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Anatomic structures are often described as being either radiopaque or radiolucent blood pressure is determined by buy cheap coumadin 5 mg online. Listed below are densities arrhythmia tachycardia buy coumadin with a visa, from the most radiolucent to the least radiolucent: Air; Fat; Soft tissue; Bone; and, Metal. Air, fat, and soft tissues are radiolucent; their shading on radiography images will range from black. The actual composition of bone depends on the area of the body, age, and health status of the patient thus bones appear in various shades of white on the radiography image. Certain orthopedic devices implanted in the patient attenuate more radiation than any of the other densities and will appear white on the radiography image. Depending on the composition, cloth bandages, elastic type bindings, and casting materials will attenuate the radiation beam to various degrees and thus their final appearance on the image will range from vary light to gray tone densities. Diseases and conditions that cause the affected body tissue to decrease in composition are referred to as destructive diseases or conditions. If a destructive disease or condition exists in the anatomic area being examined, the radiographer may need to decrease the x-ray exposure factors; otherwise, the radiography image will appear too dark (overexposed and exhibit too much photographic density). Additive diseases result in increased attenuation of the x-ray beam and requires that the x-ray exposure factors be increased. Figure 3-2 provides a partial list of the most common additive and destructive diseases affecting musculoskeletal structures. To review, an additive condition generally requires an increase in kilovoltage (kVp) to adequately penetrate the part and a destructive condition requires a decrease in kVp. The 15% rule states that an increase in kVp by 15% is equivalent to doubling the milliamperage-seconds (mAs). An important step prior to commencing the actual examination is for the radiographer to review the imaging request to glean information that may be used to determine the best combination of technical x-ray exposure factors. This information may allow the radiographer to make adaptations and adjustments to the basic imaging protocol and may prevent unnecessary retake examinations due to technical errors. With this type of information, the radiographer will use their knowledge and judgment in selecting the proper technical exposure factors for 63 the examination and in adapting the basic protocol, as necessary, to accommodate each patient. As a general guide when an increase in the x-ray exposure factors is needed, the radiographer should increase the kVp. This is the preferred method since kVp controls the penetrability of the primary x-ray beam and also controls the visible scale of contrast. To review, the 15% rule generally applies to x-ray examinations of smaller anatomic areas such as the extremities. Unless the radiographer has access to previous radiographs with recorded exposure factors; the initial x-ray exposure factors should be determined by using a standardized protocol. In this situation, it is best for the radiographer to start with the exposure factors listed on a standardized technique chart and make alterations as necessary to the x-ray exposure factors. The upright position is used when the radiographic study is being performed to determine levels of bodily fluids, gas, or air. The upright position is also used for certain weight bearing examinations of the feet, ankles, knees, hips, and vertebral spine. Routine radiography imaging of musculoskeletal structures may be performed with the patient sitting on a stool, lying on the radiographic table, and with the patient in the upright position. A lateral extremity image should be marked as either a right (R) or a left (L) to properly identify the extremity being examined. An oblique position refers to one in which the patient or a specific anatomic part is rotated (slanted) at an angle that is somewhere between a frontal and a lateral position. The side and surface closest to the image receptor is used to identify oblique body positions; and, Decubitus position refers to when the patient is lying down (recumbent) with the central ray of the x-ray tube directed horizontally. Figure 3-3 provides information about some of the accessory methods that may be considered when the patient cannot assume the required position. Radiographic Projections/Positions Pathology Indications Transthoracic Suspected fracture of the shoulder/humerus Cross Table Lateral Bilateral images Suspected fracture of the hip, femur, knee Comparison, typically of a joint such as the carpal, knees, etc. Suspected injury requires that the specific anatomic area not be moved Axial/Transaxial. An accessory method when the patient cannot assume the standard basic positioning protocols. Additional Positioning Terminology the term axial refers to the long axis of a structure or anatomic part.

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The subnarial artery extends anteromedially on the vomerine process of the maxilla keeping blood pressure chart order coumadin 5 mg mastercard, ventral to the nasal plexus arrhythmia leads to heart failure buy coumadin 5mg on line, to which it gives numerous branches. A single l a r g e medial branch c r o s s e s the dorsal surface of the lamina transversalis anterior, ventral to the anterior chamber and i t s plexus and the anterior end of the zona annularis. The subnarial a r t e r y continues to the premaxilla, through which it accompanies the medial ethmoidal nerve to the snout and ramifies broadly there. Before the a r t e r y enters the premaxilla, a s m a l l branch extends dorsally to supply the anter i o r and dorsal r i m s of the plexus around the external naris. At the anteroinferior border of the cupola a ramus turns dorsally within the cupola and along the nasal septum to supply the anteromesial surface of the plexus of the anterior chamber. The third branch of the stapedial a r t e r y, the mandibular artery (~ i g 42), extends ventrally on the mesial side of the quadrate. It supplies the lower jaw exclusively and f o r m s an extensive anastomotic network around the mandibular condyle. The mandibular a r t e r y extends anteroventrally between the paraoccipital process of the opisthotic and the mandibular groove of the quadrate bone and continues ventrally along the mesial border of the quadrate and the mesial surface of the adductor posterior muscle until it reaches the quadrate proc e s s of the pterygoid bone. The first branch extends laterally into the quadrate foramen, along with the anterior tympanic vein, and emerge s on the anterior surface of the quadrate to anastomose with the anterior condylar artery. The second branch extends laterally, giving some branches to the capsule of the pterygoquadrate articulation, and then continues to the chorda tympani nerve where it anastomoses with the chorda tympani branch of the auricular artery. The third, the continuation of the posterior condylar artery, sends some small branches to the capsule of the mandibular joint and gives off another which anastomoses with a medial branch of the articular artery that extends from the floor of the mandibular foramen a s it passes over that joint; it then continues into the mandible with the chorda tympani nerve. The mandibular artery continues ventrally over the lateral border of the quadrate process of the pterygoid and a t its lower border gives off a second small branch, the anterior condy lay artery, which extends laterally, just anterior and dorsal to the condyle of the quadrate, to anastomose with the perforating branch of the posterior condylar artery and to supply the anterior capsule of the mandibular condyle. Its terminal r a m i supply the adductor mandibularis externus muscles surrounding it and turn dorsally along the auricular border of the quadrate. It also sends a branch to join the lateral perforating branch of the articular artery at the posterior supra-angular foramen on the lateral surface of the mandible. The mandibular artery continues into the lower jaw, at first mesial to the origin of, and then on the anterior border of, the adductor posterior muscle. It lies between the adductor internus and externus groups and is accompanied by the mandibular division of the trigeminal nerve which lies anterior to it. As it passes between these groups of muscle, it gives off branches to each of them. As the artery enters the mandibular foramen, it gives off a posterior branch, the articular artery, which extends between the adductor mandibularis externus laterally and the adductor posterior mesially and is accompanied by a branch of the frigeminal nerve. It then anastomoses with the anterior condylar artery and extends anteriorly and posteriorly, along the origin of the intermandibularis muscle, to the skin. The medial branch extends posteriorly over the angular process of the articular and anastomoses with a branch of the posterior condylar a r t e r y at the mandibular condyle. The mandibular artery continues into the mandibular foramen, where i t lies ventral to the mandibular nerve. The a r t e r y anastomoses with the perforating branches which emerge from the dentary. It gives several short ventral branches to the adductos posterior muscle and a lateral branch which passes out with the anterior mylohyoid nerve. A large medial branch emerges from the inferior alveolar foramen, ventral to the intermandibul a r i s anterior muscle, to anastomose with the perforating branch of the musculomandibular artery. The posterior branches of this a r t e r y anastomose with the external mandibular. It usually a r i s e s from the dorsal side of these vessels and almost immediately divides into three branches. A s m a l l branch extends craniad from this a r t e r y along the mesial side of the sympathetic trunk a s f a r a s the f i r s t interspace and may give r i s e t o the f i r s t spinal a r t e r y. The second branch of the musculocervical a r t e r y extends anteromesially a c r o s s the ventral surface of the neck musculature to supply the posterior surface of the esophagus. The mesial branch anastomoses with the esophageal branch of the prevertebral a r t e r y, and the lateral branch extends to the junction of the pharyngeal space and the esophagus and supplies this a r e a.