NORMAL RADIOLOGIC ANATOMY
JOLINDA V. ALMAZAN, MD
NORMAL RADIOLOGIC ANATOMY
SKULL AND FACE
 Standard projections for skull x-ray
o 1.PA view
o 2.Lateral view
o 3.Towne’s view
 PA view
- best projection for abnormalities in
the frontal bone
- the frontal sinuses are clearly
visualized but the sphenoid and
ethmoid sinuses are superimposed
- the petrous pyramids are projected
into the orbits
- a short dense convex line between
the orbits is often visible-Granger’s
line –formed by the roof of the
sphenoid sinus.
 Lateral view
o Anterior cranial fossa –lies anterior
to the anterior clinoids
o Posterior fossa-between the petrous
pyramids and the occipital bone
o Middle fossa-between the two
o Towne’s view
- shows the occipital bone,
foramen magnum, the
petrous portions of the
temporal bone and the
mastoids
 Cranial vault
o Adult cranial vault is composed of 3
layers
o Inner and outer layer of compact
bone
o diploe- central less dense area of
cancellous bone. It is the spongy
structure of the diploe that produces
the granular appearance of the
skull.
 In the lateral view 4 sites are more
radiolucent (thinner)
o frontal poles
o 2 occipital poles
o 3.temporal squamosal
o 4.postero-inferior aspect of the skull
adjacent to the cerebellum
 Sutures –have serrated appearance
o The sutures on the lateral view
1.coronal
2.lambdoid
 Sella Turcica
o forms the roof of the posterior part
of the sphenoid sinus
o size- 5-16mm in the AP diameter
o 4-12mm in vertical depth
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o Tuberculum sella –most anterior
and superior point
o Dorsum sella-posterior wall
o The lateral superior corners of the
dorsum sella expands into the
posterior clinoids
 Vascular markings
o common vascular marking is the
groove produced in the inner table
by the middle meningeal artery.
 The groove for the anterior division
o division of the middle meningeal
artery parallels the coronal suture.
 The posterior branch of the middle
meningeal artery crosses the squamosal
portion of the temporal bone.
 The largest and most constant venous sinus
seen on the lateral view is the transverse
sinus.
 Physiologic Areas of Calcification
o 1.Pineal gland
o 2.Falx cerebri
o 3.Glomus of choroid plexus
o 4.Habenula
o 5.Basal ganglia
 Developmental Abnormalities
o 1.Brachycephaly-the cranium is
relatively round with short antero-
posterior diameter.
o 2.Dolichocephaly-the skull is long
and relatively narrow from side to
side with a short vertical diameter
o 3.Asymmetry-one side maybe
slightly smaller or larger than the
other without pathological
significance
o 4.Bathrocephaly-occipital bone
protrudes posteriorly
 WATER’S VIEW-PA projection of the face
 Parts of a long bone
o 1.epiphysis-the cartilaginous end of
a bone
o 2.physis-the cartilaginous zone
between the epiphysis and the
calcified cartilage
o 3.metaphysis-the flared end of the
shaft of a long bone
o 4.diaphysis-the tubular shaft of a
long bone
o 5.apophysis-accessory ossification
center. It serves as attachments for
muscles or ligaments
 Shoulder
o -Radiographically, the shoulder
includes the distal end of the
clavicle, the scapula and the
proximal end of the humerus
o -The gleno-humeral joint is the
major articulation of the shoulder.
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It is a ball and socket type of joint.
The articular surface of the humeral
head and glenoid are both covered
with hyaline cartilage
 Humerus
o Medial Epicondyle – flexors of the
forearms are attached here
o Lateral Epicondyle – extensor
muscles of the forearm are attached
here
o Capitulum-articulate with the head
of the radius
o Trochlea-articulate with the ulna
 Elbow
 Anterior humeral line-line should
normally intersect he capitellum near
the junction of its anterior and middle
thirds
 Proximal mid-radial line- line drawn from
the mid-radial shaft at the level of the
radial tubercle and extending to the
proximal radial head. It should bisect
the capitellum.
o To recognize subtle capitellar
epiphyseal displacements and subtle
supracondylar and transcondylar
fractures.
 Wrist Carpal bones
 Proximal-navicular, lunate, triquetrum,
pisiform
 Distal-trapezium, trapezoid, capitate,
hamate
PELVIS
- Routine view for non-traumatic condition –
AP view
- This projection must include the iliac crests,
each hip joint and the proximal portion of
each femur.
- A lateral projection provides little useful
information because of the superimposition
of dense skeletal parts.
- The belly of the internal obturator internus
muscles and urinary bladder are soft tissue
structures normally present in the pelvic
extraperitoneal space.
Shenton’s line
- smooth, curved imaginary line formed by
the inner margins of the femoral neck and
the inner surface of the obturator foramen.
- lateral displacement of the femur disrupts
the smooth curve.
Femur
- head
- neck
- greater trochanter
- lesser trochanter
- shaft
- medial epicondyle
UST FMS MEDICAL BOARD REVIEW 2019
NORMAL RADIOLOGIC ANATOMY
JOLINDA V. ALMAZAN, MD
- lateral epicondyle
Knee
- In the frontal projection, the patella is
obscured by the density of the
superimposed intercondylar portion of the
femur
- The medial and lateral intercondylar spines
are well seen within the concavity of the
intercondylar notch of the femur
- Lateral view- patella-femoral joint is clearly
evident
- If injury of the patella is suspected, an axial
(tangential or sunrise view) of the
- patella is needed.
 Fabella- sesamoid bone located in the lateral
head of the gastrocnemius muscle. It should
not be mistaken for a fracture. Tibia and
Fibula
Ankle
- Ankle mortise – comprised of the malleoli,
horizontal plate of the distal articulating
surface of the tibia(plafond) and the
ligamentous structure that are not visible on
plain radiographs
- Boehler’s angle - formed by the intersection
of a line drawn tangentially to the anterior
and posterior elements of the superior
surface of the calcaneus
Normal range -28-40 degrees.
CHEST X-RAY
Tele-radiography
Prerequisites
1.PA view
2.Upright position
3.Deep inspiration
4.Tube film distance of 6 feet
Standard views- PA and lateral
Areas to be inspected
 Lungs
 Mediastinum-including the heart and the
great vessels
 Trachea and central bronchi
 Diaphragm
 Bony Thorax
 Soft tissues of the thorax and the neck
 Subdiaphragmatic upper abdominal
structures
Lobar anatomy
 Right lung-3 lobes-upper, middle and lower
lobes
 Left lung-2 lobes- upper and lower lobes
Fissures
 Right major-extends from the level of the
5th posterior rib downward and forward to
the level of the 6th rib anteriorly
Left major-slightly more vertical.
 extends from the level of the 3rd to 5th
2 | RADIOLOGY
 NORMAL RADIOLOGIC ANATOMY
JOLINDA V. ALMAZAN, MD

 posterior ribs down to the level of the 7th rib
anteriorly
- Minor fissure-horizontal and lies at the level
of the anterior arc of the 4th rib or
interspace
Zones
 Inner zone-contains the large main trunk
 Middle zone-intermediate sized vessels
 Peripheral-contains vessels less than 1 mm
in diameter
 In the upright position, the upper lobe
vessels are smaller than those on the bases
 The difference in size tends to reflect
distribution of blood flow, which is greater in
the lower lung.
b. widening of the carinal angle
c. upliftment of the left mainstem bronchus
d. double silhouette on the right cardiac
border
Left ventricular enlargement
a. increase cardiac diameter
b. cardiac apex displaced downward
c. obliteration of the retrocardiac space
Diaphragm - dome-shaped
 Normal level of right hemi-diaphragm-in the
region of the 5th interspace or the level of
the posterior arc of the tenth rib. The left is
slightly lower
Costophrenic sulcus-sharply and clearly defined.

Pulmonary Hilum  Bony Thorax

-contains the  Pigeon breast-anterior protrusion
a. pulmonary arteries and veins deformities of the sternum
b. bronchi  Pectus excavatum-funnel chest deformity
c. bronchial arteries and veins  Scoliosis
d. lymph nodes
SCOUT FILM OF THE ABDOMEN
Left hilum-higher because the left pulmonary artery  Upright and supine views
extends above the left main bronchus while the right  Contrast studies
pulmonary artery crosses below the right upper lobe  Upper Gastro-intestinal series
bronchus  Barium enema

Normal size of the descending right pulmonary Intravenous urography-for visualization of the upper
artery collecting systems, ureters and bladder
 Males –up to 1.6 cms
 Females-up to 1.5 cms

Trachea
 extends from C6 to T5 where it divides into
the right and left main bronchus
 Normal carinal angle -65-70 degrees

Heart
 normal cardio-thoracic ratio- 0.50

BORDERS OF THE HEART

Right side
-lower segment-lateral border of the right
atrium
-upper segment –superior vena cava
Left side
1. aortic knob
2. pulmonary artery
3. left atrial appendage
4. left ventricle

Right atrial enlargement - prominence of the right

cardiac border

Right ventricular enlargement –

a. increase cardiac size
b. prominence of the pulmonary artery
segment
c. cardiac apex displaced laterally
d. obliteration of the retrosternal space

Left atrial enlargement

a. prominence of the left atrial appendage
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NORMAL RADIOLOGIC ANATOMY REVIEW
TEST (CHOOSE THE BEST ANSWER)

_____1. Upright view of the abdomen is used to _____10. The main source of gas seen in the
demonstrate: abdominal xray is from:
a. air fluid levels a. swallowed air
b. gastric dilatation b. bacterial putrefaction
c. colonic distension c. intestinal metabolism
d. interserosal spaces d. action of hydrochloric acid on food
particles
_____2. This marker shows that the pathology is
retroperitoneal in location: _____11. Hill-Sachs lesion involve this portion of the
a. flank stripes humeral head:
b. properitoneal fat lines a. postero-lateral
c. psoas muscle b. antero-medial
d. obturator line c. supero-anterior
d. infero-posterior
_____3. Supine film of the abdomen will not
demonstrate: _____12. The atlanto-axial distance is increase due
a. calcific lymph nodes to involvement of this ligament:
b. phleboliths a. transverse
c. cystine calculus b. anterior
d. atheromatous aorta c. posterior
d. laminar
_____4. This shadow is not identified on scout film:
a. liver _____13. Hangman’s fracture involves this cervical
b. pancreas vertebral body:
c. spleen a.1
d. kidneys b.2
c.3
_____5. The small intestines on x-ray will show the d.7
following characteristic:
a. valvulae conniventes _____14. When the falciform ligament is visualized
b. taenia coli in plain film, this is secondary to:
c. haustrations a. abscess
d. crypts of Lieberkuhn b. hepatic mass
c. pneumoperitoneum
_____6. Upper GI series cannot demonstrate: d. ascites
a. obstruction
b. neoplasm _____15. An air fluid level is seen on the left upper
c. bleeding ulcer quadrant. This is the?
d. perforation a. magenblasse
b. pneumoperitoneum
_____7. The ligament of Treitz is the landmark for c. spleno-renal hemoperitoneum
the: d. perisplenic ascites
a. lobes of the liver
b. duodeno-jejunal junction _____16. This can cause gall bladder wall
c. C loop thickening:
d. incisura of the stomach a. cholecystitis
b. hypo-albuminemia
_____8. The small intestine are considered to be c. ascites
dilated when it measures: d. all of the above
a. 1.0 cms
b. 1.5 cms _____17. Post-prandial ultrasound is indicated for?
c. 2.5 cms a. determination of pancreatic mass
d. 3.5 cms b. visualization of hepatic metastasis
_____9. This preparation is needed for an upper c. demonstration of contractile physiology of
gastro-intestinal series: the gall bladder
a. laxative d. avoidance of intestinal gas interference
b. hydration
c. fasting _____18. This area is not included in FAST
d. water intake ultrasound:
a. subxiphoid
b. Morison’s pouch
c. spleno-renal space
d. perirenal space
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_____19. Barium enema shows a bird-beak sign.
This is consistent with:
a. intussuception
b. volvulus
c. diverticulitis
d. malignancy

_____20. This is not seen in appendicitis on plain

film:
a. appendicolith
b. sentinel loop
c. wall thickening of greater than 3mm
d. lumbar scoliosis

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