Chiropractic radiography and quality assurance handbook

511 Pages·2000·184.534 MB·English

by  Wilson, Russell L

CHIROPRACTIC
RADIOGRAPHY
A N D
QUALITY
ASSURANCE
H A N D B O O K
Russell L. Wilson
informa
healthcare
New York London
Firstpublished in2000byCRC PressLLC.
Thisedition published in2010byInformaHealthcare,Telephone House,69-77 Paul Street,LondonEC2A
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The Author
RussellWilsonhas been a Registered Radiologic Technologistsince 1970.He received his training
in theUnited States Navy. He has worked in thisfieldcontinuously sinceleavingthe Navyin 1973.
He has 17 years of experience in management of medical imaging departments and radiology
quality assurance programs.
Russell Wilson has been an instructor ofradiographic technology at Palmer College of Chi­
ropractic West since 1994. He is married and has one daughter.
Preface
This book was designed to provide students of skeletal radiography with a positioning text that
demonstrates the positioning on equipment they are likelyto see inclinical experience.Almost all
of the radiographs used as illustrations in the book were taken by chiropractic interns at Palmer
College ofChiropractic-West. The illustrations demonstrate animportant point. Chiropractic interns
and chiropractors can produce high-quality radiographs using modem radiographic equipment. In
many cases, these images are superior to what is turned in at hospitals and large medical clinics.
The early chapters cover the basics of radiography, processing films, and safety. A sequence
ofsteps to take when positioning is provided. The best way to avoiderrors is to follow a step-by-

step format. Positioning is presented in two formats. A quick reference chart is provided that can
be used to study for tests andput inthe X-ray roomof anoffice. The chart covers the main details
of the views, including film sizes, recommended identification placement, tube angulation, and
basic positioning. Note that some collegesrecommend different or larger filmsizes. Theillustrated
section provides detailed step-by-step instruction covering how to position the patient and what
needs tobe seenonthe film. Itisthe author’shope that this will provide the student withthe most
convenient method to learn the concept ofpositioning for quality radiography.
The chapters covering extremity radiography are much more extensive than most skeletal
radiographic positioning texts. Chiropractic can produce miracles in the treatment of joint and
sportsinjuries. These chapters provide the positioning toolsthat will help in diagnosing andtreating
extremity injuries.
There is no substitute for hands-on experience. The student should spend as much time as
possible in the positioning lab, getting familiar with the tools ofradiographic positioning. Confi­
dence is gainedonlythrough repetition andpractice. Iwas as nervous as any studentthe first time
I had to demonstrate how to position a view in training.
Ihave been anadvocateofthe performance ofquality control inradiography for nearly 30years.
Radiographic quality assurance and quality control are mandated by all medical facilities that
perform mammography. Itworks. The best waytohaveconsistentlygood radiography isto ensure
that all equipment is working properly and safely. The sections on quality control cover tests that
do not require expensive equipment to monitor equipment operation.
A special thanks goes to the California Department of Radiologic Health for establishing a
standard of good practice for radiography. This standard is used as the backbone of the quality
control section ofthistext. Ms. Rebecca Lem, R.T(R), wrote anexcellent home study program for
the American Society of Radiologic Technologists. This guide is used as one of the reference
materials for the processor quality control chapter.
Russell L. Wilson, R.T(R), C.R.T.
Acknowledgments
and Dedication
A special thanks anddedication gotomy students atPalmer College of Chiropractic-West. There
is no greater joy for ateacher than to see students produce films that one is proud to submit tothe
D.A.C.B.R. Their work provides the illustrations in this book.
I also want tothank the college for providing acurriculum that allows thetime andresources
to teach students of chiropractic how to position the views in this text. The encouragement from
my superior and other instructors provided the drive to complete this book.
Dr. Teresa Whitney, D.C., was such a help in proofreading the text. There are things that the
computer cannot fix and the author fails to see.
A special thanks goes to my daughter, Stephanie Wilson, for playing the patient for many of
the illustrations. Her patience with Dad during this project is greatly appreciated. It was probably
the toughest community service a teenager could experience. Others who helped by posing as
patients are Benjamin Glass, D.C., Stuart Bickel, D.C., and ShannonWhandler, D.C.
Both Linda, my wife, and Stephanie, my daughter, deserve a special reward for putting up
with me during this 3-year project.
Contents
Chapter 1 Basic Radiography Concepts and Principles.............................................1
1.1 Chiropractic Radiographic Equipment andAccessories.......................................................1
1.2 Items That Impact Image Quality: A Review ofPhysics Concepts....................................8
1.3 Technique Charts andTechnique Selection........................................................................12
1.4 Working in a Darkroom with anAutomatic Processor.......................................................15
1.5 Film Processing and the Environment................................................................................21
1.6 Sample MSDS for Working-Strength Developer................................................................27
1.7 Sample MSDS for Working-Strength Fixer........................................................................30
Chapter 2 Radiation Safety in Chiropractic Radiography........................................35
2.1 Sample Radiation Safety Plan.............................................................................................39
2.2 The Use ofCompensating Filters and Gonadal Protection...............................................42
2.3 Indications for Radiography and Imaging Studies............................................................48
Chapter 3 Developing a System or the Proper Sequence for Taking
Films..................................................................................................................55
3.1 What Views Come First?.....................................................................................................55
3.2 A Step-by-Step Approach to Taking Radiographs..............................................................57
3.3 Helpful Tips for Maintaining Image Quality............................ 61
3.4 Communications with the Patient During Radiography....................................................63
Chapter 4 Spinal Positioning Quick Reference Charts............................................67
4.1 Cervical Spine......................................................................................................................68
4.2 Thoracic Spine.....................................................................................................................71
4.3 Chest, Ribs, and Sternum....................................................................................................72
4.4 Extremities...........................................................................................................................73
4.5 Lumbar Spine andA-P Full Spine......................................................................................74
4.6 Sacrum and Coccyx.............................................................................................................76
4.7 Special Chest andAbdomen................................................................................................77
4.8 Skull.....................................................................................................................................78
4.9 Facial Bones, Sinuses, andTMJ..........................................................................................79
4.10 Sacrum, Sacral Base and Coccyx Female ofChild-Bearing Age......................................80
Chapter 5 Cervical Spine Radiography........................................................................81
5.1 Cervical Spine Radiography:Introduction..........................................................................81
5.2 Cervical Spine Positioning: A-P Open Mouth View...........................................................83
5.3 Troubleshooting the A-P Open Mouth View.......................................................................84
5.4 Cervical Spine Positioning: Fuchs Projection.....................................................................88
5.5 Cervical Spine Positioning: A-P Lower Cervical SpineView............................................90
5.6 Cervical Spine Positioning: Posterior Oblique View..........................................................92
5.7 Cervical Spine Positioning: Anterior Oblique View...........................................................94
5.8 Cervical Spine Positioning: Neutral Lateral View..............................................................96
5.9 Cervical Spine Positioning: Extension Lateral View..........................................................98
5.10 Cervical Spine Positioning: Flexion Lateral View............................................................100
5.11 Cervical Spine Positioning: A-P Pillars View...................................................................102
5.12 Cervical Spine Positioning: Posterior Oblique Pillars View.............................................104
5.13 Cervical Spine Positioning: Anterior Oblique Pillars View..............................................106
5.14 Review ofCervical Spine Positioning..............................................................................108
Chapter 6 Thoracic Spine, Chest, and Bony Thorax Radiography.....................109
6.1 Thoracic Spine, Chest, and Bony Thorax Radiography: Introduction.............................109
6.2 Thoracic Spine Positioning: A-P Thoracic Spine View....................................................110
6.3 Thoracic Spine Positioning: Lateral Thoracic Spine View...............................................113
6.4 Thoracic Spine Positioning: Swimmer’sLateral View.....................................................115
6.5 Chest Positioning: P-A View.............................................................................................117
6.6 Chest Positioning: Lateral View........................................................................................119
6.7 Chest Positioning: Apical Lordotic View..........................................................................121
6.8 Chest Positioning: Right Anterior Oblique View..............................................................123
6.9 Chest Positioning: Left Anterior Oblique View...............................................................125
6.10 Chest Positioning: A-P Posterior Ribs Above Diaphragm..............................................126
6.11 Chest Positioning: A-P Oblique Posterior RibsAbove Diaphragm................................128
6.12 Chest Positioning: P-A Anterior RibsAbove Diaphragm................................................130
6.13 Chest Positioning: P-A Oblique for Anterior Ribs Above Diaphragm...........................132
6.14 Chest Positioning: A-P Lower Ribs Below Diaphragm...................................................134
6.15 Chest Positioning: A-P ObliqueView ofLower Ribs Below Diaphragm......................137
6.16 Chest Positioning: RAOView of Sternum.........................................................................139
6.17 Chest Positioning: Lateral SternumView...................... 141
6.18 Review of Thoracic Spine and Chest Radiography..........................................................143
Chapter 7 A-P Full Spine and Lumbar, Sacrum, Coccyx Radiography.............145
7.1 A-P Full Spine....................................................................................................................145
7.2 Step-by-Step Positioning oftheA-P Full Spine................................................................147
7.3 Lumbar Spine Radiography: Introduction..........................................................................152
7.4 Lumbar Spine Positioning: A-P Lumbopelvic View.........................................................154
7.5 Lumbar Spine Positioning: P-A Lumbopelvic View........................................................156
7.6 Lumbar Spine Positioning: Lateral View...........................................................................158
7.7 Lumbar Spine Positioning: Posterior Oblique View..........................................................160
7.8 Lumbar Spine Positioning: Anterior Oblique View...........................................................163
7.9 Impact ofPositioning on Lumbar ObliqueViews............................................................165
7.10 Lumbar Spine Positioning:A-P Sacral Base View..........................................................167
7.11 Lumbar Spine Positioning:P-A Sacral BaseView..........................................................170
7.12 Lumbar Spine Positioning: Lateral SpotView ofL-5/S-1 DiscSpace...........................171
7.13 Lumbar Spine Positioning: Posterior Oblique View of Sacroiliac Joints........................173
7.14 Lumbar Spine Positioning: A-P Sacrum View.................................................................175
7.15 Lumbar Spine Positioning: P-A Sacrum View..................................................................177
7.16 Lumbar Spine Positioning: A-P Coccyx View..................................................................179
7.17 Lumbar Spine Positioning: P-A Coccyx View..................................................................181
7.18 Lumbar Spine Positioning: Lateral Sacrum and Coccyx View........................................183
7.19 Review ofFull Spine, Lumbar Spine, Sacrum, and Coccyx
Radiography......................................................................................................................185
Chapter 8 Abdominal and Chest Decubitus Radiography.....................................187
8.1 Abdominal and Chest Decubitus Radiography: Introduction...........................................187
8.2 Abdominal Positioning: KUB or P-AAbdomen View.....................................................188
8.3 Abdominal Positioning: Upright View ofAbdomen.........................................................189
8.4 Abdominal Positioning: Left Lateral DecubitusView ofAbdomen................................191
8.5 Chest Positioning: Decubitus Lateral Chest View............................................................193
Chapter 9 Basic Skull and Facial Radiography........................................................195
9.1 Skull and Facial Radiography: Introduction.....................................................................195
9.2 Skull Positioning: P-A SkullView....................................................................................196
9.3 Skull Positioning: Chamberlain-Towne’s Skull View...................... 198
9.4 Skull Positioning: Lateral View of Skull..........................................................................200
9.5 Skull Positioning: Base Posterior View of Skull..............................................................201
9.6 Skull Positioning: Schuller’sView ofMastoids andTemporal Mandibular
Joints.................................................................................................................................203
9.7 Skull Positioning: P-A Cauldwell Facial or Sinus View..................................................205
9.8 Skull Positioning: WatersView ofFacial Bones and Sinuses..........................................207
9.9 Skull Positioning: Lateral View Sinus and Facial Bones.................................................210
9.10 Skull Positioning: Submentovertex View of Sinuses........................................................212
Chapter 10 Introduction to Extremity Radiography..................................................215
10.1 Basic Concepts ofExtremity Radiography.......................................................................216
Chapter 11 Extremity Positioning Quick Reference Charts....................................219
11.1 Fingers andThumbs..........................................................................................................220
11.2 Wrists and Hands...............................................................................................................221
11.3 Humerus, Elbow, and Forearm..........................................................................................223
11.4 Clavicle, AC Joint, and Scapula........................................................................................225
11.5 Lateral Scapula, AC Joint, and Shoulder..........................................................................227
11.6 Pelvis, Hip, and Femur......................................................................................................229
11.7 Knee and Patella................................................................................................................230
11.8 Tibia-Fibula andAnkle......................................................................................................232
11.9 Calcaneus and Foot............................................................................................................233
11.10 Toes....................................................................................................................................234
11.11 Special Extremity Views....................................................................................................235
Chapter 12 Hand and Wrist Radiography.....................................................................237
12.1 Finger, Hand, andWrist Radiography: Introduction........................................................237
12.2 Thumb Radiography..........................................................................................................238
12.3 Finger Radiography...........................................................................................................241
12.4 Hand Series: P-AView......................................................................................................244
12.5 Hand Series: Oblique View...............................................................................................246
12.6 Hand Series: Lateral View.................................................................................................248
12.7 Wrist Series: P-A View......................................................................................................250
12.8 Wrist Series: ObliqueView...............................................................................................252
12.9 Wrist Series: Lateral View.................................................................................................254
12.10 Wrist Series: P-AView for Scaphoid Injury....................................................................256
12.11 Wrist Series: Ulnar Flexion View forScaphoid Injury.....................................................258
12.12 Wrist Series: A-P Clenched Fist View............................................ 260
Chapter 13 Forearm, Elbow, and Humerus Radiography........................................263
13.1 Forearm, Elbow, and Humerus Radiography: Introduction.............................................263
13.2 A-P Forearm View.............................................................................................................264
13.3 Lateral Forearm View........................................................................................................266
13.4 A-P ElbowView................................................................................................................268
13.5 Lateral Oblique ElbowView.............................................................................................270
13.6 Medial Oblique ElbowView.............................................................................................272
13.7 Lateral ElbowView...........................................................................................................274
13.8 Coyle Trauma View ofElbow...........................................................................................276
13.9 Axial View ofElbow.........................................................................................................278
13.10 A-P Humerus View............................................................................................................280
13.11 Lateral Humerus with Arm Across Chest View................................................................282
13.12 Lateral Humerus with Internal Rotation View..................................................................283
13.13 Lateral Humerus (BabyArm) View..................................................................................285
Chapter 14 Shoulder, Scapula, and Clavicle Radiography......................................287
14.1 Shoulder, Scapula, and Clavicle Radiography: Introduction..........................................287
14.2 Shoulder: A-P with Internal Rotation..............................................................................289
14.3 Shoulder: A-P with External Rotation............................................................................290
14.4 Shoulder: Apical Oblique................................................................................................292
14.5 Shoulder: ProneAxillary orWest Point View.................................................................294
14.6 Shoulder: Outlet or Lateral ScapulaView......................................................................296
14.7 Shoulder: Stryker NotchView.........................................................................................298
14.8 Clavicle: P-A Clavicle View..............................................................................................300
14.9 Clavicle: P-AAxial Clavicle View..................................................................................302
14.10 Clavicle: A-P Clavicle View..............................................................................................304
14.11 Clavicle: A-P Axial Clavicle View..................................................................................306
14.12 Shoulder: A-P Acromioclavicular Joint Unilateral.........................................................308
14.13 Shoulder: A-P Acromioclavicular Joint Bilateral............................................................310
14.14 Shoulder: Zanca Modification for Acromioclavicular Joint...........................................312
14.15 Shoulder: A-P Scapula.....................................................................................................314
14.16 Shoulder: Lateral Scapula or Outlet................................................................................316
Chapter 15 Pelvis, Hips, and Femur Radiography.....................................................319
15.1 Pelvis, Hip, and Femur Radiography:Introduction............................................................319
15.2 A-P Pelvis and Hips..........................................................................................................320
15.3 A-P Pelvis with Bilateral Frog LegHips............................................................................322
15.4 A-P Hip..............................................................................................................................323
15.5 Frog Leg Lateral Hip..........................................................................................................325
15.6 A-P Lower Femur..............................................................................................................327
15.7 Lateral Lower Femur.........................................................................................................329