Bontrager's Textbook of Radiographic Positioning and Related Anatomy

Description

Master radiographic positioning with this comprehensive, user-friendly text. Focusing on one projection per page, Bontrager’s Textbook of Radiographic Positioning and Related Anatomy, 9th Edition includes all of the positioning and projection information you need to know in a clear, bulleted format. Positioning photos, radiographic images, and radiographic overlays, presented side-by-side with the explanation of each procedure, show you how to visualize anatomy and produce the most accurate images. Updated to reflect the latest ARRT competencies and ASRT curriculum guidelines, it features more than 200 of the most commonly requested projections to prepare you for clinical practice. Key Features Labeled radiographs (radiographic overlays) identify key radiographic anatomy and landmarks to help you recognize anatomy and determine if you have captured the correct diagnostic information on your images. Positioning chapters, organized with one projection per page, present a manageable amount of information in an easily accessible format. Unique page layout with positioning photos, radiographic images, and radiographic overlays presented side-by-side with the text explanation of each procedure to facilitate comprehension and retention. Pathologic Indications list and define the pathologies most likely to be encountered during procedures covered in each chapter to help you understand the whole patient and improve your ability to produce radiographs that make diagnosis easy for the physician. Pathology Demonstrated sections explain why a particular projection is needed, or what pathology might be demonstrated, to give you a larger frame of reference and a better understanding of the reasoning behind each projection. Radiographic Criteria on positioning pages provide standards for evaluating the quality of each radiograph, helping you develop a routine for evaluating radiographic quality. Pediatric Applications prepare students for clinical success — and prepare technologists to deal competently with the special needs of their pediatric patients. Geriatric Applications include general information on positioning techniques and patient handling for geriatric patients, fostering an understanding of the challenges these patients present to the technologist. Critique Radiographs demonstrate positioning errors and help you avoid similar errors in clinicals. Instructor resources include an accompanying Evolve website with PowerPoint slides, an image collection, and a test bank to help instructors prepare for class. Student resources include a workbook and handbook to help you better understand and retain complicated material. Front Cover Bontrager's Textbook of Radiographic Positioning and Related Anatomy Copyright Page Acknowledgments and Dedication Contributors Contributors to Past Editions Reviewers Preface Purpose and Goal of the Ninth Edition Methodology New to This Latest Edition Ancillaries Workbook Evolve Instructor Resources Handbook Mosby’s Radiography Online How to Use the Positioning Pages Table Of Contents 1 Terminology, Positioning, and Imaging Principles Contents Part One ■ Terminology and Positioning General, Systemic, and Skeletal Anatomy and Arthrology General Anatomy Structural Organization Cells Tissues Organs System Organism Systemic Anatomy Body Systems Skeletal System Circulatory System Digestive System Respiratory System Urinary System Reproductive System Nervous System Muscular System Endocrine System Integumentary System Skeletal Anatomy Osteology Axial Skeleton Appendicular Skeleton Sesamoid Bones Classification of Bones Long Bones Composition Short Bones Flat Bones Irregular Bones Development of Bones Blood Cell Production Bone Formation Intramembranous Ossification Endochondral Ossification Primary and Secondary Centers of Endochondral Ossification (Fig. 1.21) Radiograph Demonstrating Bone Growth Arthrology (Joints) Classification of Joints Functional Structural Fibrous Joints 1. Syndesmoses1 2. Sutures 3. Gomphoses Cartilaginous Joints 1. Symphyses 2. Synchondroses Synovial Joints Movement Types of Synovial Joints 1. Plane (gliding) joints 2. Ginglymus (hinge) joints 3. Pivot (trochoid) joints 4. Ellipsoid (condylar) joints 5. Saddle (sellar) joints 6. Ball and socket (spheroidal) joints 7. Bicondylar joints3 Body Habitus Impact of Body Habitus on Radiographic Positioning Positioning Terminology General Terms Radiographic Examination or Procedure Anatomic Position Viewing Radiographs Body Planes, Sections, and Lines (Fig. 1.39) Plane: Straight Line Surface Connecting Two Points Sagittal Plane Coronal Plane Horizontal (Axial) Plane Oblique Plane Sectional Image of Body Part Longitudinal Sections—Sagittal, Coronal, and Oblique Transverse or Axial Sections (Cross-Sections) Sagittal, Coronal, and Axial Images Planes of the Skull (Fig. 1.44) Base Plane of Skull Occlusal Plane Body Surfaces and Parts Terms for the Back and Front Portions of the Body (Fig. 1.45) Posterior or Dorsal Anterior or Ventral Terms for Surfaces of the Hands and Feet Plantar Dorsal Foot Hand Palmar Radiographic Projections Common Projection Terms Posteroanterior (PA) Projection Anteroposterior (AP) Projection AP Oblique Projection PA Oblique Projection Mediolateral and Lateromedial Projections Body Positions General Body Positions Specific Body Positions Lateral Position Oblique Position5 Left and Right Posterior Oblique (LPO and RPO) Positions Right and Left Anterior Oblique (RAO and LAO) Positions Decubitus (Decub) Position Right or Left Lateral Decubitus Position—AP or PA Projection Dorsal Decubitus Position—Left or Right Lateral Ventral Decubitus Position—Right or Left Lateral Additional Special Use Projection Terms Axial Projection Inferosuperior and Superoinferior Axial Projections Tangential Projection Examples AP Axial Projection—Lordotic Position Transthoracic Lateral Projection (Right Lateral Position) Dorsoplantar and Plantodorsal Projections Parietoacanthial and Acanthioparietal Projections Submentovertical (SMV) and Verticosubmental (VSM) Projections Relationship Terms Medial Versus Lateral Examples Proximal Versus Distal Examples Cephalad Versus Caudad Interior (Internal, Inside) Versus Exterior (External, Outer) Superficial Versus Deep Example Ipsilateral Versus Contralateral Example Terms Related to Movement Flexion Versus Extension Hyperextension Abnormal Hyperextension Normal Flexion and Hyperextension of Spine Normal Hyperextension of Wrist Acute Flexion of Wrist Ulnar Deviation Versus Radial Deviation of Wrist Dorsiflexion Versus Plantar Flexion of Foot and Ankle Dorsiflexion of Foot Plantar Flexion of Foot Eversion Versus Inversion Valgus Versus Varus1 Medial (Internal) Rotation Versus Lateral (External) Rotation Abduction Versus Adduction Supination Versus Pronation Protraction Versus Retraction Example Elevation Versus Depression Example Circumduction Rotation Versus Tilt Summary of Potentially Misused Positioning Terms Position Projection View Positioning Principles Evaluation Criteria Evaluation Criteria Format Image Markers and Patient Identification Patient Identification and Date (Film-Screen Cassette [ANALOG] Systems) Digital Systems Anatomic Side Marker Additional Markers or Identification Professional Ethics and Patient Care Essential Projections Routine Projections Special Projections General Principles for Determining Positioning Routines Minimum of Two Projections (90° From Each Other) 1. Superimposition of anatomic structures 2. Localization of lesions or foreign bodies Example 3. Determination of alignment of fractures Minimum of Three Projections When Joints Are in Area of Interest Exceptions to Rules Palpation of Topographic Positioning Landmarks Palpation Image Receptor (IR) Alignment Viewing Radiographic Images Viewing CT or MRI Images Part Two ■ Imaging Principles Image Quality in Film-Screen (Analog) Radiography Analog Images Exposure Factors for Analog (Film-Screen) Imaging Image Quality Factors Density Definition Controlling Factors Adjusting Analog Image Density Density and Anode Heel Effect Compensating Filters Summary of Density Factors Contrast Definition Adjusting Analog Image Contrast Controlling Factors Grids Correct Use of Grids 1. Off-center grid Exception: decubitus—short dimension (SD)—type linear grids: 2. Off-level grid 3. Off-focus grid 4. Upside-down focused grid Summary of Contrast Factors Spatial Resolution Controlling Factors Geometric Factors Film-Screen System Motion Difference between voluntary and involuntary motion Summary of Spatial Resolution Factors Distortion X-Ray Beam Divergence Controlling Factors 1. SID Minimum 40-inch (or 102-cm) SID 2. OID 3. Object image receptor alignment Effect of improper object IR alignment 4. Central ray alignment CR angle Summary of Factors That May Affect Distortion Image Quality in Digital Radiography Digital Images Exposure Factors for Digital Imaging Image Quality Factors Brightness Controlling Factors Contrast Resolution Controlling Factors Pixels and Bit Depth Pixel Size Scatter Radiation Control Spatial Resolution Controlling Factors Distortion Controlling Factors Exposure Indicator Deviation Index Controlling Factors Noise Signal-to-Noise Ratio (SNR) High SNR Low SNR Postprocessing Postprocessing and Exposure Indicator Range Postprocessing Options Applications of Digital Technology Digital Imaging Systems Computed Radiography (CR) (Photostimulable Storage Phosphor Plate-PSP) Technologist Workstation Image Archiving Application of CR Digital Systems Collimation Accurate Centering of Part and IR Use of Lead Masks Use of Grids Exposure Factors Evaluation of Exposure Indicator Direct Radiography (DR) (Flat-Panel Detector With Thin-Film Transistor) Advantages of DR Systems Application of DR-Based Systems Image Receptor Sizes and Orientation Picture Archiving and Communication System (PACS) Advantages of PACS Digital Imaging Glossary of Terms Part Three ■ Radiation Protection Radiation Units Traditional and SI Units Dose Limits Personnel Monitoring ALARA Pregnant Technologists Radiographic Patient Dose Patient Protection in Radiography Minimum Repeat Radiographs Correct Filtration Accurate Collimation Collimation and Tissue Dose Positive Beam Limitation (PBL) Manual Collimation Collimation Rule Specific Area Shielding Shadow Shields Contact Shields Male Female Summary of Rules for Specific-Area Shielding Pregnant Patient Optimum Speed Minimize Patient Dose by Selecting Projections and Exposure Factors With Least Patient Dose Radiation Safety Practices Fluoroscopic Patient Dose Dose Area Product (DAP) Skin Injury Dose Reduction Techniques During Fluoroscopy Scattered Radiation Radiation Protection Practices During Fluoroscopy Image Wisely 2 Chest Contents Radiographic Anatomy Chest Bony Thorax Topographic Positioning Landmarks Vertebra Prominens (Seventh Cervical Vertebra) Jugular Notch (Manubrial or Suprasternal Notch) Xiphoid Process (Tip) Respiratory System Pharynx Esophagus Four Parts of the Respiratory System Larynx (Voice Box) Sectional image of larynx Trachea Thyroid gland Parathyroid glands Thymus gland Radiographs Sectional image of the trachea Branches of aortic arch Right and Left Bronchi Secondary bronchi, lobes, and alveoli Sectional image of bronchi and lungs Lungs Sectional drawing of lungs and heart Sectional image PA Chest Radiograph Parts of Lungs Lateral Chest View Mediastinum Thymus Gland Heart and Great Vessels Trachea and Esophagus Radiographic Positioning Body Habitus Breathing Movements Degree of Inspiration Positioning Considerations Radiation Protection Repeat Exposures Collimation Lead Shielding Backscatter Protection Technical Factors Kilovoltage Exposure Time and Milliamperage (mAs–Milliampere Seconds) Placement of Image Markers Pediatric Applications Supine Versus Erect Technical Factors Geriatric Applications CR Centering Technical Factors Instructions and Patient Handling Obese Patient Considerations Breathing Instructions Hold Breath on Second Inspiration Inspiration and Expiration Erect Chest Radiographs PA 72-inch (183-cm) source image receptor distance Evaluation Criteria PA Chest Positioning True PA, No Rotation Extending the Chin Minimizing Breast Shadows Lateral Chest Positioning Side Closest to IR True Lateral, No Rotation or Tilt Direction of Rotation No Tilt Arms Raised High CR Location CR Chest-Positioning Method Vertebra Prominens (PA Chest) Exceptions Jugular Notch (AP Chest) Lung Dimensions and IR Placement PA Chest AP Chest Collimation Guidelines Digital Imaging Considerations Alternative Modalities and Procedures Conventional Tomography and CT Sonography Nuclear Medicine MRI Clinical Indications Chest Pathology, Conditions, and Trauma5 Routine and Special Projections Routine and Special Projections PA Projection: Chest Ambulatory Patient Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Projection: Chest On Stretcher if Patient Cannot Stand Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position: Chest Ambulatory Patient Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Alternative Lateral Positions: Chest With Wheelchair or Cart if Patient Cannot Stand Clinical Indications Technical Factors Shielding Patient Position on Cart Patient Position in Wheelchair Part Position CR Recommended Collimation Respiration AP Projection: Chest Supine or Semierect (in Department or as Bedside Portable) Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Decubitus Position (AP Projection): Chest Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Alternative Positioning AP Lordotic Projection: Chest Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Alternative Lordotic Projection Anterior Oblique Positions—RAO and LAO: Chest Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Exception Posterior Oblique Positions—RPO and LPO: Chest Clinical Indications Technical Factors Shielding Patient Position (Erect) Patient Position (Recumbent) Part Position CR Recommended Collimation Respiration Lateral Position: Upper Airway Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Note on Centering and Exposure for Neck Region Centering and Exposure for Distal Larynx and Trachea Region AP Projection: Upper Airway Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Note on Exposure Centering for Upper Airway and Trachea Radiographs for Critique 3 Abdomen Contents Radiographic Anatomy Abdominal Radiography Acute Abdominal Series Abdominal Muscles Abdominal Organ Systems Digestive System Oral Cavity, Pharynx, and Esophagus Stomach and Small and Large Intestines Stomach Small Intestine Duodenum (A) Jejunum and ileum (B and C) Radiograph of Stomach and Small Intestine Large Intestine Spleen Accessory Digestive Organs Pancreas Liver Gallbladder Cholelithiasis CT Sectional Images Urinary System Excretory or Intravenous Urogram Sectional Image Abdominal Cavity Peritoneum Mesentery Omentum Mesocolon Greater Sac and Lesser Sac Retroperitoneal and Infraperitoneal Organs Retroperitoneal Organs Infraperitoneal Organs Intraperitoneal Organs Male Versus Female Peritoneal Enclosures Quadrants and Regions Four Abdominal Quadrants Nine Abdominal Regions Names of Regions Topographic Landmarks Seven Landmarks of the Abdomen Radiographic Positioning Patient Preparation General Positioning Considerations Breathing Instructions Image Markers Radiation Protection Repeat Exposures Close Collimation Gonadal Shielding Pregnancy Protection Exposure Factors Special Patient Considerations Pediatric Applications Geriatric Applications Obese Patient Considerations Digital Imaging Considerations Alternative Modalities CT and MRI Sonography Nuclear Medicine Clinical Indications Routine and Special Projections Routine and Special Projections AP Projection—Supine Position: Abdomen KUB Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Projection—Prone Position: Abdomen Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Decubitus Position (AP Projection): Abdomen Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Projection—Erect Position: Abdomen Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Dorsal Decubitus Position (Right or Left Lateral): Abdomen Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position: Abdomen Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Acute Abdominal Series: Acute Abdomen (1) AP Supine, (2) Erect (or Lateral Decubitus) Abdomen, (3) PA Chest Departmental Routine Specific Clinical Indications for Acute Abdominal Series Positional Guidelines Patient and Part Positioning Breathing Instructions CR Radiographs for Critique 4 Upper Limb Contents Radiographic Anatomy Upper Limb Hand and Wrist Phalanges—Fingers and Thumb (Digits) Metacarpals (Palm) Joints of the Hand Thumb (First Digit) Fingers (Second Through Fifth Digits) MPJ and CMC Joints Review Exercise With Radiographs Carpals (Wrist) Proximal Row Distal Row Carpal Sulcus (Canal or Tangential Projection) Summary Chart of Carpal Terminology Review Exercise With Radiographs Forearm—Radius and Ulna Radius and Ulna Proximal Ulna Distal Humerus True Lateral Elbow Review Exercise With Radiographs Classification of Joints Hand and Wrist Interphalangeal Joints Metacarpophalangeal Joints Carpometacarpal Joints Intercarpal Joints Wrist Joint Wrist Ligaments Elbow Joint Wrist Joint Movement Terminology Ulnar Deviation Radial Deviation Forearm Rotational Movements Summary Elbow Rotational Movements Importance of Visualizing Fat Pads Wrist Joint Elbow Joint Summary Radiographic Positioning General Positioning Considerations Lead Shielding Distance Multiple Exposures per Imaging Plate Special Patient Considerations Trauma Patients Pediatric Applications Geriatric Applications Exposure Factors Image Receptors Increase Exposure With Cast Collimation, General Positioning, and Markers Correct Centering Digital Imaging Considerations Exposure Factors Alternative Modalities and Procedures Arthrography CT and MRI Nuclear Medicine Clinical Indications Malignant bone tumors Benign bone or cartilaginous tumors (chondromas) Routine and Special Projections Routine and Special Projections PA Projection: Fingers Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation PA Oblique Projection—Medial or Lateral Rotation: Fingers Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Optional Medial Oblique Lateromedial or Mediolateral Projections: Fingers Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Projection: Thumb Clinical Indications Technical Factors Shielding Patient Position—AP Part Position—AP Exception—PA (Only if Patient Cannot Position for Previous AP) CR Recommended Collimation PA Oblique Projection—Medial Rotation: Thumb Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Lateral Position: Thumb Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Axial Projection (Modified Robert’s Method)5: Thumb Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation PA Stress Thumb Projection Folio Method8 Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation PA Projection: Hand Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation PA Oblique Projection: Hand Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Exception “Fan” Lateral—Lateromedial Projection: Hand Clinical Indications Technical Factors Compensation Filter Shielding Patient Position Part Position CR Recommended Collimation Lateral in Extension and Flexion—Lateromedial Projections: Hand Alternatives to Fan Lateral Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Oblique Bilateral Projection: Hand Norgaard Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation PA (AP) Projection: Wrist Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Alternative AP PA Oblique Projection—Lateral Rotation: Wrist Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Lateromedial Projection: Wrist Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation PA and PA Axial Scaphoid—With Ulnar Deviation: Wrist Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation PA Scaphoid—Hand Elevated and Ulnar Deviation: Wrist Modified Stecher Method10 Clinical Indications Technical Factors Shielding Patient Position Part Position Alternative Method CR Recommended Collimation PA Projection—Radial Deviation: Wrist Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Carpal Canal (Tunnel)—Tangential, Inferosuperior Projection: Wrist Gaynor-Hart Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Alternative Imaging Carpal Bridge—Tangential Projection: Wrist Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Projection: Forearm Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Lateromedial Projection: Forearm Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Projection: Elbow Elbow Fully Extended Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Projection—Alternate Partial Flexion: Elbow When Elbow Cannot Be Fully Extended Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Acute Flexion Projections: Elbow AP Projections of Elbow in Acute Flexion Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Oblique Projection—Lateral (External) Rotation: Elbow Clinical Indications Lateral (External Rotation) Oblique Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Oblique Projection—Medial (Internal) Rotation: Elbow Clinical Indications Medial (Internal Rotation) Oblique Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Lateromedial Projection: Elbow Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Trauma Axial Lateromedial and Mediolateral Projections: Elbow Coyle Method13 Clinical Indications Technical Factors Shielding Patient Position Part Position 1—Radial Head–Axial Lateromedial Projection Part Position 2—Coronoid Process–Axial Mediolateral Projection Recommended Collimation Radial Head—Lateromedial Projections: Elbow Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Radiographs for Critique 5 Humerus and Shoulder Girdle Contents Radiographic Anatomy Upper Limb (Extremity) Humerus Proximal Humerus Anatomy of Proximal Humerus on Radiograph Shoulder Girdle Clavicle Radiograph of the Clavicle Scapula Anterior View Posterior View Lateral View Review Exercise With Radiographs AP Projection Lateral Projection Proximal Humerus and Scapula Inferosuperior Axial Projection Classification of Joints Classification Mobility Type Movement Type Radiographic Positioning Proximal Humerus Rotation Radiographs of Proximal Humerus External Rotation Internal Rotation Neutral Rotation Positioning and Exposure Considerations Technical Considerations Average Adult Humerus and Shoulder Radiation Protection Gonadal Shielding Shielding of Thyroid, Lungs, and Breasts Special Patient Considerations Pediatric Applications Geriatric Applications Obese Patient Considerations Digital Imaging Considerations Alternative Modalities and Procedures Arthrography CT and MRI Nuclear Medicine Sonography Clinical Indications Routine, Alternate, and Special Projections Routine and Special Projections AP Projection: Humerus Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Rotational Lateral—Lateromedial or Mediolateral Projections: Humerus Clinical Indications Technical Factors Shielding Patient and Part Position CR Recommended Collimation Respiration Trauma Horizontal Beam Lateral—Lateromedial Projection: Mid-to-Distal Humerus Distal Humerus Clinical Indications Technical Factors Shielding Patient and Part Position CR Recommended Collimation Respiration Transthoracic Lateral Projection: Humerus (Trauma) Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Projection—External Rotation: Shoulder (Nontrauma) AP Proximal Humerus Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Projection—Internal Rotation: Shoulder (Nontrauma) Lateral Proximal Humerus Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Inferosuperior Axial Projection: Shoulder (Nontrauma) Lawrence Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Transaxillary Projection: Shoulder (Nontrauma) Hobbs Modification Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Inferosuperior Axial Projection: Shoulder (Nontrauma) Clements Modification7 Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Oblique Projection—Glenoid Cavity: Shoulder (Nontrauma) Grashey Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Apical AP Axial Projection: Shoulder8 Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Tangential Projection—Intertubercular (Bicipital) Sulcus: Shoulder (Nontrauma) Fisk Modification Clinical Indications Technical Factors Shielding Patient and Part Position Erect (Fisk Modification) Supine CR Recommended Collimation Respiration AP Projection—Neutral Rotation: Shoulder (Trauma) Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Transthoracic Lateral Projection: Proximal Humerus (Trauma) Lawrence Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Oblique Projection—Scapular Y Lateral: Shoulder (Trauma) Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Tangential Projection—Supraspinatus Outlet: Shoulder (Trauma) Neer Method9 Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Apical Oblique Axial Projection: Shoulder (Trauma) Garth Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP and AP Axial Projections: Clavicle Clinical Indications Technical Factors Shielding Patient Position Part Position CR AP AP Axial Recommended Collimation Respiration Alternative PA AP Projection (Pearson Method): AC Joints Bilateral With and Without Weights Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Weights Alternative AP Axial Projection (Alexander Method) Alternative Supine Position AP Projection: Scapula Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position: Scapula Patient Erect Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position: Scapula Patient Recumbent Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Radiographs for Critique 6 Lower Limb Contents Radiographic Anatomy Distal Lower Limb Foot Phalanges—Toes (Digits) Metatarsals Joints of Phalanges (Digits) and Metatarsals Joints of digits Joints of metatarsals Sesamoid bones Tarsals Calcaneus Articulations Talus Articulations Navicular Articulations Cuneiforms Articulations Cuboid Articulations Arches of Foot Longitudinal Arch Transverse Arch Ankle Joint Frontal View Lateral View Axial View Joint Structure Review Exercise With Radiographs Lateral Left Foot (Fig. 6.13) Oblique Right Foot (Fig. 6.14) AP Mortise View Right Ankle (Fig. 6.15) Lateral Right Ankle (Fig. 6.16) Lower Leg—Tibia and Fibula Tibia Proximal Extremity Body Distal Extremity Fibula Midfemur and Distal Femur—Anterior View Midfemur and Distal Femur—Posterior View Distal Femur and Patella (Lateral View) Distal Femur and Patella (Axial View) Patella Knee Joint Proximal Tibiofibular Joint and Major Knee Ligaments Synovial Membrane and Cavity Menisci (Articular Disks) Knee Trauma Review Exercise With Radiographs AP Lower Leg (Fig. 6.29) Lateral Lower Leg (Fig. 6.30) AP Knee (Fig. 6.31) Lateral Knee (Fig. 6.32) Lateral Knee (Fig. 6.33) Tangential Projection (Patellofemoral Joint) (Fig. 6.34) Classification of Joints Surfaces and Projections of the Foot Surfaces Projections Motions of the Foot and Ankle Radiographic Positioning Positioning Considerations Distance Shielding Collimation General Positioning Correct Centering Multiple Exposures Per Imaging Plate Exposure Factors Image Receptors Grids Special Patient Considerations Pediatric Applications Geriatric Applications Obese Patient Considerations Placement of Markers and Patient Identification Information Increase Exposure With Cast Digital Imaging Considerations Alternative Modalities and Procedures Arthrography CT MRI Bone Densitometry Nuclear Medicine Clinical Indications Routine, Alternate, and Special Projections Routine and Special Projections AP Projection: Toes Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Computed Radiography or Digital Radiography AP Oblique Projection—Medial or Lateral Rotation: Toes Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Computed Radiography or Digital Radiography Lateral—Mediolateral or Lateromedial Projections: Toes Clinical Indications Technical Factors Shielding Patient and Part Position CR Recommended Collimation Computed Radiography or Digital Radiography Tangential Projection: Toes—Sesamoids Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Alternative Projection AP Projection: Foot Dorsoplantar Projection Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Computed Radiography or Digital Radiography AP Oblique Projection—Medial Rotation: Foot Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Optional Lateral Oblique (Fig. 6.60) Lateral—Mediolateral or Lateromedial Projections: Foot Clinical Indications Technical Factors Shielding Patient Position Part Position (Mediolateral Projection) CR Recommended Collimation Digital Imaging Systems Alternative Lateromedial Projection AP Weight-Bearing Projections: Foot Clinical Indications Technical Factors Shielding AP CR Recommended Collimation Lateral Weight-Bearing Projections: Foot Lateral CR Recommended Collimation Plantodorsal (Axial) Projection: Calcaneus Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Digital Imaging Systems Lateral—Mediolateral Projection: Calcaneus Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Digital Imaging Systems AP Projection: Ankle Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Digital Imaging Systems AP Mortise Projection—15° to 20° Medial Rotation: Ankle Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Digital Imaging Systems AP Oblique Projection—45° Medial Rotation: Ankle Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Digital Imaging Systems Lateral—Mediolateral (or Lateromedial) Projection: Ankle Clinical Indications Technical Factors Shielding Patient Position Part Position (Mediolateral Projection) CR Recommended Collimation Digital Imaging Systems Alternative Lateromedial Projection AP Stress Projections: Ankle Inversion and Eversion Positions Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Digital Imaging Systems AP Projection: Lower Leg (Tibia and Fibula) Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Alternative Follow-Up Examination Routine Lateral—Mediolateral Projection: Lower Leg (Tibia and Fibula) Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Alternative Follow-Up Examination Routine Horizontal Beam (Cross-Table) Lateral AP Projection: Knee Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Oblique Projection—Medial (Internal) Rotation: Knee Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Oblique Projection—Lateral (External) Rotation: Knee Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Lateral—Mediolateral Projection: Knee Clinical Indications Technical Factors Shielding Patient Position Lateral Recumbent Projection Horizontal Beam Projection Part Position CR Recommended Collimation AP Weight-Bearing Bilateral Knee Projection: Knee Clinical Indications Technical Factors Shielding Patient and Part Position CR Recommended Collimation Alternative PA PA Axial Weight-Bearing Bilateral Knee Projection: Knee Rosenberg Method Clinical Indications Technical Factors Shielding Patient and Part Position CR Recommended Collimation Alternative Unilateral Projection PA and AP Axial Projections (“Tunnel Views”): Intercondylar Fossa Camp Coventry Method, Holmblad Method (and Variations), and Béclere Method Clinical Indications Technical Factors Shielding Patient Position Part Position 1. Prone (Camp Coventry Method) (Fig. 6.118) 2. Kneeling (Holmblad Method) (Fig. 6.119) 3. Partially Standing, Straddling Table (Holmblad Variation) 4. Partially Standing, Affected Leg on Stool or Chair (Holmblad Variation) (Figs. 6.122 and 6.123) CR Recommended Collimation AP Axial Projection: Knee—Intercondylar Fossa Béclere Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation PA Projection: Patella and Patellofemoral Joint Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Lateral—Mediolateral Projection: Patella Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Tangential—Axial or Sunrise/Skyline Projection: Patella Merchant Bilateral Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Tangential—Axial or Sunrise/Skyline Projections: Patella Inferosuperior, Hughston, and Settegast Methods Summary Technical Factors Inferosuperior Projection CR Hughston Method7 CR Settegast Method CR Superoinferior Sitting Tangential Method: Patella Hobbs Modification CR Radiographs for Critique 7 Femur and Pelvic Girdle Contents Radiographic Anatomy Lower Limb (Extremity) Femur Proximal Femur Angles of the Proximal Femur Pelvis Hip Bone Ilium Positioning Landmarks Ischium Positioning Landmarks Pubis Positioning Landmark Summary of Topographic Landmarks True and False Pelvis True Pelvis Birth Canal Male Versus Female Pelvis Differences2 Male Versus Female Pelvis Radiographs Review Exercise With Radiographs Lateral Hip Classification of Joints (Fig. 7.20) Sacroiliac Joints (Fig. 7.21) Symphysis Pubis Union of Acetabulum Hip Joint Radiographic Positioning Positioning Considerations Location of Head and Neck Appearance of Proximal Femur in Anatomic Position Internal Rotation of Leg Evidence of Hip Fracture Summary: Effect of Lower Limb Rotation Shielding Guidelines Male Shielding Female Shielding Exposure Factors and Patient Dose Special Patient Considerations Pediatric Applications Geriatric Applications Obese Patient Considerations Digital Imaging Considerations Alternative Modalities Computed Tomography Magnetic Resonance Imaging Sonography (Ultrasound) Nuclear Medicine Clinical Indications Routine and Special Projections Routine and Special Projections AP Projection: Femur—Mid- and Distal Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Lateral—Mediolateral or Lateromedial Projections: Femur—Mid- and Distal Clinical Indications Technical Factors Shielding Patient Position Part Position Lateral Recumbent (Fig. 7.39) Trauma Lateromedial Projection (Fig. 7.40) CR Recommended Collimation Lateral—Mediolateral Projection: Femur—Mid- and Proximal Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation AP Pelvis Projection (Bilateral Hips): Pelvis Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Bilateral Frog-Leg Projection: Pelvis Modified Cleaves Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Axial Outlet Projection3 (for Anterior-Inferior Pelvic Bones): Pelvis Taylor Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Axial Inlet Projection4: Pelvis Clinical Indications Technical Factors Shielding Patient Position Part Position CR Collimation Respiration Posterior Oblique PROJECTION: Pelvis—Acetabulum Judet Method Clinical Indications Technical Factors Shielding Patient Position—Posterior Oblique Positions Part Position CR Recommended Collimation Respiration PA Axial Oblique Projection—Acetabulum Teufel Method Clinical Indications Technical Factors Shielding Patient Position—Axial Oblique Positions Part Position CR Recommended Collimation Respiration AP Unilateral Hip Projection: Hip and Proximal Femur Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Axiolateral Inferosuperior Projection—TRAUMA: Hip and Proximal Femur Danelius-Miller Method Clinical Indications Technical Factors Shielding Patient Position Part Position (Figs. 7.68 and 7.69) CR Recommended Collimation Respiration Unilateral Frog-Leg Projection—Mediolateral: Hip and Proximal Femur Modified Cleaves Method Clinical Indications Technical Factors Shielding Patient Position Part Position (Fig. 7.71) Recommended Collimation Respiration Modified Axiolateral Projection—Possible Trauma: Hip and Proximal Femur Clements-Nakayama Method5 Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Radiographs for Critique 8 Cervical and Thoracic Spine Contents Radiographic Anatomy Vertebral Column Spinal canal Spinal cord Intervertebral disks Sections of Vertebral Column Cervical vertebrae Thoracic vertebrae Lumbar vertebrae Sacrum and coccyx Vertebral Column Curvatures Lordosis Kyphosis Scoliosis Typical Vertebral Anatomy (1) Body (2) Vertebral Arch Superior Perspective Lateral Perspective Summary (3) Joints in the Vertebral Column Intervertebral Joints Zygapophyseal Joints Costal Joints (4) Intervertebral Foramina (5) Intervertebral Disk Characteristics of Cervical Vertebrae Superior Perspective Lateral Perspective Cervical Zygapophyseal Joints Cervical Intervertebral Foramina Atlas (C1) Axis (C2) Relationship of C1 and C2 Characteristics of Thoracic Vertebrae Rib Articulations Costovertebral Joints Costotransverse Joints Superior and Lateral Perspectives Lateral Oblique Perspective Thoracic Zygapophyseal Joints Thoracic Intervertebral Foramina Unique C1-C2 Joint Classifications Anatomy Review With Radiographic Images AP Cervical Spine Image Lateral Cervical Spine Image Oblique (RPO) Cervical Spine Image AP and Lateral Thoracic Spine Image AP Thoracic Spine Image (Fig. 8.28) Lateral Thoracic Spine (Fig. 8.29) Intervertebral Foramina Versus Zygapophyseal Joints Cervical Spine Skeleton Cervical Spine Radiographs Thoracic Spine Skeleton Thoracic Spine Radiographs Radiographic Positioning Topographic Landmarks Cervical Landmarks Sternum and Thoracic Spine Landmarks Positioning and Technical Considerations Erect versus Recumbent Patient Radiation Protection Technical and Image Quality Factors Exposure Factors Focal Spot Size Compensating Strategies SID Scatter Radiation Part-IR Alignment Special Patient Considerations Pediatric Applications Geriatric Applications Communication Safety Patient Handling and Comfort Technical Factors Obese Patient Considerations Digital Imaging Considerations Alternative Modalities and Procedures Myelography Computed Tomography Magnetic Resonance Imaging Nuclear Medicine Clinical Indications Routine and Special Projections Routine and Special Projections AP Open Mouth Projection (C1 and C2): Cervical Spine Clinical Indications Technical Factors Shielding Patient Position—Supine or Erect Position Part Position CR Recommended Collimation Respiration AP Axial Projection: Cervical Spine Clinical Indications Technical Factors Shielding Patient Position—Supine or Erect Position Part Position CR Recommended Collimation Respiration Anterior and Posterior Oblique Positions: Cervical Spine Clinical Indications Technical Factors Shielding Patient Position—Erect or Recumbent Position Part Position CR Anterior Oblique (RAO, LAO) Posterior Oblique (RPO, LPO) Recommended Collimation Respiration Lateral Position (Erect): Cervical Spine Clinical Indications Technical Factors Shielding Patient Position—Lateral Position Part Position CR Recommended Collimation Respiration Lateral, Horizontal Beam—Trauma: Cervical Spine Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Cervicothoracic (Swimmer’s) Lateral Position: Cervical Spine C5-T3 Region Clinical Indications Technical Factors Shielding Patient Position—Erect or Recumbent Position Part Position CR Recommended Collimation Respiration Optional Breathing Technique Lateral Positions—Hyperflexion and Hyperextension: Cervical Spine Clinical Indications Technical Factors Shielding Patient Position—Erect Lateral Position Part Position CR Recommended Collimation Respiration AP or PA Projection for C1-C2 (Odontoid process–dens): Cervical Spine Fuchs Method (AP) or Judd Method (PA) Clinical Indications Technical Factors Shielding Patient and Part Position AP (Fuchs Method) PA (Judd Method) Recommended Collimation Respiration AP “Wagging Jaw” Projection: Cervical Spine Ottonello Method Clinical Indications Technical Factors Shielding Patient Position—Supine Position Part Position CR Recommended Collimation Respiration AP Axial Projection—Vertebral Arch (Pillars): Cervical Spine Clinical Indications Technical Factors Shielding Patient Position—Supine Position Part Position CR Recommended Collimation Respiration AP Projection: Thoracic Spine Clinical Indications Technical Factors Shielding Patient Position—Recumbent and Erect Position Part Position CR Recommended Collimation Respiration Lateral Position: Thoracic Spine Clinical Indications Technical Factors Shielding Patient Position—Lateral Recumbent or Erect Position Part Position CR Recommended Collimation Respiration Anterior or Posterior Oblique Position: Thoracic Spine Clinical Indications Technical Factors Shielding Patient Position—Oblique Anterior or Posterior Recumbent or Erect Positions Part Position Posterior Oblique Position (Recumbent) Anterior Oblique Position (Recumbent) Erect Anterior Oblique Position CR Recommended Collimation Respiration Radiographs for Critique 9 Lumbar Spine, Sacrum, and Coccyx Contents Radiographic Anatomy Lumbar Vertebrae Lateral and Superior Perspectives Intervertebral Foramina Zygapophyseal Joints Posterior and Anterior Perspectives Sacrum Anterior Perspective Lateral Perspective Posterior Sacrum Coccyx Anterior Coccyx Posterior Coccyx Lateral Sacrum and Coccyx Radiograph Anatomy Review Superoinferior Projection Lateral Position AP Projection Lateral Lumbosacral Spine AP Lumbosacral Spine Oblique Lumbar Vertebrae Appearance of “Scottie Dog” Oblique Lumbar Radiograph Classification of Joints Zygapophyseal (Apophyseal) Joints Intervertebral Joints Intervertebral Foramina Versus Zygapophyseal Joints Intervertebral Foramina—Lateral Lumbar Spine Zygapophyseal Joints—Oblique Lumbar Spine Posterior Oblique Anterior Oblique Radiographic Positioning Topographic Landmarks Lower Spine Landmarks Positioning Considerations Patient Radiation Protection Patient Position PA Versus AP Projections Exposure Factors Lead Masking on Tabletop SID Part-IR Alignment Special Patient Considerations Pediatric Applications Patient Motion and Safety Communication Immobilization Technical Factors Geriatric Applications Communication and Comfort Technical Factors Obese Patient Considerations Digital Imaging Considerations Alternative Modalities and Procedures Computed Tomography Magnetic Resonance Imaging Nuclear Medicine Technology Bone Densitometry Myelography Clinical Indications Routine and Special Positioning Routine and Special Projections AP (or PA) Projection: Lumbar Spine Clinical Indications Technical Factors Shielding Patient Position—Supine Position Part Position CR Recommended Collimation Respiration Posterior (or Anterior) Oblique Positions: Lumbar Spine Clinical Indications Technical Factors Shielding Patient Position—Posterior or Anterior Oblique Positions Part Position CR Recommended Collimation Respiration Lateral Position: Lumbar Spine Clinical Indications Technical Factors Shielding Patient Position—Lateral Position Part Position CR Recommended Collimation Respiration Lateral L5-S1 Position: Lumbar Spine Clinical Indications Technical Factors Shielding Patient Position—Lateral Position Part Position CR Recommended Collimation Respiration AP Axial L5-S1 Projection: Lumbar Spine Clinical Indications Technical Factors Shielding Patient Position—Supine Position Part Position CR Recommended Collimation Respiration PA Projection: Scoliosis Series Clinical Indications Technical Factors Shielding Patient Position—Erect and Recumbent Position Part Position CR Recommended Collimation Respiration Lateral Position (ERECT): Scoliosis Series Clinical Indications Technical Factors Shielding Patient Position—Erect Lateral Position Part Position CR Recommended Collimation Respiration PA Projection (Ferguson Method): Scoliosis Series Clinical Indications Technical Factors Shielding Patient Position—Erect Part Position CR Recommended Collimation Respiration PA (AP) Projection—Right and Left Bending: Scoliosis Series Clinical Indications Technical Factors Shielding Patient Position—Erect or Recumbent Position Part Position CR Recommended Collimation Respiration Lateral Positions—Hyperextension and Hyperflexion: Spinal Fusion Series Clinical Indications Technical Factors Shielding Patient Position—Recumbent Lateral Position Part Position Hyperflexion Hyperextension CR Recommended Collimation Respiration AP Axial Projection: Sacrum Clinical Indications Technical Factors Shielding Patient Position—Supine Position Part Position CR Recommended Collimation Respiration AP Axial Projection: Coccyx Clinical Indications Technical Factors Shielding Patient Position—Supine Position Part Position CR Recommended Collimation Respiration Lateral Position: Sacrum and Coccyx Clinical Indications Technical Factors Shielding Patient Position—Lateral Position Part Position CR Recommended Collimation Respiration Lateral Position: Coccyx Clinical Indications Technical Factors Shielding Patient Position—Lateral Position Part Position CR Recommended Collimation Respiration AP Axial Projection: Sacroiliac Joints Clinical Indications Technical Factors Shielding Patient Position—Supine Position Part Position CR Recommended Collimation Respiration Posterior Oblique Positions (LPO and RPO): Sacroiliac Joints Clinical Indications Technical Factors Shielding Patient Position—Supine Position Part Position CR Recommended Collimation Respiration Radiographs for Critique 10 Bony Thorax—Sternum and Ribs Contents Radiographic Anatomy Bony Thorax Sternum Palpable Landmarks Sternoclavicular Articulation Sternal Rib Articulations Ribs Summary Typical Rib Inferior View Posterior View Rib Cage Articulations of Bony Thorax Anterior Articulations Posterior Articulations Radiographic Positioning Positioning Considerations for the Sternum Exposure Factors Source Image Receptor Distance (SID) Positioning Considerations for the Ribs Above or Below Diaphragm SID Above Diaphragm Below Diaphragm Recommended Projections Marking the Site of Injury Chest Radiography Special Patient Considerations Pediatric Applications Communication Immobilization Exposure Factors Collimation Geriatric Applications Communication and Comfort Exposure Factors Obese Patient Considerations Digital Imaging Considerations Alternative Modalities and Procedures Computed Tomography Nuclear Medicine Clinical Indications Routine and Special Projections Routine and Special Projections RAO Position: Sternum Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position—R or L Lateral: Sternum Clinical Indications Technical Factors Shielding Patient Position Part Position Erect Lateral Recumbent CR Recommended Collimation Respiration PA Projection: Sternoclavicular Joints Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Anterior Oblique Positions—RAO and LAO: Sternoclavicular Joints Images of the Right and Left Joints Are Obtained Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Projection: Bilateral Posterior Ribs Above or Below Diaphragm Clinical Indications Technical Factors Shielding Patient Position Part Position CR Above Diaphragm Below Diaphragm Recommended Collimation Respiration PA Projection: Bilateral Anterior Ribs Above Diaphragm Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Erect and Lateral Chest Study AP Projection: Unilateral Rib Study: Posterior Ribs Above or Below Diaphragm Ribs Technical Factors Shielding Patient Position Part Position CR Above diaphragm Below diaphragm Recommended Collimation Respiration Posterior or Anterior Oblique Positions: Axillary Ribs Above or Below Diaphragm Clinical Indications Technical Factors Shielding Patient Position Part Position CR Above diaphragm Below diaphragm Recommended Collimation Respiration Radiographs for Critique 11 Cranium, Facial Bones, and Paranasal Sinuses Contents Radiographic Anatomy Skull Cranial Bones Calvarium (Skullcap) Floor Frontal Bone Squamous or vertical portion Orbital or horizontal portion Articulations Parietal Bones Articulations Occipital Bone Articulations Temporal Bones Lateral view Frontal cutaway view Superior view Articulations Sphenoid Bone Superior view Oblique view Sella turcica—lateral view Articulations Ethmoid Bone Articulations Cranium—Sagittal View Joints of the Cranium—Sutures Adult Cranium Infant Cranium Fontanels Sutural, or Wormian, Bones Anatomy Review With Radiographs Cranial Bones—PA Axial Caldwell Projection −15˚ caudad (Fig. 11.21) Cranial Bones—AP Axial Projection (Fig. 11.22) Cranial Bones—Lateral Projection (Fig. 11.23) Anatomy of Organs of Hearing and Equilibrium External Ear Middle Ear CT of Temporal Bone Eustachian Tube Internal Acoustic Meatus Mastoids Auditory Ossicles Auditory Ossicles—Frontal and Lateral View Internal Ear Osseous (Bony) Labyrinth Semicircular Canals “Windows” of Internal Ear Anatomy Review With Radiographs Axiolateral Projection (Fig. 11.35) Posterior Profile Position (Fig. 11.36) Facial Bones Facial Bones Right and Left Maxillary Bones Lateral View of Left Maxilla Frontal View Hard Palate (Inferior Surface) Articulations Right and Left Zygomatic Bones Articulations Right and Left Nasal and Lacrimal Bones Lacrimal Bones Nasal Bones Articulations Lacrimal Nasal Right and Left Inferior Nasal Conchae Sectional Drawing Inferior Nasal Conchae Right and Left Palatine Bones Articulations Inferior nasal conchae Palatine Nasal Septum Vomer Articulations Mandible Lateral View Frontal View Ramus Submentovertical Projection Temporomandibular Joint Joint Classifications (Mandible and Skull) Synovial Joints (Diarthrodial) Fibrous Joints (Synarthrodial) TMJ Motion Radiographs (Open and Closed Mouth) Paranasal Sinuses Purpose Maxillary Sinuses Frontal Sinuses Ethmoid Sinuses Sphenoid Sinuses Osteomeatal Complex Radiographs—Paranasal Sinuses Lateral Position PA (Caldwell) Projection Parietoacanthial Transoral Projection (Open-Mouth Waters) SMV Projection Orbits Bony Composition of Orbits Openings in Posterior Orbit Anatomy Review Seven Bones of Left Orbit (Fig. 11.73) Openings and Structures of Left Orbit (Fig. 11.74) Parieto-orbital Oblique Projection of Orbits (Fig. 11.75) Facial Bones—Lateral (Figs. 11.76 and 11.77) Facial Bones—Parietoacanthial (Waters) Facial Bones—SMV (Inferior View) Skull Only (See Fig. 11.80) Radiograph Only (See Fig. 11.81) Facial Bones—Frontal View (Fig. 11.82) Clinical Indications of Cranium Skull and Cranial Pathology Temporal Bone Pathology Clinical Indications of Facial Bones and Paranasal Sinuses Radiographic Positioning Considerations of Cranium Skull Morphology (Classifications by Shape and Size) Mesocephalic Skull Brachycephalic and Dolichocephalic Skulls Positioning Considerations Related to Skull Morphology Cranial Topography (Surface Landmarks) Body Planes (Fig. 11.88) Anterior and Lateral View Landmarks (Figs. 11.89 and 11.90) Ear Eye Cranial Positioning Lines (Fig. 11.91) Skull Positioning Aids Positioning Considerations Erect Versus Recumbent Patient Comfort Hygiene Exposure Factors Paranasal Sinuses Exposure Factors Source Image Receptor Distance Radiation Protection Patient Shielding Causes of Positioning Errors Five Common Positioning Errors Radiographic Positioning Considerations of Facial Bones and Paranasal Sinuses Special Projections and Anatomic Relationships PA Skull Projection Parietoacanthial (Waters Method) Projection Special Patient Considerations Pediatric Applications Communication Immobilization Exposure Factors Geriatric Applications Communication and Comfort Exposure Factors Obese Patient Considerations Alternative Modalities CT MRI Sonography Nuclear Medicine Routine and Special Projections Routine and Special Projections AP Axial Projection: Skull Series Towne Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position—Right or Left Lateral: Skull Series Clinical Indications Trauma Routine Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Axial Projection: Skull Series 15° CR (Caldwell Method) or 25° to 30° CR Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Alternative 25° to 30° Alternative AP Axial Projection PA Projection: Skull Series Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Submentovertical (SMV) Projection: Skull Series Clinical Indications Technical Factors Shielding Patient Position Part Position Supine Erect CR Recommended Collimation Respiration PA Axial Projection: Skull Series Haas Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position—Right or Left Lateral: Facial Bones Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Parietoacanthial Projection: Facial Bones Waters Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Axial Projection: Facial Bones Caldwell Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Modified Parietoacanthial Projection: Facial Bones Modified Waters Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position: Nasal Bones Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Superoinferior Tangential (Axial) Projection: Nasal Bones Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Submentovertical (SMV) Projection: Zygomatic Arches Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Oblique Inferosuperior (Tangential) Projection: Zygomatic Arches Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Axial Projection: Zygomatic Arches Modified Towne Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Parieto-orbital Oblique Projection: Optic Foramina Rhese Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Axiolateral or Axiolateral Oblique Projection: Mandible Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA or PA Axial Projection: Mandible Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Axial Projection: Mandible Towne Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Submentovertical (SMV) Projection: Mandible Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Orthopantomography—Panoramic Tomography: Mandible Clinical Indications Technical Factors (Conventional Radiographic Systems) Unit Preparation Shielding Patient Position Part Position CR Recommended Collimation Digital Orthopantomography Advantages of Orthopantomography Compared With Conventional Mandible Positioning AP Axial Projection: TEMPOROMANDIBULAR JOINTS Modified Towne Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Axiolateral Oblique Projection: TMJ Modified Law Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Axiolateral Projection: TMJ Schuller Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position—Right or Left Lateral: Sinuses Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Projection: Sinuses Caldwell Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Parietoacanthial Projection: Sinuses Waters Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Submentovertical (SMV) Projection: Sinuses Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Parietoacanthial Transoral Projection: Sinuses Open-Mouth Waters Method Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Radiographs for Critique—Cranium Radiographs for Critique—Facial Bones Radiographs for Critique—Sinuses 12 Biliary Tract and Upper Gastrointestinal System Contents Radiographic Anatomy Liver Lobes of the Liver Function of the Liver Gallbladder and Biliary Ducts Functions of the Gallbladder Common Bile Duct Gallbladder and Biliary Ducts (Lateral View) Anatomy Review Radiograph of Gallbladder Oral Cholecystogram—Historical Review Medical Sonography Clinical Indications Gallbladder and Biliary Duct Radiography Biliary Calculi (Gallstones) Cholecystitis Neoplasms Biliary Stenosis Digestive System Alimentary Canal Accessory Organs Functions Common Radiographic Procedures Esophagogram or Barium Swallow (Study of Pharynx and Esophagus) Upper Gastrointestinal Series (Study of Distal Esophagus, Stomach, and Duodenum) Mouth (Oral Cavity) Accessory Organs in Oral Cavity Pharynx Cavities That Communicate With Pharynx Deglutition (Swallowing) Esophagus Diaphragmatic Openings Swallowing and Peristalsis Stomach Stomach Openings and Curvatures Stomach Subdivisions Mucosal Folds Within the Stomach—Rugae Stomach Position Air/Gas–Barium Distribution in Stomach Duodenum Four Parts of Duodenum Anatomy Review Radiograph of Stomach and Duodenum Digestion Mechanical Digestion Chemical Digestion Digested Substances and Resultant By-Products Summary Body Habitus Hypersthenic Versus Hyposthenic/Asthenic Hypersthenic Hyposthenic/Asthenic Sthenic Additional Factors Radiographs of Upper Gastrointestinal Tract Demonstrating Body Types Radiographic Procedures Similarities Contrast Media Barium Sulfate Thin Barium Thick Barium Contraindications to Barium Sulfate Double Contrast Postexamination Elimination (Defecation) Digital Fluoroscopy Digital Radiography-Fluoroscopy Optional Postfluoroscopy “Overhead” Images Multiple Frame Formatting and Multiple “Original” Films Cine Loop Capability Image Enhancement and Manipulation Worker Protection During Fluoroscopy Exposure Patterns Lead Drape Shield Bucky Slot Shield Lead Aprons Cardinal Principles of Radiation Protection Esophagogram Procedure Definition and Purpose Contraindications Clinical Indications for Esophagogram Patient and Room Preparation for Esophagogram General Procedure Fluoroscopy Demonstration of Esophageal Reflux Breathing Exercises Water Test Compression Technique Toe-Touch Maneuver Postfluoroscopy Imaging Upper GI Series Procedure Definition and Purpose Contraindications Clinical Indications for Upper GI Series Patient Preparation for Upper GI Series Pregnancy Precautions Room Preparation and Fluoroscopy Procedure Patient and Table Movements Postfluoroscopy Routines Special Patient Considerations Pediatric Applications Pediatric Patient Preparation for Upper GI Barium Preparation Room Preparation Geriatric Applications Obese Patient Considerations Summary of Positioning Tips for Upper GI Examinations Clinical History Body Habitus Fluoroscopy High kV and Short Exposure Time Digital Imaging Considerations Alternative Modalities and Procedures CT MRI Medical Sonography Nuclear Medicine Routine and Special Projections Routine and Special Projections RAO Position: Esophagogram Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Position: Esophagogram Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Optional Swimmer’s Lateral Position AP (PA) Projection: Esophagogram Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Alternative PA LAO Position: Esophagogram Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration RAO Position: Upper GI Series Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA Projection: Upper GI Series Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Alternate PA Axial Right Lateral Position: Upper GI Series Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration LPO Position: Upper GI Series Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Projection: Upper GI Series Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Alternative AP Trendelenburg 13 Lower Gastrointestinal System Contents Radiographic Anatomy Digestive System Common Radiographic Procedures Small Bowel Series—Study of Small Intestine Barium Enema (Lower GI Series, Colon)—Study of Large Intestine Small Intestine Duodenum (RUQ and LUQ) Jejunum (LUQ and LLQ) Ileum (RLQ and LLQ) Sectional Differences Jejunum Ileum CT Cross-Sectional Image Large Intestine Colon Versus Large Intestine Cecum Appendix Large Intestine—Barium-Filled Rectum and Anal Canal Large Versus Small Intestine Relative Locations of Air and Barium in Large Intestine Anatomy Review Small Bowel Radiographs Barium Enema Digestive Functions Digestive Functions of the Intestines Movements of Digestive Tract Small Intestine Large Intestine Radiographic Procedures Small Bowel Series Definition Purpose Contraindications Clinical Indications Small Bowel Procedures Contrast Media Upper GI–Small Bowel Combination Review of Images Fluoroscopic Study Delayed Radiographs Small Bowel–Only Series Enteroclysis—Double-Contrast Small Bowel Procedure Intubation Method—Single-Contrast Study Patient Preparation Pregnancy Precautions Method of Imaging Barium Enema (Lower GI Series) Definition Purpose Contraindications Appendicitis Clinical Indications for Barium Enema Barium Enema Procedure Patient Preparation Contraindications to Laxatives (Cathartics) Two Classes of Laxatives Radiographic Room Preparation Equipment and Supplies Barium Enema Containers Enema Tips Latex Allergies Contrast Media Negative-Contrast Agent Contrast Media Preparation Procedure Preparation Sims Position Preparation for Rectal Tip Insertion Enema Tip Insertion Summary of Enema Tip Insertion Procedure Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Fluoroscopy Routine Types of Lower GI Examinations (Procedures) Single-Contrast Barium Enema Procedure Double-Contrast Barium Enema Procedure Two-stage procedure Single-stage procedure Spot images (during fluoroscopy) Digital fluoroscopy Postfluoroscopy radiographs Postevacuation radiograph Evacuative Proctography—Defecography Definition and purpose Clinical indications Special equipment Contrast media Applicator Evacuative Proctogram Procedure Summary of Evacuative Proctogram Procedure Colostomy Barium Enema Clinical Indications and Purpose Special Supplies for Colostomy Barium Enema Patient Preparation Procedure Summary of Colostomy Barium Enema Procedure Special Patient Considerations Pediatric Applications Small Bowel Series and Barium Enema Geriatric Applications Obese Patient Considerations Digital Imaging Considerations Alternative Modalities and Procedures CT CT Enteroclysis CT Colonography (CTC) Patient Preparation Procedure Advantages of CT Colonography4 Disadvantages of CT Colonography Nuclear Medicine MRI Sonography Routine and Special Projections Routine and Special Projections PA Projection: Small Bowel Series Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA or AP Projection: Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration RAO Position: Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration LAO Position: Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration LPO and RPO Positions: Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Lateral Rectum Position or Ventral Decubitus Lateral: Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position (Lateral Position) CR Recommended Collimation Respiration Right Lateral Decubitus Position (AP or PA Projection): Barium Enema—Double Contrast Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Left Lateral Decubitus Position (AP or PA Projection): Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration PA (AP) Projection—Postevacuation: Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Axial or AP Axial Oblique (LPO) Projections: Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position AP Axial LPO CR AP LPO Recommended Collimation Respiration PA Axial or PA Axial Oblique (RAO) Projections: Barium Enema Clinical Indications Technical Factors Shielding Patient Position Part Position PA RAO CR PA RAO Recommended Collimation Respiration 14 Urinary System and Venipuncture Contents Radiographic Anatomy Urinary System Kidneys Ureters Urethra Kidneys Kidney Orientation Cross-Sectional View CT Axial Section Normal Kidney Location Kidney Movement Functions of Urinary System Renal Blood Vessels Urine Production Macroscopic Structure Ureters Ureter Size and Points of Constriction Urinary Bladder Bladder Functions Size and Position of the Bladder Female Pelvic Organs Female Reproductive Organs Retroperitoneal and Infraperitoneal Organs Male Pelvic Organs Male Reproductive Organs Anatomy Review Retrograde Pyelogram Voiding Cystourethrogram Computed Tomography Axial Section Venipuncture Introduction Preparation for Administration of Contrast Agents Bolus Injection Drip Infusion Equipment and Supplies Patient Preparation Signing Informed Consent Form Selection of Vein Ensure Vein and Not an Artery Type and Size of Needle Venipuncture Procedure Step 1: Wash Hands and Put On Gloves (Figs. 14.28 and 14.29) Step 2: Apply Tourniquet, Select Site, and Cleanse the Site (Figs. 14.30 to 14.33) Step 3: Initiate Puncture (Figs. 14.34 and 14.35) Step 4: Confirm Entry and Secure Needle (Figs. 14.38 to 14.41) Step 5: Prepare and Proceed With Injection (Figs. 14.42 and 14.43) Step 6: Needle or Catheter Removal (Figs. 14.44 and 14.45) Summary of Safety Considerations Radiographic Procedures Contrast Media and Urography Introduction to the Intravenous Urogram Types of Contrast Media Ionic Organic Iodides Higher Osmolality and Greater Chance of Reaction Nonionic Organic Iodide Lower Osmolality and Less Chance of Reaction Low-Osmolality Organic Iodide Common Side Effects Patient History Blood Chemistry Metformin3 Selection and Preparation of Contrast Media Reactions to Contrast Media Preparation for Possible Reaction Premedication Procedure Categories of Contrast Medium Reactions3 Local Reactions Systemic Reactions Excretory Urography—Intravenous Urography (IVU) Purpose Contraindications Glossary of Urinary Pathologic Terms Clinical Indications Patient Preparation Pregnancy Precautions Preparation of Radiographic Equipment and Supplies Ureteric Compression Contraindications to Ureteric Compression Alternative Trendelenburg General Intravenous Urography Procedure Scout Image and Injection Basic Imaging Routine (Sample Protocol) Alternatives to Routine Examination 1. Postrelease or “spill” procedure with ureteric compression 2. Erect position for bladder 3. Delayed radiographs Nephrogram Versus Nephrotomogram Hypertensive Intravenous Urography Purpose Procedure Retrograde Urography Purpose Procedure Retrograde Cystography Purpose Procedure Voiding Cystourethrography Purpose Clinical Indications Procedure Retrograde Urethrography Purpose Clinical Indications Procedure Summary of Urinary System Procedures Special Patient Considerations Pediatric Applications Geriatric Applications Obese Patient Considerations Digital Imaging Considerations Alternative Modalities and Procedures Computed Tomography CT Dose Reduction Measures Sonography (Ultrasound) Magnetic Resonance Imaging Nuclear Medicine Routine and Special Projections Routine and Special Projections AP Projection (Scout and Series): Intravenous (Excretory) Urography Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Nephrotomography and Nephrography: Intravenous (Excretory) Urography Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration RPO and LPO Positions: Intravenous (Excretory) Urography Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Projection: Intravenous (Excretory) Urography Postvoid Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Projection: Intravenous (Excretory) Urography Ureteric Compression Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration AP Projection • LPO and RPO Positions • Lateral Position (Optional): Cystography Clinical Indications Technical Factors Patient and Part Positions AP Posterior Oblique Lateral CR AP Posterior Oblique Lateral (Optional) Recommended Collimation Respiration RPO (30°) Position—Male • AP Projection—Female: Voiding Cystourethrography Anatomy Demonstrated Technical Factors Shielding Patient Position Part Position Male Female CR Recommended Collimation Respiration 15 Trauma, Mobile, and Surgical Radiography Contents Trauma and Mobile Imaging Introduction Skeletal Trauma and Fracture Terminology Dislocation Subluxation Sprain Contusion Fracture Fracture Alignment Terminology Apposition Angulation Types of Fractures Simple (Closed) Fracture Compound (Open) Fracture Incomplete (Partial) Fracture Complete Fracture Comminuted Fracture Impacted Fracture Specific Named Fractures Barton Fracture Baseball (Mallet) Fracture Bennett Fracture Boxer Fracture Colles Fracture Smith (Reverse Colles) Fracture Hangman Fracture Hutchinson (Chauffeur) Fracture Monteggia (mon-tej′-ah) Fracture Pott Fracture Additional Fracture Types Avulsion Fracture Blowout and/or Tripod Fracture Chip Fracture Compression Fracture Depressed Fracture (sometimes called a Ping-Pong fracture) Epiphyseal Fracture Pathologic Fracture Stellate Fracture Stress or Fatigue Fracture (sometimes called a “March” fracture) Trimalleolar Fracture Tuft or Burst Fracture Postfracture Reduction Closed Reduction Open Reduction Mobile X-Ray Equipment Mobile X-Ray Systems Battery-Driven, Battery-Operated, Mobile X-Ray Units Standard Power Source, Capacitor-Discharge, Non-Motor-Driven Units Digital Imaging Considerations Positioning Principles for Trauma and Mobile Radiography Principle 1: Two Projections 90° to Each Other With True CR-Part-IR Alignment Exception to True Anteroposterior (AP) and Lateral Principle Exception to CR-Part-IR Alignment Principle 2: Entire Structure or Trauma Area Included on Image Receptor Principle 3: Maintain the Safety of the Patient, Health Care Workers, and the Public Alternative Modalities Computed Tomography Sonography Nuclear Medicine Angiography and Interventional Procedures Routine and Special Projections Routine and Special Projections Trauma and Mobile Positioning AP Chest Clinical Indications Technical Factors Patient Position AP Chest Part Position AP Chest CR AP Chest Radiation Safety Respiration Lateral Decubitus AP Projection AP Supine and Decubitus: Abdomen Clinical Indications Technical Factors Patient Position AP Supine (Fig. 15.33) Left Lateral Decubitus AP (or PA) Projection (Fig. 15.34) Part Position AP Supine Left Lateral Decubitus AP (or PA) Projection CR AP Supine Left Lateral Decubitus AP (or PA) Projection Radiation Safety Respiration AP Supine and Left Lateral Decubitus AP (or PA) Projection Dorsal Decubitus, Lateral Position (Fig. 15.35) Upper Limb Clinical Indications Technical Factors Patient Position Part Position CR Radiation Safety Upper Limb Positioning Examples Shoulder Clinical Indications Technical Factors Patient Position AP Shoulder and Scapular Y Lateral—AP Oblique (Lateromedial Scapula) (Figs. 15.51 and 15.52) Inferosuperior Axial (Fig. 15.53) Transthoracic Lateral (Fig. 15.54) Part Position AP Shoulder Scapular Y Lateral—AP Oblique (Lateromedial Scapula) Inferosuperior Axial Transthoracic Lateral CR AP Shoulder Scapular Y Lateral—AP Oblique (Lateromedial Scapula) Inferosuperior Axial Transthoracic Lateral Radiation Safety Respiration Lower Limb Clinical Indications Technical Factors Patient Position Part Position CR Radiation Safety Lower Limb Positioning Examples Pelvis Clinical Indications Technical Factors Patient Position AP Pelvis Part Position AP Pelvis CR AP Pelvis Radiation Safety Respiration Hip Clinical Indications Technical Factors Patient Position AP Hip and Axiolateral-Inferosuperior Hip—Danelius-Miller Method (Figs. 15.69 and 15.70) Part Position AP Hip Axiolateral-Inferosuperior Hip–Danelius—Miller Method CR AP Hip Axiolateral-Inferosuperior Hip—Danelius-Miller Method Radiation Safety Respiration Cervical Spine Clinical Indications Technical Factors Patient Position Lateral, Horizontal Beam (Fig. 15.71) and Cervicothoracic (Swimmer’s) Lateral (Fig. 15.72) Part Position Lateral, Horizontal Beam Cervicothoracic (Swimmer’s) Lateral CR Lateral, Horizontal Beam Cervicothoracic (Swimmer’s) Lateral Radiation Safety Respiration Thoracic and Lumbar Spine Clinical Indications Technical Factors Patient Position Lateral Thoracic Spine, Horizontal Beam (Fig. 15.73) and Lateral Lumbar Spine, Horizontal Beam (Fig. 15.74) Part Position Lateral Thoracic Spine, Horizontal Beam and Lateral Lumbar Spine, Horizontal Beam CR Lateral Thoracic Spine, Horizontal Beam Lateral Lumbar Spine, Horizontal Beam Radiation Safety Respiration Cranium Lateral, Horizontal Beam Clinical Indications Technical Factors Patient Position Part Position AP Lateral, Horizontal Beam CR AP Lateral, Horizontal Beam Radiation Safety Respiration Cranium AP, AP Axial 15° (Reverse Caldwell Method) Clinical Indications Technical Factors Patient Position Part Position AP and AP Axial 15° CR AP to Orbitomeatal Line Projection (Fig. 15.77) AP Axial 15° Reverse Caldwell Method Projection (Fig. 15.78) Radiation Safety Respiration Cranium AP 30° Axial (Towne Method) Clinical Indications Technical Factors Patient Position Part Position AP Axial (Towne Method) Projection CR AP Axial (Towne Method) Projection (Fig. 15.79) Radiation Safety Respiration Facial Bones Lateral, Horizontal Beam Clinical Indications Technical Factors Patient Position AP Lateral, Horizontal Beam Part Position AP Lateral, Horizontal Beam CR AP Lateral, Horizontal Beam Radiation Safety Respiration Facial Bones Acanthioparietal (Reverse Waters Method) and Modified Acanthioparietal (Modified Reverse Waters) Clinical Indications Technical Factors Patient Position Acanthioparietal (Reverse Waters Method) Part Position Acanthioparietal (Reverse Waters Method) CR Acanthioparietal (Reverse Waters Method) Modified Acanthioparietal (Modified Reverse Waters Method) Radiation Safety Respiration Surgical Radiography Essential Attributes of the Radiologic Technologist in Surgical Radiography Confidence Communication Problem-Solving Skills Mastery Surgical Team Surgeon Anesthesiologist Surgical Assistant Certified Surgical Technologist Circulator Scrub Surgical Radiography Imaging Equipment Cleaning Operational Check Proper Equipment Location Mobile C-Arm Digital Fluoroscopy Systems Maneuverability Display Monitors and Control Cart Uses of C-Arm Controls and Operation Modes Foot Pedal Image Orientation O-Arm Radiation Protection in Surgical Radiography Staff Radiation Exposure C-Arm Orientation and Exposure Patterns Vertical Posteroanterior Projection CR Horizontal Projection CR Vertical AP Projection CR Patient Dose Summary of Radiation Protection in Surgical Radiography Time Use of Intermittent Fluoroscopy Minimize Boost Exposures Distance Vertical Alignment Minimize Distance Between Anatomy and Image Receptor Shielding Protective Lead Aprons Communication Coordination of Exposure With Surgical Team Monitor Personal Dosimetry Report Surgical Asepsis Principles Surgical Suite Environment Imaging Equipment/Personnel and Sterile Fields C-arm Image Receptors Surgical Attire Scrubs Scrub Cover Head Cover Shoe Covers Shoes Masks Protective Eyewear Nonsterile Gloves Surgical Radiographic Procedures Biliary Tract Procedures Operative (Immediate) Cholangiography Overview of Procedure Equipment Used and Setup C-arm Digital Fluoroscopic Cholangiography Mobile Radiographic Cholangiography Laparoscopic Cholecystectomy Advantages of Laparoscopy Summary of Procedures for Operative and Laparoscopic Cholangiography Images Obtained Anatomy Demonstrated Urinary Tract Procedures Retrograde Urography Overview of Procedure Equipment Used and Setup Summary of Procedure Anatomy Demonstrated Orthopedic Procedures Orthopedic Surgical Terminology and Concepts Closed Reduction Open Reduction Internal Fixation External Fixation Intramedullary Fixation Hip Fractures (Pinning, Open Reduction With Internal Fixation) Overview of Procedure Imaging Equipment Used and Setup Lateral Hip C-Arm Projection Summary of Procedure Spinal Procedures Laminectomy Overview of Procedure Equipment Used and Setup Summary of Procedure Cervical Procedure (Anterior Approach) Lumbar Procedure (Posterior Approach) Anatomy Demonstrated Thorax Procedures Pacemaker Insertion Overview of Procedure Equipment Used and Setup Summary of Procedure—Transvenous Approach Glossary of Surgical Abbreviations, Terminology, and Procedures 16 Pediatric Radiography Contents Introduction and Principles Introduction Age of Understanding and Cooperation Pre-Examination Introduction and Child and Parent Evaluation Introduction of Technologist Evaluation of Parent’s Role Immobilization Other Forms of Immobilization Wrapping With Sheets or Towels (“Mummifying”) Bone Development (Ossification) Child Abuse Classification Radiographic Indications Classic Metaphyseal Lesion Rib Fractures Healing Fractures Radiographic Imaging Alternative Imaging Modalities CT MRI Sonography Nuclear Medicine Radiation Protection and Image Gently Minimizing Exposure Dose Gonadal Protection Parent Protection Pre-Examination Preparation Child Preparation Digital Imaging Considerations Alternative Modalities CT Reducing Pediatric Dose During CT3 Sonography MRI Nuclear Medicine Clinical Indications Pediatric Chest Pediatric Skeletal System Pediatric Abdomen Routine and Special Projections Routine and Special Projections AP and PA Chest Projection: Chest Clinical Indications Technical Factors Shielding Patient Position—With Patient Supine Part Position CR Recommended Collimation Respiration AP and PA Chest Projection: Chest Erect PA Chest With Pigg-O-Stat Patient Position—With Patient Erect CR Recommended Collimation Respiration Lateral Chest Position: Chest Clinical Indications Technical Factors Shielding Patient Position—With Patient Recumbent Part Position CR Recommended Collimation Respiration Lateral Chest Position: Chest Erect Lateral Chest With Pigg-O-Stat Patient Position—With Patient Erect Procedure if Lateral Follows PA Projection CR Recommended Collimation Respiration AP and Lateral: Upper Limbs Clinical Indications Technical Factors Shielding Patient Position Part Position AP Lateral CR Recommended Collimation AP and Lateral: Lower Limbs Clinical Indications Technical Factors Shielding Patient Position and CR AP and Lateral AP and Lateral: Lower Leg AP and Lateral: Foot—Kite Method Clinical Indications Technical Factors Shielding Patient Position and CR AP Lower Leg Lateral Lower Leg Recommended Collimation AP and Lateral Foot AP foot Lateral foot Recommended Collimation Talipes (Congenital Clubfoot)—Kite Method AP and Lateral: Pelvis and Hips Clinical Indications Technical Factors Shielding Patient and Part Position AP Lateral CR Recommended Collimation Respiration AP, AP Reverse Caldwell, and AP Towne: Skull Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Lateral Projection: Skull (Head) Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Radiographic Procedures of Pediatric Abdomen Differences Between Children and Adults Patient Preparation for Contrast Media Procedures Upper GI Tract Lower GI Tract Contraindications Newborn to 2 Years Children 2 to 10 Years Children Older Than 10 Years to Adult Intravenous Urogram Routine and Special Projections AP Projection (Kub): Abdomen Clinical Indications Technical Factors Shielding Patient and Part Position Newborns and Young Infants Infants and Toddlers CR Respiration AP Erect Projection: Abdomen Clinical Indications Technical Factors Shielding Patient and Part Position CR Respiration Lateral Decubitus and Dorsal Decubitus: Abdomen Clinical Indications Technical Factors Shielding Patient and Part Position Lateral Decubitus Dorsal and Ventral Decubitus CR Respiration Upper GI Tract Study Barium Swallow, Upper GI, and Small Bowel Combination Study Clinical Indications Room Preparation Shielding Barium Preparation Patient and Parent Preparation Procedure Drinking Barium Fluoroscopy Positioning Sequence Small Bowel Follow-Through Postprocedure Instructions Lower GI Tract Study—Barium Enema Single-Contrast, Double-Contrast, or Air Enema Clinical Indications Contrast Media and Materials-Barium Enema, Single-Contrast Children Older Than 1 Year Neonates (Newborn to 1 Year) All Patients Contrast Media and Materials—Barium Enema, Double-Contrast Air Enema Materials Room Preparation Shielding Patient and Parent Preparation Procedure Fluoroscopy and Spot Imaging After Reduction of Intussusception Following Air or Barium Enema Postprocedure Tasks Genitourinary System Study—Voiding Cystourethrogram Clinical Indications Technical Factors Shielding Genitourinary System Study—Voiding Cystourethrogram (VCUG) Preparation Contrast Media and Materials Room Preparation Patient and Parent Preparation Procedure Postprocedure Tasks 17 Angiography and Interventional Procedures Contents Radiographic Anatomy Introduction Definition Divisions or Components of the Circulatory System Cardiovascular System Functions Blood Components Systemic Circulation Arteries Veins Pulmonary Circulation General Systemic Circulation Heart Coronary Arteries Coronary Veins Cerebral Arteries Blood Supply to Brain Branches of Aortic Arch Neck and Head Arteries External Carotid Artery Branches Internal Carotid Artery Anterior Cerebral Artery Middle Cerebral Artery Internal Carotid Arteriogram Vertebrobasilar Arteries Arterial Circle (Circle of Willis) Vertebrobasilar Arteriogram Cerebral Veins Great Veins of Neck Dural Venous Sinuses Cranial Venous System Thoracic Circulatory System Thoracic Arteries Thoracic Veins Abdominal Circulatory System Abdominal Arteries Abdominal Veins Hepatic Portal System (Hepatoportal System) Peripheral Circulatory System Upper Limb Arteries Upper Limb Veins Lower Limb Arteries Lower Limb Veins Angiographic Procedures Overview Angiography Team Consent and Patient Care Before Procedure Vessel Access for Contrast MEDIA Injection Seldinger Technique (Fig. 17.35) Step 1. Insertion of Compound (Seldinger) Needle Step 2. Placement of Needle in Lumen of Vessel Step 3. Insertion of Guidewire Step 4. Removal of Needle Step 5. Threading of Catheter to Area of Interest Step 6. Removal of Guidewire Angiographic Tray Contrast MEDIA Risks and Complications Postprocedural Care Special Patient Considerations Pediatric Applications Geriatric Applications Radiation Protection Contraindications Angiographic Imaging Equipment Angiographic Room Equipment Requirements Digital Acquisition Digital Subtraction Angiography Post-Processing Images Automatic Electromechanical Contrast Media Injector Alternative Modalities and Procedures Computed Tomography Nuclear Medicine Sonography Magnetic Resonance Angiography Rotational Angiography 3D Rotational Angiography Alternative Contrast Media: CO2 and Gadolinium Specific Angiographic Procedures Cerebral Angiography Purpose Clinical Indications Catheterization Contrast Media Imaging Common Carotid Arteriography Internal Carotid Arteriography Thoracic Angiography Purpose Clinical Indications Catheterization Contrast Media Imaging Thoracic Aortogram Pulmonary Arteriogram Angiocardiography Purpose Clinical Indications Catheterization Contrast Media Imaging Abdominal Angiography Purpose Clinical Indications Catheterization Contrast Media Imaging Peripheral Angiography Purpose Clinical Indications Catheterization Contrast Media Imaging Lower Limb Upper Limb Interventional Imaging Procedures Definition and Purpose Vascular Interventional Angiography Embolization Uterine Fibroid Embolization Uterine Artery Embolization Chemoembolization Intracranial Endovascular Coil Embolization Risks and Complications Examples Percutaneous Transluminal Angioplasty and Stent Placement Angioplasty Stent Placement Risks and Complications Stent-Graft Placement Risks and Complications IVC Filter Risks and Complications Insertion of Venous Access Devices Risks and Complications Transjugular Intrahepatic Portosystemic Shunt Risks and Complications Thrombolysis and Thrombectomy Risks and Complications Infusion Therapy Extraction of Vascular Foreign Bodies Risks and Complications Nonvascular Interventional Procedures Percutaneous Vertebroplasty and Kyphoplasty Vertebroplasty Kyphoplasty Risks and Complications Nephrostomy Percutaneous Biliary Drainage Percutaneous Abdominal Abscess Drainage Needle Aspiration Catheter Drainage Percutaneous Needle Biopsy Percutaneous Gastrostomy Radiofrequency Ablation 18 Computed Tomography Contents Radiographic Anatomy Gross Anatomy of the CNS—Brain and Spinal Cord Neurons Divisions of CNS Summary of Spinal Cord Anatomy Brain and Spinal Cord Coverings—Meninges Dura Mater Arachnoid Pia Mater Meningeal Spaces Epidural Space Subdural Space Subarachnoid Space Three Divisions of Brain Brainstem Forebrain Cerebrum Five Lobes of Each Cerebral Hemisphere Cerebral Hemispheres Cerebral Ventricles Lateral Ventricles Third Ventricle Fourth Ventricle Superior View of Ventricles Anterior View of Ventricles Subarachnoid Cisterns Cisternal puncture Thalamus Hypothalamus Midbrain and Hindbrain Pituitary and Pineal Glands Cerebellum Gray Matter and White Matter Summary—White Matter Versus Gray Matter White Matter Gray Matter Cerebral Nuclei (Basal Ganglia) Brain—Inferior Surface Cranial Nerves Orbital Cavity Orbital Cavities (Superior View) Visual Pathway Basic Principles Basic Principles of CT Introduction CT Terminology Evolution of CT First-Generation and Second-Generation Scanners Third-Generation Scanner Fourth-Generation Scanner Volume CT Scanners Advantages Multislice CT Scanners Advantages CT System Components Gantry X-Ray Tube Detector Array Collimator Assembly Computer Operator Console Networking and Archiving Image Reconstruction Volume Element (Voxel) Attenuation (Differential Absorption) of Each Voxel Converting 3D Voxels to 2D Pixels Computed Gray Scale and CT Numbers Window Width and Window Level (Window Center) Pitch With Volume Scanners Image Reconstruction Summary Clinical Application of CT CT Versus Conventional Radiography Patient Communication and Consent Procedure Viewing CT Images Intravenous Contrast Media Contrast Media and Blood-Brain Barrier Radiation Dose Patient Dose Pediatric CT Scans Technologist and Personnel Exposure Cranial CT—Head CT Introduction Pathologic Indications Head CT Procedure Sectional Anatomy Axial Sections of Brain Examples of Pathology Metastatic Lesion Subdural Hematoma Subarachnoid Hemorrhage Cerebrovascular Accident (Stroke) Hydrocephalus Additional CT Procedures Neck CT Musculoskeletal CT Spine CT Specialized CT Procedures 3D Reconstruction CT (Virtual) Endoscopy CT Enteroclysis CT Angiography Cardiac CT and Coronary CT Angiography CT Fluoroscopy Interventional CT Percutaneous Biopsy Percutaneous Abscess Drainage Terminology 19 Special Radiographic Procedures Contents Introduction Arthrography Introduction Knee Arthrography Purpose Clinical Indications Contraindications Patient Preparation Imaging Equipment Accessory Equipment Contrast Media Needle Placement and Injection Process Positioning Routines Radiographic Routines Conventional or Digital Fluoroscopic Imaging Evaluation Criteria Conventional Radiographic Projections Evaluation Criteria Shoulder Arthrography Purpose Clinical Indications Imaging Equipment Accessory Equipment Contrast Media Needle Placement and Injection Process Positioning and Imaging Sequence CT and MRI Arthrography Biliary Duct Procedures Postoperative (T-Tube or Delayed) Cholangiography Purpose Clinical Indications Residual Calculi Strictures Contraindications Patient Preparation Imaging Equipment Accessory Equipment Contrast Media Injection Process Endoscopic Retrograde Cholangiographic Pancreatography Endoscopy Purpose Clinical Indications Residual Calculi Strictures Contraindications Patient Preparation Imaging Equipment Accessory Equipment Contrast Media Injection Process Hysterosalpingography Introduction Anatomy Uterus Uterine Tubes Purpose Clinical Indications Infertility Assessment Demonstration of Intrauterine Pathology Contraindications Patient Preparation Imaging Equipment Accessory and Optional Equipment Contrast Media Cannula or Catheter Placement and Injection Process Positioning Radiographic Routine Digital Fluoroscopy or Conventional Imaging Radiography Evaluation Criteria Myelography Purpose Clinical Indications Contraindications Patient Preparation Imaging Equipment Accessory and Optional Equipment Contrast Media Dosages Needle Placement and Injection Process Positioning Fluoroscopy or Spot Imaging or Digital Fluoroscopy or Imaging Radiographic Myelography Positioning (After Fluoroscopy) Cervical Region Horizontal Beam Lateral (Figs. 19.35 and 19.36) Swimmer’s Lateral Horizontal Beam (Figs. 19.37 and 19.38) Thoracic Region Right Lateral Decubitus Position—AP or PA Projection With Horizontal Beam (Fig. 19.39) Left Lateral Decubitus Position—AP or PA Projection With Horizontal Beam (Fig. 19.40) Right or Left Lateral—Vertical Beam (Fig. 19.41) Lumbar Region Semierect Lateral—Horizontal Beam (Figs. 19.42 and 19.43) Radiographs Evaluation Criteria (for All Levels of Spinal Column) CT Myelography Orthoroentgenography Purpose Clinical Indications—Limb Length Discrepancies Routine and Special Projections Lower Limb Measurement (Unilateral or Bilateral on Same IR) Technical Factors Shielding Positioning and CR—Unilateral Exposure AP Hip (Figs. 19.49 and 19.50) AP Knee (Figs. 19.51 and 19.52) AP Ankle (Figs. 19.53 and 19.54) Upper Limb Measurement Technical Factors Shielding Positioning and CR AP Shoulder (Figs. 19.55 and 19.56) AP Elbow (Figs. 19.57 and 19.58) AP Wrist (Figs. 19.59 and 19.60) Hip-to-Ankle Long Bone Measurement Technical Factors Positioning and CR Evaluation Criteria Long Bone Measurement on CT (CT Scanogram) Conventional Tomography Purpose Terminology Imaging Equipment Control Console Basic Principles Fulcrum Determining Fulcrum Level and Centering Determining Sectional Thickness (Object Plane Thickness) 20 Diagnostic and Therapeutic Modalities Contents Nuclear Medicine Definition and Introduction Nuclear Imaging Equipment Clinical Applications Bone Scan Heart (Cardiac) Studies Lung Scan Thyroid Uptake Study Nuclear Medicine Team Nuclear Medicine Terminology1,2 PET Definition and Description Comparison With Nuclear Medicine Use of Positron Emitters Positron Emitting Elements Cyclotron Anatomic and Functional Image Coregistration Clinical Applications Oncology (Study of Tumors) Cardiology Coronary Artery Disease Neurology Epilepsy Brain Mapping Central Nervous System Tumor Imaging Evaluation of Dementia Radiation Oncology Introduction External Beam Irradiation Brachytherapy Proton Therapy Radiation Oncology Team Sonography Definition and Introduction History and Physical Principles of Ultrasound A-Mode B-Mode M-Mode Real-Time Imaging Doppler Digital Systems Limitations and Advantages of Sonography in Medical Imaging Advances in Sonography Clinical Applications Abdomen Obstetrics and Gynecology Cardiac Superficial Parts Vascular Imaging Musculoskeletal Imaging Sonography Team Members Sonography Terminology Mammography Breast Cancer Mammography Quality Standards Act Anatomy of the Breast Surface Anatomy Sagittal Section Anatomy Methods of Localization Anterior View Anatomy Breast Tissue Types Summary Breast Classifications Fibroglandular Breast Fibrofatty Breast Fatty Breast Summary Radiographic Positioning Positioning and Technical Considerations Patient Preparation Breast Positioning X-Ray Tube AEC Chamber Selection Compression15 Magnification Patient Dose Analog (Film-Screen) Mammography Digital Versus Analog (Film-Screen) Mammography Digital Mammography Computed Radiography Mammography Operating Costs Telemammography Archiving and PACS Options Image Manipulation Mammography Workstation Contrast Mammography18 Computer-Aided Detection Systems Alternative Modalities and Procedures Sonography (Ultrasound) Conventional Scanner and Handheld Transducer Nuclear Medicine PET Mammography Breast-Specific Gamma Imaging MRI Advantages of MRI Breast Implants Disadvantages of MRI Digital Breast Tomosynthesis Pathologic Indications Breast Carcinoma (Cancer) Cysts Fibroadenoma Fibrocystic Changes Gynecomastia Intraductal Papilloma Paget Disease of the Nipple Mammography Terminology Routine and Special Projections Routine and Special Projections Craniocaudal (CC) Projection: Mammography Clinical Indications Technical Factors Shielding Patient Position Part Position Positioning Tips CR Recommended Collimation Respiration Posterior Nipple Line Mediolateral Oblique (MLO) Projection: Mammography Superomedial-Inferolateral Oblique Clinical Indications Technical Factors Shielding Patient Position Part Position CR Recommended Collimation Respiration Special Projections (Additional Views): Mammography Mediolateral (ML) Projection: True Lateral Breast Position Clinical Indications Technical Factors Shielding Patient Position Part Position Positioning Tips CR Recommended Collimation Respiration Special Projections (Additional Views): Mammography Exaggerated Craniocaudal (Laterally) (XCCL) Projection Clinical Indications Technical Factors Shielding Patient Position Part Position CR Collimation Respiration Special Projections (Additional Views): Mammography Implant Displaced (ID) (Eklund Method)24 Clinical Indications Eklund Method23 Exception Manual Exposure Techniques Radiographs for Critique Bone Densitometry Introduction History Composition of Bone Osteoclasts and Osteoblasts Bone Mineral Content Versus Bone Mineral Density Purpose Clinical Risk Factors and Indications BMD and Fracture Risk Assessment of Fracture Risk World Health Organization Diagnostic Criteria for Diagnosis of Osteoporosis Osteoporosis Management Estrogen Mode of Action SERMs Mode of Action Bisphosphonates Mode of Action Calcitonin Mode of Action Parathyroid Hormone Mode of Action Contraindications Patient Preparation Major Equipment Methods and Techniques Dual-Energy X-Ray Absorptiometry z Score T Score Quantitative Computed Tomography Quantitative Ultrasound Radiation Safety Site Selection and Method Positioning (for DXA) Spine Hip Forearm Body Habitus DXA Precision and Accuracy Accuracy Vertebral Fracture Assessment Summary MRI Introduction Comparison With Computed Tomography (CT) Physical Principles of MRI Interaction of Nuclei With Magnetic Fields Precession Net Magnetization Vector Resonance Relaxation T1 Relaxation T2 Relaxation Spin Density Summary Magnets Permanent Magnets Resistive Magnets Superconducting Magnets Flared and Short Bore Design Open MRI System Clinical Applications Contraindications Patient Preparation Relieving Patient Anxiety Patient Monitoring Summary Basic Safety Considerations Projectiles/Missile Effects Electromechanical Implants Torque Tissue Heating Gradient Magnetic Fields (Time-Varying Magnetic Fields) Pregnancy Occupational Hazards Patient History Contrast Agents Appearance of Anatomy T1-Weighted and T2-Weighted Images Relaxation Versus Contrast Weighting Sample MRI Examinations Brain Imaging Comparisons With CT T1-Weighted Images T2-Weighted Images Spine Imaging Comparison With CT T1-Weighted Images T2-Weighted Images Joint and Limb Imaging T1-Weighted Images T2-Weighted Images Abdomen and Pelvis Imaging T1-Weighted Images T2-Weighted Images Physiologic Gating Functional MRI Spectroscopy Diffusion-Weighted Imaging (DWI) MRI Terminology35 Appendix A Answer Key: Radiographs for Critique Chapter 2: Chest (p. 104) PA Chest (Fig. C2.91) PA Chest (Fig. C2.92) Lateral Chest (Fig. C2.93) PA Chest (Fig. C2.94) Lateral Chest (Fig. C2.95) Chapter 3: Abdomen (p. 126) Left Lateral Decubitus Abdomen (Fig. C3.52) AP Supine Abdomen—KUB (Fig. C3.53) AP Supine Abdomen—KUB (Fig. C3.54) AP Erect Abdomen (Fig. C3.55) Chapter 4: Upper Limb (p. 175) PA Hand (Fig. C4.160) Lateral Wrist (Fig. C4.161) AP Elbow (Fig. C4.162) PA Wrist With Ulnar Deviation (Fig. C4.163) PA Forearm—Infant (Fig. C4.164) Lateral Elbow (Fig. C4.165) Chapter 5: Humerus and Shoulder Girdle (p. 210) AP Clavicle (Fig. C5.102) AP Shoulder—External Rotation (Fig. C5.103) AP Scapula (Fig. C5.104) AP Humerus (Fig. C5.105) Chapter 6: Lower Limb (p. 262) Bilateral Tangential Patella (Fig. C6.142) Plantodorsal (Axial) Calcaneus (Fig. C6.143) AP Mortise Ankle (Fig. C6.144) AP Lower Limb—Pediatric (Fig. C6.145) Lateral Knee (Fig. C6.146) AP Medial Oblique Knee (Fig. C6.147) Chapter 7: Femur and Pelvic Girdle (p. 289) AP Pelvis (Fig. C7.77) AP Pelvis (Fig. C7.78) Unilateral Frog-Leg Projection (Performed During Cystogram) (Fig. C7.79) Bilateral Frog-Leg Projection (Fig. C7.80) Chapter 8: Cervical and Thoracic Spine (p. 323) AP Open Mouth (C1-C2) (Fig. C8.91) AP Open Mouth (C1-C2) (Fig. C8.92) AP Axial Projection (Fig. C8.93) Right Posterior Oblique Cervical Spine (Fig. C8.94) Lateral (Trauma) Cervical Spine (Fig. C8.95) AP Projection—Fuchs Method (For Odontoid Process) (Fig. C8.96) AP Thoracic Spine (Fig. C8.97) Chapter 9: Lumbar Spine, Sacrum, and Coccyx (p. 353) Lateral Lumbar Spine (Fig. C9.83) Lateral Lumbar Spine (Fig. C9.84) Lateral L5-S1 (Fig. C9.85) RPO Lumbar Spine (Fig. C9.86) AP Lumbar Spine (Fig. C9.87) LPO Lumbar Spine (Fig. C9.88) AP Lumbar Spine (Fig. C9.89) AP Erect Lumbar Spine—Scoliosis Study (Fig. C9.90) Lateral Lumbar Spine—Scoliosis Study (Fig. C9.91) Chapter 10: Bony Thorax—Sternum and Ribs (p. 373) Bilateral Ribs Above Diaphragm (Fig. C10.47) Oblique Sternum (Fig. C10.48) Ribs Below Diaphragm (Fig. C10.49) Lateral Sternum (Fig. C10.50) Chapter 11 Cranium, Facial Bones, and Paranasal Sinuses (pp. 442-444) Critique Radiographs of Cranium Lateral Skull: 4-Year-Old (Fig. C11.201) Lateral Skull: 54-Year-Old, Post-Traumatic Injury (Fig. C11.202) AP Axial (Towne) Skull (Fig. C11.203) AP or PA Skull (Fig. C11.204) AP or PA Skull (Fig. C11.205) Critique Radiographs of Facial Bones Parietoacanthial (Waters) Projection (Fig. C11.206) SMV Mandible (Fig. C11.207) Optic Foramina, Parieto-Orbital Oblique—Rhese Method (Fig. C11.208) Optic Foramina, Parieto-Orbital Oblique—Rhese Method (Fig. C11.209) Lateral Facial Bones (Fig. C11.210) Critique Radiographs of Paranasal Sinuses Parietoacanthial Transoral (Open-Mouth Waters) (Fig. C11.211) Parietoacanthial (Waters) (Fig. C11.212) Submentovertical Projection (SMV) (Fig. C11.213) Lateral Projection (Fig. C11.214) Chapter 20: Diagnostic and Therapeutic Modalities (p. 767) Critique Radiographs of the Breast CC Projection (Fig. C20.79) MLO Projection (Fig. C20.80) CC Projection (Fig. C20.81) MLO Projection (Fig. C20.82) CC Projection (Fig. C20.83) CC Projection (Fig. C20.84) Appendix B Routine and Special Projections Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 20 References Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Interventional Angiography Chapter 18 Chapter 19 Chapter 20 Additional Resources Chapter 1 Chapter 8 Chapter 10 Chapter 14 Chapter 18 Chapter 20 Index A B C D E F G H I J K L M N O P R S T U V W X Z