ملخص الميد ترم

Shoulder Joint

The gleno – humeral Joint is The commenst Joint in th Body to

 Dislocate .

anterior dislocations , the head is displaced or dislocate forwards .

posterior dislocations, the head is displaced directly backwards.

Anterior dislocation

●  Well demonstrated on the standard AP view.

Posterior dislocation

●  Best seen on the axillary view.

●  on AP view a widened gleno-humeral space is seen .

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CR:   90° to  film center.

CP:   To mid scapulohumeral joint

Lateral Shoulder (Internal rotation) :

CR:   90° to  film center.

CP:   To mid scapulohumeral joint

NB/ a nutral rotation is Also done with same CP & CR .

Inferosuperior Shoulder (Axial) Lawrence Method :

* Non-trauma case with same indication as for AP and lateral. 

CR:    Horizontal 25° - 30° medially to film center.

CP:    Humeral head (axilla).

Inferosuperior Shoulder (Axial) West point Method :

*Non-trauma case with same indication as for AP and lateral. 

CR:    25° anterior down from horizontal and then 

              25° medially to film center.

CP:    Mid scapulohumeral joint.

APO ( Glenoid Cavity) Grashey  Method :

* For #s and dislocations of the Glenoid, and for Bankart fracture and state of scaulo -humeral joint.         

CR:    90° to film center .

CP:    Scapulohumeral joint.

Tangential ( Intertubercular Groove) Fisk  Method   :

* To show pathologies of the bicipital groove.

CR:     90° to film center.

CP:    The bicipital groove.

Transthoracic lateral  Lawrence Method :

* For #s and dislocations of proximal humerus and shoulder.

CR:    90° to film center.

CP:    Surgical neck (through thorax).

NB/the PT Gently Beath Short Shallow Breaths To Imporove quality

And plur the Lung’s shadow .

1. Clavicle
2.  Acromio-clavicular joint
3.  Acromion
4.  Greater tubercle of Humerus
5.  Head of Humerus
6.  Lesser tubercle of humerus
7.  Surgical neck of humerus
8.  Coracoid process
9.  Glenoid fossa
10. Shoulder joint
11. Lateral border of scapula

Bony Thorax

AP posterior ribs (upper and lower ribs):                                                            

For upper ribs: Patient erect  (preferred), specially  in case of trauma to  prevent lungs puncture by a fractured rib .

Lower ribs: Patient supine .

kV (65 – 75 for above diaphragm,  75 – 85 for below diaphragm), FFD 100 cm, grid.

CR:  90° to the film center.   

CP:  Upper ribs (above diaphragm):  To T7 (8 – 10 cm

                below the  jugular  notch).

               Lower ribs (below diaphragm):  Midway between

               xiphoid  and lower rib cage.

For upper ribs: 

Exposure on the  arrested full inspiration.   

For lower ribs: 

Exposure on the arrested full expiration.

RAO, RPO ribs (upper and lower ribs) :

P O:  Affected  side should be close to cassette.

AO:   Affected side away from cassette.

kV 70 – 75 (above diaphragm)

       80 – 85 (below diaphragm).

CR:   90° to film center in each case.

CP:   Upper ribs (above diaphragm):  T7 (8-10 cm below  

               jugular  notch). 

               Lower ribs: (below diaphragm):   Midway between

                xiphoid process and lower rib cage.

AP/ AP Axial Clavicle :

* For #s/ dislocations of the clavicle and Acromoiclavicular joint.

CR:    AP:  90° horizontal. AP axial:  15°- 30° cephalic. 

CP:    Mid-clavicle.

 NB/Exposure on arrested inspiration.

PA  Axial  Clavicle :

CR:    25°  to 30° caudally.

CP:    Mid shaft of clavicle.

AP ACROMIOCLAVICULAR JOINTS (ACJs)                   

* For #s/ joint separation.  Done  with /without stress weights (8 – 10 pounds, 10 – 15 for large adult patients) .

CR:    90° horizontal to film center.

CP:    Midpoint between clavicles.

 RAO sternum  :

* For pathology of the sternum (fractures /other inflammatory processes).

CR:  Horizontally 90° to film center, exposure on    

(normal)  Quiet breathing, or else, during a 

suspended expiration.

CP:  Center of sternum .

                                                                

   Lateral sternum :

* For pathology of the sternum (#s, Subluxation, and other  inflammatory processes).

CR:   90° to film center, exposure during a            

                suspended inspiration.

CP:   Center of sternum (midway between jugular

                notch  and xiphoid process).

PA bilateral sternoclavicular joints (SCJs)  :

* For joint separation and pathology.

CR:     90° to the film center, exposure done during                   suspended expiration.

CP:     At  level of T2-T3.

                  

     PAO SCJs     :

* For joint separation and pathology.

CR:     90° to film center, exposure during suspended expiration.

CP:     At  level of  T2-T3.

Lower Limbs

* Positioning principles as for upper limb applies to lower limb.  kV should be lower to medium (50 – 70) KVp.

* No secondary radiation grid used, except for knee (> 10 cm) and for the femur.

* Radiation protection has to be well observed,  using the special gonad shields over pelvic region, or the lead apron as necessary.  Also, the LBD or cone has to be used.

* FFD is generally 40 inches (100 - 102 cm).

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Pathological Indications (Lower limb)

Bone cysts :   Benign neoplastic bone lesions filled with a clear fluid near the knee

 joint in pediatric patients.

 Chondromalacia patellae (Runner’s knee):  Is the softening of  cartilage under the

 patella at a later stage.

 Ewing sarcoma : A primary bone malignancy in children, mainly in diaphysis of

 long bones.

 Osgood Schlatter's disease :  Is the inflammation of bone and cartilage in the

 anterior proximal tibia (tibial tuberosity) of children.

 Osteoclastoma:  A benign lesion in the proximal tibia/distal  femur, usually

 affecting epiphyseal closure.

 Osteogenic sarcoma    Is a malignant primary bone tumor in long bones,  usually

 causing gross destruction of the bone.

AP Toes   :

 *For fractures and dislocations, osteoarthritis (OA), and gout (especially in the 1^st digit).

CP:    MTPJ(s).

 CR:    10°-15° toward the Calcaneus (the heel)

 (90° to the phalanges).

NB/   If a 15° wedge is used, CR must be 90° to the film.  

Lateral Toes   :

 *For fractures and dislocations, osteoarthritis, and gout (especially in the 1^st digit).

CP:    IPJ (for 1^st), proximal IPJ (2^nd to 5^th)

CR :    90° to film.

AP (Dorsiplanter) foot       :

 *For #s and dislocations, tissue effusion, joint-space abnormalities, opaque foreign bodies (F.Bs.).

CP:    Base of 3^rd metatarsal

CR:    10° posteriorly (toward the heel.

NB/    Perpendicular (0°) for a F.B. and for a flat foot (pes planes),  5°  for a low arch foot, and 15° for a high arch foot.

APO foot :

 *For #s and dislocations, soft tissue effusion, joint space abnormalities, opaque F.Bs .

CP:     Base of 3^rd metatarsal.

CR:     90° perpendicular.

lateral foot  : 

 *For #s and dislocations, tissue effusion, joint space abnormalities, opaque F.Bs.

CP:     Medial cuneiform  (level of the base    

         of the 3^rd  metatarsal).

CR:    90° perpendicular to film.

AP/Lat both feet  (Weight-bearing technique)

 *To show condition of the longitudinal arches under full weight of body to exclude a flat foot abnormality .

 *AP: Patient standing erect, full weight evenly distributed on both feet (on the fluoroscopic foot-rest).

 *Lat: Patient stand erect on wood blocks on the foot  rest, film vertically between feet, cassettes changed in turn for lateral of the other foot for comparison.

CP: (AP):  CR 15° posteriorly to midpoint between the        

                        feet, at the level of the base of metatarsals.          

      (Lat): Horizontally to the level of base of the metatarsals.

Axial Calcaneus (Heel bone)  :

 *To show fractures, pathology, and lateral or medial displacement.

CP:     Base of 3^rd metatarsal.

CR:     40° cephalic from long axis of foot.

Mediolateral Calcaneus :

 *For bony lesions of Calcaneum, talocalcaneal joint, and talus.  Also shows fractures.

CP:     1 inch inferior to medial malleolus.      

CR:     90° to film.

AP Ankle :

 *For bony lesions of ankle joint, distal tibia and fibula (NB/ Lateral aspect of ankle joint must not appear open in this projection).

CP:      Midway between malleoli.

CR:      90° to film.

AP Ankle Mortise :

 *For pathology involving entire ankle mortise and proximal 5^th MT (a common fracture site).  This view is not a substitute for AP or oblique ankle.  It is basic in case of potential trauma or sprains of the ankle joint.

CP:    A point midway between malleoli.

CR:    90° to film.

Lateral Ankle (Mediolateral) :

 *For pathology and fractures, dislocations, joint effusions.

CP:    Medial malleolus.

CR:    90° to film.

APO Ankle 45° (medial rotation) :

 *For pathology/fractures involving distal Tibiofibular  joint and distal fibula and base of 5^th MT.

CP:    A point midway between malleoli.

CR:    90° to film.

1. Fibula       2. Tibia      3. Distal Tibiofibular joint    4. Malleolar fossa   5. Lateral malleolus    6. Ankle joint   7. Medial malleolus     8. Talus