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Xray ortho

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Xray ortho

  1. 1. XRAY ORTHO
  2. 2. POST GRADUATE SEMINAR TOPIC:- SPECIAL RADIOLOGICAL VIEWS IN ORTHOPAEDICS. ULTRASOUND. RADIO-ISOTOPIC BONE SCAN. PRESENTER- MODERATOR- DR. BAHARUL ISLAM CHOUDHURY DR. P. TAHBILDAR PGT PROFF & HOD.
  3. 3. INTRODUCTION X-rays is produced by firing electrons at high speed onto a rotating anode. The resulting beam of x-rays is attenuated by the patient’s soft tissue & bones casting shadows which are displaced as images. The more dense the tissue, the greater the x-rays attenuation & therefore the more white the image that is captured.
  4. 4. BODY PLANES > SAGITTAL > CORONAL > HORIZONTAL > OBLIQUE
  5. 5. POSITION
  6. 6. POSITION
  7. 7. PROJECTION B
  8. 8. PROJECTION
  9. 9. SHOULDER AP PROJECTION- ON NEUTRAL ROTATION- The post. Part of supraspinatous insertion which sometimes profile small calcific deposits.
  10. 10. SHOULDER AP PROJECTION- ON EXTERNAL ROTATION- The GT , the site of insertion of supraspinatous tendon are visualized.
  11. 11. SHOULDER AP PROJECTION – ON INTERNAL ROTATION- The proximal humerus in true lateral position , Site of insertion of subscapular tendon.
  12. 12. SHOULDER INFERO-SUPERIOR AXIAL PROJECTION- When chronic instability of shoulder is suspected. Bony abnormality of the ant. Inf. Glenoid rim. Hill- Sach defect of post-lat humeral head.
  13. 13. SHOULDER AP AXIAL PROJECTION- Useful in diagnosing post. Dislocation.
  14. 14. SHOULDER SCAPULAR Y VIEW ( PA OBLIQUE PROJECTION)- Useful in suspected shoulder dislocation.
  15. 15. SHOULDER AP OBLIQUE PROJECTION-( GRASHEY METHOD) Joint space between humeral head & glenoid cavity .
  16. 16. SHOULDER AP OBLIQUE PROJECTION ( APPLE METHOD)- Demonstrate the loss of articular cartilage.
  17. 17. SHOULDER AP AXIAL PROJECTION ( STRYKER NOTCH METHOD)- Defects on the post-lat head of the humerus.
  18. 18. SHOULDER TANGENTIAL PROJECTION-( NEER METHOD)- Demonstrate coraco-acromial arch or outlet to diagnose shoulder impingement.
  19. 19. ACROMIO-CLAVICULAR JOINT AP AXIAL PROJECTION ( ALEXANDER METHOD)- Useful in suspected AC subluxation or dislocation.
  20. 20. CLAVICLE AP AXIAL PROJECTION ( LORDOTIC POSITION)-
  21. 21. SCAPULA AP PROJECTION-
  22. 22. SCAPULA PA OBLIQUE PROJECTION-
  23. 23. SCAPULA AP AXIAL PROJECTION – To visualize coracoid process clearly.
  24. 24. ELBOW AP OBLIQUE PROJECTION ( ON MEDIAL ROTATION)- Coronoid process free of superimposition
  25. 25. ELBOW AP OBLIQUE PROJECTION ( ON LATERAL ROTATION) Radial head & neck free of superimposition.
  26. 26. ELBOW AP PROJECTION ( ACUTE FLEXION)- Demonstrate olecranon process clearly
  27. 27. ELBOW PA AXIAL PROJECTION-
  28. 28. ELBOW AXIOLATERAL PROJECTION- Demonstrate the pathological process or trauma in the area of radial head & coronoid process.
  29. 29. WRIST PA OBLIQUE PROJECTION- Gives distinct radiograph of trapezium & scaphoid.
  30. 30. WRIST AP OBLIQUE PROJECTION- Separates the pisiform from adjacent carpal bones.
  31. 31. WRIST PA PROJECTION (ON RADIAL & ULNAR DEVIATION)- Opens the interspaces between the carpals.
  32. 32. WRIST PA AXIAL PROJECTION FOR SCAPHOID ( STECHER METHOD)-
  33. 33. WRIST TANGENTIAL INFERO SUPERIOR PROJECTION- Demonstrate the carpal canal.
  34. 34. HAND PA OBLIQUE PROJECTION-
  35. 35. HAND AP OBLIQUE PROJECTION ( BALL – CATCHER POSITION)- Significant in making the diagnosis of RA.
  36. 36. PELVIS & HIP AP PROJECTION ( 15-20 deg internal rotation)-
  37. 37. PELVIS & HIP AP OBLIQUE ( FROG LEG) PROJECTION- ( CLEAVES METHOD)
  38. 38. PELVIS & HIP MEDIO LATERAL PROJECTION- ( LAUENSTEIN & HICKY METHOD)-
  39. 39. PELVIS & HIP AXIOLATERAL PROJECTION- ( DANELIUS- MILLER METHOD)-
  40. 40. PELVIS & HIP PA AXIAL OBLIQUE PROJECTION- ( TEUFEL METHOD)- Image shows the fovea capitis & supero post wall of acetabulum.
  41. 41. PELVIS & HIP AP AXIAL OUTLET PROJECTION- ( TAYLOR METHOD)- Superior & inf. Pubic rami without foreshortened.
  42. 42. PELVIS & HIP AP & PA OBLIQUE PROJECTION- Resulting image shows entire ilium
  43. 43. KNEE PA AXIAL PROJECTION- (HOLMBLAD METHOD)
  44. 44. KNEE AP AXIAL PROJECTION- ( BECLERE METHOD)
  45. 45. KNEE TANGENTIAL PROJECTION- (HUGHSTON METHOD)-
  46. 46. KNEE TANGENTIAL PROJECTION- ( MERCHANT METHOD)-
  47. 47. ANKLE AP OBLIQUE ( ON MEDIAL ROTATION)-
  48. 48. SUBTALAR JOINT AP AXIAL OBLIQUE PROJECTION-
  49. 49. CALCANEUS AXIAL PROJECTION ( PLANTO DORSAL)-
  50. 50. CALCANEUS AXIAL PROJECTION ( DORSO PLANTAR)-
  51. 51. FOOT AP OBLIQUE PROJECTION ON MEDIAL & LATERAL ROTATION
  52. 52. FOOT AP AXIAL PROJECTION
  53. 53. FOOT TANGENTIAL PROJECTION-
  54. 54. CHEST AP PROJECTION-
  55. 55. CHEST AP & PA OBLIQUE PROJECTION-
  56. 56. CERVICAL VERTEBRA AP PROJECTION ( OPEN MOUTH)-
  57. 57. CERVICAL VERTEBRA AP AXIAL PROJECTION-
  58. 58. CERVICAL VERTEBRA AP AXIAL OBLIQUE PROJECTION- The image shows the intervertebral foramina & pedicles.
  59. 59. LUMBO-SACRAL VERTEBRA AP & PA AXIAL PROJECTION- ( FERGUSON METHOD)- L-S joint & S-I joint free of superimposition.
  60. 60. ULTRASOUND IN ORTHOPAEDICS CLINICAL APPLICATION- Haematoma Abscess Popliteal cyst Arterial aneurysm Intra-articular effusion Tendinitis Tendon rupture or partial tear Meniscus & ligament injury. CDH DOPLER ULTRASOUND is used in cases where there is abnormal increase in blood flow as in the areas of inflamation & aggressive tumours. & other condition like DVT, Peripheral vascular disease.
  61. 61. RADIO ISOTOPIC BONE SCAN Radio nuclide compounds are- 99m Tc 67 Ga 111 In Clinical applications- > Early detection of osteomyelitis. > Small bone abscess , osteoid osteoma. > Stress # & other undisplaced #. > Loosening & infection around prosthesis. > Femoral head ischemia & AVN > Early detection of bone metastasis >Useful in patient with metallic implants. > Gives a more physiological picture.
  62. 62. The uptake is related to > Osteoblastic activity > Regional blood flow. It is relatively highly sensitive but non specific. Increased activity in early phase signifies increased blood flow as in inflamation, fracture, highly vascular tumour. Decreased activity in early phase signifies local vascular insufficiency. Increased activity in delayed bone phase signifies fracture, local tumour, infection, implant loosening. Decreased activity in delayed bone phase signifies absent blood supply as in femoral head after neck #

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