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X-ray Examination of the Elbow


Radiographic study of the elbow will best demonstrate the elbow joint. Elbow joint includes the proximal radioulnar joints and the distal humerus which is articulated to radius and ulnar. The three joints are Examined in radiography and provide a technician guide while positioning. Elbow x-ray is also provide an image of the proximal radius and ulna, and the distal humerus.

Basic Projections on Elbow
AP Projection
AP Obliques
Lateral View


What is Trauma?

Trauma is defined as any physical damage to the body caused by a sudden, unexpected, dramatic, forceful, violent or accident event or fracture etc. In medical field trauma is known as “Physical Injuries”. The greek word “trauma” literally means “wound”. Trauma is the leading cause of death in the United States for persons of 1 to 34 years old. Suicide and homicide related cases are excluded in this statistic. Trauma, homicide and suicide rank 1st, 2nd and 3rd, respectively, as the leading causes of death in ages 15 to 24. Emergency medical care often is the difference between life and death when intentional and unintentional injuries occurs.

Common Radiography Trauma:

Blunt Trauma - a condition resulted from a blunt force from a mechanism and the surface of the skin remains intact. Examples are: Motor Vehicular Accidents (MVA), Collisions with pedestrians, falls, and aggravated assault.
Penetrating Trauma - a condition or injury in which the skin is pierced by an object and reaches in tissue of the body, resulted an open wound. Examples are: Gunshot wound, stab wounds, impalement injuries, and foreign body ingestion or aspiration.
trauma radiography
Trauma Radiography
Explosive Trauma - it is also known as “blast injury”, this injury are caused by a direct or indirect exposure to an explosion and several mechanisms, including pressure shock wave, high velocity projectiles, and Burns. Burns may be caused by a number of agents including fire, steam and hot water, chemicals, electricity, and frostile.

Best Practices in Trauma Patients

A routine position is necessary to achieve the right radiographic images of the anatomy of interest. But radiography of the trauma patient is seldom allows the use of routine position and projections. Because these traumatized patient requires special attention to patient care techniques, while radiologic technologist performing difficult radiographic imaging procedures. Enumerated below are Technician’s best practices and provided with some universal guidelines for the trauma radiographer.

Speed - Trauma technician must take a quality radiograph in the shortest period of time. Performing Quick or rapid diagnostic examination is critical to saving the patients life.
Accuracy - Technician must provide an accurate images with a minimal amount of distortion and the maximum amount of recorded detail. Also, the central ray, the part, and the image receptor must be accurately placed and aligned it is also applies in trauma radiology. The use of shortest exposure time is important to minimize possibility of imaging involuntary and uncontrollable motion.
Quality - The quality of a radiograph does not have to sacrifice to produce an image quickly. The patient’s condition is not an excuse for a careless positioning and not providing more high quality radiographic images.
Positioning - Careful precaution for a trauma radiographer must be taken to ensure the performance of the radiographic imaging technique does not worsen the patient condition or injuries. The two projections at the right angles from one another ( the “golden rule” of technicians) still applies. As often as possible, move the tube and IR, rather than the patient, to obtain the desired projections.
Practice Standard Precautions - Blood and body fluids should be expected scene in trauma radiography. Gloves, mask, and gown must be properly worn by the technician. Protect the IR and sponges from body fluids by placing it on a nonporous plastic before an xray exam and keep all equipment and accessory devices clean and ready for use. Wash hand frequently, especially between patients.
Immobilization - Never remove any immobilization device without physician’s order. Provide proper immobilization and support to increase patient comfort and minimize risk of motion.
Anticipation - Anticipating required special projections or diagnostic procedure for certain injuries makes the radiographer a vital part of the emergency room (ER) team. Ex. If patients requiring an xray of the chest. Fractures of the pelvis is often require a cystogram to determine the status of the urinary bladder. Being preferred to perform these examination quickly and understanding the necessity of these additional images instills confidence in, and creates an appreciation for, the role of the radiologic technologist in the emergency setting.
Attention to Detail - When performing an imaging procedure never leave the trauma patient or any patient unattended because the patient condition may change at any time, and its the radiographer’s responsibility to note these changes and report them immediately to the attending physician. During film processing, an eye contact with your patients is impossible, call for help. Someone must be with the trauma patient at all times.
Attention to Department Protocol and Scope of Practice - Radiographer must know the department protocols and practice only within your competence and abilities. This scope of practice for radiologic technicians varies from state to state and country by country. Understand and study the scope of your role in the emergency setting. Do not provide or offer a patient anything by mouth. Always ask the attending physician before giving the patient anything to eat or drink no matter how persistent the patient may be.
Professionalism - Ethical conduct and professionalism in all situations and with every person is a requirement of all health care professionals, but the conditions encountered in the emergency room can particularly complicated. Adhere to Code of Ethics for Radiologic Technologist and the Practice Standards. Be aware of the people present or nearby at all times when discussing a patient’s care. The ER radiologic technician is exposed to a myriad of tragic conditions. Emotional reactions are common and expected, but must be controlled until the emergency care of the patient is complete.

Common Traumatic Conditions

Hypovolemic or hemorrhagic shock
Is a medical condition where there are abnormally low levels of blood plasma in the body, in this such situation, the body is unable to properly maintain blood pressure, cardiac output of blood and normal amounts of fluid in the most common type of shock in trauma patients.

Symptoms of Hypovolemic or Hemorrhagic Shock

  • Diaphoresis,
  • Cool and dammy skin
  • Decrease in venous pressure
  • Decrease in urine output
  • Thirst
  • Altered state of consciousness

Vasovagal Reactions

Is also called a vasovagal attack or situational syncope, as well as vasovagal syncope. It is a reflex of the involuntary nevous system or a normal physiologic response to emotional stress.

Symptoms of Vasovagal Attack

  • The patient may complain of nausea
  • Feeling Flush (warm feeling)
  • Feeling Lightheaded
  • They may appear pale before they lose consciousness for several seconds.

Cerebrovascular Accident CVA

is commonly known and called a stroke and may be caused by thrombosis, embolism or hemorrhage in the vessels of the brain

Drugs and Alchohol

Patients under the influence of drugs and or alchohol are common patients in the ER. In this situation, the usual symptoms of shock and head injury are unreliable. Be on guard for aggressive physical behaviors and abusive language.

Hyperglycemia

is also commonly known as diabetic ketaacidosis. The cause is increased blood sugar levels. The patient may exhibit any combination of symptoms noted, and will have fruity-smelling breath.

Pelvic Fracture

it has a high mortality rate of all open fractures and are as high as 50%. Hemorrhage and shock are very often associated with this type of injury. Emergency cystograms are often ordered on patients with known pelvic fractures.

Abdominal Radiography

Abdomen Basic Anatomy

The digestive system consist of the alimentarty tract and certain organs that contribute to the digestive process. The teeth is the most important accessory organs of the digestive systems in radiology, because it use to masticate the food. Furthermore, salivary glands has also an important role in masticating by secreting fluid that helps soften the food. As the food swallowed the liver and pancreas secretes an especial digestive juices into the small intestine.

What is Peritoneum?

The peritoneum is an abdominopelvic cavity that is enclosed in a doulble-walled seromenbranous sac. There are two sac in the peritoneum. The outer sac which is in the outer surface called the parietal peritoneum, and it is close in contact with the abdominal wall. And the vinceral peritoneum that is positioned around the contained organs and forms a fold called the mesentery and omenta, which supports the viscera in position. There is a space in between the two layers of the peritoneum that called peritoneal cavity and contains serous fluid. These two are not attach and pelvic surgery is possible without entering in the peritoneal cavity. Retroperitoneum Cavity It is the cavity behind the peritoneum, Kidneys and panceas are located in the retroperitoum.

Radiographic Examinations of Abdomen:




These Projection are frequently performed in the United States and Canada. Students should be competently knowledgeable with these projections.

Routine Preliminary Preparations:
In radiology, investigating the abdominal viscera, preliminary preparation of the intestinal tract is essential. These preparations are the combination of Laxative, controlled diet also known as the Nothing per Orum (NPO), and enemas are done to a non severe conditions. Although majority of the patients who is referred for the abdominal examination are well enough to undergo these routine preparation. These routine preliminary preparation is never administered to patients who are acutely ill or have the condition such as visceral rupture or intestinal obstruction or perforation. As for these patients, referring physician is consulted as to the presumptive diagnosis, and the procedure is varied as needed.

Exposure Technique Tips for an Abdominal Radiography:

Plain abdominal examination, without the use of contrast media, it is imperative to obtain maximum soft tissue diffentiation of radiograph throughout the different regions of the abdomen. Because abdomen has a wide range in the thickness and delicate diffenrence in physical density between the contained viscera, radiologic technologist must select for a more critical exposure factors than the normal to demonstrate the diffenrece in density between an opacified organ and the structures near to it. Radiograph with moderate gray tones and less black and white contrast is needed. If the kilovolt-peak (kVp) is too high, demonstrating small or semiopaque gallstones may not be visualized. The criteria for an optimal quality abdominal radiograph is when outlines of the psoas muscles, the lower border of the liver, the kidneys, ribs, and the tranvese processes of the lumbar vertebrae are sharply defined.
abdominal radiograph
Proper Abdominal Radiograph

Controlling Motion: Voluntary and Involuntary

The primary requirements to achieve good radiographic images of the abdomen is to eliminate motion both voluntary and involuntary. Voluntary motion produces a blurred outline of the structures, that do not have involuntary movements, such as the liver, psoas muscles and the spine. Involuntary motion in the abdomen like the peristalsis, may produce either a localized or generalized haziness radiographic image. Meanwhile, Contraction of the abdominal wall or the muscles around the spine may cause movement of the whole abdominal area and create a generalized radiographic haziness. These can be minimized or eliminated by the following steps:
  • Place the patient in a comfortable position so that he or she is relax, this will prevent the contraction of the muscle that caused by tenseness of patients.
  • Breathing procedure must be explained to patient, and make sure he or she understand exactly what is expected.
  • Compression band may be use if needed, for immobilization but not compression.
  • When making the exposure, do not trigger the exposure 1 to 2 seconds after the suspension of respiration to allow the patient to come to rest and the involuntary movement of the viscera is subsided.

Angiogram with Computed Tomogram

Computed Tomographic Angiography (CTA) is more safe than conventional angiography for radiographic studies of blood vessels.A combination of CT scanning together with injection of contrast medium into peripheral vien, in this technique we will be able to
CT angiography
SOMATOM DefinitionAS40 By: Siemens
visualize the blood flow in arterial and venous structures througthout the body. The Computerize Tomography CT captures different image data and manipulated and analyzed by the computerized radiographic techniques from one or two planes, into a complex computer reconstruction in 3 dimentional, popularly known as the 3D CT Images. Obviously, CT scan machine emits ionizing radiation, this should be not forgoten when considering the use of this radiologic technology.

Magnetic Resonance Angiogram

Angiography

Magnetic Resonance Angiography (MRA)  is  the  MRI examination of vascularity, and it is also general the use to describe magnetic resonance imaging of the vascular structures. Instead of arterial MR, Magenetic resonance examination of the veins is termed as Magnetic Rsonance Venography (MRV). Speaking of technical capability of this machine, MRA is most suitable for evaluation of large and medium size vessels such as the thoracic aorta and major aortic branch vessels or the larger caliber central veins. Theoritically, Pulmonary MR angiography has the ability to replace the conventional angiography and  eliminate its associated risk in its upcoming developments. Moreover, MRA has a unique ability to provide cross-sectional and projectional images of of the vascular system in their expected orientations and optimal display formats without the use of contrast media. MRA also has a capability of simultaneous demonstration of vascular anatomy of interest, which can facilitate planning of surgical procedure accurately and providing a 3 dimentional anatomic interralationships of the structures.

What is Angiography?

Angiography is a radiographic examination of blood vessels, commonly use by medical physician to study and investigate a suspected abnormalities in arterial and venous systems. An enhancing agent, usually iodinated contrast media is use, this medium absorb xray then blood vessels, veins,
arteries including its lumen and the heart chambers can be visualize radiographically. A thin flexible catheter is then inserted in femoral artery or brachial artery for administration of contrast solution. Fluoroscopy, CT scan and MRI machines is the equipment use, as these machine is design to produced an analogous time lapse images and emit rapid sets of xray for fluoroscopy and CT scan machine.

Angiography Procedure:

3d brain angiography
3D Cerebral Angiogram
Conventional angiographic procedure may last up to 1 to 3 hours. Patient need to stay at the hospital for about 3-6 hours depending of what catheter and closure used. Concious sedation or local anesthesia is given before the procedure. Accessing to the arterial and venous system of the head it is administered commonly safely though the femoral artery in inguinal part, found in hip area. fluoroscopy is maneuvered by a technician to view the exact location of catheter when inserting upto the cervical vessels upto the cervical vessels. Likewise, Realtime radiographic footage are viewed while contrast media is injected to the arterial and venous system with the supervision of Radiologist.
Afterwards, when catheter is removed, apply hemostatic patch on  puncture site, compress manually and the leg held straight for up to 3 - 6 hours to allow the artery to heal sufficiently. Patients are always seen by their referring physician prior to discharge. Patient are restricted to exercise for 10 days and avoiding swimming for 5 days. In some cases, if bleeding occur patients are instructed to go to have someone to apply direct pressure to the site and go to the nearest hospital.

Why Angiography?

Diagnostic Angiography or arteriography is the most accurate and relatively safe procedure to diagnose aneurysms, arteriovenous malformations, carotid stenosis and many other disease of veins or vessels, like embolism. Although its safe, every patients undergo angiography, they must be aware of the risk and and other negative occurances, on the time and after angiogram, that will may possibly occur. To do well, it can be done by giving a full explanation to them before they undergo the procedure.

cerebral angiography
Cerebral Angiogram

What is Angiogram?

Angiogram is the the images produced by angiographic procedure, this also known as the angiograph. Arteriography and venograph is also use in other countries and department synonymously. Traditional Fluoroscopic Angiography or Digital Subtructed Angiography, angiogram is latently developed in an usual xray film, while in latest CT scan and MRI machines, latent images can be easily constructed in Rotational 3D and 4D images. In addition, Highly sophisticated computers are combined together with these equipments and an automated software is installed to compute binary bits to construct the xray data sense by the detectors and become a viewable and realtime images viewed on a monitor screen.