Beruflich Dokumente
Kultur Dokumente
radiographers
Part 1. Shoulder to fingers inclusive.
Part 2. Knee to toes inclusive.
Details of the projections mentioned can be found in a selection of text including the latest edition of
Clark's Positioning in Radiography which should the standard for techniques.
Indications:
These will be grouped into four major components.
The foot is a special case for deformities, with the several common examples following sometimes
requiring radiological investigation.
Club Foot, Calcaneo Valgus, Accessory Bones, Pes Cavus and Pes planus.
Degenerative diseases,
Rheumatoid arthritis.
This is a collagen disease and affects the collagen of multiple body systems particularly the joints
and tendons but may more rarely affect the eyes, lungs and arteries. Rheumatoid arthritis chiefly
affects the synovial tissues of joints and tendons with the most common sites being the hands, feet
and knees. In children the disease is known as 'Still's disease'.
Three % of the population in England are affected with women more commonly afflicted.
Radiographic features; early in the disease there may be increased radiolucency of the juxta-articular
bone due to re absorption secondary to hyperaemia. Later the joint space becomes narrow and
subchondral cysts may be visible. As secondary degenerative joint changes develop, frank erosion of
the bony surfaces is seen (secondary osteoarthrosis), and the joint may sub-lux.
Osteo arthritis.
In this condition the joint space narrows (1), usually at the site of maximum weight bearing, sclerosis
(increase in white-ness (bone density))(2) develops round the affected areas, and marginal bony
protuberances and cysts form(3) eventually completely destroying the joint space with increasing
sclerosis.(4)
Osteochondrosis
This is a self healing disorder affecting the growing epiphysis where the bony centre of growth
becomes avascular and dies, the bone is subsequently revascularised and reforms, sometimes there
is a permanent residual deformity, the whole cycle can take up to two years.
Avascular necrosis probably forms after a period of ishcaemia, the cause may be from trauma but
the full aetiology is unknown.
Rickets (osteomalacia)
(osteomalacia)
Rickets is a juvenile form of adult osteomalacia a demineralisation of the osteoid tissue caused by
vitamin D deficiency. The growing metaphysis becomes trumpet shaped, a woolly appearances
replaces the dense line of provisional calcification, a widened translucent epiphyseal plate and a less
distinct centre of ossification.
Osteoid osteoma.
Patients: 10-25 Years males
Pathology: A spherical mass of osteoid tissue surrounded by a large region of sclerotic bone
Radiology: The nidus is often invisible in the mass of sclerotic bone, which may require tomography
to demonstrate it.
Enchondromata.
Patients: Any
Pathology: A cartilaginous cyst which expands from within the bone thinning the overlying cortex
Radiology: A radio lucent cyst expanding the bone and thinning the cortex.
Malignant Neoplasm's
Osteosarcoma.
Patients: Usually under 30
Pathology: The lesion commences within the bone and destroys the medulla and cortex. It spreads
under the periosteum along the bone and around the circumference to produce a swelling, the
elevated periosteum lays down new bone in spicules under it at right angles to the shaft.
Radiology: A fusiform enlargement of bone with areas of destruction and irregular sclerosis from
new bone formation is visible. The periosteum is elevated along the shaft. The spicules of new bone
under it form a 'sunray' appearances. At the edge of the area of periosteal elevation the new bone
forms a dense triangle called Codmans triangle.(C)
Multiple myeloma
Patients: Over 40.
Pathology: Multifocal proliferation of plasma cells of bone marrow.
Radiology: The bones are generally less dense with multiple small punched out lesions.
Ewing's Tumour
Patients: Under 30
Pathology: The lesion commences in the medulla and spreads through the nutrient.
Radiology: Usually shows destruction in the medulla and cortex and elevation of the cortex with an
onion cell appearance.
Patients Preparation:
In general and if possible, free access to the area to be examined is required, bandages, dressings
and splints should be removed, any doubts should be discussed with a medical or nurse practitioner
and advice taken in cases where the patient's safety may be compromised.
Basic psychological preparation with reassurance and explanation of technique.
Normal patient examination interview.
Equipment:
Medium powered X-Ray generator 40 -80 kW.
Ceiling suspended tube with good range of movements, especially vertical.
Fine focus X-Ray tube, preferably 0.3 mm focus.
Accessories:
Fine and standard/regular resolution, film speed screen combinations in an assortment of sizes.
Curved cassettes may be useful for some examinations.
Pads and immobilisation aids.
Basic Anatomy:
The basic anatomy of these regions will only be considered in terms line diagrams of the bones and
joints. Reference may be made to soft tissue structures of importance in certain circumstances.
Projections:
Upper limb,
AP shoulder survey,
AP shoulder joint examination,
AP Clavicle,
Infero superior shoulder,
Lateral scapula
AP & Lateral humerus.
AP & Lateral elbow
AP & Lateral wrist
DP & DP oblique hand
AP & Lateral thumb
AP & Lateral finger/s
Note: projections of limbs must include both medial and distal joints and be imaged with two
projections at 90°.
Film Sequence:
An appropriate sequence of projections should be determined to minimise patient discomfort and
maximise examination speed.
Additional Projections:
Modifications for 'plaster' immobilisation.
Shoulder:
Modified axial,
Trans thoracic head of humerus,
Elbow:
Radial head
Wrist:
Oblique,
Scaphoid projection series,
Carpal tunnel,
Macro carpal bones.
Hand:
"Ball catching" Norgard's projection.
Radiation Protection:
In addition to all normal good techniques for radiation protection.
Direct lead rubber gonad protection when the primary beam is directed towards the gonads.
7. Supracondylar fractures.
Lt Femur.
Left Foot,
Note projections of limbs must include both proximal and distal joints and be imaged with two
projections at 90°.
Film Sequence:
An appropriate sequence of projections should be determined to minimise patient discomfort and
maximise examination speed.
Additional Projections:
Knee:
Stress views for joint luxation
Intra condylar projections for loose bodies 90° and 110°.
Oblique projections of patella.
Axial 'Skyline' patella,
Soft tissue tibial tubercle projection.
Weight bearing joint projections.
Ankle:
Stress views for joint luxation
Lateral malleolus projection.
Axial Calcaneum.
Talo-caneal joint projections (10°-40° cranial angulations)
Oblique projections of the tarsal bones.
Foot:
Lateral
Weight bearing projections,
Sesamoid bone projections.
Patient Aftercare:
General psychological reassurance.
Check patient understands how to receive the results.
Replace any splints and dressings removed.
Ensure patient understands any preparation instructions are finished
Escort to changing rooms/waiting area and bid good-bye.
If any fractures or dislocations are discovered the patient's affected limb should be immobilised and
the patient referred for medical opinion, a trolley/wheelchair should be used to transport the patient
in safety due to the risks of delayed shock.