RT 112 Module 2

RADTECH
112
COURSE LEARNING OUTCOMES

At the end of the term, the future
Radiologic Technologists are expected to:
1. Explain the human body as a

structural and functional unit
2. Assertively describe the differences
of each radiologic imaging
modality in the presentation of body
structures and decide which
radiologic imaging modality is best
for the imaging of organ of interest.
3. Apply understanding of general
medical terminology, human
anatomy and physiology and
patient positioning in radiographic
imaging to aid in diagnosis and
treatment of diseases.
4. Apply concepts and knowledge of
anatomy and physiology related to
HUMAN ANATOMY AND different organ systems to technical
and/ or radiographic clinical
PHYSIOLOGY scenarios.
5. Critically evaluate information on
(MODULE 2) human health and medical
research and identify the role of
radiographer in different special
procedure as to its social and
ethical implications as part of
Prepared by: responsible radiologic technologist.
Lorie Ann Mariñas – de Velez, RRT
Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited.
1
TABLE OF CONTENTS
Unit 3: SKELETAL SYSTEM 3-67
Functions of Bone and The Skeletal System 3
Structure of Bone 3-4
Histology of Bone Tissue 4-6
Types of Bones 7-8
Arthrology 8-11
Bone Surface Markings 12-13
Common Types of Fracture 13
Formative Assessment 112.4 14
Divisions of the Skeletal System 14-15
Axial Skeleton 15-50
Activity 112.6—Identify and Label 17-18
Activity 112.7—Identify and Label 27
Activity 112.8—Identify and Label 31
Appendicular Skeleton 50-66
SUMMATIVE ASSESSMENTS ARE PROVIDED AS A SEPARATE ATTACHMENT
Unit 3: Skeletal System

After unit 3, the future Radiologic Technologist is expected to:
1. Identify and locate the bones of human skeleton and summarize the function of skeletal
system.
2. Define medical terminologies and pathologies related to skeletal system.
3. Describe and differentiate the presentation of bones in different imaging modality and
identify the best modality for different medical condition.
4. Apply knowledge in surface landmarks in imaging axial and appendicular skeleton.
5. Discuss patient positioning consideration applicable for trauma and non - trauma
patients.
6. Identify radiographers’ role in diagnosing and treating diseases of each systems to
provide patient needs.
2
UNIT 3: SKELETAL SYSTEM
3.1 FUNCTIONS OF BONE AND THE SKELETAL SYSTEM
1. Support
- The skeleton serves as the structural framework for the body by supporting soft tissues
and providing attachment points for the tendons of most skeletal muscles
2. Protection
- The skeleton protects the most important internal organs from injury. For example,
cranial bones protect the brain, vertebrae (backbones) protect the spinal cord, and
the rib cage protects the heart and lungs.
3. Assistance in movement
- Most skeletal muscles attach to bones; when they contract, they pull on bones to
produce movement.
4. Mineral homeostasis (storage and release)
- Bone tissue stores several minerals, especially calcium and phosphorus, which
contribute to the strength of bone. Bone tissue stores about 99% of the body’s
calcium. On demand, bone releases minerals into the blood to maintain critical
mineral balances (homeostasis) and to distribute the minerals to other parts of the
body.
5. Blood cell production
- Within certain bones, a connective tissue called red bone marrow produces red
blood cells, white blood cells, and platelets, a process called hemopoiesis (hemo-
blood; poiesis- making). Red bone marrow consists of developing blood cells,
adipocytes, fibroblasts, and macrophages within a network of reticular fibers. It is
present in developing bones of the fetus and in some adult bones, such as the hip
bones, ribs, breastbone, vertebrae (backbones), skull, and ends of the bones of the
arm and thigh.
6. Triglyceride storage
- Yellow bone marrow consists mainly of adipose cells, which store triglycerides. The
stored triglycerides are a potential chemical energy reserve. In a newborn, all bone
marrow is red and is involved in hemopoiesis. With increasing age, much of the bone
marrow changes from red to yellow.
3.2 STRUCTURE OF BONE
- Bone structure may be analyzed by considering the parts of a long bone, such as the
humerus. A long bone is one that has greater length than width. A typical long bone
consists of the following parts:
1. Diaphysis
- The bone’s shaft or body—the long, cylindrical, main portion of the bone.
2. Epiphyses (singular- epiphysis)

- The proximal and distal ends of the bone.
3
3. Metaphyses (singular- metaphysis)
- The regions between the diaphysis and the
epiphyses. In a growing bone, each metaphysis
contains an epiphyseal (growth) plate (Fig. 3.1),
a layer of hyaline cartilage that allows the
diaphysis of the bone to grow in length. When a Fig. 3.1
bone ceases to grow in length at about ages Radiograph of
18–21, the cartilage in the epiphyseal plate is humerus of an 8-year
replaced by bone; the resulting bony structure is old
known as the epiphyseal line.
4. Articular cartilage
- Thin layer of hyaline cartilage covering the part of the epiphysis where the bone
forms an articulation (joint) with another bone
- It reduces friction and absorbs shock at freely movable joints.
5. Periosteum
- Surrounds the external bone surface wherever it is not covered by articular cartilage.
- It is composed of an outer fibrous layer of dense irregular connective tissue and an
inner osteogenic layer that consists of cells.
6. Medullary cavity/ Marrow cavity

- A hollow, cylindrical space within the diaphysis that contains fatty yellow bone
marrow in adults.
7. Endosteum
- A thin membrane that lines the internal bone surface facing the medullary cavity. It
contains a single layer of cells and a small amount of connective tissue.
3.3 HISTOLOGY OF BONE TISSUE
- Four types of cells are present in bone tissue: osteogenic cells, osteoblasts,
osteocytes, and osteoclasts
1. Osteogenic cells
- Osteogenic cells are stem cells derived from mesenchyme, the tissue from which
almost all connective tissues are formed.
- They are the only bone cells to undergo cell division; the resulting cells develop into
osteoblasts.
- Found along the inner portion of the periosteum, in the endosteum, and in the canals
within bone that contain blood vessels
2. Osteoblasts
- Bone-building cells
- As osteoblasts surround themselves with extracellular matrix, they become trapped in
their secretions and become osteocytes.
- Note: The ending -blast in the name of a bone cell or any other connective tissue cell
means that the cell secretes extracellular matrix.
3. Osteocytes
4
- Mature bone cells
- They are the main cells in bone tissue and maintain its daily metabolism, such as the
exchange of nutrients and wastes with the blood.
4. Osteoclasts
- Huge cells derived from the fusion of as many as 50 monocytes (a type of white
blood cell) and are concentrated in the endosteum
- Note: The ending -clast in a bone cell means that the cell breaks down extracellular
matrix.)
Fig. 3.2
* The spongy bone

tissue of the epiphyses
and metaphysis
contains red bone
marrow, and the
medullary cavity of the
diaphysis contains
yellow bone marrow
(in adults).
Fig. 3.3
5
COMPACT BONE TISSUE
- 80% of the skeleton is compact bone
- Contains few spaces and is the strongest form of bone tissue. It is found beneath the
periosteum of all bones and makes up the bulk of the diaphyses of long bones.
Compact bone tissue provides protection and support and resists the stresses
produced by weight and movement.
- The components of compact bone tissue are arranged into repeating structural units
called osteons or haversian systems.
SPONGY BONE TISSUE

- 20% of the skeleton is compact bone
- Spongy bone tissue does not contain osteons
- The term “spongy” does not refer to the texture of the bone, only its appearance
- Makes up most of the interior bone tissue of short, flat, and irregularly shaped bones,
and most of the epiphyses of long bones
- Spongy bone is always covered by a layer of compact bone for protection
BONE SCAN
- A Nuclear Medicine (branch of Radiology)

diagnostic procedure that takes advantage of the
fact that bone is living tissue. A small amount of a Fig. 3.4
radioactive tracer compound that is readily absorbed Normal bone scan
by bone is injected intravenously. The degree of image
uptake of the tracer is related to the amount of blood
flow to the bone. A scanning device (gamma
camera) measures the radiation emitted from the
bones, and the information is translated into a
photograph that can be read like an x-ray on a
monitor. Normal bone tissue is identified by a
consistent gray color throughout because of its
uniform uptake of the radioactive tracer. Darker or
lighter areas may indicate bone abnormalities. Darker
areas called “hot spots” are areas of increased
metabolism that absorb more of the radioactive
tracer due to increased blood flow. Hot spots may
indicate bone cancer, abnormal healing of fractures,
or abnormal bone growth. Lighter areas called “cold
spots” are areas of decreased metabolism that
absorb less of the radioactive tracer due to Fig. 3.5
decreased blood flow. Cold spots may indicate Bone Scan—Hot spots
problems such as degenerative bone disease, (dark areas) showing bone
metastases.
decalcified bone, fractures, bone infections, Paget’s
disease, and rheumatoid arthritis. A bone scan
detects abnormalities 3 to 6 months sooner than
standard x-ray procedures and exposes the patient to
less radiation. A bone scan is the standard test for
bone density screening, particularly important in
screening for osteoporosis in females.
6
3.4 TYPES OF BONES
- Almost all bones of the body can be classified into five main types based on shape
(Fig. 3.6):
1. Long bones
o Have greater length than width, consist of a shaft and a variable number of
extremities (ends), and are slightly curved for strength
o Consist mostly of compact bone tissue in their diaphyses but have considerable
amounts of spongy bone tissue in their epiphyses.
o Vary tremendously in size and include those in the femur (thigh bone), tibia and
fibula (leg bones), humerus (arm bone), ulna and radius (forearm bones), and
phalanges (finger and toe bones).
2. Short bones
o Somewhat cube-shaped and are nearly equal in length and width.
o They consist of spongy bone tissue except at the surface, which has a thin layer of
compact bone tissue.
o Examples of short bones are the carpal (wrist) bones (except for the pisiform,
which is a sesamoid bone) and the tarsal (ankle) bones (except for the
calcaneus or heel bone, which is an irregular bone).
3. Flat bones
o Generally thin and composed of two nearly parallel plates of compact bone
tissue enclosing a layer of spongy bone tissue.
o Flat bones afford considerable protection and provide extensive areas for muscle
attachment.
o Flat bones include the cranial bones, which protect the brain; the sternum
(breastbone) and ribs, which protect organs in the thorax; and the scapulae
(shoulder blades).
4. Irregular bones
o Have complex shapes and cannot be grouped into any of the previous
categories. They vary in the amount of spongy and compact bone present.
o Such bones include the vertebrae (backbones), hip bones, certain facial bones,
and the calcaneus.
5. Sesamoid bones
o Develop in certain tendons where there is considerable friction, tension, and
physical stress, such as the palms and soles.
o They may vary in number from person to person, are not always completely
ossified, and typically measure only a few millimeters in diameter. Notable
exceptions are the two patellae (kneecaps), large sesamoid bones located in
the quadriceps femoris tendon that are normally present in everyone.
o Functionally, sesamoid bones protect tendons from excessive wear and tear.
7
Fig. 3.6
A, The humerus is a long bone. B, The carpals are short bones. C, The sternum is a flat bone. D, The
vertebra is an irregular bone. E, The patella is a sesamoid bone.
3.5 ARTHROLOGY
- Arthrology the study of the joints, or articulations between bones.
- Joints make it possible for bone to support the body protect internal organs, and
create movement.
- The two classifications of joints are functional and structural.
3.5.1 FUNCTIONAL CLASSIFICATION

- When joints are classified as functional, they are broken down into three
classifications.
- The three classifications are based on the mobility of the joint as follows:
a) Synarthroses: immovable joint
b) Amphiarthroses: slightly movable
c) Diarthroses: freely movable
3.5.2 STRUCTURAL CLASSIFICATION

- The structural classification of joints is based on the type of tissue that unite or bind
the articulating bones.
a) Fibrous joints
o They do not have a joint cavity, but are united by various fibrous and
connective tissues or ligaments. These are the strongest joints in the body
because they are virtually immovable.
o The three type of fibrous joints follow:
1) Syndesmosis
• An immovable joint or very slightly movable joint united by sheets of
fibrous tissue.
8
• Example: inferior tibiofibular joint
2) Suture
• An immovable joint occurring only in the skull.
• They are held tightly together by strong connective tissues.
• Example: coronal suture of the skull
3) Gomphosis
• An immovable joint occurring only in the roots of the teeth.
• The roots of the teeth that lie in the alveolar sockets are held in place
by fibrous periodontal ligaments
Fig. 3.7
Examples of the three types of fibrous joints.
A- Syndesmosis: inferior tibiofibular joint
B- Suture: sutures of the skull.
C- Gomphosis: roots of
D- the teeth in the alveolus.
b) Cartilaginous joints
o Cartilaginous joints are similar to fibrous joints in two ways: (I) they do not have
a joint cavity, and (2) they are virtually immovable.
o Hyaline cartilage or fibrocartilage unites these joints
o The two types of cartilaginous joints follow:
1) Symphysis
• A slightly movable joint.
• The bones in this joint are separated by a pad of fibrocartilage. The
ends of the bones contain hyaline cartilage.
• A symphysis joint is designed for strength and shock absorbency
• Examples: the joint between two pubic bones (pubic symphysis) and
the joint between each vertebral body
2) Synchondrosis
• An immovable joint.
• This joint contains a rigid cartilage that unites two bones.
9
• Example: epiphyseal plate found between the epiphysis and diaphysis
of a growing long bone
Fig. 3.8
Examples of the two types of cartilaginous
joints
A- Symphysis: the pubic symphysis
B- Synchondrosis: epiphyseal plate
(arrows) found between the
epiphysis and diaphysis of growing
long bones.
c) Synovial joints
o They permit a wide range of motion, and therefore they are all freely
movable. These joints are the most complex joints in the body. Their
distinguishing features are shown in Fig. 3.9.
o An articular capsule completely surrounds and enfolds all synovial joints to join
the separate bones together. The outer layer of the capsule is called the
fibrous capsule, and its fibrous tissue connects the
capsule to the periosteum of the two bones.
o The synovial membrane, which is the inner layer, surrounds the entire joint to
create the joint cavity. The membrane produces a thick, yellow, viscous fluid
called synovial fluid. Synovial fluid
lubricates the joint space to reduce
friction between the bones.
o The ends of the adjacent bones are
covered with articular cartilage. This
smooth and slippery cartilage permits
ease of motion. The two cartilages do
not actually touch because they are
separated by a very thin layer of
synovial membrane and fluid.
o Some synovial joints contain a pad of
fibrocartilage called the meniscus,
which surrounds the joint. They act as
shock absorber by conforming to and
filling in the large gaps around the
periphery of the bones.
o Some synovial joints also contain
synovial fluid-filled sacs outside the Fig. 3.9
main joint cavity, which are called the Lateral cutaway view of the knee showing the
distinguishing features of a synovial joint.
bursae. Bursae help reduce friction
10
between skin and bones, tendons and bones, and muscles and bones.
o The six types of synovial joints are the following:
1) Gliding
• Uniaxial movement. This is the simplest synovial joint. Joints of this type
permit very slight movement.
• Example: intercarpal and intertarsal joints of the wrist and foot
2) Hinge
• Uniaxial movement. A hinge joint permits only flexion and extension.
The motion is similar to that of a door.
• Example: elbow, knee, and ankle
3) Pivot
• Uniaxial movement. These joints allow only rotation around a single
axis.
• A rounded or pointed surface of one bone articulates within a ring
formed partially by the other bone.
• Example: articulation of the atlas and axis of the cervical spine.
4) Ellipsoid
• Biaxial movement, primary.
• An ellipsoid joint permits movement in two directions at right angles to
each other.
• Example: radiocarpal joint
5) Saddle
• Biaxial movement. This joint permit movement in two axes, very similar
to the ellipsoid joint. The joint is so named because the articular
surface of one bone is saddle shaped and
the articular surface of the other bone is
shaped like a rider sitting in a saddle.
• Example: The carpometacarpal joint
between the trapezium and the first
metacarpal is the only saddle joint in the
body
6) Ball and socket
• Multi-axial movement. This joint
permits movement in many axes: flexion and
extension, abduction and adduction,
circumduction, and rotation.
• Example: hip and shoulder
Fig. 3.10
Examples of the six types of synovial joints.
A, Gliding: intercarpal joints of the wrist.
B, Hinge: elbow joint.
C, Pivot: atlas and axis of the cervical spine
(viewed from top).
D, Ellipsoid: radiocarpal joint of the wrist.
E, Saddle: carpometacarpal joint.
F, Ball and socket: hip joint
11
3.6 BONE SURFACE MARKINGS
- There are two major types of surface markings:

1. Depressions and openings
o Allow the passage of soft tissues (such as blood vessels and nerves) or form
joints
2. Processes, projections or outgrowths
o Either help form joints or serve as attachment points for connective tissue
(such as ligaments and tendons
BONE SURFACE MARKINGS

MARKING DESCRIPTION EXAMPLE
DEPRESSIONS AND OPENINGS: SITES ALLOWING THE PASSAGE OF SOFT TISSUE (NERVES, BLOOD
VESSELS, LIGAMENTS, TENDONS) OR FORMATION OF JOINTS
Narrow slit between adjacent parts
Superior orbital fissure of the
Fissure of bones through which blood
sphenoid bone
vessels or nerves pass.
Foramen Opening through which blood Optic foramen of the
(hole) vessels, nerves, or ligaments pass. sphenoid bone
Fossa Coronoid fossa of the
Shallow depression.
(trench) humerus
Furrow along a bone surface that
Sulcus Intertubercular sulcus of the
accommodates a blood vessel,
(groove) humerus
nerve, or tendon.
Meatus External auditory meatus of
Tubelike opening.
(passageway) the temporal bone
PROCESSES: PROJECTIONS OR OUTGROWTHS ON BONE THAT FORM JOINTS OR ATTACHMENT

POINTS FOR CONNECTIVE TISSUE, SUCH AS LIGAMENTS AND TENDONS
A. Processes that form joints
Condyle Large, round protuberance at the
Lateral condyle of the femur
(condylus= knuckle) end of a bone
Superior articular facet of a
Facet Smooth flat articular surface.
vertebra
Rounded articular projection
Head supported on the neck (constricted Head of the femur
portion) of a bone.
B. Processes that form attachment points for connective tissue
Prominent ridge or elongated
Crest Iliac crest of the hip bone
projection.
Epicondyle (epi- Medial epicondyle of the
Projection above a condyle.
above) femur
Long, narrow ridge or border (less
Line (linea) Linea aspera of the femur
prominent than a crest).
Spinous process of a
Spinous process Sharp, slender projection.
vertebra
Greater trochanter of the
Trochanter Very large projection.
femur
Greater tubercle of the
Tubercle (tuber= knob) Small, rounded projection
humerus
12
Large, rounded, usually roughened Ischial tuberosity of the hip
Tuberosity
projection bone
3.7 COMMON TYPES OF FRACTURE
* Fracture
- Any break in a bone.
- Named according to their severity, the shape or position of the fracture line
- Among the common types are the following:
1. Open (compound) fracture

o The broken ends of the bone protrude through the skin
2. Closed (simple) fracture

o The broken ends of the bone do not break the skin
3. Comminuted fracture
o The bone is splintered, crushed, or broken into pieces, and smaller bone
fragments lie between the two main fragments
4. Greenstick fracture
o A partial fracture in which one side of the bone is broken and the other side
bends
5. Impacted fracture
o One end of the fractured bone is forcefully driven into the interior of the other
Fig. 3.11
13
FORMATIVE ASSESSMENT 112.4 (*Answers should be placed at the Google Form
provided in the Google Classroom)
1. Match the following:

_____ a) knee 1) Gliding
_____ b) shoulder 2) Hinge
_____ c) intercarpal 3) Pivot
_____ d) atlantoaxial joint 4) Ellipsoid
_____ e) carpometacarpal joint 5) Saddle
_____ f) radiocarpal joint 6) Ball and socket

_____ a) prominent ridge or elongated projection 1) Foramen
_____ b) tubelike opening 2) Tuberosity
_____ c) large round protuberance at the end of a bone 3) Spinous process
_____ d) smooth, flat articular surface 4) Crest
_____ e) sharp, slender projection 5) Facet
_____ f) opening for passage of blood vessels, nerves, 6) Fissure
or ligaments 7) Condyle
_____ g) large, rounded, rough projection 8) Fossa
_____ h) shallow depression 9) Meatus
_____ i) narrow slit between adjacent parts of bones for
passage of blood vessels or nerves
3.8 DIVISIONS OF THE SKELETAL SYSTEM
• The adult human skeleton consists of 206 named bones, most of which are paired, with
one member of each pair on the right and left sides of the body. The skeletons of infants
and children have more than 206 bones because some of their bones fuse later in life.
• Bones of the adult skeleton are grouped into two principal divisions: the axial skeleton
and the appendicular skeleton (appendic- to hang onto).
• The axial skeleton consists of the bones that lie around the longitudinal axis of the human
body, an imaginary vertical line that runs through the body’s center of gravity from the
head to the space between the feet: skull bones, auditory ossicles (ear bones), hyoid
bone, ribs, sternum (breastbone), and bones of the vertebral column.
• The appendicular skeleton consists of the bones of the upper and lower limbs
(extremities), plus the bones forming the girdles that connect the limbs to the axial
skeleton.
14
Fig. 3.12
3.9 AXIAL SKELETON
3.9.1 SKULL
o The skull (cranium), with its 22 bones, rests on the superior end of the vertebral column
(backbone). The bones of the skull are grouped into two categories: cranial bones
and facial bones.
o The cranial bones (crani- brain case) form the cranial cavity, which encloses and
protects the brain. The eight cranial bones are the frontal bone, two parietal bones,
two temporal bones, the occipital bone, the sphenoid bone, and the ethmoid bone.
o Fourteen facial bones form the face: two nasal bones, two maxillae (or maxillas), two
zygomatic bones, the mandible, two lacrimal bones, two palatine bones, two inferior
nasal conchae, and the vomer.
3.9.1a SKULL TOPOGRAPHY

▪ The basic localization points and planes of the skull (all of which can be
either seen or palpated) used in radiographic positioning are illustrated in
Figs. 3.13 and 3.14.
▪ Accurate positioning of the skull requires a full understanding of these
landmarks, which should be studied thoroughly before positioning of the
skull is learned. The planes, points, lines, and abbreviations most frequently
used in skull positioning are as follows:
• Midsagittal plane
• Interpupillary line
• Acanthion
• Outer canthus
15
• Infraorbital margin
• External acousstic meatus (EAM)
• Orbitomeatal line (OML)
• lnfraorbitomeatal line (IOML)
• Acanthiomeatal line (AML)
• Mentomeatal line (MML)
• Glabellomeatal line (GML)
▪ In the adult an average 7-degree angle difference exists between the
OML and IOML, and an average 8-degree angle difference exist
between the OML and the glabellomeatal line.
3.9.1b SKULL MORPHOLOGY

▪ Mesocephalic
• Typical shaped head.
▪ Brachycephalic
• Short from front to back, broad from side to side, and shallow from
vertex to base.
▪ Dolichocephalic
• Long from front to back, narrow from side to side, and deep from
vertex to base
Fig. 3.13
Anterior Landmarks.
Fig. 3.14
Lateral landmarks.
Fig. 3.15
Skull morphology
16
ACTIVITY 112.6 WILL BE UPLOADED IN THE GOOGLE CLASSROOM
THE CRANIAL BONES
***SEE APPENDIX A FOR MORE COMPREHENSIVE LABELLED

ILLUSTRATIONS OF THE SKULL***
17
3.9.1.1 CRANIAL BONES
1. Frontal bone
Parts of the Frontal Bone:
o Frontal squama,
▪ The vertical portion of the frontal bone; forms the forehead and the
anterior part of the vault.
o Frontal eminence
▪ Rounded elevation on the superior portion of the squama.
o Superciliary arches
▪ Two arched ridges that correspond in position to the eyebrows.
o Supraorbitalforamen.
▪ Located at the center of the supraorbital margin; an opening for nerves
and blood vessel
o Glabella (radiographic landmark)
▪ The smooth elevation between the superciliary arches
o Frontal sinuses
▪ Situated between the two tables of the squama on each side of the
midsagittal plane.
18
o Nasion (radiographic landmark)
▪ The midpoint of the frontonasal suture
o The orbital plates of the horizontal portion of the frontal bone are separated by a
notch called the ethmoidal notch.
▪ At the anterior edge of the ethmoidal notch is a small inferior
projection of bone, the nasal spine, which is the most superior
component of the bony nasal septum.
o The frontal bone articulates with the right and left parietals, the sphenoid, and the
ethmoid bones of the cranium.
Fig. 3.16
Anterior aspect of frontal bone.
Fig. 3.17
Inferior aspect of frontal bone.
Posteroanterior (PA) Projection, prone position x-ray of the skull is used when the frontal bone is of
primary interest.
Note: Projection refers to the direction or path of the central ray of the x-ray beam as it passes through
the patient. In PA projection, the central ray enters the posterior aspect and exits the anterior aspect.
See Figure 3.18.
* MODIFICATION FOR TRAUMA PATIENTS

Lateral decubitus position, PA projection x-ray of the skull is used when the patient cannot be
turned to the prone position for x-ray of the frontal bone. Elevate one side
enough to place the patient's head in a true lateral position and support the
shoulder and hip on pillows or sandbags if needed.
19
Fig. 3.18 Fig. 3.19
PA projection, prone position PA projection, Lateral decubitus position
2. Ethmoid bone
Parts of the ethmoid bone:
o Cribriform plate
▪ The horizontal portion of the ethmoid bone
▪ Perforated by many foramina for the transmission of olfactory nerves. The
plate also has a thick, conical process, the crista galli, that serves as the
anterior attachment for the falx cerebri.
o Perpendicular plate
▪ The vertical portion of the ethmoid bone is called the.
o Labyrinths
▪ Contain the ethmoidal sinuses, or air cells.
▪ Projecting inferiorly from each medial wall of
the labyrinths are two thin, scroll-shaped
processes called the superior and middle nasal
conchae.
o The ethmoid bone articulates with the
frontal and sphenoid bones of the cranium.
Fig. 3.20
Anterior aspect
of ethmoid bone.
Fig. 3.21
Lateral aspect of
ethmoid bone.
20
*Submentovertical/SMV Projection (Schuller’s Method) x-ray of the skull demonstrates the
ethmoid air cells.
Note: In SMV projection, the central ray enters the submental area and exits the vertex.
Fig. 3.22
SMV projection
3. Parietal bones
Parts of the parietal bones:
o Parietal eminence (Fig 3.23)
▪ A prominent bulge of the parietal bone
▪ In radiography the width of the head should be
measured at this point because it is the widest point of
the head.
o Each parietal bone articulates with the frontal, temporal, Fig. 3.23
occipital, sphenoid, and opposite parietal bone of the Arrows pointing to
cranium. parietal eminence.
*Anteroposterior (AP) Axial projection (Towne’s Method) x-ray of the skull with 30 degrees
caudal/inferior angulation of the central ray demonstrates the posterior aspect of the parietal
bone. Note that the infraorbitomeatal line (IOML) is perpendicular to the radiographic table
Note: Axial projection is produced by angling the x-ray tube/ central ray cephalic or caudal.

*Fig 3.25 shows an AP Axial skull, Towne’s Method, on a trauma patient. Note that the OML
and IOML lines are not perpendicular, which would require a central ray angulation greater than 37
degrees.
Fig. 3.24 Fig. 3.25

Towne’s Method Modified Towne’s Method
21
4. Sphenoid bone
o Irregularly wedge-shaped bone that somewhat resembles a bat with its wings
extended.
o The sphenoid bone consists of a body; two lesser wings and two greater wings,
which project laterally from the sides of the body; and two pterygoid processes,
which project inferiorly from each side of the inferior surface of the body.
Parts of the Sphenoid bone:

o Body of the sphenoid bone
▪ Contains the two sphenoidal sinuses, which are incompletely separated
by a median septum.
▪ The superior surface presents a deep depression called the sella turcica
and contains a gland called the pituitary gland.
• The sella turcica is bounded anteriorly by the tuberculum sellae
and posteriorly by the dorsum sellae, which bear the posterior
clinoid processes.
• Posterior and inferior to the dorsum sellae is the clivus. The clivus
supports the pons.
▪ Carotid sulcus,
• The internal carotid artery and cavernous sinus lie within this sulcus.
▪ Optic groove
• Extends across the anterior portion of the tuberculum sellae.
▪ Optic canal
• The opening into the apex of the orbit for the transmission of the
optic nerve and ophthalmic artery. The optic foramen is the actual
opening to the optic canal.
o Lesser wings
▪ The lesser wings form the upper margin of
the superior orbital fissures. The medial ends
of their posterior borders form the anterior
clinoid processes.
▪ Each process arises from two roots. The
anterior (superior) root is thin and fiat, and
the posterior (inferior) root, referred to as the
sphenoid strut (See Fig. 3.30), is thick and
rounded. The circular opening between the Fig. 3.26
two roots is the optic canal. Anterior aspect of cranium
(magnified view of orbit area
showing sphenoid strut).
o Greater wings
▪ The foramina rotundum, ovate, and spinosum are paired and are situated
in the greater wings.
▪ The pterygoid processes arise from the lateral portions of the inferior
surface of the body of the sphenoid bone and the medial portions of the
inferior surfaces of the greater wings.
• Each pterygoid process consists of two plates of bone, the medial
and lateral pterygoid laminae.
• The inferior extremity of the medial lamina is the pterygoid hamulus
o The sphenoid bone articulates with each of the other seven bones of the cranium.
22
Fig. 3.27
Superior aspect of sphenoid bone. Fig. 3.28
Lateral aspect of sphenoid
bone.
Fig. 3.29
Oblique aspect of sphenoid bone
Fig. 3.30 Axial CT image of the sphenoid bone.
*Lateral Projection x-ray of the skull demonstrates the lateral aspect of the sellar region.
Lateral Projection, dorsal decubitus or supine lateral position x-ray of the skull is used when patient
cannot assume standing position or lateral recumbent position.
Fig. 3.31 Fig. 3.32

Lateral projection of sellar region. Dorsal decubitus lateral skull.
23
5. Occipital bone
o The occipital bone has four parts: the squama, two occipital condyles, and the
basilar portion. The occipital bone also has a large aperture, the foramen
magnum. Through which the inferior portion of the medulla oblongata passes as it
exits the cranial cavity and joins the spinal cord.
Parts of the occipital bone:

o Squama
▪ Located on the external surface of the occipital bone
▪ Midway between its summit and the foramen magnum, is a prominent
process termed the external occipital protuberance, or inion
(radiographic landmark); that corresponds in position with the internal
occipital protuberance.
Fig. 3.33 Fig. 3.34

External surface of occipital bone. External surface of occipital bone.
o Occipital condyles
▪ Articulate with the atlas of the cervical spine to form the occipitoatlantal
joints.
▪ The hypoglossal canals are found at the anterior ends of the condyles
and transmit the hypoglossal nerves.
▪ At the posterior end of the condyles are the condylar canals, through
which the emissary veins pass.
▪ The anterior portion of the occipital bone contains a deep notch that
forms a part of the jugular foramen.
o Basilar portion
▪ The sloping surface of the junction between the dorsum sellae of the
sphenoid bone and the basilar portion of the occipital bone is called the
clivus.
o The occipital bone articulates with the two parietals, the two temporals and the
sphenoid of the cranium, and the first cervical vertebra.
*Anteroposterior (AP) projection (Towne’s Method) x-ray of the skull with 30 degrees
caudal/inferior angulation of the central ray demonstrates the occipital bone.
Refer to Figure 3.25 for the modification for trauma patients.
24
Fig. 3.35
Towne’s Method
6. Temporal bones
o Each temporal bone consists of a squamous portion, a tympanic portion, a styloid
process, a zygomatic process, and a petromastoid portion (the mastoid and
petrous portions) that contains the organs of hearing and balance.
Parts of the temporal bone:

o Squamous portion
▪ It forms a part of the side wall of the cranium and has a prominent arched
process, the zygomatic process, which projects anteriorly to articulate
with the zygomatic bone of the face and thus complete the zygomatic
arch.
▪ On the inferior border of the zygomatic process is the articular tubercle,
which forms the anterior boundary of the mandibular fossa. The
mandibular fossa receives the condyle of the mandible to form the
temporomandibular joint (TMJ).
o Tympanic portion
▪ Situated below the squama and in front of the mastoid and petrous
portions of the temporal bone.
o Styloid process
▪ A slender, pointed bone projecting from the inferior portion of the
tympanic part of the temporal bone.
o Petromastoid portion
▪ Mastoid portion
- Forms the inferior, posterior part of the temporal bone is prolonged
into the mastoid process. The mastoid process varies considerably
in size, depending on its pneumatization, and is larger in males
than in females.
- The first of the mastoid air cells to develop is situated at the upper
anterior part of the process and is termed the mastoid antrum.
Shortly before or after birth, smaller air cells begin to develop
around the mastoid antrum and continue to increase in number
and size until around puberty.
▪ Petrous portion
- Often called the petrous pyramid, is the thickest, densest bone in
the cranium. This part of the temporal bone contains the organs of
hearing and balance.
25
- The internal carotid artery in the carotid
canal enters the inferior aspect of the petrous
portion, passes superior to the cochlea, then
passes medially to exit the petrous apex. Near
the petrous apex is a ragged foramen called the
foramen lacerum.
- At the center of the posterior aspect of the
petrous portion is the internal acoustic meatus
(lAM), which transmits the vestibulocochlear and
facial nerves. The upper border of the petrous
portion is commonly referred to as the petrous
ridge. The top of the ridge lies approximately at
the level of an external radiography landmark
called the top of ear attachment (TEA).
Fig. 3.36 o The temporal bone articulates with the
CT image of the petrous portion at the level of the EAM. parietal, occipital, and sphenoid bones of the
cranium.
Fig. 3.37
A- Anterior aspect of temporal
bone in relation to
surrounding structures.
B- Coronal section through
mastoid and petrous
portions of the temporal
bone.
3.9.1.2 BONES OF THE EAR (Fig. 3.38)

- The smallest bones in the body, the
auditory ossicles, named for their
shape, are the malleus (hammer),
incus (anvil), and stapes (stirrup). These
three delicate bones are articulated to
permit vibratory motion.
- They bridge the middle ear cavity for
the transmission of sound vibrations
from the tympanic membrane to the
internal ear.
Fig. 3.38
Bones of the ear.
26
3.9.1.3 FACIAL BONES
- The 14 facial bones include two nasal bones, two maxillae (or maxillas), two zygomatic
bones, the mandible, two lacrimal bones, two palatine bones, two inferior nasal
conchae, and the vomer.
ACTIVITY 112.7 WILL BE UPLOADED in the Google Classroom
1. Nasal Bones
o The paired nasal bones meet at the midline and form the bridge of the nose. The
rest of the supporting tissue of the nose consists of cartilage.
Fig. 3.39
X-ray of the nasal bones
A- Right lateral
B- Left lateral
27
2. Lacrimal bones
o They are the smallest facial bones.
o Each lacrimal bone contains a lacrimal foramen through which a tear duct
passes.
3. Maxillae
o The two maxillary bones are the largest of the immovable bones of the face.
o Each articulates with all other facial bones except the mandible.
o The body of each maxilla contains a large, pyramidal cavity called the maxillary
sinus, which empties into the nasal cavity.
o An infraorbital foramen is located under each orbit and serves as a passage
through which the infraorbital nerve and artery reach the nose.
o At their inferior borders the maxillae possess a thick, spongy ridge called the
alveolar process, which supports the roots of the teeth.
o In the anterior midsagittal plane at their junction with each other, the maxillary
bones form a pointed, forward-projecting process called the anterior nasal spine.
The midpoint of this prominence is called the acanthion (radiographic landmark).
4. Zygomatic bones
o The zygomatic bones form the prominence of the cheeks.
o A posteriorly extending temporal process unites with the zygomatic process of the
temporal bone to form the zygomatic arch.
5. Palatine bones
o The two palatine bones are L-shaped bones composed of vertical and horizontal
plates.
o The horizontal plates articulate with the maxillae to complete the posterior fourth
of the bony palate, or roof of the mouth
o The vertical portions of the palatine bones extend upward between the maxillae
and the pterygoid processes of the sphenoid bone in the posterior nasal cavity.
6. Inferior nasal conchae

o They are long, narrow, and extremely thin; they curl laterally, which gives them a
scroll-like appearance.
7. Vomer
o The vomer is a thin plate of bone situated in the midsagittal plane of the floor of
the nasal cavity, where it forms the inferior part of the nasal septum
8. Mandible
o The mandible, the largest and densest bone of the face, consists of a curved
horizontal portion, called the body, and two vertical portions, called the rami,
which unite with the body at the angle of the mandible, or gonion (radiographic
landmark).
o At the site of ossification is a slight ridge that ends below in a triangular
protuberance, the mental protuberance.
o The symphysis is the most anterior and central part of the mandible. This is where
the left and right halves of the mandible have fused.
28
o The superior border of the body of the mandible consists of spongy bone, called
the alveolar portion, which supports the roots of the teeth.
o Below the second premolar tooth is a small opening on each side for the
transmission of nerves and blood vessels. These two openings are called the
mental foramina.
o Each ramus presents two processes at its upper extremity, one coronoid and one
condylar, which are separated by a concave area called the mandibular notch.
▪ The anterior process, the coronoid process, is thin and tapered and
projects to a higher level than the posterior process.
▪ The condylar process consists of a constricted area, the neck, above
which is a broad, thick, almost transversely placed condyle that
articulates with the mandibular fossa of the temporal bone.
• This articulation, the TMJ, is situated immediately in front of the
EAM.
Fig. 3.40
A- Anterior aspect of mandible
B- Lateral aspect of mandilbe
* Nasal Septum
- The inside of the nose, called the nasal cavity, is divided into right and left sides by a
vertical partition called the nasal septum, which consists of bone and cartilage.
- The three components of the nasal septum are the vomer, septal cartilage, and the
perpendicular plate of the ethmoid bone.
* Orbits (Fig. 3.41)

- Seven bones of the skull join to form
each orbit (eye socket), which
contains the eyeball and associated
structures.
- The three cranial bones of the orbit
are the frontal, sphenoid, and
ethmoid; the four facial bones are
the palatine, zygomatic, lacrimal,
and maxilla.
Fig. 3.41
Details of the orbit (eye socket)
29
* Foramina
PRINCIPAL FORAMINA OF THE SKULL

Foramen Location Structures Passing Through
Internal carotid artery and
Carotid Petrous portion of temporal bone
sympathetic nerves for eyes.
Hypoglossal Cranial nerve XII (hypoglossal)
(hypo- under; Superior to base of occipital condyles and branch of
glossus -tongue) ascending pharyngeal artery
Infraorbital nerve and blood
Infraorbital vessels and a branch of the
Inferior to orbit in maxilla
(infra- below) maxillary division of cranial
nerve V (trigeminal).
Posterior to carotid canal between Internal jugular vein, cranial
Jugular
petrous portion of temporal bone and nerves IX (glossopharyngeal), X
(jugul- the throat)
occipital bone (vagus), and XI (accessory).
Bounded anteriorly by sphenoid bone,
Lacerum
posteriorly by petrous portion of Branch of ascending
(lacerum-
temporal bone, and medially by pharyngeal artery
lacerated)
sphenoid and occipital bones
Medulla oblongata and its
Magnum membranes (meninges), cranial
Occipital bone
(= large) nerve XI (accessory), and
vertebral and spinal arteries.
Mandibular Inferior alveolar nerve and
Medial surface of ramus of mandible
(mand- to chew) blood vessels
Emissary vein to transverse sinus
Mastoid Posterior border of mastoid process of
and branch of occipital artery
(= breast-shaped) temporal bone
to dura mater.
Mental Inferior to second premolar tooth in
Mental nerve and vessels
(ment- chin) mandible
Olfactory
Cribriform plate of ethmoid bone Cranial nerve I (olfactory).
(olfact- to smell)
Optic Between superior and inferior portions Cranial nerve II (optic) and
(= eye) of small wing of sphenoid bone ophthalmic artery
Ovale Mandibular branch of cranial
Greater wing of sphenoid bone
(= oval) nerve V (trigeminal).
Rotundum Junction of anterior and medial parts Maxillary branch of cranial
(= round) of sphenoid bone nerve V (trigeminal).
Stylomastoid
Between styloid and mastoid processes Cranial nerve VII (facial) and
(stylo- stake or
of temporal bone stylomastoid artery
pole)
Supraorbital Supraorbital margin of orbit in frontal
Supraorbital nerve and artery.
(supra- above) bone
* Sutures
- Immovable joint in most cases in an adult skull that holds most skull bones together.
- Of the many sutures found in the skull, we will identify only four prominent ones:
30
o Coronal suture
▪ Unites the frontal bone and both parietal bones
o Sagittal suture
▪ (sagitt- arrow); so named because in the infant, before the bones of the
skull are firmly united, the suture and the fontanels (soft spots) associated
with it resemble an arrow
▪ Unites the two parietal bones on the superior midline of the skull
o Lambdoid suture
▪ Unites the two parietal bones to the occipital bone. This suture is so
named because of its resemblance to the Greek letter lambda (Λ)
o Squamous sutures
▪ Unite the parietal and temporal bones on the lateral aspects of the skull
ACTIVITY 112.8—IDENTIFY AND LABEL THE SUTURES OF THE SKULL
1.
2.
3.
4.
5.
6.
7.
Posterior view Superior view
31
* Paranasal Sinuses
- The paranasal sinuses (para- beside) are cavities within certain cranial and facial bones
near the nasal cavity.
- The paranasal sinuses are lined with mucous membranes. Secretions produced by the
mucous membranes of the paranasal sinuses drain into the nasal cavity.
- Skull bones containing the paranasal sinuses are the frontal, sphenoid, ethmoid, and
maxillary.
- The sinuses lighten the mass of the skull and increase the surface area of the nasal
mucosa, thus increasing the production of mucus to help moisten and cleanse inhaled
air. In addition, the paranasal sinuses serve as resonating (echo) chambers within the skull
that intensify and prolong sounds, thereby enhancing the quality of the voice.
Fig. 3.42
Paranasal sinuses
32
Fig. 3.43
A, Coronal CT image of the frontal sinuses.
B, Coronal CT scan of the maxillary sinuses.
C, Axial CT image of the maxillary sinuses.
D, Axial CT image of the sphenoid sinuses.
E, Sagittal CT Image of the sphenoidal sinus.
F, Coronal CT image of the ethmoid sinuses.
G, Axial CT image of the ethmoidal sinuses.
*Lateral Projection x-ray of the paranasal sinuses (PNS) demonstrates ALL four sinus groups.
Fig. 3.44
Lateral projection of PNS
*PA Axial Projection (Caldwell Method) x-ray of the PNS best demonstrates the frontal and
anterior ethmoidal sinuses.
Figure 3.45
PA Axial of sinuses
33
*Parietoacanthial Projection (Waters Method) x-ray of the PNS best demonstrates the maxillary
sinuses.
Fig. 3.46
Parietoacanthial projection
of sinuses
*Parietoacanthial Projection (Open-Mouth Waters Method) x-ray of the PNS best demonstrates
the maxillary and sphenoid sinuses.
Fig. 3.47
Open-mouth Waters modification
demonstrates the sphenoid sinuses
projected through the open mouth
along with the maxillary sinuses.
* Fontanels
- At birth, mesenchyme-filled spaces called
fontanels commonly called “soft spots,” are
present between the cranial bones.
Fontanels are areas of unossified
mesenchyme. (*Mesenchyme: embryonic
connective tissue found almost exclusively in
the embryo; the tissue from which almost all
other connective tissues eventually arise)
- Eventually, they will be replaced with bone
by intramembranous ossification to become
sutures. Functionally, the fontanels provide
some flexibility to the fetal skull, allowing the
skull to change shape as it passes through
the birth canal and later permitting rapid
Fig. 3.48
growth of the brain during infancy. Fontanels at birth.
a. Unpaired anterior fontanel
34
•
The largest fontanel, is located at the midline between the two
parietal bones and the frontal bone, and is roughly diamond-shaped.
• It usually closes 18 to 24 months after birth.
b. Unpaired posterior fontanel
• Located at the midline between the two parietal bones and the
occipital bone.
• Because it is much smaller than the anterior fontanel, it generally
closes about 2 months after birth.
c. Paired anterolateral fontanels
• Located laterally between the frontal, parietal, temporal, and
sphenoid bones, are small and irregular in shape.
• Normally, they close about 3 months after birth.
d. Paired posterolateral fontanels
• Located laterally between the parietal, occipital, and temporal
bones, are irregularly shaped.
• They begin to close 1 to 2 months after birth, but closure is generally
not complete until 12 months.
3.9.2 HYOID BONE

- Small, U-shaped structure situated at the
base of the tongue.
- The hyoid is the only bone in the body
that does not articulate with any other
bone. It is held in position in part by the
stylohyoid ligaments extending from the
styloid processes of the temporal bones.
- The hyoid bone consists of a horizontal
body and paired projections called the
lesser horns and the greater horns.
- The hyoid bone and the cartilages of the
larynx and trachea are often fractured
during strangulation. As a result, they are
carefully examined at autopsy when
strangulation is a suspected cause of
death.
Fig. 3.49
The hyoid bone supports the tongue, providing attachment
sites for muscles of the tongue, neck, and pharynx.
SUMMARY OF PATHOLOGY
Basal fracture Fracture located at the base of the skull
Blowout fracture Fracture of the floor of the orbit
Fracture to one side of a structure caused by trauma to the other
Contre-coup fracture
side
Fracture causing a portion of the skull to be depressed into the
Depressed fracture
cranial cavity
Leforte fracture Bilateral horizontal fractures of the maxillae
Linear fracture Irregular or jagged fracture of the skull
Fracture of the zygomatic arch and orbital floor or rim and
Tripod fracture
dislocation of the frontozygomatic suture
35
Mastoiditis Inflammation of the mastoid antrum and air cells
Metastases Transfer of a cancerous lesion from one area to another
Osteomyelitis Inflammation of bone due to a pyogenic infection
Osteopetrosis Increased density of atypically soft bone
Osteoporosis Loss of bone density
Paget's Disease Thick, soft bone marked by bowing and fractures
Polyp Growth or mass protruding from a mucous membrane
Sinusitis Inflammation of one or more of the paranasal sinuses
TMJ Syndrome Dysfunction of the temporomandibular joint
Acoustic Neuroma Benign tumor arising from Schwann cells of the eighth cranial nerve
Malignant neoplasm of plasma cells involving the bone marrow and
Multiple Myeloma
causing destruction of the bone
Osteoma Tumor composed of bony tissue
Pituitary Adenoma Tumor arising from the pituitary gland, usually in the anterior lobe
FORMATIVE ASSESSMENT 112.5
1. Enumerate the cranial bones:

____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. Enumerate the facial bones:

____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
3. Enumerate the seven bones of the skull that form each orbit (eye socket),
____________________________________________________________________
_____________________________________________________________________
4. Enumerate the three components of the nasal septum

____________________________________________________________________
36
3.9.3 VERTEBRAL COLUMN
- The vertebral column, also called the spine, backbone, or spinal column, is composed of
a series of bones called vertebrae (singular is vertebra).
- It encloses and protects the spinal cord, supports the head, and serves as a point of
attachment for the ribs, pelvic girdle, and muscles of the back and upper limbs.
- The total number of vertebrae during early development is 33. As a child grows, several
vertebrae in the sacral and coccygeal regions fuse. As a result, the adult vertebral
column typically contains 26 vertebrae.
- These are distributed as follows:
o 7 cervical vertebrae (cervic- neck) are in the neck region.
o 12 thoracic vertebrae (thorax - chest) are posterior to the thoracic cavity.
o 5 lumbar vertebrae (lumb- loin) support the lower back.
o 1 sacrum (= sacred bone) consists of five fused sacral vertebrae.
o 1 coccyx (= cuckoo, because the shape resembles the bill of a cuckoo bird)
usually consists of four fused coccygeal vertebrae.
NORMAL CURVES OF THE VERTEBRAL COLUMN

- The vertebral column shows four slight bends called normal curves.
- The cervical and lumbar curves, which are convex anteriorly, are called lordotic curves.
The thoracic and pelvic curve are concave anteriorly and are called kyphotic curves.
- The curves of the vertebral column increase its strength, help maintain balance in the
upright position, absorb shocks during walking, and help protect the vertebrae from
fracture.
- Any abnormal increase in the anterior concavity (or posterior convexity) of the thoracic
curve is termed kyphosis.
- Any abnormal increase in the anterior convexity (or posterior concavity) of the lumbar or
cervical curve is termed lordosis.
- An abnormal lateral curvature of the spine is called scoliosis.
Fig. 3.51
Abnormality of
vertebral curves.
Fig. 3.50
A- Anterior view
showing regions of
the vertebral
column.
B- Right lateral view
showing four normal
curves.
37
INTERVERTEBRAL DISCS
- Intervertebral discs are found between the
bodies of adjacent vertebrae from the
second cervical vertebra to the sacrum (Fig.
3.52).
- Each disc has an outer fibrous ring consisting
of fibrocartilage called the annulus fibrosus
(annulus- ringlike) and an inner soft, pulpy,
highly elastic substance called the nucleus
pulposus (pulposus - pulplike).
- The discs form strong joints, permit various
movements of the vertebral column, and
absorb vertical shock.
- Since intervertebral disc are avascular, the
Fig. 3.52
annulus fibrosus and nucleus pulposus rely on Intervertebral disc.
blood vessels from the bodies of vertebrae to
obtain oxygen and nutrients and remove wastes.
PARTS OF A TYPICAL VERTEBRA

- Vertebrae typically consist of a body, a vertebral arch, and several processes.
1) Body
o The thick, disc-shaped anterior portion, and is the weightbearing part of a
vertebra.
o The anterior and lateral surfaces contain foramina, openings through which
blood vessels deliver nutrients and oxygen and remove carbon dioxide and
wastes from bone tissue.
2) Vertebral arch
o Two short, thick processes, the pedicles, project posteriorly from the vertebral
body to unite with the flat laminae, to form the vertebral arch.
o The vertebral arch extends posteriorly from the body of the vertebra; together,
the body of the vertebra and the vertebral arch surround the spinal cord by
forming the vertebral foramen.
o The vertebral foramen contains the spinal cord, adipose tissue, areolar
connective tissue, and blood vessels. Collectively, the vertebral foramina of all
vertebrae form the vertebral (spinal) canal.
o The pedicles exhibit superior and inferior indentations called vertebral notches.
When the vertebral notches are stacked on top of one another, they form an
opening between adjoining vertebrae on both sides of the column. Each
opening, called an intervertebral foramen, permits the passage of a single spinal
nerve that passes to a specific region of the body.
3) Processes
o Seven processes arise from the vertebral arch.
o At the point where a lamina and pedicle join, a transverse process extends
laterally on each side. A single spinous process (spine) projects posteriorly from
the junction of the laminae.
o The two superior articular processes of a vertebra articulate (form joints) with the
two inferior articular processes of the vertebra immediately above them. In turn,
the two inferior articular processes of that vertebra articulate with the two
superior articular processes of the vertebra immediately below them, and so on.
38
o The articulating surfaces of the articular processes, which are referred to as
facets, are covered with hyaline cartilage. The articulations formed between the
bodies and articular facets of successive vertebrae are termed intervertebral
joints.
Fig. 3.53
Parts of a typical
vertebra.
REGIONS OF THE VERTEBRAL COLUMN
1) Cervical Region
o The bodies of the cervical vertebrae (C1–
C7) are smaller than all other vertebrae
except those that form the coccyx. Their
vertebral arches, however, are larger.
o All cervical vertebrae have three foramina:
one vertebral foramen and two transverse
foramina.
o The vertebral foramina of cervical
vertebrae are the largest in the spinal
column because they house the cervical
enlargement of the spinal cord.
o Each cervical transverse process contains
a transverse foramen through which the
vertebral artery and its accompanying
vein and nerve fibers pass.
o The spinous processes of C2 through C6
are often bifid—that is, split into two parts Fig. 3.54
(see Fig 3.54.)
Posterior view of articulated
o The first two cervical vertebrae differ considerably from the others.
▪ The atlas (C1), named after the mythological Atlas who supported the
world on his shoulders, is the first cervical vertebra inferior to the skull.
• It lacks a body and a spinous process.
• They articulate with the occipital condyles of the occipital bone to
form the paired atlanto-occipital joints. These articulations permit
you to move your head (to nod) to signify “yes.”
39
▪ The second cervical vertebra (C2), the axis, does have a body.
• It has a peglike process called the dens or odontoid process.
• The dens makes a pivot on which the atlas and head rotate
(atlanto-axial joint). This arrangement permits side-to-side
movement of the head, as when you move your head to signify
“no.”
o The third through sixth cervical vertebrae (C3–C6) correspond to the structural
pattern of the typical cervical vertebra previously described.
o The seventh cervical vertebra (C7), called the vertebra prominens, is somewhat
different (see Figure 3.54). Its single large spinous process may be seen and felt at
the base of the neck.
Fig. 3.55
Parts of a cervical vertebra.
40
Routine x-ray projections of the Cervical Vertebrae: Anteroposterior (AP) Axial (upright
or recumbent) with 15-20 degrees cranial angulation of the central ray and Lateral
Projection (Grandy Method). (See Figures 3.56 and 3.57)
Fig. 3.56
AP axial cervical spine.
Fig. 3.57
Lateral cervical spine:
Grandy method.

Dorsal Decubitus Position is used for trauma patients. This position is also used for the lateral
projection of the thoracic and lumbar vertebrae.
Fig. 3.58
Dorsal decubitus lateral
projection of the cervical
spine. Image on the right shows
dislocation of the C3 and C4
articular processes (arrow).
41
2) Thoracic Region
o Thoracic vertebrae (T1–T12; Fig. 3.60) are considerably larger and stronger than
cervical vertebrae.
o The spinous processes on T1 and T2 are long, laterally flattened, and directed
inferiorly. In contrast, the spinous processes on T11 and T12 are shorter, broader,
and directed more posteriorly.
Fig. 3.59 Fig. 3.60

Parts of a thoracic vertebra. Right lateral view of several articulated thoracic vertebrae.
o The feature of the thoracic vertebrae that distinguishes them from other
vertebrae is that they articulate with the ribs. The articulations between the
thoracic vertebrae and ribs, called vertebrocostal joints.
Routine x-ray projections of the Thoracic Vertebrae: AP (upright or recumbent) Lateral Projection.
(See Figures 3.61 and 3.62)
Fig. 3.61
AP projection thoracic vertebrae.
42
Fig. 3.62
Lateral projection thoracic vertebrae.
3) Lumbar Region
o The lumbar vertebrae (L1–L5) are the largest and strongest of the unfused bones
in the vertebral column because the amount of body weight supported by the
vertebrae increases toward the inferior end of the backbone.
o Their various projections are short and thick.
o The spinous processes are quadrilateral in shape, thick and broad, and project
nearly straight posteriorly.
Fig. 3.63
Parts of the lumbar
vertebrae.
Routine x-ray projections of the Lumbosacral and coccyx Vertebrae: AP (upright or recumbent)
and Lateral Projection. (See Figures 3.64 and 3.65)
43
Fig. 3.64
AP projection lumbar vertebrae.
Fig. 3.65
Lateral projection lumbar vertebrae.
Comparison of Major Structural Features of Cervical, Thoracic, and Lumbar Vetebrae

CHARACTERISTIC CERVICAL THORACIC LUMBAR
Overall
structure
Body Small Larger Largest

One vertebral and
Foramina One vertebral. One vertebral.
two transverse
Short and blunt (project
Spinous Slender and often Long and fairly thick
posteriorly rather than
processes bifid (C2–C6). (most project inferiorly).
inferiorly)
Transverse
Small Fairly large Large and blunt.
processes
Articular
Absent. Present. Absent.
facets for ribs
Direction of
Posterosuperior. Posterolateral. Medial.
superior
44
articular
facet
Direction of
inferior
Anteroinferior. Lateral.
articular Anteromedial.
facet
Size of
Thick relative to size of Thin relative to size of
intervertebral Massive.
vertebral bodies. vertebral bodies.
discs
4) Sacrum
o The sacrum is a triangular bone formed by the union of five sacral vertebrae (S1–
S5).
o The female sacrum is shorter, wider, and more curved between S2 and S3 than
the male sacrum.
o Parts of the sacrum (See Fig. 3.66):
▪ Four transverse lines (ridges)
• Mark the joining of the sacral vertebral bodies
▪ Four pairs of anterior sacral foramina
▪ Sacral ala
• Formed by the fused transverse processes of the first sacral
vertebra (S1).
▪ Median sacral crest
• The fused spinous processes of the upper sacral vertebrae
▪ Lateral sacral crest
• The fused transverse processes of the sacral vertebrae
▪ Four pairs of posterior sacral foramina
• They connect with anterior sacral foramina to allow passage of
nerves and blood vessels
▪ Sacral canal
• Continuation of the vertebral cavity
▪ Sacral hiatus
• Portion of the sacrum where the laminae of the fifth sacral
vertebra fail to meet
▪ Sacral cornu
• The inferior articular processes of the fifth sacral vertebra
▪ Apex
• The narrow inferior portion of the sacrum.
▪ Base
• The broad superior portion of the sacrum.
▪ Sacral promontory
• The anteriorly projecting border of the base.
▪ Auricular surface
• Large ear-shaped; articulates with the ilium of each hip bone to
form the sacroiliac joint
▪ Sacral tuberosity
• Contains depressions for the attachment of ligaments
45
▪ Superior articular processes
• Articulate with the inferior articular processes of the fifth lumbar
vertebra
Fig. 3.66
Parts of the sacrum.
5) Coccyx
o Triangular in shape; formed by the fusion of usually four coccygeal vertebrae
o In females, the coccyx points inferiorly to allow the passage of a baby during
birth; in males, it points anteriorly.
o Parts of the coccyx (See Fig. 3.66):
▪ Coccygeal cornua
• Connected by ligaments to the sacral cornua
▪ Transverse processes
Ankyloslng Spondylitis Rheumatoid arthritis variant involving the SI Joints and spine
Clay Shoveler's Fracture Avulsion fracture of the spinous process in the lower cervical
and upper thoracic region
Compression fracture Fracture that causes compaction of bone and a decrease in
length or width
Hangman's fracture Fracture of the anterior arch of C2 due to hyperextension
Jefferson fracture Comminuted fracture of the ring of C2
Herniated Nucleus Pulposus Rupture or prolapse of the nucleus pulposus into the spinal
(HNP) canal
Kyphosis Abnormally Increased convexity in the thoracic curvature
Lordosis Abnormal forward curvature of the cervical and lumbar
spine
Metastases Transfer of a cancerous lesion from one area to another
Osteoarthritis or Degenerative Form of arthritis marked by progressive cartilage
Joint Disease deterioration in synovial Joints and vertebrae
Osteopetrosis Increased density of atypically soft bone
46
Osteoporosis Loss of bone density
Scheuermann's Disease Kyphosis with onset in adolescence
or Adolescent Kyphosis
Scoliosis Lateral deviation of the spine with possible vertebral rotation
Spina Bifida Failure of the posterior encasement of the spinal cord to
close
Spondylolisthesis Forward displacement of a vertebra over a lower vertebra,
usually L5-Sl
Spondylolysis Breaking down of the vertebra
Subluxation Incomplete or partial dislocation
Multiple Myeloma Malignant neoplasm of plasma cells involving the bone
marrow and causing destruction of the bone
THORAX
- The term thorax refers to the entire chest. The skeletal part of the thorax, the thoracic
cage, is a bony enclosure formed by the sternum, ribs and their costal cartilages, and
the bodies of the thoracic vertebrae.
3.9.4 STERNUM
- AKA “breastbone”; is a flat, narrow bone located in the center of the anterior thoracic
wall
- Parts of the sternum:
o Manubrium
▪ The junction of the manubrium and body forms the sternal angle.
▪ Has a depression on its superior surface, the suprasternal notch.
▪ Lateral to the suprasternal notch are clavicular notches that articulate
with the medial ends of the clavicles to form the sternoclavicular joints.
▪ Articulates with the costal cartilages of the first and second ribs.
o Body
▪ Articulates with the costal cartilages of the second through tenth ribs.
o Xiphoid process
▪ No ribs are attached to it, but the xiphoid process provides attachment
for some abdominal muscles.
3.9.5 RIBS
- Twelve pairs of ribs, numbered 1–12 from superior to inferior, give structural support to the
sides of the thoracic cavity.
- The ribs increase in length from the first through seventh, and then decrease in length to
the twelfth rib.
- Each rib articulates posteriorly with its corresponding thoracic vertebra.
- The first through seventh pairs of ribs have a direct anterior attachment to the sternum by
a strip of hyaline cartilage called costal cartilage.
o The ribs that have costal cartilages and attach directly to the sternum are called
true (vertebrosternal) ribs.
47
oThe articulations formed between the true ribs and the sternum are called
sternocostal joints.
- The remaining five pairs of ribs are termed false ribs because their costal cartilages either
attach indirectly to the sternum or do not attach to the sternum at all.
o The cartilages of the eighth, ninth, and tenth pairs of ribs attach to one another
and then to the cartilages of the seventh pair of ribs. These false ribs are called
vertebrochondral ribs.
o The eleventh and twelfth pairs of ribs are false ribs designated as floating
(vertebral) ribs because the costal cartilage at their anterior ends does not
attach to the sternum at all. These ribs attach only posteriorly to the thoracic
vertebrae.
- Spaces between ribs, called intercostal spaces, are occupied by intercostal muscles,
blood vessels, and nerves. The lungs or other structures in the thoracic cavity are
commonly accessed surgically through an intercostal space.
Fig. 3.67
* PA Oblique Projection, right anterior oblique/RAO (right anterior side of the body is in contact with
the radiographic table) position and Lateral Projection is used in x-ray of the sternum.
* On trauma patients, obtain these projections with the patient supine, and use the left posterior
oblique/LPO (left posterior side of the body is in contact with the radiographic table) position for
the AP oblique projection and dorsal decubitus position for the lateral projection (see Figure 3.69B).
Fig. 3.68
PA Oblique sternum, RAO position
48
A
Fig. 3.69
B A- Lateral sternum
B- Dorsal decubitus position for lateral sternum
* AP Projection (upright or recumbent) is used for x-ray of the ribs.
Fig. 3.70
AP projection of ribs.
49
1. Enumerate the three parts of a typical vertebra.

__________________________ __________________________ __________________________

_____ a) Spinous process long and thick
_____ b) Has articular facets for ribs 1) Cervical
_____ c) Superior articular facet is directed posterosuperiorly 2) Thoracic
3) Lumbar
_____ d) Thick intervertebral disc relative to size of vertebral bodies
_____ e) Has the largest body
_____ f) One vertebral and two transverse foramina
_____ g) Transverse process large and blunt
3.10 APPENDICULAR SKELETON

PECTORAL (SHOULDER) GIRDLE
- The human body has two pectoral or shoulder girdles that attach the bones of the upper
limbs to the axial skeleton (see Figure 3.71). Each of the two pectoral girdles consists of a
clavicle and a scapula.
Fig. 3.71
Parts of the shoulder girdle.
3.10.1 CLAVICLE
- AKA “collarbone” lies horizontally across the anterior part of the thorax superior to the first
rib.
- The medial end, called the sternal end, is rounded and articulates with the manubrium of
the sternum to form the sternoclavicular joint.
- The broad, flat, lateral end, the acromial end, articulates with the acromion of the
scapula to form the acromioclavicular joint.
50
3.10.2 SCAPULA
- AKA “shoulder blade” is situated in the superior part of the posterior thorax between the
levels of the second and seventh ribs.
Parts of the scapula:

- Spine
o Prominent ridge runs diagonally across the posterior surface of the scapula
- Acromion
o The lateral end of the spine projects as a flattened, expanded process
- Glenoid cavity
o Accepts the head of the humerus (arm bone) to form the glenohumeral joint
- Medial (vertebral) border
o The thin edge of the scapula closer to the vertebral column
- Lateral (axillary) border
o The thick edge of the scapula closer to the arm
- Inferior angle
o Point where the medial and lateral borders join
- Superior border
- Medial border
- Superior angle
o Point where the superior and medial borders meet
- Scapular notch
o Prominent indentation
along the superior border
- Coracoid process
o A projection of the
anterior surface
- Supraspinous fossa
o Surface of
attachment for the
supraspinatus muscle of
the shoulder
- Infraspinous fossa
o Surface of
attachment for the
infraspinatus muscle of the
shoulder
- Subscapular fossa
o Surface of
attachment for the
subscapularis muscle
Fig. 3.72
Parts of the scapula.
51
* AP Projection (upright or recumbent) is used for routine x-ray of the clavicle.
Fig. 3.73
AP clavicle.
* AP Projection (upright or recumbent) and Oblique/“Scapular Y” (45-60 degrees obliquity)

Projection is used for routine x-ray of the scapula.
Fig. 3.74
AP scapula.
Fig. 3.75
Oblique scapula.
UPPER LIMB (EXTREMITY)

- Each upper limb (upper extremity) has 30 bones in three locations—(1) the humerus in
the arm; (2) the ulna and radius in the forearm; and (3) the 8 carpals in the carpus (wrist),
the 5 metacarpals in the metacarpus (palm), and the 14 phalanges (bones of the digits)
in the hand.
52
3.10.3 HUMERUS
- AKA “arm bone”, is the longest and largest bone of the upper limb.
- It articulates proximally with the scapula and distally at the elbow with two bones, the
ulna and the radius.
Parts of the humerus:

- Head
o Proximal end of the humerus that articulates with the glenoid cavity of the
scapula to form the glenohumeral joint.
- Anatomical neck
o Distal to the head; visible as an oblique groove
- Greater tubercle
o Lateral projection distal to the anatomical neck; It is the most laterally palpable
bony landmark of the shoulder region.
- Lesser tubercle
- Intertubercular sulcus
o Located between the greater and lesser tubercles
- Surgical neck
o Constriction in the humerus just distal to the tubercles; it is so named because
fractures often occur here.
- Body (shaft)
- Deltoid tuberosity
o V-shaped area at the middle portion of the shaft
- Capitulum
o Located at the distal end of the on the lateral aspect; it articulates with the head
of the radius
- Radial fossa
o Anterior depression
above the capitulum that
articulates with the head of
the radius when the forearm is
flexed (bent)
- Trochlea
o Spool-shaped surface
that articulates with the ulna
- Coronoid fossa
o Anterior depression
that receives the coronoid
process of the ulna when the
forearm is flexed
- Olecranon fossa
o Large posterior
depression that receives the
olecranon of the ulna when
the forearm is extended
(straightened).
- Medial epicondyle
and lateral epicondyle
o Rough projections on
either side of the distal end of
Fig. 3.76 the humerus
Right humerus in relation to the scapula, ulna, and radius.
53
3.10.4 ULNA AND RADIUS
- The ulna is located on the medial aspect (the little-finger side) of the forearm and is
longer than the radius.
Parts of the ulna:

o Olecranon
▪ Proximal end of the ulna which forms the prominence of the elbow
o Coronoid process
▪ Anterior projection which articulates with the trochlea of the humerus
o Trochlear notch
▪ Large curved area between the olecranon and coronoid process that
forms part of the elbow joint
o Radial notch
▪ Depression which articulates with the head of the radius
o Ulnar tuberosity
o Head
▪ Located at the distal end of the ulna
o Styloid process
▪ Located on the posterior side of the ulna’s distal end
- The radius is the smaller bone of the forearm and is located on the lateral aspect (thumb
side) of the forearm.
Parts of the radius:

o Head
▪ Proximal end of the
radius that articulates with
the capitulum of the
humerus and the radial
notch of the ulna
o Neck
o Radial tuberosity
o Styloid process
▪ Lateral side, which
can be felt proximal to the
thumb
Fig. 3.77
Right ulna and radius in relation to the humerus and carpals.
54
3.10.5 CARPALS, METACARPALS, AND PHALANGES
- The carpus (wrist) is the proximal region of the hand and consists of eight small bones, the
carpals. Articulations among carpal bones are called intercarpal joints. The carpals are
arranged in two transverse rows of four bones each. Their names reflect their shapes.
Carpal bones:
o Scaphoid (boatlike)
▪ Most commonly fractured carpal bone MNEMONIC for carpal bones*:
o Lunate (moon-shaped)
o Triquetrum (three-cornered) Stop Letting Those People
Scaphoid Lunate Triquetrum
o Pisiform (pea-shaped)
Pisiform
o Trapezium (four-sided figure with no two sides parallel) (Proximal Row; Lateral to Medial)
o Trapezoid (four-sided figure with two sides parallel) Touch The Cadaver’s Hand
o Capitate (head-shaped) Trapezium Trapezoid Capitate
Hamate
▪ Largest carpal bone (Distal Row; Lateral to Medial)
o Hamate (hooked)
- The metacarpus, or palm, consists of five bones called metacarpals. Each metacarpal
bone consists of a proximal base, an intermediate shaft, and a distal head. The
metacarpal bones are numbered I to V (or 1–5), starting with the thumb, from lateral to
medial. The bases articulate with the distal row of carpal bones to form the
carpometacarpal joints. The heads articulate with the proximal phalanges to form the
metacarpophalangeal joints.
- There are 14 phalanges in the five digits of each hand and, like the metacarpals, the
digits are numbered I to V (or 1–5), beginning with the thumb, from lateral to medial. A
single bone of a digit is referred to as a phalanx. Each phalanx consists of a proximal
base, an intermediate shaft, and a distal head. The thumb (pollex) has two phalanges,
and there are three
phalanges in each of
the other four digits.
o The first row of
phalanges, the
proximal row,
articulates with the
metacarpal bones
and second row of
phalanges. The
second row of
phalanges, the
middle row,
articulates with the
proximal row and the
third row, called the
distal row. The thumb
has no middle
phalanx. Joints
between phalanges
are called
interphalangeal
joints.
Fig. 3.78
Right wrist and hand in relation to the ulna and radius.
55
* AP Projection and Lateral Projection (upright or recumbent) is used for routine x-ray of the
humerus.
Fig. 3.79
AP and Lateral humerus.
* AP Projection (forearm supinated) and Lateral Projection (note that elbow is flexed) is
used for routine x-ray of the elbow.
Fig. 3.80
AP and Lateral elbow.
* AP Projection (forearm supinated) and Lateral Projection (note that elbow is flexed) is
used for routine x-ray of the forearm.
Fig. 3.81
AP and Lateral forearm.
56
* PA Projection (note that elbow is flexed) and Lateral Projection (note that elbow is
flexed) is used for routine x-ray of the wrist.
Fig. 3.82
PA and Lateral wrist.
* PA Projection (note that elbow is flexed) and Oblique Projection (note that elbow is
flexed) is used for routine x-ray of the wrist.
Fig. 3.83
PA and Oblique hand.
Bone Cyst Fluid filled cyst with a wall of fibrous tissue
Bursitis Inflammation of the bursa
Dislocation Displacement of a bone from the joint space
Bennett's Fracture Fracture at the base of the first metacarpal
Boxer's Fracture Fracture at the base of the fifth metacarpal
Colle's Fracture Fracture of the distal radius and ulnar styloid with posterior
displacement
Smith's Fracture Fracture of the distal radius and ulnar styloid with anterior
displacement
Torus or Buckle Impacted fracture with bulging of the periosteum
Gout Hereditary form of arthritis where uric acid is deposited in joints
Joint Effusion Accumulation of fluid in the joint associated with an underlying
condition
57
Osteoarthritis or Form of arthritis marked by progressive cartilage deterioration in
Degenerative Joint synovial joints and
Disease vertebrae
Rheumatoid Arthritis Chronic, systemic, inflammatory collagen disease
Chondrosarcoma Malignant tumor arising from cartilage cells
Enchondroma Benign tumor consisting of cartilage
Ewing's Sarcoma Malignant tumor of bone arising in medullary tissue
Osteosarcoma Malignant. primary tumor of bone with bone or cartilage formation
PELVIC (HIP) GIRDLE

- The pelvic (hip) girdle consists of the two hip bones, also called coxal or pelvic bones or
os coxa.
- The hip bones unite anteriorly at a joint called the pubic symphysis. They unite posteriorly
with the sacrum at the sacroiliac joints.
- Each of the two hip bones of a newborn consists of three bones separated by cartilage:
a superior ilium, an inferior and anterior pubis, and an inferior and posterior ischium. By
age 23, the three separate bones fuse together
3.10.6 ILIUM
- Largest of the three components of the hip bone.
Parts of the Ilium

- Ala
- Body
o Helps form the acetabulum, the socket for the head of the femur
- Iliac crest
o Superior border of the ilium
- Anterior superior iliac
spine/ASIS (radiographic
landmark)
- Anterior inferior iliac spine
- Posterior superior iliac spine
- Posterior inferior iliac spine
- Greater sciatic notch
o The sciatic nerve, the
longest nerve in the
body, passes through
this
- Iliac fossa
- Iliac tuberosity
- Auricular surface
o Articulates with the
sacrum to form the
sacroiliac joint
- Arcuate line
- Posterior gluteal line
- Anterior gluteal line
- Inferior gluteal line Fig. 3.84
Detailed lateral view.
58
3.10.7 ISCHIUM
- The inferior, posterior
portion of the hip bone.
Parts of the ischium:

- Body
- Ramus
o Portion of the
ischium that fuses
with the pubis
- Ischial spine
- Lesser sciatic notch
- Ischial tuberosity
o Also known as the
sitting bone
* Together, the ramus of the

ischium and the pubis surround
the obturator foramen, the largest
foramen in the skeleton.
Fig. 3.85
Detailed medial view.
3.10.8 PUBIS
- Meaning pubic bone, is the anterior and inferior part of the hip bone.
Parts of the pubis:

- Superior ramus
- Inferior ramus
- Body
- Pubic crest
o The anterior, superior
border of the body.
- Pubic tubercle
- Pectineal line
* The pubic symphysis is the joint

between the two pubes of the hip
bones.
* The inferior rami of the two pubic bone
converge to form the pubic arch.
* The acetabulum is a deep fossa
formed by the ilium, ischium, and pubis.
It functions as the
socket that accepts the rounded
head of the femur. Together, the Fig. 3.86
acetabulum and the femoral Midsagittal section indicating locations of true and false pelves.
head form the hip (coxal) joint.
* The acetabular notch forms a foramen through which blood vessels and nerves pass and
serves as a point of attachment for ligaments of the femur.
59
FALSE AND TRUE PELVES (see Figure 3.86)
- The bony pelvis is divided into superior and inferior portions by a boundary called the
pelvic brim.
- The portion of the bony pelvis superior to the pelvic brim is referred to as the false
(greater) pelvis.
- The portion of
the bony pelvis
inferior to the
pelvic brim is
the true (lesser)
pelvis. It has an
inlet, an outlet,
and a cavity
o The
true pelvis
surrounds the
pelvic cavity.
o The
superior
opening of the
true pelvis,
bordered by
the pelvic brim,
is called the
pelvic inlet; the
inferior opening
of the true
pelvis is the
pelvic outlet.
Fig. 3.87
Comparison of Female and Male Pelves.
60
* AP Projection is used for routine x-ray of the pelvis.
Fig. 3.88
First radiograph—male AP pelvis; Second radiograph—female AP pelvis
LOWER LIMB (EXTREMITY)

- Each lower limb (lower extremity) has 30 bones in four locations—(1) the femur in the
thigh; (2) the patella (kneecap); (3) the tibia and fibula in the leg; (4) and the 7 tarsals in
the tarsus (ankle), the 5 metatarsals in the metatarsus, and the 14 phalanges (bones of
the digits) in the foot.
3.10.9 FEMUR
- The femur, or thigh bone, is the longest, heaviest, and strongest bone in the body.
- Its proximal end articulates with the acetabulum of the hip bone. Its distal end articulates
with the tibia and patella.
Parts of the femur:

- Body (shaft)
o Angles medially and, as a result, the knee joints are closer to the midline. The
angle (angle of convergence) is greater in females because the female pelvis is
broader.
- Head
o Articulates with the acetabulum of the hip bone to form the hip (coxal) joint.
o Contains a small centered depression (pit) called the fovea capitis (fovea- pit;
capitis- of the head).
- Neck
o Constricted region distal to the head.
- Greater trochanter and lesser trochanter
o projections from the junction of the neck and shaft that serve as points of
attachment for the tendons of some of the thigh and buttock muscles.
- Intertrochanteric line
o Between the anterior surfaces of the trochanters.
- Intertrochanteric crest
o A ridge between the posterior surfaces of the trochanters.
- Gluteal tuberosity
o a vertical ridge on the posterior surface of the body of the femur
61
- Linea aspera
o Blends with the gluteal tuberosity
- Medial condyle and the lateral condyle
- Medial epicondyle and lateral epicondyle
- intercondylar fossa
o depressed area between the condyles on the posterior surface
Fig. 3.89
Right femur in relation to the hip bone,
patella, tibia, and fibula.
* AP Projection and Lateral Projection is used for routine x-ray of the Femur.
Fig. 3.90
AP and Lateral femur.
62
3.10.10 PATELLA
- The patella or kneecap, is a small, triangular bone located anterior to the knee joint.
Parts of the patella:

- Base
- Apex
- Articular facets (two)
o one for the
medial condyle
of the femur and
another for the
lateral condyle
of the femur Fig. 3.91
Parts of the patella.
* The patellofemoral joint,

between the posterior surface of the
patella and the patellar surface of the femur, is the intermediate component of the tibiofemoral
(knee) joint.
* AP Projection and Lateral Projection is used for routine x-ray of the Knee.
Fig. 3.92
AP and Lateral Knee
3.10.11 TIBIA AND FIBULA

- The tibia, or shin bone, is the larger, medial, weight-bearing bone of the leg.
- The tibia articulates at its proximal end with the femur and fibula, and at its distal end
with the fibula and the talus bone of the ankle.
- Unlike the tibia, the fibula does not articulate with the femur.
Parts of the tibia:

- Lateral condyle and a medial condyle
o These articulate with the condyles of the femur to form the lateral and medial
tibiofemoral (knee) joints.
- Intercondylar eminence
o Separates the lateral and medial condyles
- Tibial tuberosity
- Anterior border (crest) or shin
o a sharp ridge that can be felt below the skin
- Medial malleolus
63
o medial surface of the distal end of
the tibia
- Fibular notch
o Articulates with the distal end of
the fibula to form the distal
tibiofibular joint
* Of all the long bones of the body, the tibia is

the most frequently fractured and is also the
most frequent site of an open (compound)
fracture.
Parts of the fibula:

- Head
o The proximal end of the fibula; it
articulates with the inferior surface
of the lateral condyle of the tibia
to form the proximal tibiofibular
joint.
- Lateral malleolus
o Distal end of fibula; articulates
with the talus of the ankle
Fig. 3.93
Right tibia and fibula in relation to the femur,
patella, and talus.
* AP Projection and Lateral Projection is used for routine x-ray of the Leg (tibia and fibula).
Fig. 3.94
AP and Lateral Leg
3.10.12 TARSALS, METATARSALS, AND PHALANGES

- The tarsus (ankle) is the proximal region of the foot and consists of seven tarsal bones.
- The metatarsus, the intermediate region of the foot, consists of five metatarsal bones
numbered I to V (or 1–5) from the medial to lateral position.
- The phalanges comprise the distal component of the foot and resemble those of the
hand both in number and arrangement. The toes are numbered I to V (or 1–5) beginning
with the great toe, from medial to lateral.
64
Tarsal bones:
- Talus
o The only bone of the foot that articulates with the fibula and tibia to form the
talocrural (ankle) joint.
- Calcaneus MNEMONIC for tarsal bones*:
o largest and strongest tarsal bone
- Navicular Tiger Cubs Need
Talus, Calcaneus, Navicular
- Third (lateral) cuneiform
MILC
- Second (intermediate) cuneiform Medial cuneiform (1st),
- First (medial) cuneiform Intermediate cuneiform (2nd),
- Cuboid Lateral cuneiform (3rd), Cuboid
* Joints between tarsal bones are called intertarsal joints.
Parts of a metatarsal:
- Base
- Shaft
- Head
* The metatarsals articulate

proximally with the first, second, and
third cuneiform bones and with the
cuboid to form the tarsometatarsal
joints. Distally, they articulate with the
proximal row of phalanges to form
the metatarsophalangeal joints.
Parts of a phalanx:
- Base
- Shaft
- Head
* The great or big toe (hallux) has

two large, heavy phalanges called
proximal and distal phalanges. The
other four toes each have three
phalanges—proximal, middle, and
distal. Joints between phalanges of
the foot, like those of the hand, are Fig. 3.95
called interphalangeal joints. Parts of the tarsals, metatarsals, and phalanges.
65
* AP Projection and Lateral Projection is used for routine x-ray of the ankle.
Fig. 3.96
AP and Lateral ankle.
* AP Projection and Oblique Projection is used for routine x-ray of the foot.
Fig. 3.97
AP and Oblique foot.
Congenital Clubfoot Abnormal twisting of the foot. usually inward and downward
Pott's Fracture Avulsion fracture of the medial malleolus with loss of the ankle
mortise
Osgood-Schlatter Disease Incomplete separation or avulsion of the tibial tuberosity
Osteomalacia or Rickets Softening of the bones due to a vitamin D deficiency
Osteochondroma or Benign bone tumor projection with a cartilaginous cap
Exostosis
Osteoclastoma or Lucent lesion in the metaphysis, usually at the distal femur
Giant Cell Tumor
Osteoid Osteoma A benign lesion of cortical bone
Osteosarcoma Malignant. primary tumor of bone with bone or cartilage
formation
66
Match the following:

_____ a) a large, triangular, flat bone found in the posterior part of (1) calcaneus
the thorax (2) scapula
_____ b) an S-shaped bone lying horizontally in the superior (3) patella
and anterior part of the thorax (4) radius
_____ c) articulates proximally with the scapula and distally (5) femur
with the radius and ulna (6) clavicle
_____ d) located on the medial aspect of the forearm (7) ulna
_____ e) located on the lateral aspect of the forearm (8) tibia
_____ f) the longest, heaviest, and strongest bone of the body (9) humerus
_____ g) the larger, medial bone of the leg (10) fibula
_____ h) the smaller, lateral bone of the leg
_____ i) heel bone
_____ j) sesamoid bone that articulates with the femur and tibia
REFERENCES:
Books
Tortora, Gerard J. (2019). Principles of Anatomy & Physiology.
Long, Bruce W. (2016) Merrill's Atlas of Radiographic Positioning and Procedure. Thirteenth edition.
Websites
https://slideplayer.com/slide/9951297/
https://radiopaedia.org/cases/metastatic-prostate-cancer-bone-scan
https://www.bing.com/images/search?view=detailV2&ccid=1ms1q872&id=81B49B47A043B158D
CBDFFB67132EB66C2B4C88B&thid=OIP.1ms1q872bpZvKBP1CG6dKAHaFj&mediaurl=https%3a%2f
%2fimage3.slideserve.com%2f5669687%2fopenings-in-posterior-orbit-
l.jpg&exph=768&expw=1024&q=sphenoid+strut&simid=608019201163200002&ck=D3E30D5D1240
35E255AF274B63B93E7C&selectedIndex=5&ajaxhist=0
https://i.4pcdn.org/pol/1490047095293.jpg
https://www.google.com/search?q=normal+curves+of+the+vertebral+column+kyphosis&tbm=is
ch&ved=2ahUKEwiRwO2_3tTqAhX3yIsBHVzDCFoQ2-
cCegQIABAA&oq=normal+curves+of+the+vertebral+column+kyphosis&gs_lcp=CgNpbWcQAzo
ECAAQHlD29gdYkYUIYMiGCGgAcAB4AIABogGIAYwHkgEDNi4zmAEAoAEBqgELZ3dzLXdpei1pbW
fAAQE&sclient=img&ei=BdYRX9GpNveRr7wP3Iaj0AU&bih=766&biw=1061#imgrc=MOPeFvH4crJs
vM
67

RT 112 Module 2

Uploaded by

Copyright:

Available Formats

RT 112 Module 2

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

RT 112 Module 2

Uploaded by

Copyright:

Available Formats

RADTECH

COURSE LEARNING OUTCOMES

1. Explain the human body as a

Lorie Ann Mariñas – de Velez, RRT

Unit 3: Skeletal System

3.1 FUNCTIONS OF BONE AND THE SKELETAL SYSTEM

3.2 STRUCTURE OF BONE

2. Epiphyses (singular- epiphysis)

6. Medullary cavity/ Marrow cavity

3.3 HISTOLOGY OF BONE TISSUE

* The spongy bone

SPONGY BONE TISSUE

- A Nuclear Medicine (branch of Radiology)

3.5.1 FUNCTIONAL CLASSIFICATION

3.5.2 STRUCTURAL CLASSIFICATION

- There are two major types of surface markings:

BONE SURFACE MARKINGS

PROCESSES: PROJECTIONS OR OUTGROWTHS ON BONE THAT FORM JOINTS OR ATTACHMENT

3.7 COMMON TYPES OF FRACTURE

1. Open (compound) fracture

2. Closed (simple) fracture

1. Match the following:

2. Match the following:

3.8 DIVISIONS OF THE SKELETAL SYSTEM

3.9 AXIAL SKELETON

3.9.1a SKULL TOPOGRAPHY

3.9.1b SKULL MORPHOLOGY

THE CRANIAL BONES

***SEE APPENDIX A FOR MORE COMPREHENSIVE LABELLED

* MODIFICATION FOR TRAUMA PATIENTS

* MODIFICATION FOR TRAUMA PATIENTS

Fig. 3.24 Fig. 3.25

Parts of the Sphenoid bone:

Fig. 3.30 Axial CT image of the sphenoid bone.

Fig. 3.31 Fig. 3.32

Parts of the occipital bone:

Fig. 3.33 Fig. 3.34

Refer to Figure 3.25 for the modification for trauma patients.

Parts of the temporal bone:

3.9.1.2 BONES OF THE EAR (Fig. 3.38)

ACTIVITY 112.7 WILL BE UPLOADED in the Google Classroom

6. Inferior nasal conchae

* Orbits (Fig. 3.41)

PRINCIPAL FORAMINA OF THE SKULL

ACTIVITY 112.8—IDENTIFY AND LABEL THE SUTURES OF THE SKULL

Posterior view Superior view

3.9.2 HYOID BONE

FORMATIVE ASSESSMENT 112.5

1. Enumerate the cranial bones:

2. Enumerate the facial bones:

4. Enumerate the three components of the nasal septum

NORMAL CURVES OF THE VERTEBRAL COLUMN

PARTS OF A TYPICAL VERTEBRA

REGIONS OF THE VERTEBRAL COLUMN

* MODIFICATION FOR TRAUMA PATIENTS

Fig. 3.59 Fig. 3.60

Comparison of Major Structural Features of Cervical, Thoracic, and Lumbar Vetebrae

Body Small Larger Largest

* AP Projection (upright or recumbent) is used for x-ray of the ribs.