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Mid Term Revision

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

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Mid Term Revision

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  1. Mid Term Revision • Radiological Imaging and Processing 1 Dr Mohamed El Safwany, MD.

  2. 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 AXIAL CORONAL SAGITTAL RT RT 3

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

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

  6. AUTOMATIC PROCESSING TRANSPORTATION SYSTEM DEVELOPER FIXER WASHER DRYER REPLENISHMENT SYSTEM

  7. Automatic Processor

  8. 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

  9. Digital Image Printing Dry processing – no chemistry No darkroom Less environmental impact Reduce costs

  10. I. Radiographic Terminology General Body Positions Supine Prone Erect (stand or sit) Recumbent Lying down in any position Dorsal (supine) Ventral (prone) Lateral

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

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

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

  14. III. Positioning Principles Positioning Sequences Traditional Radiography Step1 Step2 Step3 Step4

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

  16. Lateral erect chest (Basic) 17

  17. LAO, RAO chest (heart) (special) 18

  18. Preliminary bowel preparation 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

  19. Position of the patient

  20. Central ray • 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

  21. 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.

  22. 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.

  23. 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 .

  24. 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 .

  25. 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

  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.

  27. 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

  28. 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

  29. Thank You

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