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Proc and Posi Exam 4

What is the tibia? 2nd largest bone in the body, medial side of the bone and bears the weight of the leg
The superior/proximal tibia consist of what? Condyles: medial, lateral, articulates with the femoral condyle and superior surface is called tibial plateau
What does the tibial plateau articulate with The femur
What is the Fibula? Lateral bone, slender, and consist of the shaft (body) and and two articular extremities.
What does the proximal fibula articulate with The head articulates with the lateral condyle of tibia apex
What does the distal fibular articulate with? The lateral malleolus 15-20% posterior than medial malleolus
What is the femur? Longest, strongest, heaviest bone, and slopes medially as it goes inferiorly
Parts of the proximal femur head, neck and trochanter (greater and lesser). intertrochanteric crest is located on the posterior and intertrochaneric line is on the anterior side
Parts of the distal femur Medial condyle, lateral condyle, medial epicondyle, lateral epicondyle, patellar surface, intercondylar fossa, shaft
Medial condyle is larger
The anterior surface of the femur articulate with what? patella
The medial condyle is how many degrees lower than the lateral condyle 5-7
Parts of the knee femur, medial condyle, lateral condyle, tibia, tibial plateau, tibial spine, medial condyle, lateral condyle
Routine projections of the lower leg AP and lateral
Why may you use an SID of 48 instead of 40 to decrease the divergence of the beam and demo more of the leg
AP lower leg IR: 14 x 17 SID: 40 or 48 CR: perpendicular to center of the leg Patient Positioning: Collimate 1/2 inch beyond ankle and knee and supine with foot dorsal flexed
Structures Shown and Evaluation Criteria for AP Lower leg tib/fib adjacent jts, no rotation, proximal and distal articulations of tib/fib moderately overlapped, fibular midshaft free of tibial superimposition
Lateral lower leg IR: 14 X 17 SID: 40 or 48 CR: perpendicular to center of the leg Patient Position: turn to affected side, collimate 1/2 inch beyond knee and ankle
Structures Shown and Evaluation Criteria for Lateral lower leg tib/fib jts, distal fib over posterior half of tibia, slight overlap of tib on proximal fibular head, ankle and knee jt not rotated, femoral condyle not superimposed, moderate separation of tib and fib bodies
Routine projections for femur AP proximal, AP distal, lateral proximal, lateral distal
AP Femur IR: 14 x 17 SID: 40 IR Placement:For proximal place top of IR at level of ASIS and rotate limb 15-20 degrees internally. For distal place limb in true anatomic position, epicondyle parallel with IR, bottom of the IR is 2 inches below the knee joint
Structures shown for AP femur Lesser trochanter not seen beyond medial border of femur, femoral neck not foreshortened
What happens if the lower limb is externally rotated too much? The epicondyle are not demonstrated in profile, medial condyle is larger than the lateral, tibia has more than 1/2 inch superimposition on fibular head
What happens if the lower limb is internally rotated too much? lateral femoral condyles larger than medial condyle and superimposition of fibular head and tibia less than 1/4 inch
Lateral lower leg IR: 14 x 17 SID: 40 IR placement: Proximal place top of IR at ASIS level, adjust pelvis so it is rolled posteriorly 10 to 15 degress from lateral. Distal adjust pelvis to be in true lateral, flex affected 45 degrees, bottom 2 inches beyond knee
Structures shown and evaluation criteria for lateral lower leg Superimposed anterior surface of the femoral condyles, patella in profile, open patellofemoral space, inferior surface of condyle not superimposed because of divergent rays, opposite thigh not over area of interest
Pelvis consists of 4 bones that are what? 2 hip bones or innominate bones, sacrum and coccyx
hip bone are called what? Ilium, Ishcium and Pubis
What is the acetabulum? Deep, cup shaped cavity that accepts the femoral head and is a ball and socket joint
What is the illum? crest of the ilium, upper margin of the ala, extends from ASIS to PSIS
what does ASIS and AIIS stand for? Anterior superior iliac spine, and Anterior inferior iliac spine
what does PSIS and PIIS stand for? posterior superior iliac spine, and posterior inferior iliac spine
What is the greater sciatic notch? located between the PSIS and ischial spine and this is where the sciatic nerve passes through
what is the ischium? inferior and posterior to acetabulum and includes 2/5 of the posterior acetabulum
What does the Ischial Tuberosity bear most of? body weight when sitting
Where is the ischial spine? directly posterior to the body
What is the body of the pubis? anterior and inferior to acetabulum and includes anteroinferior 1/5 of acetabulum
What is the superior pubic rami? superior pubic ramus extends anterior and medial to the body of each pubi
What is the inferior pubic rami? inferior pubic ramus passes down and posterior from symphysis pubis where it joins the inferior ramus of ischium
What is the obturator foramen? larger opening, formed by rami of ischium and pubis, largest foramen in the body
What is the sacrum? consists of 5 fused segments, shaped like a shovel
what is the coccyx? also called the tailbone and consists of 3-5 fused segments
What is the difference between female and male pelvis? female's pelvis is more broader and more flared, shallower, larger and inlet is oval. male's pelvis is narrower and less flared and inlet in round
What are the SI joints in the pelvis? wide, flat joints, located obliquely between the sacrum and each ilium.
What is the pubis symphysis? LImited expansion during late pregnancy and child birth and separates
What type of joints are hip joints? ball and socket joints
The highest point of the greater trochanter is the same plane as what? hip joint
Most prominent point of the greater trochanter is in the same plane as what? symphysis
Routine projections for pelvis AP
AP Pelvis IR: 4 x 17 SID: 40 CR/IR placement: center midway between ASIS and symphysis, 2 inch inferior to ASIS and 2 inch superior to pubis symphysis Patient position: 15-20 degrees of medial rotation of the lower limbs
Structures shown and Evaluation criteria for AP Pelvis see entire pelvis, femoral head, neck and trochanters. 1/4 to 1/3 of femoral shafts, lesser trochanter on medial border, greater trochanter in profile, hip bones and obturator foramen are symmetric
Routine projections of the hip if no recent images do AP pelvis, AP hip, lateral or axiolateral. if there are recent film do AP hip, lateral or axiolateral
AP Hip IR: 10 x 12 SID: 40 CR: perpendicular to femoral neck, 2.5 inch distal on the line perpendicular to mid point of line between ASIS and pubic Patient: Medially rotate affected limb 15-20 degree
Structures show and evaluation criteria for AP HIP Greater trochanter in profile, femoral neck not foreshortened, show orthopedic appliance in entirely
Lateral Hip, Lauenstein Method IR: 10 x 12 SID:40 CR: perpendicular to hip joint midway between ASIS and pubic Patient: oblique the patient towards the affected side, the angle of oblique depends on how much the patient can abduct the leg, flex the knee almost to a right angle
Lateral Hip Hickey method IR: 10 x 12 SID: 40 CR: angel 20 - 25 degrees cephalic to hip point midway between ASIS and pubic Patient: Oblique the patient toward the affected side, the angle of oblique depends much they can abduct their leg, flex the affected knee to right angle
Structures show and evaluation criteria for Lateral Hip include acetabulum and proximal femur, the femoral neck free of superimposition in the hickey, hip jt centered, femoral neck superimposed on greater trochanter is important
Axiolateral Hip IR: 10 x 12 SID: 40 CR/IR: dependent on pt Patient postion: supine
Structures shown and evaluation criteria for axiolateral hip acetabulum, head, neck and trochanter, hip jt demonstrated withough soft tissue superimposition, orthopedic appliance inlcuded, ischial tuberosity below femoral neck, small amount lesser and greater trochanter
What is tomography? predetermined plane of the body is demonstrated in focus while structures above and below are eliminated by a controlled blur
Different names for tomography planiography, startiography, laminography, body section,
What is tomographic amplitude total distance tube travels, amplitude and blurring are directionally proportionaly
Exposure amplitude total distance tube travels during exposure, is always equal or less than tomographic amplitude
Fulcrum pivot point, can be fixed so the patient would be moved up and down to change section level, more commonly it is adjustable so that it moves up and down while the patient is still
Focal plane section or region in focus
section level layer height
object plane depth of focus
section of thickness width of focal plane and is controlled by the exposure angle, exposure angle is inversely proportional to the section thickness
Exposure factors: time critical that time is set first, exposure time must match the length of time required for the x-ray tube to complete the tomographic amplitude, if time is short blurring will not be complete, time too long, end position of tube will increase record detail
Exposure factor:mA have fixed time setting because of the length of the exposure, 30% more mAs is required
Exposure factor: kVp all the exposure adjustments are accomplished by variations of kVp, since the mA and time limits are present
Type of Motion: Linear when movement of the tube and IR are along a straight line, first form, amplitude up to 48 degrees, tube and grid go opposite direction, best for blurring objects perp, to motion of tube
Type of Motion: Circular all elements are equally blurred regardless of there orientation, not used much because most units capable of achieving this most are capable of achieving more complex motions
Type of motion: Elliptical has both linear and circular aspects, eliminates some of the edge phantoms of circular motions, especially when the long axis of the ellipse is perpendicular to the long axis of the object
Type of motion: Hypocycloidal Provides maximum tomographic amplitude, thus producing the thinnest possible section, about 1mm thickness
Type of motion: spiral AKA trispiral, provides maximum tomo amplitude this producing the thinnest section possible, about 1mm thickness
Digital tomosynthesis digital radiographic tomography, time to be set first,
general description of lumbar spine forms central axis of the skeleton, midsagittal plane, purpose is to protect spinal cord, support skull, attachment for muscles and ribs
Divisions Cervical(7), Thoracic(12), Lumbar(5), Sacrum(5), Coccyx(3-5)
Curvatures Cervical and lumbar is lordotic curve, Thoracic and pelvic is kyphotic curve, Primary curve is thoracic and pelvic, Secondary forms in early childhood development
Lordosis butt more out
Kyhposis hunch over
Scolosis lateral
Typical vertebrae Consists of 2 parts that are the body and vertebral arch that are the pedicles and lamina
Process of the typical vertebra transverse process, spinous process, and four articular process
Vertebral notch inferior, superior, intervertebral foramina
Joints of lumbar zygapophyseal joints, intervertebral joints or disk space
Intervertebral disks functions as a cushion, consists of annulus fibrosis layer and nucleus pulpous layer,
Spondylolistheis slipping of the vertebrae
Spina bifida failure of lamina to meet or form
Radiographic landmarks for lumbar Thoracic: 2 inch above manubrial notch(T1), manubrial notch (T2-3), Sternal angle(T4-5), xiphoid tip(T9-10).
Lumbosacral spine (LSS) AP, oblique, left lateral, left lateral (L5-S1, spot)
AP Lumbosacral IR: 14 x 17 SID: 40 or 48 Patient: recumbent, hip and knee flexed CR: vertical midsagittal, horizontal is crest
Structures Shown and Evaluation criteria for AP l-spine all vertebrae body, see T12 and S1, no rotation, joint spave,
AP Oblique L-spine: RPO and LPO IR: 14 x 17 SID:40 Patient position: supone or erect, turn 45 degrees toward left or right side CR: 1/2 inch above crest for horizontal, 2 inch medial from elevated ASIS
AP oblique L-spine: LPO and RPO all 5 vertebrae, zygopophyseal joint open, see scotty dog, if too rotated pedicle is posterior, if under rotated pedicle is anterior
Parts of the Scotty Dog Ear: superior articular process, Leg: Inferior articular process, Nose:transverse process, Eye: pedicle, Neck: pars inerarticularis, Body: lamina
Lateral L-spine IR: 14 x17 SID: 40 Patient: turn to left side CR: midcoronal, angle 5 degree caudad for men and 8 degree caudad for women, center at iliac crest
Structures shown and evaluation criteria for lateral L-spine vertebra body lateral, open joint space, spinous process, nearly superimposed crest
L5-S1 the spot IR: 8 x 10 SID: 40 Patient postion: on left side, knee flexed CR: 1/2 inch inferior to the crest, 2 inch posterior to ASIS Angle 5 degree for men and 8 degree for women caudad
Structures shown and evaluation criteria for L5-S1 the spot open lumbar sacral joint, all of L5 and S1
For what projection of the foot plantar surface is perpendicular and metatarsals are nearly superimposed
For Becelere method the CR is directed perpendicular to long axis of the leg
Pharmacology the study of drug actions on and interactions with living organisms
Drug Name Chemical: 7- cholor-1 Generic: given by original manufacture, diazepam Trade: given by pharmaceutical company, Valum
Medication Orders must have physician, date, drug, dose, route, frequency
6 right of safe administration right patient (3 times: when you pull med, prepare med, and administer), right drug, right dose, right time, right route, with the right documentation
Rules for safe administration aseptic technique, right to refuse, check name strength, an expiration date, administer what you have prepared, correct patient, record immediately, report medical error, be prepared for reaction
Factors affecting drug administration age, gender and weight, nutritional state, emotional state, time of day(evening better), routes of administration, drug tolerance and resistance, metabolism, and absorption
Routes of Administration Topically and transdermal: on top of skin, eye drops Inhalation: o2, high absorption rate Orally: mouth, ibuprofen Buccal: between teeth and cheek Sublingually: under the tongue Rectally: butt Parenterally: IV, injection, IM
Oral Administration safest, most desirable when can be used, don't use if bad taste, potential to be destroyed by stomach acid, risk to aspirate, pt uncooperative, need for immediate effect, vomiting
Parenteral Administration Subcutaneous: SQ usually 1-2 mL, TB, under skin, 45 degrees, small amount Intramuscular: IM, into muscle, prompt absorption, larger amount than SQ, 1-5mL, flu shot Intradermal: between layer of skin, small amounts, absorption slow, 1 mL
Parenteral Administration continue Intravenous: IV, fast effect,most hazardous, monitor pt, heparin lock, piggy back, butterfly, angiocatheter, contrast use large vein and inject fast, skin prep is clean with alcohol, iv stand 18-24 inch abover vein, 10-20 drops per min, intravenous pump
Needles disposable, parts, length and gauge of needle, contaminated and don't recap, stick pt bevel up
Parts of needle Hub, cannula or shaft and bevel
Syringes Disposable, parts, sizes, leur-loc, eccentric tip syringe
Parts of syringe plunger, barrel, tip
Preparing Medication aseptic techniques, universal precautions, maintain sterility, check MD order, read label 3 time, check expiration date, check patient ID, keep medication container, disposal of needle and syringe
Container Vial: prepare medication Ampule: prepare medication
Created by: bbesler