CLINICAL PRACTICE I ( X-RAY )
Case study presentation RAD323 , 2023/2024 ( 451 ) QUMC
- ABDULLAH ABDULRAHMAN ALSEDRANI
- - ABDULAZIZ IBRAHIM ALHOMEDANI
BEFORE START OUR PROCEDURE
you have to think about ?
Patient identification .
Patient position
Part position
CR
CP
Anatomical appearance
Patient information
He is male.
The age of patient is 19 years and 5 months .
The indication : post-operative and limited in movements
He has cruciate ligament in the knee and had a ligament operation
The request and preparation :
The request : X-RAY KNEE AP AND LATERAL for the left knee .
Patient preparation :
remove all radiopaque from the interest area ( KNEE )
remove also all the material and clothes from the interest area
( KNEE )
remove also knee brace from the knee
LEFT knee joint for ( AP )
THE PATIENT POSITION :
• left knee joint for ( AP POSITION )
Erect position of the patient and his leg extended
By standing front of the X-RAY detector ( Stand Bucky )
PART POSITION : left knee joint
1. adjust the left knee to center the cassette .
2. Then rotate the leg medially to centralize the patella
CR :
central ray horizontal to IR because, the erect position
LEFT knee joint for ( AP )
CP :
The center point is 1 cm inferior to apex of patella.
COLLIMATION :
open the collimation to include distal portion of the femur and the
knee joint at the center and proximal portion of the tibia and fibula .
* As equal collimation of femur and leg .
IR SIZE :
Large detector
SID : 110 cm
Grid :
used grid
LEFT knee joint for ( AP )
The exposure
factors :
o Kvp is 75
o mAs is 16
o TIME is 80 ms
You have to put the markers
L , AP , STANDING
AP LEFT KNEE
EDITING THE IMAGE
How image quality assessment tools are
used to optimize image : After
1. Good patient position and part position ;
placed it perfectly.
2. Use correct exposure factor, and avoid re-
shooting
3. PUT the anatomical in identical from the
superior of the image to inferior
4. Increase brightness 8 Before
5. Increase latitude 3
6. Increase contrast image 3
ANATOMICAL APPEARANCE :
Distal femur
Medial and lateral epicondyle of
femur
Apex and base of patella
Proximal tibia and fibula
The head and neck of fibula
Medial and lateral condyle of tibia
LEFT KNEE JOINT FOR ( LATERAL )
PATIENT POSITION FOR ( LATERAL POSITION ) :
Let the patient in supine position then turn onto the affect side ( left
side of the patient ) and put the right foot front of the left femur of
the patient to view as SEMIPRON TURN ONTO AFFECTED SIDE
PART POSITION :
Knee flexed 20-30 degrees
Center knee by placing cassette at the knee.
CR :
Central ray 7 degrees cephalic
CP:
Center point 1cm inferior to medial condoyle.
LEFT KNEE JOINT FOR ( LATERAL )
COLLAMATION :
open the collimation to include distal portion of the femur and the
knee joint at the center and proximal portion of the tibia and fibula .
IR SIZE :
Used large detector
SID :
100 cm
GRID :
Used grid
LEFT KNEE JOINT FOR ( LATERAL )
The exposure factors :
o Kvp is 75
o mAs is 20 *
o TIME is 80 ms
You have to put the markers
L , LATERAL
Left knee - lateral
EDITING THE IMAGE
How image quality assessment tools are
After
used to optimize image :
1. Good patient position and part position ;
placed it perfectly.
2. Use correct exposure factor with increase
mAs for lateral to 20 , and avoid re-shooting
3. Increase brightness 1
4. Increase latitude 2 Before
5. The head of femur should be superimposition
from medial to lateral .
6. The patella space most be visible
ANATOMICAL APPEARANCE :
Distal femur
Apex and base of patella
Proximal tibia and fibula
The head and neck of fibula
The head of femur superimposition
from medial to lateral .
Patella space
The finding in the left knee of the
patient :
THE REPORT FROM QUMC RADIOLOGY DEPARTMENT
COMPARIOSON : MRI KNEE 8/22/2023
FINDING :
Status post ACL reconstruction revealed normal post-
operative sequela with normal alignment of the femoral
and tibial buttons.
No evidence of anterior tibial translation
THANK YOU
