Radiography Structure and Roles

The Four Tier model in Radiography states there are four main roles within a Radiography Department since the Agenda for Change enforced pay-band changes (Employees were to be paid according to their skill and competence, rather than their professional status).

Assistant Practitioner - Undertakes specific roles under supervision from a registered professional

Practitioner - Undertakes a wide-range of tasks and has professional accountability, Continuously develops practice (CPD)

Advanced Practitioner - Autonomous in clinical practice within a defined field and defines scope of practice for others - CPD

Consultant Practitioner - Clinical, professional leadership through research, education and development in practice within a specific field. Partakes largely in Interprofessional Working as their role crosses over other's roles also (must partake in MultiDisciplinary Team Meetings), 50% of their time must be clinical practice - undertaking (and reporting of) procedures - CPD 

According to the Department of Health the Four Tier structure betters patient outcomes, develops career opportunities (such as Consultant Radiographers), develops workforce, retention of expertise and improves leadership. It improves Clinical governance (audits, protocols, CPD), patient pathway and national policies.

Although the Four Tier framework allows for clearly defined roles, Constultant Practioners must overlap roles and work together in order to provide a more efficient, patient focussed NHS. 

We must all go the extra mile. Just put in that little bit more time and make someone else's life easier. You never know when you'll need their help.

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User Involvement

User involvement has become a fundamental aspect since the Health and Social Care Act stated NHS reformation due to the Francis, Keogh and Berwick Reports. The NHS constitution states the rights of the patient, what the NHS promises to provide and what patients should expect from the NHS.

"The NHS belongs to us all" - The NHS consitution

User involvement ensures this is the case.

It improves patient care, experience and outcomes alongsidge hospital services, accountability, partnership between patients and providers. Users include Patients, Relatives, Carers, Friends and representatives.

There are several forms of involvement:

• Informal - through comments and suggestions
• Formal - Surveys, PALS, Service User groups, Patient representation on hospital committees.
• Statutory - Complaints to Trusts, involvement on Healthwatch England or Foundation Trust Governors boards

User Involvement gives service users a voice; it gives value to the patient's opinion to implement change within the NHS. Patient Led Assessment of Clinical Environment allows for the fact that often, hospitals and it's staff can become blind to problem areas, whereas service users have the ability to see areas which could be improved for the sake of both patients and staff. It allows for openness and transparency - user involvement can be used as a platform to promote ideas, complaints and response.

"Expert Patients" can be involved on the CQC inspection boards which regulate the quality of care provided by hospitals. Patients can be involved in the design and delivery of services and influence change within services for a better, safer NHS.

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Structure and services of the NHS

The structure of the NHS is so that service users are at the centre of everything we do.

There's the Governmental sections:

Department of Health - Creators of policies, legislation, law 

Parliament - Passes these laws

The Non-Departmental and Regulatory Bodies:

NHS England - Set out from the Health and Social Care Act'12

 runs the day-to-day life of the NHS including finances and budgeting

 Care Quality Commission - Regulate all NHS services through inspection 

to ensure they meet protocol, law and legislation 

 Monitor - Regulate all Foundation Trusts through inspection

 to ensure they meet protocol, law and legislation

 Health Research Authorities - Regulates research within the NHS to protect patients,

 ensures evidence based practice.

The National Organisations: 

Clinical Commissioning Groups - Commission Any Qualified Provider 

for patients to choose their care from.

HealthCare Professions Council - Provide protected-title registration for

 Healthcare Professionals who meet their standards.
Healthwatch England - Local health groups which raise awareness
of patient's concerns to the CQC 

The Local Services:

Primary Care providers - Provide prevention, advice and

 initial treatment (GP's, Dentists)

Secondary Care providers - Provide acute treatment (Emergency Departments)

Tertiary Care providers - Provide care for chronic illnesses (Oncology departments)

Finally, the most important:

Service Users - Patients, Carers, Family and Friends.

The White Paper'10

The NHS has committed to constantly improving it's services to provide the best care possible, best value and better efficiency. The White Paper (2010) set out the NHS to become more efficient and less bureaucratic. The White Paper changed Primary Care Trusts to Clinical Commissioning Groups of general practice, who are responsible for choosing and buying health services from AQP's. £80 billion of the NHS budget will be held by GP's (who need to be trained in financial and managerial aspects of commissioning). CCG's allow for more user involvement when planning service delivery and allow the patients to have a better choice of care. Also, by allowing healthcare services to be commissioned away from the NHS, it increases motivation within departments to be better, so that the patient would choose their service.

The Patient Advice and Liaison Service (PALS)

PALS provides general advice to patients about their care, but also is platform for patients to raise concerns and complaints about the care they have received. Every hospital must have a PALS department, and must advertise it's existence and encourage it's usage. 

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Leadership within the NHS

Lack of leadership within the NHS has been highlighted in reports such as the Francis, Keogh and Berwick.

Well established chains of command, structure and management is important within a healthcare organisation, however, individual leadership of all staff members is also vital to establishing a well-motivated and efficient National Health Service. 

The difference between management and leaders? We're all called to be leaders.

Managers administer and maintain previously existing views and is very much focussed on the system and control, with a short term view. They ask the questions such as "How?" and "When?"

Leaders innovate and develop ideas whilst inspiring trust; they're more people focused and look to the long-term. They ask questions such as "What?" and "Why?"

Organisational culture, the shared attitudes and values of an organisation and it's members, gives the NHS, it's departments and hospitals, a sense of identity. By individuals having leadership qualities, they can aim to affect the management style which is effective to the group, the organisation's decision making processes and it's determinants of success. 

Previously, the NHS was focused on:

• The needs of the business
• Functional aspects of care
• Efficiency, productivity and clinical outcome
• There was no emphasis on feedback
• Management (not staff) empowerment

Transactional leadership was the main method of organisation. This involved emphasis on the chain of command, authority and obedience to such, target meeting and based on a reward/punishment scheme. 

However, since 2011, the aim is to be:

• Patient focussed (with user involvement in planning of pathways and service provision)
• Relational and emotional aspects of care 
• Staff experience and empowerment
• Integrated care
• Better feedback handling
• Better information sharing

By the NHS being supporting leadership within the NHS, they are empowering staff to become more proactive, innovative and involved. This moves the NHS towards Transformational leadership, this is where a leader adopts and expresses the whole group's goals and values, it enables us to advance one-another in best practice, it allows for intellectual stimulation with greater emphasis on Continuous Professional Development and takes into account each individual's needs. Transformational leaders become influential through respect instead of necessity, they inspire motivation through a clear vision.

Professional Autonomy teaches us to challenge and question, to implement change and audit the effectiveness of our practice. This increases higher standards and gives each individual a voice -thereby bringing a cudltral change. This change is represented through the Healthcare Leadership Model  

This model brings leadership through a change in care, by sharing the vision of the NHS and integrating our services with better communication and information sharing. 

We're accountable to our actions as Healthcare professionals - so why not make those actions make a difference?

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Interprofessional Learning

Interprofessional learning, where several groups of healthcare professionals join together to improve the service of care they provide, is essential for the NHS to break down barriers between professionals. Protectiveness and territorialism amongst the NHS reduces patient care and outcome, staff moral and efficiency as people just won't communicate.

"The application of principles of adult learning to interactive, group-based learning, which relates collaborative learning to collaborative practice within a coherent rationale which is informed by understanding of interpersonal, group, organisational and inter-organisational relations and processes of professionalism" - Barr (2001)

Aims:

• To improve knowledge of the service
• Learn how to better patient care and safety
• Improve patient pathway
• Integrate systems better
• Improve communication and collaboration

How?

Within universities, training days and qualification attainment IPL has greatly impacted interprofessional working outcomes. Modules, lectures and seminars are catered not to specific departments, but for the overall healthcare profession, which creates one universal understanding of what is expected from everyon -this improves set standards for protocol and legislation which everyone adheres to.

Why?

Patients deserve to know that their care is being provided by the best-qualified people for the job, as part of registration, communication and IPW is a fundamental aspect of a healthcare professional's role.

The NHS constitution (2009) has core principles which state:

• To provide a comprehensive service to all
• Access is based on clinical need not financial ability
• Patient centred care and involvement when planning services
• Interprofessional Working
• Accountability

QIPP (Quality, Innovation, Productivity and Prevention) developed by the Department of Health drives to improve quality of care and can reduce £20 billion expenditure by 2015. This can be accomplished by improving how organisations are run, staffed and supplied (and commissioning of these services). To improve how organisations are run, there must be a Organisational Culture which focuses on improving patient care, information sharing and communication between departments and primary and secondary care givers (GP's, Hospitals).

Cases of neglect and mistreatment within the NHS (such as that at Winterbourne View care home, Mid-Staffordshire Foundation Trust and seen through the Keogh and Berwick reports) could have been prevented if professions communicated better; IPL and IPW can prevent neglect like that seen within these cases from ever happening again. IPW can increase the acceptance of whistle-blowing within the NHS - if unacceptable practice is seen, through having better ties between departments, it becomes easier to be able to raise concerns about other's practices. 

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Clinical Imaging

There are 3 main goals of Diagnostic Radiography:

• Production of images of dianostic quality to determine the existence of a pathology determining the correct treatment and care for the patient
• Dose is to be minimised as much as possible (As Low As Reasonably Achievable) to prevent the ionising radiation causing stochastic and nonstochastic effects on a patient.
• Patient/staff safety in regards to positioning and infection control 

The X-ray source needs to produce a uniform beam in terms of their kV (energy) set by the radiographer. kV causes the amount of contrast on the image; due to the penetration through the object (patient).. mAs causes the Blackening of the X-rays due to image density. The X-ray beam attenuates after being distributed, it is either absorbed or scattered, once interacting with matter the properties of the beam alter and the object becomes magnified or distorted.

When electrons are produced from a cathode (the source of electrons - made of a filament and a focusing cup) they are then accelerated through thermionic emission towards the anode target usually made of tungsten (melting point of 3410 degrees), as it approaches the target it is suddenly decelerated by braking radiation and produces an x-ray photon. X-rays should come from a point source, should be controllable and safe.

Typically we want X-rays to come out at a point source to reduce penumbra (fuzziness of xrays) this is created by a small anode angle (17degrees) but this then produces the Anode heel effect. This effect states that as the x-ray photons come closer to the anode angle (C) there is less intensity as it is parallel to the anode and the inverse square law. This says that the further away the object is from the anode, the more diverse the x-rays become therefore more penumbra is produced.

Fine focus produces less penumbra and a more detailed X-ray image, due to the source being smaller this is used when geometric factors limit image quality and this reduces tube loading. Broad focus is used when less detail is needed (Abdominal X-ray) but dose produce more penumbra (Figure H) This image is limited by patient attenuation,there is higher tube loading and more heat dissipation.

Fine Focus

Broad Focus

The use of filters can reduce X-ray dose by removing the low kV X-rays, filters typically are made of aluminium and low penetrating X-rays are 'absorbed' by the aluminium.

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The Thorax

When looking at a chest X-ray it is important to remember that we are not only looking at the thorax but everything inside it too; the lungs, their markings and anatomy, the heart, boney anatomy (sternum, ribs) and soft tissue anatomy (liver). It is also important to remember that inspiration/expiration on taking a radiograph will have an affect on the appearance of it.

The Respiratory System

We should be able to see the apex/base of the lungs, the trachea and bification of such, the bronchi and the Hilum (the point at which the bronchi, blood vessels, nerves diverge from. Held together by pleura and connective tissue)

Lung markings are due to blood vessels and are important as absence of such can indicate pneumothorax and more prominent markings indicate other pathologies.

The Bronchial Tree - commences at the bification of the trachea (upper border of T5). The Right main bronchus is wider, shorter and more vertical than the left one, this means any foreign bodies may lodge in this one. The left Bronchus passes behind the arch of the aorta and in front of the oseophagus. The bronchi within  each lobe of the lung divide into smaller branches and lobules.

The right lung is separated into three lobes (Superior, medial and inferior lobe) whereas the left is only in two (<5% of people have an extra azygos lobe) Oblique (bottom) fissures and transverse (top) fissures seperate these lobes, fissures are infolding of pleural membrane which protect each lung (alongside the parietal pleura layer) These membranes contain a lubricating fluid (serous fluid) which reduces friction in respiration.  Each lung is further divided into bronchopulmonary segments composed of lobules which are wrapped in elastic connective tissue (Alveoli, Nerves, Lympathic vessels, branches of pulmonary and bronchiole arteries and terminal bronchiole).

The Heart

The heart lay inside the Mediastinum - a collection of tissues between the lungs, it is a broad partition medial to the lungs and extending from sternum and includes all contents of thoracic cavity (minus lungs).

Superior Mediastinum contains Arch of aorta
Anterior Mediastinum contains Right main pulmonary artery, left atrium, left atrial border, inferior vena cava and the right ventricle.
Middle Mediastinum contains Birfurcation of trachea and the main bronchi.
Posterior Mediastinum contains Thoracic part of decending aorta, Oesophagus, thoracic duct and lymph glands.

The ventricles of the heart have difference cardiac muscle thickness depending on how much pressure is generated (the left which supplies the whole body has a much thicker wall). Atria have comparatively little muscle wall as the pressure is a lot less there.

There are two coronary arteries which branch from the ascending aorta: the left divides into ventricular and circumflex branches. The anterior interventricular branch is in the anterior interventricular sulcus and supplies oxygenated blood to the walls of both ventricles. The circumflex lies in the coronary sulcus and distributes oxygenated blood to the walls of the left ventricle and atrium.

The right coronary artery supplies small branches to the right atrium and continues inferiorly to the right auricle dividing into posterior interventricular and marginal branches. The posterior interventricular branch supplies the walls of the two ventricles and septum with oxygenated blood. The marginal branch in the coronary sulcus transports oxygenated blood to the myocardium of the right ventricle.  

The Oseophagus

Extends from the laryngopharynx through mediastinum, diaphragm and to the superior portion of the stomach.

Composed of 4 layers 

1. Outer areolar layer (elastic fibres - attaches it to surrounding structures)
2. Muscular coat (muscle fibres - enables swallowing)
3. Submucous coat (loose areolar tissue - contains vessels, nerves and muscous glands)
4. Inner mucous coat (stratified squamous epithelium - folded rugae when empty)

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Muscoskeletal system

JOINTS

There are several types of joints:

Fibrous

These joints are fixed and move minimal amounts.

Sutures are dense fibrous connective tissue found in the skull of babies and are the 'soft spots' on their head. In older age these sutures ossify and become fixed (synostosis). The irregular interlocking edges allow for additional strength and minimise possible fractures.

Gomphosis joints (GUMphosis) bind teeth into their bony sockets of the maxillary and mandible. The connection between tooth and socket is called the periodontal ligament.

Syndesmoses joints are found between the articulated surfaces of the tibia and fibula, made up of considerably more fibrous connective tissue than sutures and are united by interosseous ligaments.

Cartilaginous (symphysis and synchondrosis)

Cartilaginous joints have no joint cavity and are held together between cartilage, they allow more movement than in the fibrous joints but less so than synovial.

Symphysis joints such as the pubis symphysis and the external vertebral bodies are made up of broad fibrocartilage

Synchondrosis joints are made up of hyaline cartilage and can be found in epiphyseal plates, found between the first rib and the sternum. 

Synovial joints

1. Ball and socket 2. Ellipsoid joint 3. Saddle joint 4. Hinge Joint 5. Pivot Joint

These joints have a joint cavity and are subclassified by their movements, they are also usually accompanied by accessory ligaments which allow two bones of different shapes to tightly fit and stablizes the joint. Inside the joint cavity it contains synovial joint fluid which reduces friction (similar to bursae) it also supplies nutrients and removes metabolic waste and waste formed from wear and tear of cartilage by phagocytes. The articular capsule has two layers; fibrous outter layer and articulated inner layer (formed by synovial membrane). The fibrous layer allows for movement and its tensile strength reduces changes of injury and dislocation. 

Ball and socket moves on three planes; rotation, flexion/extension and abduction/adduction.

Hinge joints such as the knee consist of a convex bone surface fitting into a concave bone surface and usually only flex/extend

Saddle joints such as the first carpo-metacarpal joint consist of a saddle shaped articular surface and a concave/complex opposing surface. Flexion/extention, Abduction/Adduction and Circumduction.

Gliding joints such as the patellofemural are flat articulated surfaces which are restricted by ligaments so can only move side to side and back and forth.

Pivot joints can be found in the radioulnar which allow full rotation: pronation and supination.

Ellipsoidal (condyloid) joints such as the wrist joint allow two plane movement (flexion/extention, cirumduction, adduction/abduction)

Hyaline cartilage is a pearly white cartilage which is found at the ends of bones and in your ears and nose, trachea, bronchi and parts of the larynx. It provides smooth surfaces for joints to move without friction, it has a high tensile strength and is avascular so is supplied by surrounding synovial fluid.

Bursaes are fluid filled connective tissue (similar fluid to synovial fluid) which reduce friction in areas of high movement such as the knee joint.

Tendons and Ligaments

A tough band of connective tissue made of collagen fibres, they usually connect muscle to bone at periosteum; very strong and pliable. Tendons do not move at all but ligaments do to accommodate for joint movement. Tendons are inclosed by sheaths to allow them to move back and forward without friction.

 

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How to take X-rays

Upper Limb

Antero-Posterior Shoulder

Keep patient in anatomical position (Neutral with hand facing X-ray tube, or arm is in a sling then hand facing the ceiling) with back against the X-ray board

Centering point: 2.5cm inferior to coracoid process

Collimation:

Superiorly: Outer Skin Margins

Inferiorly: Angle of Scapula

Medially: End of clavicle

Laterally: Outer Skin Margins

• Broad Focus
• 100cm Distance
• No Grid/Bucky

For Osteoarthritis you should turn the patient 20 degrees laterally to better visualise the glenoid joint

70kV 6mAs

Axial Shoulder

Sit the patient on a chair next to the X-ray bed with the affected arm closest to the bed. Put a cassette on the bed underneath the patient's armpit and extend the patient's arm as far away from their body as they can manage. 

Centering point: Glenoid Cavity

Collimation:

Superiorly: Boarder of ribs

Inferiorly: Distal 3rd of Humerous

Medially: Outer Skin Margins

Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

70kV/6mAs

AP Elbow

The Humerous needs to be flat against the film.

Centering point: In Crease of Elbow - Condyles of humerous
Collimation:
Superiorly: Distant 1/3 humerous
Inferiorly: Proximal 1/3 radius and ulna
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

62kV 4mAs

Lateral elbow

Humerous needs to be at the same level as shoulder, 90 degrees to ulna and need to point the thumb to the sky.

Centering point: Funny bone (Olecranon) 4cm medial to this

Collimation:

Superiorly: Distant 1/3 humerous

Inferiorly: Proximal 1/3 radius and ulna

Medially: Soft Skin Margins

Laterally: Soft Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 6mAs

AP (PA) Wrist

Centering point: Midway between radial and ulna styloid process
Collimation:
Superiorly: Metacarples
Inferiorly: Distal 1/3 radius and ulna
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

62kV 4mAs

Lateral Wrist

Radius and Ulna need to overlap and the thumb needs to point upwards

Centering point: Radus and ulna styloid process
Collimation:
Superiorly: Metacarples
Inferiorly: Distal 1/3 radius and ulna
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

64kV 4mAs

Dorso Parma Hand

Hand down needs to be flat down
Centering point: Head of 3rd Metacarple
Collimation:
Superiorly: Outer Skin Margins
Inferiorly: Wrist Joint
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 2.5mAs

Oblique Hand

Angle to beam, Get patient to make the O shape with finger and thumb and curve fingers round

Centering point: Head of 3rd Metacarple

Collimation:

Superiorly: Outer Skin Margins

Inferiorly: Wrist Joint

Medially: Outer Skin Margins

Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 3mAs

Lateral Hand

The Lower Limb

AP Hip

Centering point: Anterior Superiour Illiac Spine (ASIS) midway between synthesis pubis, 4cm inferior.

Collimation:

Superiorly: ASIS

Inferiorly: Some Femur

Medially: 1/2 synthesis

Laterally: Outer Skin Margins

• Broad Focus
• 100cm Distance
• Grid and Bucky

75kV 12mAs

AP Knee

Centering point: 2.5 inferior to patella
Collimation:
Superiorly: Distal 1/3 femur
Inferiorly: Proximal 1/3 Tibia and Fibula
Medially:Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 5mAs

Lateral Knee

Centering point: 2.5cm distal to femural condile (will be superimposed)
Collimation:
Superiorly: Distal 1/3 femur
Inferiorly: Proximal 1/3 Tibia and Fibula
Medially:Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

65kV 8mAs

AP Ankle

Put your pen to the heel 1/2 section when internally rotating the foot, the heel base should be 2/3rds down the film in line with pen
Centering point: Midway of malioli
Collimation:
Superiorly: Distal 1/3 Tibia and Fibula
Inferiorly: Outer Skin Margins
Medially: Base of 5th metatarsal
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

65kV 4mAs

Lateral Ankle

Maliolli needs to be superimposed


Centering point: Medial maliolus
Collimation:
Superiorly: Distal 1/3 Tibia and Fibula
Inferiorly: Half metatarsals
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

65kV 4mAs

DP Foot

Centering point: Base of 3rd metatarsal
Collimation:
Superiorly: Toes Outer Skin Margins
Inferiorly: Outer Skin Margins
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 3mAs

Oblique Foot

Turned medially


Centering point: Base of 3rd metatarsal
Collimation:
Superiorly: Toes Outer Skin Margins
Inferiorly: Outer Skin Margins
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 3mAs




Appendicular Skeleton

PA Chest

Cassette needs to be landscape, distance is higher to reduce magnification of the heart. Angle towards the feet (cordally) to avoid scatter to the eyes and thyroid but not too much (5-10 degrees) as this can result in an elongated chest. To push scapula out of the lung view roll the patient's shoulders forward
On Inspiration

Centering point: T7 - same level as inferior angle of scapula
Collimation:
Superiorly: Just above the shoulders - include the apices of lungs
Inferiorly: Costophrenic angles
Medially: None
Laterally: Outter margins of chest wall

Broad Focus
180cm
No Grid or Bucky

90kV 2-3mAs

AP abdomen

MUST check for pregnancy! 28 day rule and 10 day rule.
On expiration

Centering point: Illiac crest, top of pelvis to the midline (belly button usually)

Collimation:
Superiorly: Diaphram for kidneys
Inferiorly: Synthesis pubis
Medially: None
Laterally: Walls of abdomen

Broad focus
100cm
Grid and Bucky

80kV 25mAs
75kV 15mAs

AP pelvis

To be done landscape. Toes should point inwards in order to see the greater trocanters clearly. Must have gonad shield.

Centering point: Anterior Superior Illiac Spine (ASIS) 5cm distal to this and to the midline.

Collimation:
Superiorly: illiac Crest
Inferiorly: Proximal femur
Medially: None
Laterally: Outter Skin Margins

Broad focus
100cm
Grid and Bucky

80kV 12mAs

AP Cervical Spine

Chin should be parallel to the floor so that the Mandible and Occiput are superimposed angle cranially 15 degrees


Centering point: C4 level of thyroid cartilage

Collimation:
Superiorly: External Auditory Meatus
Inferiorly: T1
Medially: None
Laterally: Outter Skin Margins

Broad focus
100cm
Grid and Bucky

75kV 15mAs

Lateral Cervical Spine

Centering point: 2.5cm inferior and posterior to the angle of the manible

Collimation:

Superiorly: External Auditory Meatus

Inferiorly: T1

Medially: None

Laterally: Outer Skin Margins

Broad Focus

180cm

No Grid/Bucky

75kVp 28mAs

AP Thoracic Spine

Centering point: 18-21cm below jugular notch/inferior angle of the scapula

Collimation:

Superiorly: C7

Inferiorly: L7

Medially: Anterior boarder of Vertebral bodies

Laterally: Spinous processes

Broad Focus

100cm 

Bucky

80kV 48mAs

Lateral Thoracic Spine

Centering point: 18-21cm below jugular notch/inferior angle of the scapula

Collimation:

Superiorly: C7

Inferiorly: L7

Medially: Anterior boarder of Vertebral bodies

Laterally: Spinous processes

Broad Focus

100cm 

Bucky

80kV 48mAs

AP Lumbar Spine

On Expiration

Centering point: In between Iliac Crest and Lower Costal margins

Collimation:

Superiorly: T12

Inferiorly: Sacrum

Medially: Sacroilliac joints

Laterally: Sacroilliac joints

Broad focus

100cm

Bucky

80kV 15mAs

Lateral Lumbar Spine

Centering Point: Level of iliac crest

Collimation:

Superiorly: T12

Inferiorly: Sacrum

Medially: Anterior boarder of the vertebral bodies

Laterally: Spinous processes

Broad focus

100cm

Bucky

80kV 15mAs

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The Basics

BONE:

Properties:

• Highly Vascular
• Connective Tissue
• Strong
• Durable
• Light
• Dynamic

Functions:

• Support
• Movement
• Protection
• Mineral Storage
• Haemopoesis 
• Energy Storage

Composition:

• Organic - Collagen Fibres which provides resistance and resilience
• Inorganic - Hydroxyapite crystals for strength 

Classification:

• Trabecular Bone - Trabeculae is orientated so stress is evenly beared
• Cortical Bone -Various thickness

Long Bones:

Humerous, Radius, Ulna, Femur, Tibia, Fibula, Metacarpals and Metatarsals. 

• Distribute stress evenly 
• Slightly curved
• Trabecula at epiphysis 
• Cortical throughout shaft

Short Bones:

Carpals and Tarsals

• Cube Shaped
• Trabecula 
• Thin layer of Cortical

Flat Bones:

Cranial Bones, Sternum, Ribs and Scapula

• Protection/attachment
• Trabecula
• Thin layer of Cortical

Irregular Bones:

Vertebrae and some facial bones

• Varying ratios of Cortical to Trabecular

Sesamoid Bones:

Bipartite Patella and Pistiform

• Found inside tendon where it passes over a joint

Bone Surface Markings:

Trocanter, Tuberosity and Tubercle

• Transmit nerves and vessels
• Sulcus, Foramen, Fissure

Ossification

The process by which connective tissue is replaced by bone.

Intramembranous Ossification:

Skull bones

• Occurs in loose connective tissue membranes

Endochondrial Ossifcation:

Long Bones

• Formation occurs in hyaline models
• Perichondral cells differentiate into Osteoblasts
• Occurs in long bones at 8th week of intrauterine life

Epiphysal plate:

Real People Have Careers

Vertically:

Resting

Proliferating

Hypertrophic

Calcified 

Horizontally:

Periosteal cells differentiate into osteoblast which surround themselves in bone matrix

Normal Variants

Sesamoid, Cervical rib, Spina Bifida Occulta, Idiopathic Scoliosis

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