Standing full length X-ray for HTO - scannogram ? tips

Clement Joseph

4 May 202001:39

Summary

TLDRThis video provides essential tips for obtaining proper full-length standing x-rays of the lower limbs, crucial for planning osteotomies in early arthritis cases. It emphasizes the importance of accurate x-ray positioning, including using a 50-inch cassette and a 10-foot distance for the x-ray source. Key steps include rotating the lower limb to face the patella forward, attaching a metallic sphere for calibration, and ensuring no pelvic obliquity. Proper alignment is verified by specific anatomical markers, ensuring an accurate scan for successful surgical planning.

Takeaways

🏥 Importance of X-rays: X-rays are crucial for planning osteotomies in joint preservation for early arthritis.
📏 Proper Technique: A full-length standing x-ray of the lower limbs is essential for accurate planning.
📐 Correct Positioning: The patient should stand with the patella facing forwards and the limb internally rotated until the patella is aligned.
🔍 Equipment Use: A 50-inch cassette is used for capturing the full length of the lower limb.
📸 X-ray Source: The x-ray source should be kept at a distance of 10 feet for proper exposure.
🛡️ Exposure Level: The exposure should be similar to that used for hip or pelvic x-rays.
🔨 Marking Tool: A metallic sphere is attached around the lower thigh to provide a size reference in the x-ray.
🔍 Sphere Significance: The metal ball ensures a round shadow, aiding in calibration and avoiding misinterpretation from other shapes.
👨‍⚕️ Surgeon's Review: The surgeon must carefully study the x-ray to ensure proper technique was used and no errors are present.
⚠️ Check for Pelvic Obliquity: Rule out any pelvic obliquity, especially if caused by limb shortening, to ensure accurate assessment.
🦵 Limb Length Correction: If there is limb shortening, the shorter limb should be raised on planks to correct pelvic obliquity.
🧍‍♂️ Patella Positioning: The patella should be centrally positioned for a proper x-ray view.
🦿 Tibial and Fibular Alignment: The lateral border of the tibia should cross the widest part of the fibula, ensuring correct anatomical alignment.
🦴 Distal Femur View: The distal femur should be viewed orthogonally for accurate assessment in the x-ray.

Q & A

What is the main purpose of the video?
-The main purpose of the video is to provide tips on how to take a proper full-length standing X-ray of the lower limbs, which is crucial for planning osteotomies in joint preservation for early arthritis.
Why are osteotomies increasingly performed for joint preservation in early arthritis?
-Osteotomies are performed for joint preservation in early arthritis to delay or avoid the need for joint replacement surgery, thus maintaining the joint's function for a longer period.
What is the importance of X-rays in the planning of osteotomies?
-X-rays are vital in planning osteotomies because they provide the necessary images to assess the joint and bone conditions accurately, which in turn influences the quality and effectiveness of the surgical planning.
What is the significance of the patella facing forwards during the X-ray process?
-Having the patella facing forwards is important as it ensures the correct alignment and positioning of the lower limb during the X-ray, which is crucial for obtaining accurate and reliable images for surgical planning.
What is the role of a 50-inch cassette in obtaining full-length leg views?
-A 50-inch cassette is used to capture the entire length of the lower limb in a single X-ray image, providing a comprehensive view necessary for proper assessment and planning of osteotomies.
How should the patient stand for the X-ray to ensure proper positioning?
-The patient should stand with the patella facing forwards and internally rotate the lower limb until the patella is correctly positioned. This ensures that the X-ray captures the limb in its natural, anatomically correct alignment.
What is the recommended distance for the X-ray source during the procedure?
-The X-ray source should be kept at a distance of 10 feet from the patient to ensure proper exposure and image quality without overexposing the patient to radiation.
Why is attaching a metallic sphere around the lower thigh important in the X-ray process?
-Attaching a metallic sphere around the lower thigh helps in calibrating the size and dimensions of the bone, as the sphere always casts a round shadow that can be easily measured and compared on the X-ray image.
How can the metallic sphere be used for calibration in X-ray images?
-The metallic sphere, being a consistent size, can be calibrated in any imaging software or even on a tracing to provide a reference point for measuring bone dimensions and angles in the X-ray images.
What should the surgeon do after the X-ray is taken?
-The surgeon should study the X-ray to ensure it is taken properly, checking for correct pelvic alignment, central patella positioning, and proper overlap of the tibia and fibula, as well as an orthogonal view of the distal femur.
What is the significance of checking for pelvic obliquity in the X-ray?
-Checking for pelvic obliquity is important because it can indicate limb shortening or other alignment issues. If present, adjustments such as raising the shorter limb on planks may be necessary to correct the obliquity before proceeding with surgical planning.

Outlines

00:00

📸 Proper Full-Length Standing X-ray Techniques

This paragraph discusses the importance of taking accurate full-length standing X-rays for lower limbs, especially in the context of osteotomies for joint preservation in early arthritis. The process emphasizes the correct positioning of the patient, with the patella facing forward and the lower limb internally rotated. It also highlights the technical aspects of the X-ray setup, including the use of a 50-inch cassette, the distance of the X-ray source, and the exposure settings. Additionally, the paragraph introduces the use of a metallic sphere for calibration and the importance of checking for pelvic obliquity and proper alignment of the limbs in the X-ray.

Mindmap

Keywords

💡Full-length standing x-ray

A full-length standing x-ray is a radiographic imaging technique that captures the entire length of a patient's lower limbs while they are standing. This method is crucial for accurately assessing the alignment and length of the legs, which is essential in planning orthopedic surgeries such as osteotomies. In the video script, it is emphasized as the most important step in planning, highlighting its significance in joint preservation for early arthritis treatment.

💡Osteotomies

Osteotomies refer to surgical procedures where a bone is cut and then repositioned to change its alignment, often to relieve pressure on joints or to correct deformities. The script mentions that osteotomies are increasingly used for joint preservation in early arthritis, indicating a growing trend in orthopedic surgery to delay or avoid joint replacement.

💡Joint preservation

Joint preservation is a medical approach aimed at maintaining the function of a joint for as long as possible, often through surgical or non-surgical means, to delay the need for joint replacement. The script discusses osteotomies as a method of joint preservation, suggesting that this technique can help patients with early arthritis maintain joint health.

💡Arthritis

Arthritis is a medical condition characterized by inflammation and stiffness in the joints, which can lead to pain and reduced mobility. The script mentions early arthritis, indicating a focus on the early stages of the disease where joint preservation techniques like osteotomies can be particularly beneficial.

💡Patella

The patella, also known as the kneecap, is a small bone that protects the knee joint and improves the leverage of leg muscles. In the context of the video, the correct positioning of the patella is crucial for obtaining accurate x-rays, as it should be facing forwards with the lower limb internally rotated to ensure proper alignment.

💡Internal rotation

Internal rotation refers to the turning of a limb inward, towards the body's midline. The script specifies that the patient's lower limb should be internally rotated until the patella is facing forwards, which is a key step in achieving the correct scanner gram for osteotomy planning.

💡Metallic sphere

A metallic sphere, as mentioned in the script, is a calibration tool used in x-ray imaging to ensure the accuracy of the image. The sphere should be placed at the level of the bone entry posteriorly and is used to verify the orthogonality of the x-ray beam, which is important for precise surgical planning.

💡Orthogonal view

An orthogonal view in radiography refers to an image where the x-ray beam is perpendicular to the plane of the image receptor, resulting in an undistorted representation of the bone structure. The script emphasizes the importance of an orthogonal view of the distal femur for accurate surgical planning.

💡Pelvic obliquity

Pelvic obliquity is a condition where one side of the pelvis is higher than the other, which can be due to various reasons including limb length discrepancy. The script advises checking for and correcting pelvic obliquity in the x-ray, especially if it is due to limb shortening, to ensure the accuracy of the osteotomy planning.

💡Limb shortening

Limb shortening refers to a condition where one limb is shorter than the other, which can affect a person's gait and posture. The script mentions that if there is limb shortening, the shorter limb should be raised on planks during the x-ray to correct for pelvic obliquity, which is important for obtaining a proper standing long leg view.

💡Scanner gram

A scanner gram is a term that seems to be used in the script to refer to the x-ray image itself, specifically the full-length standing x-ray of the lower limbs. The script provides detailed steps on how to obtain a proper scanner gram, which is essential for the planning of osteotomies.

Highlights

Osteotomies are increasingly carried out for joint preservation in early arthritis.

The success of an osteotomy is as good as the planning, which heavily relies on proper x-rays.

The most important step in planning is to obtain proper standing long-leg views of both lower limbs.

A 50-inch cassette is used for full-length standing x-rays of the lower limbs.

The patient should stand with the patella facing forwards, achieved by internally rotating the lower limb.

The x-ray source is kept at a distance of 10 feet, with exposure settings similar to those used for hip or pelvic x-rays.

A metallic sphere is attached around the lower thigh at the level of the bone entry posteriorly to aid in calibration.

A 3 cm metal ball is recommended for calibration, which can be done using software or by tracing.

A sphere always casts a round shadow, unlike coins or rectangular objects that can produce distorted shadows.

Post-x-ray analysis is crucial; the surgeon should first ensure there is no pelvic obliquity.

If limb shortening is present, the shorter limb should be raised on planks to correct pelvic obliquity.

The patella should be centrally positioned in the x-ray.

The lateral border of the tibia should cross the fibula at its widest part for accurate imaging.

The tibia should overlap one-third of the fibula to ensure proper alignment.

The distal femur should have an orthogonal view in the x-ray.