How I get really awesome sunrise views.

My secret to consistently getting perfect sunrise views are from one sponge.
This beautiful sponge:

When the patient is laying down supine on the table I slip this under their knees and angle the tube just right... BAM. Perfection.

This is my set up.

Just pretend there is a person there.

That's at 110 degrees. Which is a 30 degree angle cephalic.

Each and every time my pictures turn out like this.

Except not blurry!

I found one similar online to the one my work bought for me here:

http://www.supertechx-ray.com/PatientPositioning/FoamandGelPositioners/TorsoandBody.html

Bolster, 6.63 X 9.00 X 18.00


It really helps make the perfect angle and patients find this more comfortable then holding the legs up themselves or by laying on their stomach.

Ankle fusion

Penile implants

On an 80 year old patient with a new hip implant. Good for him!

Nonunion tibial fracture

Patient broke ankle over 2 years ago. Patient is also a heavy smoker.
This is why you shouldn't smoke, it delays bone growth!

Testing

Xrayed my water bottle and a rock... for science!

Finger amputation

This was two weeks after the patient had a lawn mower roll over them. The patient brought both arms up the their face and sustained a radial head fracture on the other arm as well as this amputation. There was a fragment of the proximal phalanx still attached at the time of the accident but was removed during surgery.

Carpal canal

My best one yet!

Old injury

No history was obtained besides the knowledge of an old injury.

Hip fusion

This patient had a hip fusion at a young age due to osteomyelitis. The last picture is an attempt at a lateral view.
The patient also had a revised hip arthroplasty.

Ouch...

Patient with knee pain. They had a very slow gait.
I call this type of damage 'peeling away arthritis'.
I don't think that term will catch on...

Another elbow ORIF...

This one isn't as straight forward with the healing process.
It's a supracondylar fracture of the elbow. The patient underwent surgery including an olecranon osteotomy fixation.
The screws other than the olcranon fixation got infected. There is also degeneration in the elbow joint itself.
Movement with the patient was difficult. They couldn't supinate the arm so i had to do the AP view (or for this case PA) cross-table.
While there is bone growth from the previous films, the likelihood of easy movement is very unlikely.

Osgood Schlatter disease

66 y/o patient with Osgood Schlatter disease presenting with bilateral knee pain, left greater than the right.

Acromium fracture

85 y/o patient.
This is a first for me!

New position?

I think one of my doctors just invented a new xray position.
Any thoughts?
This was to see what the bump was on the right side and it only showed up when flexed.

Magic floating buttons!

I was xraying a patient who had on a shirt with buttons with metal in them. Rather than making them change, I just stuck a sponge down their shirt.

Interesting artifact

53 y/o patient complaining of bilateral hip pain. Found this interesting artifact. It might be hard to read but it says je t'taime ("I love you" in French).

Wrist implant

AP and Lateral views of a wrist arthroplasty performed 4 years ago.

Radial head prosthesis

A patient came in for a check up on their implant.

Patella dysplasia/ Patellectomy

This patient came in with left knee pain. They had a trauma at the age of 18 and had a near complete patellectomy.
The bits are multiple calcifications in the patellar region.
I got this information from the patients chart.

Bone on bone shoulder

Arthritis in a middle aged patient.

Foot surgery

The before and after xrays of a patient with multiple fractures in the foot. The patient had a log roll over their foot.

Learned something new!

I had to hold a patient for an xray and found that not only do I have a sesamoid bone in my thumb but also one in my pointer. Very neat! :)
I also have them in the backs of my knees too!

Navicular view

This was my attempt at a navicular view on a patient who needed to stay in the thumb spica cast.

Heel spur

I find these often in patients.

Antalgic gait

This patient came in with bilateral knee pain and antalgic gait. The patient was recommended for knee replacements.

Stress test

After a much needed week long vacation I am back to the real world. I haven't seen anything too interesting today.
Here is a stress test exam done on a young child. I believe the test was positive due to the differences in the gap between the lateral malleolus and the talus.
A stress view is when the doctor comes in and puts stress both joints (like ankles or fingers) in one at a time. This is to see if there is joint instability or ligament tears. They are also used when testing for non union fractures.
For ankle stress films the patient is supine with both legs outstretched. There is then pressure applied on the lateral aspect of the foot, adducting the heel and forcing the foot into a varus position. 


Source: boneandspine.com/musculoskeletal-radiology/understanding-stress-views-for-orthopaedics-xrays/

Diabetic foot

This patient came in for check up on their diabetic foot. I came in casted to below the knee with a window cut out of the medial side due to an ulcer. It was not fun unearthing the leg. As soon as I removed the window the ulcer stench hit my nose.
Thank goodness for gloves.
The first view is the AP shot. As you can see the foot is greatly deformed out to the lateral aspect. This could be due to neuropathuc arthropathy also known as "Charcot foot". That refers to the break joint of a weightbearing joint i.e. the ankle. This looked like one of the more severe cases.
The second view was a lateral attempt.
The patient stated that the leg itself was pretty numb so any pain wasn't noted.



Information found on the diabetic foot was found on wikipedia.

Thumb spur

Took an xray of this little thing today!
Patient complained of pain, swelling and redness over the knuckle.