Different Body Parts Radiographic Analysis

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 in a portrait position running parallel to the long axis to that of the cervical spine on the patient's left side. The patient is informed that the image is to be taken while in a suspended inspiration. Traction and lateral projection are used when obtaining this radiograph to visualize the T1 vertebra; this technique is only performed by qualified personnel. However, full expiration must be completed for the inferior shoulder displacement to bring T1 under visualization. In a case where T1 cannot be visualized, the swimmer's lateral projection is used (Lampignano et al., 2017). The x-ray image is obtained when there is a clear visualization of C1 -T1; the vertebral bodies, zygapophyseal joints, and articular pillars are laterally superimposed.

While taking a cervical spine x-ray, the technical factors involve lateral projection with the centering point about 2.5cm above the jugular notch, C4 level. Collimation is superior to C1 and inferior to the T1 vertebra; soft tissues are included anterior and posteriorly. The image orientation is a portrait with a detector size of 24cm by 30cm, exposure of 50-75kVp and 20-40mAs, SID of 150-180cm with a grid. Pregnancy and present medications should be considered as a precaution when taking the radiograph. This radiograph is indicated to visualize the pathologies of the cervical spine such as osteoarthritis and spondylitis, also commonly to trauma patients to demonstrate injuries to the soft tissues around the fractures. Anatomical structures visualized include the trachea, the vertebral bodies, soft tissues, atlas notches, articular pillars, and intervertebral disks (Figure 2).

Figure 3

Antero-posterior Thoracic spine x-ray

(He?man et al., 2021)

Thoracic spine radiograph in AP view allows for the visualization of the thoracic spine images consisting of the twelve thoracic vertebrae. The picture is taken when the patient is supine or erect. In non-trauma patients, the ideal image should be captured in an upright position to view the thoracic spine adequately. When injuries or spinal trauma is suspected, the picture is taken supine with limited movements with the hands. The technical factor includes arrested inspiration in which the diaphragm is pushed over the lumbar vertebrae. The centering points include the 7th vertebra level at the MSP, the central beam of rays projected perpendicular to the image receptor (He?man et al., 2021). Collimation superiorly consists of the C7 and T1 junction, inferiorly the junction of T1 and L1. The lateral collimation has right paraspinal and costotransverse joints.

Orientation of the image takes portrait with detector size of 35cm by 43cm, exposure of 70-80kVp, and 25-40mAs. The SID is 110cm with the correct grid selected based on the presence of a focus. Protecting sensitive body parts like the gonads to mask the x-ray beams, pregnancy, and medical history should be considered safety measures. The anatomical viewed under this radiograph includes the twelve thoracic vertebrae and part of cervical vertebrae, the clavicle, the first rib, the transverse processes, intervertebral disks, the 6th posterior rib, tracheal bifurcation, and the thoracic bodies. Thoracic spine AP x-ray is indicated in trauma patients to visualize the thoracic vertebral fractures and chronic osteogenic diseases postoperatively. The image also helps to visualize vertebral compression fractures and kyphosis or subluxation.

The image quality can be improved by adequate penetration and contrast to visualize the vertebral bodies and trabecular and cortical bones (Figure 3). When taking the image on a trauma patient on a trolley, the image receptor must be aligned to the central ray to exclude anatomical obstruction and gride cut-off. Comfort should be provided to the patient by providing a pillow under the knees when flexing the legs; this technique also reduces the spinal lordosis.

Figure 4

Lateral lumbar spine x-ray

(McWilliam,2021)

The lumbar spine lateral radiograph views the lumbar spine generally consisting of the five vertebrae and the lumbosacral segment. The patient is placed in a supine, erect, or lateral recumbent position depending on the clinical condition and history. When using lateral decubitus, the patient is positioned to extend the humeri about 90 degrees to the thorax, the elbows flexed, and the arms parallel to the thorax. In the AP projection, the spinal curvature determines if the right or left lateral projection is performed. The distal upper arms are excluded from overlying the region of interest when using the horizontal beam. The lateral decubitus position is achieved by asking the patient to cross or extend their arms over the thorax.

The technical factor for 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.