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Flashcards in Radiographic Anatomy Deck (58)

Properties of an X-ray

-travel straight lines at the speed of light
-diverge in space from the source
-cause certain crystals to flourecence
-cannot be detected by the human eye
-differential absorbtion
-cannot be refracted by lens
-produce biological effects


Clinical use

-harmful effects identified as ALARA
as low as reasonably achievable


Advanced Imaging

-computed tomography (CT)
-magnetic resonance imaging (MRI)
-Myelography (w/wout CT)
-diagnostic ultrasound
-nuclear medicine
-dual energy X-ray absorption (DEXA)


Producing a radiograph

-minimal equipment: X-ray source->image recorder->subject
-xray beam travels from source, thru subject, to the film


Image formation

-x ray tube, source of electrons
-xray beam, focused source of photons based on density
-object, beam absorbed or passed based on density
-film, photons pass object to strike film with silver coating
Image - record of proton interactions


Xray Photons

produced when electrons hit the target


Xray photon interactions

xray photons penetrate object, absorbed or pass thru to hit film


Xray beam

-is cone shaped from a point source
-the most central portion is called central ray
-the central ray diverges less and gives the truest image
-typically the beam will be perpendicular to the film


Differential Absorbtion

-penetration dependant on density
-denser object=less penetration
-move beam striking film=dark
-less beam striking film=whiter


Tissue Density

-a product of type of tissue and thickness
-results in differential absorbtions
-increase tissue density = whiter
-decrease tissue dens = darker


Differential Absorbtion

black - Air (lungs, trachea,outside of body)
fat (parietal fat, fascial fat)
water (muscle, organs)
bone (bone, atherosclerotic placing)
metal (filling,markers,orthodevices)


X ray photon Pass thru

non dense object
air and soft tissue
immage apears blacker
radioleucent appearance


Xray photons absorbed

-by dense object
-metal and bone
-image appears white
-radioopaque appearance


Image Terminology

Body Position



Anteroposterior/Posteroanterior - x ray beam enters AP front to back or PA back to front
Lateral - x ray beam enters side project side of patient alone coronal plane and travels left to right, names for which side is against the film
Oblique - positioned on film so X-ray passes thru at 45 degree angle


Body Position

Upright - AP or PA or lateral
Recumbent - supine or prone or lateral
Oblique - right or left and anterior or posterior
Decubitis - laying on side and take PA or AP


Upright Positions

patient stands
allows for veal to postural information
chiros can use this to analyze upright lumbar and sacral



patient laying down
no reliable evaluation of postural elements
useful when patient is in a lot of pain


Minimum Diagnostic Series

-standard views required to evaluate an area
-variation by facility or circumstance
-add more views depending on case
-must take at least 2 views
-projection oriented 90 degrees to one another
-view 3D object in 2D


Choice of Postioning

place the structures closest to the film
starts with standard series
what structures you wish to visualize
patients clinical presentation
different diagnosis under consideration
patients size
patients protection (female pelvis)


Film Markers

Informational markers
Mitchell Markers
Name blockers
ID markers - Type of study, Clinic and Tech


Informational Markers

provide information about patient
provide information about the doctor and or facility
identifies side of patient or patient positioning


General marker rule

without a marker you cannot identify which side of the patient is the left and which is the right


Mitchell Markers

metal markers
taped to cassette
label anatomical side of patient
label side of patient
usually contains BB's
BBs at centre of bubble and are gravity dependant


Markers are also used to ID

type of study
patient positioning


Name Blocker

Patients name
Patients gender
Patients age
Doctors name
Facility where films were taken
Date of study


View a Radiograph

composite shadowgram
-structures added contrasting densities
in a profile vs on end


Composite Shadowgram

represents the sum of the densitites interposed b/w the beam source of the film
involves superimpostion of object and orientation of objects



orientation of beam, position of object will affect image
objects that lie on the same path



shutters that block peripheral portions of beam
limits area exposed to beam, uses most central portion of beam
limits size of xray beam field
uses smallest area possible
decreases the scatter radiation
decerases the patients dose
acheives better dose
tube light stimulate xray beam


Compat bone

outer shell of bone
encloses meddulary bone
covered by periosteum
homogeneous density


Spongy Bone

network of trabecula


Long / Tubular Bone

Epiphysis - articular end of the bone
Metaphysis - tappering portion b/w the physis and the shaft
Diaphysis - shaft of the bone



fibrous layer of bone
membranous bone formation, attachment of tendonous and ligmanets
contains vascular supply
not distinguishable on a radiograph



tuberosity, tubercles, trochanters, processes, spinous processes
osseous projections
develop to support and resonce of forces


Radiographic Evaluation and Interpretation

differentiate normal from abnormal
localize abnormality
describe abnormality
list pertinant positives/pertinant negatives
give impression of clinial significance


Radiographic evaluation

have a systm
use the system every time
be thorough


Extent of Evaluation

you are legally responsible
evaluate the whole xray
evaluate for all pathologies/conditions


Method of Evaluation

A - alignment
B - Bone
C - Cartilage
S - soft tissue


Search Pattern
Steps in Evaluation

know the ABCS for each region
steps: - identify the study
-identify the informational markers
- note collimation, shielding and artifacts
-the the technical quatlity of the film
- evaluate anatomy using ABCS search pattern


Normal Anatomy

the first step om recognizing abnormalities on radiographs is to know the appearanfce of notmal radiographic anatomy
-each person is a unique anatomical entity
-anatomical variations exist that are normal or abnormal
-pathology ften alters anatomical structures
-may be present with no radiographically visible alterations in anatomical structures


Abnormal Anatomy

know pathology, learn patients history, ID patients clinical presentation put it all together, radiographs are not isolated, it represents patient


Method of Evaluation

compare one side to the other
compare one level to the adjacent lebels


Cervical Spine Standard Series

neutral lateral
AP lower cervical
APOM open mouth


Lateral Cervical (neutral lateral)

you want all 7 cervical vertebrae and have the base of the skull
head and neck in a neutral position (hard palate level)


The 5 Assessing Cervical Lines

Paravertebral Lines - rules of 2s and 6s
Anterior Body line - smooth curve, no interuptions
Posterior Body line- Georges line, eval vert bodies
Spinolaminar Line - line thru spinolaminar junction
Spinous Process Interspacing- spacing of SP's


Atlantodental Interspace (Interval)

space b/w post aspect of C1 anterior tubercle and the anterior aspect of odontoid process
adults < 3mm
children 8-10yrs <5mm


McGregor's Line

Posterior-superior margin of hard palate to inferior most surface of the occiput
tip of dens to the line: <10mm in females


Relevant soft tissues of the Lateral Cervical

pharyngeal air shadow
laryngeal air shadow
tracheal air shadow
note calcification of cartilages
posterior cervical soft tissues


AP lower cervical

used to visualize the structures of C3-C7 vertebral bodies
-good to also see the postior elements but they come in variavle in size
see the articular pillars and SP's and other oblique structures


AP Open Mouth

used to visualize the structures of C0-C1 articulation and the C1-C2 joint space
-you also see the lateral masses of C1 and the arches
-odontoid process, paraodontoid notches, body of C2, skull, madible, and dental structures


Georges Line

Lateral spine (neutral, flexed, or extended)
a line is drawn along the posterior aspect of the vertebral bodies to extrapolate across disc space
-offset indicates anter or retrolithesis having a translation of >= 4mm as the indicator


Sagittal Dimention of Cervical Spine Canal

lateral cervical
posterior surface of mid vertebral body to spinolaminar junction
-there are minimum measurements for this one at each vertebral body
C1-16mm, C2-14mm, C3-13mm, C4-7-12mm
positive shows the patient may have canal stenosis


Atlantoaxial Alignment

seen on the AP open mouth
lateral mass of atlas should not overhang lateral margin of C2 superior facet (>1mm)
>=2mm overhang shows the patient may be suspect to a Jefferson's fracture
this may be normal in children 4 years of age or younger
you can draw an X from one C0-C1 joint to the opposite C1-C2 joint and the and by doing the same on the other side you can determine rotation at the C1-C2 joint


Coronal Dimensions of the Cervical Spine

measure the shortest distance between the inner cortical margins of pedicles at given segment, cary by spinal level, evaluated for stenosis


Cervical Gravity Line

Lateral neutral cervical
vertical line drawn through the apex of odontoid process should pass through the seventh cervical vertebral body
gross assessment of where the gravitational stresses are acting at the C/T junction
Ruth Jackson stress lines on flex/extension can also assess stress focus


Angle of Cervical Curve

lateral cervical
two lines are drawn, one through and parallel to the inferior endplate of the 7th cervical body and the other through the midpoints of the anterior and posterior tubercles of the atlas
construct perpindiculars and measure the angle, normally 35 - 45 degrees
lack of lordosis may indicate trauma, muscle spasm, or degenerate disease
many stress lack of correlation between curve and symptoms


Prevertebral soft tissue

lateral cervical
space measured between the vertebral bodies and the air shadow of the pharynx, larynx and trachea
normally 10mm at C1
rules of 2's and 6's
C2 < 6mm
C6 < 22mm
increases with any soft tissue mass (hematoma, abscess or tumour)