PREFACE
Welcome to the twelfth edition of Merrill’s Atlas of Radiographic Positioning and Procedures. The twelfth edition continues the tradition of excellence begun in 1949, when Vinita Merrill wrote the first edition of what has become a classic text. Over the last 62 years, Merrill’s Atlas has provided a strong foundation in anatomy and positioning for thousands of students around the world who have gone on to successful careers as imaging technologists. Merrill’s Atlas is also a mainstay for everyday reference in imaging departments all over the world. As the coauthors of the twelfth edition, we are honored to follow in Vinita Merrill’s footsteps.
Learning and Perfecting Positioning Skills
Merrill’s Atlas has an established tradition of helping students learn and perfect their positioning skills. After covering preliminary steps in radiography, radiation protection, and terminology in introductory chapters, the first two volumes of Merrill’s then teaches anatomy and positioning in separate chapters for each bone group or organ system. The student learns to position the patient properly so that the resulting radiograph provides the information the physician needs to correctly diagnose the patient’s problem. The atlas presents this information for commonly requested projections, as well as those less commonly requested, making it the only reference of its kind in the world.
The third volume of the atlas provides basic information about a variety of special imaging modalities, such as mobile, surgical, geriatrics, computed tomography, cardiac catheterization, magnetic resonance imaging, sonography, nuclear medicine technology, and radiation therapy.
Merrill’s Atlas is not only a comprehensive resource for students to learn from but also an indispensable reference as they move into the clinical environment and ultimately into their practice as imaging professionals.
New to This Edition
Since the first edition of Merrill’s Atlas in 1949, many changes have occurred. This new edition incorporates many significant changes designed not only to reflect the technologic progress and advancements in the profession but also to meet the needs of today’s radiography students. The major changes in this edition are highlighted as follows.
WORKING WITH THE OBESE PATIENT
Many in the profession, especially students, requested that we include material on how to work with obese and morbidly obese patients. Joe Garza of our Advisory Board conducted initial research on the topic and prepared the master outline for a new section. With input from a wide variety of educators and practitioners, we are pleased to state that Merrill’s now includes an extensive illustrated section in Chapter 1 on working effectively with this growing segment of the population.
DIGITAL RADIOGRAPHY COLLIMATION
With the expanding use of digital radiography (DR) and the decline in the use of plates and cassettes in Bucky mechanisms, concern was raised regarding the collimation sizes for the various projections. With collimation considered one of the critical aspects of obtaining an optimal image, especially with CR and DR, this edition contains the specific collimation sizes that students and radiographers should use when using manual collimation with DR in-room and DR mobile systems. The correct collimation size for projections is now included as a separate head.
ENGLISH/METRIC IR SIZES
English and metric sizes for image receptors (IRs) continue to challenge radiographers and authors in the absence of a standardized national system. With film/screen technology there was a trend toward metric for most of the cassette sizes. However, with computed radiography (CR) and digital radiography (DR) there has been a trend back to English sizes. Most of the DR x-ray systems use English for collimator settings. With this trend, the IR sizes and collimation settings for all projections are stated in English with metric in parentheses.
SECTIONAL ANATOMY CHAPTER
With the growing use of computed tomography (CT) and magnetic resonance imaging (MRI), the Sectional Anatomy chapter has been updated with new images and matching art. This revised chapter is comprehensive enough to learn all the essential aspects of cross-sectional anatomy.
CT AND MRI CHAPTERS
With CT slowly working its way into the curriculum, the CT chapter had been updated with the basic protocols for the most common examinations done. The CT and MRI chapters have been updated with many new images to reflect the current state-of-art images in these modalities.
INTEGRATION OF CT AND MRI
In the past two editions, both CT and MRI images have been included in the anatomy and projection pages. This edition continues the trend of having students learn cross-section anatomy with regular anatomy. Over 40 additional CT and MRI images are included in every chapter of this edition.
NEW ILLUSTRATIONS
Many who use Merrill’s in teaching and learning have stated that the line art is one of the most useful aspects in learning new projections. Many new illustrations have been added to all chapters in this edition to enable the user to comprehend bone position, central ray (CR) direction, and body angulations.
REVISED VERTEBRAL ART
Learning cross-sectional anatomy as shown in CT and MRI images is now commonplace in radiography classrooms. CT and MRI anatomy is displayed in a very specific manner with the spine “down” and the anterior aspect of the body “up.” To enable students to learn anatomy as seen in radiology department, the vertebral body art in Chapter 8 has been turned so that the spine is down instead of up. All anatomical art in the Atlas is standardized to CT and MRI imaging.
SIMPLIFIED SHOULDER GIRDLE CHAPTER
The projections in this chapter have been rearranged in a more user-friendly manner. All projections are now arranged by body part.
SIMPLIFIED DIGESTIVE SYSTEM CHAPTERS
The material in Chapter 16 is now focused exclusively on the abdomen, improving instructional delivery for educators and increasing learning for the radiography student. Chapter 17 now includes all material related to the digestive system, with the transfer of biliary system content to this chapter.
COMPENSATING FILTERS CHAPTER
This edition of Merrill’s is the second in which the new Compensating Filters chapter has been included. We have added a new commonly used filter for the foot, with and without images, to help students understand the importance of the use of filters in positioning.
NEW PATIENT PHOTOGRAPHY
New patient positioning photographs are included in Chapters 10 and 22. These new photographs show positioning detail to a greater extent. In addition, the equipment in these photos is the most modern available and computed radiography plates are used. The use of electronic central ray angles enables a better understanding of where the central ray should enter the patient. Scott Slinkard, from the Southeast Missouri Hospital College of Nursing and Health Sciences, Cape Girardeau, Missouri, provided the photographs.
DIGITAL RADIOGRAPHY UPDATED
Because of the rapid expansion and acceptance of computed radiography (CR) and direct digital radiography (DR), either selected positioning considerations and modifications or special instructions are indicated where necessary. A special icon alerts the reader to digital notes. The icon is shown here:
OBSOLETE PROJECTIONS DELETED
Projections identified as obsolete by the authors and the advisory board continue to be deleted. A summary is provided at the beginning of any chapter containing deleted projections so that the reader may refer to previous editions for information. Continued advances in CT, MRI, and ultrasound have prompted these deletions.
CHAPTERS DELETED OR MERGED
The Tomography chapter has been eliminated from the atlas beginning with this edition. Very few, if any, tomogram procedures are done in today’s radiology department. Tomograms are done with some regularity for Intravenous Urography (IVU) and continue to be described in Chapter 18.
NEW RADIOGRAPHS
Nearly every chapter contains new and additional optimum radiographs, including many that demonstrate pathology. With the addition of new radiographic images, the twelfth edition has the most comprehensive collection of high-quality radiographs available to students and practitioners.
Learning Aids for the Student
The new edition of Merrill’s Pocket Guide to Radiography complements the revision of Merrill’s Atlas. In addition to instructions for positioning the patient and the body part for all the essential projections, the new pocket guide includes information on digital radiography and exposure indexes for use with CR and DR. A new Collimation header had been added that state the exact sizings needed for the projections. Tabs have been added to help the user locate the beginning of each section. Space is provided for writing department techniques specific to the user.
RADIOGRAPHIC ANATOMY, POSITIONING, AND PROCEDURES WORKBOOK
The new edition of this workbook features extensive review and self-assessment exercises that cover the first 31 chapters in Merrill’s Atlas in one convenient volume. The features of the previous editions, including anatomy labeling exercises, positioning exercises, and self-tests, are still available, but this edition features more image evaluations to give students additional opportunities to evaluate radiographs for proper positioning and more positioning questions to complement the workbook’s strong anatomy review. The comprehensive multiple-choice tests at the end of each chapter help students assess their comprehension of the whole chapter. New exercises in this edition focus on improved understanding of essential projections and the necessity of appropriate collimated field sizes for digital imaging. Additionally, review and assessment exercises in this edition have been expanded for the Pediatrics, Geriatrics, Vascular and Interventional Radiography, Sectional Anatomy, and Computed Tomography chapters in Volume 3. Exercises in these chapters will help students learn the theory and concepts of these special techniques with greater ease.
Teaching Aids for the Instructor
EVOLVE INSTRUCTOR ELECTRONIC RESOURCES
This comprehensive resource provides valuable tools, such as lesson plans, power point slides, and an electronic test bank, for teaching an anatomy and positioning class. The test bank includes more than 1500 questions, each coded by category and level of difficulty. Four exams are already compiled within the test bank to be used “as is” at the instructor’s discretion. The instructor also has the option of building new tests as often as desired by pulling questions from the Examview pool or using a combination of questions from the test bank and questions that the instructor adds.
Evolve may be used to publish the class syllabus, outlines, and lecture notes; set up “virtual office hours” and e-mail communication; share important dates and information through the online class Calendar; and encourage student participation through Chat Rooms and Discussion Boards. Evolve allows instructors to post exams and manage their grade books online. For more information, visit http://www.evolve.elsevier.com or contact an Elsevier sales representative.
MOSBY’S RADIOGRAPHY ONLINE
Mosby’s Radiography Online: Anatomy and Positioning is a well-developed online course companion that includes animations with narration and interactive activities and exercises to assist in the understanding of anatomy and positioning. Used in conjunction with the Merrill’s Atlas textbook, it offers greater learning opportunities while accommodating diverse learning styles and circumstances. This unique program promotes problem-based learning with the goal of developing critical thinking skills that will be needed in the clinical setting.
EVOLVE—ONLINE COURSE MANAGEMENT
Evolve is an interactive learning environment designed to work in coordination with Merrill’s Atlas. Instructors may use Evolve to provide an Internet-based course component that reinforces and expands on the concepts delivered in class.
We hope you will find this edition of Merrill’s Atlas of Radiographic Positioning and Procedures the best ever. Input from generations of readers has helped to keep the atlas strong through ten editions, and we welcome your comments and suggestions. We are constantly striving to build on Vinita Merrill’s work, and we trust that she would be proud and pleased to know that the work she began 62 years ago is still so appreciated and valued by the imaging sciences community.