Radiographic Analysis

Radiological findings are the diagnostic mainstay in orthopedic surgery for most fractures. This technique allows visualizing the soft tissues around the fractures involving low energy, high energy, and pathological fractures in aged patients. X-ray findings make it possible to classify the fractures and initiate robust management such as reduction, immobilization, and stabilization. This article describes the radiographic pictures taken at different positions and projections and the associated structures and the rationale for requesting such radiographs.

Figure 1

Antero-posterior Ribs X-ray

(Murphy,2020)

The anteroposterior rib view is a projection used in the assessment of the posterior ribs. Unlike a standard chest x-ray, use lower kV and mAs in highlighting the bony structures in the area under investigation. While taking this radiograph, the patient is placed in an erect or supine position facing the x-ray tube, the posterior portion of the patient is resting on the detector. The patient's chin is raised to prevent inclusion in the image field; the hands are placed resting by the patient's side. The anteroposterior ribs view usually involves two projections: one supradiaphragmatic rib and the other two subdiaphragmatic ribs.

The technical factors while taking this radiograph includes an anteroposterior oblique projection. The ribs are placed above and below the diaphragm in a suspended inspiration manner. Centering points are located above the diagram about 10cm just below the jugular notch around the position of the midsagittal plane and the midway point between the xiphoid process of the sternum and the 12th rib below the diaphragm (Murphy,2020). Collimation is made at a place superior to the 1st rib, inferior to the detector, and lateral to the skin borders with the ribs suspended above the diagram. On the ribs below the diaphragm, the collimation is made superior to the 9th thoracic vertebra and inferior to the 12th rib just above the iliac crest of the hip bone. The orientation of this radiograph is a portrait to make it more adequate. The detector size dimensions used for this radiograph are 43cm by 35cm or 35cm by 43cm. The exposure that gives a clear image is 260-70kVp and 30-40mAs. The distance between the focal spot to the image receptor cassette is 100cm and a grid. The ideal CR is perpendicular to the long axis more than 5 degrees to prevent clavicle obstructing apices,

The anatomical structures visualized on this radiograph include posterior ribs, clavicle, supraclavicular joints, lungs, and the peritoneal space (Figure 1). Antero-posterior x-ray is indicated to demonstrate simple rib fractures that commonly lead to complications such as pneumothorax. In cases where pneumothorax or cardio-pulmonary infections are suspected, the chest x-ray would be most appropriate. Pregnancy and present medication regimen should be considered as precautions; lead masking of the gonads to prevent x-ray exposure is ideal. The AP projection produces less magnification on the ribs, providing more detailed bony structures than the PA view. High contrast or brightness do not significantly improve the image. Putting the patient in an erect or supine supported by the immobilization into oblique position produces a better shot.

Figure 2

Lateral cervical spine x-ray

(Lampignano et al., 2017)

When taking a cervical spine x-ray laterally, the patient is placed in an erect or supine position depending on the nature of the trauma or the patient's follow-up. The detector of the image is placed...…this imaging involves the lateral projection; the patient is in expiration to minimize the diaphragm from being superimposed on the lumbar spine. The centering point is at the level of the iliac crest of the hip bone, the coronal end directly on the lumbar spine corresponding to the posterior third of the abdomen. The central ray is positioned perpendicular to the image receptor. Collimation superiorly includes the T12 and L1 junction, inferiorly including the sacrum (McWilliam,2021). The anterior collimation consists of the vertebral bodies' anterior border, while the posterior is the elements of the posterior column and the spinous processes. Portrait orientation with a detector size of 35cm by 43cm is used, exposure of 70-80kVp and60-80mAs, SID of 110cm, and a grid selected based on the focus applied. Lead shielding should be done to mask the x-ray beam from reaching the gonads.

The anatomical structures visualized on this image include the sacrum, the body of T12, intervertebral disks, the crest of the ilium, lumbosacral segment, and intervertebral foramen (Figure 4). This x-ray is requested for trauma patients postoperatively and to diagnose chronic bone infections such as osteoarthritis. The adequacy of the radiograph is influenced by the visibility of the T12 and L1 junction to the L5 and S1 junction. In patients with spinal scoliosis, the side with the convexity is placed closest to the IR; this allows the utilization of the diverging beam to achieve the superimposition of both lower and upper endplates for better image quality. Visualization of the L4/L5/S1 junction may require a spot radiograph. Cases not requiring the demonstration of the sacral region, smaller cassettes of 30x35 may be used in a…