Get Books. Master radiographic positioning with this comprehensive, user-friendly text. Positioning photos, radiographic images, and radiographic overlays, presented side-by-side. Textbook of Radiographic Positioning and Related Anatomy. Authors: Kenneth L. Bontrager, John P. Reinforce your knowledge of radiographic positioning and anatomy, and produce quality radiographs! Corresponding to the chapters in this 8th Edition, this practical workbook offers a wide variety of exercises including situation-based questions, film critique questions, laboratory activities, and self-evaluation tests.
New to this edition: Updated content matches the revisions to. Focusing on one projection per page, Textbook of Radiographic Positioning and Related Anatomy, 8th Edition includes all of the positioning and projection information you need to know in a clear, bulleted format. They maintained a high degree of professionalism and tremendous patience throughout the long photo shoots. Sonya was our leader through the ninth edition from its inception to completion. Sonya helped us navigate through dif cult waters and always with a kind word and smile.
She is a perfectionist who challenged us to bring forth our best effort in a loving way. Her support was ongoing, professional, and always positive. First, I must acknowledge the contributions from students and imaging faculty throughout the United States and various aspects of the world.
I hear frequently from them, as they provide feedback on the text and ancillaries. They have provided us with fresh ideas and perspectives for the text and how to improve it. A special thank you to Michele L. Gray-Murphy and her students from Allen College for their constant feedback on the text and ancillaries.
The Diagnostic Medical Imaging and Therapy faculty at GateWay are outstanding role models for their students and the profession. Mary J. Carrillo, Jeanne Dial, Nicolle M. Hightower, Julia Jacobs, Bradley D. Johnson, and Nancy Johnson were instrumental in contributing to this text, providing images, and serving as reviewers and consultants. Special recognition to Jerry Olson for teaching me radiography over 40 years ago.
His wisdom and unique insights still ring true. Special recognition to Mark Barry for being a trusted friend and outstanding technologist. Also, thanks to Terry L. Gaberdiel, my close friend, whose passing left a void for his family and friends.
Sem per delis. The contributing authors for the ninth edition did an outstanding job in researching and writing the content for numerous chapters. My heartfelt gratitude to each of them for making this edition truly re ective of the current practice in medical imaging. Special thanks to Andrew Woodward and Bradley D.
Andrew redesigned Chapters 1 and 18 in this edition, served as consultant for all of the digital imaging concepts, and provided numerous photographs and images.
Brad redesigned Chapter 15 to make the content more current and relevant. Brad and his students helped us secure many of the new images for this edition. Christopher Wertz of Idaho State University was also instrumental in obtaining new images for this edition. Most importantly, a thank you to Elsevier Publishing for allowing us to continue to be part of this wonderful reference for the past 44 years. Finally, my thanks to my family for their ongoing support.
My wife Deborah, son Daniel, daughter Molly, and granddaughter, Tatum. They are both excellent professionals and they understand the importance of treating their patients with dignity and compassion. My true inspiration is my granddaughter, Tatum, who makes me smile daily. What a beautiful and kind person she has become. When things got dif cult and overwhelming, I only needed to see her picture or spend a few minutes with her and my spirit was renewed.
Tatum will always own my heart. Finally, to Buddy, the wonder dog, for sitting in the of ce ok…sleeping while I wrote. Deborah has been at my side for over 39 years. She has been the compassionate anchor that provides our family with the stability and encouragement to be successful in all of our professional and personal endeavors.
My life changed in so many positive ways since I rst met her. I dedicate this edition to my family. Ke n d rick life-long learning. To Joie Burns, a special thanks for your continued support as an invaluable resource of knowledge, a colleague, and a mentor.
You each stand as a pillar of greatness in the eld. It is truly an honor to have been your student and now a colleague. I also thank my loving family for their unfailing patience. My three youngest children, Atticus, Aubrie, and Livia, have endured many hours of mommy reading and writing to complete this ninth edition. Thank you for being so kind and understanding. I also thank my incredible husband, Travis, for recognizing the honor of my participation in this project and supporting my insatiable desire to get it right.
Words cannot express the pride I feel when I re ect on my family: seven beautiful children—each talented, kind, and a blessing to those around them: CJ, Ren, Robyn, Kade, Atticus, Aubrie, and Livia; four lovely grandchildren—each lled with wonder and delight: Fox, Killian, Kellen, and Charlotte; one amazing husband who loves me unconditionally and makes my life complete.
Thank you for sharing so much of yourselves. Lastly, thank you to John Lampignano for entrusting this co-authorship to me. The honor to be part of this project is something I never imagined, but I accept it with humility and respect. The rst time I met John, I was impressed by his professionalism and poise.
To now be his colleague is an incredible privilege. I will work hard to uphold the standards set by Kenneth Bontrager and now John for this textbook and ancillaries. I will continue to recognize the value of collaboration with professionals across the United States and world to ensure quality and accuracy. I encourage communication from all readers of these materials on how to improve and better meet the needs of the users. It is our goal to be an invaluable resource for educators, students, and imaging professionals.
John Lampignano has eloquently acknowledged many outstanding individuals from the worlds of medical imaging and publishing. I sincerely echo his appreciation and recognition that this ninth edition has been made possible with the minds and hands of many.
Being part of the realm of medical imaging with so many amazing professionals is an incredible honor. We not only have unfaltering dedication and compassion for our patients, but we also share tremendous respect and regard for each other as health care professionals and friends. I take this opportunity to give back to the profession as the co-author of this textbook and ancillaries with utmost gratitude for the trust placed in my abilities.
I am especially grateful to Darlene Travis, O. You each freely shared your vast knowledge and expertise in the eld of radiologic sciences. New procedures and current CT technology was added in this chapter. A different perspective was used with these photos. They demonstrate close-ups of the positioning model so students and technologists can better view positioning landmarks, CR centering points, and collimation.
We hope this makes the art of positioning easier for the students rst learning these positions. We replaced many analog lm-based images with digital versions. Several of the commercial medical imaging companies graciously allowed us to use their images for this edition. Terminology, technical factors, part centering, and kV ranges are described with a primary focus on digital systems. Projection names are used that are formally recognized in the profession.
The number of chapters for the ninth edition rem ains 20 chapters. To keep the size and page count of the text to a reasonable size, we kept this edition to the relative size of the previous edition. The body of knowledge in medical imaging continues to grow exponentially. This edition provides the most essential concepts in radiographic anatomy and positioning while keeping the size and weight of this text consistent with past editions.
Positioning remains as one of the critical variables in medical radiography that is solely in the hands of the technologist. Proper positioning displays anatomy and pathology correctly to enable the radiologist and other physicians to make an accurate diagnosis. The authors and contributors had this goal in mind as we made the revisions for the ninth edition.
Each position and procedure were carefully evaluated to provide the most accurate information for the student and practicing technologist.
Our goals were to be accurate, use language that was easy to follow, and observe current practices for reducing dose to the patient and technologist. Our aim was to continue this format in the Workbook, Handbook, and web-based resources. We hope we have met these goals. We continue to be open to your feedback and suggestions to make this text and its ancillaries more accurate and valuable resources. Me tho do lo gy We apply the principle of presenting information from simple to complex, from known to unknown, and we provide diagrams and images to illustrate these concepts.
The chapters are arranged to rst describe the more basic radiographic procedures and proceed to the more complex ones in later chapters.
This method is continued in the format of the Workbook and Handbook as well. Information on analog and digital radiographic concepts has been updated and re ects current practices. One distinct change is the use of portrait and landscape rather than lengthwise and crosswise to describe image receptor alignment.
The terms lengthwise and crosswise have been eliminated from this edition. In doing so, we retained key concepts while eliminating procedures no longer performed. Ancillarie s WORKBOOK This edition contains new learning-exercise and self-test questions, including more situation-based questions and new questions on digital imaging. All questions have been reviewed by a team of educators and students to ensure the accuracy of the content and answers.
The test bank features over questions. They include registry-type questions, which can be xiii xiv PREFACE used as nal evaluation exams for each chapter, or they can be put into custom exams that educators create. These tests can be administered as either computer- or print-based assessments, and are available in ExamView format.
Also available on Evolve is an electronic image collection featuring over images that are fully coordinated with the ninth edition Textbook and Workbook.
Instructors can create their own customized classroom presentations using these electronic images, which closely follow the Textbook and Workbook, chapter by chapter. Faculty can download these images into web-based and PowerPoint applications.
HANDBOOK The new ninth edition revised pocket Handbook, also authored by John Lampignano and Leslie Kendrick, is now available from Elsevier as one of the ancillary components along with student workbooks and an electronic image collection for a complete current student resource on radiographic positioning. This brief review helps the technologist understand the purpose of the examination and which structures or tissues should be most clearly demonstrated.
The minimum SID source-to-image receptor distance is listed. The CR icon is included for all those projections in which the CR is of primary importance to remind the technologist to pay special attention to the CR during the positioning process for that projection.
This process is divided into the following three broad categories: 1 anatomy demonstrated, 2 position, 3 exposure. The erect position is usually less painful for patient, if condition allows.
Rotate body slightly toward affected side, if necessary, to place shoulder in contact with IR or tabletop Fig. S ca pulohume ra l joint Cora coid proce s s Gre a te r tube rcle Le s s e r tube rcle P roxima l hume rus Fig. The labeled image, in most cases, matches the radiographic image example on the same page.
In the living subject, it is almost impossible to study anatomy without also studying some physiology. However, radiographic study of the human body is primarily a study of the anatomy of the various systems, with less emphasis on the physiology. Consequently, anatomy of the human system is emphasized in this radiographic anatomy and positioning textbook.
Atoms Mole cule Ce ll n T : Phonetic respelling1 of anatomic and positioning terms is included throughout this text to facilitate correct pronunciation of the terms commonly used in medical radiography. The lowest level of organization is the chem ic l level. All chemicals necessary for maintaining life are composed of tom s, which are joined in various ways to form m olecules. Various chemicals in the form of molecules are organized to form cells.
Tis s ue Orga n Ce lls The cell is the basic structural and functional unit of all living tissue. Every single part of the body, whether muscle, bone, cartilage, fat, nerve, skin, or blood, is composed of cells.
Tissu e s Tissues are cohesive groups of similar cells that, together with their intercellular material, perform a speci c function. The four basic types of tissue are as follows: 1. Connective: Supportive tissues that bind together and support various structures 3. Muscular: Tissues that make up the substance of a muscle 4. Nervous: Tissues that make up the substance of nerves and nerve centers Orga n s When complex assemblies of tissues are joined to perform a speci c function, the result is an organ.
Organs usually have a speci c shape. Examples of organs of the human body are the kidneys, heart, liver, lungs, stomach, and brain.
S ys te m Orga nis m 10 s ys te ms Syste m A system consists of a group or an association of organs that have a similar or common function. The urinary system, consisting of the kidneys, ureters, bladder, and urethra, is an example of a body system.
The total body comprises 10 i ivi u l bo y system s. Orga n ism The 10 systems of the body when functioning together make up the total organism—one living being Fig. The skeletal system includes the sep te bo es of the body and their associated cartilages and joints. The study of bones is termed osteology, whereas the study of joints is called th ology. The four functions of the skeletal system are as follows: 1. Support and protect many soft tissues of the body 2. Allow movement through interaction with the muscles to form a system of levers 3.
Produce blood cells 4. Store calcium Fig. Distribute oxygen and nutrients to the cells of the body 2. Transport cell waste and carbon dioxide from the cells 3. Transport water, electrolytes, hormones, and enzymes 4. Protect against disease 5. Prevent hemorrhage by forming blood clots 6. The alimentary canal is made up of the mouth, pharynx, esophagus, stomach, small intestine, large intestine, and anus.
Accessory organs of digestion include the salivary glands, liver, gallbladder, and pancreas. The twofold function of the digestive system is as follows: 1.
Prepare food for absorption by the cells through numerous physical and chemical breakdown processes 2. Eliminate solid wastes from the body Ca rdiova s cula r orga ns Lympha tic orga ns Fig.
The structures that make up the passageway from the exterior to the alveoli of the lung interior include the nose, mouth, pharynx, larynx, trachea, and bronchial tree. The three primary functions of the respiratory system are as follows: 1. Supply oxygen to the blood and eventually to the cells 2.
Eliminate carbon dioxide from the blood 3. The organs of the urinary system consist of the kidneys, ureters, bladder, and urethra Fig.
The four functions of the urinary system are as follows: 1. Regulate the chemical composition of the blood 2. Eliminate many waste products 3. Regulate uid and electrolyte balance and volume 4. Maintain the acid-base balance of the body 5 1 Fig. The testes in the male and the ovaries in the female produce mature germ cells.
Transport and storage organs of the male include the vas deferens, prostate gland, and penis. The organs of reproduction in the female are the ovaries, uterine fallopian tubes, uterus, and vagina see Fig.
The function of the reproductive system is to reproduce the organism. Ma le Fe ma le Fig. The function of the nervous system is to coordinate voluntary and involuntary body activities and transmit electrical impulses to various parts of the body and the brain. Most of the muscle mass of the body is skeletal muscle, which is striated and under voluntary control. The voluntary muscles act in conjunction with the skeleton to allow body movement.
Smooth muscle, which is involuntary, is located in the walls of hollow internal organs such as blood vessels, the stomach, and intestines. These muscles are called involuntary because their contraction usually is not under voluntary or conscious control. Cardiac muscle is found only in the walls of the heart and is involuntary but striated. The three functions of muscle tissue are as follows: 1. Allow movement, such as locomotion of the body or movement of substances through the alimentary canal 2.
Maintain posture 3. Produce body heat Fig. These glands include the testes, ovaries, pancreas, adrenals, thymus, thyroid, parathyroid, pineal, and pituitary.
The placenta acts as a temporary endocrine gland. Hormones, which are the secretions of the endocrine glands, are released directly into the bloodstream. The function of the endocrine system is to regulate bodily activities through the various hormones carried by the cardiovascular system. These derived structures include hair, nails, and sweat and oil glands.
The skin is an organ that is essential to life. The ve functions of the integumentary system are as follows: 1. Regulate body temperature 2. Protect the body, within limits, against microbial invasion and mechanical, chemical, and ultraviolet UV radiation damage 3. Eliminate waste products through perspiration 4.
Receive certain stimuli such as temperature, pressure, and pain 5. T The adult skeletal system is composed of sep te bo es, which form the framework of the entire body. Certain cartilages, such as those at the ends of long bones, are included in the skeletal system. These bones and cartilages are united by ligaments and provide surfaces to which the muscles attach. Because muscles and bones must combine to allow body movement, these two systems sometimes are collectively referred to as the locomotor system.
The adult human skeleton is divided into the xi l skeleto and the ppe icul skeleto. The adult axial skeleton consists of 80 bo es and includes the skull, vertebral column, ribs, and sternum the dark-shaded regions of the body skeleton in Fig. This division consists of all bones of the upper and lower limbs extremities and the shoulder and pelvic girdles the dark-shaded regions in Fig. The appendicular skeleton attaches to the axial skeleton.
The adult appendicular skeleton comprises sep te bo es Table 1. Although sesamoid bones are present even in a developing fetus, they are not counted as part of the normal axial or appendicular skeleton except for the two patellae, the largest sesamoid bones.
The other most common sesamoid bones are located in the posterior foot at the base of the rst toe Figs. In the upper limb, sesamoid bones are found most commonly in tendons near the anterior palmar surface of the hand at the base of the thumb. Others may be found in tendons of other upper or lower limb joints. Sesamoid bone may be fractured by trauma; sesamoid bones can be demonstrated radiographically or by CT computed tomography. Tangential projection base of rst toe.
Long bones are found only in the appendicular skeleton. Body Fig. Extre mity Fig. Compact bone has few intercellular empty spaces and serves to protect and support the entire bone. The bo y older term is sh ft contains a thicker layer of compact bone than is found at the ends, to help resist the stress of the weight placed on them.
Inside the shell of compact bone and especially at both ends of each long bone is found spo gy, or c cellous, bo e. Cancellous bone is highly porous and usually contains red bone marrow, which is responsible for the production of red blood cells. The body of a long bone is hollow. In adults, the medullary cavity usually contains fatty yellow marrow.
The articulating surfaces are covered by a layer of hy li e c til ge Fig. It is present in many places, including within the covering over ends of bones, where it is called ticul c til ge. The pe iosteum is essential for bone growth, repair, and nutrition. Bones are richly supplied with blood vessels that pass into them from the periosteum.
Near the center of the body of long bones, a ut ie t te y passes obliquely through the compact bone via a ut ie t fo m e into the medullary cavity. Short bones consist mainly of cancellous tissue with a thin outer covering of compact bone. The eight c p l bo es of each wrist Fig. Examples of at bones are the bones that make up the c lv i skull cap Fig. Flat bones provide protection for interior contents and broad surfaces for muscle attachment.
Ve teb e Fig. The embryonic skeleton is composed of brous membranes and hyaline cartilage. Ossi cation begins at about the sixth embryonic week and continues until adulthood.
This becomes the bo y in a fully developed bone. Most secondary centers appear after birth, whereas most primary centers appear before birth. Epiphyses of the distal femur and the proximal tibia are the rst to appear and may be present at birth in a term newborn. Cartilaginous plates, called epiphyse l pl tes, are found between the metaphysis and each epiphysis until skeletal growth is complete. The m et physis is the wider portion of a long bone adjacent to the epiphyseal plate.
The metaphysis is the area where bone growth in length occurs. Growth in the length of bones results from a longitudinal increase in these epiphyseal cartilaginous plates. This is followed by progressive ossi cation through endochondral bone development until all the cartilage has been replaced by bone, at which time growth to the skeleton is complete.
This process of epiphyseal fusion of the long bones occurs progressively from the age of puberty to full m tu ity, which is betwee the ges of 20 to 25 ye s. On average, the female skeleton matures more quickly than the male skeleton. Also, geography, socioeconomic, genetic factors, and disease impacts epiphyseal fusion. Primary and secondary centers of endochondral ossi cation or bone growth are well demonstrated and labeled. It is important to understand that movement does not occur in all joints.
The rst two types of joints to be described are immovable joints and only slightly movable joints, which are held together by several brous layers, or cartilage. If the link is not responding kindly inform us through comment section.
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