Anterior-posterior radiographs

A) Anterior-posterior and (B) lateral radiographic views of an Insall/Burstein II TKR, with associated anatomical landmarks and implant terminology. In A, the femoral condyles are designated as medial (M) and lateral (L). 

Preoperative two-directional radiographs, (a) Anterior-posterior view, (b) Lateral view. Primary tunnel placement is indicated by blue lines. 

Fig. 4.63 Posterior-anterior abdominal radiograph showing the position of a pacemaker and generator lead inserted into the inferior vena cava using a retroperitoneal approach. (West JN, Shearmann CP, Gammage MD. Permanent pacemaker positioning via the inferior vena cava in a case of single ventricle with loss of right atrial-vena cava continuity. Pacing Clin Electrophysiol 1993 16(8) 1753-1755, with permission.)...

The lead must be repositioned until stable pacing is achieved if thresholds are not adequate for reliable pacing. Once stable capture and sensing thresholds are obtained, the pacing catheter should be secured to the skin with nonabsorbable suture both at the entry site and a site farther away with adequate slack between to ensure stability. The entry site is then ster-ilely dressed to prevent infection. A chest radiograph with both anterior, posterior, and lateral projections and a 12-lead ECG should be obtained to confirm appropriate positioning of the lead. 

Figure 1 Anterior-posterior chest radiograph of a patient with acute interstitial pneumonitis. There is diffuse ground-glass ahnormality present within all five lung lobes.

Figure 12.5 Lateral radiographs of active full extension (A) and flexion (B) illustrate the articulating spacer in situ with good range of motion Anterior-posterior projection of the articulating spacer (C) in situ shows good alignment and medial-lateral balance The spacer is also incongruent with the retained patella (D). Reprinted with permission from [64]. Copyright 2010 Elsevier.

Fig.5.2a,b. A 72-year-old retired tunnel worker with silicotic nodules and mixed dust fibrosis, a Posterior-anterior chest radiograph shows ill-defined multiple small nodules and reticular opacities in both upper lobes, b Photomicrograph obtained at autopsy performed 2 years after chest radiograph shows two pneumoconiotic nodules with stellate appearance. The left nodule shows irregular shape without whorled appearance (arrows) typical of silicotic nodule. The right nodule also shows irregular shape but has a central whorled appearance of silicotic nodule. Emphysema is identified around the nodules... 

Fig.5.6a,b. A 69-year-old retired construction site worker, a Posterior-anterior chest radiograph shows irregular nodular opacities in both upper- and mid-zones, b Spiral computed tomography (7-mm thickness) through the lung apices show early conglomeration of nodules, particularly on the left... 

If an individual s workload consists predominantly of radiographic procedures, where protective aprons are not worn, the recommendation given in Section 4.1 for use of Hp(lO) from one personal monitor as a surrogate for would be appropriate. For radiographic procedures, the irradiation conditions are adequately characterized by an anterior to posterior irradiation at effective energies of greater than 30 keV, with a personal monitor located on the front of the individual. 

Fig. 2.14a-d. Esophageal duplication cyst, a AP chest radiograph without appreciable abnormality, b Lateral chest radiograph with anterior bowing and narrowing of the airway above the carina. c Barium esophagram confirms the presence of a soft tissue mass, d Contrast-enhanced CT shows the cyst posterior to the airway, and deforming the airway arrow)... 

Fig.4.7a,b. Afferent loop syndrome, a Supine abdominal radiograph shows virtually absent bowel gas because of frequent vomiting, b Sagittal color Doppler sonogram of the upper abdomen shows the dilated third part of the duodenum (D3) anterior to the abdominal aorta and posterior to the superior mesenteric artery (arrows)... 

The AP radiograph should be closely reviewed for signs of pelvic ring discontinuity by identifying various anatomical lines, the absence of which implies ring disruption or a fracture. These lines are the ischio-ilial line, ilio-pectineal line, and the anterior and posterior acetabular walls. The ilio-ischial line is formed by the posterior structures of the pelvis and the ilio-pectineal by the anterior acetabular structures (Ersoy et al. 1995) (Fig. 12.3). 

This is usually the result of forces transmitted through the axial skeleton from an impact into the head and shoulders through to the lower limbs. There may be symphyseal diastasis, anterior arch fractures or posterior disruption of the sacroiliac joints with cephalic displacement. Vertical injuries are often severe with disruption of all the ligaments plus associated pelvic instability. Radiographs demonstrate ipsilateral or contralateral pubic rami fractures, with disruption of the sacroiliac joint. The major differentiating feature from compression injuries is the cephalic displacement of the pelvis on the side of the impact (Fig. 12.14). 

The anterior column corresponds to the ili-opectineal line on an AP radiograph and the posterior column the ilioischial line. Judet views allow more detailed examination of the acetabular columns, although these have largely been super-ceded by CT examination. The internal (obturator) oblique view is taken with the pelvis rotated anteriorly by 45° and shows the iliopectineal line and posterior wall of the acetabulum, but again CT is more useful and allows multiplanar reconstructions. 

The dislocation is described according to the direction of tibial displacement relative to the femur. Anterior dislocation is the commonest type, and is associated with disruption of the anterior cruciate ligament, the posterior joint capsule and popliteal artery damage. Posterior dislocation can also be associated with arterial injury. Rotary or posterolateral dislocation is caused by force abduction and internal rotation. On the lateral radiograph, the femoral condyle is in profile but the tibia is rotated posterolaterally and the proximal tibiofibular joint is seen in its entirety. An early complete assessment and documentation of the neurovascular status of the leg distally is vital. Also look for signs of compartment syndrome. 

Fig. 16.1. Showing measurement of Bohler s Angle. On a lateral radiograph a line is drawn from the posterior aspect of the calcaneum to the highest midpoint (Line A). A second line is drawn from the highest anterior point to the highest midpoint (Line B). The angle of intersection at the highest midpoint is measured (arrow)...

This can be unilateral or bilateral. Bilateral facet dislocation can often result in significant spinal cord injury. Bilateral facet dislocations with locked facets can be seen with flexion injuries and are due to significant ligamentous disruption in the posterior and middle columns (Fig. 20.13a-e). On radiographs bilateral facet dislocation is seen as anterior displacement of one vertebra with respect to the adjacent vertebra of more than 50%. Facet dislocations may be associated with facet fractures. Again these injuries are best demonstrated by CT. Spondylolisthesis is seen in association with flexion injuries and usually denotes significant soft tissue injury. Similarly retrolisthesis can be seen in extension injuries. 

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