PowerPoint Presentation - NP Skills by yaofenji

VIEWS: 3 PAGES: 51

									                       Radiographic
                       Interpretation


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                                         What’s
                                         Normal?


                                  Bucky Boaz, ARNP
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          Cervical Spine (Lateral)
                                        1. Anterior arch of the atlas

                                        2. Dens of axis
                                        3. Posterior arch of the atlas

                                        4. Soft palate
                                        5. Root of the tongue

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                                        6. Transverse process

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                                        8. Inferior articular process

                                        9. Superior articular process

                                        10. Zygapophyseal (facet) joint

                                        11. Spinous process of C7
                                        2nd-7th: The bodies of 2nd to 7th
                                            cervical vertebrae
         Lateral Cervical Spine




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Anterior soft tissue swelling
                                         •   soft tissue swelling is indirect
                                             indicator of significant trauma,
                                             esp. when the soft tissue
                                             swelling is above the epiglottis;
                                         •   retropharyngeal soft tissue
                                             swelling should not exceed:
                                              – anterior to C3 should not
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                                              – if > than 5 mm at C3 consider
                                                minimally displaced C2 fracture;
                                              – w/ children, crying increases
                                                the C3 distance;
                                              – below C4 the thickness varies
                                                from 8 to 10 mm & is less
                                                reliable;
Anterior soft tissue swelling
                                         •   distance between tracheal air
                                             column & anterior aspect of
                                             vertebral body should be No
                                             greater than:
                                              – Adults: no > than 7 mm at C2
                                                or 22 mm at C6;
                                              – Child: no > than 14 mm at C6
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                                                  • during x-ray child should be in
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                                                    full inspiration;
                                                  • fullness and laxity of child's
                                                    prevertbral soft tissues may
                                                    simulate traumatic swelling if
                                                    film is obtained during
                                                    expiration or flexion;
             Spinal Laminal Lines
                                      •   Three curves to follow
                                           – Anterior aspect of vertebral bodies
                                           – Posterior aspect of vertebral bodies
                                           – Spinolaminar line
                                      •   Abnormalities in the curves
                                           – posterior malalignment is more
                                             significant than anterior because of
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                                             proximity of the spinal cord
                                      •   spinal canal diameter is
                                          significantly narrowed if < 14 mm
                                      •   anterior subluxation is caused by
                                          facet dislocation
                                           – < 50% of vertebral body width =
                                             unilateral dislocation
                                           – > 50% of vertebral body width =
                                             bilateral dislocation
                            Lateral Findings
                                      • Examine bones for symmetry
                                      • May provide evidence of
                                        fracture
                                      • Abnormal symmetry is often
                                        due to compression
                                      • compression of > 40% of
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                                        usually indicates a burst
                                        fracture with possibility of bone
                                        fragments in the spinal canal
                                      • anterior compression may cause
                                        a teardrop shaped fracture
          Cervical Spine (Lateral)
                                        1.   Bifid spinous process of
                                             C3

                                        2. Superimposed articular
                                             processes

                                        3. Uncinate processes

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                                        4. Air filled trachea

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                                        6. Transverse process of T1

                                        7. 1st rib

                                        8. Clavicle
                                        4th-7th: The bodies of 4th to 7th
                                             cervical vertebrae
                  AP Cervical Spine




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                         Odontoid View
                                      •   to evaluate:
                                           – C1 (Jefferson), Dens, superior
                                               facets of C2
                                      •   for evaluating dens fractures, body
                                          of C2, & rotary C1-C2 dislocations;
                                      •   mach lines - teeth, C1 arch;
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                                          view, will reveal fractures of the
                                          dens ;
                                      •   atlantoaxial articulation & integrity
                                          of dens and body of C2 are best
                                          seen on the odontoid view;
                             Odontoid View
                                      •   this is most technically most
                                          difficult film to obtain as it
                                          requires patient to open his
                                          mouth as wide as possible
                                      •   lateral masses of C1 should
                                          align over the lateral masses of
                                          C2;
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                                      •   lateral displacement of masses
                                          of C1 w/ respect to C2 may
                                          indicate Jefferson or burst
                                          fracture of the Atlas;
                                            – combined lateral mass
                                               displacement > 7 mm
                                               suggests that transverse
                                               ligament is torn;
                         Anatomy of C2
                                      •   C2 provides rotation at its
                                          superior articulation w/ C1, &
                                          limited flexion, tilt, & rotation at
                                          its inferior articulation w/ C3;
                                      •   body of C2 is the largest of the
                                          cervical vertebrae;
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                                          lateral masses;
                                      •   superior projection of the
                                          odontoid is stabilized to the C1
                                          ring by transverse and alar
                                          ligaments;
                        Anatomy of C2
                                       • lateral masses of C2 have
                                         aperture for accepting
                                         transversing vertebral artery;
                                       • axis is transverse vertebra
                                         w/ its superior articular
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                                         posterior;
                                       • prominent spinous process
                                         of C2 is palpable beneath of
                                         occiput;
                                   Odontoid




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                    Thoracic Vertebra
                                       •   Each vertebra is composed of a body
                                           anteriorly and a neural arch posteriorly
                                       •   The arch encloses an opening, the vertebral
                                           foramen, which helps to form a canal in
                                           which the spinal cord is housed.
                                       •   Protruding from the posterior extreme of
                                           each neural arch is a spinous process and
                                           extending from the lateral edges of each
                                           arch are transverse processes.
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                                           known as the laminae and the parts of the
                                           arch between the transverse processes and
                                           the body are the pedicles.
                                       •   At the point where the laminae and pedicles
                                           meet, each vertebra contains two superior
                                           articular facets and two inferior articular
                                           facets.
                                       •   The pedicle of each vertebra is notched at
                                           its superior and inferior edges. Together the
                                           notches from two contiguous vertebra form
                                           an opening, the intervertebral foramen,
                                           through which spinal nerves pass
                                      Thoracic Spine

                                                                            • Spinous process
                                                                            • Pedicles
                                                                            • Intervertebral disc
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                                                                            • Ribs
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                                                                            • Vertebral body
                                                                            • Neural foramen
                     Lumbar Vertebra
                                       •   Lumbar vertebrae are
                                           characterized by massive
                                           bodies and robust spinous and
                                           transverse processes.
                                       •   Their articular facets are
                                           oriented somewhat
                                           parasagittally, which is thought
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                                           possible between lumbar
                                           vertebrae.
                                       •   Lumbar vertebrae also contain
                                           small mammillary and
                                           accessory processes on their
                                           bodies.
                                            – These bony protuberances are
                                              sites of attachment of deep
                                              back muscles
Lateral Lumbar Spine




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         Lateral Lumber Spine




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                   AP Lumbar Spine




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Vertebral Fractures




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                                    Pelvis




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                        AP Pelvis
1.  Lateral part of                                           12.   Pubic tubercle
    the sacrum
                                                              13.   Lesser trochanter
2. Gas in colon
                                                              14.   Neck of femur
3. Ilium
4. Sacroiliac joint                                           15.   Greater trochanter
5. Ischial spine                                              16.   Head of femur
6. Superior ramus                QuickTime™ and a
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                                                              18.   Anterior inferior iliac
7. Inferior ramus of                                                spine
    pubis                                                     19.   Anterior superior
8. Ischial tuberosity                                               iliac spine
9. Obturator                                                  20.   Posterior inferior
    foramen
                                                                    iliac spine
10. Intertrochanteric
    crest                                                     21.   Posterior superior
                                                                    iliac spine
11. Pubic symphysis
                                                              22.   Iliac crest
                                       AP Hip
                                          1.    Anterior superior iliac spine
                                          2.    Ilium
                                          3.    Anterior inferior iliac spine
                                          4.    Pelvic brim
                                          5.    Acetabular fossa
                                          6.    Head of femur
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                                          8.    Superior ramus of pubis
                                          9.    Obturator foramen
                                          10.   Inferior ramus of pubis
                                          11.   Pubic symphysis
                                          12.   Ischium
                                          13.   Lesser trochanter
                                          14.   Intertrochanteric crest
                                          15.   Greater trochanter
                                          16.   Neck of femur
                                Lateral Hip
                                      1.    Greater trochanter
                                      2.    Intertrochanteric crest
                                      3.    Lesser trochanter
                                      4.    Neck of femur
                                      5.    Head of femur
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                                      7.    Superior ramus of pubis
                                      8.    Obturator foramen
                                      9.    Inferior ramus of pubis
                                      10.   Ischium
                                       AP Knee
                                           1.    Femur
                                           2.    Patella
                                           3.    Medial epicondyle of femur
                                           4.    Lateral epicondyle of femur
                                           5.    Medial condyle of femur
                                           6.    Lateral condyle of femur
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                                           8.    Intercondylar notch
                                           9.    Knee joint
                                           10.   Lateral condyle of tibia
                                           11.   Medial condyle of tibia
                                           12.   Tibia
                                           13.   Fibula
                              Lateral Knee
                                        1.    Femur
                                        2.    Lateral condyle of femur
                                        3.    Medial condyle of femur
                                        4.    Fabella
                                        5.    Patella
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                                        7.    Apex of patella
                                        8.    Intercondylar eminence
                                        9.    Apex of fibula
                                        10.   Fibula
                                        11.   Tibia
                                        12.   Tibial tuberosity
                                        AP Ankle
                                            1.   Fibula
                                            2.   Tibia
                                            3.   Distal tibiofibular joint
                                            4.   Malleolar fossa
                                            5.   Lateral malleolus
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                                            8.   Talus
                            Lateral Ankle
                                      1.    Fibula
                                      2.    Tibia
                                      3.    Ankle joint
                                      4.    Promontory of tibia
                                      5.    Trochlear surface of talus
                                      6.    Talus
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                                      8.    Calcaneus
                                      9.    Sustentaculum tali
                                      10.   Tarsal tunnel
                                      11.   Navicular
                                      12.   Cuneiforms
                                      13.   Cuboid
                                      Talar Dome
                                           •   The talar dome should be
                                               scrutinised for a subtle
                                               indentation of the joint surface,
                                               or a small detached fragment.
                                           •   This is evidence of an
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                                                – May be subtle, is often missed,
                                                  but this injury is clinically
                                                  significant.
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                               Boehler’s Angle
                                       •   Compressive fractures occur
                                           after a fall from a height.
                                       •   Subtle fractures may only be
                                           identified by assessing Boehler’s
                                           angle.
                                       •   This angle is measured by
                                           drawing a line from the highest
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                                           to the highest midpoint, and a
                                           2nd line from the highest
                                           midpoint to the highest point of
                                           the anterior process.
                                            – The angle, posteriorly, should be
                                              >30 degrees.
                                            – If there is flattening of the bone
                                              due to a fracture, this angle will
                                              be decreased, to <30 degrees.
Boehler’s Angle




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                                  AP Foot
A-E: Toes 1-5. (A:Great toe)

I-V. Metatarsals                                                         12.   Cuneiform
1,3. Distal phalax
                                                      13.   Navicular
4. Middle phalax
                                                        14.   Cuboid
                                                                         15.   Talus
2,5. Proximal phalax
                                                                         16.   Calcaneus
6. Interphalangeal joints                 Qui ckTi me™ an d a
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                                                                         17.   Tibia
7. Metatarsophalangeal                                                   18.   Fibula
     joints
                                                                         19.   Tarsometatarsal joints
8. Sesamoids                                                             20.   Transverse midtarsal joint
9. Head of metatarsal
10. Shaft (body) of metatarsal
11. Base of metatarsal
                               Oblique Foot
A-E: Toes 1-5. (A:Great toe)                                         11. Base of metatarsal
1,3. Distal phalax
                                                  12. Cuneiforms
4. Middle phalax
                                                    13. Navicular
2,5. Proximal phalax                                                 14. Cuboid
6. Interphalangeal joints                                            15. Talus
7. Metatarsophalangeal                                               16. Calcaneus
     joints                               Quic kTime™ and a

8. Sesamoids
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9. Head of metatarsal                                                18. Fibula
10. Shaft (body) of                                                  19. Tarsometatarsal
     metatarsal                                                          joints
                                                                     20. Transverse midtarsal
                                                                         joint
                                      AP Foot




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                                 Oblique Foot




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                                 Lateral Foot



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                                        Lisfranc




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   Lisfranc




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                              AP Shoulder
                                        1.    Clavicle
                                        2.    Acromioclavicular joint
                                        3.    Acromion
                                        4.    Greater tubercle of humerus
                                        5.    Head of humerus
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                                        8.    Coracoid process
                                        9.    Glenoid fossa
                                        10.   Shoulder joint
                                        11.   Lateral border of scapula
                                  AP Elbow
                                      1.    Lateral supracondylar ridge
                                      2.    Medial supracondylar ridge
                                      3.    Olecranon fossa
                                      4.    Medial epicondyle
                                      5.    Lateral epicondyle
                                      6.    Capitulum
                                      7.    Olecranon
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                                      8.    Trochlea
                                      9.    Coronoid process of ulna
                                      10.   Proximal radioulnar joint
                                      11.   Head of radius
                                      12.   Neck of radius
                                      13.   Tuberosity of radius
                                      14.   Ulna
                            Lateral Elbow
                                       1.   Supracondylar ridge
                                       2.   Trochlea
                                       3.   Olecranon
                                       4.   Trochlear notch
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                                            ulna
                                       6.   Head of radius
                                       7.   Neck of radius
                                       8.   Tuberosity of radius
                                       9.   Ulna
                                        PA Wrist
                                            I-V:   Metacarpals
                                            1.     Trapezium
                                            2.     Trapezoid
                                            3.     Capitate
                                            4.     Head of capitate
                                            5.     Hamate
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                                            8.     Lunate
                                            9.     Triquetrum
                                            10.    Pisiform
                                            11.    Styloid process of radius
                                            12.    Head of ulna
                                            13.    Styloid process of ulna
                                            14.    Radiocarpal joint
                                            15.    Distal radioulnar joint
                            Lateral Wrist
                                      1.   1st metacarpal
                                      2.   Metacarpals II-V
                                      3.   Trapezium
                                      4.   Tubercle of scaphoid
                                      5.   Lunate
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                                      7.   Radiocarpal joint
                                      8.   Distal end of radius
                                      9.   Distal end of ulna
                              Rule of 11’s
                                      • Radial length or height
                                         – Radial length is
                                           measured on the PA
                                           radiograph as the
                                           distance between one
                                           line perpendicular to the
                                           long axis of the radius
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                                           styloid. 

                                         – A second line intersects
                                           distal articular surface of
                                           ulnar head. 

                                         – This measurement
                                           averages 10-13 mm.
                             Rule of 11’s
                                      • Radial inclination or angle

                                          – Radial inclination represents the
                                            angle between one line
                                            connecting the radial styloid tip
                                            and the ulnar aspect of the distal
                                            radius and a second line
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                                            axis of the radius. 


                                          – The radial inclination ranges
                                            between 21。 and 25。. 
Loss of
                                            radial inclination will increase
                                            the load across the lunate.
                            Rule of 11’s
                                      • Radial tilt

                                          – Radial tilt is measured on a
                                            lateral radiograph. 


                                          – The radial tilt represents the
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                                            the longitudinal axis of the
                                            radius at the joint margin.

                                          – The normal volar tilt averages
                                            11。 and has a range of 2。-20。.
                                PA Hand
A.     Thumb
                                                        9.    Metacarpophalange
B.     Index                                                               al joint (V.)
C.     Middle finger                                                 10.   Carpometacarpal
D.     Ring finger                                                         joints
E.     Little finger                                                 11.   Trapezium
I-V.   Metacarpal bones                                              12.   Trapezoid
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2.     Middle phalanx

                                                                     14.   Hamate
3,5.   Proximal phalanx

6.     Sesamoid bones                                                15.   Scaphoid
7.     Distal                                                        16.   Lunate
       interphalangeal joint                                         17.   Triquetrum
       (DIP)                                                         18.   Pisiform
8.     Proximal
                                                                     19.   Radius
                                                                     20.   Ulna
QUESTIONS?

								
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