PNA 2 Flashcards
Which Csp projections are there?
AP Open Mouth
AP Lower Cervical
Neutral Lateral
Oblique
Flexion-Extension
Articular Pillars
Describe AP Open Mouth (APOM)
FFD: 102 cm
KVp: 70
collimate: 18x24
Central ray: through uvula
mouth open as wide as possible; line joining lower border of upper incisors and mastoid processes is perpendicular to film/receptor
Describe AP Lower Cervical (APLC)
FFD, KVp, collimate same as APOM;
Central ray: hyoid (C4 body)
Line joining lower edge of chin to base of occiput is perpendicular to film
How should the tube be angled in APLC and why?
15 degrees cephalad
helps in visualization of uncinate processes and joints of Luschka
What does an APLC show?
lower five cerv. vertebrae (with their components), upper 2-3 thoracic vertebrae and ribs, medial border of clavicles, lung apices, trachea, neck muscles
Describe the lateral (neutral) projection
FFD: 183cm
KVp: 70
collimate: 18x24
central ray: C4
line joining lower edge of chin to base of occiput is perpendicular to film
Describe Anterior oblique
FFD, KVp and collimate: same as lateral
tube angulation: 15 caudad
central ray: C4
facing film, body rotated 45 degrees, turn head so face is parallel to film; marker placed behind spine
Describe posterior oblique
FFD, KVp, collimate, central ray: same as anterior oblique
tube angulation: 15 cephalad
facing tube, body rotated 45, head turned so face is parallel to film;
marker placed in front of spine
Describe flexion projection
FFD, KVp, collimate, central ray: same as ones before
chin tucked in = flexed neck
Describe extension projection
FFD, KVp, collimate, central ray: same as ones before
neck bent as much as possible
Extension/Flexion and Lateral demonstrate the same anatomy. What else can you assess with extension/flexion?
patterns of global and intersegmental motion as well as ligamentous stability
Describe pillar projection
FFD: 102cm
KVP, collimate: same
tube angulation: 35 caudad
central ray: thyroid cartilage
face turned 45 away from involved side
What does pillar projection demonstrate?
articular pillars, zygapophyseal joints, laminae, SPs
Describe thoracic AP
FFD: 102cm
KVp: 80
Central ray: C6
top of film is 2 inches above shoulders; on inspiratin
What does thoracic AP demonstrate?
Tsp, posterior rib heads, lung fields, mediastinum
Describe thoracic lateral
FFD, KVp, central ray: same as AP
top is 2 inches above shoulders, hands on opposite elbows, arms parallel to floor
during shallow breathingW
What does lateral demonstrate?
Tsp, ribs, lung fields, heart
Describe thoracic Swimmer’s
FFD: 102cm
KVp: 90
central ray: T2, anterior to tube side shoulder, through sternal notch
body rotated 20 from film. arm close to film is flexed, hand placed on head. arm close to tube is extended, placed on hip
during suspended expiration
What does throacic Swimmer’s demonstrate?
cervicothoracic junction area
What are the lumbar projections?
AP
Lateral
Oblique
AP or PA lumbosacral spot
lateral lumbosacral spot
Describe AP
FFD: 102cm
kVp: 90
collimate: 14x17
central ray: midline, an inch below crests
on suspended expiration
What does AP demonstrate?
lumbar vertebrae, pelvis, hips, proximal femora, soft tissues of abdomen
Describe Lateral
FFD, kVp: same as AP
collimate: 7x17
central ray: an inch above crests, midway between ASIS and PSIS
arms on opposite shoulders, on suspended expiration, if >45 years: 14x17
What does lateral demonstrate?
T12-L5, sacrum, coccyx, soft tissues of pelvis, abdomen and lower chest
Describe Anterior Oblique
FFD, kVp: same as AP
collimate: 10x12
central ray: an inch above crest, 2 inches above SP on raised side
semi-prone/standing, body rotated 45, on suspended expiration, marker behind spine
What does anterior oblique demonstrate?
posterior neural arch elements, TPs, pedicle, articulating processes, facet joints, pars interarticularis, lamina
+ vertebral bodies and abdominal soft tissues
Describe Posterior Oblique
FFD, kVp and collimate same as AO
central ray: an inch aboce crests, 2 inches medial to ASIS
semi-prone/standing, body rotated 45, on suspended expiration, marker in front of spine
Describe AP lumbosacral spot
FFD, kVp, collimate: same
tube angulation: 25 cephalad
central ray: midline, level ASIS
no gonadal shielding
Describe PA lumbosacral spot
FFD, kVp, collimate: same
tube angulation: 25 caudad
central ray: midline, level ASIS
no gonadal shielding
What does PA lumbosacral spot demonstrate?
L5 vertebrae, L5-S1 disc, upper sacrum, SIJ
Describe lateral lumbosacral spot
FFD, kVp: same
collimate: 8x10
central ray: 1-2 inches below crest, 3-4 inches anterior to posterior body surfaces
Describe Flexion/Extension
FFD, kVp: same
collimate: 10x12
central ray: at crests, 2 inches posterior to mid-axillary line
patient seated. either flexed or extended
Describe left lateral bending
FFD, kVp, collimate: same as flexion/extension
central ray: midline, 1 inch above crests
patient seated. bent either to left or right
Describe sacrum AP
FFD: 102cm
kVp: 80
collimate: 10x12
tube angulation: 15 cephalad
central ray: midline, between pubic symphisis and ASIS
What does it demonstrate?
sacrum, SIJ, coccyx, lumbosacral joint
Describe sacrum lateral
FFD: 102cm
kVp: 90
collimate: 10x12
central ray: at ASIS, 3 inches posterior to mid-axillary line
What does it demonstrate?
sacrum, lumbosacral joint, coccyx, presacral soft tissues
Describe AP coccyx
FFD: 102cm
kVp: 80
collimate: 8x10
tube angulation: 10 caudad
central ray: midline, 2 inches posterior to pubic symphysis
What does it demonstrate?
coccyx, lower sacrum
Describe lateral coccyx
FFD: 102cm
kVp: 90
collimate: 10x12
central ray: an inch superior to greater trochanter, 5 inches posterior to mid-axillary line
What does it demonstrate?
coccyx and lower sacrum
Describe full spine AP
FFD: 84 inches
kVp: 90
collimate: 14x36
central ray: xiphoid process
filter top half, OM, gonadal and breast shielding, on suspended expiration
Describe AP hip
FFD: 102cm
kVp: 80
collimate: 17x14
central ray: midline, midway between pubic symphysis, iliac crests
feet medially rotated 15
What does it demonstrate?
acetabulum, pelvis, joint space, femoral head, neck, trochanters, proximal diaphysis
Describe frog leg hip
FFD: 102cm
kVp: 80
collimate: 10x12
central ray: midpoint of line between ASIS and pubic symphysis, 2 inches away from umbilicus
legs in frog leg position
What does it demonstrate?
acetabulum, pelvis, joint space, femoral head, neck, trochanters, proximal diaphysis
Describe AP knee
FFD: 102cm
kVp: 70
collimate: 8x10
tube angulation: 5 cephalad
central ray: apex of patella
foot medially rotated
Describe lateral knee
FFP, kVp, collimate: same as AP
tube angulation: 12 cephalad
central ray: anterior border of medial tibial condyle
Describe knee tunnel
FFD, kVp, collimate: same
central ray: through popliteal space
patient on all fours, weight on uneffected side
Describe alternate knee tunnel
FFD, kVp, collimate: same
tube angulation: 45 caudad
central ray: popliteal space
knee flexed 45
Describe skyline knee
FFD, kVp, collimate: same
central ray: perpendicular through joint space
patient prone, hyperflexion of knee
Describe ankle AP
FFD: 102cm
kVp: 60
collimate: half of 10x12
central ray: perpendicular through mid-malleolar plane
slight dorsiflexion, leg medially rotated
Describe ankle medial oblique
FFD, kVp, collimate: same
central ray: at level of malleoli
leg medially rotate, so intermalleolar line forms 35-45 degree angle with cassette
Describe lateral ankle
FFD: 102cm
kVp: 60
collimate: 8x10
central ray: through medial malleolus
slight dorsiflexion, lateral part of affected ankle in contact with cassette
Describe dorsiplantar foot
FFD: 102cm
kVp: 50
collimate: half of 10x12
tube angulation: 10 cephalad
central ray: base 3rd metatarsal
Describe medial oblique foot
FFD, kVp, collimate: same
central ray: base 3rd metatarsal
leg medially rotated so plantar surface forms 45 angle with cassette
Describe foot lateral
FFD: 102cm
kVp: 50
collimate: 8x10
central ray: mid-foot at navicular
lateral part of foot against cassette. ankle dorsiflexed to 90
Describe tangenital calcaneous foot
FFD: 102cm
kVp: 55
collimate: 8x10
tube angulation: 40 cephalad
central ray: 2 inches above base of calcaneous
foot dorsiflexed to 90
Describe dorsiplantar and oblique toes
FFD: 102cm
kVp: 50
collimate: half of 8x10
central ray: through PIP joint
Describe AP external rotation shoulder
FFD: 102cm
kVp: 70
collimate: 10x12
central ray: coracoid process
patient angled 35, UL externally rotated
Describe AP internal rotation shoulder
FFD, kVp, collimate: same
central ray: coracoid process
patient angled 35, UL internally rotated
Describe abduction shoulder
FFD: 102cm
kVp: 70
collimate: 12x10
central ray: coracoid process
patient angled 35, humerus abducted 90, elbow flexed 90
Describe transthoracic lateral humerus shoulder
FFD: 102cm
kVp: 90
collimate: 10x12
tube angulation: 10 cephalad
central ray: mid-humeral shaft
on full inspiration
Describe AP ACJ
FFD: 102cm
kVp: 70
collimate: 8x10
tube angulation: 5 cephalad
central ray: through ACJ
2 scans. one with and one without 15 pound weight
Describe AP elbow
FFD: 102cm
kVp: 60
collimate: quarter of 10x12
central ray: antecubital fossa
shoulder and elbow on same plane, hand supinated
Describe oblique elbow
FFD: 102cm
kVp: 60
collimate: quarter of 10x12
central ray: perpendicular to antecubital fossa
shoulder and elbow on same plane, hand pronated
Describe lateral elbow
FFD, kVp, collimate: same
central ray: through elbow joint
elbow flexed 90, hand lateral, ulnar aspect on cassette, humerus and forearm on same plane
Describe Jone’s tangential elbow
FFD, kVp, collimate: same
central ray: 2 inches above olecranin process
elbow hyperflexed, distal humerus on cassette
Describe PA wrist
FFD: 102cm
kVp: 60
collimate: quarter of 10x12
central ray: through mid-carpals
loosely clenched fist
Describe PA Ulnar Deviation Wrist
FFD, kVp, collimate: same
central ray: through scaphoid
extreme ulnar flexion
Describe lateral wrist
FFD, kVp, collimate: same
central ray: at radial styloid
forearm lateral
Describe PA hand
FFD: 102cm
kVp: 50
collimate: 8x10
central ray: head of third metacarpal
What does it demonstrate?
oblique view of thumb
Describe medial oblique hand
FFD, kVp, collimate: same
central ray: head of 2nd metacarpal
What does it demonstrate?
lateral view of thumb
Describe lateral hand
FFD, kVp, collimate: same
central ray: head of 2nd metacarpal
hand rests on ulnar aspect, fingers should be positioned so that they dont superimpose
Describe bilateral Ballcatcher’s hand
FFD: 102cm
kVp: 50
collimate: 10x12
central ray: centre of cassette
hands cupped, 5th metacarpal joints are in contact with cassette
Describe PA, Oblique and Lateral fingers
FFD: 102cm
kVp: 50
collimate: third of 8x10
central ray: through PIP
Describe AP thumb
FFD: 102cm
kVp: 50
collimate: third of 8x10
central ray: through interphalangeal joint
hand in extreme internal rotation, so thumb rests on posterior surface
Describe lateral thumb
FFD, kVp, collimate: same
central ray: through interphalangeal joint
What are the skull projections?
Lateral
PA Caldwell’s
Lateral sinuses
Water’s Projection for sinuses, orbits, zygomatic arches
What does the lateral projection demonstrate?
lateral cranial structures closest to bucky, sella turcica, sphenoid sinus, occipitocervical junction, calvarium
What does PA Caldwell’s projection demonstrate?
frontal bone, frontal sinus, ethmoid sinus, orbits, sphenoid wings, petrous ridges, internal auditory canals
What does lateral sinus and facial bones projection demonstrate?
maxilla, hard palate, maxillary sinus, ethmoid sinus, sphenoid sinus, frontal sinus, orbits
What does Water’s projection demonstrate?
maxillary sinuses, ethmoid sinuses, frontal sinuses, orbits, zygomatic arches
Describe PA chest
FFD: 72 inches
kVp: 100-110
collimate: 14x17
central ray: centre of cassette
on 2nd deep inspiration
Describe lateral chest
FFD, kVp, collimate: same
central ray: centre of cassette
patients arms crossed overhead, on 2nd deep inspiration
Describe Apical Lordotic Chest
FFD, kVp, collimate: same
tube angulation: 35 cephalad
central ray: centre of cassette
Describe AP KUS (kidney, ureter, bladder) abdomen
FFD: 102cm
kVp: 70
collimate: 14x17
central ray: midline, at level of iliac crests
on suspended expiration
