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 2

3 TOMOGRAPHIC IMAGES ARE IN A SPECIFIC PLANE SAGITTALAXIALCORONAL RT

RADIOLOGY TOOLS 4 X- RAY ULTRASOUND NUCLEAR MEDICINE MAGNETIC RESONANCE COMPUTED TOMOGRAPHY

5  Air  Soft Tissue  Fat  Bone X - RAY --- FOUR BASIC DENSITIES

AUTOMATIC PROCESSING TRANSPORTATION SYSTEMTRANSPORTATION SYSTEM DEVELOPERDEVELOPER FIXERFIXER WASHERWASHER DRYERDRYER REPLENISHMENT SYSTEMREPLENISHMENT SYSTEM

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 Terminology General Body PositionsGeneral Body Positions –Supine –Prone –Erect (stand or sit) –Recumbent Lying down in any position Dorsal (supine)Dorsal (supine) Ventral (prone)Ventral (prone) LateralLateral

I. Radiographic Terminology Specific Body PositionsSpecific Body Positions The body part closest to the IR (oblique and lateral) or by the surface on which the patient is lying The body part closest to the IR (oblique and lateral) or by the surface on which the patient is lying –Lateral Right/LeftRight/Left –Oblique LPO/RPOLPO/RPO LAO/RAOLAO/RAO

I. Radiographic Terminology Radiographic ProjectionRadiographic Projection The direction or path of the CR of the x-ray beam –Anteroposterior –Posteroanterior –AP or PA Oblique –Mediolateral or Lateromedial

Image Markers and Patient IdentificationImage Markers and Patient Identification –Patient ID and Date –Anatomic side marker –Additional markers or Identification II. Basic Imaging Principles

III. Positioning Principles Positioning SequencesPositioning Sequences –Traditional Radiography Step1 Step3 Step4 Step2

16 PA Chest (Normal/ ambulance patients) (Basic)

17 Lateral erect chest (Basic)

18 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 22 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 23 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 24 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 25 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 cm CP: 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 cm CP: 1.25 cm inferior to naison CR: 90  to film center NB/ A long narrow cone should be used. 26

Submentovertex (SMV)  S 27 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 28 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 29 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

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