Basic Chiropractic Assistant Radiologic Certification Program

Transcription

1 Basic Chiropractic Assistant Radiologic Certification Program Module 3 Instructor: Dr. Roxzanne Breland

2 Special Notice THE PRINTED MATERIALS USED IN THIS CLASS ARE COPYRIGHTED AND MAY NOT BE COPIED, REPRODUCED OR USED IN ANY MANNER IN WHOLE OR IN PART WITHOUTH THE WRITTEN CONSENT OF THE SCCA

3

4 Directional Terms Anatomical Position

5 Body Planes Midcoronal Midsagittal Transverse

6 Anterior (Ventral) Posterior (Dorsal)

7 Medial Lateral

8 Directional Terms Proximal Distal

9 Cephalad (Superior) Caudad (Inferior)

10 Body Movement Flexion Extension

11 Palmar (Volar)

12 Dorsiflexion Inversion Eversion

13 Plantar surface of the foot Dorsal surface of the foot

14 Body Movement Abduction Adduction

15 Pronate Supinate

16 Positioning Terms Position Oblique: -RAO

17 -LAO

18 -RPO

19 LPO

20 Positioning Terms Decubitus -Right Lateral decubitus

21 Left Lateral Decubitus

22 Ventral Decubitus Dorsal Decubitus

23 Positioning Terms Supine Prone

24 Projection Terminology Projection AP Projection

25 PA projection

26 Left lateral projection

27 Projection Terminology Obliques, as projections RAO- PA projection LAO- PA projection RPO- AP projection LPO- AP projection

28 Body Habitus Hyperstenic: 5% of population Broad thorax, elevated diaphragm, stomach and g.b. very high and almost horizontal

29 Body Habitus Sthenic: 50% of population Thorax slightly longer and narrower than hypersthenic, stomach and g.b. are lower and not as transverse

30 Body Habitus Hyposthenic: 35% of population Thorax longer and diaphragm lower, stomach and g.b. closer to midline

31 Body Habitus Asthenic: 10% of population Thorax narrow and shallow, diaphragm very low, stomach and g.b. very low, vertical and near the midline

32 Procedural Considerations Best to obtain 2 projections that are 90 degrees from each other Must demonstrate all anatomy Use short exposure times Use restraint devices when necessary Give clear breathing instructions

33 Guidelines for Lead Marker Use Must be used on all films Should always be clearly seen When extremities are radiographed, the markers are placed on the lateral side of the body part One film contains 2 projections, only 1 needs to be marked

34 Lead Marker Use Auxiliary markers should be used when possible (decub, post-void) Lateral Decub film, always mark the side that is up Lateral projections, always mark the side closest to the film

35 Lead Marker Use When spine is radiographed, markers should be placed anterior to the spine When an oblique is obtained, the side against the film is generally marked

36 Procedure Protocol Assess request and prepare room Prepare the patient Identify patient Obtain hx Determine pregnancy status Instruct pt in removing metallic objects Explain exam and assist patient

37 Procedure Protocol Prepare the equipment Select appropriate cassettes/grids Measure patient Set exposure factors

38 Procedure Protocol Position patient Center bucky to tube Use correct markers Shield patient Give breathing instructions

39 Procedure Protocol Complete post-exam procedure Critique radiographs Dismiss patient Clean table and place clean sheet and pillowcase on table Wash hands

40 Film Display Radiographs should be hung as if the patient is facing you The right marker should be on the radiographer s left side Fingers, hand, wrist, toes, and foot are positioned with the fingers or toes pointing upward

41 Film Critique Film Identification Is correct pt ID on film? -- Is the film correctly marked

42 Film Critique Radiation Protection: Was the maximum amount of collimation used? Is there evidence of shielding

43 Film Critique Patient Positioning: Was the patient s body part positioned correctly? Was the C.R. correctly centered to the part? Was the C.R. correctly angled?

44 Film Critique Radiographic Quality Do the density and contrast provide adequate recorded detail? Are there any artifacts detracting from the film?

45 Film Critique Anatomy Is the appropriate anatomy demonstrated on each projection?

46

47 Part of Axial Skeleton Function of the vertebral column: Supports the head Gives base to the ribs Encloses the spinal canal

48 Vertebrae Cervical: 7 Thoracic: 12 Lumbar: 5 Sacrum: 5 fused bones Coccyx: 3, 4, or 5 incomplete bones

49 Curvatures of the Spine Cervical: Lordotic (Convex) Thoracic Kyphotic(Concave) Lumbar: Lordotic Sacrum/Coccyx: Kyphotic

50 Vertebral Morphology Body: anterior portion of vertebra; bears most weight. Vertebral foramen: opening for spinal cord to pass through Superior/Inferior articular processes: articulate superiorly or inferiorly with other vertebrae.

51 Vertebral Morphology Pedicle: Extend posteriorly from the body of a vertebra. Lamina: Extend posteriorly and unite to form the spinous process. Transverse Processes: Extend laterally from the body.

52 Morphology Intervertebral foramina Zygapophyseal joints: Formed when the superior articulating surface of one vertebra touches against the inferior articulating surface of another vertebra

53 Terms Spina bifida: Right and left laminae fail to unite with each other Scoliosis: Lateral curvature of the spine

54 1 st Cervical Vertebrae Atlas: First vertebra Has no body, has two arches (anterior and posterior), transverse processes and transverse foramina, opening for odontoid process, a vertebral foramen, lateral masses.

55 2 nd Cervical Vertebrae Axis: Second vertebra Body, transverse processes and transverse foramina, lamina, a bifid spinous process, a vertebral foramen, an oodontoid process (dens).

56 Atlantoaxial Joint Space Space between the atlas and the axis On an open mouth cervical radograph, you will see: lateral masses of C-1, odontoid process, body of C-2, and the joint space between C-1 and C-2.

57 Cervical Vertebrae: C3-C7 Each have a body, 2 transverse processes and foramina, 2 laminae, a spinous process, a vertebral foramen, a superior and inferior articulating surface, a vertebral notch that joins with the vertebrae beneath it to form an intervertebral foramen.

58 Characteristics of C3-7 Spinous procsses are short C3-C5 are bifurcated Have small bodies

59 Thoracic (Dorsal) Vertebrae 12 Thoracic Vertebrae T1-T12 Larger than the cervical vertebrae Articulate with posterior aspect of ribs

60 Thoracic Vertebrae Have a body, vertebral foramen, pedicle, transverse processes, laminae, superior and inferior articulating surfaces. These vertebrae contain costal pits on the transverse processes for attachment of ribs

61 Lumbar Vertebrae Larger than the thoracic vertebrae 5 Lumbar vertebrae L1-L5

62 Sacrum Longer, narrower, and more vertical in males than females Contains sacral foramina Contains ala or wing Contains lateral masses Has an apex on the distal end

63 Coccyx Composed of 4 segmented or incomplete vertebrae

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65

66 Suggested History Questions for C-Spine Injury: Pain, paralysis, numbness, previous surgery? No Injury: Pain in shoulder, arm, hand; numbness, arthritis, previous surgery?

67 C-Spine Patient Preparation Remove clothing from the waist up Remove dentures, hairpins, glasses, and jewelry Need (5) cassettes (size preference) Possible Positions: Left lateral, AP, Odontoid, RPO and LPO (All Erect) Extra Positions: Flexion and extension

68 Left Lateral C-Spine Place patient standing at board with left side against film Adjust film so top will be at the top of the ear Adjust head so it is not rotated to either side and elevate chin slightly

69 To ensure getting all 7 cervical vertebrae, have patient hold sandbags in each hand Tube is placed at 72 distance (if possible) to decrease magnification C.R. is centered to mid-point of cassette (approximately at the thyroid cartilage)

70 Evaluation Criteria Must be able to see all seven cervical vertebrae Good to also see T-1. By using sandbags the shoulders are depressed so that this vertebrae are more easily seen.

71 Radiographic Anatomy Review Lateral Cervical Spine

72 Swimmer s or Twining Position Will demonstrate C-7 and T-1 when they are not demonstrated on a left lateral cervical film Particularly useful on patients with large shoulders

73 Place patient s left side against the board Have patient raise the arm that is closest to the board Top of cassette is at the top of the ear Can angle tube 5 degrees caudad thyroid cartilage if interested in lower c-spine of lower for upper t-spine

74 Evaluation Criteria Seven vertebrae with C7-T1 interspace best demonstrated

75 Radiographic Anatomy Review Cervico-Thoracic Junction

76 AP Place patient erect with back against the board Place film in bucky tray LW Elevate the chin slightly until the lower edge of upper incisors and mastoid tips are in same vertical plane

77 AP Cervical C.R. at the thyroid cartilage

78 Evaluation Criteria Should see at least C-3 to C-7 and T-1

79 Radiographic Anatomy Review AP Cervical Spine

80 Odontoid (aka Open Mouth or George Position) Instruct patient to open mouth as wide as possible and adjust chin until a line from the lower edge of upper incisors to mastoid tip is perpendicular to table C.R. at mid-point of mouth Use cylinder cone if available

81 Evaluation Criteria Will demonstate lateral masses of -- C-1, body of C-2 along with odontoid process, and atlantoaxial joint space -- Base of skull and upper incisors are superimposed and not over C-2

82 Radiographic Anatomy Review-- Open Mouth Odontoid View

83 Fuchs: Pt supine. Chin extended upward CR angled cephalad Odontoid demonstrated within the foramen magnum

84 Right Posterior Oblique RPO Place patient with back against the board in the RPO position Oblique head and shoulders approximately 45 degrees

85 Instruct patient to relax shoulders toward feet, keeping them obliqued for a clearer view of lower cervical vertebrae Direct the CR perpendicular to the film at the level of the thyroid cartilage

86 Evaluation Criteria Body obliqued 45 degrees Demonstrates intervertebral foramina of cervical vertebrae LPO is obtained the same way

87 Radiographic Anatomy Review-- Oblique Cervical Spine

88 Flexion and Extension Flexion: Patient stands as for a lateral c-spine film and looks down toward floor as much as possible CR same as Left Lateral

89 Evaluation Criteria All cervical vertebrae are visualized

90 Extension: Patient stands in the lateral c-spine position and looks up toward ceiling as much as possible

91 All cervical vertebrae are visualized

92 Thoracic Spine Erect AP and lateral positions (2) 14 x 17 LW of (2) 7 x 17 LW Bucky 40 SID

93 AP Patient is positioned erect with back against the board Adjust film unstil marker clears the shoulder. Approximately 1 ½ above the shoulders Collimate to spine area T6 Make exposure on inspiration

94

95 Evaluation Criteria All 12 thoracic vertebrae should be visualized along with the disk spaces

96 Radiographic Anatomy Review-- Thoracic Spine

97 Lateral Thoracic Spine Patient is erect and turned so that the left side is positioned against the board. Adjust body to true lateral position. Adjust arms so the humeri are at right angles to the body Instruct pt. to breathe normally for exposure (long exposure time used if possible) Suggested use of Pb blocker to improve radiographic quality

98

99 Evaluation Criteria On both films, all twelve thoracic vertebrae are demonstrated On lateral: intervertebral foramina are demonstrated

100 Radiographic Anatomy Review-- Lateral Thoracic Spine

101 Obliques may be obtained: Rotate the body 20 degrees from 90 degrees (Total obliquity of the body is 70 degrees). Demonstrates apophyseal joints.

102 Lumbar Spine Have patient remove all clothing except underwear (if no snaps) Suggested views: AP, RPO, LPO, Left Lateral, and L5_S1 spot film are obtained Suggested cassettes needed: (2) 14 x 17 or (2)7 x 17 LW. (2) 11 x 14 LW and (1) 8 x 10 LW

103 AP Lumbar Spine Patient is positioned erect with back against the board CR at the iliac crest using a 14 x 17 cassette Ensure all of symphysis pubis and ischial tuberosities are on the film

104 Radiograph of AP Lumbar Demonstrates all five lumbar vertebrae and SI joints Symphysis pubis and ischial tuberosities should also be included.

105 Radiographic Anatomy Review-- AP Lumbar Spine

106 Obliques RPO: Instruct patient to turn toward his right until the plane 2 medial to the ASIS is centered to the midline of the table Rotate patient approximately 45 degrees CR 1 above iliac crest Obtain LPO the same way

107

108 Evaluation Criteria Demonstrates the Scottie Dogs Demonstrates the spophyseal joints Must see all five lumbar vertebrae and SI jointssi joint on the side that is up will be more open

109 Scottie Dogs

110 Radiographic Anatomy Review-- Oblique Lumbar Spine

111 Left Lateral Have patient turn with left side against the board Adjust body into true lateral position CR at the iliac crest if using a 14 x 17 cassette

112 Evaluation Criteria Must see all five lumbar vertebrae super imposed

113 Radiographic Anatomy Review-- Lateral Lumbar Spine

114 L-5/S-1 Spot Film Patient should be turned with left side against the board. CR to the joint space. The landmark used will be ½ way between the iliac crest and the ASIS

115

116 Evaluation Criteria L5-S1 disk space should be well visualized.

117 Radiographic Anatomy Review-- L5-S1 Lateral Spot

118 What if the spot film does NOT demonstrate joint space?? If the patient has a curvature of the spine, the joint space may not be demonstrated with a left lateral spot film You may need to turn the patient toward the RIGHT side and obtain a spot film

119 Spine for Scoliosis Suggested positions: AP and Lateral Erect PA projection is better for radiation protection purposes, but AP is more commonly done

120 Evaluation Criteria Demonstrates thoraco-lumbar area of spine to evaluate curvature

121 Lumbar Spine Flexion and Extension Done in cases of suspected whiplash Can be done on lumbar spine as well as cervical spine AP, right bending and AP left bending

122 Sacrum and Coccyx Suggested views: AP Sacrum, AP Coccyx, Lateral Sacrum/ Coccyx

123 AP Sacrum-patient is erect with back against board. (Tube can be angled 15 degrees cephalad) CR mid-way between symphysis pubis and ASIS

124 Evaluation Criteria Sacrum should be well visualized

125 Radiographic Anatomy Review-- AP Sacrum

126 AP Coccyx Patient with back against the board Tube can be angled degrees caudad Centering same as AP Sacrum Use cylinder cone if available for coccyx

127

128 Evaluation Criteria Coccyx should be well visualized

129 Radiographic Anatomy Review-- AP Coccyx

130 Lateral Sacrum and Coccyx Patient is positioned with left side against the board Center coronal plane 3 posterior to mid-line of body Cassette at the top of the iliac crest CR mid-point of cassette Suggested use of Pb blockers to improve radiographic quality

131

132 Evaluation Criteria Should demonstrate sacrum and coccyx in lateral position

133 Radiographic Anatomy Review-- Lateral Sacrum and Coccyx

134 SI Joints Obtain an AP Sacrum film RPO and LPO Oblique patient 20 degrees CR 1 below the iliac crest Demonstrates SI joint on the side that is UP

135 Skull Anatomy

136 8 Cranial Bones: Calvarium or cranial vault 1- Frontal 2 - Parietal 1 - Occipital 2 - Temporal 1 - Sphenoid 1 - Ethmoid

137 Skull cap is divided into sections: Calvarium: frontal bone, left parietal, right parietal, and occipital Floor of the skull: Sphenoid bone, ethmoid, left and right temporal bones.

138 Frontal (in purple) Forms forehead, orbits, and nasal cavity. Vertical portion is called the squama Supra-orbital ridge

139 Frontal (in purple) Glabella Frontal sinuses Superciliary arches

140 Parietal (in green) Forms roof and sides of skull

141 Occipital (in blue) Forms posterior and base of skull External Occipital Protuberance

142 Foramen Magnum Occipital condyles (joint formed is the occipitoatlantal joints)

143 Temporal (in gold) Forms lateral walls and floor of skull Squamous: side of skull. Contains Zygomatic arch.

144 Tympanic: forms wall of ext. ear. Contains E.A.M. Styloid process projects inferiorly.

145 Temporal (continued) Mastoid: Behind ear. Contains mastoid process. Mastoid air cells.

146 Petrous: Known as petrous pyramids and/or pars petrosa. Forms part of base. Contains organs of hearing and balance. Contains: Int. aud. meatus, Int. aud. foramen.

147 Portions of the Ear External ear: pinna or auricle, E.A.M., and the tympanic membrane Middle ear: Contains the auditory ossicles Inner ear: Contains the semicircular canals and the cochlea

148 Sphenoid (in yellow) Forms part of lateral wall and base of skull.

149 Body Greater and lesser wings Pterygoid processes.

150 Sphenoid (continued) Sella turcica: Dorsum sella Anterior clinoid processes Posterior clinoid processes Hypophyseal gland Sphenoid sinuses

151 Radiograph of Sella Turcica (Sphenoid)

152 Ethmoid Culbe-shaped bone situated between the orbits.

153 Cribriform plate Perpendicular plate Crista Galli Ethmoid sinuses Layrinth

154

155

156 Sutures Mid-Sagittal Coronal Lambdoidal Squamosal

157 Sutures Mid-Sagittal

158 Prominences Bregma Lambda Fontanels Vertex

159 Skull and Sinuses Positioning

160 Skull History Questions Injury: Where? Unconscious? Swelling? Type of injury Non-Injury: Dizziness? Headaches? Stroke? Paralysis? Visual disturbance? Fever?

161 Skull and Sinuses 5-10 X 12 cassettes 40 SID Bucky

162 AP Semi-Axial, Towne s, Grashey Patient supine Depress chin until OMBL or IOMBL is perpendicular to table OMBL used: Angle tube 30 degrees caudad IOMBL used: Angle tube 35 degrees caudad

163 AP Semi-Axial (cont.) C.R. to enter the hairline. It will emerge in the region of the external occipital protuberance Hypersthenic patients may need sponges to elevate the top part of the head (better to be done upright)

164

165 Structures Demonstrated Occipital bone and foramen magnum should be well penetrated Petrous ridges should be symmetrical Dorsum sellae and posterior clinoid processes in the foramen magnum Occipital bone is demonstrated

166

167 Submentovertex, Basilar, Schuller Patient supine Elevate shoulders about 8-10 by placing a folded pillow under the back Have pt. Drop head back until vertex is resting on the table The IOMBL is parallel to the table

168 Submentovertex (cont.) Tilt the tube cephalad until the C.R. is perpendicular to the IOMBL C.R. enters the neck so that is passes ¾ anterior to the EAM

169

170 PA Axial, Caldwell s Patient prone Pt tucks chin until the OMBL is perpendicular to the talbe Angle tube 15 degrees caudad (Modified Caldwell s) Angle 23 degrees caudad (True Caldwell s)

171

172 PA Axial (cont.) Do not use an angle and the frontal bone is best demonstrated (see radiograph to right) Central ray enters the vertex and exits the nasion Petrous ridges should be in the lower 1/3 of the orbits

173 Structures Demonstrated Entire cranium form vertex through petrous portions Frontal bone penetrated Distances between margins of the orbits and lateral margins of the skull should be equal Petrous ridges symmetrical

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175

176 Lateral (right and left lateral) Patient semi-prone Place the interpupillary line perpendicular to the table top and the midsagittal suture parallel to the table

177 C.R. passes through the sella turcica (3/4 ant. And sup. To EAM)

178 Lateral Demonstrates all of the skull in the lateral position The ant and post clinoid processes must be superimposed The mandibular rami are superimposed

179 Structures Demonstrated Parietal bones are adequately penetrated Post. And ant. Clinoid processes are superimposed Mandibular condyles are superimposed IOMBL is parallel to film

180

181 Sinuses 4-8 X 10 cassettes 40 SID Bucky Remove glasses, dentures, hairpins, etc. Must be radiographed in the upright position

182 Parietoacanthial, Water s Patient erect, facing the upright bucky Extend the chin until the mentomeatal line is perpendicular to the table C.R. enters the parietal region and exits the acanthion

183

184 Parietoacanthial (cont.) Demonstrates the maxillary sinuses The petrous ridges should be located below the maxillary sinuses

185

186 Pirie Water s Projection that is obtained with the mouth open during the exposure Demonstrates the sphenoid sinus.

187

188 Submentovertex Same as skull positioning Demonstrates the ethmoid and sphenoid sinuses

189

190 Caldwell s Same as skull positioning Demonstrates the frontal sinuses

191 Lateral of affected side Same as skull positioning except for C.R. placement C.R. is at the outer canthus Demonstrates all sinuses!

192

193 General Anatomy of the Skull Review

194 There is a 40 degree distance between the mid-sagittal suture and the broadest portion of the skull. What skull type is this? Dolichocephalic

195 What is the name given to the point where the mid-sagittal and coronal sutures meet? Bregma

196 What is the name of the suture that separates the two parietals from the occipital bone? Lambdoidal

197 There is a 54 degree distance between the mid-sagittal suture and the broadest portion of skull. What is the skull type? Brachycephalic

198 What is the name of the suture that divides the head into left and right halves? Mid-sagittal

199 What is the total number of cranial bones? Eight

200 Which suture divides the two parietals from the two temporal bones? Squamosal

201 What is another name for the cranial vault or skull cap? Calvarium

202 What is the total number of sutures in the skull? Four

203 What is the most superior portion of the skull? Vertex

204 Frontal bone and Occipital bone Anatomy Review

205 What is the name of the protuberance that protrudes anteriorly from the frontal bone? Glabella

206 What is another name for the eyebrows? Superciliary arches

207 The frontal bone contains an areas that makes up the superior portion of the orbits. What is this area called? Supra-orbital ridge

208 What is the name of the vertical portion of the frontal bone? Squama

209 What is the name of the large opening in the base of the occipital bone? Foramen Magnum

210 What is another name for the external occipital protuberance? Inion

211 What are the projections that are located on each side of the foramen magnum? Occipital condyles

212 Temporal Bone Anatomy Review

213 What is the external landmark that corresponds to the petrous ridges? T.E.A.

214 Which portion of the temporal bone contains the organs of hearing and balance? Petrous ridges (AKA Pars Petrosa and Petrous Pyramids

215 Which portion of the temporal bone contains the E.A.M.? Tympanic

216 What is the name of the slender bony projection of the temporal bone that extends downward? Styloid process

217 Which portion of the temporal bone contains the zygomatic arch? Squamous portion

218 What is the name of the processes of the temporal bone that are located posteriorly to the ears? Mastoid processes

219 Which bone of the skull houses the organs of hearing and balance? Temporal bone

220 The temporals, sphenoid, and ethmoid bones make up what portion of the cranium? Floor

221 What portion of the ear contains the malleaus, incus, and stapes? Middle ear

222 Which portion of the ear contains the cochlea and semicircular canals? Inner ear

223 Which portion of the ear contains the E.A.M.? External ear

224 Ethmoid Anatomy Review

225 What is the name of the vertical portion of the ethmoid bone? Perpendicular plate

226 What is the name of the sharp process extending superiorly from the cribriform plate? Crista galli

227 What is the name of the horizontal portion of the ethmoid bone? Cribriform plate

228 Where does the ethmoid lie primarily? Under the floor of the cranium

229 How is the crista galli often described (appearance)? A rooster s comb

230 What is the purpose of the crista galli? Serves as an attachment for the falx cerebri

231 Sphenoid Anatomy Review

232 What is the name of the projections that extend inferiorly from the sphenoid? Pterygoid processes

233 What portion of the sphenoid houses the pituitary gland? Sella turcica

234 What does the term sella turcica mean? Turkish saddle

235 What is the pituitary gland responsible for? Growth

236 What are the two projections located on the lesser wings of the sphenoid that project posteriorly over the sella? Anterior clinoid processes

237 What is the posterior portion of the sella turcica called? Dorsum sellae

238 What is the posterior portion of the sella turcica called? Dorsum sellae

239 What is another name for the pituitary gland? Hypophysis or Hypophyseal gland

240 The sphenoid bone is considered to be the bone for all 8 cranial bones. Primary anchor

241 Skull Positioning Review

242 What position is the patients head placed in when the mid-sagittal suture is parallel to the plane of the film? Lateral

243 Which baseline is used to determine correct positioning for a Patietoacanthial projection? Mento-meatal baseline

244 Which projection of the sinuses will determine all four sets? Lateral projection

245 Which of the sinuses is considered to be the most posterior sinus? Sphenoid

246 Which baseline is used to determine correct positioning for a lateral of the skull and sinuses? Interpupillary baseline

247 Which projection of the sinuses will best demonstrate the frontal and ethmoid sinuses? Caldwell or PA Axial projection

248 What anatomical structures must be superimosed for a a lateral skull radiograph to be of diagnostic quality? Clinoid processes and mandibular rami

249 Where does the central exit for a PA Axial (Caldwell s) projection radiograph? Nasion

250 Where should the central ray enter for a correctly positioned AP Axial (Towne s) radiograph of the skull? Level of hairline

251 The pt is positioned with vertex touching the table. Where should the central ray enter for this projection? ¾ anterior to EAM at the level of the gonion

252 Which skull projection will demonstrate the foramen magnum between the petrous ridges? Towne s or AP Axial

253 What is another name for the Towne s or AP Axial projection? Grashey

254 Which projection of the skull and facial bones will demonstrate a possible deviated nasal septum? Patietoacanthial Projection or Water s

255 For a AP Axial projection of the skull, what tube angle is used when the IOMBL is utilized? 35 degrees caudad. Technically should be 37 degrees.

256 What is the approprriate criteria for determining if a PA Axial (Caldwell s) projection is adequate? Petrous ridges should be in lower 1/3 of orbits

257 Where does the central ray exit for a Water s projection radiograph? Acanthion or anterior nasal spine

258 Which baseline should always be used when obtaining a Basilar projection of the skull? IOMBL

259 For a Basilar projection of the skull, how should the IOMBL be placed in relation to the cassette? Parallel

260 What is the appropriate criteria for determining if a Parietoacanthial projection is adequately positioned? Petrous ridges should be below the maxillary sinuses

261 What is another name for the orbitomeatal baseline? Radiographic baseline

262 For a properly positioned Caldwell s projection radiograph, which baseline is placed perpendicular to the cassette? OMBL

263 What position is the body in when a lateral skull is being obtained? Oblique

264 Where is the central ray placed for a lateral projection of the sinuses? Outer canthus

265 On a Water s projection radiograph, what angle does the OMBL and the cassette form? 37 degrees

266 The patient is prone and the OMBL is perpendicular to the table. The tube is angled 23 degrees caudad. True Caldwell s projection

267 Mental protuberance against table. Central ray enters parietal region and exits the acanthion. What projection? Water s projection or Parietoacanthial projection

268 Which bone of the skull is best demonstrated on an AP Axial projection? Occipital

269 Interpupillary line is perpendicular to the table and the midsagittal plane is parallel to the film. What projection? Lateral skull

270 Where will the central ray exit for a Towne s projection radiograph? External occipital protuberance or inion

271 OMBL is perpendicular to table. C.R. enters the hairline and exits inion. What tube angle should be utilized? 30 degree caudad

272 Central ray enters the vertex and exits the nasion. What projection of the skull is described? PA Axial or Caldwell s projection

273 Patient s vertex rests on table. The IOMBL is parallel to film. C.R. is ¾ anterior to EAM. What projection? Submentovertex or Basilar

274 Patient is prone. OMBL is perpendicular to table. Tube is angled 15 degrees caudad. What projection? Modified Caldwell s

275 What structure should projected within the shadow of the foramen magnum on a well-positioned Towne s radiograph? Dorsum sellae

276 Where is the exact location of the optic foramen? Apex of the orbit

277 How much tube angle is used for a Towne s projection radiograph when the OMBL is perpendicular to the film? 30 degrees caudad

278 What structures are best demonstrated on a Submentovertex projection radiograph of the skull? Basal structures: foramina, petrous ridges

279 What projection is used to demonstrate the optic foramen? Rhese projection

280 What should be obtained when a patient has a depressed zygomatic arch? Basilar projection with the head rotated 15 degrees toward affected side

281 How much should the head be rotated for a Parieto-orbital (Rhese) projection radiograph? 53 degrees

282 What tube angle is used for an axiolateral mandible projection? 20 degrees caphalad

283 For a Law s projection of the mastoid air cells, what position is the head placed in and what is the tube angle? Head lateral and then tilted 15 degrees toward the table with a 15 degree caudad tube angle.

284 How much is the head rotated for a Stenver s projection of the mastoids? 45 degrees

285 How much is the tube angled for a Stenver s projection of the mastoid air cells? 12 degrees cephalad

286 What should always be done prior to obtaining mastoid films? Tape the auricles forward

287 What does the Towne s projection radiograph for the mandible demonstrate? Bilateral mandibular rami

288 Where is the central ray placed for a lateral projection of the facial bones? Zygoma or malar bones

289 On a Rhese projection, what positioning error has occurred when the optic foramen is found to have lateral deviation? Head was not rotated properly

290 Oh a Rhese projection, what positioning error has occurred when the optic foramen is found to be more superior or inferior? Acanthiomeatal baseline was not positioned properly

291 Vertebral Column Anatomy Review

292 What is the term used to describe the failure of the lamina to unite? Spina fifida

293 What portion of the vertebra extends posteriorly from the body? Pedicle

294 What two structures form the zygapophyseal joints? Superior and inferior articulating processes

295 What is another name for the first cervical vertebra? Atlas

296 Which portion of the vertebral column has bifid spinous processes? Cervical sine (C3-C6)

297 What is the name of the small depression located on the transverse process that serves as an attachment for a rib? Costal pit or rib facet

298 What is the name of the opening for the spinal canal? Vertebral foramen

299 What structures form the intervertebral foramina? Superior and inferior vertebral notches

300 What projection will demonstrate the Scottie Dogs? Oblique Lumbar Spine

301 What does the eye of the Scottie Dog represent? Pedicle

302 What does the paw of the Scottie Dog represent? Inferior articulating process

303 What portion of the vertebra extends laterally and is most often seen on AP projections? Transverse processes

304 What are the tear-drop shaped structures that are seen on AP projection radiographs of the cervical, thoracic, and lumbar spines? Spinous processes

305 Which vertebra does not possess a body? C-1

306 What is the total number of bones that comprise the vertebral column? 33

307 What is another name for the odontoid process? Dens

308 In the cervical region, what is found on the transverse processes? Transverse foramina

309 In the lumbar region, what is found on the transverse processing? Nothing

310 Which curves of the spine are considered to be the primary curves? Thoracic and sacrum

311 Which curves of the spine are associated with the term lordotic? Cervical and lumbar

312 What is the term used to describe the slipping forward of one vertebra over another usually at the L5-S1 juncture? Spondylolisthesis

313 What portion of C-1 articulates with the occipital condyles of the skull? Superior articulated process

314 What portions (more than one) of the vertebra unite posteriorly to form the spinous process? Laminae

315 What does the ear of the Scottie Dog represent? Superior articulating process

316 Which projections of the spine will demonstrate the intervertebral foramina? Oblique cervical Lateral thoracic Lateral lumbar

317 What is another name for the seventh cervical vertebra? Vertebra Prominens

318 What is the term for the fibrocartilage located between the bodies of adjacent vertebrae? Intervertebral disc spaces

319 What is the term for a slipped disc? Herniated nucleus pulposus

320 Where do the spinal nerves exit within the vertebral column? Intervertebral foramina

321 What is the term used to describe when C-7 has a rib attached? Cervical rib

322 What are the wing-like lateral masses of the sacrum? Ala

323 How many bones comprise the sacrum? Five

324 How many bones comprise the coccyx? 3 or 4 or 5

325 Portion of the spine with the largest bodies Lumbar

326 Located on the inferior surface of a vertebra, it is considered to be ½ of an intervertebral foramen Inferior vetebral notch

327 Lateral curvature of the spine Scoliosis

328 Number of thoracic vertebrae 12

329 Instead of pedicles, C-1 has Lateral masses

330 What is the top portion of the sacrum called? Base

331 How many bones comprise the cervical region? Seven

332 What is the name of the ridge that is located on the posterior aspect of the sacrum? Median sacral crest

333 What are the names of the holes that are found in the sacrum? Sacral foramina

334 Which projections will demonstrate the zygapophyseal joints? Lateral cervical, oblique thoracic, oblique lumbar

335 What is the name given to the large, block-shaped structure of a vertebra? Body

336 Condition of the spine that affects the SI joints by fusing them. The spine also becomes known as bamboo spine Ankylosing spondylitis

337 Spondylitis is usually caused by a defect of the Pedicle

338 What is the term used to describe when the spine is characterized by fixation and stiffness? Spondylosis

339 What type of spinal fracture may be sustained by patients with osteoporosis? Compression fractures

340 What is the term used to describe when L5 partially or totally fuses to the sacrum? Sacralization

341 Anatomy of the Respiratory System

342 Functions of the System The respiratory system provides an extensive area for gas exchange between air and circulating blood. The system moves air into and out of the lungs.

343 Functions The respiratory system also provides sounds involved in speaking, singing, and nonverbal communication by providing the breath necessary to accomplish these tasks. The system also provides olfactory sensations to the CNS. This is how we have a sense of smell.

344 The nasal cavity and pharynx (upper respiratory system) protect the surfaces from dehydration, temp. changes and other environmental variations. The upper portion of the respiratory system consists of the nose, nasal cavity, sinuses, and pharynx. The primary purpose is to filter and warm the air.

345 Nasal Cavity Nares: Term used to describe the nostrils. Nasal septum: Divides nose into left and right portions. Paranasal sinuses: There are 4 sets as discussed previously.

346 The pharynx is common to the digestive and respiratory systems because both food and air follow this path. The area of the larynx is where the division between the two systems occurs.

347 The pharynx is divided into three portions:

348 The nasopharynx begins in the nose and extends backward into the opening of the throat. The oropharynx begins in the back of the throat and extends to the larynx. The larynogopharynx is the portion of the pharynx that is located in the area of the larynx or voice box.

349 The lower respiratory system consists of the larynx, trachea, bronchi, bronchioles, and lungs

350 Larynx Thyroid Cartilage: The largest laryngeal cartilage is shield-shaped. It is commonly called the Adam s Apple. It is located at the level C-5. The thyroid cartilage is situated anteriorly (in front) and superiorly (on top) to the trachea.

351 Epiglottis The epiglottis is the fold of skin situated superiorly to the opening of the trachea on top of the larynx. This flap prevents food from entering the trachea while swallowing by sealing off the trachea. You cannot swallow and breathe at the same time. Try it!!

352 Trachea Known as the windpipe Tough, flexible tube beginning at C- 6 and ending at T-5 Made up of cartilaginous rings

353 Air enters the trachea and food enters the esophagus. The esophagus is located posterior (behind) to the trachea.

354 When you swallow, the flag close to prevent food from entering the trachea. When you breathe, the flap is open to allow air to enter the trachea

355 The trachea branches into right and left primary bronchi. Right primary bronchus Left primary bronchus

356 Branching of the trachea is called the bifurcation. It resembles the forking of a road. Ring of muscle surrounding the area of bifurcation is the carina. Bifurcation Carina

357 Right and Left Primary Bronchi (Main Stem) Primary bronchi are main branches of the trachea Hilus: Area of the lung where the bronchus enters.

358 Primary or Main Stem Bronchi The right bronchus is wider and more vertical than the left bronchus so forein objects are more apt to enter the right bronchus instead of the left. This can lead to aspiration pneumonia in the right lung. The right bronchus supplies the right lung The left bronchus supplies the left lung

359 Air-filled trachea Bifurcation into right and left primary bronchi. The bronchi are seen because they contain air.

360 Secondary Bronchi (Lobar) The right primary bronchus branches into three secondary bronchi. Each one goes to a lobe in the right lung The left primary bronchus branches into two secondary bronchi. Each one goes to a lobe in the left lung. Segmental bronchi: Smaller branches of the secondary bronchi. Bronchioles: Located on the ends of segmental bronchi. Alveoli: Located on distal ends of the bronchioles

361 To remember the bronchi, think of a tree! Alveoli Bronchioles Primary bronchi Secondary Trachea

362 The trunk is the trachea The main branches are the primary bronchi The smaller branches are the secondary bronchi The segmental bronchi are even smaller branches The bronchioles are the small stick ends of the leaves, and The leaves are the alveoli

363

364 The Lungs The left and right lungs are situated in the pleural cavity The lungs are made of a spongy material called the parenchyma. This spongy material allows for lung expansion during respiration. The thoracic cavity also contains two types of pleural linings.

365 The parietal pleura is the lining of the thoracic cavity. It lies directly against the chest wall and not against the lungs. The visceral pleura is the lining that lies directly on top of the lungs. The space that exists between the parietal and visceral pleura is classed the pleural space. This space contains a fluid to reduce friction within the thoracic cavity during respiration. If other types of fluid or air enter into the space, it will be demonstrated on a chest radiograph.

366 The mediastinum is bounded on both sides by the lungs. It is the area that is located between the two lungs and contains the heart, trachea, esophagus, and great vessels such as the aorta. Mediastinum

367 Right Lung The right lung has three lobes The right lung is shorter and broader than the left due to the placement of the liver.

368 Left Lung The left lung has two lobes Contains the cardiac notch which is the depression in which the heart rests against the lung

369 Mechanics of Breathing Inspiration: Contraction of diaphragm and external intercostal muscles. Lungs will appear larger and more expanded and the diaphragm will drop to its lowest point. Expiration: Relaxation of the diaphragm and external intercostal muscles. Lungs will appear smaller and less expanded and the diaphragm will be in a higher

370 Radiographic Anatomy Associated With the Lungs

371 Apices Area of lungs that are found above the clavicles. Apex refers to one lung. The term apices will refer to both lungs.

372 The apices are superimposed in the lateral position.

373 Bases Broadest portion of the lungs. Diaphragm lies directly beneath the bases. Each base is often referred to as hemi-diaphragm. The right hemi-diaphragm is higher due to placement of the liver.

374 Costophrenic Angles Area of the lungs where the rib and diaphragm meet. The most pointed areal of the lung. This is usually where fluid settles when the patient has pneumonia or pleural effusion.

375 The costophrenic angles will be superimposed on the lateral projection radiograph

376 Diaphragm It is the muscle that separates the thoracic cavity from the abdominal cavity. It is also used during breathing. It follows the contour of the bases of the lungs.

377 Mediastinum Area between both lungs

378 Aortic Arch Also known as the aortic knob. Takes blood from the heart to the rest of the body.

379 The aortic arch can be seen on the lateral projection radiograph as a thick white area.

380 Heart Located posterior to the sternum. It is situated more toward the left side of the chest. Because it is a dense structure, it will be demonstrated as the large white area on the radiograph.

381 The heart is seen as a white area on the lateral projection radiograph

382 Air in trachea Air in esophagus

383 12 Pairs of Ribs The thoracic cavity consists of 12 pairs of ribs attached to the thoracic vertebrae. Since they are made of calcium, they will appear white on the radiograph.

384 The spine is seen on a lateral projection radiograph of the chest

385 Additional Anatomy Clavicle Scapula Sterno-clavicular joint (space between the sternum and clavicle)

386 The scapulae are seen on the lateral projection radiograph.

387

388 You need to be familiar with pathology in order to accurately select the appropriate technical factors for each individual case. Fluid is hard to penetrate and air is easier to penetrate. The easiest way to remember how to alter the technical factors is to increase (doungle) mas or increase kvp by 15% when fluid is present and to decrease (half) mas or decrease kvp by 15% when air is present. So, fluid (double mas or increase kvp 15%) and air(half mas or decrease kvp 15%).

389 Air will be demonstrated as a dark area Fluid will be demonstrated as a white area

390 Keeping in mind that fluid is thick and is harder to penetrate and that air is light and is easier to penetrate, let s look at the following types of pathology associated with the respiratory system!

391 Asthma A pulmonary disorder with increased mucus (fluid) production in bronchi, causing hyperventilation (air) of the lungs. When the bronchi are primarily of interest, you are dealing with fluid, will it be easier or harder to penetrate?

392 When the lungs are primarily of interest, you are dealing with increased air, will it be easier or harder to penetrate?

393 Atelectasis Collapse of lung tissue which means decreased volume of air and increased areas of fluid Since you are dealing with fluid, will it be easier or harder to penetrate?

394 Bronchiectasis Dilation and destruction of bronchial walls There is consolidation present. The term consolidation means fluid. Since you are dealing with fluid, will it be easier or harder to penetrate?

395 Chronic Bronchitis Pulmonary disease with substantial increase of mucus production in the trachea and bronchi Bronchitis can be a little tricky to radiograph because if the patient also has emphysema then you need to make some decisions concerning the number of films you will need to obtain

396 COPD Chronic Obstructive Pulmonary Disease Progressive condition marked by diminished capabilities of inspiration and expiration Chronic bronchitis and emphysema are categorized as COPD A patient with bronchitis means you are primarily dealing with fluid, will it be easier or harder to penetrate?

397 A patient with emphysema means you are primarily dealing with increased air, will it be easier or harder to penetrate?

398 Emphysema Overinflation of alveolar walls Easier to penetrate Should not be imaged using AEC because minimum reaction time of equipment usually results in overexposure and subsequent repeat films.

399 Croup Acute viral infection of infant s respiratory system Characterized by bark-like cough Radiograph will demonstrate a narrowing in the trachea Since the trachea contains air, will it be easier or harder to penetrate?

400 Pleural Effusion Accumulation of fluid in intrapleural spaces. It is usually found in the bases of the lugs. Since you are dealing with fluid, will it be easier or harder to penetrate?

401 Pneumonoconiosis Lung disease caused by inhaling dust. There are three types of pneumonoconiosis. Silicosis: occurs when Silicon Dioxide (sand) is inhaled Anthracosis: occurs when Anthracite (coal dust) is inhaled Asbestosis: occurs when Asbestos is inhaled

402 Pneumonia Acute inflammation of lungs characterized by fluid Since you are dealing with fluid, will it be easier or harder to penetrate?

403 Pneumothorax Air in the pleural space that causes the lung to collapse Since air is present, will it be easier or harder to penetrate?

404 Pulmonary Metastases Spread of cancer into the lungs from a primary site Usually characterized by increased fluid production Since you are dealing with fluid, will it be easier or harder to penetrate?

405 Tuberculosis Chronic infection of the lungs caused by acid-fast bacillus. It is demonstrated as white densities on the radiograph due to the fluid that is present. Since you are dealing wit fluid, will it be easier or harder to penetrate?

406 Easier to Penetrate: (contain air) Asthma: to visualize the lungs Croup Emphysema Pneumothorax

407 Harder to Penetrate: (contain fluid) ARDS Asthma: To visualize the bronchi Atelectasis Bronchiectasis Chronic Bronchitis COPD

408 Harder to Penetrate Cystic fibrosis Empyema Hyaline Membrane disease Pleural effusion Pneumoconiosis Pneumonia Pulmonary Metastases Tuberculosis

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