(BQ) Part 2 book Radiological anatomy presents the following contents: Radiological anatomy (superior extremity, inferior extremity, bone age, thorax, abdomen and pelvis, head and neck, vertebral column, angiography, new imaging devices).
Radiological Anatomy SUPERIOR EXTREMITY INFERIOR EXTREMITY BONE AGE THORAX ABDOMEN AND PELVIS HEAD AND NECK VERTEBRAL COLUMN ANGIOGRAPHY NEW I M A G I N G DEVICES NOTES Introduction INTRODUCTION (Fig 1) 10" 10'° 10s 10" 10" 102 10° 10'2 10- - Cosmic rays Gamma rays X-rays - Ultraviolet - Visible • Infrared • Radiowaves • Electrical waves The study of anatomy by using X-rays is referred to as Radiological Anatomy Many a fact in gross anatomy can be revealed and demonstrated in an X-ray plate (radiograph) and some of the organs (e.g heart, diaphragm, stomach) may be seen functioning by looking into the screen on which shadows fall (fluoroscopy) 106 10" 10'° 1012 WauAR-lfinrith in ran Fig 1: Position of X-rays in electromagnetic radiations Radiographs are an essential element in clinical diagnosis and a doctor has therefore to be well conversant with the anatomy of the normal radiograph of various regions before he can be proficient in the interpretation of complexities in disease X-rays were discovered by Wilhelm Konrad Rontgen, a German physicist, in 1895 They form a part of the spectrum of electromagnetic radiations, where the long electric and radio-waves are found at the one end; the infra red, visible, and ultraviolete light waves in the middle; and the X-rays, gamma rays and cosmic rays at the shortwave length end It is thus apparent that the X-rays are of the same nature as light rays but have the distinguishing feature that their wavelengths are very short, /10000 of the wave length of visible light It is this characteristic that permits X-rays to penetrate materials which otherwise would absorb or reflect light 87 88 Radiological Anatomy Properties of X-rays i Penetrating effect: The penetration of a beam of X-rays is limited partly by scattering and partly by absorption Substances absorb them according to their atomic weights and density; the higher the atomic weight or density of a substance, the greater the absorption This is fundamental property as far as obtaining an image is concerned, Bone with a high percentage of calcium absorbs the X-rays more than skin and muscle which have a low percentage of calcium The lower the atomic weights of the elements in a substance the more transparent will it be Radiography is, therefore, based on the differential absorption of X-rays Structures readily penetrated by X-rays are radiolucent; substances penetrated with difficulty or not at all are radiopaque ii Photographic effect: X-rays affect photographic emulsions in much the same way as light If a suitable type of photographic film is placed behind an object and an exposure made, the translucent parts allow the X-rays to pass through, so that these parts appear dark on the developed film The dense parts absorb the X-rays, either partially or completely, and largely prevent them from reaching the film In the corresponding parts of the film there is, therefore, less blackening effect so that when the film is viewed by transmitted white light a black and white picture is seen, the white parts corresponding to the dense parts in the object This is known as a negative picture, and is in the form in which a skiagram (so called X-ray) is usually examined Skiagram is therefore really a shadowgram (skia = shadow and gramma = a writing) iii Fluorescent effect: Light waves are produced if X-rays strike certain metallic salts (phosphorous) This is called fluorescence Fluoroscopy or screening depends on this effect iv Biological effect: X-rays can destroy abnormal cells (e.g., in malignant tumours) without destroying adjacent normal cells to the same degree This is the basis of radiotherapy STANDARD VIEWS OF A RADIOGRAPH Skiagrams are taken in different positions of the subject in relation to the source of X-ray! and the photographic film Some of the common positions used are: Antero-posterior view (AP) It is taken with the X-ray tube anterior to the subject and the film posteriorly placed Posterior structures are better visualised in this view Postero-anterior view (PA) In this the X-ray tube is posterior to the subject and the film anterior, the rays thus passing postero-anteriorly through the subject Anteriorly placed structures are more clearly visible in this view The more commonly taken X-ray of the chest is a P.A view Introduction 89 Lateral views These are used to assess the depth of the structures and can be: i Right lateral view: when the film is in contact with the right side of the subject, ii Left lateral view: when the film is kept against the left side of the subject Oblique views These are used for special study of a particular structure In the case of chest X-rays these could be: i ii Right anterior oblique view (R.A.O) Left anterior oblique view (L.A.O) The subject stands in front of upright film casette holder and is then turned 45° oblique (left or right) The orientation of a radiograph is marked by incorporating a lead letter into the cassette before exposing a film, e.g the right side with an 'R', and left side with an 'L TYPES OF RADIOGRAPHS Plain Radiographs When X-rays are allowed to pass through the subject without the use of any medium the translucent portions appear black on the developed X-ray plate, whereas the dense areas absorb the X-rays in varying degrees resulting in different shades of white Contrast Radiographs When X-rays are taken after filling a cavity or space with a contrast medium in order to visualise the lumen of the viscus or extent of the cavity The contrast media are of two types: a Opaque, e.g b a r i u m sulphate for the gastro-intestinal tract, and iodine compounds for the urinary tract b Translucent, e.g air or oxygen for ventricles of brain X-RAY APPEARANCES OF NORMAL SKELETON (Fig 2) Structure of Mature Bone Because of their high calcium content, the bones of the skeleton are clearly defined and contrasted with the soft parts The long bones show a dense white homogenous outer layer, the cortex, which encloses a less dense inner portion, the cancellous bone, which is repre-sented by a series of fine white lines that correspond to the thin sheets of bone known as the trabeculae or lamellae These lamellae are arranged mainly in the direction of the predominant stress, but are joined to each other by cross bracing lamellae Lamellae placed on the lines of pressure are seen particularly clearly, in the neck of the femur (calcar-femorale) and in the calcaneum, because 90 Radiological Anatomy Calcar femorale Cancellous bone lamellae Cortex Fig 2: Structure of mature bone they are subjected to great stress In the long bones of the limbs generaly they tend to run vertically, but the number of cross bracing obscures the pattern Study of the trabecular architecture and the distribution of the cortical and cancellous layers in each bone is useful because alterations occur in many pathological conditons In the shafts of the long bones the cancellous bone is absent and is replaced by a space, the medullary (marrow) cavity, which can be seen in a skiagram though its limits are not clearly demarcated Structure of Immature bone At birth considerable p o r t i o n s of the skeleton are f o r m e d of cartilage, the radiographic density of which is much the same as that of the overlying skin and muscles These portions are therefore not normally distinguished in a skiagram e.g the cartilaginous carpal elements in the wrist and the ends of certain long bones of the extremities Superior Extremity SHOULDER REGION RADIOGRAPHIC APPEARANCE Antero-posterior View (Fig 7.1) When an antero-posterior view is taken with the arm by the side the following details are noticed Q Acromioclavicular joint as a gap between the clavicle and the acromion U Acromion lying partly behind the head of humerus and superimposed on it Q Anatomical neck of humerus: Medial portion is on a level with the junction of the middle and lower thirds of the glenoid cavity It appears as an angular notch O Clavicle Lateral half of the clavicle projects a little higher than the adjacent upper surface of the acromion O Conoid tubercle as a bony prominence on the inferior surface of the clavicle near the outer third O Coracoid process as a more or less circular shadow below the lateral third of the clavicle Q Glenoid cavity as a narrow ellipse Si Greater tuberosity of humerus as the most lateral bony point in the shoulder region O Head of the humerus lying against the glenoid cavity O Inferior angle of scapula is seen partly superimposed on the lung field, at the level of the seventh rib or seventh intercostal space O Lesser tuberosity and bicipital groove are difficult to identify Q Superior angle of scapula projects upwards in the angle between the clavicle and the first rib 91 106'Radiological Anatomy Conoid tubercle Clavicle Acromio-clavicular joint of scapula Acromion Coracoid Greater tuberosity Head of humerus Glenoid cavity Anatomical neck Inferior angle of scapula Fig 7.1: S h o u l d e r — A P v i e w Introduction 93 ELBOW RADIOGRAPHIC APPEARANCE Antero-Posterior View (Fig 7.2) With fully extended elbow shows the following: £ Elbow joint space as a translucent broad line passing across the ulna between the trochlea and coronoid process It separates the head of the radius from the capitulum Q Head and tuberosity of radius is seen slightly overlapping the ulna Q Lateral epicondyle of humerus gives a flatter appearance as compared to the medial epicondyle til Medial epicondyle of humerus is seen projecting medially, y Olecranon process is superimposed on the shadow of the humerus and its proximal limit can be recognised below the shadow cast by the Coronoid and olecranon fossae Q Trochlea is superimposed by ulna Olecranon and coronoid fossae Olecranon process ateral epicondyle- Medial epicondyle Trochlea Elbow joint space Head and tuberosity of radius Fig 7.2 Elbow—AP view 94 ' Radiological Anatomy Lateral View (Fig, 7.3) In right angle flexion the special features to be noted are: y Capitulum is seen projecting anteriorly beyond the line of the anterior edge of the shaft of the humerus O Coronoid process partly overlaps the shadow of the head of the radius, y Epicondyles The shadows of lateral and medial epicondyles are superimposed, t ) Head of the radius lies opposite the capitulum Olecranon process is seen projecting backwards Supracondylar ridges are seen as white lines passing u p w a r d s from the epicondylar shadows Supracondylar ridge Epicondyle Capitulum Head of radius Olecranon process Coronoid process Fig 7.3: Elbow—lateral view 198 Radiological A n a t o m y Right brachiocephalic vein Subclavian artery Trachea Oesophagus/common carotid Head of humerus artery First rib Scapula Erector spinae muscle Fig 15.3: CT scan thorax at the level of third thoracic vertebra Superior vena cava Body of sternum Ascending aorta Trachea Oesophagus (Tracheal bifurcation) Descending aorta Subscapularis Fig 15.4: CT scan thorax at the level of fourth thoracic vertebra Infraspinatus muscle New Imaging Devices f} 199 Sternum Pulmonary trunk Left atrial appendage Azygos vein i Left atria Oesophagus Serratus anterior muscle Aorta (Descending aorta) Latissimus dorsi Fig 15.5: CT scan thorax at the level of fifth thoracic vertebra Superior most part of liver just below diaphragm Liver Left lung Lower end of oesophagus Abdominal aorta Right lung Azygous vein Fig 15.6: CT scan thorax at the level of eleventh thoracic vertebra 0 m Radiological A n a t o m y Duodenum Stomach Bowel loops Gallbladder Inferior vena cava Liver Right adrenal gland Abdominal aorta 1 Left kidney Right crus of diaphragm Spleen Erector spinae muscle Fig '15.7: CT scan abdomen at the level of twelfth thoracic vertebra Bowel loops Iliopsoas muscle Gluteus minimus Gluteus medius Piriformis muscle Uterus Ilium - Gluteus maximum Fig 15.8: CT scan pelvis at the level of third sacral vertebra New Imaging Devices f} 201 CT scanning and can be distinguished from other caliceal filling defects, such as blood clots and small tumours In the pelvis, urinary bladder, prostate, seminal vesicles, uterus and ovaries can be imaged and their lesions detected MAGNETIC RESONANCE IMAGING (MRI) (Figs 15.9 and 15.10) Instead of X-rays a combination of radio-waves and a strong magnetic field are used in this revolutionary technique It relies on the principle that hydrogen atoms when subjected to a magnetic field line up If a radio-frequency is aimed at these atoms, it changes the alignment of their nuclei When the radio-waves are turned off, the nuclei realign themselves, transmitting a small electrical signal Since the body is primarily composed of hydrogen atoms, an image can be generated from the returning pulses, showing tissue and bone marrow as never seen before The tissues having higher water density appear brightest with MRI since it focuses on the behaviour of hydrogen atoms in water molecule This allows MRI to certain things better than CT scanners, such as distinguishing between the brains white matter and water rich grey matter Teeth and bones which contains little water, not appear at all in MRI, enabling doctors to see tissues surrounded by bone, such as the spinal cord The contrast resolution of MRI is superior to that of CT scanning and crosssectional images can be obtained in any plane It is being increasingly used for imaging the heart and great vessels as it can distinguish between tissues better than CT scanning and can identify structures containing flowing blood MRI has proved to be an effective means of examining the spinal cord because of its ability to depict soft tissues in high contrast Examination of spinal cord with X-ray required injection of a contrast medium during a procedure which could be risky and painful It has limitations in calcified structures because they contain very small amount of water which is the source for hydrogen ions CT scan is better than MRI in the lesion of such structures An additional advantage of MRI is that it involves no X-ray radiation ULTRASONOGRAPHY (Figs 15.11 to 15.14) It uses sound waves to look within A small transducer or transmitter receiver is placed in contact with the area of the body being investigated High frequency sound waves penetrate the body, strike the organs within, and reflect back to the surface, where the transducer now functions as a receiver The time delays of these returning signals sketch the targets location, size, shape, even its texture, for a display line by line on a screen Echoes are thus translated into faint signals which are processed by computer into a video image Rapid anatomic 'real time' or two dimensional scanning allows clear visualisation of tissue movements which assist in the identification of anatomical and pathological structures It is a non-invasive rapid and safe technique and gives good details The accuracy of ultrasound diagnosis is 90% 202 Radiological A n a t o m y Frontal lobe Corpus collosum Occipital lobe Pons Sphenoidal sinus Fourth ventricle Cerebellum Medulla oblongata Soft palate Tongue C-, vertebra Spinal cord Fig 15.9: Midline sagittal magnetic resonance image (MRI) of normal brain Vertebral body Intervertebral disc Thecal sac Spinous process Sacrum Fig 15.10: Midline sagittal magnetic resonance image (MRI) of normal spinal cord Mew Imaging Devices (j 203 N02M BG:17 BOmilMWWS CS14 HdTHI-R »du* Abdonwn 170mm Jlb-vl™ |'.I'D: |or)M i gVol,.m» |tll»m |Ot« Fig 15.11: USG through gall bladder GB (Gallbladder), CBD (Common bile duct), PV (Portal vein) PANCREAS IN BC:1« B»H(2/4/0M6 C814 HdTHI-R Adult Abdomen i?Smm |SPIS; |ODM Q T|lteri«w TRANSVERSE SCAN N0.41 /46 EVnli.ra,- gllwn.s gohs Fig 15.12: USG through pancreas ST (Stomach), NP (Neck of pancreas), BP (boay of pancreas), HP (heaa of pancreas), CBD (common bile duct), PV (Portal vein), SMA (Superior mesenteric artery), TP (Tail of pancreas) Solid and cystic structures transmit sound waves in straight lines, and reflect them from interfaces Gas filled structures dissipate the ultrasonic beam, and therefore the liver, gallbladder and solid or cystic tumours in the abdomen can be depicted by abdominal ultrasound Structures which reflect ultrasound appear bright (hyperechoic), w h e r e a s s t r u c t u r e s w h i c h t r a n s m i t u l t r a s o u n d a p p e a r dark (hypoechoic) 204 Radiological Anatomy HITACHI Indtaffiagno»tic«ResearchC*ntp:H FR:37 CHAND 107 IjitiHH C» 08-JAN-10 19:36:26 M » LT KIDNEY BG28 75/H/2/4/0/-/8 C814 HTMl-G Kidney @SM); |C)!)M TjRcvtew 000 > No.178/179 128mm | S++*- fUohime |Ratio Ms §Hi»Iici Ah** Fig 15.13: USG showing the longitudinal cut through the left kidney Fig 15.14: Digital subtraction angiography of cerebral vessels The most significant application of ultrasound has been in the diagnosis of gallbladder disease, the differential diagnosis of jaundice and diseases of liver It is cheaper than CT scanning It gives good detail of renal parenchyma, and is sensitive in the detection of hydronephrosis, non-opaque stones and perirenal collections The normal ureter is not routinely visualised, but is seen when dilated The mid-section of the ureter is often obscured by overlying structures particularly gas containing bowel, but the lower ureter should easily be seen in filled bladder Bladder abnormalities may be identified, the size of the prostate may be assessed, and bladder volume before and after voiding can be measured It is the only body scanning technique recommended for pregnant women, and has tremendous application in diagnosing the diseases of uterus and ovaries In pregnancy it is being widely used for age and sex determination, congenital anomalies of foetus, placental abnormalities and to see the presentation of the foetus Mew Imaging Devices (j 205 The viability and growth of the foetus are monitored periodically by ultrasound In case of infertility it is useful for timing the follicular maturation which helps in m a n y ways U l t r a s o u n d has useful applications for diseases of thyroid and parathyroids, breast, neonatal head, orbit and scrotum Ultrasonography of heart is known as Echocardiography Two echocardiographic methods are in use at the present time, the M-Mode and the cross-sectional, otherwise k n o w n as 'real time' or two dimensional The M-Mode records the echoes of structures along a single linear beam emanating from a transducer placed on the precordium From this the movement of the right and left ventricular cavity and wall thickness can be measured as well as the movement of the mitral, aortic and tricuspid valves The pulmonary valve is less readily echoed Echocardiography is one of the certain ways of diagnosing prolapsed mitral cusps In cross-sectional echocardiography the images obtained from the two-dimensional echo are dynamic so that movement of the ventricles can be seen directly, as well as the functioning of the valves Echocardiography has a very important place in congenital heart disease The interatrial and interventricular septa are relatively easy to visualise and the presence of a defect in either of these can almost always be seen if they are of a size which is clinically significant DIGITAL SUBTRACTION ANGIOGRAPHY (DSA) It is an imaging technique that produces clean clear views of flowing blood or its blockage by narrowed vessels DSA depends on the injection into the vessels of a contrast agent containing iodine that is opaque to X-rays The shadow, this opacity creats allow doctors to see the flow of blood Before injection of the contrast substance, an X-ray image is made and stored in a computer After injection a second image is made highlighting the flowing blood as revealed by the substance The computer then substracts image one from image two, leaving a sharp picture of blood vessels such as the coronary arteries It is thus a method for computerised enchancement of the images obtained at angiography RADIO-ISOTOPE IMAGING (PET/SPECT) Positron emission t o m o g r a p h y (PET) and single p h o t o n emission computed tomography (SPECT) are a form of radio-isotope imaging SPECT shows blood flow by imaging trace amounts of radio-isotopes PET can also measure metabolism revealing how well the body is working The use of radioactive tracers is well suited to studies of epilepsy, schizophrenia, Parkinson's disease and can indicate brain damage from a stroke Both PET and SPECT depict the distribution of blood into tissue, but PET does so with greater accuracy By tracing the radioactive substance, a doctor can pin point areas of abnormal brain activity or determine the health of cells Index Acetabulum 97, 123 Acromion 91 tip of Angiography 204, 205 aortic 205 carotid 193, 194 cerebral 203 digital subtraction 203 vertebral 194-196 Angle acromial cardiophrenic 136, 138 inferior, of scapula 7, 38, 91, 136, 139, 146 infrasternal 42 sternal 6, 42 Aorta 39, 52, 53 Aortography 189, 191 Appendix 49, 58 Arch 184 anterior, of atlas 83 deep palmar 21 neural 184 of cricoid 73, 76 superficial palmar 21 Areas, cortical 83 auditary 65, 68, 73 brocas 83 motor 71, 83, 84 sensory 84 visual 84 Arteries 21, 26, 31 anterior tibial 31 aorta 52, 53 abdominal 52 arch of 37 ascending 37 descending thoracic 38 axillary 12 brachial 10,11 brachialcephalic 44 coeliac 53 common carotid 38, 73, 79 common iliac 55 deep palmar arch 21 dorsalis pedis 33 external carotid 79 external iliac 53, 55 facial 69, 72 femoral 24-27 hepatic 53, 59 inferior epigastric 54 inferior gluteal 26 inferior mesenteric 54 internal carotid 79 internal thoracic 39 lateral plantar 33 left gastric 54 median plane 39 middle meningeal 71 popliteal 27-31 posterior tibial 31, 32 radial 15, 16 renal 54 splenic 53, 59 subclavian 39, 79, 80 superficial palmar arch 21 superior gluteal 26 superior mesenteric 54 ulnar 11, 14, 16 Asterion 73 Atrium 143 left 143 right 143 Axillary fold, anterior Biliary apparatus 59 Bladder 51,61 gall 51,61 urinary 18 Bones (also see individual) 103 sesamoid 103 supernumerary 103 Borders 35 anterior, of tibia 35 of brain 89 of heart 36 of liver 51 Box, Anatomical snuff 15-17 Bowel 164 large, radiology of 171 small, radiology of 171 Breast 7, 138 Bregma 65 Brocas area 83 Bronchogram 145, 148-150 anterior 156 lateral 150, 152, 154 Bronchography 145 technique 145 207 208 Surface and Radiological Anatomy Bronchus 48, 141, 147, 152 left 54, 159, 161 right 155, 156 Caecum 58 Calcaneum 105, 106 Calyces 171, 173 Canal 52 inguinal 52, 54 pyloric 162, 166, 168 Cardiovascular shadow 136 Carpal bones 95, 106 Cavity, glenoid 91 Centre 84 motor speech 71, 83 Cerebrum borders of 82 inferolateral 93 superciliary 81 superomedial 81 Cholecystography 164, 166 intravenous 166, 169, 171 oral 164, 166 Clavicle 91 Coccyx 188 Colon 58,59 ascending 61, 164, 171 decending 66,175 transverse 59, 168, 171 Computed tomography 195, 204 Condyle 27 lateral femoral 27, 99 mandibular 68, 69, 179 medial femoral 27 tibial 31 Cranial fossa anterior 177 Crest 23 iliac 23, 38, 49, 50 pubic 52-55 of scapular spine of trapezium 19 Cuboid 104, 106 Cuneiform bone 102 medial 36 Digestive system 56 Digital subtraction 204, 205 angiography 204, 205 Discs, intervertebral 182 Duct 59 common bile 59 parotid (Stenson's) 68, 69 thoracic 40 Duodenum 57, 61, 156, 162 Ear, external 176 Echocardiography 204 Eminence, intercondylar of tibia 99 Epicondyle 106 lateral of humerus lateral of femur 26, 100, 106 medial of humerus 6,107 medial of femur 22 Femur 26 condyles 26 greater trochanter of 23, 26 head of 107 intercondylar notch of 100 lateral epicondyle of 27, 111 lesser trochanter of 97 medial epicondyle of 27, 111 neck of 97 Fibula 99, 101, 104 head of 107 lower end of 115 neck of 28 styloid process 96, 99 Fissures of lungs 43, 44 Flexure 57, 59, 155, 162, 164 duodenojejunal 162 hepatic 59, 164 splenic 59, 164 Fold, anterior axillary Foramina, sacral 188 Fossa 177, 179 anterior cranial 177 coronoid 93, 94 nasal 179 olecranon 93, 94 pituitary 69, 177, 179 popliteal 24 Ganglion 70, 72, 78 inferior cervical 78 middle cervical 78 superior cervical 78 trigeminal 70, 72 Gastrointestinal tract 89, 155 Genital tract, female 173 Gland breast parotid 68, 69 pituitary 69 submandibular 69 suprarenals 64 tonsil 68, 69 thyroid 73-75 Gonion 64 Groove 91 bicipital 91 middle meningeal 177 transverse sinus 179 Index Hamate, hook of 13, 17 Head of 97 femur 97 fibula 27, 28, 30, 99 humerus 91 metacarpals 96 radius 93, 94 Heart 36,41 apex beat of 36 borders of 35, 42, 184 orifices of 41 shadow of 138, 141 sternocostal surface of 42 Hilar region 138 Hilar shadows 138 Humerus 91 capitulum of 93, 94 epicondyles of 94 fossae of 93 head of 91, 93 neck of, anatomical 97 ridges of, supracondylar 94 trochlea of 93 tuberosities of 5, 103, 105 Hyoid, body of 72 Hysterosalpingogram 173 Hysterosalpingography 173 Inguinal ligament 24 Inion 73 Intestine, mesentery of small 58 Isthmus of thyroid 73 Joint 33,90 acromioclavicular 90 calcaneocuboid 33 elbow 8,93 hip 23, 96,98 intertarsal 102 knee 28, 30, 105 metacarpophalangeal 19 metatarsophalangeal 33 mid-tarsal 33 radio-carpal 96 sacroiliac 155, 171 shoulder talonavicular 33 tarsometatarsal 33 wrist 19, 20 xiphisternal 38 Kidneys 61 anterior aspect 62 posterior aspect 62 radiographic appearance 136, 153, 155 Lambda 65, 71 Laminae 182 Landmarks palpable visible Laryngeal prominence 73, 74 Ligament, inguinal 23 midpoint of 23 Line 23 Nelaton's 23 Reid's base 66 Shenton's 99 spinotrochanteric 26 Linea 49 alba 49 semilunaris 49, 59 Liver 50, 60 Lumbarisation 188 Lungs 42-45 apex of 38 borders 42, 43, 45 bronchi of, right 54, 158, 161 bronchi of left 54, 159, 161 fields of 136, 138, 139, 141 fissures of 43, 44 lobes of 43 root of 45 Magenblase 155 Magnetic resonance imaging 201 Malleolus 26 lateral 26 medial 26 Margin 36,37 subcostal 36, 37 Mastoid 177, 179 air cells 177, 179 process 177, 179, 184 Meatus, auditary 177 Mesentery of small intestine 58 Mesocolon, pelvic 58 Metacarpals 96, 107 Metatarsals 103, 107 Muscles 4, 14, 37 biceps brachii deltoid diaphragm 141, 143, 148, 155 flexor carpiradialis 13, 14, 16, 17 flexor carpiulnaris 13, 16-18 palmaris longus 18 pectoralis major psoas 155 scalenus anterior 75 sternomastoid 75-77, 79, 80 triceps Nasion 65, 69, 71 Navicular 102, 103 Neck, median line of 73 209 210 Surface and Radiological Anatomy Nerve 75 accessory 77 anterior cutaneous, of neck 75 axillary common peroneal 27, 28 deep peroneal 28 facial 69 femoral 24, 25 glossopharyngeal 77 great auricular 76 hypoglossal 77 inferior alveolar 69 infra-orbital 70 lateral plantar 33 lesser occipital 76 lingual 69 mandibular 69 maxillary 70 medial plantar 33 median 9, 14 musculocutaneous 10 phrenic 76 posterior interosseous 15 radial 10 sciatic 24 superficial peroneal 29 supraclavicular 86 tibial 29,30 ulnar 16 vagus 78 Nipple 36,37 Notch 70, 73, 100 intercondylar, of femur 100 supra-orbital 67, 70 suprasternal 37 Occipital prostuberance, external 64 Odontoid process 184 Oesophageogram 148, 151 Oesophagus 47, 148, 152 Olecranon 93,94 apex posterior surface Opening 23, 26 saphenous 23, 26 of vermiform appendix 58 Orifice 41 aortic, of heart 41 ileocolic 58 mitral, of heart 41 pulmonary, of heart 41 tricuspid of heart 41 Orbit 178, 179 Ossification, sequence of 128 at ankle 128 at elbow 111 at at at at at at foot 128 hand 115 hip 119 knee 124 shoulder 108 wrist 115 Palate, hard 177 Pancreas 61 Patella 100 Pedicles 182, 184 of vertebrae 184, 188 vascular 141, 143 Petrous temporal 177, 179 Phalanges 107, 115 foot 103 hand 96 Pineal body 179 Pisiform 20 Planes 50 lateral vertical 50 median vertical 50 subcostal 52 transpyloric 51, 52 transtubercular 52 Pleural reflection, lines of 45 cervical 46-48 costo-diaphragmatic 44, 46 Plexus 75 brachial 75 cervical 75 Point 49 highest of iliac crest 49 McBurney's 49 midinguinal 26 pre-auricular 70, 71 Pole, temporal, of brain 81 Process 44, 65 anterior clinoid 177 condyloid, of mandible 64 coracoid 5, 90 coronoid 94 mastoid 73 olecranon 106 odontoid 184 posterior clinoid 179 styloid, of radius 96 styloid, of ulna 96 transverse of atlas 78 protuberance 83 external occipital 73 mental 65, 69 Pterion 66,67 Pyelogram 169, 171 ascending 171 descending 168 Index Radiographic appearances 135 abdomen 153 ankle 101,103 appendix 164 biliary tract 164 bronchogram 145, 148-150 chest 136, 138, 139, 145, 152 cholecystogram 166, 167 colon 164 coccyx 153, 176, 188 duodenum 156, 158, 160 elbow 93,94 foot 102, 103 genital tract, female 173 hand 95 hip 96 hysterosalpingogram 173, 174 ileum 162, 163 jejunum 163 knee 99, 100, 105 oesophageogram 148, 151 pelvis, female 172 pyelogram 169-172 sacrum 184, 188 shoulder 91,92 skeleton 89,90 skull 177, 178, 181 stomach 156, 158-162 thorax 138, 140, 142, 144 urinary tract 169 vertebral column 182, 195, 196 wrist 95 Radiograph 88 standard views 88 types 89 Radio-isotope 205 imaging 205 Radius 13 dorsal tubercle of 13 head of 7, 104 lower end of 14 styloid process of 14, 96 tuberosity 93 Rectum 164 Retinaculum 20 extensor, of hand 20 flexor, of hand 20 flexor, of foot 32 inferior extensor 35 superior extensor 35 Ribs 37,139 Root of 45 lungs 45 mesentery of small intestine 58 Sacralisation 187 Scaphoid, tubercle of 14 Scapula 136, 139 coracoid process of 5, 91 glenoid cavity of 91 inferior angle of 91 superior angle 91 Sinuses, air 179 frontal 179 maxillary 179 sphenoidal 179 Sinuses, venous 72 cavernous 72 sigmoid 72 superior sagittal 72 transverse 73 Space 140 retrocardiac 141, 152 retrosternal 139, 141 Sphenoid, wings of 179 Spines 50, 184 anterior superior iliac 22, 23, 26, 49, 50 cervical 73, 182 lumbar 184, 187 posterior superior iliac 24, 26, 50 second sacral 50 thoracic 43, 184, 186 Spleen 63 Stomach 56, 57 Sulcus 82 central (Rolando) 82 lateral 82 parieto-occipital 83 postcentral 82 precentral 82 superior temporal 82 Superior vena cava 41, 136 Suprarenals 61, 62 Sustentaculum tali 32 Sternum 141 Sutures 65 coronal 177, 179 fronto-zygomatic 65, 66 lambdoid 177, 179 sagittal 179 Symphysis pubis 23, 50 Synovial sheath hand 21 of common flexors of digits 21 of index, middle and ring fingers 21 Tables, inner and outer 179 Talus 101, 103 head of 32 Tarsal 103, 106 Temporal, petrous 177, 179 Tendon bicep flexor carpiradialis 13, 17 flexor carpi ulnaris 13, 17 palmaris longus 13, 18 211 212 Surface and Radiological Anatomy Tibia 27 condyles of 27 intercondylar eminence of 100 lower end of 101, 104 malleolus of 27, 29 medial surface of 27 Tip of acromion Thyroid 74-76, 79 Trachea 48, 73 first ring of 73 Tract 155, 164, 169, 173 biliary 164 gastrointestinal 155 genital, female 173 urinary 169 Trapezium, crest of 13, 19 Triangle 21, 143 aortic 143 Bryant's 21 Trochanter of femur 23 greater 23, 25, 97, 99 lesser 97 Trunk 39, 143, 199 pulmonary 39, 40, 143, 199 sympathetic 78 Tube uterine 173 Tubercle 13, 14, 22 adductor 22 base 5th metatarsal 32 carotid 73 conoid 90 dorsal, of radius 13, 15 of iliac crest 49 of scaphoid 13, 14 peroneal 31 pubic 50, 52, 53 tibial 29 Tuberosity 32 greater, of humerus 6, 92 lesser, of humerus of ischium 23 of navicular 32, 33 of radius 93 Ulna 93,96 coronoid process 93 head of 10 olecranon process of 93 posterior border of 14 styloid process of 14, 96, 99 Ultrasonography 200 Umbilicus 49-53 Ureters 62,63 pelvis of 171, 173 Urinary tract 169 Uterus 173, 175 Vein 72,80 anterior facial 72 axillary 12 basilic 12 brachiocephalic left 40 brachiocephalic right 40 cephalic 11 common iliac 53, 55 external iliac 53, 55 external jugular 80 femoral 27 internal jugular 80 long sphenous 27 Vena cava 41, 55 inferior 55 superior 41 Vertebra, bodies 181, 184 Window 143 aortic 143 prevertebral 141 Xiphisternum 38 X-rays 87 position of 87 properties of 88 Surface and Radiological ANATOMY Third Edition This thoroughly revised edition of t h e popular book features diagrams of surface a n a t o m y in colour since colour captures a reality that is m o r e consistent w i t h t h e m o d e of learning and is an increasingly i m p o r t a n t e l e m e n t for most of the students today In a d d i t i o n , full labelling of the figures has been d o n e for better understanding of t h e a n a t o m i c details N e w digital X-ray plates, ultrasonographs, c o m p u t e r i s e d axial t o m o g r a p h s and M R I scans have been included to bring in a t o u c h of their clarity The n e w imaging techniques have replaced contrast radiographic techniques like bronchography and cholecystography Ultrasonography of hepatobiliary system is m o r e sensitive than cholecystography in detecting small stones and biliary sludge Contrast radiographs have their a n a t o m i c a l value to t h e student so chapters dealing w i t h these have been retained The text retains its essential essence and easy a p p r o a c h w h i c h the students have liked in this book over t w o decades It makes an ideal t e x t b o o k for t h e medical students to learn applied clinical and diagnostic aspects of a n a t o m y A Halim is former Professor and Head, Department of Anatomy, King George's Medical College, Lucknow Prof Halim completed his graduation and postgraduation at King George's Medical College with honors in anatomy, pharmacology and pathology He was awarded "The Best Student of Anatomy" gold medal during his preclinical years and later on had a brilliant academic record He taught anatomy with equal distinction for 38 years to undergraduate, postgraduate and dental students in his alma mater Prof Halim attended W H O sponsored National Course on Educational Science at JIPMER, Pondicherry, and was awarded W H O fellowship to attend a Course on Medical Education at the Centre for Medical Education, University of Dundee, Scotland and UK He visited the medical schools at Dundee, Edinborough, St Adrews, London, Nottingham and Southampton to apprise himself of the new trends in the teaching of anatomy He is Fellow of the British Association of Clinical Anatomists, Fellow of the International Medical Sciences Academy, and a member of the Academic Council of CSM Medical University (previously King George's Medical University), Lucknow Apart from this book, Prof Halim has written several books, viz Human Anatomy: Regional and Clinical for MBBS students, Anatomy of Head and Neck for BDS students, Anatomy of Female Pelvis and Breast for students of obstetrics and gynecology and Textbook of Human Histology These are being widely prescribed in medical and dental colleges in India ISBN : 978-81-239-1952-2 CBS CBS Publishers & Distributors Pvt Ltd 4819/XI, Prahlad Street, 24Ansari Road, Daryaganj, New Delhi 110 002, India Website: www.cbspd.com E-mail: cbspubs@airtelmail.in; delhi@cbspd.com New Delhi | Bengaluru | Pune j Kochi | Chennai Mumbai I Kolkata I Hyderabad I Patna I Mariipa! ^ i a o _u t j j i j c: t: ... 10" 1 02 10° 10 '2 10- - Cosmic rays Gamma rays X-rays - Ultraviolet - Visible • Infrared • Radiowaves • Electrical waves The study of anatomy by using X-rays is referred to as Radiological Anatomy. .. absorb or reflect light 87 88 Radiological Anatomy Properties of X-rays i Penetrating effect: The penetration of a beam of X-rays is limited partly by scattering and partly by absorption Substances... an object and an exposure made, the translucent parts allow the X-rays to pass through, so that these parts appear dark on the developed film The dense parts absorb the X-rays, either partially