2nd week(mon,tuse.ppt

8/12/2019 2nd week(MON,TUSE.ppt

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Ribs, sternum, SCJs, ACJs.

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ENCLOSE THE ORGANS STERNUM (breast bone) 12 PAIR OF RIBS 12 THORACIC

VERTEBRAATTACH UPPEREXTREMITY 2 CLAVICLES 2 SCAPULA

Posterior view

Bony Thorax (Anatomy)


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AP posterior ribs (upper and lower ribs) ( Basic)

A basic projection for pathology and fractures .

Film: 35 x 43 cm, crosswise.

For upper ribs: Patient erect (preferred), specially in case of traumato prevent lungs puncture by a fractured rib. Erect PA chest is alsorecommended).Lower ribs: Patient supine, shoulders rotated anteriorly to remove

scapula away from the lungs, chin raised to prevent superimpositionwith upper ribs, patient looks straight ahead,kV (65 75 for above diaphragm, 75 85 for below diaphragm),FFD 100 cm, grid.

CP: Upper ribs (above diaphragm): To T7 (8 10 cm below the jugular notch).

Lower ribs (below diaphragm): Midway between xiphoid

and lower rib cage.

CR: 90 to the film center.

For upper ribs: Exposure on the arrestedfull inspiration.

For lower ribs: Exposure on the arrestedfull expiration.


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RAO, RPO ribs (upper and lower ribs) ( Basic)

A basic projection for pathology, fracturesFilm: 35 x 43 cm, lengthwise.Upper ribs: Patient erect (preferred), specially in case of trauma to preventlungs puncture by a fractured rib. An erect PA chest also recommended.Lower ribs: Patient supine, then rotated 45 posteriorly or interiorly.PO: Affected side should be close to cassette.

AO: Affected side away from cassette, arm of elevated side raised abovehead, opposite arm extended down away from thorax, kV 70 75 (abovediaphragm, 80 85 (below diaphragm).CP: Upper ribs (above diaphragm): T7 (8-10 cm below jugular notch).

Lower ribs: (below diaphragm): Midway between xiphoid process andlower rib cage.

CR: 90 to film center in each case.


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AP/ AP Axial Clavicle B

For #s/ dislocations of the clavicle and Acromoiclavicular joint.

Patient supine or erect, arms at sides, chin raised, back of shoulder incontact with the film or couch top.Film: HD 24x30 cm.

CP: Mid-clavicle.CR: AP: 90 horizontal. AP axial: 15- 30 cephalad.

Exposure on arrested inspiration.


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AP ACROMIOCLAVICULAR JOINTS (ACJs) B

For #s/ joint separation. Done with /without stress weights (8 10pounds, 10 15 for large adult patients), cassette crosswise.

Patient erect, back of shoulders against film, 2 films taken in the sameposition (one with the weights, other without), film 2 above shoulders,35x43 film.CP: Midpoint between clavicles.CR: 90 horizontal to film center.


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For pathology of the sternum (fractures /other inflammatoryprocesses).

Patient erect with arms on sides, or: Semi prone and slightlyoblique (15 - 20 , to the right side ) with the left arm up and theright arm down by the side.

Film: HD 24x30 cm.

CP: Center of sternum (midway between jugular notch and thexiphoid process).

CR: Horizontally 90 to film center, exposure on (normal)quiet breathing, or else, during a suspended expiration.

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RAO sternum (Basic)


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RAO sternum (Basic)


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For pathology of the sternum (#s, Subluxation, and otherinflammatory processes).

Patient erect (arms drawn to back), or in a lateral recumbent(lying on the side, arms above the head), shoulders well back.

Film: HD 24x30 cm.

CP: Center of sternum (midway between jugular notchand xiphoid process).

CR: 90 to film center, exposure during a suspended

inspiration.

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Lateral sternum (Basic)


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For joint separation and pathology.

Patient prone, pillow for head which must be turnedto one side, arms up beside the head.

Film: HD 18x24 cm.

CP: At level of T2-T3.

CR: 90 to the film center, exposure done duringsuspended expiration.

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PA bilateral sternoclavicular joints (SCJs) (Basic)


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CT sternoclavicular joints (SCJs)


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Pelvis ,Hips and Sacroiliac joints

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Basic/ AP pelvis (bilateral hips)1. Lateral part of the sacrum2. Gas in colon3. Ilium4. Sacroiliac joint5. Ischial spine6. Superior ramus of pubis7. Inferior ramus of pubis8. Ischial tuberosity9. Obturator foramen10. Intertrochanteric crest11. Pubic symphysis 12. Pubic tubercle13. Lesser Trochanter14. Neck of femur15. Greater Trochanter16. Head of femur17. Acetabular fossa18. Anterior inferior iliac spine19. Anterior superior iliac spine20. Posterior inferior iliac spine21. Posterior superior iliac spine22. Iliac crest


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Basic / AP pelvis frog-leg lateral)

Basic to show congenital hip dislocation in non-trauma patients. Showsfemoral heads, necks, trochanters, and the whole pelvis.

Patient supine, arms on the sides or across chest, pillow for head, supportunder knee, ASISs should be equidistant from table top, both knees flexed90 , feet soles placed together, both femurs abducted 40 to 45 fromvertical, kV 75 80,FFD 100 cmCR: 90 vertically to the film center .

CP: A point 1 inch (2.5 cm) above symphysis pubis.


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Basic/ AP hip joint unilateral)

A basic view (post-operative or follow-up) to show acetabulum, femoral headand neck, the greater Trochanter.

Patient in semi-supine, arms by the side or over chest, the affected leg rotated

internally 15 to 20 , kV 85 95, FFD 100 cm, with grid.

CR: 90 to film center.

CP: Mid femoral neck (2.5 cm medial to ASIS).

or inguinal crest ( where the leg bends)


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Unilateral frog-leg hip non-trauma)

A special (non-trauma) view for the hip joint and proximal femur.Patient supine, pillow for head, affected knee and hip flexed (thigh 45) withsole of the foot against the inside of the opposite leg (near the knee), affectedfemoral neck centered to midline of film, kV 85 95, FFD 100 cm, with grid.


CP: Mid femoral neck.


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Unilateral frog-leg hip non-trauma)

1. Greater Trochanter2. Intertrochanteric crest3. Lesser Trochanter4. Neck of femur

5. Head of femur

6. Acetabular fossa7. Superior ramus of pubis8. Obturator foramen9. Inferior ramus of pubis

10. Ischium


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Axiolateral Inferosuperior hip)

A lateral view for hip fractures and dislocations, (acetabulum and femoralheads, and neck) when the patient is injured and can not move his leg. Can bedone on bed or stretcher .Patient supine, pillow for the head, pelvis elevated 5 cm by supports under

pelvis, the affected leg elevated such that thigh is near vertical and outside the

radiation field, cassette placed in crease above iliac crest, such that it is parallel

to the femoral neck, leg rotated internally 15 to 20 , kV 85 95, FFD 102 cm,with grid..


CP: Femoral neck.


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AP axial sacroiliac joints

Basic view for fracture, dislocation, and Subluxation of the sacroiliac joints.

Patient supine, pillow for head, legs fully extended, with support under knees.CR: 30 cephalic (males), and 35 cephalic (females) to film center.

CP: Midway between level of ASIS and symphysis pubis.

N.B. Urinary bladder should be emptied+ cleansing enema to exclude

gas and fecal matter.


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RPO for left SI joint (upside)

RPO sacroiliac joint left side up)Basic view to show sacroiliac joints farthest from the film for fracture,dislocation, and Subluxation .

Patient supine, a pillow for head, patient is turned 25 to 30 posterior oblique(side of interest up), support under the elevated hip, elevated knee flexed,

Urinary bladder should be emptied, preferably + Cleaning enema


CP: 1 inch (2.5 cm) medial to upside ASIS.


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Good Luck

2nd week(mon,tuse.ppt

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