Correlating gross anatomy with Radiographic anatomy. Labelled anatomy diagrams and plain radiographs. Comprehensive skeletal radiographic anatomy lecture

1. CONVENTIONAL RADIOGRAPHY
Part 2
Lecture 5: SKELETAL RADIOGRAPHIC
ANATOMY
Nchanji Nkeh Keneth
kennchanji@yahoo.com/ nkeh92@gmail.com
662695118/671459765
B.TECH/HPD MDIRT
CHM Virtued Academy India(Ongoing)
LEADER
Radiology Department
St. Louis University, Mile 3 Nkwen Bamenda
Level 200 MDI, 2016/2017 Academic Year
5/31/2017 5-1NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt.
2016/2017 Academic Year

2. Out line of the presentation
• Radiographic anatomy of the skeleton, covering
all bones of the axial and appendicular skeleton
and the major joints and exam indications
• Selected commonly encountered pathologies of
the various parts
• Highlights on the major radiographic views
• Key points as regard image success criteria: use
of the PACEMAN rule
• Gross anatomy visualized vis-à-vis
Radiographic anatomy and special points of
interest5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt. 2016/2017
5-2

3. To be included in this lecture also:
• Plain radiographic anatomy of the chest
• Plain radiographic anatomy of the
abdominopelvic region
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-3

4. Expectations from the students at
the end of the lecture
• Students should be able to recognize and label
plain radiographs
• Identify and differentiate radiographs based
on the views
• Identify deviations from the normal
structures on the radiographs
• Be fully armed to handle the technical aspects
of Conventional Radiography
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-4

5. Part 1
THE SKULL
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-5

6. Recall
• The skull constitutes part of the axial skeletal
and of the dorsal body cavity
• It has 14 facial bones and 8 cranial bones
• There is only one moveable joint
• Protects the brain
• Has sinuses which serve as resonating
chambers and equally reduce the skull weight
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-6

7. Common pathologies
• Sinusitis
• Tumors
• Fractures
• Sinus polyps
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-7

8. Some indications for radiographic
exam of the skull
To rule out skull fracture post trauma
Severe headache
Suspected sinusitis
Sinus polyp evaluation
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-8

9. Common radiographic views are
• Water’s projection(blondeau)
• Schuler's projection
• AP views
• PA views
• Lateral views
• Submentovertex view
• Town’s Projection etc
5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-9

10. Gross anatomy vs. Radiographic Anatomy
5/31/2017
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Dpt. 2016/2017 Academic Year
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11. PA skull view
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-11
1 Frontal Bone
2 Superior Orbital Margin
3 Petrous Ridge
4 Maxillary Sinus
5 Ethmoid Air Cells
6 Nasal Cavity
7 Mastoid Process
8 Greater wing of sphenoid
9 Lesser wing of sphenoid
10 Frontal Sinuses
11 Parietal Bone
12 Coronal Sutre

12. exercise
Recall the labeled
parts!!!!
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NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-12

13. • 1 Lambdoid Sutre
• 2 Occipital Bone
• 3 Dorsum Sellae
• 4 Petrous Ridge
• 5 Superior
Semicircular Canals
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NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-13
SKULL HALF AXIAL
PROJECTION

14. GIVE ANSWERS
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-14

15. SKULL LATERAL
5/31/2017 NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt.
2016/2017 Academic Year
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16. 5/31/2017
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17. 5/31/2017 5-17
1. OUTER CORTICAL
LAYER
2. INNER CORTICAL
LAYER
3. DIPLOE
4. FRONTAL SINUS
5. ORBITAL PLATES
6. ANTERIOR CLINOID
PROCESS
7. PITUITARY FOSSA
8. POSTERIOR CLINOID
PROCESS
9. SPHENOID SINUS
10. PETROUS TEMPORAL
BONE
11. LAMDOID SURTURE
12. EXTERNAL OCCIPITAL
PROTRUBERANCE

18. GIVE THE ANSWERS
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Nkwen B'da, MDI Dpt. 2016/2017 Academic Year
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21. 5/31/2017 NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt.
2016/2017 Academic Year
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22. Isocentric Technique For AP SKULL
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year
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2016/2017 Academic Year
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29. 5/31/2017
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30. 5/31/2017 NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3
Nkwen B'da, MDI Dpt. 2016/2017 Academic Year
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31. PART 2
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-31

32. 5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-32

33. Recall
• Bones of the lower limbs constitute part of the
appendicular skeleton
• they are very essential for locomotion
• They form the human gait
• Major bones are long bones
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-33

34. Common pathological conditions
• Sprains
• Strains
• Fracture
• Arthritis
• Tumors
• Cysts
• Cellulitis
• Bony infarcts
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-34

35. Indications for radiographic exam
• To diagnose the cause of bone pain
• Rule out fracture
• Evaluate fractures post trauma
• Diagnose extent of dislocation
• Evaluate cystic lesions
• Evaluate bony tumours
• Evaluate developmental defects
• Evaluate rickets
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-35

36. Common projections are
• AP view
• Lateral view
• Oblique view
• and special radiographic views for the
sesamoid bones and the calcaneus
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-36

37. Radio anatomy vs. Gross anatomy
5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-37

38. 5/31/2017
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39. Radiographic evaluation of the foot
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-39

40. 5/31/2017
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41. 5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-41

42. Forefoot
• 1 Distal phalanx 1st Digit
• 2 Proximal phalanx
• 3 Sesamoid Bones
• 4 Metatarsal
• 5 Distal Interphalangeal
joint. 2nd digit
• 6 Proximal Interphalangeal
joint.3rd digit
• 7 Metatarsal phalangeal
joint.4th digit
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-42

43. 5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-43

44. • 1 Distal phalanx 1st. Digit
• 2 Proximal phalanx
• 3 Sesamoid Bones
• 4 Metatarsal
• 5 Middle phalanx 2nd digit
• 6 Base of 5th Metatarsal
• 7 Medial Cunieform
• 8 Intermediate Cunieform
• 9 Lateral Cunieform
• 10 Cuboid
• 11 Navicular
• 12 Calcaneum
• 13 Talus
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45. • 1 Distal phalanx 1st. Digit
• 2 Proximal phalanx
• 3 Sesamoid Bones
• 4 Metatarsal
• 5 Middle phalanx 2nd digit
• 6 Base of 5th Metatarsal
• 7 Medial Cunieform
• 8 Intermediate Cunieform
• 9 Lateral Cunieform
• 10 Cuboid
• 11 Navicular
• 12 Calcaneum
• 13 Talus
• 13 Medial Malleolus
• 13 Lateral Malleolus5/31/2017 5-45

46. 5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-46

47. Exercise
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2016/2017 Academic Year
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48. 5/31/2017
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2016/2017 Academic Year
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49. • 1 Distal phalanx 1st.
Digit
• 2 Proximal phalanx
• 3 Sesamoid Bones
• 4 Metatarsal
• 5 Middle phalanx 2nd
digit
• 6 Base of 5th Metatarsal
• 7 Medial Cunieform
• 8 Intermediate
Cunieform
• 9 Lateral Cunieform
• 10 Cuboid
• 11 Navicular
• 12 Calcaneum
• 13 Talus5/31/2017 5-49

50. 5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-50

51. • 1 calcaneus
• 2 Calcaneal Apophysis
• 3 Talus
• 4 Navicular
• 5 Cuboid
• 6 Cuneiforms
superimposed
• 7 Base of 5th Metatarsal
• 8 Sulcus Tali
5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-51

52. 5/31/2017
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53. • Self test
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-53

54. 5/31/2017
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55. 5/31/2017
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56. • 1 Tibia
• 2 Fibula
• 3 Medial Malleolus
• 4 Lat. Malleolus
• 5 Ankle jt
• 6 Inf. Tibiofibular jt
• 7 Posterior Malleolus
• 8 Talus
5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-56

57. • Test area
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58. 5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-58

59. • 1 Tibia
• 2 Fibula
• 3 Medial Malleolus
• 4 Lat. Malleolus
• 5 Ankle jt
• 6 Talus
• 7 Calcaneus
• 8 Navicular
• 9 Cuboid
• 10 Base of 5th.
Metatarsal
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-59

60. • 1 Calcaneus
• 2 Talus - Posterior
tubercle, may be separate
from talus - os trigonum
• 3 Talus
• 4 Navicular
• 5 Cuboid
• 6 Cuneiforms
superimposed
• 7 Base of 5th. Metatarsa
5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-60

61. Axial view of the calcaneus
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-61

62. • 1 Sustentaculum Tali
• 2 Posterial Talocalcaneal
joint
• 3 Anterial Talocalcaneal
joint
• 4 Lateral malleolus
• 5 Apophysis
5/31/2017
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-62

63. • Bohler’s angle (assessed on lateral)
measured by drawing a line from the
posterior aspect of the calcaneum to its
highest midpoint. The second line is
drawn from this point to the highest
anterior point. The angle normally is
between 30 – 40°.
• Sometimes the appearance of the
calcaneus can appear normal despite the
presence of a fracture.
• This is because of the form and shape of
the bone (compact outer bone
surrounding the cancellous inner bone) –
the thickness of the bone means that
fracture lines may not be visualised.
• Bohler’s angle can be measured to check
for abnormality
5/31/2017 5-63

64. To be cont next class…
The Leg
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-64

65. References
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Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-65