Download Film

Mid Term Revision
• Radiological Imaging and Processing 1
Dr Mohamed El Safwany, MD.
RADIOLOGIST
ROLE
 Separate: Normal from Abnormal
 Characterize / Describe: Abnormality
 Determine:
 Suggest:
Extent (stage) of disease
Diagnosis / Differential
 Recommend: Further exams / follow-up
2
TOMOGRAPHIC IMAGES
ARE
IN A SPECIFIC PLANE
AXIAL
RT
CORONAL
SAGITTAL
RT
3
RADIOLOGY TOOLS
X- RAY
ULTRASOUND
NUCLEAR MEDICINE
MAGNETIC RESONANCE
COMPUTED TOMOGRAPHY
4
X - RAY --- FOUR BASIC DENSITIES
 Air
 Soft Tissue
 Fat
 Bone
5
AUTOMATIC PROCESSING
• TRANSPORTATION
SYSTEM
• DEVELOPER
• FIXER
• WASHER
• DRYER
• REPLENISHMENT
SYSTEM
Automatic Processor
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
Digital Image Printing
•
•
•
•
Dry processing – no chemistry
No darkroom
Less environmental impact
Reduce costs
I. Radiographic Terminology
• General Body Positions
– Supine
– Prone
– Erect (stand or sit)
– Recumbent
Lying down in any position
• Dorsal (supine)
• Ventral (prone)
• Lateral
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
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
II. Basic Imaging Principles
• Image Markers and Patient Identification
– Patient ID and Date
– Anatomic side marker
– Additional markers or Identification
III. Positioning Principles
• Positioning Sequences
– Traditional Radiography
Step1
Step2
Step3
Step4
PA Chest (Normal/ ambulance patients)
(Basic)
16
Lateral erect chest
(Basic)
17
LAO, RAO chest (heart)
(special)
18
• 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
• 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
PA Skull (0 Occipital-frontal) projection
B
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
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
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
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:
CP:
CR:
NB/
26
HD 18x24 cm
1.25 cm inferior to naison
90 to film center
A long narrow cone should be used.
Submentovertex (SMV)
S
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
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
28
CP:
At level of lower border of the orbits to exit at the acanthion.
CR:
90 horizontal to film center
Parietoacanthial (OM) (Open-Mouth Waters for sinuses )
S
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:
29
90 horizontal to film center
Thank You