Transcript film critique unit 4

FILM CRITIQUE
UNIT 4
PELVIS HIPS SPINE
Including ST Neck
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Hands
Note
Intertrochanteric fx
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End of
Prosthesis
Device
Not seen
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Subcapital fx
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Intertrochanteric fx
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Osteoporosis
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c/o Lt buttock pain
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Osteo arthritis
Pagets sarcoma
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Name of “view” for acetabulum?
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This is not a
Axiolateral HIP !
What is it?
INF/SUP Shoulder
No gonad shield
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DISCLOCATED SI JT
CA
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C-1 ring fx
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Jefferson’s fx
a burst fx of C-1 –atlas = results from
compression of the C.SP – may also
be associated with fx of C-2 (axis)
May or may not involve the
transverse ligament
Rheumatoid arthritis
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Hangmans fx
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Ankylosing Spondylitis
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Hangman fx
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pointing to the superior and inferior vertebral notches on adjacent vertebrae. The pedicles
form the intervertebral foramina; however, the atlas does not have pedicles nor does it form
any intervertebral foramina
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torticolis
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Spaces not well seen -calcification of ligaments
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CA mets transverse process
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fx
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A body
E transverse process
D pedicle
O superior articular
facet, left
P pars
interarticularis, left
R inferior articular
facet, left
I apophyseal
(interfacetal) joint, left
V disk space
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Calc disc
comp fx osteop
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Facets distroyed
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spondylolithesis
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spondylolythesis
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sacralization
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spurring
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“CAGE”
POST OP FOR HERNIATED DISK
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SPINE CRITIQUE
additional information
Review on your own
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If the technologist had pulled down on the patient’s shoulders to
image this person’s spine, paralysis may have occurred.
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Next, observe that the 7th
cervical vertebra has no rib
attachment, and as its name
(vertebra prominens) implies, it
has a long spinous process
that is not bifid (white arrow).
Note the rib attachment to the
first thoracic vertebra (long
yellow arrow).
All apophyseal joints,
especially C7/T1 so easily
seen on this radiograph (short
yellow arrow) must be seen on
the Swimmer’s view when is it
made.
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This radiograph is difficult to critique
because of the poor radiographic contrast. A
good radiographer can make a good
radiograph even under the most difficult
patient conditions.
Adequate penetration is demonstrated; but
because of the graininess due to technical
factors subject detail is lacking. Increasing
the mAs, using high ratio grid, and using
tighter collimation will optimize the subject
detail.
To find T1 on this radiograph we must
identify the 1st rib. It has an attachment to
the manubrium at the clavicular notch
anteriorly (white arrow). Just below it is the
1st costal cartilage where the 1st rib
attaches. The yellow arrow indicates the first
rib and T1.
The apophyseal joints of C7/T1 are seen but
without good subject contrast. The
alignment of the vertebrae can be
determined because the positioning is good.
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Here is an example of the
head being extended too far.
This view resembles a reverse
Water’s view for profiling the
odontoid tip (Fuchs).
Also notice that the
radiographic technique is
inadequate. This low contrast
image shows poor bone detail.
In addition good patient
positioning, subject detail must
be adequate for soft tissues
and bone detail.
Repeat this image with the
head tilted downward.
Use a higher ratio grid, or
select a technique that allows
for an increase in the mAs of at
least a 15% reduction in kVp to
improve subject contrast. Not
using above 80 kVp initially will
be less radiation to the patient
than a repeated film
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Diagnostic Criteria for Imaging the Open- 168
mouth odontoid view of the Cervical Spine
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Position the patient so that the upper incisors are
superimposed over the base of the skull’s external occipital
protuberance. This can be accomplished by placing the
acanthiomeatal line perpendicular to the tabletop.
Align the mid-sagittal plane (MSP) perpendicular to the
horizontally directed central ray (CR). The part is positioned
for non-trauma patients by having them raise or tuck their chin
to achieve alignment. If the patient is in a cervical collar the
CR is angled so that it is parallel with the infraorbitomeatal
line (IOML).
The lateral margins of C1/C2 should be aligned unless there
is pathological reason for its misalignment. The spinous
process of the axis should be on the mid-sagittal line. The
spacing of the atlantoaxial joints should be equal. Equal
spacing on the lateral borders of the odontoid process; the tip
should be completely seen.
Structures demonstrated are: atlantoaxial joints,
occipitoatlantal joints, odontoid process and body of the axis,
and lateral masses and transverse processes of the atlas.
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In addition to adequately
visualizing C1 and C2, the
following alignments should be
meet when positioning the
patient:
The lateral margins of C1/C2
should be aligned unless there
is pathological reason for its
misalignment.
The spinous process of the
axis should be on the midsagittal line.
The spacing of the atlantoaxial
joints should be equal.
Equal spacing on the lateral
borders of the odontoid
process; the tip should be
completely seen.
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Notice that this image is poorly
collimated. There is nothing to
be gained by including the
maxillary sinuses!
Secondly, the upper incisors are
projected above the base of the
skull. The chin should be tucked
down (flexed) to line up the
teeth and base of skull. The
acanthiomeatal line should be
perpendicular to the tabletop.
The atlantoaxial joints are not
opened because of the poor
positioning. Also notice the
rotation of the spinous process
and spacing on the lateral
borders of the odontoid process.
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Don’t be fooled into thinking that this
is a good radiograph just because the
anatomy is present.
The anatomical relationships must be
presented as well.
Here is another example of an open
mouth odontoid view in which the
head is extended too far back.
The chin should be brought down
until the upper teeth are
superimposed over the base of the
skull (arrows). This will require
bringing the acanthiomeatal line
perpendicular to the tabletop. The
spacing of the atlantoaxial joints is
not properly demonstrated.
It is very possible to get a good view
that demonstrates the joint spaces
and odontoid process. Unfortunately,
this view should be repeated.
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Because of the metal
tooth plate it will be
difficult to image the
odontoid tip.
Because the alignment of
the teeth and base of the
skull are adequate
repeating this view may
not yield the desired
result.
Instead, bring the head
down just a little, then
lower the tube to about
20 cm.
Allow the divergence of
the CR to clear the part.
The other option is to add
a Fuchs view.
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Consider that the
Should the image should be repeated!
lateral masses are
covered by dental
fillings; your
positioning becomes
even more critical.
The chin is tucked
down too much!
Slightly tilt the head
backwards. This will
help to demonstrate
more of each lateral
mass and the odontoid
tip.
You still may need to
add a Fuchs view to
demonstrate the
spacing on each side
of the odontoid peg
Collimation???
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70 degrees for
zygos
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Breathing
tech
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C7 and L1 must be entirely
demonstrated to evaluate for
subluxation of the thoracic spine.
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Poor centering
poor contrast / spaces not open
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Because of
the chest
tube and
intubation,
the
positioning
seen here is
acceptable.
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It appears there was some difficulty in
locating the lumbosacral junction.
To find L5/S1 you should remember that the
iliac crest is at the level of L4.
This places L5/S1 at approximately 1 inch
below this point. T
there is too much of the lumbar spine
demonstrated and too little of the sacrum.
The collimation is poor
This radiograph must be repeated using the
radiological landmarks for locating L5/S1.
The radiographic exposure technique
should also be changed so that the part is
well penetrated. This is a high contrast film
having poor penetration of the lumbosacral
junction.
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For L5- S1 – is it acceptable?
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part is not centered
it is clipped
metal snaps are present
The patient is not
positioned in a true lateral.
A disruption of the
column, or encroachment
on the vertebral canal
cannot be evaluated.
Also, 5% of patients have
spondylolisthesis
secondary to chronic
stress fractures
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Special thanks to the radiographers and physicians at Regions
Hospital in St. Paul, Minnesota, a Level I trauma center, for their
expert advice and radiographs.
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