Mid Term Revision

• Radiological Imaging and Processing 1

Dr Mohamed El Safwany, MD.

RADIOLOGIST ROLE

Separate: Normal from Abnormal

Characterize / Describe: Abnormality

Determine: Extent (stage) of disease

Suggest: Diagnosis / Differential

Recommend: Further exams / follow-up

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TOMOGRAPHIC IMAGES ARE

IN A SPECIFIC PLANE

SAGITTALAXIAL CORONAL

RTRT

RADIOLOGY TOOLS

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X- RAY

ULTRASOUND

NUCLEAR MEDICINE

MAGNETIC RESONANCE

COMPUTED TOMOGRAPHY

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Air

Soft Tissue

Fat

Bone

X - RAY --- FOUR BASIC DENSITIES

AUTOMATIC PROCESSINGAUTOMATIC PROCESSING

• TRANSPORTATION TRANSPORTATION SYSTEMSYSTEM

• DEVELOPERDEVELOPER

• FIXERFIXER

• WASHERWASHER

• DRYERDRYER

• REPLENISHMENT REPLENISHMENT SYSTEMSYSTEM

Automatic Processor

Replenishment System

• Main function: Keep solution tanks full and assure proper solution concentration.

• As film is introduced into processor, sensor initiates solution replenishment

• Right & wrong way to feed in film

-Feed in along short edge

Digital Image Printing

• Dry processing – no chemistry

• No darkroom

• Less environmental impact

• Reduce costs

I. Radiographic TerminologyI. Radiographic Terminology

• GeneralGeneral Body Positions Body Positions – SupineSupine– ProneProne– Erect (stand or sit)Erect (stand or sit)– RecumbentRecumbent

Lying down in any positionLying down in any position• Dorsal (supine)Dorsal (supine)• Ventral (prone)Ventral (prone)• LateralLateral

I. Radiographic TerminologyI. Radiographic Terminology

• SpecificSpecific Body Positions Body Positions The body part closest to the IR (oblique and The body part closest to the IR (oblique and

lateral) or by the surface on which the patient lateral) or by the surface on which the patient is lyingis lying

– LateralLateral• Right/LeftRight/Left

– ObliqueOblique• LPO/RPOLPO/RPO• LAO/RAOLAO/RAO

I. Radiographic TerminologyI. Radiographic Terminology

• Radiographic Radiographic ProjectionProjectionThe direction or path of the CR of the x-ray The direction or path of the CR of the x-ray

beambeam– AnteroposteriorAnteroposterior– PosteroanteriorPosteroanterior– AP or PA ObliqueAP or PA Oblique– Mediolateral or LateromedialMediolateral or Lateromedial

• Image Markers and Patient IdentificationImage Markers and Patient Identification– Patient ID and DatePatient ID and Date– Anatomic side markerAnatomic side marker– Additional markers or IdentificationAdditional markers or Identification

II. Basic Imaging PrinciplesII. Basic Imaging Principles

III. Positioning PrinciplesIII. Positioning Principles

• Positioning SequencesPositioning Sequences– Traditional RadiographyTraditional Radiography

Step1

Step3

Step4

Step2

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PA Chest (Normal/ ambulance patients) (Basic)

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Lateral erect chest (Basic)

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LAO, RAO chest (heart) (special)

• Preliminary bowel preparation in nonacute patients is administered with a combination of laxatives, enemas, and controlled diet. Preparation is important if the patient will be undergoing contrast examination of the gastrointestinal tract or an IVP.

• In all other cases, the decision regarding whether or not a patient undergoes preliminary bowel preparation is determined by the requesting physician. Bowel preparation should not be administered to patients suspected of having bowel obstruction, visceral perforations, or abdominal trauma, or to an acutely ill patient

• For a supine-position radiograph, the central ray (CR) should be perpendicular to the cassette at the level of iliac crests.

• For an upright-position film, the CR should be horizontal and 2 inches (5 cm) above the level of the iliac crests and should include the diaphragm

PA Skull (0 Occipital-frontal) projection B

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For frontal bone, #s and neoplastic processes of the cranium,

Paget’s disease, orbits (obscured by petrous temporals), I.A.M,

frontal and ethmoidal sinuses, dorsum sellae.

Patient nose and forehead against the couch center, neck flexed so

that OML is 90 to the couch, MSP 90 to couch center, head not

rotated, EAMS equidistant from the couch top.

Film: HD 24x30 cm

CP: Exits the glabella

CR: 0 (that is 90) to film center

NB/ AP is not recommended as it produces 200 times eyes

absorbed dose

produced in the PA position.

PA Axial Skull (15 Caldwell) projection for facial bones B

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For #s, neoplastic processes of frontal, parietal and facial bones, and for cranium and an unobstructed view of the orbits, I.A.M, frontal and ethmoidal sinuses, clinoids, dorsum sellae, zygomatic bones.

Same position as for PA

Film: HD 24x30 cm

CP: Exits the naison.

CR: 15 caudal (for showing the petrous ridges). 25 - 30 gives better view of

orbital rim and floors and superior orbital fissure.

AP Axial (Towne’s projection – for mandible) B

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For #s, neoplastic or inflammatory processes of the condyloid processes of the mandible.

Same position as for Towne AP (OML 90 to couch top.

Film: HD 18x24 cm

CP: Glabella (midway between EAMs and angles of the

mandible). A CP at one inch anterior to level of TMJs will show

TMJs.

CR: 35- 40 caudal to RBL .

Lateral Skull (general) B

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Same indication as for PA (0). A horizontal beam is used for trauma cases to show air-fluid levels in the sphenoid sinus (a sign of # in the base of skull with internal bleeding) with CR 25-30 caudad – Clark!

Patient in a semiprone (Sim’s position), recumbent or erect sitting, head in a true lateral (required side close to the film), MSP parallel to couch, IPL 90 to couch top. Film: HD 18x24 cmCP: 5 cm superior to EAM .CR: 90 to film center .

Lateral Skull (for nasal bones) B

For nasal bone fractures. Head in true lateral (same position as for lateral skull as in Sim’s position) or erect, chin adjusted so that both IPL and IOML are 90 to couch top.

Film: HD 18x24 cmCP: 1.25 cm inferior to naisonCR: 90 to film centerNB/ A long narrow cone should be used.

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Submentovertex (SMV) S

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For base of the skull (Basilar view), occipital bone, mandible, foramen ovale and foramen magnum, TMJs, orbits, zygomatic arches, sphenoidal, maxillary sinuses and mastoid processes.

Patient supine or erect sitting, chin raised, neck hyperextended till IOML is parallel to film, MSP 90 to couch top. A pillow under patient’s back allows for sufficient extension.

Film: HD 24x30 cm.

CP: Midway between angles of mandible (2 cm anterior to level of

EAMs).

CR: 90 to IOML.

Parietoacanthial (OM) (Waters View for

sinuses ) B

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Best for maxillary and frontal sinuses and nasal fossae. Also shows

other inflammatory conditions (secondary ostemyelitis, and sinus

polyps).

Patient erect, neck extended, chin and nose against couch, head

adjusted till MML is 90 to the film, OML makes 37 with film. AML

makes 90 to the film, a long narrow cone should be used.

Film: HD 18x24 cm

CP: At level of lower border of the orbits to exit at the acanthion.

CR: 90 horizontal to film center

Parietoacanthial (OM) (Open-Mouth

Waters for sinuses ) S

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Same as for Waters..

Same position as for Waters view, but with open mouth (patient drops his jaw without moving the head).

Film: HD 18x24 cm.

CP: At level of lower border of the orbits to exit at the acanthion.

CR: 90 horizontal to film center

Thank You