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1. XRAY ORTHO

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. 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. BODY PLANES
> SAGITTAL
> CORONAL
> HORIZONTAL
> OBLIQUE

5. POSITION

6. POSITION

7. PROJECTION
B

8. PROJECTION

9. SHOULDER
AP PROJECTION-
ON NEUTRAL ROTATION- The post. Part of supraspinatous insertion
which sometimes profile small calcific deposits.

10. SHOULDER
AP PROJECTION-
ON EXTERNAL ROTATION- The GT , the site of insertion of
supraspinatous tendon are visualized.

11. SHOULDER
AP PROJECTION –
ON INTERNAL ROTATION- The proximal humerus in true lateral position ,
Site of insertion of subscapular tendon.

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. SHOULDER
AP AXIAL PROJECTION-
Useful in diagnosing post. Dislocation.

14. SHOULDER
SCAPULAR Y VIEW ( PA OBLIQUE PROJECTION)-
Useful in suspected shoulder dislocation.

15. SHOULDER
AP OBLIQUE PROJECTION-( GRASHEY METHOD)
Joint space between humeral head & glenoid cavity .

16. SHOULDER
AP OBLIQUE PROJECTION ( APPLE METHOD)-
Demonstrate the loss of articular cartilage.

17. SHOULDER
AP AXIAL PROJECTION ( STRYKER NOTCH METHOD)-
Defects on the post-lat head of the humerus.

18. SHOULDER
TANGENTIAL PROJECTION-( NEER METHOD)-
Demonstrate coraco-acromial arch or outlet to diagnose shoulder
impingement.

19. ACROMIO-CLAVICULAR JOINT
AP AXIAL PROJECTION ( ALEXANDER METHOD)-
Useful in suspected AC subluxation or dislocation.

20. CLAVICLE
AP AXIAL PROJECTION ( LORDOTIC POSITION)-

21. SCAPULA
AP PROJECTION-

22. SCAPULA
PA OBLIQUE PROJECTION-

23. SCAPULA
AP AXIAL PROJECTION –
To visualize coracoid process clearly.

24. ELBOW
AP OBLIQUE PROJECTION ( ON MEDIAL ROTATION)-
Coronoid process free of superimposition

25. ELBOW
AP OBLIQUE PROJECTION ( ON LATERAL ROTATION)
Radial head & neck free of superimposition.

26. ELBOW
AP PROJECTION ( ACUTE FLEXION)-
Demonstrate olecranon process clearly

27. ELBOW
PA AXIAL PROJECTION-

28. ELBOW
AXIOLATERAL PROJECTION-
Demonstrate the pathological process or trauma in the area of radial
head & coronoid process.

29. WRIST
PA OBLIQUE PROJECTION-
Gives distinct radiograph of trapezium & scaphoid.

30. WRIST
AP OBLIQUE PROJECTION-
Separates the pisiform from adjacent carpal bones.

31. WRIST
PA PROJECTION (ON RADIAL & ULNAR DEVIATION)-
Opens the interspaces between the carpals.

32. WRIST
PA AXIAL PROJECTION FOR SCAPHOID ( STECHER METHOD)-

33. WRIST
TANGENTIAL INFERO SUPERIOR PROJECTION-
Demonstrate the carpal canal.

34. HAND
PA OBLIQUE PROJECTION-

35. HAND
AP OBLIQUE PROJECTION ( BALL – CATCHER POSITION)-
Significant in making the diagnosis of RA.

36. PELVIS & HIP
AP PROJECTION ( 15-20 deg internal rotation)-

37. PELVIS & HIP
AP OBLIQUE ( FROG LEG) PROJECTION-
( CLEAVES METHOD)

38. PELVIS & HIP
MEDIO LATERAL PROJECTION-
( LAUENSTEIN & HICKY METHOD)-

39. PELVIS & HIP
AXIOLATERAL PROJECTION-
( DANELIUS- MILLER METHOD)-

40. PELVIS & HIP
PA AXIAL OBLIQUE PROJECTION-
( TEUFEL METHOD)-
Image shows the fovea capitis & supero post wall of acetabulum.

41. PELVIS & HIP
AP AXIAL OUTLET PROJECTION-
( TAYLOR METHOD)- Superior & inf. Pubic rami without
foreshortened.

42. PELVIS & HIP
AP & PA OBLIQUE PROJECTION-
Resulting image shows entire ilium

43. KNEE
PA AXIAL PROJECTION-
(HOLMBLAD METHOD)

44. KNEE
AP AXIAL PROJECTION-
( BECLERE METHOD)

45. KNEE
TANGENTIAL PROJECTION-
(HUGHSTON METHOD)-

46. KNEE
TANGENTIAL PROJECTION-
( MERCHANT METHOD)-

47. ANKLE
AP OBLIQUE ( ON MEDIAL ROTATION)-

48. SUBTALAR JOINT
AP AXIAL OBLIQUE PROJECTION-

49. CALCANEUS
AXIAL PROJECTION ( PLANTO DORSAL)-

50. CALCANEUS
AXIAL PROJECTION ( DORSO PLANTAR)-

51. FOOT
AP OBLIQUE PROJECTION ON MEDIAL & LATERAL ROTATION

52. FOOT
AP AXIAL PROJECTION

53. FOOT
TANGENTIAL PROJECTION-

54. CHEST
AP PROJECTION-

55. CHEST
AP & PA OBLIQUE PROJECTION-

56. CERVICAL VERTEBRA
AP PROJECTION ( OPEN MOUTH)-

57. CERVICAL VERTEBRA
AP AXIAL PROJECTION-

58. CERVICAL VERTEBRA
AP AXIAL OBLIQUE PROJECTION-
The image shows the intervertebral foramina & pedicles.

59. LUMBO-SACRAL VERTEBRA
AP & PA AXIAL PROJECTION-
( FERGUSON METHOD)- L-S joint & S-I joint free of superimposition.

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. 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. 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 #