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Skeletal Radiology I - #20010


 

 

Christopher C. Major, DC
Instructor
1.5
30
1
1

Students will study normal radiographic anatomy with an emphasis on the musculoskeletal system. As a means to understanding radiographic anatomy, routine x-ray projections will be covered, in addition to fundamental x-ray physics. This is a foundational course for the skeletal radiology curriculum.

Co-requisite: Spine and Pelvis, Gross Anatomy I
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The Institution-wide learning goals define the common ground that unites the programs within the university. They are purposefully broad so that the various colleges and schools can continue to develop their unique identities through varying ways in which the goals are met.

  1. Effective Communication
    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
  2. Self Directed and Lifelong Learning
    Graduates will be aware of the limits of one’s personal knowledge and experience and have an intellectual interest in scholarly and creative endeavors. Graduates will actively set appropriate learning goals, pursue them, and apply the knowledge gained.
  3. Ethical Reasoning
    Graduates will demonstrate a willingness to recognize the values of others while maintaining one’s own integrity, and act ethically and professionally in all endeavors.
  4. Individuals, Communities and Cultures
    Graduates will demonstrate awareness and sensitivity to the cultural and health practices of individuals and communities. Graduates will be able to identify appropriate health related resources.
  5. Service to the Community
    Graduates will understand and value the benefits of service to the community.
  6. Influence of Mind, Body and Spirit on Health
    Graduates will recognize the inter-relationship of the mind, body and spirit and the influence of extrinsic factors on an individual’s health.
  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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By the end of the course, the student will:

  1. be able to identify and recognize normal structures on radiographs.
  2. be able to identify and recognize the five radiographic densities.
  3. be able to identify and recognize routine musculoskeletal radiographic projections.
  4. have developed a basic vocabulary of radiological terminology.
  5. have a fundamental understanding of the limitations of musculoskeletal radiographs, including tissue contrast, edge resolution, superimposition of structures, projectional distortion, and darkroom/technical problems.
Materials
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A. Required Text(s):
  1. None

B. Recommended Text(s):
  1. Essentials of Skeletal Radiology, Yochum and Rowe, third edition. (approx. $250) This will be required for Skeletal Radiology 2, 3, and 4 and is somewhat helpful for this class.
  2. Squire's Fundamentals of Radiology, Novelline, sixth edition. (Approx. $75)
  3. Normal Radiographic Anatomy, Weir

C. Required Materials for Lab:
  1. Course notes.
  2. It would be helpful to bring a gross anatomy text or atlas to each lab.
Assignments
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None
Attendance
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Attendance is expected at lecture and assigned lab. "No Shows" for exams result in maximum penalty of not being able to take the missed exam and a minimum 10% loss of grade on make-up exam.
Grading Criteria
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Format Lab practical examinations, mainly short answer with approximately 30 stations. Midterm written examination, multiple choice, T/F, matching; approximately 40 questions.
Midterm Written approximately 40 questions; multiple choice, T/F and matching. 15% of course grade.
Midterm Practical 30 short answer stations, approximately 7th or 8th week. 40% of course grade.
Final Practical 30 short answer stations. Cumulative -- approximately 25% pre-midterm material. 45% of course grade.

Guaranteed grades are as follows:

A = 92-100
B = 82-91
C = 74-81
D = 68-73
F = 67
Course Competencies
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-

COGNITIVE DOMAIN



Cervical Spine , Skull Base and Selected Facial Structures
Routine Projections: AP lower cervical, AP open mouth, Lateral, 45° Oblique

sphenoid sinus
sella turcica
occipital condyle (Only on APOM)
mastoid process
internal occipital protruberance NTK
external occipital protuberance
styloid process
mandible
teeth
hard palate
lateral masses of C1
inferior and superior articular process
inferior and superior articular facet
anterior and posterior arch of C1
transverse process
atlanto-occipital joint
atlanto-axial joint
atlantodental interval (ADI)
odontoid process
vertebral body
vertebral body endplate
intervertebral disc
pedicle
spinal (neural) canal
NTK = Nice to know, but will not be on test


lordotic curve
spinous process (bifid)
laminae
articular pillar
zygapophyseal joint
intervertebral foramen
uncinate process
uncovertebral joint
laminar junction line (aka: spinolaminar line, posterior cervical line)
prevertebral soft tissue (retropharyngeal, retrotracheal spaces)
tracheal air column
lung apex
thyroid cartilage
cricoid cartilage NTK
hyoid bone
epiglottis
pharynx NTK
clavicle
posterior vertebral body margin line (aka: George's Line)
posterior cervical line (aka: laminar junction, spinolaminar line)
pediatric growth centers NTK
Mach effect
"White dots" (=pedicle, lamina and IAP -- only at C2, only on APOM)

Thoracic Spine and Chest
Routine Projections: AP, Lateral Thoracic, PA chest

vertebral body
intervertebral disc
pedicle
transverse process
spinous process
inferior and superior articular process
articular facet
lamina
interlaminar space
zygapophyseal joint
intervertebral foramina
ribs (anterior and posterior)
intercostal space (anterior and posterior)
costotransverse joint NTK
costovertebral joint NTK
NTK = Nice to know, but won't be on test

manubrium/sternum
manubriosternal joint (sternal angle)
sternoclavicular joint
scapula
clavicle
trachea
main stem bronchi NTK
heart
aorta NTK
diaphragm
gastric air bubble (magenblase)
muscle planes NTK
breast shadows NTK
paraspinal line NTK
kyphotic curve
imbrication of spinous processes NTK


Lumbar Spine, Sacrum and Abdomen
Routine Projections: AP lumbopelvic, Lateral lumbosacral, 45° Oblique
vertebral body
intervertebral disc
pedicle
transverse process
spinous process
inferior and superior articular processes
articular facet
lamina
interlaminar space
zygapophyseal joint
intervertebral foramina
spinal (neural) canal
pars interarticularis
NTK = Nice to know, but won't be on test

posterior vert. body margin line (aka: Georges's Line)
sacrum
sacral foramina
sacroiliac joint (anterior and posterior)
sacral promontory
sacral ala
coccyx
sacrococcygeal joint
psoas muscles
intestinal gas
liver
kidneys
urinary bladder

Pelvis and Hip
Routine Projections: AP pelvis, AP hip, Frogleg hip

ilium
iliac crest
iliac fossa
ASIS
AIIS
PSIS
[PIIS (This is not visible on radiographs as a discrete structure)]
ischium
ischial spine
ischial tuberosity
NTK = Nice to know, but won't be on test

pubic bone (inferior and superior rami)
obturator foramen
symphysis pubis
Kohler's teardrop (=quadralateral surface of ilium and medial aspect of acetabulum)
acetabulum
hip joint
femoral head
femoral neck
fovea capitis
greater and lesser trochanters
triradiate "Y" cartilage (only in children)
male vs. female pelvis shape

Knee
Routine Projections: AP, Lateral, Intercondylar Fossa, Sunrise
distal femur
proximal tibia
proximal fibula
fibular head and apex
patella
patellar apex
intercondylar notch
tibial tuberosity
patellofemoral joint
infrapatellar fat

patellar ligament
quadraceps tendon
medial and lateral femoral condyle
medial tibial plateau
lateral tibial plateau
medial tibial spine
lateral tibial spine
tibial eminence = medial and lateral tibial spines together
adductor tubercle
popliteal groove (on lateral side of femur)

Ankle
Routine Projections: AP, Mortise, 45° Oblique, Lateral Ankle

talonavicular joint
calcaneocuboid joint
metatarsal bases
tibial plafond
tarsometatarsal joints
sinus tarsi NTK (best on oblique ankle view)
medial and lateral malleoli
tibiotalar joint
NTK = Nice to know, but won't be on test

subtalar (talocalcaneal) joint
calcaneus
calcaneal tuberosity
sustentaculum tali
cuboid
navicular
cuneiforms, 1-3
talus (head, dome, neck, posterior process, lateral process)
Achilles tendon
pre-Achilles fat

Foot
Routine Projections: DP, Lateral, Medial Oblique Foot

metatarsals, 1-5
metatarsal base, shaft, head
metatarsophalangeal joints
proximal, distal phalanges, 1-5
middle phalanges, 2-5
terminal tufts, 1-5
tarsometatarsal joints
proximal and distal interphalangeal joints,
2-5
interphalangeal joint of great toe
nutrient channel NTK
sinus tarsi NTK (best on oblique foot view)
medial and lateral malleoli
tibiotalar joint
NTK = Nice to know, but won't be on test

talonavicular joint
calcaneocuboid joint
subtalar (talocalcaneal) joint
medial and lateral sesamoid
calcaneus
calcaneal tuberosity
sustentaculum tali NTK
cuboid
navicular
cuneiforms, 1-3
talus (head, dome, neck, posterior process, lateral process)
Achilles ligament
pre-Achilles fat

Shoulder
Routine Projections: AP Internal Rotation, External Rotation, Baby Arm
humeral head
anatomical neck
surgical neck
greater and lesser tubercles
bicipital groove
scapula
scapular spine
inferior, superior angles
medial (vertebral) border
lateral (axillary) border
NTK = Nice to know, but won't be on test
 ribs
clavicle
conoid tubercle
supraspinatous fossa NTK
infraspinatous fossa NTK
coracoid process
acromion process
acromioclavicular joint
glenohumeral joint
deltoid tuberosity

Elbow
Routine Projections: AP, Lateral, Oblique, Jone's (tangential)
distal humerus
trochlea
capitulum
coranoid fossa
olecranon fossa
medial and lateral epicondyle
proximal radius
NTK = Nice to know, but won't be on test
 radial head
radial neck
proximal ulna
radial notch
olecranon process
trochlear notch
coranoid process
anterior and posterior fat pads

Wrist and Hand
Routine Projections Wrist: PA, Lateral, Palmar Oblique, Ulnar Deviation
Routine Projections Hand: PA, Palmar Oblique, Lateral
distal radius
distal ulna
Some (scaphoid)
Lovers (lunate)
Try (triquetral)
Positions (pisiform)
That (trapezium)
They (trapezoid)
Can't (capitate)
Handle (hamate), hook of hamate
radiocarpal joint
intercarpal joints
scapholunate joint
ulnar styloid process
radial styloid process
NTK = Nice to know, but won't be on test
 triangular fibrocartilage
metacarpals, 1-5
metacarpal base, shaft, head, 1-5
proximal phalanges, 1-5
distal phalanges, 1-5
middle phalanges, 2-5
metacarpophalangeal joints, 1-5
proximal interphalangeal joints, 2-5
distal interphalangeal joints, 2-5
interphalangeal joint of the thumb
terminal tufts
sesamoids at thumb
pronator fat pad
scaphoid fat pad NTK
nutrient channel NTK


Conditions:
Occasionally, trauma or other pathological conditions might be used to convey clinically oriented anatomical concepts.

PSYCHOMOTOR DOMAIN


Students will:

a. practice the skill of interpreting and understanding two-dimensional representations of three-dimensional structures.
b. correlate radiographic structures with gross anatomical structures.
c. learn the proper terminology for radiographic projections.
d. learn the proper method of handling films, placing them on viewboxes in a consistent manner.
e. to identify structures in a highly specific manner, to include side (if applicable), level (if applicable) and location.



AFFECTIVE DOMAIN


Students will conduct themselves in a manner befitting a professional and demonstrate respect, sensitivity and compassion between themselves and their instructors, including teaching assistants. They can expect the same from the instructor and teaching assistants.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 -- Lecture. Orientation to NWCC radiology curriculum. Course notes handed out. Course expectations outlined. Required text shown. Discussion of radiologists as specialists in chiropractic. Brief history of diagnostic radiology, beginning with W. Roentgen. Brief introduction to the physics of diagnostic x-ray. Discussion of basic terms, such as anteroposterior, lateral, orthogonal x-rays, x-ray marking, . Introduction to concept of inherent tissue contrast. .
Week 2 -- Lecture. Begin cervical spine -- AP, lateral and AP open mouth.
Lab. Films available for small group study, including templates.
Week 3 -- Lecture. Continue cervical spine.
Lab. Films available for small group study, including templates.
Week 4 -- Lecture. Continue cervical spine. Start cervical spine obliques.
Lab. Films available for small group study, including templates.
Week 5 -- Lecture. Continue cervical obliques. Begin thoracic spine.
Lab. Films available for small group study, including templates.
Week 6 -- Lecture. Continue thoracic spine.
Lab. Films available for small group study, including templates.
Week 7 -- Midterm likely this week. Will confirm.
Week 8 -- Lecture. Begin lumbar spine.
Lab. Films available for small group study, including templates.
Week 9 -- Lecture. Continue lumbar spine, including lumbar obliques.
Lab. Films available for small group study, including templates.
Week 10 Lecture. Begin lower extremity--pelvis and hip.
Lab. Films available for small group study, including templates.
Week 11 -- Lecture. Finish lower extremity--knee, ankle, foot.
Lab. Films available for small group study, including templates.
Week 12 -- Lecture. Begin upper extremity--shoulder.
Lab. Films available for small group study, including templates.
Week 13 -- Lecture. Finish upper extremity--elbow, wrist and hand.
Lab. Films available for small group study, including templates.
Week 14 -- Finals
Week 15 -- Finals
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Christopher C. Major, DC, ATC
Last updated:7 December, 2006
 

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