Comprehensive Skeletal Radiographic Anatomy, MDIRT, Nchanji Nkeh Keneth

CONVENTIONAL RADIOGRAPHY
Part 2
Lecture 5: SKELETAL RADIOGRAPHIC
ANATOMY
Nchanji Nkeh Keneth
kennchanji@yahoo.com/ nkeh92@gmail.com
662695118/671459765
B.TECH/HPD MDIRT
CHM Virtued Academy India(Ongoing)
LEADER
Radiology Department
St. Louis University, Mile 3 Nkwen Bamenda
Level 200 MDI, 2016/2017 Academic Year
5/31/2017 5-1NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt.
2016/2017 Academic Year

Out line of the presentation
• Radiographic anatomy of the skeleton, covering
all bones of the axial and appendicular skeleton
and the major joints and exam indications
• Selected commonly encountered pathologies of
the various parts
• Highlights on the major radiographic views
• Key points as regard image success criteria: use
of the PACEMAN rule
• Gross anatomy visualized vis-à-vis
Radiographic anatomy and special points of
interest5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt. 2016/2017
5-2

To be included in this lecture also:
• Plain radiographic anatomy of the chest
• Plain radiographic anatomy of the
abdominopelvic region
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS,
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year 5-3

Expectations from the students at
the end of the lecture
• Students should be able to recognize and label
plain radiographs
• Identify and differentiate radiographs based
on the views
• Identify deviations from the normal
structures on the radiographs
• Be fully armed to handle the technical aspects
of Conventional Radiography
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Part 1
THE SKULL
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Recall
• The skull constitutes part of the axial skeletal
and of the dorsal body cavity
• It has 14 facial bones and 8 cranial bones
• There is only one moveable joint
• Protects the brain
• Has sinuses which serve as resonating
chambers and equally reduce the skull weight
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Common pathologies
• Sinusitis
• Tumors
• Fractures
• Sinus polyps
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Some indications for radiographic
exam of the skull
To rule out skull fracture post trauma
Severe headache
Suspected sinusitis
Sinus polyp evaluation
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Common radiographic views are
• Water’s projection(blondeau)
• Schuler's projection
• AP views
• PA views
• Lateral views
• Submentovertex view
• Town’s Projection etc
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Gross anatomy vs. Radiographic Anatomy
5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI
Dpt. 2016/2017 Academic Year
5-10

PA skull view
5/31/2017
1 Frontal Bone
2 Superior Orbital Margin
3 Petrous Ridge
4 Maxillary Sinus
5 Ethmoid Air Cells
6 Nasal Cavity
7 Mastoid Process
8 Greater wing of sphenoid
9 Lesser wing of sphenoid
10 Frontal Sinuses
11 Parietal Bone
12 Coronal Sutre

exercise
Recall the labeled
parts!!!!
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• 1 Lambdoid Sutre
• 2 Occipital Bone
• 3 Dorsum Sellae
• 4 Petrous Ridge
• 5 Superior
Semicircular Canals
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SKULL HALF AXIAL
PROJECTION

GIVE ANSWERS
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SKULL LATERAL
5/31/2017 NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt.
5-15

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5/31/2017 5-17
1. OUTER CORTICAL
LAYER
2. INNER CORTICAL
LAYER
3. DIPLOE
4. FRONTAL SINUS
5. ORBITAL PLATES
6. ANTERIOR CLINOID
PROCESS
7. PITUITARY FOSSA
8. POSTERIOR CLINOID
PROCESS
9. SPHENOID SINUS
10. PETROUS TEMPORAL
BONE
11. LAMDOID SURTURE
12. EXTERNAL OCCIPITAL
PROTRUBERANCE

GIVE THE ANSWERS
5/31/2017 NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3
Nkwen B'da, MDI Dpt. 2016/2017 Academic Year
5-18

5/31/2017
NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt.
5-19

5/31/2017
5-20

5/31/2017 NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt.
5-21

Isocentric Technique For AP SKULL
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NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3 Nkwen B'da, MDI Dpt. 2016/2017
5-22

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5/31/2017
Mile 3 Nkwen B'da, MDI Dpt. 2016/2017 Academic Year
5-26

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5-27

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5/31/2017 NCHANJI N. Kenneth, BTech MDI, St. Louis UNIHEBS, Mile 3
Nkwen B'da, MDI Dpt. 2016/2017 Academic Year
5-30

PART 2
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5/31/2017

Recall
• Bones of the lower limbs constitute part of the
appendicular skeleton
• they are very essential for locomotion
• They form the human gait
• Major bones are long bones
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Common pathological conditions
• Sprains
• Strains
• Fracture
• Arthritis
• Tumors
• Cysts
• Cellulitis
• Bony infarcts
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Indications for radiographic exam
• To diagnose the cause of bone pain
• Rule out fracture
• Evaluate fractures post trauma
• Diagnose extent of dislocation
• Evaluate cystic lesions
• Evaluate bony tumours
• Evaluate developmental defects
• Evaluate rickets
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Common projections are
• AP view
• Lateral view
• Oblique view
• and special radiographic views for the
sesamoid bones and the calcaneus
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Radio anatomy vs. Gross anatomy
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Radiographic evaluation of the foot
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5/31/2017

Forefoot
• 1 Distal phalanx 1st Digit
• 2 Proximal phalanx
• 3 Sesamoid Bones
• 4 Metatarsal
• 5 Distal Interphalangeal
joint. 2nd digit
• 6 Proximal Interphalangeal
joint.3rd digit
• 7 Metatarsal phalangeal
joint.4th digit
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5/31/2017

• 1 Distal phalanx 1st. Digit
• 4 Metatarsal
• 5 Middle phalanx 2nd digit
• 6 Base of 5th Metatarsal
• 7 Medial Cunieform
• 8 Intermediate Cunieform
• 9 Lateral Cunieform
• 10 Cuboid
• 11 Navicular
• 12 Calcaneum
• 13 Talus
5/31/2017 5-44

• 1 Distal phalanx 1st. Digit
• 4 Metatarsal
• 5 Middle phalanx 2nd digit
• 8 Intermediate Cunieform
• 10 Cuboid
• 11 Navicular
• 12 Calcaneum
• 13 Talus
• 13 Medial Malleolus
• 13 Lateral Malleolus5/31/2017 5-45

5/31/2017

Exercise
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5-47

5/31/2017
5-48

• 1 Distal phalanx 1st.
Digit
• 4 Metatarsal
• 5 Middle phalanx 2nd
digit
• 8 Intermediate
Cunieform
• 10 Cuboid
• 11 Navicular
• 12 Calcaneum
• 13 Talus5/31/2017 5-49

5/31/2017

• 1 calcaneus
• 2 Calcaneal Apophysis
• 3 Talus
• 4 Navicular
• 5 Cuboid
• 6 Cuneiforms
superimposed
• 8 Sulcus Tali
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5-52

• Self test
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• 1 Tibia
• 2 Fibula
• 4 Lat. Malleolus
• 5 Ankle jt
• 6 Inf. Tibiofibular jt
• 7 Posterior Malleolus
• 8 Talus
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• Test area
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5/31/2017

• 1 Tibia
• 2 Fibula
• 4 Lat. Malleolus
• 5 Ankle jt
• 6 Talus
• 7 Calcaneus
• 8 Navicular
• 9 Cuboid
• 10 Base of 5th.
Metatarsal
5/31/2017

• 1 Calcaneus
• 2 Talus - Posterior
tubercle, may be separate
from talus - os trigonum
• 3 Talus
• 4 Navicular
• 5 Cuboid
• 6 Cuneiforms
superimposed
• 7 Base of 5th. Metatarsa
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Axial view of the calcaneus
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• 1 Sustentaculum Tali
• 2 Posterial Talocalcaneal
joint
• 3 Anterial Talocalcaneal
joint
• 4 Lateral malleolus
• 5 Apophysis
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• Bohler’s angle (assessed on lateral)
measured by drawing a line from the
posterior aspect of the calcaneum to its
highest midpoint. The second line is
drawn from this point to the highest
anterior point. The angle normally is
between 30 – 40°.
• Sometimes the appearance of the
calcaneus can appear normal despite the
presence of a fracture.
• This is because of the form and shape of
the bone (compact outer bone
surrounding the cancellous inner bone) –
the thickness of the bone means that
fracture lines may not be visualised.
• Bohler’s angle can be measured to check
for abnormality
5/31/2017 5-63

To be cont next class…
The Leg
5/31/2017

References
5/31/2017

Comprehensive Skeletal Radiographic Anatomy, MDIRT, Nchanji Nkeh Keneth

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