Barschony’s X-ray of the sacroiliac joints

RTG of sacroiliac (SI) joints according to Barschony represents a specific radiological projection that enables a clearer visualization of the joint between the pelvis and the spine. This technique uses a specific patient position to visualize the SI joints as clearly as possible, especially when there is suspicion of inflammatory or degenerative changes. The name “according to Baršunij” refers to a modified oblique projection that minimizes the overlap of pelvic structures and thus enables a more precise analysis of the joint itself.

Why This Type of Imaging Performed

RTG according to Barschony is performed when the doctor wants to assess: presence of sacroiliitis (inflammation of SI joints), changes typical for spondyloarthritides (ankylosing spondylitis, psoriatic arthritis, etc.), degenerative changes that may cause pain in the lower back, possible erosions, sclerosis, narrowing of the joint space, or deformities. Due to its precision, this projection provides better insight than a standard AP pelvic image.

Procedure Details

The imaging is simple, although it requires a specific position. The patient is placed in a slightly rotated position at the appropriate angle, thereby separating the SI joints from the shadow of the pelvic bones. The radiological technician adjusts the tilt and rotation so that the joint is clearly visible. Exposure lasts only a moment, and the procedure is painless and requires no special preparation. As a rule, two Baršunij projections are made – for the left and right SI joint.

What Can Be Seen on This RTG

The Barschony’s method enables a more detailed view of:

• early and advanced signs of sacroiliitis,
• erosions on joint surfaces,
• sclerosis (thickening) of bone around the joint,
• narrowing or widening of the joint space,
• partial or complete ankylosis (fusion of the joint).

However, it should be kept in mind that early changes are sometimes difficult to see on X-ray, so in unclear cases, MRI of the sacroiliac joints is recommended, which detects even early inflammatory processes.

Advantages and Limitations

This projection is very useful when the goal is to detect changes in the SI joints without the need for more complex diagnostics. However, RTG shows only structural changes, so early inflammatory processes may go unnoticed. Therefore, in cases of suspected early spondyloarthritis, it is often combined with magnetic resonance imaging.