Anatomy

Clinical Anatomy

Regional = Organisation of anatomy into parts (regions)

Systemic = Organ systems
circulatory, respiratory, GI, renal, etc.
Applied anatomy
Patient presentation
Mechanism of injury (if applicable)
Key clinical findings
Imaging characteristics

Standard anatomical position:

Patient standing erect with feet flat on the floor, facing forward
Arms at the side with palms facing forward
Head, feet, and palms facing forward

Terminology used relative to anatomical position

Directional terms
Terms of laterality
Depth
Body positioning
Movement
Planes of imaging

Terminology used relative to the major regions of the body:

Vertical axis
Cephalic (head)
Cervical (neck)
Thoracic (chest)
Abdominal (stomach)
Oblique axis
Upper limb
Lower limb

Directional terms = vertical axis of the body

Superior, cranial, cephalic - Toward the head
Inferior, caudal - Toward the feet
Anterior, ventral - Toward the front of the body
Posterior, dorsal - Toward the back of the body

Directional terms = vertical axis

Medial - Toward the midline of the body
Lateral - Away from the midline of the body

Directional terms = oblique axis

Proximal - Closer to the origin of the body part or point of attachment of a limb to the trunk
Distal - Farther from the origin of the body part or point of attachment of the limb to the
trunk

Directional terms = region specific

Hand:

Anterior surface is PALMAR

Posterior surface is DORSAL

Foot:

PLANTAR surface of foot (bottom of the foot) is the “anterior surface”

DORSAL surface of the foot (top of the foot) is the “posterior surface”

Terms of Laterality
Right and Left - Remember to cross your sides – you are Always referring to the PATIENT’S
right or left which is opposite to your own
Bilateral - Describing paired structures (e.g. structures for which you have a left and a right)
Unilateral - Describing one side of the body
Ipsilateral - Describing structures on the same side of the body
Contralateral - Describing structures on opposite sides of the body

Terms of Depth
Superficial, external - Toward or at the body surface
Deep, internal - Away from the surface of the body

Note: Terms of depth are NOT dependent on normal anatomical position

Terms of Positioning
Supine x Patient is lying face up
To help remember:
Supine = “lying on the spine”
Prone - Patient is lying face down
Lateral decubitus (recumbent) - Patient is lying on their side
If lying on their right side = right lateral decubitus
If lying on their left side = left lateral decubitus

Terms of Movement
Flexion
For the extremities: movement that decreases the angle between two body parts
For the spine: forward bending
Extension
For the extremities: movement that increases the angle between two body parts
For the spine: bending backward

Abduction
Movement away from the midline
In the hand and foot – movement away from the midline of the hand/foot (3rd digit for
the hand; 2nd digit for the foot)
Adduction
Movement toward the midline
In the hand and foot - movement toward the midline of the hand/foot (3rd digit for the
hand; 2nd digit for the foot)

Medial/internal rotation
Rotation toward the midline of the body
Lateral/external rotation
Rotation away from the midline of the body

Elevation
Movement in a superior direction
Depression
Movement in an inferior direction

Common Imaging technique

1. Utilises ionising radiation

Radiography (X-ray)
Chest X-ray
Mammography
Computed Tomography (CT)
CT Angiography

2. Do not use Ionising Radiation

Ultrasonography
Doppler Ultrasound
Magnetic Resonance Imaging (MRI)
MR Angiography

Higher risk patients: Children, Pregnant women, Young women (developing breasts), People
with a high accumulated doses

ALARA PRINCIPLE: Try to keep the radiation dose AS LOW AS REASONABLY ACHIEVABLE

Radiographic Densities and Tissue thickness

Tissue Radiographic Densities

Air Dark black

Fat Light black

Water and Soft tissues Shades of gray

Bone (calcium) White

Metal Bright white

X-ray Images
X-rays are a type of electromagnetic radiation
An x-ray machine sends individual x-ray waves through the body. The images are recorded
on a computer or film.
Structures that are dense (such as bone) will block most of the x-ray waves, and will appear
white on the final image
Metal and contrast media (special dye used to highlight areas of the body) will also
appear white.
This is why it is important for the patient to remove as many external objects (like
jewellery) as possible
Structures containing air will be black, and muscle, fat, and fluid will appear as shades of
gray.
Orientation/view is named by which way the X-ray tube and film plates are placed
Remember for x-rays, you will be seeing all anatomical structures overlaying on top of one
another

Common X-ray Positions

A = Anterior to posterior (AP) projection

Patient is facing the machine

Back of patient is facing the x-ray screen

B = Posterior to Anterior (PA) projection.

Patient is facing the screen

Back of patient is facing the machine

C = Lateral projection in a right lateral position

Right side of the patient is touching the screen

D = Lateral projection in a left lateral position.

Left side of the patient is touching the screen

Note: Always remember to read AP or PA films as if you were facing the patient

Reading X-rays: Remember your “ABCs”!

A = Anatomy & alignment
Does the anatomy look normal?
Are the joints / bones aligned?
B = Smooth cortical BONE
Disruption in smooth cortical bone could mean a fracture
Changes in radiographic density of bone
C = Cartilage
Look for uniform density, widening of joint spaces
Narrowing of joint spaces could mean degeneration / arthritis
S = Soft tissues
Look for swelling, masses, radiographic abnormalities

Keep in mind:

External objects
Internal objects
Superimposition of structures
Patient positioning
Mechanism of injury
Soft tissue layers
Limitations of x-ray

Note: Look at the whole image and then apply the search pattern

Body Planes & Planes of Imaging for CT & MRI

Difference Between CT SCAN & MRI

Orientation for CT & MRI

Orientation to Transverse/Axial Images

As if you are standing at the foot of the supine patient, looking toward the head – NO MATTER
how the image was obtained

Each slice (image) that you see in lecture is only ONE of potentially thousands of images
(stack)
Structures will appear/disappear as they come in and out of the plane (as you scroll through
the stack)

Rules for reading axial CT and MRI

Patient always supine (lying face up)

“Criss-cross” interpretation of sides
Remember that the patient’s left is on the right side of the image

Orientation to Coronal Images

As if you are face to face with the patient – NO MATTER how the image was obtained

Therefore, patient’s left will be on the right side of the captured image
“Criss-cross” interpretation of sides

Orientation to Sagittal Images

As if you are standing at the side of the patient facing their left or right side of the body) there
are usually plenty of anatomical clues to help you determine position; identify anterior (front)
from posterior (back)

Tips for Reading MRI’s

1. Determine which plane you are looking at

2. Orient your self!
3. Identify known structures
4. Perform a full search patte

Advantages and Disadvantages of Imaging Techniques