Radiographic Positioning PDF

RADIOGRAPHIC POSITIONING Prepared by: Andrea Darla L. Espinosa, RRT, MSRT  BODY PLANES  PLANE - any real or imaginary flat surface  Four fundamental body planes referred to in radiography:  SAGITTAL - divides the entire body or a body part into right and left segmen...

RADIOGRAPHIC POSITIONING Prepared by: Andrea Darla L. Espinosa, RRT, MSRT  BODY PLANES  PLANE - any real or imaginary flat surface  Four fundamental body planes referred to in radiography:  SAGITTAL - divides the entire body or a body part into right and left segments.  CORONAL - divides the entire body or a body part into anterior and posterior segment.  HORIZONTAL - passes crosswise through the body or a body part at right angles to the longitudinal axis.  OBLIQUE - can pass through a body part at any angle between the three planes.  SPECIAL PLANES  INTERILIAC PLANE - transects the pelvis at the top of the iliac crests at the level of the fourth lumbar spinous process.  OCCLUSAL PLANE - is formed by the biting surfaces of the upper and lower teeth with the jaws closed. DIVISIONS OF THE ABDOMEN  ABDOMINAL QUADRANTS  Right upper quadrant (RUQ)  Right lower quadrant (RLQ)  Left upper quadrant (LUQ)  Left lower quadrant (LLQ)  ABDOMINAL REGIONS 1. Right Hypochondriac region:  Most of the right lobe of liver, hepatic flexure of the colon, part of the renal body 2. Epigastric region:  Most of the left lobe of the liver and the remainder right lobe of the liver, gall bladder, most of the stomach, duodenum, pancreas, part of the spleen. 3. Left Hypochondriac region:  Greater curvature of the stomach, remainder of the spleen, tail of the pancreas, splenic flexure of the colon part of the renal body. 4. Right lumbar/lateral region:  ascending colon & most of the right renal body.  ABDOMINAL REGIONS 5. Umbilical region:  Most of the transverse colon, part of the duodenum,jejunum &ileum, parts of the renal pelvis. 6. Left Lumbar/lateral region:  Descending colon, part of jejunum, most of the left renal body. Lower Region: 7. Right Iliac/ inguinal region:  Cecum, appendix, terminal end of the ileum and ileocecal valve. 8. Hypogastric region:  Ileum, flexure of sigmoid colon, rectum, urinary bladder  Female: uterus, ovaries, vagina & fallopian tubes Male: seminal vesicle, prostate gland and bulbourethral gland/Cowper’s gland. 9. Left Iliac/ inguinal region:  Sigmoid colon, jejunum, ileum. SURFACE LANDMARKS  BODY HABITUS  The common variation in the hape of the human body  COMMON ANATOMIC TERMINOLOGIES Processes – extends beyond or jut out from the body of structure described by the following: 1. Condyle – rounded projection at an articular extremity. 2. Coracoid / Coronoid process – beaklike process. 3. Crest – ridge like projection. 4. Epicondyles – projection above condyle. 5. Facet – small, smooth surfaced process for articulation. 6. Head – expanded end of the long bone. 7. Malleolus – club shaped process. 8. Protruberance – general term for projection. 9. Spine – sharp projection. 10.Styloid – long pointed process. 11.Trochanter – either of two large rounded process. 12.Tubercle – small rounded process. 13.Tuberosity – large rounded process.  COMMON ANATOMIC TERMINOLOGIES Depressions – are hollow depressed areas 1. Fissure – cleft or groove. 2. Foramen – hole in a bone. 3. Fossa – pit, fovea or hollow. 4. Groove – shallow depression. 5. Sulcus – furrow, trench or fissure like depressions. 6. Sinus – recess or groove, cavity or hollow space.  Posterior (dorsal) – refers to the back half of the patient or that part of the body seen when viewing the person from the back, includes the bottom of the feet and the back of the hands as seen in the anatomic position.  Anterior (ventral) – refers to the front half of the patient or that part seen when viewed from the front which includes the top of the feet and the fronts or palms of the hand when in anatomic position.  Plantar – refers to the posterior surface of the foot.  Dorsum  foot- refers to the top or anterior surface of the foot (dorsum pedis).  hand – refers to the back posterior aspect of the hand (dorsum manus).  Palmar – refers to the palm of the hand in anatomic position the same as anterior or ventral surface of the hand.  RELATIONSHIP TERMS  Medial – towards the center  Lateral – away from the center  Proximal – near the source or origin  Distal – away from the source or origin  Cephalad – means toward the head  Caudad – means away from the head  Inferior – inside or something near the center  Exterior – situated on or near the outside  Superficial – near the skin surface  Deep – farther away from the surface  Ipsilateral – on the same side  Contralateral – opposite sides  Lordosis – sway back curvature commonly of the lumbar and cervical spines.  Kyphosis – hump-back curvature commonly of the thoracic and coccyx.  GENERAL BODY POSITIONS  ANATOMICAL POSITION  A reference position that defines specific surfaces and planes of the body.  It is an upright position with arms abducted slightly (down), palms forward, and head and feet directed straight ahead.  SUPINE - lying on back facing  PRONE - lying on front facing upwards downward and the head may be rotated sideways  ERECT - an upright position, to sit or stand erect  RECUMBENT - lying down in any position. a. Dorsal recumbent – lying on back (supine). b. Ventral recumbent – lying on front (prone). c.Lateral recumbent – lying on side (right or left lateral).  FOWLERS POSITION - a  TRENDELENBURG - a recumbent recumbent positon with the body position with the whole body tilted so tilted so that the head is higher than that the head is lower than the feet. the feet.  SIM'S POSITION - a recumbent LITHOTOMY - a recumbent position oblique with the patient lying on the with knees and hip flexed and left anterior side with the left leg thighs abducted and rotated extended and the right knee and thigh partially flexed. externally supported by ankle supports.  SPECIFIC BODY POSITIONS  position that identifies the body part closest to the film or by the surface on which the body is lying.  Lateral position – refers to the side view.  Oblique position – an angled position in which neither the sagittal nor the coronal body plane is perpendicular or at right angles to the IR. 1. Left and Right Posterior Oblique Positions (LPO & RPO) 2. Right and Left Anterior Oblique (RAO & LAO)  Left and Right Posterior Oblique Positions (LPO & RPO) – describes specific oblique position in which the left or right posterior aspect of the body is closest to the film. These can also be reffered to as AP Oblique positions because of the entry and exit of the CR beam to the body.  LEFT POSTERIOR OBLIQUE POSITION  RIGHT POSTERIOR OBLIQUE POSITION  Right and Left Anterior Oblique (RAO & LAO) – refers to those oblique positions in which the right or left anterior aspect of the body is closest to the IR and can be erect or recumbent general body positions. These could also be described as PA Oblique projections.  RIGHT ANTERIOR OBLIQUE POSITION  LEFT ANTERIOR OBLIQUE POSITION  Decubitus – to lie down or the position assumed in lying down on a horizontal surface and is always used with the beam in horizontal position. i. Right and left Decubitus position (AP or PA) ii. Dorsal Decubitus position (Right or Left Lateral) iii. Ventral Decubitus position (Right or Left Lateral)  RIGHT AND LEFT DECUBITUS POSITION  DORSAL AND VENTRAL DECUBITUS POSITION  RADIOGRAPHIC TERMINOLOGIES  Radiograph – is a film or other base material containing a processed image of anatomic part of a patient as produced by action of x-rays on IR.  Radiography – the production of radiographs or other forms of radiographic images. Qualities of Radiographic Examination Procedures 1. Positioning body parts and CR alignment 2. Selection of radiation protection measures 3. Selection of exposure factors 4. Patient instructions 5. Film processing  Position – overall posture of the patient or the general body position. - refers to the specific placement of the body part in relation to the radiographic table or IR during imaging.  Projection – the path of the central ray as it exits the x-ray tube and goes through the patient to the IR.  View – used to describe the body part as seen by the IR.  Radiographic Projection – is a positioning term that describes the direction or path of the CR of the x-ray beam as it passes through then patient projecting an image to the IR.  Common Projection Terms  Posteroanterior Projection (PA) – projection of the CR from posterior to anterior. The CR beam enters at the posterior and exits at the anterior.  Anteroposterior Projection (PA) – projection of CR from anterior to posterior where the beam enters at the anterior and exits at the posterior.  AP /PA Oblique Projections – AP or PA projection of the upper or lower limbs that is obliqued or rotated and not in true AP or PA.  Mediolateral / Lateromedial Projections – a lateral projection described by the path of the CR.  Axial Projection – This angulation is based on the anatomic position and is most often produced by angling the central ray cephalad or caudad. - refers to all projections in which the longitudinal angulation between the central ray and the long axis of the body part is 10 degrees or more. The term axial is used because the angulation could exceed 10 degrees.  Tangential – means touching a curve or surface at only one point. - the central ray is directed toward the outer margin of a curved body surface to profile a body part j ust under the surface and project it free of superimposition.  BODY MOVEMENT  Abduction – the lateral movement of the arm / leg away from the body.  Adduction – the lateral movement of part towards the body.  Supination – rotational movement of the hand into the anatomic position with palms up in supine position.  Pronation – palm down or back.  Circumduction – means to move around to form a circle.  Flexion – decreasing angle between parts.  Extension – increasing angle between parts.  Hyperextension – extending beyond the straight or normal position.  Deviation – to turn aside or to turn away from the standard course.  Eversion – an outward stress movement.  Inversion – inward stress movement.  Rotation – turn the part or rotate in its axis.  Medial rotation – turning of body part moving the anterior aspect to the inside.  Lateral rotation – turning of part moving the anterior outside the body.  Tilt – slanting movement  Varus – describes the bending of parts outward from the midline of the body  Valgus– meaning “knock kneed” or bending of part toward the midline  Dorsiflexion of foot – to decrease the angle between the dorsum and the lower leg.  Plantar Flexion – extending the ankle joint. IDENTIFICATION OF RADIOGRAPHS The identification marker should include: 1. Patient name and or Identification or case number 2. The date of examination 3. the side marker, right or left 4. Institutional Identity FILM PLACEMENT  The part of interest is usually centered to the center point of the cassette or to where the angulations of the CR will project it to the center.  The cassette should be adjusted oftentimes with its long axis parallel to the long axis of the part being examined.  All long bone studies should include at least one joint so long/big films should be used in all long bone studies.  Always use the rule “place the part as close to the film as possible for accurate anatomic projection  COLLIMATION OF THE X-RAY BEAM  The beam of x-ray should be limited to irradiate only the area under examination for 2 purposes: a.It minimizes the amount of radiation to the patient and reduces scattered radiation that is in the room and thus able to reach the film. b.It allows the radiograph to show clear structural delineation and increased contrast by: 1. reducing scatter radiation thereby producing short scale radiographs. 2. preventing secondary radiation from unnecessarily exposing surrounding tissues with resultant film fogging from this source. RADIOGRAPHIC MARKERS  IMAGE RECEPTOR  The device that receives the energy of the x-ray beam and forms the image of the body part.  FOUR DEVICES CONSIDERED AS IR 1. CASSETTE WITH FILM 2. IMAGE PLATE 3. DIRECT RADIOGRAPHY 4. FLUOROSCOPIC SCREEN  FOUR DEVICES CONSIDERED AS IR 1. CASSETTE WITH FILM – a device that contains special screen that glow when struck by x-rays and imprints the x-ray image on film. The use of darkroom is required where the film is developed in the processor.  FOUR DEVICES CONSIDERED AS IR 2. IMAGE PLATE – a device similar to a cassette that contains special phosphorus that stores the x-ray image. It is inserted into a reader device which does not require a darkroom and the images is then converted to digital format and is viewed on a computer monitor or printed out on film.  FOUR DEVICES CONSIDERED AS IR 3. DIRECT RADIOGRAPHY – does not use a cassette or IP. A flat panel detector built into digital format and the image is viewed in computer monitor or printed on a film.  FOUR DEVICES CONSIDERED AS IR 4. FLUOROSCOPIC SCREEN – the x-rays strike a fluoroscopic screen where the image is formed and the body part is transmitted to a television monitor via a camera. This is a real time device in which body parts are viewed live in television.  RADIOGRAPH  Is the end result of an exacting technical procedure. FILM RADIOGRAPH Fresh Exposed Unexposed Shade of black with image Tint of blue No image  STAND POINTS FOR RADIOGRAPHIC 1. The relationship of the structural shadows as to size, shape, position and angulationsANALYSIS must be reviewed. 2. Each anatomic structure must be compared with that of adjacent structures such as the head of the humerus compared with glenoid fossa and acromion process. 3. The density of the radiograph must be within the useful density range. If a radiograph is too light or too dark, an accurate diagnosis becomes difficult or impossible. If change in the technique is necessary the factors that primary control density are milliamperage seconds (mas) and source-image-distance (SID). STAND POINTS FOR RADIOGRAPHIC ANALYSIS 4.The contrast of the radiograph must be sufficient to allow radiographic distinction of adjacent structures with different tissue densities. The primary controlling factor of radiographic contrast is peak voltage. 5.The sharpness of detail must be sufficient to clearly demonstrate the desired anatomic part, Sharpness of the detail is controlled by several factors which can be categorized as geometric factors, motion and materials.  STAND POINTS FOR RADIOGRAPHIC 6.The magnification in sizeANALYSIS of the body part must be evaluated and the controlling factor of the object film distance and SID. All radiographs yield some degree of magnification. 7.The shape distortion of the body part must be analyzed and the controlling factors of direction of the CR-film alignment and the part film alignment must be studied. Shape distortion is often used as an advantage in radiography. An example of shape distortion is an axial projection of the cranium to demonstrate the occipital bone.  DISPLAY OF RADIOGRAPH  VIEW BOX/ILLUMINATOR –device for viewing radiograph. - Radiographs are usually placed on the illuminator and oriented so that the person looking at the image sees the body part placed in anatomic position. CLINICAL HISTORY NEEDED BY THE TECHNOLOGIST  TECHNOLOGIST – responsible for performing radiographic examinations according to standard procedure except when contraindicated due to patients conditions. The technologist must know: A) normal anatomy and normal anatomic variations so that the patient can be accurately positioned. B) the radiographic characteristics of numerous pathologic conditions which could affect normal radiopacity of structures.  CLINICAL HISTORY NEEDED BY THE TECHNOLOGIST  The requisition received by the technologist must state the exact region to be radiographed and the suspected and existing patient diagnosis.  The patients must be positioned and the exposure factors selected according to the region involved and the radiographic characteristics of the existing abnormality.  The technologist must understand the rationale behind the examination, otherwise he/she can't produce radiograph of the greatest possible value.  INITIAL EXAMINATION  The projections used for the initial examination are usually held to the minimum required to detect any demonstrable abnormality in the region. It saves time, eliminates unnecessary radiographs and reduces radiation exposure to the patient.  DIAGNOSIS AND THE TECHNOLOGIST  The technologist should tactfully advise the patient that the physician will receive the report as soon as the radiologist has interpreted the radiographs.  If the requesting physicians will ask for explanation for the interpretations made, they should be referred to the radiologist.  CARE OF RADIOGRAPHIC EXAMINATION ROOMS  The radiographic examination room should be scrupulously cleaned as any other rooms used for medical purposes  The mechanical parts of the x-ray machine should be wipes with a clean damp cloth everyday  The metal parts should be cleaned with disinfectants  The overhead system, x-ray tube, and other parts that conduct electricity should be cleaned with alcohol or clean dry cloth (water should never be used in cleaning it)  CARE OF RADIOGRAPHIC EXAMINATION ROOMS  Other accessories should be cleaned daily and the gummy residue left to the cassettes and cassette stands by adhesive tapes should be removed and the cassettes disinfected.  Cassettes should be protected from patients with bleeding, ulcerated or other exudative lesions by use of protective covers. Stained and physically abused cassettes are inexcusable and do not represent a professional.  CARE OF RADIOGRAPHIC EXAMINATION ROOMS  The radiographic room should be prepared for the examination before the patient in brought into the room and fresh linens should readily be available in case the technologist will be needing it.  The accessories that will be used for the procedure should be cleaned and placed nearby to minimize the time.  STANDARD PRECAUTIONS  HANDWASHING – the easiest way and most convenient method of preventing the spread of microorganisms - Radiographer should wash their hands before and after each procedure and without exceptions in the following situation  After examining patients with known communicable diseases  After coming in contact with blood and body fluids  Before beginning invasive procedures  Before touching patients who at risk of infections  STANDARD PRECAUTIONS  OTHER CONSIDERATIONS: 1. Hands should always be smooth and free from abrasions roughness and chapping 2. The law of asepsis and prophylaxis must always be obeyed 3. Radiographers should practice scrupulous cleanliness when handling all patients whether the patients have infectious disease or none 4. Patient should see the radiographers wash hands 5. A sufficient supply of gowns and disposable gloves should be kept in the radiographic room to be used to care for infectious px  STANDARD PRECAUTIONS  OTHER CONSIDERATIONS: 6.Before bringing an isolation unit patient to the radiology department, the transporter should drape the stretcher or wheelchair with a clean cloth to prevent contamination of anything that patient might touch 7.A folded sheet should be placed over the end of the stretcher or table to protect the IR when a non bucky technique is used. 8.If a patient has any moisture or body fluids that would come in contact with the patients, a non moisture penetrable material must be used to cover the IR 9.When the examination is finished the contaminated linen should be folded with the clean side out and returned to the patients room with the patients  PATIENT INSTRUCTIONS  All special procedures requires the proper patient instructions so as to eliminate mistakes in bowel preparation  Radiography that requires breathing instructions requires proper patient monitoring and control  In order for radiographers to know if the patient is really properly instructed  IDENTIFICATION OF RADIOGRAPHS  THE IDENTIFICATION MARKER SHOULD INCLUDE: 1. Patient name and or identification or case number 2. The date of examination 3. The side marker, right or left 4. Institutional identity  FILM PLACEMENT  The part of interest is usually centered to the center point of the cassette or to where the angulations of the CR will project it to the center.  The cassette should be adjusted oftentimes with its long axis parallel to to the long axis of the part being examined.  All long bone studies should include at least one joint so long/big films should be used in all long bone studies.  Always us the rule “place the part as close to the film as possible for accurate anatomic projection”  DIRECTION OF CENTRAL RAY The CR is angled through the part of interest under the following conditions: 1. When it is necessary to avoid the superimposition of underlying or overlying structures 2. When it is necessary to avoid stacking a curved structure on itself- such as the sacrum and the coccyx 3. When it is necessary to project through angled joints such as the knee joint 4. When it is necessary to project through angled structures without foreshortening or elongation  COLLIMATION OF THE X-RAY BEAM The beam of x-ray should be limited to irradiate only the area under examination for 2 purposes: a. It minimizes the amount of radiation to the patient and reduces scattered radiation that is in the room and thus able to reach the film. b. It allows the radiograph to show clear structural delineation and increased contrast by (1) reducing scatter radiation thereby producing short scale radiographs and (2) preventing secondary radiation from unnecessarily exposing surrounding tissues with resultant film fogging from this source. End of Lecture, Thank You!