Normal Musculoskeletal Imaging

Prof. S. Sager, MPAS, PA-C

Normal Musculoskeletal Imaging

Upon satisfactory completion of this lecture, and in conjunction with textbooks, lecture handouts, WebCT, and recommended internet web sites, the student will be able to:• Recognize normal X - ray anatomy of

the skeletal system

X - Ray Basics: Radiopaque vs. Radiolucent

X - Ray basics:The four basic densities

Normal Bone Imaging

An X-Ray is a three dimensional summation of densities, seen as a two dimensional image

Normal Musculoskeletal Imaging

How to study radiographs

Be systematic. Compare densities. If in doubt, order a

contralateral view.

Is this an adult or child? What was the gender? What was the social

status?

Normal Musculoskeletal Imaging

Most common views:• anteroposterior (AP)• lateral (Lat)

An oblique view of the lumbar spine exposes the patient to 5 times as much radiation as the AP and lateral views.• “Do I really need this test?”

Normal Musculoskeletal Imaging

The Skull & Face

AP View

Frontal sinuses

Ethmoid sinuses

Orbital floor

Nasal septum

Maxillary sinuses

Skull(lateral view)

Maxillary sinuses

Frontal sinuses

Sella turcica

Nasopharyngeal airway

Face(lateral view)

Maxillary sinuses

Frontal sinuses

Sella turcica

Nasopharyngeal airway

Sphenoidal sinuses

Temporomandibular joint

Water’s view

Caldwell Projection

Nose (frontal) Nose (lateral) Zygomatic arch

Maxilla

Mandible

Sella Turcica (lateral view)

Base of the skull

CT head

Normal Musculoskeletal Imaging

The Spine

Normal Musculoskeletal Imaging

Normal Musculoskeletal Imaging

Cervical spine imaging

You must see all seven vertebrae

“Portable cross-table” is the most common initial X-ray taken in ED

Used to “clear” possible neck injuries

Cervical spine imaging

Thoracic spine imaging

Lumbar spine imaging

Normal Musculoskeletal Imaging

The Pelvis

Normal Musculoskeletal Imaging

The Chest & Ribs

Specifics of CXR assessment

Airway and adenopathy: • assess the airway, inspecting the trachea and mainstem bronchi and looking for

deviation or evidence of luminal obstruction• assess adenopathy (either peritracheal or hilar)

Bones and breast shadows: • inspect the bones for radiographic density, fractures, lytic lesions, or bony deformity• evaluate the breast shadows for gross symmetry, evidence of prior surgery, and any

gross calcifications

Cardiac silhouette: • assess the cardiac silhouette for general size and contour

Diaphgram: • assess the hemidiaphgrams with attention to the contour and costaphrenic angle

Everything else: • review everything else around the lung fields including the subcutaneous soft tissues

and pleural boundaries

Fields: • assess the lung fields themselves looking for evidence of infiltrate, mass, and pattern of

vascularity

Normal Musculoskeletal Imaging

Upper Extremity

Shoulder joint (A/P view)

Shoulder joint (Erect view)

Scapula (AP view)

Scapula (lateral view)

MRIShoulder

Upper arm (AP view)

Upper arm (lateral view)

Elbow Joint (AP view)

Elbow Joint (lateral view)

Forearm (AP view)

Forearm (lateral view)

Wrist (AP view)

Wrist (lateral view)

Hand (AP view)

Hand, Oblique view

Navicular (Scaphoid views)

Normal Musculoskeletal Imaging

Lower Extremity

Proximal femur

fovea capitis femoral neck greater

trochanter lesser

trochanter epiphyseal line intertrochanteri

c line

Hip (AP view)

Hip (lateral view)(Lauenstein’s view)

Femur (AP view)

Femur (lateral view)

Knee joint (AP view)

Knee Joint (lateral view)

Lower leg (AP view)

Lower leg (lateral view

Ankle Joint (AP view)

Ankle joint (lateral view)

Foot (AP view)

The X-ray in photo C belongs to which of the following patients?

0%

0%

0%

0%

0% 1. 2-year-old 2. 6-year-old3. 10-year-old4. 15-year-old5. 20-year-old

The arrow is pointing to which of the following structures?

0%

0%

0%

0%

0% 1. Scaphoid2. Talus3. Calcaneus4. Fibula5. Lateral malleolus

Thought for the day…

We can’t direct the wind…but we can adjust our sails!