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Positioning Test 3

Osteology Study of structure and function of bones. 206 bones. 126 Appendicular and 80 Axial bones.
Trabeculae definition Network of spaces in spongy bone
Ossification definition Bone formation. Primary:starts before birth. Secondary:occurs after birth, epiphyseal plate,usually closed by age 21
Classifications of bones 1)long-limbs only (femur, phalanges,etc) 2)short-carpals and tarsals 3)flat-sternum, cranium, etc 4)irregular-no other category (vertebra,pelvic bones) 5)sesamoid-patella,foot,base of thumb and great toe
Arthrology definition Study of joints (arthritis: Inflammation of a joint)
Rule out F/B protocol 2 projections 90° from each other. AP/PA and a lateral. May need to mark entrance/exit of F/B on film. Soft tissue technique:decrease mAs 1/3 from what you would normally use.
Adjustments in techniques for casts Dry plaster casts:increase 5-7 kvp from normal range used for that part. Wet plaster casts:increase 8-10 kvp or double mas. Fiberglass cast:increase 3-4 kvp
Don't forget the golden rule! Set your panel before you position the patient!!!!
Most frequently fractured carpal bone? Scaphoid/Navicular located in the "anatomical snuff box"
Carpal Sulcus Bridge made by metacarpals. Comprises roof of carpal tunnel (floor is flexor retinaculum). Houses the median nerve. Compression of nerve is carpal tunnel syndrome.
1)Colles Fracture 2)Boxers Fracture 1)fracture of distal radius w/ posterior displacement 2)fracture to neck of metacarpal (typically the 5th metacarpal)
Definitions: 1)metastases 2)osteopetrosis 3)osteoporosis 1)spread of cancer from one site to another 2)increased density of bone 3)loss of bone density
Routine finger radiography digits 2-5 3 views: 1.PA 2.PA Oblique 3.Lateral (Mediolateral 2&3 and lateromedial 4&5). Decrease field of view, increase collimation, 40"SID tabletop,want to see bony trabeculation
Why keep digits parallel to film? 1) Keep joint spaces open 2) Prevent foreshortening
PA digits 2-5 pos,proj,cr loc 1)Projection: PA 2)Position of part: prone 3)CR location: proximal interphalangeal joint space
PA digits 2-5 image evaluation Rotation: 1)equal concavity of phalangeal shafts 2)equal amount soft tissues on both sides 3)fingernail centered over distal phalanx
Lateral digits 2-5 pos,proj,cr loc 1)Position:lateral 2)Projection:Mediolateral (2&3) Lateromedial (4&5) 3)CR location: proximal interphalangeal joint space
Lateral digits 2-5 image evaluation Rotation: 1)Concave anterior bone 2)Open joint spaces 3)No overlap w/other digits 4)Anatomy:head, body, and base
Oblique digits 2-5 pos,proj,cr loc 1)Position:lateral or external rotation (45°) 2)Projection: Posteroanterior Oblique 3)CR location: proximal interphalangeal joint space
Thumb Routine 1) AP 2) PA Oblique 3) Mediolateral
AP Thumb (NOT PA!) pos,proj,cr loc 1)Position:supinated 2)Projection:anteroposterior 3)CR location:metacarpophalangeal joint space
AP Thumb evaluation criteria Rotation: 1)equal concavity of phalangeal shafts 2)equal amount soft tissues on both sides 3)thumbnail centered over distal phalanx //include trapezium\\
PA Oblique Thumb pos,proj,cr loc 1)Position:hand pronated 2)Projection:PA Oblique 3)CR location:metacarpophalangeal joint
Lateral Thumb pos,proj,cr loc 1)Position:Lateral 2)Projection:Mediolateral 3)CR location:metacarpophalangeal joint
Lateral Thumb evaluation Concave anterior surface
Hand radiography routine and optional 1)PA 2)PA Oblique 3)"Fan" Lateral 4)optional:lateral in extension
PA Hand pos,proj,cr loc 1)Position: prone 2)Projection: PA 3)CR Location: 3rd metacarpophalangeal joint
Hand radiograph evaluation & 3 ways to determine 1)equal concavity 2)equal amounts of soft tissue 3)fingernail centered over distal phalanx & open joint spaces, soft tissue, and 1" of distal forearm
PA Oblique hand pos,proj,cr loc 1)Position:lateral rotation 2)Projection:PA Oblique 3)CR Location:3rd metacarpophalangeal joint
PA Oblique hand evaluation 1)minimum overlap 3-4 & 4-5 metacarpal shafts 2)slight overlap of metacarpal base and heads 3)separation of 2-3 metacarpals
Fan Lateral pos,proj,cr loc 1)pos:fan lateral 2)proj:lateromedial 3)CR loc:2nd metacarpophalangeal joint
Fan Lateral evaluation 1)superimposed metacarpal 2)individual phalanges without superimposition 3)distal forearm superimposed
Lateral in extension pos,proj,cr loc 1)pos:lateral in extension 2)proj:lateromedial 3)CR loc:2nd metacarpophalangeal joint
Lateral in extension evaluation 1)superimposed digits, metacarpals, & distal forearm 2)thumb abducted
Why use lateral in extension? 1)locate foreign body 2)show soft tissue 3)show metacarpal fracture displacements
Wrist radiography routine 4 views 1)PA 2)PA Oblique 3)Lateromedial 4)AP Oblique
Wrist radiography optionals 1)ulnar deviation 2)radial deviation 3)Stecher method 4)Gaynor Hart Method
PA wrist pos,proj,cr loc 1)pos:prone 2)proj:PA 3)CR loc:midcarpals
Lateral wrist pos,proj,cr loc 1)pos:lateral 2)proj:lateromedial 3)CR loc:wrist joint
Lateral wrist evaluation 1)prox 1/2 metacarpal to distal forearm 2)superimposed radius, ulna, carpals, and metacarpals 3)trapezium and scaphoid are most anterior carpal bones, thumb abducted
PA Oblique wrist pos,proj,cr loc 1)pos:lateral rotation from prone 2)proj:PA Oblique 3)CR loc:midcarpals
PA Oblique wrist evaluation Demos scaphoid and trapezium; carpals on lateral aspect
AP Oblique wrist pos,proj,cr loc 1)pos:medial rotation from supine 2)proj:AP Oblique 3)CR loc:midcarpals
AP Oblique wrist evaluation Shows pisiform free from superimposition
Ulnar Deviation wrist pos,proj,cr loc 1)pos:prone w/ ulnar deviation 2)proj:PA 3)CR loc:to scaphoid
Ulnar Deviation wrist evaluation Carpals on lateral aspect; shows scaphoid w/o foreshortening & adjacent joints open
Radial Deviation wrist pos,proj,cr loc 1)pos:prone with radial deviation 2)proj:PA 3)CR loc:midcarpal
Radial Deviation wrist evaluation Carpals on medial aspect
Stecher Method pos,proj,cr loc 1)pos:Stecher method 2)proj:PA Axial 3)CR loc:angled 20° toward elbow entering scaphoid
3 ways to do Stecher method (all PA Axial Projections,improved images with ulnar deviation) 1)wrist and film on 20°sponge, cr perpendicular 2)wrist and film flat, cr angled 20° 3)wrist and film flat, curl fingers, cr perpendicular
Stecher method wrist evaluation Shows scaphoid w/o foreshortening; from proximal 1/2 of metacarpals to distal ulna and radius
Gaynor Hart Method pos,proj,cr loc 1)pos:Gaynor Hart Method,slight rotation to thumb 5-10° 2)proj:tangential 3)CR loc:25-30° to long axis of hand,1" distal to base of 3rd metacarpal
Tangential pos,proj,cr loc Another Gaynor Hart view 1)pos:extreme hyperextension 2)proj:tangential 3)CR loc:angled 25-30°,enters midpoint of wrist
3 Elbow Fat Pads Anterior and supinator fat pads always seen. Occult fracture will show posterior fat pad.
Forearm: Routine 1)AP-supine 2)Lateromedial //2 projections 90° from eachother,long bones require both joints on IR,humerus and elbow in same plane
AP Forearm pos,proj,cr loc 1)pos:hand supinated 2)proj:AP (humeral epicondyles should be parallel to film) 3)cr loc:mid shaft
AP Forearm evaluation Elbow to proximal carpals shown; elbow joint slightly open if shoulder was in same plane; minimal superimposition of radial head
Good Lateral forearm position (3 important points) 1)elbow flexed 90° 2)hand and wrist in true lateral position 3)humerus resting on tabletop
Lateral Forearm pos,proj,cr loc 1)pos:lateral 2)proj:lateromedial 3)cr loc:midshaft of forearm
Lateral Forearm evaluation Superimposed distal radius and ulna, radial head over coronoid, superimposed humeral epicondyles, superimposed humeral condyles (if not, trochlear notch not seen)
Basic elbow routine 1)AP supine 2)2 AP Obliques:medial rotation and lateral rotation 3)Lateromedial
Optional elbow exams 1)2 APs: partial flexion 2)Coyle method 3)radial head series
AP elbow pos,proj,cr loc 1)pos:supinated (fully extend limb, entire limb same plane, humeral epicondyles parallel,hand supinated) 2)proj:AP 3)cr loc:elbow joint
Lateromedial Elbow pos,proj,cr loc 1)pos:lateral 2)proj:lateromedial 3)cr loc:elbow joint
What does lateral elbow best demonstrate? Superimposed humeral epicondyles open the trochlear notch and demos the Olecranon process
AP Oblique Elbow w/ medial rotation pos,proj,cr loc 1)pos:medial rotation or internal rotation 2)proj:AP Oblique 3)cr loc:elbow joint ((Best demos coronoid process))
AP Oblique Elbow w/ lateral rotation pos,proj,cr loc 1)pos:lateral Oblique or external Oblique 2)proj:AP Oblique 3)cr loc:elbow joint ((Shows radial head, neck, and tuberosity))
AP Projection - partially flexed elbow pos,proj,cr loc 1)pos: partial flex distal humerus 2)proj:AP 3)cr loc:elbow joint
AP Projection - partially flexed elbow pos,proj,cr loc 1)pos: partial flex proximal forearm 2)proj:AP 3)cr loc:elbow joint
Radial Head Series Done with hand in 4 positions
Coyle Method pos,proj,cr loc 1)pos:Coyle method 2)proj:axiolateral 3)cr loc:elbow joint;angulation and direction:45° toward shoulder ((Demos radial head, neck, and tuberosity))
The Coyle Method takes the place of what oblique position? External Oblique
Created by: Rsuter