Non contrast radiography

UNIT 1:-

Clinical indications, contraindications, and patient preparation are essential

considerations in various medical procedures and interventions. Let’s explore these
concepts in more detail:

1:- Clinical Indications:

Clinical indications refer to the reasons or medical conditions for which a specific
procedure or intervention is recommended. These indications are based on clinical
assessment, diagnostic tests, medical history, and the patient’s symptoms. Examples
of clinical indications include:

• Diagnostic Imaging:

Indications for X-rays, CT scans, MRI, ultrasound, etc., based on suspected conditions
such as fractures, tumors, infections, or internal injuries.

• Laboratory Tests:

Indications for blood tests, urine tests, genetic tests, etc., to assess various parameters
like blood cell counts, hormone levels, genetic disorders, infections, and organ
function.

• Surgical Procedures:

Indications for surgeries such as appendectomy, joint replacement, organ

transplantation, etc., based on medical necessity to treat conditions like appendicitis,
arthritis, organ failure, etc.

• Medication Prescriptions:

Indications for medications like antibiotics, antihypertensive, painkillers, etc., based on

diagnosed conditions such as infections, hypertension, pain, etc

2:-Contraindications:

Contraindications are specific factors or conditions that make a particular procedure or

intervention inappropriate or potentially harmful for a patient. It is crucial to identify
contraindications to ensure patient safety and prevent adverse outcomes. Examples of
contraindications include:

• Medical Conditions:
Contraindications based on medical conditions such as allergies, pregnancy, heart
disease, liver or kidney failure, bleeding disorders, etc., that may pose risks during
certain procedures or with specific medications.

• Medication Interactions:

Contraindications related to potential interactions between medications, such as

combining drugs that may lead to adverse reactions or reduced efficacy.

• Allergies and Sensitivities:

Contraindications due to known allergies or sensitivities to medications, contrast

agents, anesthesia, etc., which can cause allergic reactions or anaphylaxis.

• Physical Limitations:

Contraindications based on physical limitations, mobility issues, or anatomical factors

that may affect the safety or feasibility of a procedure or intervention

3:- Patient Preparation:

Patient preparation involves specific steps and considerations to ensure that patients
are adequately informed, physically prepared, and emotionally ready for procedures or
interventions. This may include:

• Education and Informed Consent:

Providing detailed information to patients about the procedure, potential risks and
benefits, alternatives, post-procedure care, and obtaining informed consent.

• Medical History and Assessment:

Conducting a thorough medical history review, physical examination, and pre-

procedure assessments to identify any contraindications, allergies, or risk factors.

• Pre-procedure Instructions:

Providing instructions to patients regarding fasting, medication adjustments, hydration,

hygiene practices, clothing, and any specific preparations required for the procedure.

• Anaesthesia and Sedation:

If applicable, discussing anesthesia or sedation options, potential side effects, fasting

requirements, and post-anesthesia care instructions.

• Psychological Support:
Addressing patient anxiety, concerns, and providing emotional support through
counseling, relaxation techniques, or involving mental health professionals if needed.

UNIT 1:-

Radiographic projections abdomen soft tissue:-

Radiographic projections for soft tissue radiography of the abdomen involve specific
imaging techniques and positions to visualize internal organs, soft tissues, and
structures within the abdominal cavity. Here are commonly used radiographic
projections for abdominal soft tissue imaging:

1:- Supine Abdominal Radiograph:

• Positioning: The patient lies flat on their back (supine position) on the X-ray table
with arms extended by their sides.
• Purpose: This projection is used to assess the overall abdominal anatomy,
including the liver, spleen, kidneys, gastrointestinal tract, and soft tissue
structures.
• Collimation: The X-ray beam is centered at the level of the iliac crest, covering
the entire abdomen from the diaphragm to the pelvis.
• Marker: Anatomic markers indicating patient’s right and left sides are used for
orientation.

2:- Erect Abdominal Radiograph:

• Positioning: The patient stands upright (erect position) against the X-ray receptor
with arms raised above the head or resting on a support.
• *Purpose: This projection assesses the abdominal contents in the weight-
bearing position, which can reveal changes in organ position, air-fluid levels, and
the presence of free air (pneumoperitoneum).
• Collimation: The X-ray beam covers the entire abdomen from the diaphragm to
the pubic symphysis.
• Marker: Anatomic markers indicating patient’s right and left sides are used for
orientation.

3:- Decubitus Abdominal Radiograph:

• Positioning: The patient lies on their side (right or left lateral decubitus position)
on the X-ray table with arms positioned comfortably.
• Purpose: This projection is used to evaluate for free air or fluid within the
abdominal cavity, particularly around the liver and spleen.
• Collimation: The X-ray beam is centered over the area of interest, typically the
upper abdomen to visualize the diaphragm, liver, and spleen.
 • Marker: Anatomic markers indicating patient’s right or left side and decubitus
position are used for orientation.

4:-Oblique Abdominal Radiograph:

• Positioning: The patient is positioned in a semi-lateral oblique position, usually

30-45 degrees from the frontal plane, with the side of interest closer to the X-ray
receptor.
• Purpose: Oblique views provide additional visualization of abdominal structures,
especially the kidneys, ureters, and retroperitoneal structures.
• Collimation: The X-ray beam is centered over the area of interest, such as the
kidneys and lower ribs.
• Marker: Anatomic markers indicating patient’s right or left side and oblique
position are used for orientation

UNIT 2:-

Radiation protection and timing:-

Radiation protection involves various strategies and measures aimed at minimizing

the risks associated with exposure to ionizing radiation. Timing plays a crucial role in
radiation protection, especially concerning the timing of exposure, duration of
exposure, and timing of procedures involving radiation. Here are key aspects of
radiation protection related to timing:

#Timing of Exposure:

1:- Justification:
• The timing of radiation exposure should be justified based on medical necessity
and the potential benefits outweighing the risks.
• Healthcare professionals should ensure that radiological procedures are only
performed when necessary and when the information obtained will directly
impact patient management or diagnosis.
2:-Optimization (ALARA Principle):
• As Low As Reasonably Achievable (ALARA) is a guiding principle in radiation
protection that emphasizes minimizing radiation doses to patients, healthcare
workers, and the public.
• Timing of exposure should be optimized to use the lowest radiation dose
necessary to achieve the desired diagnostic or therapeutic outcome.
1:- Duration of Exposure:
Pulse Technique:
• In radiographic imaging, timing can refer to the duration of exposure. Techniques
such as pulse or intermittent exposures help reduce overall radiation dose by
limiting exposure time.
• Using pulse techniques during fluoroscopy or dynamic imaging minimizes
radiation exposure while capturing essential diagnostic information.
2:-Real-Time Monitoring:
• Real-time monitoring of radiation dose rates during procedures allows
healthcare providers to adjust exposure parameters and minimize unnecessary
exposure.
• Continuous monitoring helps ensure that radiation doses remain within safe
limits and that ALARA principles are followed.
1:-Timing of Procedures:
• Patient Scheduling:
Scheduling radiological procedures should consider factors such as patient age,
condition, pregnancy status, and the urgency of the procedure.
• Pregnant patients or those of reproductive age may require special consideration
to minimize fetal radiation exposure, including scheduling procedures outside of
sensitive gestational periods when feasible.
2:- Pediatric Imaging:
• Timing of pediatric imaging procedures should account for the child’s age,
weight, and ability to cooperate during the exam.
• Sedation or anesthesia may be used to facilitate imaging in young children,
reducing motion artifacts and the need for repeat exposures

#- Timely Reporting and Communication:

1:- Radiation Dose Reporting:

• Healthcare facilities should provide timely and accurate reports of radiation
doses received by patients during procedures, including cumulative doses and
exposure parameters.
• Patients and referring clinicians should be informed promptly of radiation doses
and any relevant safety information.

2:- Education and Training:

• Timely education and training programs for healthcare professionals on radiation

protection, dose optimization, and ALARA principles contribute to safe practices
and effective radiation management.
• Continuous education ensures that healthcare providers stay updated on
advancements in radiation technology and safety protocols.

UNIT 3:-
 Normal anatomy on radiographic film:-

Normal anatomy on radiographic films refers to the expected appearance of

various anatomical structures and tissues in X-ray images, which serve as
reference points for interpreting images and detecting abnormalities. When
assessing normal anatomy on radiographic films, it’s important to
understand the expected appearance of bones, soft tissues, organs, and
other structures.

• Bones:
1:- Long Bones: Long bones, such as the femur, humerus, radius, and ulna,
appear as solid, dense structures with a cortical bone layer surrounding a
marrow cavity.
2:- Vertebrae: Vertebrae show characteristic bony structures, including vertebral
bodies, neural arches, spinous processes, transverse processes, and
intervertebral foramina.
3:- Skull: The skull displays various cranial bones (frontal, parietal, temporal,
occipital) and facial bones (maxilla, mandible, nasal bones) with distinct sutures
and sinuses.

• Soft Tissues and Organs:

1:-Lungs: The lungs are visible as radiolucent (dark) areas with vascular
markings, pleural spaces, and diaphragmatic domes.
2:-Heart and Mediastinum: The heart appears as a mediastinal structure with
cardiac silhouette, great vessels (aorta, pulmonary arteries, vena cavae), and
thymus gland in pediatric patients.
3:-Abdomen: Abdominal films show abdominal organs such as the liver, spleen,
kidneys, stomach, intestines, and urinary bladder with characteristic densities
and outlines.
4:- Muscles and Soft Tissues: Muscles, soft tissues, and subcutaneous fat layers
contribute to the overall soft tissue shadow, with variations in density and
visibility depending on body habitus and positioning

• Foreign Body Localization:

Localization of foreign bodies in radiographic films involves identifying and
precisely locating objects or materials that are not normally present within the
body. Additional techniques and considerations for foreign body localization
include:
 1:- Metallic Foreign Bodies: Metallic objects, such as bullets, fragments, or
swallowed objects, appear as dense opacities with sharp edges and artifacts
(beam hardening).
2:- Soft Tissue Foreign Bodies: Non-metallic foreign bodies, such as wood, glass,
plastic, or organic materials, may require special imaging techniques like
ultrasound, CT, or MRI for visualization
3:- Localization Markers: Radiopaque markers or clips may be used to mark
suspected areas of foreign bodies for precise localization and surgical planning.
4:- Localization Views: Additional imaging views, such as orthogonal
(perpendicular) views or oblique views, may be obtained to better localize
foreign bodies in three-dimensional space.
5:- Dynamic Imaging: Fluoroscopy or real-time imaging allows for dynamic
visualization of moving foreign bodies, such as swallowed objects or airway
obstructions.

• Additional Techniques:

1:-Contrast Studies: Contrast media, such as iodinated contrast for

gastrointestinal (GI) studies or intravenous (IV) contrast for vascular studies,
enhance visibility of structures and aid in diagnosing conditions like bowel
obstructions, tumors, or vascular abnormalities.

2:-Stress Imaging: Stress radiography involves applying stress or loading to joints

(e.g., weight-bearing for lower extremities) to evaluate joint stability, ligamentous
injuries, or fractures.

3:- Tomography: Tomographic imaging techniques, such as CT scans with

reconstruction algorithms or specialized tomographic X-ray units, provide detailed
cross-sectional images by reducing superimposed structures.

4:- Digital Radiography: Digital radiographic systems offer advanced image processing,
enhancement tools, and image manipulation capabilities for improved visualization and
analysis

UNIT 3:-

Identification and differentiation of various images:-

Identification and differentiation of various images in radiology involve recognizing

specific anatomical structures, abnormalities, pathologies, and imaging
modalities. Here’s a guide to identifying and distinguishing different types of
radiographic images

1:- Radiographs (X-rays):

Identification:

• Bones: Long bones, vertebrae, ribs, skull, pelvis, and joints with cortical bone,
trabecular bone, growth plates (epiphyses), and joint spaces.
• Soft Tissues: Lung fields, heart silhouette, mediastinal structures, abdominal
organs, soft tissue densities, and foreign bodies.

Differentiation:

• AP (Anteroposterior) vs. PA (Posteroanterior): Direction of X-ray beam and

positioning of patient (front to back or back to front).
• Lateral vs. Oblique Views: Side-to-side orientation or angled views for better
visualization of specific structures.
• Weight-Bearing Views: Assessing joints and spine under load to detect fractures,
joint space narrowing, or instability.
• Pathologies: Fractures, dislocations, arthritis, pneumonia, pneumothorax,
pleural effusion, bowel obstruction, foreign bodies, and calcifications.

2:- Computed Tomography (CT):

Identification:

• Cross-sectional images (slices) of body parts with varying densities: air (black),
soft tissues (gray), bones (white).
• Multiplanar Reformats (MPR) and 3D reconstructions for detailed visualization.

Differentiation:

• Contrast-Enhanced CT: IV contrast for vascular studies, oral or rectal contrast for
GI studies, highlighting blood vessels, organs, tumors, or lesions.
• Non-Contrast CT: Evaluating structures without contrast, useful for detecting
hemorrhages,
calcifications, or bone fractures

Pathologies: Tumors, hemorrhages (e.g., intracranial hemorrhage), strokes, trauma,

fractures, infections, organ abnormalities, and masses

3:-Magnetic Resonance Imaging (MRI):

• Identification:
• Detailed images of soft tissues, organs, and vascular structures using magnetic
fields and radio waves.
• T1-weighted (anatomical details), T2-weighted (fluid and edema), and contrast-
enhanced sequences.
• Differentiation:
• Contrast-Enhanced MRI: Gadolinium-based contrast agents highlighting blood
vessels, tumors, or areas of inflammation.
• Functional MRI (fMRI): Assessing brain function, perfusion, and metabolic
activity.

4:- Ultrasound (Sonography):

Identification:

• Real-time images using sound waves to visualize soft tissues, organs, blood flow,
and fetal development.
• Doppler ultrasound for assessing blood flow velocity and direction.

Differentiation:

• Colour Doppler: Differentiating blood flow patterns (arterial vs. Venous) and
detecting vascular abnormalities.
• Translational vs. Transabdominal: Probe placement for pelvic or abdominal
imaging, including pregnancy evaluations.

4:- Nuclear Medicine:

Identification:

• Functional imaging using radiopharmaceuticals to assess organ function,

metabolism, and disease processes.
• Gamma cameras and PET scanners capturing radioactive tracer distribution.

Differentiation:

• PET-CT: Combining PET and CT images for anatomical localization and

metabolic activity assessment.
• SPECT (Single Photon Emission Computed Tomography): 3D imaging based
on gamma ray emissions.
6:- Mammography:
• Identification:
• X-ray imaging of breast tissue for breast cancer screening and diagnosis.
• Calcifications, masses, architectural distortions, and asymmetries in breast
tissue.
• Differentiation:
• Digital Mammography vs. Analog Mammography: Digital images for
computer analysis and manipulation.
• Screening Mammography vs. Diagnostic Mammography: Routine screening
vs. Focused evaluation of abnormalities.

UNIT 4:-

Radiation protection patient management care of patients during and after

examination:-

Radiation Protection:

• ALARA Principle: As Low As Reasonably Achievable (ALARA) principle is

fundamental in minimizing radiation exposure to patients, healthcare workers,
and the public.
• Optimization of Imaging Protocols: Use of appropriate imaging techniques,
equipment settings, and shielding to reduce radiation doses while maintaining
image quality.
• Lead Aprons and Shields: Providing lead aprons, thyroid shields, gonadal
shields, and protective eyewear to patients and personnel to minimize radiation
exposure to sensitive organs
• Pregnancy Considerations: Special precautions for pregnant patients, including
pregnancy tests, shielding, and alternative imaging modalities when possible to
avoid fetal exposure.
• Radiation Safety Training: Continuous education and training for healthcare
professionals on radiation safety protocols, dose monitoring, and risk
communication to patients.

• Patient Management:
• Informed Consent: Providing detailed information to patients about the
procedure, risks, benefits, alternatives, and obtaining informed consent prior to
the examination.
• Patient Screening: Assessing patient history, allergies, pregnancy status, and any
contraindications to imaging contrast agents or radiation exposure.
• Patient Comfort: Ensuring patient comfort during positioning, immobilization,
and image acquisition, especially for pediatric, elderly, or claustrophobic
patients.
• Communication: Clear communication with patients regarding instructions,
expectations, breathing techniques (for breath-hold imaging), and any
sensations during the procedure.
• Anxiety Management: Addressing patient anxiety and concerns through
reassurance, explanation of procedures, distraction techniques, and offering
support throughout the examination.
 • Care During Examination:
• Positioning and Immobilization: Proper positioning of patients and
immobilization devices to minimize motion artifacts and ensure accurate
imaging.
• Breathing Instructions: Providing clear instructions for breath-hold maneuvers or
controlled breathing during imaging to reduce blurring and improve image
quality.
• Monitoring: Continuous monitoring of patients during procedures, including vital
signs, comfort level, and responses to contrast agents or sedation if used.
• Injection Techniques: Skillful administration of contrast agents (if applicable),
ensuring appropriate dosage, injection rates, and monitoring for adverse
reactions.
• Radiation Safety Measures: Implementing radiation safety protocols,
collimation, exposure time optimization, and personnel distancing to minimize
radiation exposure to patients and staff

Care After Examination:

• Post-Procedure Instructions: Providing clear post-procedure instructions to
patients regarding any restrictions, medication usage, hydration, and follow-up
appointments.
• Adverse Reaction Management: Monitoring patients for potential adverse
reactions to contrast agents, sedation, or radiation exposure and providing
prompt medical intervention if needed.
• Patient Education: Educating patients about potential side effects, expected
recovery, imaging results (if available immediately), and any precautions to take
post-examination.
• Follow-Up Care: Arranging follow-up consultations, imaging studies, or referrals
as needed based on examination findings and patient care plans.
• Documentation: Accurate documentation of procedures, radiation doses,
contrast usage, patient responses, and any incidents or adverse events for
medical records and quality assurance purposes.

UNIT 4:-

Radiographer’s role in the team:-

The radiographer plays a crucial role in the healthcare team, especially in the field of
radiology and diagnostic imaging. Here are some key responsibilities and contributions
of radiographers within the healthcare team:
 1:-Patient Care and Safety:
• Ensuring patient comfort, safety, and well-being during imaging procedures.
• Following radiation safety protocols to minimize radiation exposure to patients,
staff, and the public.
• Educating patients about procedures, positioning requirements, and any
necessary preparations.

2:- Imaging Procedure Execution:

• Performing diagnostic imaging procedures such as X-rays, CT scans, MRI scans,

ultrasound, and nuclear medicine studies.

• Operating imaging equipment, positioning patients accurately, and obtaining

high-quality images for diagnostic interpretation.

• Collaborating with radiologists and other healthcare professionals to optimize

imaging protocols and techniques.

3:-Image Quality Assurance:

• Assessing image quality, ensuring proper exposure parameters, and identifying

and correcting technical issues that may affect image clarity.

• Maintaining equipment functionality, performing quality control tests, and

reporting equipment malfunctions or abnormalities.

4:-Collaboration and Communication:

• Collaborating effectively with radiologists, referring physicians, nurses, and other

healthcare team members to coordinate patient care and imaging priorities.

• Communicating clearly and accurately with patients regarding procedures,

instructions, and potential risks or side effects.