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Abstract
Learn to produce quality radiographs on the first try with Radiographic Image Analysis, 5th Edition. This updated, user-friendly text reflects the latest ARRT guidelines and revamped chapters to reflect the latest digital technology. Chapters walk you through the steps of how to carefully evaluate an image, how to identify the improper positioning or technique that caused a poor image, and how to correct the problem. For each procedure, there is a diagnostic-quality radiograph along with several examples of unacceptable radiographs, a complete list of radiographic evaluation guidelines, and detailed discussions on how each of the evaluation points is related to positioning and technique. It’s everything you need to critically think, evaluate, and ultimately produce the best possible diagnostic quality radiographs.
- Chapter objectives, key terms, and outlines reinforce what is most important in every chapter.
- Bold and defined key terms at first mention in the text ensure that you understand the terms from the start of when they are used in discussions.
- Expanded glossary serves as a quick reference and study tool.
- Two-color text design makes it easier to read and retain pertinent information.
- NEW! Updated content reflects the latest ARRT guidelines.
- NEW! Revamped sections on digital imagery within pediatric, obesity, and trauma situations incorporate the latest technology.
- NEW! Additional images offer further visual guidance to help you better critique and correct positioning errors.
- NEW! More robust digital halftones throughout images paint a clearer picture of proper technique.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | cover | ||
End Sheet 2 | IFC1 | ||
Radiographic Image Analysis | i | ||
Copyright Page | iv | ||
Dedication | v | ||
Reviewers | vi | ||
Preface | vii | ||
This Edition | vii | ||
Acknowledgments | viii | ||
Table Of Contents | ix | ||
1 Guidelines for Image Analysis | 1 | ||
Outline | 1 | ||
Objectives | 1 | ||
Key Terms | 1 | ||
Why Image Analysis? | 2 | ||
Terminology | 3 | ||
Characteristics of the Optimal Projection | 3 | ||
Image Analysis Process | 4 | ||
1. Demographic Requirements Are Visualized on the Projection | 6 | ||
2. Projection Is Accurately Displayed on the Workstation Screen | 6 | ||
3. Correct Marker Is Visualized on Projection and Demonstrates Accurate Placement | 8 | ||
4. Appropriate Collimation Practices Are Evident | 12 | ||
5. Relationships Between the Anatomic Structures Are Accurate for the Projection Demonstrated | 12 | ||
Steps for Repositioning the Patient and CR for Repeat Projections. | 28 | ||
6. Projection Demonstrates Maximum Spatial Resolution | 28 | ||
7. Radiation Protection Is Present on Projection When Indicated, and Good Radiation Protection Practices Are Used During the Procedure | 29 | ||
2 Visibility of Details | 38 | ||
Outline | 38 | ||
Objectives | 38 | ||
Key Terms | 38 | ||
Digital Radiography | 39 | ||
Image (Data) Acquisition | 39 | ||
Computed Radiography. | 39 | ||
Direct-Capture Digital Radiography. | 39 | ||
Histogram Construction | 39 | ||
Exposure Field Recognition | 40 | ||
Automatic Rescaling | 42 | ||
Exposure Indicators | 43 | ||
Histogram Analysis and Exposure Indicator Errors | 44 | ||
Quality Image (Resolution) | 49 | ||
Brightness and Density | 49 | ||
Radiographic Contrast and Gray Scale | 49 | ||
Subject Contrast | 50 | ||
Penetration | 51 | ||
Saturation | 53 | ||
Noise | 53 | ||
Scatter Radiation. | 53 | ||
Quantum Noise. | 54 | ||
Signal to Noise Ratio | 54 | ||
Contrast Resolution | 54 | ||
Bit Depth and Dynamic Range | 54 | ||
Exposure | 55 | ||
Other Exposure-Related Factors | 55 | ||
Grids. | 60 | ||
Source–Image Receptor Distance. | 60 | ||
Object–Image Receptor Distance. | 61 | ||
Collimation. | 61 | ||
Anode Heel Effect. | 61 | ||
Additive and Destructive Patient Conditions. | 64 | ||
Automatic Exposure Control. | 65 | ||
Postprocessing | 65 | ||
Windowing. | 65 | ||
Artifacts | 66 | ||
Postprocedure Requirements | 66 | ||
Defining Image Acceptability | 66 | ||
Special Imaging Situations | 67 | ||
Mobile and Trauma Imaging | 67 | ||
Guidelines for Aligning CR, Part, and IR. | 74 | ||
Lateral Projections. | 74 | ||
Oblique Projections. | 75 | ||
Alignment of CR and Part Versus CR and IR. | 75 | ||
Imaging Long Bones. | 76 | ||
Pediatric Imaging | 77 | ||
Technical Considerations. | 78 | ||
Clothing Artifacts. | 78 | ||
Obese Patient Imaging | 78 | ||
Technical Considerations. | 79 | ||
Scatter Radiation Control. | 79 | ||
Focal Spot Size. | 79 | ||
Automatic Exposure Control. | 79 | ||
3 Image Analysis of the Chest and Abdomen | 81 | ||
Outline | 81 | ||
Objectives | 81 | ||
Key Terms | 82 | ||
Image Analysis Guidelines | 82 | ||
Technical Data. | 82 | ||
Source-to-IR Distance. | 82 | ||
Vascular Lung Markings. | 82 | ||
Ventilated Patient. | 82 | ||
Lung Conditions Affecting Vascular Lung Marking Visualization | 82 | ||
Pneumothorax and Pneumectomy. | 82 | ||
Pleural Effusion. | 82 | ||
Free Intraperitoneal Air. | 83 | ||
Chest Devices, Tubes, Lines, and Catheters. | 83 | ||
Tracheostomy. | 84 | ||
Endotracheal Tube. | 85 | ||
Pleural Drainage Tube. | 86 | ||
Central Venous Catheter. | 87 | ||
Pulmonary Arterial Catheter (Swan-Ganz Catheter). | 87 | ||
Umbilical Artery Catheter. | 88 | ||
Umbilical Vein Catheter. | 88 | ||
Pacemaker. | 88 | ||
Automatic Implantable Cardioverter Defibrillator. | 88 | ||
External Monitoring Tubes and Lines. | 88 | ||
Chest: PA Projection | 89 | ||
Large Pendulous Breasts. | 89 | ||
Nipple Shadows. | 89 | ||
Singular Mastectomy. | 89 | ||
Augmentation Mammoplasty. | 91 | ||
Body Habitus and IR Placement. | 91 | ||
Chest Rotation. | 91 | ||
Distinguishing Scoliosis From Rotation. | 92 | ||
Clavicles. | 93 | ||
Scapulae. | 93 | ||
Anterior Midcoronal Plane Tilting. | 94 | ||
Posterior Midcoronal Plane Tilting. | 95 | ||
Lung Aeration. | 95 | ||
PA Chest Analysis Practice | 96 | ||
4 Image Analysis of the Upper Extremity | 160 | ||
Outline | 160 | ||
Objectives | 160 | ||
Key Terms | 161 | ||
Image Analysis Guidelines | 161 | ||
Technical Data. | 161 | ||
Finger: PA Projection | 161 | ||
Finger Rotation. | 161 | ||
External Finger Rotation. | 163 | ||
Internal Finger Rotation. | 163 | ||
Open IP and MCP Joint Spaces and Nonforeshortened Phalanges. | 163 | ||
Finger Alignment With CR. | 163 | ||
Positioning the Nonextendable Finger. | 163 | ||
PA Finger Analysis Practice | 164 | ||
Analysis. | 164 | ||
Correction. | 164 | ||
Analysis. | 165 | ||
Correction. | 165 | ||
Finger: PA Oblique Projection | 165 | ||
Insufficient Finger Rotation. | 165 | ||
Excessive Finger Rotation. | 165 | ||
Adjacent Finger Overlap. | 165 | ||
Open IP and MCP Joint Spaces and Nonforeshortened Phalanges. | 165 | ||
PA Oblique Finger Analysis Practice | 167 | ||
Analysis. | 168 | ||
Correction. | 168 | ||
Finger: Lateral Projection | 168 | ||
Adjacent Finger Overlap. | 168 | ||
Extending Fractured Finger. | 168 | ||
Inadequate Finger Rotation. | 170 | ||
Lateral Finger Analysis Practice | 170 | ||
5 Image Analysis of the Shoulder | 254 | ||
Outline | 254 | ||
Objectives | 254 | ||
Key Terms | 254 | ||
Image Analysis Guidelines | 255 | ||
Technical Data. | 255 | ||
Shoulder: AP Projection | 255 | ||
Supine Versus Upright. | 255 | ||
Torso Rotated Toward Affected Shoulder. | 256 | ||
Torso Rotated Away From Affected Shoulder. | 256 | ||
Upper Midcoronal Plane Tilted Anteriorly. | 256 | ||
Upper Midcoronal Plane Tilted Posteriorly. | 256 | ||
Kyphotic Patient. | 256 | ||
External Humerus Rotation. | 258 | ||
Internal Humerus Rotation. | 258 | ||
Identifying the Location of the Tubercles When Positioning. | 258 | ||
AP Shoulder Projections Taken to Demonstrate Lesser and Greater Tubercles. | 259 | ||
Excessive External Rotation. | 259 | ||
Proximal Humeral Fractures. | 260 | ||
Anterior Shoulder Dislocation. | 260 | ||
Posterior Shoulder Dislocation. | 260 | ||
AP Shoulder Analysis Practice | 261 | ||
6 Image Analysis of the Lower Extremity | 299 | ||
Outline | 299 | ||
Objectives | 299 | ||
Key Terms | 300 | ||
Image Analysis Guidelines | 300 | ||
Technical Data. | 300 | ||
Weight-Bearing Projections. | 300 | ||
Toe: AP Axial Projection | 300 | ||
Toe and Foot Rotation. | 300 | ||
Lateral Toe Rotation. | 301 | ||
Medial Toe Rotation. | 301 | ||
Open Joint Spaces and Unforeshortened Phalanges. | 301 | ||
Positioning for Nonextendable Toes. | 304 | ||
AP Axial Toe Analysis Practice | 304 | ||
Analysis. | 304 | ||
Correction. | 304 | ||
7 Image Analysis of the Hip and Pelvis | 427 | ||
Outline | 427 | ||
Objectives | 427 | ||
Key Terms | 427 | ||
Image Analysis Guidelines | 427 | ||
Technical Data. | 427 | ||
Pelvis: AP Projection | 427 | ||
Fat Planes. | 427 | ||
Differences Between Male and Female Pelves. | 428 | ||
Pelvis Rotation: LPO Position. | 430 | ||
Pelvis Rotation: RPO Position. | 430 | ||
External Leg Rotation. | 430 | ||
Insufficient Internal Leg Rotation. | 430 | ||
Proximal Femur or Femoral Neck Fracture. | 430 | ||
Hip Dislocation. | 431 | ||
Total Hip Replacement. | 431 | ||
Hip and Proximal Femur Orthopedic Apparatuses. | 431 | ||
AP Pelvis Analysis Practice | 432 | ||
Analysis. | 432 | ||
Correction. | 432 | ||
Pelvis: AP Frog-Leg Projection (Modified Cleaves Method) | 432 | ||
Pelvis Rotation: LPO Position. | 432 | ||
Pelvis Rotation: RPO Position. | 432 | ||
Lesser and Greater Trochanter Positioning. | 432 | ||
Insufficient Knee and Hip Flexion. | 432 | ||
Excessive Knee and Hip Flexion. | 432 | ||
Femoral Abduction. | 433 | ||
Insufficient Femoral Abduction. | 434 | ||
Excessive Femoral Abduction. | 434 | ||
Projections to Determine Hip Mobility. | 434 | ||
AP Frog-Leg Pelvis Analysis Practice | 436 | ||
Analysis. | 436 | ||
Correction. | 436 | ||
Hip: AP Projection | 436 | ||
Pelvis Rotated Toward Affected Hip. | 436 | ||
Pelvis Rotated Away From Affected Hip. | 436 | ||
External Leg Rotation. | 438 | ||
Insufficient Internal Leg Rotation. | 438 | ||
Proximal Femur or Femoral Neck Fracture. | 439 | ||
Hip Dislocation. | 439 | ||
Hip and Proximal Femur Orthopedic Apparatuses. | 439 | ||
Localizing the Femoral Head and Neck. | 439 | ||
AP Hip Analysis Practice | 441 | ||
8 Image Analysis of the Cervical and Thoracic Vertebrae | 456 | ||
Outline | 456 | ||
Objectives | 456 | ||
Key Terms | 457 | ||
Image Analysis Guidelines | 457 | ||
Technical Data. | 457 | ||
Cervical Vertebrae: AP Axial Projection | 457 | ||
Cervical Rotation. | 457 | ||
CR Alignment: Intervertebral Disk Space Openness. | 457 | ||
Upright Versus Supine Position. | 459 | ||
Kyphotic Patient. | 460 | ||
Insufficient Cephalic CR Angulation. | 460 | ||
Excessive Cephalic CR Angulation. | 460 | ||
Mandibular Mentum Superior to Occipital Base. | 461 | ||
Mandibular Mentum Inferior to Occipital Base. | 461 | ||
Cervical Column and Exposure Field Alignment. | 461 | ||
Cervical Trauma. | 461 | ||
AP Cervical Vertebrae Analysis Practice | 462 | ||
Analysis | 462 | ||
9 Image Analysis of the Lumbar Vertebrae, Sacrum, and Coccyx | 490 | ||
Outline | 490 | ||
Objectives | 490 | ||
Key TermS | 490 | ||
Image Analysis Guidelines | 491 | ||
Technical Data. | 491 | ||
Lumbar Vertebrae: AP Projection | 491 | ||
Psoas Muscle Demonstration. | 491 | ||
Rotation. | 492 | ||
Scoliotic Patient. | 492 | ||
Openness of Intervertebral Disk Spaces. | 493 | ||
AP Lumbar Analysis Practice | 495 | ||
Analysis. | 495 | ||
Correction. | 495 | ||
Lumbar Vertebrae: AP Oblique Projection (RPO and LPO Positions) | 495 | ||
AP or PA Projection. | 495 | ||
Scottie Dogs and Accurate Lumbar Obliquity. | 496 | ||
Insufficient Vertebral Obliquity. | 496 | ||
Excessive Vertebral Obliquity. | 496 | ||
AP Oblique Lumbar Analysis Practice | 497 | ||
Analysis. | 498 | ||
Correction. | 498 | ||
Lumbar Vertebrae: Lateral Projection | 498 | ||
Rotation. | 498 | ||
Openness of Intervertebral Disk Spaces. | 498 | ||
Scoliotic Patient. | 499 | ||
Flexion and Extension of Lumbar Vertebrae. | 500 | ||
Lumbar Vertebrae and IR Center Alignment. | 501 | ||
Supplementary Projection of the L5-S1 Lumbar Region. | 502 | ||
Gonadal Shielding. | 502 | ||
Lateral Lumbar Vertebrae Analysis Practice | 503 | ||
Analysis. | 503 | ||
Correction. | 503 | ||
L5-S1 Lumbosacral Junction: Lateral Projection | 503 | ||
Rotation. | 503 | ||
Openness of L5-SI Disk Space. | 504 | ||
Adjusting for the Sagging Vertebral Column. | 505 | ||
Lateral L5-S1 Analysis Practice | 505 | ||
Analysis. | 505 | ||
Correction. | 505 | ||
Sacrum | 505 | ||
Sacrum: AP Axial Projection | 505 | ||
Emptying Bladder and Rectum. | 505 | ||
Rotation. | 505 | ||
CR Angulation and Sacral Foreshortening. | 507 | ||
AP Sacrum Analysis Practice | 508 | ||
Analysis. | 508 | ||
Correction. | 508 | ||
Sacrum: Lateral Projection | 508 | ||
Rotation. | 508 | ||
Openness of L5-S1 Disk Space and Sacral Foreshortening. | 508 | ||
Lateral Sacrum Analysis Practice | 511 | ||
Analysis. | 511 | ||
Correction. | 511 | ||
Coccyx: AP Axial Projection | 511 | ||
Emptying Bladder and Rectum. | 511 | ||
Rotation. | 511 | ||
CR and Coccyx Alignment. | 513 | ||
AP Coccyx Analysis Practice | 513 | ||
Analysis. | 513 | ||
Correction. | 513 | ||
Coccyx: Lateral Projection | 513 | ||
Rotation. | 513 | ||
Coccyx Foreshortening. | 515 | ||
Collimation. | 515 | ||
10 Image Analysis of the Sternum and Ribs | 516 | ||
Outline | 516 | ||
Objectives | 516 | ||
Image Analysis Guidelines | 516 | ||
Technical Data. | 516 | ||
Sternum: PA Oblique Projection (RAO Position) | 516 | ||
Homogeneous Sternum Brightness and RAO Positioning. | 516 | ||
Excessive Chest and Sternum Obliquity. | 516 | ||
Insufficient Chest and Sternum Obliquity. | 518 | ||
Blurring Overlying Sternal Structures. | 519 | ||
Field Size. | 519 | ||
PA Oblique Sternum Projection Analysis Practice | 519 | ||
Analysis. | 519 | ||
Correction. | 519 | ||
Sternum: Lateral Projection | 519 | ||
Positioning for Homogeneous Brightness. | 519 | ||
Rotation. | 520 | ||
Kyphotic Patient. | 522 | ||
Ribs: AP or PA Projection (Above or Below Diaphragm) | 522 | ||
Soft Tissue Structures of Interest. | 522 | ||
Rib Marker. | 522 | ||
AP Versus PA Projection. | 522 | ||
AP Projection: Rotation. | 524 | ||
PA Projection: Rotation. | 525 | ||
Scoliotic Patient. | 525 | ||
Scapula Positioning. | 525 | ||
Above Diaphragm Ribs: Respiration. | 525 | ||
Below Diaphragm Ribs: Respiration. | 525 | ||
Bilateral AP/PA Projection. | 526 | ||
AP/PA Rib Projection Analysis Practice | 527 | ||
Analysis. | 527 | ||
Correction. | 527 | ||
Ribs: AP Oblique Projection (RPO and LPO Positions) | 527 | ||
Controlling Magnification. | 527 | ||
Chest Incorrectly Rotated. | 527 | ||
Insufficient Chest and Rib Obliquity. | 527 | ||
Excessive Chest Obliquity. | 527 | ||
AP/PA Oblique Rib Projection Analysis Practice | 530 | ||
11 Image Analysis of the Cranium | 531 | ||
Outline | 531 | ||
Objectives | 531 | ||
Key Terms | 531 | ||
Image Analysis Guidelines | 531 | ||
Technical Data. | 531 | ||
Cranial Positioning Landmarks. | 531 | ||
Cranium and Mandible: PA or AP Projection | 531 | ||
Cranium: Rotation. | 531 | ||
Mandible: Rotation. | 532 | ||
Cranium OML Alignment: Insufficient Chin Tucking. | 532 | ||
Cranium OML Alignment: Excessive Chin Tucking. | 534 | ||
Mandible OML Alignment: Insufficient Chin Tucking. | 535 | ||
Mandible OML Alignment: Excessive Chin Tucking. | 535 | ||
Positioning for Trauma. | 535 | ||
Trauma: Correcting for Poor CR and OML Alignment. | 536 | ||
Mandible: Jaw Positioning. | 537 | ||
Head Tilting and Midsagittal Plane Alignment. | 537 | ||
PA or AP Analysis Practice | 537 | ||
Analysis. | 537 | ||
Correction. | 537 | ||
12 Image Analysis of the Digestive System | 558 | ||
Outline | 558 | ||
Objectives | 558 | ||
Key Terms | 558 | ||
Image Analysis Guidelines | 558 | ||
Technical Data. | 558 | ||
Using the AEC for Double-Contrast Examinations. | 558 | ||
Pendulous Breasts. | 558 | ||
Peristaltic Activity and Exposure Times. | 559 | ||
Body Habitus Positioning Variations. | 559 | ||
Hypersthenic. | 559 | ||
Asthenic. | 560 | ||
Sthenic. | 560 | ||
Respiration. | 560 | ||
Esophagram: Upper GI System | 560 | ||
Esophagram Preparation. | 560 | ||
Stomach and Duodenum Preparation. | 561 | ||
Contrast Medium. | 561 | ||
Esophagram: PA Oblique Projection (RAO Position) | 562 | ||
Body Obliquity. | 562 | ||
Inaccurate Patient Rotation. | 562 | ||
Esophagram: Lateral Projection | 563 | ||
Rotation. | 563 | ||
Esophagram: PA Projection | 565 | ||
Rotation. | 565 | ||
Stomach and Duodenum | 567 | ||
Contrast Medium. | 567 | ||
Single Contrast. | 567 | ||
Double Contrast. | 567 | ||
Stomach and Duodenum: PA Oblique Projection (RAO Position) | 567 | ||
Patient Obliquity. | 567 | ||
Stomach and Duodenum: PA Projection | 569 | ||
Rotation. | 569 | ||
Stomach and Duodenum: Lateral Projection (Right Lateral Position) | 571 | ||
Rotation. | 571 | ||
Stomach and Duodenum: AP Oblique Projection (LPO Position) | 573 | ||
Patient Obliquity. | 573 | ||
Stomach and Duodenum: AP Projection | 575 | ||
Patient Obliquity. | 575 | ||
Rotation. | 575 | ||
Small Intestine | 575 | ||
Small Intestine Preparation. | 575 | ||
Contrast Medium. | 575 | ||
Variations in Positioning Procedure Because of Body Habitus. | 577 | ||
Supine Hypersthenic Patient. | 577 | ||
Supine Obese Patient. | 578 | ||
Small Intestine: PA Projection | 578 | ||
CR Centering for Early Versus Later Series Projections. | 578 | ||
Rotation. | 578 | ||
Large Intestine | 579 | ||
Large Intestine Preparation. | 579 | ||
Good Double-Contrast Lower Intestinal Filling. | 580 | ||
Barium Pools. | 581 | ||
Poor Double Contrast. | 581 | ||
Large Intestine: PA or AP Projection | 581 | ||
Rotation. | 581 | ||
PA Projection. | 582 | ||
AP Projection. | 583 | ||
Large Intestine (Rectum): Lateral Projection | 583 | ||
Rotation. | 583 | ||
Large Intestine: AP or PA Projection (Lateral Decubitus Position) | 585 | ||
IR Size and Direction for Hypersthenic and Obese Patients. | 585 | ||
Rotation. | 585 | ||
PA Decubitus Projection. | 585 | ||
AP Decubitus Projection. | 585 | ||
Large Intestine: PA Oblique Projection (RAO Position) | 587 | ||
Patient Obliquity. | 587 | ||
Detecting Inadequate Obliquity. | 587 | ||
Large Intestine: PA Oblique Projection (LAO Position) | 588 | ||
Patient Obliquity. | 588 | ||
Detecting Inadequate Obliquity. | 588 | ||
Large Intestine: PA Axial Projection and PA Axial Oblique Projection (RAO Position) | 589 | ||
PA Axial: Rotation. | 589 | ||
PA Axial Oblique Projection (RAO Position): Patient Obliquity. | 589 | ||
Detecting Inadequate Obliquity. | 589 | ||
CR Angulation. | 589 | ||
Detecting Inadequate CR Angulation. | 591 | ||
Bibliography | 592 | ||
Glossary | 593 | ||
Index | 599 | ||
A | 599 | ||
B | 601 | ||
C | 601 | ||
D | 602 | ||
E | 603 | ||
F | 603 | ||
G | 603 | ||
H | 604 | ||
I | 604 | ||
J | 605 | ||
K | 605 | ||
L | 605 | ||
M | 607 | ||
N | 607 | ||
O | 607 | ||
P | 607 | ||
Q | 608 | ||
R | 608 | ||
S | 609 | ||
T | 610 | ||
U | 610 | ||
V | 610 | ||
W | 610 | ||
X | 610 |