"Wu Shaochen, tell me, how many bones are there in the skull?"
"The human skull has a total of 23 bones, including 8 brain bones, including the frontal bone, ethmoid bone, sphenoid bone, occipital bone, temporal bone, and parietal bone. The facial bones have 15 bones, including the maxilla, mandible, nasal bone, inferior turbinate, lacrimal bone, zygomatic bone, hyoid bone, vomer and palatine bone."
Chen Xia clapped his hands: "Beautiful, she has the same charm as I did back then."
Hahahaha~~~~
"I believe everyone knows where these bones are located. Remember this. Next, I'm going to talk about the commonly used baselines for cranial tomography. This is very important. Director Hua, don't just stand there. Take notes quickly."
Hehehe~~~~
If you didn’t know, you would think Chen Xia was performing some stand-up comedy in the conference room.
The first baseline is called the Reid baseline, which runs from the midpoint of the external auditory canal to the infraorbital margin. Transverse sections of the head are often prepared based on this line, while coronal sections are prepared with the baseline perpendicular to it.
The second baseline is the orbitoauricular line or canthal-auricular line, which connects the midpoint of the external auditory canal to the lateral canthus. This line is often used as the baseline for axial and transverse cranial scans.
The third baseline is the superior orbital ear line, which is a line connecting the midpoint of the external auditory canal and the midpoint of the superior orbital margin. The plane passing through this line is approximately consistent with the plane of the skull base, which is beneficial for displaying the posterior cranial fossa structure and reducing skull artifacts.
As Chen Xia spoke, he pointed out the skulls in his hand one by one to everyone, and the only sound left at the scene was the rustling sound of writing.
"When we get a CT scan, we need to know how to read it correctly. Generally speaking, a CT scan of the head is in the axial position, which means it is sliced in the up-down direction. Each image is 10 mm thick, which means that one image shows the condition of 10 mm thick head tissue.
A skull CT scan consists of multiple images. The first image is the lowest layer, typically showing the line connecting the external auditory canal and the outer canthus of the eye. The last image is the top of the head, typically consisting of 11 slices. A typical skull CT scan uses a soft tissue window, primarily viewing brain tissue.
We can see a white circle on the outside, which is our skull. The inside is a gray part, which is the brain tissue. There are also some black parts inside the brain tissue, which are the sulci and cisterns. They appear black because they contain cerebrospinal fluid.
If a CT scan is taken for trauma, there will be a bone window below the soft tissue window. As shown in this picture, the lower bone window mainly shows the skull. The bones are obviously white, and the brain tissue inside is difficult to see and appears black.
Chen Xia took out a CT film and placed it on the projector so that everyone could see more intuitively what he had just said and understand it better.
Actually, it was a bit like listening to a foreign language just now. Although I kept writing, my brain couldn't remember it. Now that the film is out, everyone can see it clearly and vividly.
Then, Chen Xia pointed to the corner of the CT film:
"The second step is to learn to distinguish front, back, left, and right after receiving the CT scan. The easiest way is to look at the information on the CT scan. This information is usually located in the upper left corner of each image.
Another important issue is left and right. Generally, you can see signs on the right side of "R" and the left side of "L" on both sides of the middle of each image. These represent left and right. Through these signs, you can distinguish the left and right brain hemispheres in each image.
Everyone must remember this clearly. Although this problem seems simple, serious medical errors have occurred in other hospitals.
For example, if the patient's left kidney clearly requires surgery, but the doctor misdiagnoses and removes the healthy right kidney, the patient will die, and you won't be able to keep your clothes. This is no joke; it's a real tragedy that has happened overseas."
hiss~~~
Everyone gasped. It was easy to imagine that if they got things wrong and ended up putting the patient in dire straits, not only would the patient die, but they would also definitely be fired.
If it is a brain surgery and the left or right ventricle is wrong, the patient may die on the operating table.
After being frightened by Chen Xia, everyone became more focused. Many people remembered Chen Xia's warning many years later and were extremely careful when seeing a doctor.
After explaining some basic knowledge and anatomical diagrams, some people began to yawn. Chen Xia smiled and said:
"It seems everyone is sleepy, so let's talk about the specific case. This will definitely make a deeper impression on everyone."
Everyone will smile knowingly.
Chen Xia placed a CT scan on the projector:
"This is a CT scan of a traumatic cerebral hemorrhage. Look carefully. The white part in the gray brain is the cerebral hemorrhage. The most common types are subdural hemorrhage and epidural hemorrhage. The simple difference between the two is that subdural hemorrhages are crescent-shaped, while epidural hemorrhages are biconvex and spindle-shaped."
Chen Xia pointed to a part on the film.
"Generally, after a hemorrhage, there will be displacement of midline structures, and the lateral ventricles will be compressed and displaced, causing increased intracranial pressure and symptoms such as vomiting. Director Tan has probably seen this many times. The next time you see this crescent-shaped or biconvex fusiform shape, you'll know what the disease is."
Tan Zhigui smiled and nodded. "It would be even better if you could give me this CT scan. I will definitely put it by my bed every day, look at it when I get up in the morning, and look at it again before I go to bed at night. I will definitely remember it well."
Chen Xia pretended to shudder. "Hey, I'm afraid Mrs. Ren will have nightmares if she looks at this skull image every day. I won't let you go to bed then. Don't blame me for ruining your relationship."
Hahaha, everyone laughed again.
Chen Xia put another CT scan on the projector, and everyone's attention was drawn to the white screen.
"Everyone can see this area now, right? Come on, guess what's going on here."
Young Doctor A: "Is this intracranial hemorrhage?"
Doctor B: "Is this liquefaction of brain tissue?"
Ren Chenan: "Could this be a cerebral infarction?"
Chen Xia patted the table lightly. "Look! This is the proof that old hands are always wise. Director Ren guessed it right away. Our young comrades need to hurry up and learn."
Young Doctor A murmured softly, "You are younger than me."
The young doctors nearby covered their mouths and laughed secretly when they heard it.
"Cerebral infarction can generally be divided into large-area cerebral infarction and lacunar cerebral infarction. Large-area cerebral infarction is a large dark gray area, while lacunar cerebral infarction is a dot-like dark gray area, the depth of which is between normal brain tissue and black cerebrospinal fluid.
Over time, the infarcted area will liquefy, becoming darker and approaching the density of the ventricles. I believe everyone who has seen this film will be able to immediately identify the problem when they get a CT scan of the patient in the future, right?
Everyone nodded again and lowered their heads to take notes.
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