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Positioning Procedures Reviewer Radiography UPPER EXTREMITIES Projections Body / Part CR / RP Structure Position Shown First Digit (Thum...

Positioning Procedures Reviewer Radiography UPPER EXTREMITIES Projections Body / Part CR / RP Structure Position Shown First Digit (Thumb) a. AP a. Hand ⊥ to MCP jt. Equal amount of extreme soft tissues on both supination sides on the area of b. PA b. Hand lateral the distal tip to the c. LATERAL c. Hand prone trapezium oblique d. OBLIQUE d. Hand prone AP Robert method Hand extreme ⊥ to 1st CMC CM jt. Free from supination w/ jt. superimposition posterior of the hand in contact w/ the table Long & Rafert ↑ 15 deg. Proximally Arthritic changes, modi. same at CMC jt. fractures, & displacement of 1st CMC jt. Lewis modi. ↑ 10-15 deg. Bennett’s fx. same Proximally at MCP jt. AP Burman method Hand hyper 45 deg. Towards the Magnified concavo- extended w/ a loop elbow at 1st CMC jt. convex of the 1st of bandage around CMC jt. the palm PA Folio method Hand prone w/ ⊥ midway to Ulnar collateral rubber band tightly the thumb ligament rupture in wrapped around MCP jt. (skiers both thumb thumb / gamekeeper’s thumb) Hand Volar / vola- palm of the hands PA Hand prone ⊥ at 3rd MCP Relationship of carpals, metacarpals, distal radius & ulna PA oblique (lateral Hand oblique ⊥ at 3rd MCP For fx. & pathologic rotation) ulnar side down conditions LATERALS ⊥ to 2nd MCP jt. Positioning Procedures Reviewer Radiography a. Fan a. Fan style a. Individual phalanges b. Extension b. Digits b. For foreign extended bodies & metacarpals fx. Displacement c. Flexion c. Digits c. Anterior & flexed posterior displacement in fx. Of metacarpals AP oblique Both hands ⊥ bet. Both hands Early rheumatoid norgaard method / anterior oblique at MCP jt. arthritis ball-catcher posi. (medial rotation) (semi-supine) Wrist PA ⊥ to midcarpal - Carpal bones. - Ulna slightly oblique AP (best proj.) ↑ - Carpal Same interspaces. - Ulna is best seen Lateral (lateromedial) ↑ - Lat. Of Same metacarpals & carpals. - Distal radius & ulna PA oblique (lat. Hand prone ↑ Trapezoid & scaphoid rotation) oblique Same AP oblique (medial Hand supine ↑ Triquetrum & hamate rotation) oblique Same PA ulnar deviation 10-15 deg. Foreshortening of the Proximally / scaphoid distally PA radial deviation ⊥ to midcarpal Opens the interspaces bet. The carpals and the medial side of wrist PA axial (stecher Hand in prone w/ - ⊥ to  Fx. Line the method) 20 angle board, scaphoid. wrist & angled -scaphoid- digits extended - 20 deg. inferiorly / Towards towards the Positioning Procedures Reviewer Radiography the elbow digits.  To widen the fx. Line, px. Hand must be clenched into a fist to elevate the scaphoid PA & PA axial Hand prone w/ 0, 10, 20, 30 deg. To show fx. of Rafert Long method extreme ulnar Cephalad to scaphoid in diff. angles (scaphoid series) deviation scaphoid PA axial oblique Hand in prone 45 deg. Distally Trapezium Clements-Nakayama oblique w/ 45 deg. to trapezium (trapezium) Foam wedge in ulnar deviation Tangential carpal Palm upward on 1 ½ ” proximal to - scaphoid fx. bridge the IR w/ hand at wrist - lunate dislocation right angles to the - calcifications, & forearm 45 deg. Caudad. - foreign bodies / chip fx. In the dorsum of the wrist Tangential carpal Hand prone then Inferosuperior canal / carpal tunnel hyper extended it - 1” distal to Gaynor Hart Method w/ a looped the base of around the palm the 3rd metacarpal (25-30 deg. To the axis of hand) Superoinferior - Midpt. Of the wrist (20-35 deg. To the hand) Forearm AP ⊥ - Elbow jt. (* PCAS - posterior - slightly Collens superimposition - anterior of radius & ulna Smith) Positioning Procedures Reviewer Radiography Lateral Flexed 90 deg. ⊥ - Proximal row of True lat. carpal bones - Lat. Of forearm - Superimposition of distal end of radius & ulna Elbow AP ⊥ to elbow jt. Radial head, neck, & tuberosity is slightly superimposed w/ proximal ulna Lat. (lateromedial) 90 deg. True lat. ⊥ to elbow jt. - Olecranon process - Elbow fat pads AP oblique ⊥ to elbow jt. a. Medial rot. a. Prone a. Coronoid process b. Lateral rot. b. supine b. Radial head & neck AP partial flexion a. Distal humerus a. Elbow a. ⊥ to a. Distal humerus supine w/ humerus forearm elevated 45 deg. b. Proximal b. Elbow b. ⊥ to elbow b. Proximal forearm supine w/ jt. forearm humerus elevated 45 deg. AP acute Acutely flexed flexion→(jones view elbow method) a. Distal humerus a. ⊥ - 2” S to a. Olecranon olecranon process process b. Proximal b. ⊥ - 2” D to b. Elbow jt. More forearm olecranon open than distal process humerus Positioning Procedures Reviewer Radiography Lat. Elbow in lat. w/ ⊥ to elbow jt.  1 & 2 - anterior Radial head series / hand in: radial head green span view 1. supine  3&4– (lateromedial) 2. lateral posterior radial 3. prone head 4. extreme internal PA axial Affected forearm ⊥ medial to - Epicondyles Distal humerus on the table top w/ olecranon process - Trochlea hand supine and - Ulnar sulcus humerus 75 deg. - Olecranon fossa From forearm PA axial Affected forearm - ⊥ to - Dorsum of the Olecranon process on the table top w/ olecranon olecranon hand supine and process humerus 45-50 deg. - 20 deg. To - Articular margin wrist of olecranon process Humerus AP ⊥ to the mid of Entire length of Upright or humerus humerus w/ shoulder & Recumbent elbow jt. Lat. ⊥ to the mid of True lat. of humerus a. Upright a. Hand in hip humerus bone b. Recumbent b. Hand extreme supination c. Lat. c. Cassette placed bet. Axilla and the body LOWER EXREMITIES Toes AP / AP axial a. (AP) ⊥ to a. →Phalanges of 3rd MTP jt. toes * sole of the foot – → Distal of PLANTAR metatarsals b. → Open b. (AP Axial) interphalangeal Positioning Procedures Reviewer Radiography 15 deg. P → MTP jt. to 3rd MTP jt. rd PA Px. Prone ⊥ to 3 MTP jt. - Toes - Interphalangeal - Distal of metatarsals AP oblique Toes rotated ⊥ to 3rd MTP jt. 2 to 5th MTP jt. nd (medial rot.) internally / medially forming 30-45 deg. PA oblique Dorsal of toes in ⊥ to 3rd MTP jt. Distal of metatarsals (medial rot.) contact w/ the IR turned laterally then foot turned medially forming 30 deg. Lat.  1st digit – ⊥ to 3rd MTP jt. - Open (mediolateral / px. In lat. interphalangeal lateromedial) recumbent jts. on - Proximal of unaffected phalanx side w/ foot in true lat.  2nd to 5th digit - px. In lat. recumbent on affected side Sesamoids Tangential Prone. ⊥ & tangential to - Metatarsal head Lewis(image) & Affected ankle 1st MTP jt. - Sesamoid bones Holly(px.comfortabili elevated w/ the ty) method great toe in dorsiflexion Tangential Lat. 40 deg. To heel Sesamoid bone slightly Causton method Recumbent on entering 1st MTP overlap unaffected side jt. Foot AP / AP Axial - ⊥ to the - Tarsals anterior base of 3rd to talus Positioning Procedures Reviewer Radiography metatarsal - Metatarsals - 10 deg. To - Phalanges the base of 3rd  angled tube metatarsal reduces foreshortening & the TMT jt. Spaces of the midfoot AP oblique a. medial a. foot rotated ⊥ to the base of a. → interspaces of internally 3rd metatarsal cuboid w/ 30 deg. calcaneus → 4th & 5th metatarsal b. lateral b. foot rotated b. → interspaces externally bet. 1st & 2nd 30 deg. metatarsal → Bet. Medial & intermediate cuneiform PA oblique Prone. ⊥ to the base of Grashey methods Heel rotated: 3rd metatarsal (medial / lat. rotation) a. 30 deg. a. 30 deg.medially Medially → 1st & 2nd metatarsals → navicular bone OR b. 20 deg. b. 20 deg.laterally laterally → 3rd to 5th metatarsals → tuberosity of 5th metatarsal → cuboid PA oblique (medial Lat. recumbent ⊥ to the base of Articulation bet. The rot.) affected side. 5th metatarsal cuboid and adjacent Plantar of foot bones forming 45 deg. Lat. ⊥ to the base of A. Mediolat. a. Affected 3rd metatarsal a. Entire foot, side lat. ankle jt. Fibula B. Lateromedial b. Unaffected b. ↑ same as, w/ Positioning Procedures Reviewer Radiography side medial tibiotalar jt. Lat. Upright. ⊥ above the base LONGITUDINAL Longitudinal arch Cassette placed of 3rd metatarsal ARCH. (lateromedial) bet. The foot Weight bearing standing AP Axial Upright. 10-15 deg. To the Comparison of tarsals Weight bearing Cassette placed heel at 3rd & metatarsals under the foot metatarsals AP Axial Standing. 1st exposure- 15 Entire foot w/out the Weight bearing 1st exposure, deg. Towards the leg Composite method affected foot on heel at the base of *intact ang right foot the cassette & the 3rd metatarsal other foot is placed one step 2nd exposure- 25 *weight bearing is backwards. deg. Anteriorly to always Bilateral. the posterior of 2nd exposure, ankle unaffected foot forwards Congenital clubfoot Seated. 15 deg. P to Foot & the bones or AP kite methods Affected foot in tarsals ossification centers AP *clubfoot (talipes equinovarus) Congenital clubfoot Recumbent. ⊥ to mid-tarsal ↑ same as Lat. kite methods Affected foot in lat. Congenital clubfoot Upright. 40 deg. A to the Sustentaculum talar jt. Axial Foot on top of lower leg (dorso-plantar) cassette Kandel methods Calcaneus Axial (plantodorsal) Supine. 40 deg. To the Axial of calcaneus Heel on top of the long axis of foot table w/ bandage around the phalanges Axial (dorsoplantar) Prone. ↑ same as, - Calcaneus Ankle on top of entering to dorsal - Subtalar jt. sandbags supine of ankle jt. - Sustentaculum tali Positioning Procedures Reviewer Radiography Weight bearing Standing 45 deg. A at the Calcaneotalar coalition th Coalition methods 5 metatarsal Lat. (mediolateral) Lat. ⊥ to calcaneus, 1” - Ankle jt. Affected side w/ D to medial - Calcaneus ankle in lat. malleolus - Sinus tarsi - Sustentaculum tali Lateromedial oblique Upright. 45 deg. Caudal to - Calcaneal Weight bearing Cassette under the lateral malleolus tuberosity method foot - Stress fx. Of calcaneus / tuberosity Subtalar jt. PA axial oblique (lat. Prone. Double Middle & posterior rotation) Affected side w/ angulation. articulations of the obliquity of foot & 5 deg. A & 23 subtalar jt. heel is elevated 1 deg. Caudally to ½ ” & the foot is ankle jt. forward 25 deg. AP axial oblique Supine. 40, 30, 20, 10 40 deg.- anterior (medial rotation) Heel on top of deg. Cephalad, 2 portion of posterior Broden method cassette w/ a or 3cm facet. bandage around caudoanteriorly to the ball of foot lat. malleolus 10 deg.- posterior turning inwards portion  Articulation bet. Talus & sustentaculum tali AP axial oblique (lat. ↑ same as, 2cm distal & 2cm - Posterior facet rotation) turning outwards anterior to medial of calcaneus Broden method malleolus @ 15 - Articulation bet. deg. Ce. Talus & sustentaculum tali Lateromedial oblique Supine. ⊥ 1” A to lat. Anterior subtalar (medial rot. foot) Unaffected side malleolus articular surface Isherwood me. lean the affected foot medially AP Axial (medial rot. Sitting. 1” distal & 1” Middle articulation of ankle) Leg medially w/ anterior to lat. subtalar jt. Positioning Procedures Reviewer Radiography Isherwood me. foot & ankle malleolus @ 10 resting on a 30 deg. Ce. deg. Foam wedge AP Axial oblique Lat. recumbent on 1” distal to Posterior articulation (lateral rot. ankle) affected side & medial malleolus of subtalar jt. Isherwood me. dorsiflex the foot @ 10 deg. Ce. Ankle AP ⊥ to ankle jt. Distal end of tibia & fibula Lat. Lower 3rd of tibia & a. Mediolateral a. Affected a. ⊥ to ankle fibula side jt. To medial malleolus b. Lateromedial b. Unaffected b. ½” S to side lateral malleolus AP Oblique ⊥ to ankle jt. a. Medial a. 45 deg. a. Distal end of Foot tibia & fibula inwards b. Lat. b. 45 deg. b. Superior of Foot calcaneus outwards AP Oblique Foot internally ⊥ to ankle jt. Entire mortise jt. Mortise jt. (medial rotated 15-20 deg. rotation) AP Foot rotating ⊥ to ankle jt. Ligamentous tear Stress me. outwards w/out rotating the leg as much as possible AP ⊥ - Both ankle Weight bearing - Distal tibia & fibula Leg AP ⊥ to mid-leg Tibia & fibula Lat. (mediolat.) Lat. on affected ⊥ to mid-leg ↑ same as side AP Oblique Leg is turned ⊥ to mid-leg a. medial either laterally or Medial- proximal & Positioning Procedures Reviewer Radiography medially 45 deg. distal tibiofibular articulations b. lateral Lateral- fibula superimposed by lateral tibia Knee AP ½” inferior to - Open patellar apex femorotibial jt. Space  less than - Patella 19cm superimposed w/ (thin) 3-5 femur deg. Caudad  19-24cm (⊥)  Greater than 24cm (fat) 3-5 deg. cephalad PA 5 deg. Caudad Open femorotibial jt. exiting ½” Space inferior to patellar apex Lateral (mediolateral - Lat. on 1” distal to Lateral of: rot.) affected medial - Distal end of side epicondyle @ 5-7 femur - 20 to 30 deg. Cephalad - Patella deg. Knees - Knee jt. flexed AP ⊥ @ ½” below - Varus & valgus Weight bearing the patellar apex deformities - Arthritic knees PA Knees slightly 10 deg. Caudal Articular cartilage dse. Weight bearing flexed Rosenberg me. AP Oblique (lateral Knees laterally 45 ½” inferior to Laterally rotated: rot.) deg. patellar apex - Femoral condyles  less than - Patella Positioning Procedures Reviewer Radiography 19cm - Tibial (thin) 3-5 - Condyles deg. Caudad  19-24cm (⊥)  Greater than 24cm (fat) 3-5 deg. cephalad AP Oblique (medial Knees medially 45 ½” inferior to Tibia & fibula rot.) deg. patellar apex separated at proximal articulation  less than 19cm (thin) 3-5 deg. Caudad  19-24cm (⊥)  Greater than 24cm (fat) 3-5 deg. cephalad PA oblique (lat.) 45 deg. Laterally ⊥ @ ½” below Laterally rotated: the patellar apex - Femoral condyles - Patella - Tibial - Condyles PA oblique (medial) 45 deg. medially ⊥ @ ½” below Medially rotated: the patellar apex - Femoral condyles - Patella - Tibial - Condyles Intercondylar fossa (HBC) PA Axial Kneeling w/ the IR ⊥ to lower leg - Intercondylar Holmblad method / in the anterior of fossa tunnel knee. - Medial & lateral intercondylar Positioning Procedures Reviewer Radiography  Standing w/ tubercles the affected knee flexed is the best. PA Axial Prone. ⊥ to leg @ 40-50 - Intercondylar Camp-Coventry me. Knees flexed 40 or deg. Caudally fossa 50 deg. - Medial & lateral intercondylar tubercles AP Axial Supine. ⊥ to tibia @ ½” - Intercondylar Beclere me. Knees flexed 60 below the patellar eminence deg. apex - Knee jt. Space Patella nd Fabella- 2 largest sesamoid bone PA Patella 5-10 deg. ⊥ to IR Patella completely *by image Laterally superimposed by femur Lateral (mediolat.) Flexed the knee 5- ⊥ to IR Lat. of patella & 10 deg. in lateral patellofemoral jt. PA Oblique (medial) Flexed the knee 5- ⊥ to IR - Medial portion 10 deg. & rotate of patella the knee 45-55 - Majority of deg. Medially patella free from superimposition PA Oblique (lat.) Flexed the knee 5- ⊥ to IR lateral of patella free of 10 deg. laterally & femur rotate the knee 45- 55 deg. PA Axial oblique Hip elevated 2-3” 25-30 deg. Slightly oblique of (lateral rot.) & knee 35-40 Caudad to patella free from Kuchendorf me. laterally posterior of superimposition patella Patella & patellofemoral jt. (High School Musical / sunrise view) Tangential Prone. 45 deg. Cephalad - Subluxation of Hughston me. / Leg flexed upward to patellofemoral patella sunrise or skyline 50-60 deg. jt. - Patellar fx. view Tangential Supine. 40 deg. tube - Axial proj. of Merchant me. / At the edge of the angulation. 30 patellofemoral sunrise or skyline table, knees flexed deg. Caudad to jt. view 40 deg. & cassette patellofemoral jt. - Femoral placed at the foot condyles - Intercondylar Positioning Procedures Reviewer Radiography sulcus Tangential Prone. ⊥ to joint space. - Vertical fx. Of Settegast me. / Knees flexed as 15-20 deg. bones sunrise or skyline much as possible Towards knees - Articulating view until patella is ⊥ to surface of IR. patellofemoral Maybe supine / articulation seated. Femur AP Feet turned 10-15 ⊥ to mid-femur - Femur deg. Internally - Femoral neck Lat. (mediolat.) Affected knee ⊥ to mid-femur ¾ of the femur & flexed 45 deg. adjacent jt. SHOULDER GIRDLES / PECTORAL GIRDLES Shoulder AP ⊥/ 1” I to a. External rot. a. Hand coracoid process a. Supraspinatus supine tendon b. Neutral b. Palm of b. Small calcific hand on the deposits thigh c. Internal c. Arm c. Subscapular internally tendon rotated til posterior of the hand placed in hip Transthoracic lat. Upright. ⊥ to surgical neck - Lat. of shoulder Lawrence me. Affected side in - Proximal contact to IR & 15 deg. Cephalad humerus *3 methods of unaffected arm (if px. can’t - Scapula glenoid cavity: raised to the head tolerate the - Clavicle, (GAG) elevation of arm) projected over - Grashey the shoulder - Apple - Garth Shoulder jt. (L-R-W-C) Inferosuperior axial Supine. 15-30 to shoulder Scapular tendon on Lawrence Arm abducted @ lesser tubercle right angles & Positioning Procedures Reviewer Radiography humerus in external rot. Inferosuperior axial Supine. 15 medially to Hill sachs compression Rafert Arm abducted @ AC jt. fx. right angles & humerus in exteme external rot. Inferosuperior axial Prone. 25 deg. AM to - Humeral head West pt. Arm abducted 90 acromial edge free of the deg. Lying coracoids hanging on the process edge of the table - Articulation of humeral head Inferosuperior axial Lat. recumbent. ⊥ Space of the shoulder Clements Arm 90 deg. jt. Pointing the 5-15 Med.(if arm ceiling & cassette can’t be on top of the abducted) shoulder Superoinferior axial Sitting on the side 5-15 lat. to - Proximal end of of the table & shoulder jt. humerus & affected side in glenoid cavity contact to cassette - AC articulation & px. Leaning w/ humeral head laterally w/ shoulder jt. centered AP axial Affected extremity 35 ce. To Diagnose cases of normally extended scapulohumeral posterior dislocation jt. Scapular Y Standing in ⊥ To a. Anterior PA oblique RAO/LAO 45-60 scapulohumeral dislocation- (LAO/RAO) w/ extremity jt. humeral head normally extended beneath coracoid process b. Posterior- acromion process AP oblique Supine oblique ⊥ to glenoid Open jt. Space bet. Grashey (LPO/RPO). cavity Humeral head & *masakit ang tiyan 35-45 body glenoid cavity Positioning Procedures Reviewer Radiography rotation Supraspinatus outlet Prone. 10-15 caudad to Posterior of acromion Tangential 45-60 body rot. Superior humeral process & jt. Neer (RAO/LAO) head *nakasandal AP Axial Supine. 10 cephalad to Hill sach’s defects Strykers notch Hand on top of the coracoid process Proximal humerus head *gwapo me. AP oblique Upright. ⊥ to coracoid Loss of articular Apple Hand of the process cartilage Glenoid cavity affected shoulder abduct 90 deg. & weight placed. 45 deg. Body rot. AP Axial oblique Supine. 45 caudad to Hill sach’s lesion Garth 45 deg. Body rot. scapulohumeral Glenoid cavity Elbows flexed & jt. hand placed across *sa heart the chest region in pronation. Proximal humerus Tangential Supine. 10-15 posteriorly Intertubercular groove Fisk me. Arm abducted down to humerus away from the body & cassette placed on top of the shoulder while hand in supination PA Prone. ⊥ to humeral Greater tubercle Teres minor insertion Affected shoulder head anterior to rotated Blacket Healy me. centered to the humeral head cassette & elbows flexed 90 deg. AP Supine. ⊥ to shoulder jt. - Insertion of Subscapularis Elbows flexed & subscapularis at insertion placing the hand at the lesser Blacket Healy me. the side of the tubercle body in pronation - Greater tubercle Positioning Procedures Reviewer Radiography superimposing the head Acromioclavicular jt. AP Axial Supine. 25 caudad to - Greater tubercle Infraspinatus Hand external coracoid process - Insertion of insertion rototation- open supraspinatus Stress view subacromial space. tendon - Open Arm internal subacromial rotation- evaluate space & humeral humeral head head AP (bilateral) Upright. ⊥ to Bilat. Image of the Pearson me. / survey Both shoulder is acromioclavicular acromioclavicular jt. view taken for jt. For dislocation / comparison. separation 2 exposures: - w/ weight - w/out weight AP Axial Upright. 15 cephalad to - open Alexander me. Hand in neutral coracoid process acromioclavicul posi. ar jt. - Subluxation / dislocation of acromioclavicul ar PA Axial oblique Upright oblique, 15 caudad to acromioclavicular jt. & Alexander me. prone posi. acromioclavicular relationship of shoulder 45-60 body rot. jt. bones. Px. Lean firmly against the VCH placing the hand over the chest to pull the jt. As close as possible. Clavicle AP Supine ⊥ to mid-clavicle Frontal image of clavicle PA Prone ⊥ to mid-clavicle ↑ same as. But it has a better detail, less magnification & Positioning Procedures Reviewer Radiography distortion AP axial Standing. Standing→ 0-15 Clavicle over the ribs Lordotic posi. Only upper cephalad & scapula thoracic is in contact to the VCH & arms at recumbent→ 15- the side for 30 to mid-clavicle support PA axial Prone. 15-30 caudad to Clavicle above the ribs Standing / mid-clavicle & scapula recumbent Tangential Supine. 25-40 bet. The Inferosuperior of the Arms at the side of clavicle & chest clavicle the body & wall cassette placed on top of the shoulder Medial portion→ 15-25 cephalad Tarrant me. Upright. 25-35 anteriorly Clavicle above the Part of the body & inferiorly to thoracic cage on tube side & mid-clavicle cassette placed on the forearm w/ flexed elbows held tight by the hands Scapula AP Supine / upright. ⊥ 2” inferior to - Scapula Arms abducted 90 coracoid process - Acromion deg. & hands process placed on the head - Inferior angle Lateral LAO/RAO posi. ⊥ to medial Lat. of scapula Hand is placed at border of scapula the back, same in scapular Y, w/ hand in supine PA oblique Lat. recumbent / ⊥ bet. Chest wall - Scapular borders Lorenz / Lilienfield upright. & scapula - Acromion me. Lorenz- arm at process right angles to the body, head is rest on top of the hand & body is slightly rotated forward. Positioning Procedures Reviewer Radiography Lilienfield- affected arm is extended obliquely upward & head is rest on top of the hand & body is slightly forward. AP oblique Supine. ⊥ to lateral border - Oblique scapula Arms placed of rib cage - Lat. border superiorly w/ adjacent to ribs elbows flexed & hand supine. Shoulder rotated at 15-25 and body rotated at 25-35 AP axial Supine. 15-45 cephalad Slightly elongated Coracoid process Hands on the side inferosuperior of & abduct the arm coracoid process w/ hand in supine Scapular spine Tangential Supine. 35-45 caudad Scapular spine above to Laquerriere - Body is rotated scapular body Pierquin me. slightly. Tangential Prone. 45 cephalad Scapular spine above Hands at the side the scapular wing in supine. PELVIC GIRDLE Pelvis & Upper femora AP Supine. ⊥ to IR AP of pelvis & head, Feet is medially neck, trochanter, & rotated 15-20 deg. proximal shaft of w/ a distance of 8- femora 10” & upper *pelvis (4 bones) border of cassette - 2 hip bones is 1- 1½” above - sacrum the iliac crest - coccyx  Internal rotation- *pelvic girdle lesser - 2 hip bones trochanter Positioning Procedures Reviewer Radiography is not visible.  External rotation- lesser trochanter is visible Lat. Lat. recumbent. ⊥ to 2” or 5cm - Gull wing sign Affected side above greater - Lat. of LS down trochanter junction, sacrum, coccyx, & superimposed hip bones & upper femora Pelvis & Hip jt. Axial Seated on the edge ⊥ to pubic - Relationship bet. Chassard Lappine / of the table, & px. symphysis Femoral heads Jack Knife view is bent down until & acetabulum the chest touches - Greater the knees & pelvis trochanter is tilted @ 45 deg. equidistant to sacrum Femoral necks AP Oblique Supine. ⊥ to 1” S to pubic Bilat. Image of the Bilat. Frog leg posi. Px. Hips & knees symphysis femoral heads, necks, Modified cleaves are flex & draw & trochanters for me. the feet up as far comparison as possible, abduct *cleaves me→ for the thigh as much non-trauma px. as possible & the feet turn inwards *can be bilat. Or to brace the sole unilateral(1) against each other Axiolateral ↑ Same as. Parallel to Axiolateral proj. of Original cleaves me. femoral shafts or femoral heads, necks, 25-45 Ce. & trochanters Hip (os coxae / innominate bone) AP Foot rotated ⊥ to femoral head, neck, trochanter, internally 15-20 necks & proximal shaft of deg. To place the femora femoral necks Positioning Procedures Reviewer Radiography parallel to IR Lateral Supine. Launstein- ⊥ to Launstein- femoral Launstein & Hickey Rotated to affected hip jt. Bet. ASIS neck overlapped by the me. side until the leg is & pubic greater trochanter abducted to symphysis oblique posi. Hickey- 20-25 Hickey- femoral neck Ce. free from superimposition Axiolateral Supine. ⊥ To femoral Hip Danelius miller me. Unaffected leg neck. (Also called cross- raised up & table / surgical lat.affected leg is proj.) extended, cassette is placed on supero lateral of hips & foot inverted 15-20 Axiolateral Supine. 15 ce. To femoral Lateral hip image. Clements-nakayama Position of neck (used if danelius miller me. cassette is like in is contraindicated in danelius miller, trauma px.) but foot is not rotated internally Axiolateral Lat. 35 ce. To femoral Axiolateral view of Friedman Knees flexed & neck femoral head, neck, & unaffected leg trochanter moved 10 deg. P PA Oblique RAO/LAO. ⊥ to hip jt. Posterior dislocation of Hsieh me. Affected side femoral head down 40-45 rot. Mediolateral oblique RAO/LAO. ⊥ to hip jt. Mediolateral oblique Lilienfield me. Affected side of: down 15 deg. - Ilium - Acetabulum - Proximal femur (contraindicated to px. w/ acute hip injury) Acetabulum (cotyloid cavity / vinegar cup) PA axial oblique Prone. RAO/LAO 12 ce. To Fovea capitis Teufel me. posi. acetabulum 45 body rot. Positioning Procedures Reviewer Radiography AP Oblique Semi-supine. (in gen. it shows the Judet me. Acetabular Rim ) a. Internal a. ⊥ 2” I to a. Iliopubic oblique / ASIS column & obturator posterior rim of view- acetabulum affected hip up forming 45 deg. Body rot. (elevated side that is need to expose) b. External b. ⊥ to pubic b. Ilioischial oblique / symphysis column & ALAR view- anterior rim affected hip down forming 45 deg. Body rot. (the side that is in contact to IR need to expose) Anterior pelvic bone PA Prone ⊥ to distal coccyx - Pubic symphysis & exits @ pubic - Ishium symphysis - Obturator foramen - Hip jts. AP Axial Supine Male- 20 to 35 - Pubic rami Taylor me. (oulet ce. 2” D to w/out view) superior border of foreshortening pubic symphysis - Outlet of pelvis Female- 30 to 45 ce. 2” D to superior border of pubic symphysis Positioning Procedures Reviewer Radiography Superoinferior axial Supine 40 caudad @ the - Pelvic ring (Inlet / false proj.) level of ASIS - Inlet in its Bridgeman me. entirety Superoinferior axial Supine ⊥ @ 1½” - Anterior pubic (Inlet) Legs raised & superior to pubic bones Lilienfield me. body in fowlers symphysis - Ischial bones posi. In 45-50 deg. - Pubic symphysis - Anterior pelvic bones - Inlet of pelvis PA Axial (inlet) Prone 35 deg. Below Medially superimposed Staunig me. gluteal fold exit superior & inferior @ pubic rami of pubic bones symphysis Ilium AP Oblique Supine. ⊥ @ hip jt. - Entire ilium 40 deg. Body rot. - Broad surface of To affected side iliac wing w/out rotation - Hip jts. PA Oblique Prone. ⊥ @ hip jt. ↑ same as 40 deg. Body rot. to Affected side down VERTEBRAL COLUMN Atlanto- occipital articulations AP Oblique Supine. ⊥ to IR 1” A to - Oblique of Cassette centered EAM Atlanto- @ EAM & 45- 60 occipital head rot. Away articulations from the side - Jt. Bet. Orbit & examined. mandibular rami IOML (⊥) - Dens of axis - Used when px. Can’t tolerate open mouth posi. PA Prone. ⊥ to IR level of PA of Atlanto- Forehead & nose IOML occipital articulations rested on cassette through the maxillary & OML (⊥) sinuses Positioning Procedures Reviewer Radiography Dens AP Supine ⊥ to IR @ distal Dens of axis lying w/in Fuch’s me. Neck extended tip of chin the circular foramen until the chin & magnum mastoid process are vertical AP Axial oblique Supine. 10-15 caudad bet. Oblique of dens in Kasabach me. 40-45 head rot. to Outer canthus & conjunction w/ the AP affected side EAM & lateral Atlas & Axis AP Supine w/ open ⊥ to midpt. Of Atlas & axis in an open Open mouth mouth open mouth mouth PA Prone ⊥ to distal of Dens / axis & atlas Judd Chin rested on top mastoid tips through the foramen of the table magnum Lat. Supine. ⊥ 1” distal to Lat. of atlas & axis (transtable for trauma IR @ the lateral mastoid tips px.) side affected in vertical posi. Cervical V. C1- atlas / cerebro epiphysis C2- axis / epistropheous AP axial Supine. 15-20 ce. @ c4 Lower 5 cervical Chin extended till bodies & upper 2-3 *40 SID the occlusal palne thoracic bodies is ⊥ to table Lat. Lat. upright. Horizontal to c4 - Lat. of cervical Grandy Shoulders rotated bones & their anteriorly / interspaces *72 SID posteriorly while - pillars chin is slightly - lower 5 elevated zygaphophyseal jt. Lat. Lat. (upright / ⊥ to c4 Motility of cervical Hyper flexion / standing). spine. hyperextension 2 exposure, 1 neck hyperflexed & 1 Hyperflexion- spinous *60-70 SID is neck processes are elevated recommended bec. Of hyperextended. & widely separated. ↑ OID. A longer - All 7 spinous distance helps show Top of IR is processes are Positioning Procedures Reviewer Radiography c7. 2”(5cm) above the seen EAM - All 7 cervical V. in true lat. posi. Hyperextension- depressed in closed approximation. - Body of mandible in horizontal - All 7 cervical V. in true lat. posi. AP Supine. ⊥ to c4 Entire cervical column Otonello / wagging Chin elevated to w/ blurred mandible jaw tech. place the occlusal plane & mastoid tips in vertical while moving the mandible in chewing motion Cervical intervertebral foramina AP Axial oblique Supine. 15-20 ce. @ C4 Intervertebral foramina RPO / LPO posi. 45 body rot. To & pedicles farthest unaffected side w/ from the IR IR centered to C3 AP Oblique Supine. ⊥ to c4 - Functional Hyperextension / 45 head rot. To studies & fx. Of hyperflexion one side & articular hyperflexed / processes hyperextend while - Obscure both sides are dislocations & taken for subluxations comparison PA Axial oblique Prone (recumbent 15-20 ca. @ C4 Intervertebral foramina RAO / LAO posi. / upright). & pedicles of the 45 body rot. To closest side affected side & chin protruded Cervical & upper thoracic V. Vertebral arch pillars Supine w/ neck 20-30 ca. to C7 - Posterior of AP Axial hyperextended @ 25 deg. cervical V. Entering the - Upper 3-4 thyroid cartilage thoracic V. Positioning Procedures Reviewer Radiography - Articular processes & their facets Vertebral arch pillars Supine. 35 ca. to C7 Vertebral arches / AP Axial oblique Articular process pillars of C2-7→ is seen w/ 45-50 head rot. Away from the side examined C6-T4→ 60-70 head rot. Vertebral arch pillars Prone w/ head 35 ce. To C7 Posterior arch & pillars PA Axial oblique rested on cheek. w/ open zygapophyseal MSP 45 deg. From jts. the IR. C2-5→ is seen w/ neck in flexed. C5-7 & T1-4→ is seen w/ neck in moderate extension. Cervicothoracic reg. Lateral Lat. upright. Well depressed Lat. of Lower cervical Twinning me. Forearm rested on shoulder- ⊥ to V. & upper thoracic V. (swimmers view) the head & C7-T1 interspace shoulder farthest from the film is Not well depressed depressed- 3 to 5 caudad Lat. Same swimmers 3-5 ca. to C7 & Lat. of cervicothoracic Pawlow & modified view in recumbent T1 V. bet. The shoulders pawlow me. in affected side Thoracic V. AP Supine. ⊥ To IR bet. 12 thoracic V. Hips flexed to Jugular notch & reduce kyphosis xiphoid process Lat. Left lat. recumbent ⊥ to T7 - Interspaces disk posi. of the thoracic V As much as M- 15 ce. to T7 - Intervertebral possible left, to foramina place the heart F- 10 ce. To T7 - Lower spinous Positioning Procedures Reviewer Radiography closer to the process cassette to (upper portion may not minimize be well demonstrated overlapping of due to the shoulder) heart and vertebrae Zygapophyseal jts. (thoracic) AP / PA oblique Oblique posi. ⊥ to T7 AP Oblique- jts. a. Upright 20 deg. Anterior Farthest from the IR b. recumbent (PA Oblique) or posterior (AP PA Oblique- jts. Oblique) so that Closest to IR coronal plane forms 70 dg. From the IR Lumbar- LS reg. AP / PA Hips flexed in AP Lumbar- 1½” AP- distortion of for ↓ lordotic above iliac crest bodies & poor curve of lumbar & delineation of extended for ↑ LS- ⊥ to iliac intervertebral disk lordotic curve crest- L4 spaces PA- intervertebral disk spaces Lat. Lat. recumbent ⊥ to iliac crest - lumbar bodies & M- 5 ca. their interspaces F- 8 ca. - LS junction - Intervertebral foramina of L1- 4 L5 – S1 LS reg. Lat. Lat. recumbent ⊥ 2” P to ASIS & Lat. of LS reg. 1½” I to iliac crest Zygapophyseal jts. (Lumbar) AP Oblique Lumbar process- ⊥ 2” M to ASIS Articular process 45 body rot. to & 1½” above closer to IR affected side iliac crest LS process- 30 deg. PA Oblique Oblique in ⊥ to L3 above Articular process Positioning Procedures Reviewer Radiography unaffected side iliac crest farthest from IR Intervertebral foramen L5 Lat. 15-30 ca. to L5 L5 intervertebral PA Axial oblique Hip / pelvis foramen closer to IR Kovacs me. rotated 30 deg. w/ both side for anteriorly comparison LS & Sacroiliac jts. AP / PA Axial Supine. M- 30 ce. - LS jt. Ferguson F- 35 ce. - Symmetric (entering 1½” S image of both to pubic sacroiliac jts. symphysis) Sacroiliac jts. AP Oblique Supine. ⊥ 1” M to ASIS SJ farthest from the IR 25-30 deg. Away from the side examined PA Oblique Prone. ⊥ 1” M to ASIS SJ closest to IR 25-30 deg. Towards the side examined Pubic symphysis PA Prone upright. ⊥ to pubic - 2 images in 2 Chamberlain me. Weight bearing on symphysis exposures of (abnormal sacroiliac) alternating limbs pubic symphysis w/ each of them - Abnormal hanging free motion of sacroiliac jts. Sacrum & Coccyx AP / PA Axial Supine / prone w/ Sacrum Sacrum & coccyx free legs separated a. Supine- 15 from superimposition ce. 2” w/out foreshortening above pubic symphysis b. Prone- 15 ca. to sacral curve Coccyx a. Supine- 10 Positioning Procedures Reviewer Radiography ca. 2” above pubic symphysis b. Prone- 10 ce. To coccyx Lat. Lat. recumbent w/ ⊥ 3½” P to ASIS Lat. of sacrum & hips & knees coccyx in its natural flexed curvature Sacral vertebral canal & Sacroiliac jts. Axial Seated at the edge ⊥ to sacrum Slight flexion Nolke me. of the table. - Lower sacral Several exposures vertebral canal. are made in diff. - Junction of posi. Slight, sacrum & moderate, & hyper coccyx flexion - Last lumbar V. Moderate flexion - Cross section of upper & lower sacral vertebral canal Acute flexion - upper sacral vertebral canal Lumbar intervertebral disks PA Upright prone. 15-20 ca. to L3 Mobility of the Weight bearing Exposure taken in intervertebral jts. R & L bending R / L bending (L4-L5 / L5-S1 if these are of (px. w/ disk protrusion, interest) it is used to shows the involved jt. By a limitation of motion @ the site of lesion) Scoliosis radiography PA Upright prone ⊥ to IR Amt. of degree of lat. Frank et al. method curvature that occurs w/ the force of gravity Lat. Lat. upright. ⊥ to IR Amt. of degree of Positioning Procedures Reviewer Radiography Arms placed @ anterior / posterior right angles to the curvature body THORACIC VISCERA Trachea & superior mediastinum AP Supine. ⊥ to manubrium Air filled trachea Neck slightly superimposed in the (Used grid tech. to extended. shadow of the cervical minimize scatter Inhaling slowly to V. rad’n bec. The kVp fill the trachea w/ must be high enough air to penetrate the sternum & cervical V.) Lat. Hand clasp behind ⊥ bet. Jugular - Thymus the body (it keeps notch & (hormone: the superimposed midcoronal plane thymosin) & body of the arms thyroid glands. from obscuring the - For pedia, shows structures of the enlargement superior of the Thymus mediastinum). & thyroid glands Exposure made in recumbent during Slow inspiration. Axiolat. Affected arm 15 ca. - Air filled Twinning me. abducted placing trachea at the head. - Apex of the lung closer to IR Trachea- inhale slowly during exposure. Pulmonary apex- exposure @ the end of inhalation Chest, Lungs, & Heart PA Akimbo posi.- ⊥ to T7 - Diaphragmatic Shoulders rolled domes *72” SID (183cm)→ forward & hands - Thoracic viscera minimize at the waist in - Air filled Positioning Procedures Reviewer Radiography magnification of pronation. trachea heart & obtained - Lungs in greater recorded Exposure in 2nd expansion detail of the delicate full inspiration - Heart aortic lung structures. (ensure max. knob *pedia- 0 to 17 y/o expansion of the - Prominent *upright→ prevent lungs & For the vascular engorgement of max. downward markings pulmonary vessels excursion of the - Bronchial tree in → For the dia.) oblique max. downward excursion of the dia. → shows air – fluid level *left lat.→ it places the heart closer to IR, resulting in a less heart magnification *deep ins.→ diaphragm move inferiorly, resulting in elongation of heart. Radiographs of the heart should be obtained @ the end of normal inspiration to prevent distortion. More air is inhaled during 2nd breath than 1st breath. *pneumothorax(air in pleural cavity)→ 1st expo, end of full ins. 2nd expo, end of full expi. to show small amts. of free air in the pleural cavity that might be obscured on the ins. exposure. *inspiration & Positioning Procedures Reviewer Radiography expiration radiographs→ used to show the movement of diaphragm, presence of foreign body, & atelectasis. Lat. Forearm on head ⊥ to T7 Visualized depth of reg. injury / penetrating 2nd full inspiration trauma (gunshot / stab wound) PA Oblique 45 body rot. ⊥ to T7 RAO- max. of left lung RAO / LAO Posi. field along w/ thoracic viscera - best posi. For left atrium LAO- right lung fields & anterior portion of lung superimposed by the spine AP Oblique 45 posteriorly ⊥ to T7 - Lung field of the LPO / RPO posi. elevated side is foreshortened due to magnification of dia. - Heart & great vessels appear to be larger due to magnification Chest Pyothorax- or empyema (pus) AP 2nd full inspiration ⊥ to sternum 3” - Heart & great below jugular vessels notch magnified - Lung fields is shorter bec. Of the posi. Of the abdomen Pulmonary apices Positioning Procedures Reviewer Radiography AP Axial Only upper of ⊥ to IR level of - Interlobar Lindblom me. thorax is in contact midsternum effusions Lordotic posi. to IR. - Clavicles lying 2nd full inspiration superior to apices PA Axial Akimbo posi. 10-15 ce. to T3 Apices above the 2nd full inspiration clavicles *ins. (clavicles elevated) *ex. (clavicles depressed) AP Axial ↑ same as 15-20 ce. to T2 Apices below the clavicles Lungs & Pleurae AP / PA Lat. recumbent AP- ⊥ to IR 3” - Change in fluid R / L lat. decubitus either on L / R below jugular posi. posi. side w/ the notch - Cases of cassette @ the pneumothorax *affected side- back of the px. & PA- ⊥ to T7 shows fluid extremities on *unaffected- air head reg. * For best 2nd full inspiration visualization, px. Remain in the posi. For 5 mins. before exposure. This allows the fluid to settle & air to rise. Lat. Cassette on lat. Dorsal- ⊥ 3-4” - Change in fluid Prone / ventral & 2nd full inspiration below jugular posi. supine / dorsal decub. notch - Pulmonary areas Posi. that are Ventral- ⊥ to T7 obscured by the fluid BONY THORAX Sternum PA Oblique 30” SID (trauma: ⊥ to elevated side - Sternum RAO px. Supine. LPO of T7. 1” lat. to projected over posi. & AP MSP heart oblique proj.) - Slightly oblique sternum 15-20 body rot. Positioning Procedures Reviewer Radiography PA Oblique Px. Stand at the 25 deg. Sternum free from Moore me. (High side of the table, Enters T7 2” to superimposition of quality sternum bending @ the the R. of spine vertebral column image in a more waist, placing the comfortable for the sternum in the *large px.- less px.) center of the table. angulation Modified prone posi. Arms above the *thin px.- more shoulder & palms angulation than down on the table 25 Lat. Lock hands behind ⊥ to IR - Entire length of R / L upright posi. the back so the sternum shoulders rotate - Sternum free of (LATERAL is the best posteriorly. superimposition proj. to visualized the by the ribs sternum.) Deep inspiration- - Superimposed sharper contrast sternoclavicular bet. Posterior of jts. sternum & adjacent structures. Lat. Flex hips & knees ⊥ to IR Entire length of R / L recumbent posi. / extend the arms sternum over the head to prevent them from overlapping the sternum. Deep inspiration. (dorsal decub. For px. w/ severe injury) Sternoclavicular jts. PA ⊥ to T3 - Both sternoclavicular jts. - Medial ends of clavicles PA Oblique Upright. Enters @ T2-T3 Oblique of SC jts. Body rotation me. & 1-2” lat. To RAO / LAO posi. Affected side is MSP adjacent to IR. 10- Positioning Procedures Reviewer Radiography 15 deg. Obliquity of the px. To project the vertebrae behind the SC jt. Closest to IR. PA Oblique Prone. 15 deg. toward Oblique of SC jts. (Central ray Grid IR under the the MSP. angulation me.) upper chest. Enters T2-3 and Non- bucky 1-2” lateral to For this proj. the MSP joint is closer to IR, and less distortion is obtained. Grid IR is placed on the tabletop, also enables the jt. to be projected w/ minimal distortion. Upright if px. is in trauma. Axiolateral Lateral to affected Directed through Unobstructed Kurzbauer me. side with arms the SC jt. closest axiolateral image of the placed at the head to the film at an jt. closest to the film region angle of 15 caudad PA Prone. ⊥ to T7 or 10-15 - Anterior ribs & (upper anterior ribs) upright/recumbent. caudad to show 7- above the 9 ribs diaphragm *A. ribs- px. facing Px. hands against - posterior ribs IR for PA hips to rotate seen scapula away from - A. ribs is close *P. ribs- px. facing the rib cage. Neck to IR xray tube for AP is hyperextended & exposure made at full inspiration to depress the diaphragm as much as possible. Upright posi, diaphragm Positioning Procedures Reviewer Radiography descends to its lowest level & also shows fluid levels in the chest. AP Upright, ribs ⊥ to IR - P. ribs above or (posterior ribs) above the below the diaphragm diaphragm *shallow breathing- (suspend full - A. ribs seen used to obliterate inspiration & - P. ribs close to lung markings. depress IR diaphragm) Supine, ribs below diaphragm to permit gravity to assist in moving the px’s diaphragm (full expiration & elevate diaphragm) Axillary AP oblique proj. Upright/recumbent ⊥ to IR P. ribs closest to IR RPO/LPO posi. (Closest) 45 body rotation. And the affected side is closest to IR. Abduct the arm of the affected side, & elevate it to carry the scapula away from rib cage. PA oblique Upright/recumbent ⊥ to IR A.ribs farthest from IR RAO/LAO (farthest) 45 body rotation. Affected side away to IR Costal jts. AP axial Supine. 20 ce. entering 2” - rheumatoid above xiphoid spondylitis Positioning Procedures Reviewer Radiography Suspend end full process - costovertebral & inspiration bec. the costotransverse lung markings are Dorsal jts. less prominent at kyphosis(5-10 this phase of deg. arms along breathing. the sides of the body) SKULL Cranium Petrous Pyramid- strongest part of skull Lateral Seated-upright / ⊥ 2” above EAM - Superimposed R / L posi. semiprone halves of the cranium MSP = - sella turcica IOML ⊥ - anterior & IPL ⊥ posterior clinoid process - dorsum sellae Lateral Dorsal decub. ⊥ 2” superior to Dorsal decub/ supine -supine EAM lateral