1. Chapter 1: General Anatomy, Terminology and Positioning Dr Mohamed El Safwany, MD.

2. Intended learning outcome The student should learn at the end of this lecture general Radiological Anatomy, terminology and positioning procedures.

3. Review of Structural Organization Atoms Molecules Cell Tissue Organ System organism

4. Body Systems-10 Skeletal Circulatory Digestive Respiratory Urinary Reproductive Nervous Muscular Endocrine Integumentary

5. Skeletal Much general diagnostic radiography involves exams of the bones and joints (osteology and arthrology) 206 separate bones Divided into axial and appendicular

6. Axial Skelton- 80 bones Cranium-8 Facial-14 Hyoid-1 Auditory ossicles-6 Cervical vert.-7 Thoracic vert.-12 Lumbar vert.-5 Sacrum-1 Coccyx-1 Sternum-1 Ribs-24 Total-80

7. Appendicular Skeleton- 126 Clavicles-2 Scapulae-2 Humeri-2 Ulnae-2 Radii-2 Carpals-16 Metacarpals-10 Phalanges-28 Hip bones-2 Femora-2 Tibias-2 Fibulas-2 Patellae-2 Tarsals-14 Metatarsals-10 Phalanges-28 total: 126

8. Sesamoid Bones Special, oval-shaped bones found in tendons mostly near joints Not present in developing fetus The only sesamoids that are included in the total body bone count are the patellae Commonly found on the palmar surface of hand and sometimes in tendons of other upper of lower limb joints Any sesamoid can be fractured and may need to be demonstrated radiographically

9. Bone Classification Long Flat Short Irregular

10. Long Bones Body 2 ends or extremities Composed of compact bone or cortex, body, spongy bone (red marrow), medullary cavity, periosteum, hyaline cartilage, articular cartilage and the periosteum

11. Short Bones Carpals and tarsals

12. Flat Bones Consist of 2 plates of compact bone with cancellous bone and marrow between them Examples- calvarium, sternum, ribs and scapulae Diploe: space between the inner and outer table of flat bones in the cranium

13. Irregular Bones Bones with peculiar shapes- vertebrae, facial bones, bones of the cranial base and bones of the pelvis

14. Blood Cell Production RBCs (red blood cells) are produced in the red bone marrow of certain flat and irregular bones

15. Bone Development Ossification begins in the sixth embryonic week and continues until adulthood 2 kinds of bone formation –Intramembranous: occurs rapidly in bones necessary for protection (i.e. sutures of the skull) –Endochondral: much slower than intramembranous; occurs in most parts of the skeleton

16. Centers of Endochondral Ossification Primary center- midbody or diaphysis Secondary center- ends or extremities of the long bones or epiphysis –Epiphyseal plates: found between the diaphysis and the epiphysis until skeletal growth is complete

17. Arthrology: study of joints Functional classification- –Synarthrosis- immovable –Amphiarthrosis- limited movement –Diarthrosis- freely moveable

18. Structural Classification #1 Fibrous: held together by fibrous connective tissue –Syndesmosis: only one in the body- distal tibiofibular joint- amphiarthrodial –Sutures: between the bones of the skull- synarthrodial –Gomphoses: roots of the teeth- very limited movement

19. #2 Cartilaginous: held tightly together by cartilage –Symphyses:example is intervertebral disks- amphiarthrodial –Synchondroses: these are temporary growth joints; example is the acetabulum- they are synarthrodial

20. #3 Synovial: fibrous capsule containing synovial fluid- they are diarthodial and some examples are the knee, elbow.

21. 5 Functions of a Radiographic Procedure Positioning of the body and CR alignment Selection of the radiation protection measures Selection of exposure factors on the control panel Patient instructions relating to breathing Processing of the IR (image receptor- could be film or a digital plate)

22. Anatomic Position Upright, arms adducted, palms forward, head and feet directed straight ahead Viewing Radiographs: Display x-rays so that the patient is facing the viewer in anatomic position R

23. Body Planes, Sections and Lines Sagittal- any longitudinal plane dividing the body into right and left parts Mid-sagittal or median plane- divides the body into equal right and left halves Coronal- longitudinal plane dividing the body into anterior and posterior parts Mid-coronal- divides the body into equal anterior and posterior parts

24. Horizontal or axial plane- transverse plane passing through the body at right angles to the longitudinal plane; divides into superior and inferior portions Oblique plane- longitudinal or transverse that is on an angle or slant to the sagittal, coronal or horizontal planes.

25. Understanding CT and MRI Images Longitudinal sections can be taken in sagittal, coronal or oblique planes Transverse (axial) or cross sections

26. Planes of the Skull Base plane Occlusal plane

27. Body Surfaces and Parts Posterior or dorsal Anterior or ventral Plantar- sole of foot Dorsal- top of anterior surface of foot, back or posterior aspect of hand Palmar- palm of hand or the anterior/ventral surface

28. Radiographic Projections Posteroanterior or PA Anteroposterior or AP AP oblique (LPO and RPO) PA oblique (LAO and RAO) Mediolateral or Lateromedial

29. Clarification on Positioning Terms Position: use this when indicating the patient’s general physical position such as supine, prone, etc. It is also used to describe specific body positions such as obliques and laterals. Restrict the use of this word to the patient’s physical position. Projection: describes the path or direction of the central ray; restrict the use of this word to the CR View: not a correct positioning term in the US; restrict the use of the word view to describing the image from the vantage of the image receptor

30. Radiographic Criteria The goal of every technologist should be not just a passable radiograph, but rather an optimal one that can be evaluated by a definable standard as described under radiographic criteria –Structures shown –Position –Collimation and CR –Exposure criteria –Image markers

31. Image Markers and Patient ID All films should have two markers: –Patient ID and date –Anatomic side markers

32. Principle for Determining Positioning Routines A minimum of two projections (90 degrees from each other) is required for most procedures. Why? Because: –Certain conditions may not be visualized on one projection only –Sometimes foreign bodies are embedded and two projections are needed to determine exact location –All fractures require two projections at 90 degree angles to determine alignment of the fracture parts A minimum of three projections when joints are in interest area. Why? Because more information is needed than can be provided by two projections. See list in book on page 37 to determine which procedures require two projections and which require three.

33. IR (Film) Sizes Must be familiar with metric and traditional units or be able to convert –20 x 25 cm or 8 x 10 in –25.4 x 30.5 cm or 10 x 12 in –30 x 35 cm or 11 x 14 in –35 x 43 cm or 14 x 17 in

34. Body Habitus Hypersthenic Sthenic Hyposthenic Asthenic

35. Text Book David Sutton’s Radiology Clark’s Radiographic positioning and techniques

36. Assignment Two students will be selected for assignment.

37. Question Define 5 Functions of a Radiographic Procedures?

38. Thank You 38