Prior learning

Question 1

Cervical X-Ray angles

Answer 1

"Davis series"
AP open mouth: C1 and C2
AP lower cervical
R and L lateral
R and L oblique posterior
\+ stress related views (e.g. in flexion, in extension)

Question 2

Levels of osteopoenia

Answer 2

MRI: 1-5% of bone loss
CT: 10-20% bone loss
X-Ray: 40-70% bone loss

Question 3

System of reading x-rays

Answer 3

ALL ABCs
ALL: all films are there, all bones are present, patient identifiers (e.g. skeletally immature/ mature), artefacts
A- Alignment
B- Bone quality: look at medulla, cortex, periosteum.
C- Cartilage: joint space and symmetry
S- Soft tissue

Question 4

Calcification of cartilage

Answer 4

Initially hyaline cartilage with an outside layer of perichondrium (everywhere but where the bone articulates) > Blood vessels supply the perichondrium, and osteoblasts start to form a woven bone collar with periosteal layer > Chondrocytes start to hypertrophy in the diaphysis and the ECM starts to mineralise > Chondrocytes die leaving lacunae in the calcified matrix

Question 5

Primary ossification

Answer 5

Blood vessels invade lacunae and bring in osteoblasts and osteoclasts > Osteoblasts produce bone trabeculae therefore cancellous bone in diaphysis (primary ossification centre) > Medullary cavity is formed as osteoclasts move bone from diaphysis

Question 6

Secondary ossification

Answer 6

Established in the epiphysis of the long bones, appear in late foetal development and continues up until 18-20 years old (medial clavicle), has no medullary cavity

Question 7

Lines of alignment cervical

Answer 7

Anterior longitudinal line
Posterior longitudinal line (George’s line)
Spino laminar line (posterior margin of spinal cord)

Question 8

Measurements in cervical

Answer 8

Spinal canal width: SLL to PLL, <12mm stenosis
Cervical angle: apex of C2 to ant/sup aspect of C7, 35-45 deg.
Physiological line of stress/ COG: posterior dens to posterior c7, should pass through c4/5 IVD
Atlanto dental interspace: anterior dens to posterior anterior tubercle 1-3mm adults, 1-5 mm children

Question 9

Thoracic standard views

Answer 9

AP, lateral and rib views

Question 10

AP thoracic view

Answer 10

These are the things you can see in AP tx view:

interpeduncular distance > 14mm
Pedicle method: see rotation of the vertebrae
Tracheal deviation/ level
Scoliosis: Cobb method, same as determining tx kyphosis OR risser ferguson method, centre of the vertebare

Question 11

Lateral thoracic view

Answer 11

These are the things you can see in Tx lateral:

ALL, PLL, ALL
Angle of the thoracic spine kyphosis: 20-50 deg. Draw a line superiot end plate of T1 (or T4) and inferior enT12 (T9). Then draw perpendicular lines

Question 12

Lumbosacral normal views

Answer 12

AP (15 degree tilt)
Lateral
Oblique
L5/S1 spot AP and Lateral

Question 13

Lumbosacral lines of alignment

Answer 13

ALL, PLL, SLL<
Lumbar curve: superior end plate L1, inferior endplate L 5, 35-45 deg OR superior sacral base 50-60 deg.
Ferguson’s line: perpendicular line drawn straight down centre of L3, should strike anterior 1/4 of sacral base
Interpeduncular distance >20 mm

Question 14

Pelvis and hip views

Answer 14

AP
Spot AP hip
Frogleg
Lateral

Question 15

Measurements for the pelvis

Answer 15

Hip joint width (teardrop): measured superiorly, medially and laterally to acetabular notch
Acetabular depth: line from superior margin of pubic symph to end of acetabilum and then measure depth
Pubic symph width

Question 16

Measurements for the hip

Answer 16

Femoral angle: line through the head/neck of femur and shaft, angle is taken on inside 120-130 deg
Iliofemoral line: Line along the illim to the femoral head and neck
Shentons line: curved line under femoral neck to inferior margin of superior pubic ramus

Question 17

Knee normal X-Ray views

Answer 17

AP, Lateral, intercondylar, skyline and medial oblique

Question 18

Knee X-ray measurements

Answer 18

Femoral shaft line, tibial shaft line, Femoral condyle line, tibial condyle line, femoral angle, tibial angle
Q line: line through ASIS and mid patella and then line through tibial plateau to mid patella 14 degrees men, 17 degrees women
Patella positon

Question 19

Ankle normal views

Answer 19

AP, lateral, Oblique

Question 20

Normal foot views

Answer 20

Dorsal plantar, lateral and oblique medial

Question 21

SHoulder normal views

Answer 21

AP, AP IR, AP ER, Axial , Scapular Y, AC joint spot

Question 22

Elbow normal views

Answer 22

AP, lateral, Medial oblique, and supination/ pronation AP

Question 23

Wrist normal views

Answer 23

PA, lateral, lateral oblique PA, medial oblique PA and scaphoid

Question 24

Chest normal X-ray views

Answer 24

PA and lateral

always taken eith inspiratio