Why is Radiology Important

The field of radiology was originally oriented on using X-ray radiation for imaging of the body. Current radiology is not limited to X-rays; it also uses magnetic fields, radiation and sound waves. Radiology can be used both for diagnostic purposes, as well as a form of treatment for some diseases.

Radiology is a medical specialty that uses imaging equipment to examine the human body for the purposes of diagnostics and to treat certain diseases. Radiology deals with such techniques as magnetic resonance imaging, computed tomography and ultrasound. Although historically limited to using X-rays for diagnostic purposes, radiology has expanded to using a variety technologies for diagnosis, treatment and guidance of other medical techniques.

TYPES OF GENERAL RADIOLOGY EXAMS:

GENERAL RADIOGRAPHY – ABDOMEN 2 VIEWS

PREPARATION: None required.

DESCRIPTION: Two full films of the abdomen taken to show the anatomy of the abdomen (general size and shape of liver, kidneys, spleen; any intra-abdominal calcifications, general abnormalities, fluid levels, abnormal gas patterns, etc.). Does not show function of organs, however. Function is determined by specialized studies of each individual organ.

PROCEDURE EXPLAINED: The patient will be asked to change into a gown, removing any garments containing buttons, snaps, hooks, zippers, etc. Usually, the first film is taken with the patient lying on his/her back on the x-ray table. Patient will be asked to hold their breath during the exposure. The second film is generally taken with the patient in an upright (standing) position. Again, it’s a “hold your breath” situation. If the patient cannot stand, the second film may be taken on the table with the patient lying up on his/her left side. A film is placed in front of the abdomen and the exposure is made by placing the x-ray tube behind the patient.

Approximately 15 – 20 minutes.

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GENERAL RADIOGRAPHY – ABDOMEN- KUB 1 VIEW

PREPARATION: None.

DESCRIPTION: One full film of the abdomen taken to show the general anatomy, most often for Kidneys, Ureters and Bladder (KUB). Frequently ordered as a follow-up to kidney studies to check location of a calcification as well as several other reasons.

PROCEDURE EXPLAINED: Patient will be asked to remove clothing containing buttons, snaps, zippers, hooks, etc. and put on a gown. Film is taken with patient lying on his/her back on the x-ray table. Suspend respiration during exposure.

TOTAL TIME REQUIRED: Approximately 15 minutes.

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GENERAL RADIOGRAPHY – AC JOINTS (ACROMIOCLAVICULAR)

PREPARATION REQUIRED: None.

DESCRIPTION: Two or more films taken to demonstrate dislocation, separation and function of the joints. The AC joints are in your shoulder area where the clavicle (collarbone) and the scapula (shoulder blade) meet.

PROCEDURE EXPLAINED: If necessary, patient will be asked to remove clothing containing hooks, metal strap adjusters, etc. and dress in a gown. There are many views that can be utilized to visualize the AC joints. The most common two are taken with the patient either standing with his/her back to a cassette for the first exposure. Then a second film is taken, same patient position, but with the x-ray tube angled up for a different view of the same area.

TOTAL TIME REQUIRED: Approximately 15 – 20 minutes.

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GENERAL RADIOGRAPHY – ANKLE 2 OR 3 VIEWS

PREPARATION REQUIRED: None.

DESCRIPTION: Two or three exposures taken to demonstrate the bones of the ankle (distal tibia & fibula, talus and calcaneus).

PROCEDURE EXPLAINED: Patient will be asked to remove shoe and sock of affected foot. The three most common views taken of the ankle are AP, Oblique and Lateral projections; the first two taken with the patient lying on his/her back on the x-ray table with affected foot extended straight out. A cassette is placed directly under the ankle and two exposures are made, one with the toes directed up straight towards the ceiling and the second with the foot turned in slightly towards the other leg. Patient is then asked to turn up on the affected side (e.g. if left ankle is injured he/she turns up on left side) so a side (lateral) view may be taken. These films are checked and, depending upon the suspected injury, other views may be required.

TOTAL TIME REQUIRED: Approximately 15 – 20 minutes.

DESCRIPTION: A series of films with and without x-ray dye to determine the existence of a tear in the muscle of a joint (or other abnormality).

PROCEDURE EXPLAINED: Preliminary ‘scout’ films are taken. The Radiologist will cleanse the area prior to inserting a needle into the joint. The area will first be numbed with local anesthetic. Once the needle is in place in the joint space, x-ray dye will be injected through tubing into the joint space and the needle is removed. X-rays are taken in various positions. The joint is then “exercised” and more films are taken “post exercise”.

TOTAL TIME REQUIRED: Approximately 1 hour.

GENERAL RADIOGRAPHY – BONE AGE

PREPARATION: None.

DESCRIPTION: An x-ray taken of the hands of a child to determine bone age.

PROCEDURE EXPLAINED: Hands are placed palm down on an x-ray plate and one exposure is made. The film is compared to those contained in a medical specialty book for evaluation of the joint spaces, etc.

TOTAL TIME REQUIRED: 15 minutes.

GENERAL RADIOGRAPHY – SPINE CERVICAL, 1 OR 2 VIEWS

PREPARATION: None.

DESCRIPTION: The cervical spine is the neck area and consists of 7 cervical vertebrae. Two view studies are generally taken to follow-up on surgical changes.

PROCEDURE EXPLAINED: The standard ‘two view’ spine consists of a frontal view (patient either lying on their back on the table or standing facing the x-ray tube) and a side view (lateral) always taken in the standing position.

TOTAL TIME REQUIRED: 15 minutes.

GENERAL RADIOGRAPHY – SPINE CERVICAL COMPLETE (NECK)

PREPARATION: None.

DESCRIPTION: The cervical spine (neck) consists of seven vertebral bodies. Radiographs are taken for the purpose of demonstrating degenerative changes (arthritis), diminished disc spaces, bony changes that cause impingement upon nerves, surgical changes, anatomical and pathological abnormalities, etc.

PROCEDURE EXPLAINED: A complete cervical x-ray study consists of five films taken with the patient in various positions. These films may be taken with the patient lying on the x-ray table or in a standing position, depending upon the Technologist’s preference. There is always a standing side view (lateral) taken. Two oblique films, with head tilted from side to side and an AP film (straight on) of the neck as well as an ‘open mouth’ view of the 2nd cervical vertebrae (odontoid process).

TOTAL TIME REQUIRED: 15 – 30 minutes.

GENERAL RADIOGRAPHY – CHEST FLUOROSCOPY

PREPARATION: None.

DESCRIPTION: A procedure that allows the Radiologist to observe the function of the diaphragms as the patient breathes. Also may be done to observe a specific area within a lung.

PROCEDURE EXPLAINED: The x-ray table is in an upright position with the patient standing in front of it. The fluoroscopy unit is in front of the patient. The Radiologist controls the fluoro time and asks the patient to turn from side to side and will give breathing instructions. He/she watches the area of concern on a monitor. Films may be taken of certain areas.

TOTAL TIME REQUIRED: About 15 minutes.

GENERAL RADIOGRAPHY – CHEST X-RAYS

PREPARATION REQUIRED: None

DESCRIPTIONS: Unless specifically ordered otherwise, a routine chest x-ray consists of two views; a PA and a Lateral. CHEST 1 VIEW: A PA view demonstrating the heart, lungs, diaphragms, etc. Or a special view requested by the physician, such as a Lordotic view to show the apices of the lungs. CHEST 2 VIEWS: The routine chest x-ray; a PA and Lateral. CHEST 3 VIEWS: Usually, a routine chest x-ray and one additional, special view. CHEST 4 VIEWS: Can be a combination of PA, Lateral and both obliques, for instance. Sometimes there is something seen on the initial chest film that is suspicious for artifact or the exact location must be determined. Hence, the additional views.

PROCEDURE EXPLAINED: The patient will be asked to remove clothing from the waist up and be given a gown to wear. Chest films are done in a standing position with the patient facing the x-ray plate and asked to take a very deep breath and hold it during the exposure. A side view is then done with the same breathing instructions. There are various other chest views with different patient positions required. The most important factor is that the patient take as deep a breath as possible for full visualization of the lungs.

TOTAL TIME REQUIRED: Approximately 15 minutes for a “standard” chest x-ray. More time may be needed if additional or special views are required.

GENERAL RADIOGRAPHY – CLAVICLE (COLLARBONE)

PREPARATION: None.

DESCRIPTION: X-rays of the clavicle to determine fracture or other abnormality.

PROCEDURE EXPLAINED: While the patient is lying on his/her back, two or more x-rays are taken of the clavicle.

TOTAL TIME REQUIRED: Approximately 15 minutes.

GENERAL RADIOGRAPHY – ELBOW

PREPARATION: None.

DESCRIPTION: A series of 3 or 4 x-rays taken of the elbow joint to determine the presence of fracture, dislocation or other abnormality. The elbow joint consists of three bones; ulna, radius and humerus.

PROCEDURE EXPLAINED: There are four common x-rays taken of the elbow joint 1) The arm is extended out with palm facing up. 2) Same as #1 but palm is facing down. 3) Arm in 90 degree angle with hand up on outer edge. 4) Point of elbow (olecranon process) extended out with hand brought back to shoulder.

TOTAL TIME REQUIRED: Depending upon degree of injury and patient’s ability to move, anywhere from 15 to 30 minutes.

GENERAL RADIOGRAPHY – FACIAL BONES

PREPARATION: None.

DESCRIPTION: A series of several x-rays taken to determine fracture, dislocation or other abnormality. There are 14 bones of the face that require various positions to image.

PROCEDURE EXPLAINED: Most often the films of the facial bones are taken with the patient lying on his/her stomach on the x-ray table. Depending upon the area of interest, several x-rays of that area will be taken and shown to the Radiologist.

TOTAL TIME REQUIRED: Approximately 30 minutes.

GENERAL RADIOGRAPHY – FEMUR (THIGH BONE)

PREPARATION: None.

DESCRIPTION: Two or more x-rays to show the femur in two planes (frontal and side).

PROCEDURE EXPLAINED: The entire femur must be demonstrated in two views. The first view is done with the patient lying on his/her back on the x-ray table, leg extended out straight, toes pointed up towards the ceiling. The lateral view is done with the patient turned up on his side with the unaffected leg forward of the one being x-rayed. Depending upon the size of the patient, additional films of the knee joint and hip joint may have to be taken on separate cassettes (film holders).

TOTAL TIME REQUIRED: Approximately 15 minutes.

GENERAL RADIOGRAPHY – FINGER

PREPARATION: None.

DESCRIPTION: A series of three views to demonstrate the bones and joint spaces of the finger.

PROCEDURE EXPLAINED: The hand is extended out straight, palm down. Area of exposure is limited to the digit of interest. A second exposure is made with the hand turned up slightly on its side. The last image is of the finger in a side view (lateral).

TOTAL TIME REQUIRED: 15 minutes.

GENERAL RADIOGRAPHY – FOOT

PREPARATION: None.

DESCRIPTION: A series of three or more x-rays to demonstrate the bones of the foot. To determine fracture or other bony abnormality.

PROCEDURE EXPLAINED: Patient is on x-ray table with knee bent and foot flat on x-ray cassette for the first film. Then the knee is turned in towards the other leg thereby turning the foot up on its’ inside edge slightly. The third view is of the foot on its’ outside edge completely (lateral view).

TOTAL TIME REQUIRED: 15 minutes.

GENERAL RADIOGRAPHY – FOREARM

PREPARATION: None. DESCRIPTION: Usually three x-rays to demonstrate the ulna and radius (forearm bones) including the wrist joint and elbow joint.

PROCEDURE EXPLAINED: Three films taken with the patient sitting on a chair next to the x-ray table. 1) Arm is extended out straight, palm facing up. 2) Same position with palm facing down. 3) Arm in 90 degree angle, hand up on outer edge (5th finger). To demonstrate fracture or other bony abnormality.

TOTAL TIME REQUIRED: 15 minutes.

GENERAL RADIOGRAPHY – HAND

PREPARATION: None.

DESCRIPTION: A series of three or more x-rays to depict the various bones of the hand, to include the wrist joint. To determine fracture, dislocation, foreign body or bony abnormality.

PROCEDURE EXPLAINED: Three views done on the x-ray table with the patient seated. 1) Entire hand palm down on x-ray cassette. 2) Hand slightly up on outside edge. 3) Side view with hand resting on outside edge.

TOTAL TIME REQUIRED: 15 minutes.

GENERAL RADIOGRAPHY – HIP: (Bilateral = both hips; Unilateral = one hip)

PREPARATION: None.

DESCRIPTION: Series of two or more x-rays of the hip joint to determine fracture, dislocation, pathology or bony abnormality.

PROCEDURE EXPLAINED:Patient lies on the x-ray table on his/her back, legs extended out straight, toes pointed in slightly towards each other. One film is taken of the entire pelvis that includes both hip joints. The second view is of the affected hip only. The knee of the affected leg is bent up and out slightly, creating a lateral view of the joint.

TOTAL TIME REQUIRED: Approximately 15 minutes.

GENERAL RADIOGRAPHY – HUMERUS (Upper arm)

PREPARATION: None.

DESCRIPTION: X-rays to demonstrate the upper arm, including the shoulder and elbow joints. Taken to determine fracture, dislocation or other abnormality.

PROCEDURE EXPLAINED: These films can be taken either with the patient on the x-ray table or standing up. One film is taken with the arm out straight, palm facing out. The other film is taken with the arm extended out away from the body, elbow bent (as if “making a muscle”). Special views may be necessary to determine dislocation.

TOTAL TIME REQUIRED: About 15 minutes.

REQUIRED LAB TESTS: Must have results of BUN and CREATININE at our office By 4:30 p.m. the day BEFORE the exam (if patient is under age 50 these labs are not required).

PREPARATION REQUIRED: The importance of having a thoroughly cleansed gastrointestinal tract cannot be overstressed. Even a small amount of intestinal debris can obscure pathology or mimic an abnormality. Please see the instructions for LIQUIPREP BOWEL EVACUANT KIT.

DESCRIPTION: An IVP is an x-ray study of the function of the kidneys, ureters and bladder. The kidneys are the organs that absorb fluid wasted from the blood system and excrete it via the ureters (tubes from the kidneys) to the bladder. This is a time study to assure that each kidney is functioning properly. An injection of “x-ray dye” is necessary to demonstrate the internal structures of the kidneys.

PROCEDURE EXPLAINED: The patient will be asked to remove clothing containing snaps, buttons, hooks, zippers, etc. and put on a patient gown. An explanation of the procedure will be given to the patient along with several questions asked specifically designed to assess allergies to x-ray “dye”. We utilize non-ionic contrast material. However, allergic reactions are not totally eliminated and a signed patient consent must be obtained prior to injection. Two preliminary “scout” films will be taken; the first will be a plain abdominal film of the patient while lying on his/her back on the x-ray table. This film gives an image of the abdomen as it appears without any contrast material. The second film is a “tomogram” which is a film that focuses on a particular level of the patient’s kidneys thereby “blurring” all other anatomy above and below that point. For that film, the x-ray tube will be moving in an arc from the foot end of the x-ray table towards the head end of the table. Page 4 After those films have been seen by the Radiologist, the Technologist will inject the contrast material into a vein in the patient’s arm. Immediately following that injection, the tomogram films are taken focusing at three different levels of the kidneys. Then five minute films are taken of the full abdomen to see how the total excretory system is functioning. The tomograms and the five minute film are taken with the patient lying on his/her back on the x-ray table. At ten minutes following the injection three more films are taken to assess function. The first film is a ‘flat on back’ film followed by two oblique views which require the patient to turn up slightly to the right for one film and then to the left for the other. All films are shown to the Radiologist IVP WITH NEPHRO.continued and, if no other special views are required, the patient is asked to empty his/her bladder in the restroom and a final film is taken of the patient standing to assess the location and remaining urine in the bladder.

TOTAL TIME REQUIRED: Approximately 45 minutes to 1 hour.

FOLLOW-UP INFORMATION FOR THE PATIENT: All the “x-ray dye” will probably have been excreted through your bladder prior to your leaving our office. There should be no latent affect from the injection. However, although they are extremely rare, delayed reactions have been documented. If you experience any difficulty breathing, hives, nausea, irritation at the injection site or other unexplained discomforts, please contact our nurse immediately (569-9745). If any of these conditions occur after office hours, you should go to the Emergency Room. Explain that you had x-rays of your kidneys and were injected with 100 cc’s of non-ionic Isovue contrast material.

GENERAL RADIOGRAPHY – KNEE

PREPARATION: None.

DESCRIPTION: Three or four views of the knee joint to demonstrate distal femur, proximal tibia & fibula and patella (knee cap).

PROCEDURE EXPLAINED: All films are taken with the patient lying on the x-ray table. 1). Leg extended straight out, toes pointing up towards ceiling. 2). Leg turned in slightly towards other leg (oblique). 3). Patient lying on affected knee side with opposite leg bent in front of the one being x-rayed. Affected knee bent slightly. And, if required, a special view of the knee cap.

TOTAL TIME REQUIRED: Approximately 15 minutes.

GENERAL RADIOGRAPHY – SPINE LUMBAR – 2 VIEWS
PREPARATION: None.
DESCRIPTION: The lumbar spine consists of the lowest five vertebral bodies, called “L1 through L5”. These vertebral bodies do most of the weight bearing for our bodies. They are x-rayed for possible fracture, misalignment, pathology or other bony abnormalities.
PROCEDURE EXPLAINED: A two-view spine is ordered to specifically view the spine in a frontal and side projection. The patient is lying on the x-ray table on his/her back for the first view, then up on the left side for the lateral view. Usually, a third film is taken of the 5th lumbar vertebrae which requires different penetration technique because of its’ location.

TOTAL TIME REQUIRED: About 15 minutes.

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GENERAL RADIOGRAPHY – SPINE LUMBAR- COMPLETE
PREPARATION: None.
DESCRIPTION: The Lumbar Spine consists of the lowest five vertebral bodies in our spine. They bear the most weight also. In order to adequately examine the lumbar spine, five views are required. The Lumbar Spine is x-rayed to evaluate degenerative changes (arthritis), scoliosis (curvature of the spine), malformation, mal-alignment, fractures due to trauma or pathology (osteoporosis) as well as other pathologic or bony abnormalities.
PROCEDURE EXPLAINED: The routine five views of the spine are taken with the patient lying on the x-ray table supine (on their back). The first film is taken with the patient lying straight on the table, the next two are taken with the patient turned to each side approximately 25 degrees and the final two films are taken with the patient lying on their left side.
TOTAL TIME REQUIRED: Approximately 20-30 minutes.

 

GENERAL RADIOGRAPHY – MANDIBLE (LOWER PORTION OF JAW)

PREPARATION: None.

DESCRIPTION: A series of x-rays taken to demonstrate the mandible, including the tempero-mandibular joints. Imaging for possible fracture or other bony abnormality.

PROCEDURE DESCRIBED: There are many ways to image the mandible and the area of injury will determine the films taken by the Technologist. Most films are taken with the patient lying on the x-ray table.

TOTAL TIME REQUIRED: About 30 minutes, depending upon the degree of difficulty and ability of patient to move into required positions.

GENERAL RADIOGRAPHY – MYELOGRAM

PREPARATION: Patient should not have any blood thinning agents for at least one week prior to Myelogram. These include prescription drugs, aspirin products or vitamin E.
DESCRIPTION: A study of the spinal column using a contrast agent injected into the spinal fluid for the determination of stenosis, etc.

PROCEDURE EXPLAINED: The patient lies on his/her stomach on the x-ray table. Following preliminary ‘scout’ films of the specific area of the spine to be examined, the Radiologist will cleanse the area over the spine and insert a needle into the spinal column under fluoroscopic control. A tube will be attached to the needle through which the x-ray dye will be injected into the spinal fluid. X-rays are then taken of the area of concern and the patient will have a CT Scan of the spine before being allowed to leave the office. Our Nurse will give the patient specific instructions for at-home care following the exam.

TOTAL TIME REQUIRED: At least two hours.

GENERAL RADIOGRAPHY – NASAL BONES

PREPARATION: None.

DESCRIPTION: Three or more films to demonstrate the nasal bones for determination of fracture or abnormality.

PROCEDURE EXPLAINED: At least one film will be taken in the standing position if there is a trauma injury. Two or more additional films will be taken with the head in different positions to properly image the nasal architecture.

TOTAL TIME REQUIRED: About 15 – 20 minutes.

GENERAL RADIOGRAPHY – ORBITS (BONES SURROUNDING THE EYES)

PREPARATION: None.

DESCRIPTION: Four or more films taken at different positions to image the bony architecture surrounding the eyes.

PROCEDURE EXPLAINED: Usually these films will be taken with the patient lying on the x-ray table (prone.on their stomach). Because of the bony complexity of the facial area, exacting positioning is necessary by the Technologist. Many different views can be taken depending upon the exact area of injury or abnormality.

TOTAL TIME REQUIRED: About 30 minutes.

GENERAL RADIOGRAPHY RIBS

PREPARATION: None.

DESCRIPTION: A series of films taken to image the ribs in their entirety on the side affected to demonstrate fracture or pathology.

PROCEDURE EXPLAINED: If patient has experienced trauma, a one-view chest x-ray is taken for possible pneumothorax (partial collapsed lung). Three or more films are taken with the patient lying on the x-ray table on their back. Usually, one is taken with patient flat, a second is taken in the same position of the lower (abdominal) ribs and a third is taken with the patient turned up to one side or the other depending upon the location of the injury.

TOTAL TIME REQUIRED: 15 to 30 minutes.

GENERAL RADIOGRAPHY – SCAPULA (Shoulder Blade)

PREPARATION: None.

DESCRIPTION: Two or more x-rays to demonstrate the scapula for possible fracture or other bony abnormality.

PROCEDURE EXPLAINED:Usually, for ease of positioning and patient comfort, these films are taken with the patient standing. A film is taken with the patient’s back against the film surface. A second film is taken with the affected scapula rolled away from the film surface. There are other views designed to demonstrate specific areas of the scapula and will be used depending upon the area of concern.

TOTAL TIME REQUIRED: 15 minutes.

GENERAL RADIOGRAPHY – SHOULDER

PREPARATION: None.

DESCRIPTION: The shoulder joint consists of the upper humerus, clavicle (collar bone) and scapula (shoulder blade). Films are taken to demonstrate the possibility of fracture, dislocation, calcifications, bony spurs and other abnormalities.

PROCEDURE EXPLAINED: Depending on the type of injury or abnormality, there are many different views of the shoulder. The number and type will be determined by the diagnosis supplied by the physician and information gathered by the Technologist. Films may be taken with the patient standing or lying on the table with the upper arm in a variety of positions.

TOTAL TIME REQUIRED:Depending on the injury, mobility of the patient and views required. 15 – 30 minutes.

GENERAL RADIOGRAPHY – SINUSES

PREPARATION: None.

DESCRIPTION: The sinuses are air cavities within the skull. The paranasal sinuses are the frontal, maxillary, sphenoid and ethmoid. Films are taken of the sinuses to demonstrate fluid levels, masses, foreign bodies and other abnormalities.

PROCEDURE EXPLAINED: Sinus films are taken with the patient standing. Usually, three films are taken with the head in various positions to demonstrate all the paranasal sinuses.

TOTAL TIME REQUIRED: Approximately 15 minutes.

GENERAL RADIOGRAPHY – SKELETAL SURVEY

PREPARATION REQUIRED: None.

DESCRIPTION: A series of films taken of various parts of the skeletal system to ‘survey’ for metastatic spread of cancer to the bones.

PROCEDURE EXPLAINED: Several films are required for this study. One side view of the skull, “long bone” films (upper arm, thigh bone), spine films, a pelvis film, etc. These are studied for possible bone cancer.

TOTAL TIME REQUIRED: Approximately 30 minutes.

GENERAL RADIOGRAPHY – SKULL

PREPARATION: None.

DESCRIPTION: The bones of the cranium form the floor and domelike vault than encloses the brain. There are eight bones of the skull connected by lines of union called sutures. X-rays are taken of the skull to demonstrate fracture, pathology, abnormalities and suture condition.

PROCEDURE EXPLAINED: The standard skull series consists of four films taken with the patient lying on the x-ray table. A frontal view, an angled view and two side view films.

TOTAL TIME REQUIRED: 15-30 minutes.

GENERAL RADIOGRAPHY – SPINE THORACIC (Mid back)

PREPARATION: None.

DESCRIPTION: The thoracic spine is the mid portion of the spine and consists of 12 vertebral bodies. It is referred to as “T1 through T12” and is located below the cervical spine (neck). Frequently, the thoracic spine is the location for pathological fractures called ‘compression fractures’ due to osteoporosis. Other reasons to x-ray the thoracic spine are trauma, metastatic involvement, arthritic spurring, as well as other bony abnormalities.

PROCEDURE EXPLAINED: Generally, there are three films taken for a Thoracic Spine series. The first is with the patient lying on his/her back in a straight position. The second is a side view (lateral) usually taken with the patient lying on the left side. A third view may be necessary to visualize the upper thoracic vertebrae.

TOTAL TIME REQUIRED: Less than 30 minutes.

PREPARATION: None.

DESCRIPTION: The lower leg consists of the tibia and fibula. Proper x-ray examination of the lower leg must include both the ankle and knee joints. Films are taken for possible fracture, pathology or other bony abnormality.

PROCEDURE EXPLAINED:Two views of the tibia & fibula are standard. One is taken with the patient lying on the x-ray table, leg extended out straight with toes pointing up towards the ceiling. The second is a side view with the patient turned up onto the affected side, other leg positioned out of the way. Both knee and ankle joints must be visualized in each position. Depending upon the size of the patient, more than two films may be necessary in each position.

TOTAL TIME REQUIRED: About 15 minutes.