot elevate the affected shoulder?
angle the CR 10 to 15 degrees cephalad to obtain a comparable radiograph
What is the minimum exposure time for the transthoracic lateral projection - lawrence method of the shoulder?
3 seconds (4 to 5 if desirable)
Where does the CR enter on a PA oblique scapular Y projection (PA Y-view)?
Enters at the scapulohumeral joint
For the PA oblique scapular Y projection (PA Y-view) how many degrees do you rotation the pt to the IR?
rotate so that the MCP forms an angle of 45 to 60 degrees to the IR
For the scapula “outlet” tangential projection, how many degrees do you rotation the pt to the IR?
average degree of pt rotation varies from 45 to 60 degrees from the IR
For the scapula “outlet” tangential projection, where should the CR enter and how many degrees is it angled?
angled 10 to 15 degrees caudad, entering the superior aspect of the humeral head
For the AP axial projection of the AC joints, how many degrees is the CR angled? Why do we put an angle for this projection? What is the name of this method?
The CR is directed to the coracoid process at a cephalic angle of 15 degrees. This angulation projects the AC joint above the acromion.
Alexander method
For the AP axial projection of the clavicle, where does the CR enter? How many degrees is the CR angled at? Why do we put an angle for this projection?
Directed to enter the midshaft of the clavicle. Cephalic CR angulation can vary depending on the chest; thinner pt require an increased angle to project the clavicle above the scapula and ribs. Typically 15 to 30 degrees is recommended. This puts the clavicle in a more horizontal orientation.
Where should the CR enter on a AP projection of the scapula? What should the pt do with their arm in this position?
pt should abduct the arm to a 90 degree angle. The CR enters the midscapular area at a point approximately 2 inches inferior to the coracoid process
When the femur is vertical, what is the degree difference of the medial condyle to the lateral condyle? Which condyle is bigger?
There is a 5 to 7 degree difference. The medial condyle is bigger than the lateral condyle
Where does the CR enter for the AP Axial toes projection? How many degrees is the CR for the toes?
CR enters at the third MTP (metatarsophalangeal joint). CR angulation of 15 degrees
Where does the CR enter for the AP oblique toes projection? How many degrees should you rotate the foot?
enters the third MTP (metatarsophalangeal joint)
30 to 45 degrees medially
Where does the CR enter for the lateral toes projection?
enters IP joint (interphalangeal joint) of the great toe or the proximal IP joint of the lesser toes
Where does the CR enter for the AP Axial foot projection? How many degrees is the CR angled?
10 degrees towards the heel entering the base of the third metatarsal
Where does the CR enter for the AP oblique foot projection? How many degrees should the pt rotate their foot?
enters at the base of the third metatarsal
30 degrees medially
Where does the CR enter for the lateral foot projection? How many degrees should the pt have their foot formed to?
enters to the base of the third metatarsal
Dorsiflex the foot to form a 90 degree angle
Where does the CR enter for the longitudinal arch - weight bearing method - lateral foot projection?
enters to a point just above the base of the third metatarsal
Where does the CR enter for the AP Axial - weight bearing - bilateral feet projection? What about unilateral feet? How many degrees is the CR angled to for bilateral and unilateral feet?
CR is positioned between the feet and at the level of the base of the third metatarsal for bilaterals and has a 10 degree angle towards the heel (minimum of 15)
CR is directed along the plane of alignment of the foot, and at the base of the third metatarsal. The angulation is 15 degrees toward the heel
Where does the CR enter for the calcaneus axial projection? How many degrees is the CR angled?
CR is directed to the midpoint of the IR at a cephalic angle (entering the plantar surface and toward the heel) of 40 degrees. CR enters near the base of the third metatarsal
Where does the CR enter for the lateral calcaneus projection?
Center about 1 inch distal to the medial malleolus. This places the CR at the subtalar joint
Where does the CR enter for the AP ankle projection?
through the ankle joint at a point midway between the malleoli
Where does the CR enter for the lateral ankle projection?
Dorsiflex foot, CR enters the medial malleolus
Where does the CR enter for the AP oblique ankle projection?
CR enters midway between the malleoli
How many degrees different is the ankle rotated from a oblique to a mortise rotation?
Oblique: 45 degrees
Mortise: 15 to 20 degrees
Where does the CR enter for the AP oblique mortise joint projection? How many degrees do we rotate the pt for this projection? What do we see when we rotate it to this specific angle?
Enters midway between the malleoli.
15 to 20 degrees
Shows us the talofibular and the tibiotalar articulation open
Where does the CR enter for the AP leg projection?
Enters at the center of the leg
How many bones make up the leg?
2 - tibia and the fibula
Where does the CR enter for the lateral leg projection?
to the midpoint of the leg
Where does the CR enter for the AP oblique leg projection?
to the midpoint of the leg
Where does the CR enter for the AP knee projection?
directed to a point 1/2 inch inferior to the patellar apex
The CR for the AP knee could change depending on the size of the patient. What angulation do you use for the CR if the pt’s leg is 25cm and above? What about 18cm and below? What about 19-24cm?
25cm and above = 5 degree cephalad
19-24cm = perpendicular (no angle)
18cm and below = 5 degree caudad
Where does the CR enter for the lateral knee projection? How much of an angulation is put on the CR? How much should the pt flex their knee?
Directed to the knee joint 1 inch distal to the medial epicondyle at an angle of 5 to 7 degrees cephalad. The medial condyle is slightly inferior to the lateral condyle. The pt should flex 20 to 30 degrees
Where does the CR enter for the AP - weight bearing - knee projection?
CR is horizontal/perpendicular to the IR, entering at a point 1/2 inch below the apices of the patellae
Where does the CR enter for the PA - weight bearing - knee projection? What is this method called? What is the angulation of the CR?
The CR is horizontal/perpendicular to the IR, entering at the midpopliteal area and exiting 1/2 inch below the patellar apex. The CR is perpendicular to the tibia and fibula. A 10 degree caudal angle is sometimes used
Rosenberg Method
Where does the CR enter for the AP oblique knee projection?
Directed 1/2 inch inferior to the patellar apex (depending on the pt thickness, a angle might be used)
For the PA Axial knee projection - Holmblad method - where does the CR enter? What positions can be done for this projection?
Enters the superior aspect of the popliteal fossa and exiting at the level of the patellar apex. This can be done by standing w/ knee bent on a stool, standing with knee bent into the bucky, or kneeling on the IR
What should be clearly seen on the Holmblad method?
Open intercondylar fossa, posteroinferior surface of the femoral condyles, knee joint space open w/ one or both tibial plateaus in profile (superimposed anterior and posterior surfaces), Apex of the patella not superpositioning the fossa, No rotation, slight tibiofibular overlap, centered intercondylar eminence
For the PA Axial knee projection - camp-coventry method - where does the CR enter? How many degrees is the CR angled?
Enters the popliteal fossa and exiting at the patella apex. Angled 40 degrees when the knee is flexed 40 degrees, and 50 degrees when the knee is flexed 50 degrees
What should be clearly seen on the PA Axial knee projection - camp-coventry method?
Open intercondylar fossa, posteroinferior surface of the femoral condyles, knee joint space open w/ one or both tibial plateaus in profile (superimposed anterior and posterior surfaces), Apex of the patella not superpositioning the fossa, No rotation, slight tibiofibular overlap, centered intercondylar eminence
For the AP Axial knee projection - Beclere method - where does the CR enter? How many degrees is the knee flexed?
Entering the knee joint 1/2 inch below the patellar apex. Flex the affected knee enough to place the long axis of the femur at an angle of 60 degrees to the long axis of the tibia
What should be clearly seen on the AP Axial knee projection - Beclere Method?
Open intercondylar fossa, posteroinferior surface of the femoral condyles, intercondylar eminence and knee joint space, no superimposition of the fossa by the apex of the patella, no rotation, slight tibiofibular overlap
For the tangential knee projection - Hughston method - where does the CR enter? How many degrees is the CR angled? What degree angle does the knee form?
Angled 45 degrees cephalad and directed through the patellofemoral joint. The tibia and fibula form a 50 to 60 degree angle from the table
For the tangential knee projection - Merchant method - where does the CR enter? How many degrees is the CR angled? What degree angle does the knee form?
With 40-degree knee flexion, angle the CR 30 degrees caudad from the horizontal plane to achieve a 30 degree CR to femur angle. CR enters midway between the patellae at the level of the patellofemoral joint (superior aspect of patella)
For the tangential knee projection - Settegast method - where does the CR enter? How many degrees is the CR angled?
The angulation of the CR typically is 15 to 20 degrees. Joint space between the patella and the femoral condyles (depends on the flexion of the knee)
For the AP femur projection, where does the CR enter at?
To the midfemur
For the lateral femur projection, where does the CR enter at? Where should the top of the IR be with the hip included? What about the knee? How should the pelvis be adjusted? How much should the knee be flexed?
To midfemur.
Top of IR at the level of the ASIS (for the hip) pelvis should be rolled posteriorly just enough to prevent superimposition; 10 to 15 degrees from the lateral position
For the knee, pelvis should be in true lateral position, flex the knee about 45 degrees, IR should project approximately 2 inches beyond the knee
How many bones does the pelvis consist of?
4 bones; two hip bones, the sacrum, and the coccyx
What is the pelvic girdle composed of?
it is composed of only the two hip bones
What does the hip bone consist of?
The ilium, pubis, and ischium
What do the ilium, pubis, and ischium form when joined together?
acetabulum
Which pelvis is bigger? Male or Female
Females are rounder and males are more narrow
For the AP pelvis projection, where should the IR be placed at? How far apart should the heels be placed? How many degrees are the feet rotated?
Center the IR at the level of the soft tissue depression just above the palpable prominence of the greater trochanters (approximately 1.5 inches) also midway between the ASIS and the pubic symphysis
The heels should be placed about 8 to 10 inches apart. Medially rotate the feet and lower limbs 15 to 20 degrees to place the femoral necks parallel to the IR.
For the AP hip projection, where should the CR enter at?
Place CR approximately 2.5 inches distal on a line drawn perpendicular to the midpoint of a line between the ASIS and the pubic symphysis
