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What is the central ray for the following:
† to affected PIP joint, (or MCP joint if specified)
What is the central ray for the thumb?
Name the carpal bone at the base of the thumb.
- † to the base of the thumb.
- The trapezium.
What is the central ray for the following hand projections?
PA, Oblique, and Lateral
† to the 3rd MCP joint, and 2nd for lateral. The MCP joint is the knuckle.
What is the central ray for the wrist projections?
Name the carpals. Hint: SLTP TTCU
- † to the mid-carpals for all 3 projections.
- Scaphoid, Lunate, Triquetrum, Pisiform
- Trapezium, Trapezoid, Capitate, Hamate
Where is the central ray for the AP, Oblique, and Lateral forearm projections?
How is the arm placed for the projections- extended or flexed at the elbow?
- † to the mid-forearm for all .
- Extended for AP, and flexed for Oblique and Lateral
Name the processes of the proximal ulna- posteriorly and anteriorly
Name the notch of the proximal ulna
- Olecranon process
- Coronoid process
- Trochlear notch
What are the four projections of the elbow? How are they flexed/rotated?
- AP- supinated
- Lateral- 90°
- Oblique- Medial rotation
- Oblique- Lateral rotation (leaning back)
An Oblique elbow Lateral rotation demonstrates what?
The radius and ulna free of superimposition
What is the joint anatomy of the distal humerus?
Medial and lateral epicondyles, the capitulum articulating with the head of the radius, and the trochlea articulating with the trochlear notch of the ulna.
What is the main joint articulation shown in the Oblique elbow, medial rotation?
the coronoid process demonstrated free of superimposition, and the olecranon process in the olecranon fossa.
What is the main anatomy shown in the AP humerus projection?
How is the Lateral humerus (either Internal or External Rotation) differentiated?
- AP- The greater tubercle is seen in profile laterally.
- Lateral- The lesser tubercle is seen medially.
For the trauma patients suspected of having a fx of the humeral surgical neck, what is the best projection to demonstrate this?
Transthoracic Lateral projection of the proximal humerus, Lawrence Method
What are the central rays and angles for the AP Knee, Foot, and Toes?
- AP Knee- 5º Cephalic, 2" below patella apex
- AP Axial Foot- 10º Cephalic, base of 3rd MTP joint
- AP Axial Toes- 15º Cephalic, base of 3rd MTP joint
The medial or lateral rotation of the knee demonstrates which side best?
Is the lateral knee mediolateral or lateromedial? Why is this done without flexing the knee much?
- The opposite side.
- Mediolateral. To rule out a patellar fx.
Where is the central ray for:
AP proximal femur
AP distal femur
† to the center of the IR, with the top of the IR at the level of the ASIS, or with the bottom of the IR 2" below the knee joint.
Where is the femoral neck found for the AP Hip central ray?
Where is the central ray for the AP Pelvis?
MidLine between ASIS and pubis, † to this line 2.5 inches.
Halfway between the ASIS Level and pubis.
What are the central rays for the AP Oblique Cleaves Pelvis, Bilateral and Unilateral?
AP Oblique Bilateral Cleaves Pelvis: (obliqued Femoral necks) † to 1" superior to pubis at MSP
- AP Oblique Unilateral Cleaves Pelvis::
- † to femoral neck (2.5" perp. past ASIS/Pubis line)
What angle is used to project the clavicle above the apices of the lung?
- 15º for thicker body
- 30º for thinner body
Where is the central ray for AP scapula?
† to the mid-scapula at 2" inferior to the coracoid process with arm withdrawn 90º from body
If a patient injures their right scapula, how would you best demonstrate it, and why?
Where is the central ray for this projection?
With an AP Oblique LPO scapula projection. The affected side is the side UP, away from the IR.
† to the lateral border of the rib cage at mid-scapula.
Central ray for AP (Internal or external rotation) shoulder?
What is demonstrated in the Internal rotation?
What is demonstrated in External rotation?
- † to 1" inferior and 1" medial to coracoid process
- Entire scapula and clavicle, and lesser tubercle is seen in profile medially
- Greater tubercle in profile laterally
What shoulder view of the glenoid cavity opens up the joint space when the body is rotated 15-20º towards affected side to make scapula parallel to IR?
AP Oblique shoulder, Grashey method
What projection will show a trauma dislocation of the humeral head?
Which side is demonstrated?
- The PA Oblique shoulder Scapular Y, RAO or LAO.
- The affected side is down.
For AP Oblique Axillary upper and lower rib projections, which side is demonstrated and elongated?
What is the central ray for upper ribs?
For lower ribs?
- The side down is demonstrated for ribs.
- Upper ribs- T7
- Lower ribs- T10
- Halfway between the new MSP and lateral edge of the body
For the sternum PA Oblique, RAO, what is the SID and degree of obliquity?
- 15 to 20º obliquity, 30" SID
- centered to T7, about 1" to left of spine
What is the degree of rotation for a cardiac series?
What is the vertebral central ray level for all chest Xrays?
What is the projection to best demonstrate lung fluid?
- T7 or the inferior angle of the scapula.
- LLD or RLD, (R or L lateral decubitus)side up is marked.
For a PA Oblique RAO or LAO chest 45º, which side is demonstrated?
Where is center plane?
- The side UP is demonstrated- RAO-left ribs elongated and left side of heart shown at left.
- LAO- Rt ribs elongated
- Centered to a plane between the lateral margins of the body (not the spine)
Why are ribs done tabletop? How can you tell?
40 inch SID, higher contrast, mitchell markers are in the center.
What are the central rays and angles on the tube for AP Axial sacrum and coccyx?
Can a shield be used for these?
- Central ray for both: 2" superior to the pubis
- Sacrum 15º cephalic
- Coccyx 10º caudal
- No shield for women.
What are the central rays for Lateral Sacrum and Coccyx?
What do we place next to the body on the lateral views?
- Sacrum: † to 3.5" posterior to ASIS
- Coccyx: † to 3.5" posterior to ASIS then 2" inferior
A lead mask to absorb scatter
What side is demonstrated on an AP Oblique Sacro-Iliac joints RPO/ LPO?
What is the body angle?
- The side up is demonstrated for AP. RPO shows left
- For PA, side down is shown. LAO shows left.
What is the angle of AP and oblique axial Cervical? and SID?
SID of Lateral Grandy cervical?
What is demonstrated best on an Axial Oblique RPO cervical?
- 15-20º cephalic, 40"SID for AP, 72" for Oblique
- 72" for Grandy Lateral
- The Intervertebral foramina of the side UP (left)
Describe the occlusal place used in the AP Cervical open mouth projection?
A line from the biting surface of the top teeth to the mastoid tips of the skull, † to the IR
What is the the AP lumbar central ray, and what is the positioning of the lower body?
What structures are demonstrated best?
How do we control image scatter?
- † to the midline at the iliac crest at L4, bend knees.
- Vertebral bodies, intervertebral disk spaces, laminae.
- Use a lead mask behind patient.
What projection best demonstrates the lumbar zygapophyseal joints?
AP Oblique Lumbar, RPO or LPO, showing side Down. RPO shows right, LPO shows left.
What breathing instructions are given for AP Oblique Lumbar RPO/LPO?
What is the nose of the Scotty Dog facing right?
What is the body of the Scotty Dog?
- Suspend on expiration to elevate diaphragm up out of the way.
- The Right transverse process.
- The Lamina.
Where is the central ray for Left Lateral Lumbar?
If the waist is unsupported, what is the tube angle?
- † to the MCP at the iliac crests
- Angle 5º-men and 8º-women
For the Lumbosacral L5-S1 projection, where is the central ray?
What side is affected?
Are knees bent?
What item helps control image scatter?
- 2" posterior to the ASIS and 1.5" inferior to iliac crest
- The affected side
- Hips/knees are extended
- Lead mask
Where is the Jones level of the central ray for AP and Lateral thoracic projections?
If wait can't be built up for lateral image, what is the tube angle?
- At T9 to demonstrate to L2- bisect sternum and drop 2" down.
- 10º cephalic-women, 15º cephalic-men
What are the breathing instructions for the thoracic spine?
What vertebrae are typically seen in the thoracic lateral?
- Shallow breathing to blur lung markings
- T4 is usually the first vertebrae to be clearly outlined. T3 can usually be seen somewhat.