Video summary

Video BCCT Basic Radiology oleh dr Amri Wicaksono P., Sp.Rad (2022)

Main summary

Key takeaways

Educational

Main ideas & concepts conveyed

  1. Types of radiology modalities for musculoskeletal exams

    • Multiple imaging modalities evaluate the musculoskeletal system, including:
      • Plain X-ray
      • CT
      • Ultrasound (USG)
      • MRI
      • (An additional term—“emeray/cytisken”—is mentioned in the source.)
    • Image characteristics differ by modality:
      • CT can show coronal, sagittal, axial views and 3D reconstructions.
      • Plain X-ray (radiograph) mainly provides 2D images.
      • Ultrasound (USG) is emphasized for soft tissue and smaller structures such as tendons and ligaments.

  2. Foundational physics of X-ray appearance (image density/opacity)

    • X-ray image appearance depends on:
      • Tissue thickness
      • Atomic/molecular weight (atomic density) of tissue components
    • General rule:
      • Thicker tissue → whiter / more radio-opaque
      • Thin tissue (may include air component) → black / lucent
      • Higher atomic weight/density → whiter / opaque
      • Lower atomic weight/density → darker / more lucent

  3. Applying radiology in everyday clinic/emergency settings

    • Workflow when ordering/requesting imaging for musculoskeletal pathology (e.g., fracture, dislocation):
      • Ensure patient identity is correct (avoid swapped/wrong patient).
      • Provide a clinical description to increase diagnostic value.
      • Choose the appropriate imaging type based on the condition.

  4. Why plain X-ray is still central for trauma

    • Even where advanced modalities exist, plain X-ray remains the main tool for trauma.
    • Plain X-ray helps detect and evaluate:
      • Fractures and dislocations
      • Bone lesions and lesions in surrounding soft tissue
      • Likely origin and nature of lesions (e.g., benign vs malignant, stated generally)
      • Support for tissue biopsy
      • Disease progression and post-operative evaluation

Methodology / instruction-like content (detailed checklist)

A) Rules for requesting/reading plain X-ray (the “rule of Hai”)

  • At least two projections for each bone X-ray exam:
    • Commonly AP (or PA) and lateral
    • Additional projections may be added if needed
  • Each exam must include two joints:
    • Cover the proximal and distal joints relative to the suspected bone region
  • Compare both sides:
    • Compare the affected side with the contralateral side (right vs left)
  • Use before-and-after treatment images:
    • Obtain before treatment and after treatment imaging
  • Rationale for two projections (why AP + lateral):
    • X-ray appearance depends on the direction/projection of the beam.
    • A structure seen in one view may be misleading or incomplete compared with another view (illustrated via viewing an object from different angles).

B) Patient positioning principles (projections & variants)

  • Common imaging positions:
    • AP/PA and lateral (standard)
    • Oblique projections (tilted right/left)
    • Tangential projections for specific structures needing special views
  • Specific anatomical regions require named projections (examples given):
    • Paranasal sinuses: Waters and cartwheel
    • Mastoid: Stenver
    • Mandible: E(d)dler
    • Optic foramen: Riz
    • Internal acoustic canal: Riz
    • Cranial fossa: coo(l) base
    • Patella: sunrise / Mountain View

Radioanatomy and bone anatomy concepts (how to interpret X-rays)

  1. Bone histology/macrostructure and X-ray density

    • Bones consist of:
      • Cortex: dense, calcium-rich extracellular matrix → appears whiter
      • Medulla/marrow region: more marrow component → appears blacker/gray
    • Soft tissues matter too:
      • Structures such as cartilage and joint structures can appear relatively lucent (blacker) compared with dense bone.

  2. Macro-anatomy landmarks in long bones

    • Key regions mentioned:
      • Epiphysis
      • Physis (growth plate) (noted as open in children)
      • Metaphysis
      • Diaphysis
    • These regions also involve cortex and medulla, depending on location.

  3. Radioanatomy vs gross anatomy

    • Differences emphasized:
      • X-ray is a 2D projection of a 3D structure
      • X-rays don’t show all body components, only selected parts
      • Magnification and projection affect perceived size and shape.

  4. Layered evaluation concept

    • Interpret from outside to inside:
      • Cutis/subcutis → muscle → then bone (cortex/endosteum/medullary marrow regions)

  5. Importance of patient position

    • Correct positioning prevents confusing superimposition and misalignment, improving interpretation accuracy.

Anatomical survey taught in the session (upper limb then lower limb)

Upper extremities

  • Shoulder joint

    • Structures listed:
      • Clavicle
      • Acromion/scapula parts
      • Coracoid process
      • Glenoid cavity
      • Humerus head
      • Greater tubercle
      • Lesser tubercle
    • Standard projections/positions:
      • External rotation
      • Internal rotation
    • Additional view:
      • “WiFi” projection (to evaluate scapula), with scapula described as forming a “Y”.

  • Forearm (antebrachii)

    • AP and lateral show ulna, radius (and humerus is mentioned).

  • Elbow joint

    • AP and lateral
    • Additional oblique positions:
      • Supination oblique
      • Pronation oblique
    • Lateral-view line check:
      • Anterior humeral line
      • Proximal radius line
      • Both should intersect at the capitulum; if not, consider fracture/dislocation.

  • Wrist joint

    • AP and lateral
    • Additional views:
      • Oblique supination and pronation
    • Carpal bones to memorize (as referenced):
      • Scaphoid, Lunate, Triquetrum, Pisiform
      • Trapezium, Trapezoid, Capitate, Hamate
    • Also emphasizes knowing the location of each carpal bone.

  • Hand/palm

    • AP and lateral
    • Lateral finger positioning described to ensure proper stacking/superposition
    • Includes assessment of phalanges and metacarpals, plus attention to the carpal region (and mentions “medial/proximal crystals,” as transcribed).

Lower extremities

  • Pelvis

    • Evaluates:
      • Pelvic ring components (e.g., sacrum, ilium) and femur
      • Sacroiliac joint
      • Symphysis pubis
      • Femoroacetabular joints/hip joints
    • Fracture assessment uses imaginary lines:
      • Quata line
      • Iliopectineal line
      • Additional named lines (including terms transcribed as “Riau” and “Aldan sentence line/line center”).

  • Knee joint

    • Evaluates:
      • Distal femur
      • Proximal tibia/fibula
      • Patella
      • Tibial plateau (medial and lateral)
    • Patella-specific additional view:
      • Sunrise view / Mountain View to assess patella and femur relationship.

  • Ankle joint / hindfoot

    • AP and lateral; lateral emphasized due to AP overlap issues.
    • Bones included:
      • Tibia, fibula, talus, calcaneus, and tarsal bones
      • Mentions navicular and “Coboy” (likely cuboid, as transcribed)
    • Additional projection:
      • Mortise view (“mortis position”)
        • Designed to reduce overlap so mortise joint details are visible
        • Mortise joint lines should align properly (not overlapping by the lateral malleolus, as stated)
    • Measurement on lateral ankle:
      • Böhler’s angle
        • Formed by two lines:
          • Touching the superior calcaneus
          • Touching the inferior talus
        • Normal range stated: 20–40 degrees

  • Foot

    • AP and lateral
    • Lateral view for:
      • Calcaneus and navicular
      • Metatarsals and phalanges
    • Sesamoid bone:
      • Small, oval/rounded shape; not a fracture
    • AP and oblique for whole forefoot (cross-foot):
      • Includes metatarsals and tarsals
      • Mentions cuneiforms (transcribed as “kunai/cuneiform”), cuboid, navicular
    • Talus/calcaneus overlap may be challenging on some views; lateral helps.

Conclusion / lesson takeaway

  • The session aims to improve basic radiograph reading for musculoskeletal radiology.
  • Learner is encouraged to continue independent study because full musculoskeletal radiology coverage is too broad for one video.
  • Credits an institutional source of teaching videos.

Speakers / sources featured

  • Dr. Amri Wicaksono P., Sp.Rad (speaker)
  • Department of Radiology (Eva/kmk DM) (credited as the producer of teaching videos)

Original video