Radiographic Positioning and Quality Control of Thoracic, Abdominal, and Orthopedic Studies
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Title: Radiographic Positioning and Quality Control of Thoracic, Abdominal, and Orthopedic Studies Presented by: Amanda Breyette, LVT, BT, FFCP & Adam Isack, LVT, FFCP Description: Radiographs that are positioned correctly with proper technique give a better representation of anatomy and disease processes. This, in turn, gives the patient a better chance of being treated appropriately. Throughout this course, you will learn the anatomy to be included in each study, proper/improper technique, and how to correct misaligned radiographs.
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Radiographic Positioning and Quality Control of Thoracic, Abdominal, and Orthopedic Studies
- 1. HOW TO POSITION AND QC BASIC RADIOGRAPHIC STUDIES RADIOGRAPHIC POSITIONING …
- 2. WWW.UVSONLINE.COM Radiographs that are positioned correctly give a better representation of anatomy and disease processes. This in turn gives the patient a better chance of being treated appropriately. THE IMPORTANCE OF CORRECT POSITIONING 9/26/2023 RADIOGRAPHIC POSITIONING
- 3. WWW.UVSONLINE.COM Chemical restraint Dexmed - Antisedan Butorphanol Alfaxalone Acepromazine Midazolam Fentanyl Methadone Gas anesthesia POSITIONING AIDS IN RADIOLOGY 9/26/2023 RADIOGRAPHIC POSITIONING
- 4. WWW.UVSONLINE.COM DID YOU REMEMBER YOUR MARKERS? 9/26/2023 RADIOGRAPHIC POSITIONING
- 5. WWW.UVSONLINE.COM 3 Steps •Technique – how does it look? Black and white Grayscale Contrast •Positioning – Is it straight or lateral Inspiratory or Expiratory •Anatomy – Is it all there? QUALITY CONTROL 9/26/2023 RADIOGRAPHIC POSITIONING
- 6. WWW.UVSONLINE.COM Radiographic contrast is the density difference between neighboring regions on a plain radiograph. High radiographic contrast is observed in radiographs where density differences are notably distinguished (black to white). Low radiographic contrast is seen on radiographic images where adjacent regions have a low-density difference (black to grey). CONTRAST 9/26/2023 RADIOGRAPHIC POSITIONING
- 7. WWW.UVSONLINE.COM Image 1 Image 2 IMPORTANCE OF PROPER TECHNIQUE 9/26/2023 RADIOGRAPHIC POSITIONING
- 8. WWW.UVSONLINE.COM Image 1 Image 2 PROPER TECHNIQUE CONTINUED… 9/26/2023 RADIOGRAPHIC POSITIONING
- 9. WWW.UVSONLINE.COM As defined by the National Cancer Institute, scatter radiation is secondary radiation that spreads in different directions from a beam when that beam interacts with any substance, such as body tissue, a wall, or a table. SCATTER RADIATION 9/26/2023 RADIOGRAPHIC POSITIONING
- 10. WWW.UVSONLINE.COM Views Laterals (left and right), Ventrodorsal (VD), or Dorsoventral (DV) Center beam on the heart Cranial beam at manubrium Caudal beam at the level of T13 at the vertebral body Make sure the front limbs pulled cranially in front of the manubrium Anatomy Manubrium to caudal dorsal lung tip Include spinous processes Rib heads even at the level of the vertebral body. Spinous processes on ventrodorsal will look like tear drops or diamond shape. Large breeds may need more than one projection. Cranial and caudal Inspiration Caudal dorsal lung extends to T10 – T13 THORACIC RADIOGRAPHIC STUDY 9/26/2023 RADIOGRAPHIC POSITIONING
- 11. WWW.UVSONLINE.COM Lateral view Ventrodorsal (VD) view THORACIC RADIOGRAPHIC STUDY 9/26/2023 RADIOGRAPHIC POSITIONING
- 12. WWW.UVSONLINE.COM RADIOGRAPHIC POSITIONING 9/26/2023 Limbs pulled cranially Manubrium Cd Dorsal Lung
- 13. WWW.UVSONLINE.COM 9/26/2023 Lateral view - the rib heads even at the level of the vertebral body Dorsal view - the spinous process tear or diamond shaped. RADIOGRAPHIC POSITIONING
- 14. WWW.UVSONLINE.COM RADIOGRAPHIC POSITIONING 9/26/2023 Cd Dorsal Lung Spinous process Inspiratory diaphragm pulled away from the heart
- 15. WWW.UVSONLINE.COM Inspiration Exhalation THORACIC RADIOGRAPHS 9/26/2023 RADIOGRAPHIC POSITIONING
- 16. WWW.UVSONLINE.COM Abdominal radiographs are often used as a first-line screening test for possible intra-abdominal disease. High-quality, correctly positioned radiographs are required in order to provide as accurate an assessment as possible. An abdominal series containing no less than right lateral, left lateral, and ventrodorsal view is considered the standard of care in veterinary medicine. Following a consistent, repeatable pattern for obtaining abdominal radiographs ensures that the quality of the images should be considered diagnostic. Source: https://todaysveterinarypractice.com/small-animal- abdominal-radiography/ ABDOMINAL RADIOGRAPHS 9/26/2023 RADIOGRAPHIC POSITIONING
- 17. WWW.UVSONLINE.COM Lateral (2) and Ventrodorsal (VD) projections Cranial beam should include just cranial to the liver Caudal beam centered on greater trochanter Large breeds - need a cranial and a caudal projection for both lateral and ventrodorsal views 6 radiographs in total Urinary patients - caudal to greater trochanter to include urethra. Exposure - taken on Expiration Transverse processes of the lumbar spine super imposed – lateral Spinous processes on ventrodorsal will look like tear drops or diamond shape. ABDOMINAL RADIOGRAPHIC STUDY 9/26/2023 RADIOGRAPHIC POSITIONING
- 18. WWW.UVSONLINE.COM Lateral view (Cranial) Lateral view (Caudal) ABDOMINAL RADIOGRAPHIC STUDY 9/26/2023 RADIOGRAPHIC POSITIONING
- 19. WWW.UVSONLINE.COM Ventrodorsal (VD) view ABDOMINAL RADIOGRAPHIC STUDY 9/26/2023 RADIOGRAPHIC POSITIONING
- 21. WWW.UVSONLINE.COM 9/26/2023 Lateral view the transverse processes are superimposed. Dorsal view the spinous process will look like a tear drop or diamond shape. RADIOGRAPHIC POSITIONING
- 23. HOW TO POSITION AND QC BASIC RADIOGRAPHIC STUDIES 9/26/2023 RADIOGRAPHIC POSITIONING … RADIOGRAPHIC POSITIONING
- 27. WWW.UVSONLINE.COM Lateral Thorax 1. Great positioning a. All the anatomy is present. b. Legs are pulled out of thoracic cavity c. Laterality good and good inspiratory effort. VD Thorax 1. Positioning adequate a. All the anatomy is present b. Good inspiratory effort c. Patient is rotated with the sternum oblique to the left d. If patient is unsedated and uncooperative this is an acceptable option CASE ONE: LATERAL AND VD THORAX 9/26/2023 RADIOGRAPHIC POSITIONING
- 32. WWW.UVSONLINE.COM Lateral Abdomen 1. Poorly positioned a. all the anatomy is present b. rib heads oblique c. transverse processes oblique VD Abdomen 1. Positioned correctly (straight) a. All the anatomy is not present CASE TWO: LATERAL AND VD ABDOMEN 9/26/2023 RADIOGRAPHIC POSITIONING
- 33. WWW.UVSONLINE.COM RADIOGRAPHIC POSITIONING 9/26/2023 Oblique transverse processes Ribs oblique b c
- 34. WWW.UVSONLINE.COM RADIOGRAPHIC POSITIONING 9/26/2023 missing cranial liver
- 38. WWW.UVSONLINE.COM Lateral thorax 1. Positioned correctly a. All the anatomy is present b. Inspiratory c. Lateral VD thorax 1. Positioned correctly a. Spine is straight b. Inspiratory CASE 3: LATERAL AND VD THORAX 9/26/2023 RADIOGRAPHIC POSITIONING
- 42. WWW.UVSONLINE.COM Lateral Abdomen 1. Positioned correctly/adequately a. All the anatomy is present b. Expiratory c. Transverse processes not superimposed –but not off enough to repeat VD Abdomen 1. Positioned adequately a. Spine is straight b. Missing coxofemoral joints CASE 4: LATERAL AND VD ABDOMEN 9/26/2023 RADIOGRAPHIC POSITIONING
- 48. WWW.UVSONLINE.COM Lateral thorax 1. Positioned correctly a. All the anatomy is present b. Inspiratory c. Lateral VD thorax 1. Positioned correctly a. Spine is straight b. Inspiratory CASE 5: LATERAL AND VD THORAX 9/26/2023 RADIOGRAPHIC POSITIONING
- 52. WWW.UVSONLINE.COM Lateral abdomen 1. Positioned adequately a. All the anatomy is not present the coxofemoral joints are missing b. Lateral VD abdomen 1. Positioned adequately a. All the anatomy is present but the trough is within the body cavity b. Spine is straight. CASE 6: LATERAL AND VD ABDOMEN 9/26/2023 RADIOGRAPHIC POSITIONING
- 56. HOW TO POSITION AND QC ORTHOPEDIC STUDIES RADIOGRAPHIC POSITIONING …
- 57. WWW.UVSONLINE.COM 3 Steps •Technique – how does it look? Black and white Grayscale •Positioning – Is it straight or lateral •Anatomy – Is it all there? QUALITY CONTROL 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 58. WWW.UVSONLINE.COM Radiographs that are positioned correctly give a better representation of anatomy and disease processes. This in turn gives the patient a better chance of being treated appropriately. THE IMPORTANCE OF CORRECT POSITIONING 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 59. WWW.UVSONLINE.COM Chemical restraint Dexmed - Antisedan Butorphanol Alfaxalone Acepromazine Midazolam Fentanyl Methadone Gas anesthesia POSITIONING AIDS IN RADIOLOGY 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 60. WWW.UVSONLINE.COM DID YOU REMEMBER YOUR MARKERS? 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 61. WWW.UVSONLINE.COM Lateral and Ventrodorsal (VD) Lateral projection place cranial beam at the wing of the ilium and the caudal beam at ischium, and collimate to include the femurs. VD projection place the cranial beam at the wing of the ilium and caudal beam caudal to the stifle. Limbs separated on the lateral view. Transverse processes of the lumbar spine are superimposed. Obturator foramen even size on lateral and VD. Patellas are superimposed midway between the femoral condyles unless there is patellar luxation. PELVIC STUDY 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 62. WWW.UVSONLINE.COM PELVIS 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO) Lateral view VD view VD view (looking from the side)
- 67. WWW.UVSONLINE.COM Lateral and caudal cranial (CC) views Centered on the joint Include the proximal third of the tibia Include the distal third of the femur Condyles Superimposed on the lateral Evenly shaped on the CC view with the flabellas (if normal) bisected over each condyle Patella (if normal) lies between each condyle on the CC view unless there is patellar luxation STIFLE STUDY 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 68. WWW.UVSONLINE.COM 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO) STIFLE Lateral view Caudal cranial view
- 74. WWW.UVSONLINE.COM Lateral and Cranial Caudal (CC) views Condyles superimposed on lateral view Ulna straight in the Olecranon fossa on the cranial caudal view Five views Lateral, flexed lateral, supinated lateral, CC, and pronated CC ELBOW STUDY 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 79. HOW TO POSITION AND QC ORTHOPEDIC STUDIES RADIOGRAPHIC POSITIONING …
- 82. WWW.UVSONLINE.COM Lateral pelvis 1. Not positioned correctly a. Wings of the ilia not superimposed b. Transverse process of lumbar oblique c. Ischia oblique VD pelvis 1. Positioning is adequate a. Right obturator foramen more magnified and larger this is a result of the R side of the pelvis being further away from the detector. b. Note the L hip is subluxated. The pt more than likely cannot extend this limb. This projection would be acceptable due to this condition. CASE ONE: LATERAL AND VD PELVIS 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 86. WWW.UVSONLINE.COM Lateral elbow 1. Positioned correctly a. All of the anatomy is present. b. Condyles are superimposed. Cranial Caudal elbow 1. Positioned poorly a. All of the anatomy is present. b. Olecranon is obliqued medially. CASE TWO: LATERAL AND CC ELBOW 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 91. WWW.UVSONLINE.COM Lateral pelvis 1. Positioned correctly a. All the anatomy is present. b. Obturator foramen are even. c. Transverse processes are superimposed. VD pelvis 1. Positioned correctly a. Spine is straight. b. Obturator foramen are the same size. a. (Note) The “lines” are skin folds. CASE THREE: VD PELVIS 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 94. WWW.UVSONLINE.COM Lateral pelvis 1. Positioned correctly a. All the anatomy is present. b. Obturator foramen are even. c. Transverse processes are superimposed. VD pelvis 1. Positioned incorrectly a. Spine is straight. b. Obturator foramen are the same size. c. Distal femurs are rotated laterally. CASE FOUR: LATERAL AND VD PELVIS 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)
- 95. WWW.UVSONLINE.COM Incorrect: Femurs rotated Correct: Femurs centered CASE FOUR: LATERAL AND VD PELVIS 9/26/2023 RADIOGRAPHIC POSITIONING (ORTHO)