Radiographic Positioning Notes (PDF)

RADIOGRAPHIC POSITIONING T H O R A C I C V I S C E R A: ( T R A C H E A ) AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGTH/ SUPINE - MSP perp. – ML IR...

RADIOGRAPHIC POSITIONING T H O R A C I C V I S C E R A: ( T R A C H E A ) AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGTH/ SUPINE - MSP perp. – ML IR 10X12 L - Adj. Shoulder same (Collimate closely to the - Outline of the air-filled trachea TransvP. neck) - EXTEND Neck/Chin - 40” perp.-MANUBRIUM SLIGHTLY SLOW INHALATION (To ensure filling of trachea and upper airway with AIR) LATERAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: STANDING/ SEATED (R/L) - Hands clasp behind – 10X12 L - Air-filled trachea & superior body, Shoulder placed (P) (Collimate to region of soft mediastinum - EXTEND Neck/Chin tissue of the neck) Eiselbeg & Sgalitzer ERROR SLIGHTLY - 72” perp(H) – through a - Outline of the trachea and - MSP // - IR point between MCP and bronchi JN - Foreign body localization - Retrosternal extensions of the SLOW INHALATION thyroid gland (To ensure filling of - Thymic enlargement in infants (in trachea and upper the recumbent position) airway with AIR) - Opacified pharynx and upper esophagus AXIOLATERAL PROJECTION (TWINNING METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: STANDING/ SEATED (R/L) - ELVATE Arm adjacent – 10X12 L - air-filled trachea and the apex of IR, FLEX Elbow, FA - 15° CAU. –adjacent the lung closer to the IR behind – Head SUPRACLAVICULAR - CENTER the IR – Region IMPRESSION of the Trachea @lvl of the Axilla FULL INSPI (APEX) - OPP. Shoulder SLOW INHI (TRACHEA) DEPRESSED as much as possible - MSP // - IR T H O R A C I C V I S C E R A: ( C H E S T – L U N G S & HEART) PA PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT - Arms FLEXED @Elbow 14X17 L/CW - Air-filled trachea | lungs | - DORSUM of the Hands - 72” perp.-MSP(body) - diaphragmatic dome | heart & inc. - HIPS center IR @lvl - T7 aortic knob | and if enlarged - EXTEND Chin UPWARD laterally thyroid and thymus - ROTATE Shoulder gland FORWARD - both lungs from apices to - MSP of the body perp. – 2ND FULL INSPIRATION costophrenic angles ML IR (Well expanded lungs) - Min. of 10 (P) ribs above diaphragm LATERAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT (TRUE LAT) R/L - EXTEND Arms directly 14X17 L - Left Lateral Chest Position is used UPWARD, FLEXED - 72” perp.-MCP(body) - to demonstrates the heart, the @Elbow. FA RESTING – center of IR @lvl - T7 aorta, and left-sided pulmonary Head lesions. - MCP of the body perp. – - Right Lateral Chest Position is ML of IR used to demonstrates the right- sided pulmonary lesions 2ND FULL INSPIRATION - Lateral Projections are employed (Well expanded lungs) extensively to demonstrate the interlobar fissures, to differentiate the lobes, and to localize pulmonary lesions FERN DIMACALI | 1 RADIOGRAPHIC POSITIONING PA OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: RAO/LAO - 45° B.O, PLACE dep. 14X17 L - LAO – Max. area of the Right Shoulder inc.- IR & - 72” perp.- -center of IR Lung field (farther side fr. IR) CENTER the Thorax, @lvl - T7 along with the Thoracic Viscera | Hands inc. – HIPS w/ Palm (A) Portion of the left lung is OUTWARD superimposed by the spine | - opp. Arm RAISED to Trachea & it bifurcation (Carina) & shoulder lvl, Hands the entire Right Branch of the GRASPING – TOP IR 2ND FULL INSPIRATION Bronchial Tree | Heart | - POI: FARTHER SIDE (Well expanded lungs) Descending Aorta & Arch of the Aorta are presented (55-60° - for CARDIAC - RAO – Max. area of the Left Lung SERIES) field (farther side fr. IR) along with the Thoracic Viscera | (A) Portion of the right lung is superimposed by the spine | Trachea & & the entire Left Branch of the Bronchial Tree (Best Img. Of L. Atrium, A. portion Apex of the L. Ventricle, & the R. Retrocardiac space) AP OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: RPO/LPO - 45° B.O, dep. Side inc. – 14X17 L - RPO position corresponds to the IR & CENTER the Thorax, - 72” perp.- -center of IR LAO position and the LPO position dep. Arm RAISED & @lvl – (3’’inferior JN) – corresponds to the RAO position FLEXED @Elbow. Hands EXITS T7 inc. HEAD LAO position. - Opp. Arm FLEXED The lung field of the elevated side @Elbow, Hands inc. – 2ND FULL INSPIRATION usually appears shorter, however, HIPS (Well expanded lungs) because of magnification of the - POI: CLOSEST SIDE diaphragm. The heart and great vessels also cast magnified shadows as a result of being farther from the IR. AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE/ UPRIGHT - MSP of the Lungs coin. – 14X17 L - Magnified Heart and great MLRT - 72” perp.- -center of IR vessels | Short lung field and - EXTEND Chin UPWARD @lvl – (3’’inferior JN) – engorged pulmonary vessels | - If possible, BOTH Arms EXITS T7 Clavicles are projected higher | FLEXED @Elbow & Ribs assume more horizontal PLACE on the HIPS 2ND FULL INSPIRATION plane (To draw the scapulae (Well expanded lungs) laterally.) AP AXIAL PROJECTION (LINDBLOM METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT (LORDOTIC) - UPRIGHT Pos’n FACING 14X17 L - Axial of the lungs do demonstrate – XRT - 72” perp.- -center of IR the apices for conditions such as - STANDING approx. 1FT @lvl – MIDSTERNUM interlobar effusion INFRONT – IR - LEAN BACKWARD in a pos’n of extreme lordosis 2ND FULL INSPIRATION LPO/RPO (OBLIQUE AP AXIAL OBLIQUE (Well expanded lungs) - Dependent apex & lung of the LORDOTIC) - ROTATE the Body 30° affected side in its entirety towards aff. Side - LEAN BACKWARD in a pos’n of extreme lordosis FERN DIMACALI | 2 RADIOGRAPHIC POSITIONING AP AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - CENTER IR – MSP @lvl of 10X12/ 11X14 CW - APICES lying below the T2, FLEX the Elbows, - 72” -15-20° CEP. - Clavicles Hands inc. HIPS – Palm center of IR ENTERING out/ PRONATE the Hands – MANUBRIUM - PLACE the Shoulders back against – IR End of Full Inspiration (Clavicles are elevated by inspiration). PA AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT - CENTER IR – LVL JN, 10X12/ 11X14 CW - APICES are projected above the MSP of the Body perp. ML shadows of the clavicles in the PA IR INSPIRATION: axial and PA projections - EXTEND Chin UPWARD, - 72” -10-15° CEP. – T3 FLEX Arm, DORSUM of – CENTER IR the Hands inc. – HIPS EXPIRATION: (optional - ROTATE Shoulder - 72” -perp. – T3 – FORWARD, inc – IR CENTER IR FULL INSPI - Clavicles are elevated by inspiration FULL EXPI - Clavicles are depressed by expiration PA AXIAL PROJECTION (FLEISCHNER METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT (LORDOTIC) - UPRIGHT Pos’n FACING 14X17 L - Axial of the lungs that – VGD/IR - 72” Perp. – T4 – demonstrates Magnified - LEAN BACKWARD in a CENTER IR Interlobar Effusions pos’n of extreme lordosis (Thorax should be inclined posteriorly approx. 45°) AP or PA PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: R/L LAT. DECUBITUS - LYING LATERALLY either 14X17 CW/ L - Lateral decubitus position POS’N the AFF. SIDE/ UNAFF. - 72” -perp. – CENTER demonstrates the change in fluid SIDE IR @Lvl of 3” BELOW position (pleural effusion) and - EXTEND Arms ABOVE – JN (AP) or T7 (PA) reveals suspected pneumothorax HEAD, ADJ. Thorax in a TRUE LAT. POS’N Ekimsky Recommendation: - Patient leaning laterally 45° PNEUMOTHORAX (for demonstration of small pleural (AFF. SIDE UP) effusions) PLEURAL EFFUSION (AFF. SIDE DOWN/ DEP RTABLE) LATERAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: R/L VENTRAL or DORSAL - SUPINE/ PRONE 14X17 CW/ L - shows a change in the position of DECUB. POS’N - ELEVATE Thorax 2-3” on DORSAL fluid and reveals pulmonary areas folded sheets or firm pad, - 72” -perp. – MCP @Lvl that are obscured by the fluid in centering the Thorax – of 3-4” BELOW JN standard projections GRID VENTRAL - Adj. Body – TRUE - T7 PRONE/SUPINE pos’n - AFF. SIDE inc. VGD/IR, top of IR extends (lvl of Thyroid Cartilage) - Arms ABOVE - HEAD FERN DIMACALI | 3 RADIOGRAPHIC POSITIONING ABDOMEN AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE UPRIGHT: 14X17 L UPRIGHT - Arms @THE SIDES; - 40” -perp. – CENTER - Abnormal masses, air-fluid Weight (=) distributed on IR @Lvl of IC levels, and accumulations of both Feet; CENTER IR – (SUPINE) / 2” ABOVE intraperitoneal air under 2” (S) to IC (diaphragm IC (UPR.) diaphragm included) or LVL of IC (bladder included) SUPINE END OF EXPIRATION - Size & Shape of Liver SUPINE: (Abdominal organs are - Spleen & kidneys - Arms OVER Chest Area; not compressed) - Intraabdominal calcifications Place Support UNDER - Evidence of tumor masses Knees (to relieve strain); CENTER IR - @lvl IC (pubic symphysis included) PA PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ PRONE - Arms RAISED, both 14X17 L - Less desirable Kidneys due Hands inc. Head; Weight - 40” -perp. – CENTER to increased OID but will (=) distributed on both IR @Lvl of IC / 2” greatly reduced the gonadal Feet; CENTER IR – 2” (S) ABOVE IC dose to IC (diaphragm included) or LVL of IC END OF EXPIRATION (bladder included) (Abdominal organs are not compressed) Performed when the kidneys are not of primary interest (Greatly reduces patient gonadal dose) AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: LEFT LAT. DECUBITUS - Left Lat. Pos’n on Top – 14X17 L - valuable for demonstrating air or Rtable; Arms ABOVE - 40” -perp. – CENTER fluid levels when an upright Head; Knees SLIGHTLY IR @Lvl of IC / 2” abdomen projection cannot be FLEXED ABOVE IC obtained - CENTER IR – 2” (S) to IC - best visualizes free (diaphragm included) or END OF EXPIRATION intraperitoneal air in the area of LVL of IC (bladder (Abdominal organs are the liver in the right upper included) not compressed) abdomen away from the gastric bubble Miller Recommendation: Patient kept in left lateral position for 10-20 minutes or 5 minutes before taking radiograph - allow gas to rise into the area under the right hemidiaphragm - To demonstrate small amounts of intraperitoneal gas in acute abdominal cases (10-20 mins) - To demonstrate larger amounts free air (5 mins) LATERAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: R/L LAT. RECUMBENT - Lat Pos’n on Top – Rtable 14X17 L - prevertebral space occupied by ; Knees FLEXED; Elbows - 40” -perp. – CENTER the abdominal aorta and as well FLEXED; Hands UNDER IR @Lvl of IC / 2” as any intraabdominal Head ABOVE IC calcifications or tumor masses - CENTER IR – 2” (S) to IC (diaphragm included) or END OF EXPIRATION - localization of foreign bodies LVL of IC (bladder (Abdominal organs are included) not compressed) FERN DIMACALI | 4 RADIOGRAPHIC POSITIONING LATERAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: R/L DORSAL DECUBITUS - Supine pos’n on Top – 14X17 L - Prevertebral Space occupied by Rtable; Arms ACROSS - 40” -perp. – CENTER the abdominal aorta and as well upper chest, Hands IR 2” ABOVE IC as any intraabdominal BEHIND the Head calcifications or tumor masses END OF EXPIRATION - Umbilical Hernia (Abdominal organs are - To determine the air-fluid levels not compressed) in the abdomen S H O U L D E R G I R D L E: ( S H O U L D E R ) AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - Upright (more 10X12 CW/L - Shoulder & Proximal Humerus comfortable) or supine; CW (To include entire NEUTRAL patient slightly rotated; Clavicle) NEUTRAL ROTATION scapula // to IR L (To include more - Greater Tubercle partially - CENTER IR – Shoulder Humerus) superimposing Humeral Head; Jt. posterior part of Supraspinatus - 40” -perp. – CENTER Insertion NEUTRAL ROTATION IR – 1” INFERIOR TO - Palmar/Anterior aspect of CP EXTERNAL ROTATION EXTERNAL Hand inc. – hip; Humeral - Greater Tubercle & site of Epicondyles 45° to IR insertion of supraspinatus tendon EXTERNAL ROTATION - Hand SUPINATED; Arm INTERNAL ROTATION SLIGHTLY ABDUCTED - Lesser Tubercle; site of the - Humeral Epicondyles // to insertion of the Subscapular INTERNAL IR Tendon; Proximal Humerus in true lateral position INTERNAL ROTATION - Dorsal/Posterior aspect of Hand inc. – hip; Humeral Epicondyles PERP. to IR TRANSTHORACIC LATERAL PROJECTION (LAWRENCE METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - Upright (more 14X17 L - Proximal Humerus (projected comfortable) or supine; - 40” -perp. Or 10-15° through thorax) Patient in lateral position; CEP (if cannot elevate Uninjured Arm raised; unaff. Arm) – USED WHEN Forearm rested on head; CENTER IR – @lvl of - Trauma exist & the arm cannot MCP perp. to IR Surgical Neck be rotated or abducted because of an injury Full Inspiration - Demonstrate Proximal Humerus (Improves contrast & in 90° from AP PROJECTION reduces exposure) or - Show its relationship to the breathing technique Scapula & Clavivle (slow, deep breathing) INFEROSUPERIOR AXIAL PROJECTION (LAWRENCE METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Head, Shoulder & 10X12 CW - Proximal Humerus Elbow elevated (3 in.); - 40” -H; 15-30° - Scapulahumeral joint Arm abducted 90°; MEDIALLY (greater - Lateral portion of Coracoids - Humerus rotated abduction, greater Process externally; IR placed angle) – AXILLA - Acromioclavicular (AC) against the neck; Head CENTER IR Articulation turn away from side of - Insertion site of Subscapular interest Suspended Respiration Tendon - Point of insertion of Teres Minor Tendon FERN DIMACALI | 5 RADIOGRAPHIC POSITIONING INFEROSUPERIOR AXIAL PROJECTION (RAFERT MODIFICATION) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Head, Shoulder & 10X12 CW - Coracoid Process pointing Elbow elevated (3 in.); - 40” -H; 15° MEDIALLY anteriorly Arm abducted 90°; – AXILLA - CENTER - EXAGGERATED IR - Lesser Tubercle in profile External Rotation of the Arm; Hand 45° to IR; Suspended Respiration - Hill-Sachs compression Thumb pointing fracture (defect) downward; IR placed against the neck; Head turn away from side of interest INFEROSUPERIOR AXIAL PROJECTION (WEST POINT METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: PRONE - Prone; Shoulder elevated 8X10 / 10X12 CW - Humeral Head projected free of (3 in.); head turn away - 40” - 25° (A) & 25°(M) the Coracoid Process from side of interest; Arm – 5”(I) & 1.5”(M) to abducted 90° Acromial Edge - USED WHEN - Forearm rested over the CENTER IR - Chronic instability of shoulder edge of table; IR placed is suspected vertically Suspended Respiration - To demonstrate Bankart’s Lesion & associated Hills-Sachs defect INFEROSUPERIOR AXIAL PROJECTION (CLEMENTS MODIFICATION) Pt. POS’N: PP: CRD: OBJECTIVES: LAT. RECUMBENT - Lateral recumbent; 8X10 L - Acromioclavicular Joint Unaffected Side against - 40” -H or 5-15° - Scapulohumeral Joint IR; Affected Arm MEDIALLY (cannot - Glenohumeral Joint abducted 90°; IR against abduct arm 90°) – superior aspect of MIDAXILLARY USED WHEN shoulder REGION - CENTER IR - Prone (Westpoint) or supine (Lawrence & Rafert-Long) position is not possible Suspended Respiration PA TRANSAXIALLRY PROJECTION (HOBSS MODIFICATION) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT / RECUMBENT - Upright; Body slightly 8X10 L - Lateral view of Proximal rotated 5-10° Anterior - 40” -perp– AXILLA & Humerus Oblique; Arm raised (S) HUMERAL HEAD – as much as the Pt. can GLENOHUMERAL JT. tolerate - CENTER IR - Head turned away from the aff. Arm Suspended Respiration SUPEROINFERIOR AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SEATED - Seated; Patient Lean 8X10 / 10X12 L - Relationship (Proximal End of Laterally; Elbow flexed - 40” - 5-15° – Humerus to the Glenoid Cavity) 90° & rested on table; SHOULDER JT. - Hand pronated; Humeral CENTER IR - AC articulation | Outer portion Epicondyles ┴ to table of the Coracoid Process | Points of insertion of the Subscapularis Muscle & Teres Minor Muscle | Coracoids Suspended Respiration process above clavicle | Lesser Tubercle in profile FERN DIMACALI | 6 RADIOGRAPHIC POSITIONING AP AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - Upright/Supine; 8X10 CW - Relationship (Head of Humerus Scapulohumeral Joint - 40” - 35° CEPHALAD to the Glenoid Cavity) centered to IR –SCAPULOHUMERAL JT. - CENTER IR - AC articulation | Outer portion of the Coracoid Process | Points of insertion of the Subscapularis Muscle & Teres Suspended Respiration Minor Muscle | Coracoids process above clavicle | Lesser Tubercle in profile USEFUL IN DIAGNOSING CASES OF POSTERIOR DISLOCATION PA OBLIQUE PROJECTION: SCAPULAR Y Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ RECUMBENT - Upright/recumbent; 10X12 L - Scapular body (form the vertical RAO/LAO; MCP 45-60° to - 40” – perp. – component); Acromion & IR; Scapular Flat Surface SCAPULOHUMERAL Coracoid Processes (form the ┴ to IR; RPO/LPO (for JT. - CENTER IR upper limbs) severely injured patient) - Superimposed Humeral Head & Glenoid Cavity Suspended Respiration - Superimposed Humeral Shaft & Scapular Body DESCRIBED BY - Coracoid Process superimposed RUBIN-GRAY & GREEN or projected below the Clavicle USEFUL IN EVALUATION OF SUSPECTED SHOULDER DISLOCATIONS - Anterior/subcoracoid dislocation: humeral head beneath the coracoid process - Posterior/subacromial dislocation: humeral head beneath the acromion process AP AXIAL PROJECTION (STRYKER NOTCH METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Arm flexed 10X12 L - Posterosuperior & slightly beyond 90°; Palm - 40” – 10° CEPHALAD Posterolateral areas of Humeral of hand on top of head w/ – CORACOID Head fingertips resting on head PROCESS - CENTER (places humerus in a IR USEFUL FOR DEMONSTRATION slight internal rotation); OF HILL-SACHS DEFECT Body of Humerus // to MSP of body Suspended Respiration DESCRIBED BY HALL-ISAAC-BOOTH S H O U L D E R G I R D L E: ( G L E N O I D C A V I T Y ) AP OBLIQUE PROJECTION (GRASHEY METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - Upright (more 8X10 CW - GLENOID CAVITY RPO/LPO comfortable) or supine; - 40” – perp. – 2”(M) & (scapulahumeral joint) RPO/LPO; 2”(I) to - Open joint space b/n Humeral - Body Rotated 35-45° SUPEROLATERAL Head and Glenoid Cavity (upright)/>45° (supine) BORDER OF toward the affected side; SHOULDER - scapula // to IR; Arm CENTER IR slightly abducted; Palm of hand on abdomen Suspended Respiration FERN DIMACALI | 7 RADIOGRAPHIC POSITIONING AP OBLIQUE PROJECTION (APPLE METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT - Upright; RPO/LPO 10X12 CW - GLENOID CAVITY RPO/LPO - Body rotated 35-45° - 40” – perp. – LEVEL (scapulahumeral joint) toward the affected side; (CP) - CENTER IR scapula // to IR; patient To demonstrate a loss of articular hold 1 lb. weight; arm cartilage in the scapulohumeral abducted 90° Suspended Respiration joint Similar to Grashey method but uses weighted abduction AP AXIAL OBLIQUE PROJECTION (GARTH METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE/SEATED/UPRIGHT - Supine/seated/upright; 10X12 L - GLENOID CAVITY RPO/LPO RPO/LPO - 40” – 45° CAUDAD – (scapulahumeral joint) - Body Rotated 45° toward SCAPULAHUMERAL  Humeral head the affected side; Elbow JT. - CENTER IR  Coracoid process flexed; Arm placed across  Scapular Head & Neck the chest For acute shoulder trauma & Identifying posterior Suspended Respiration scapulohumeral dislocations  Posterior disocation: Humeral head projected superiorly from glenoid cavity  Anterior disocation: Humeral head projected inferiorly from glenoid cavity - Glenoid fxs - Hill-Sachs lesions/defect - Soft tissue calcification S H O U L D E R G I R D L E: ( S U P R A S P I N A T U S OUTLET) TANGENTIAL PROJECTION (NEER METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: SEATED/ UPRIGHT - Seated/upright; 8X10/ 10X12 L - Posterior surface of Acromion & RPO/LPO ERROR RPO/LPO; unaffected - 40” – 10-15° CAUDAD AC joint (superior border of RAO/ LAO side rotated 45-60° away – SUPERIOR ASPECT coracoacromial outlet) from IR; arm at side OF HUMERAL HEAD - CENTER IR - USEFUL TO DEMO. TANGENTIALLY CORACOACROMIAL ACH/OUTLET - To diagnose Shoulder Suspended Respiration Impingement S H O U L D E R G I R D L E: ( P R O X I M A L H U M E R U S ) TANGENTIAL PROJECTION (FISK MODIFICATION) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE/ UPRIGHT (FISK M.) - SUPINE: Chin extended; 8X10/ 10X12 CW - Intertubercular Groove Head rotated away from SUPINE: affected side; Hand - 40” – 10-15° (P) supinated; IR against downward from (H). – superior surface of LONG AXIS OF shoulder HUMERUS – CENTER IR - UPRIGHT (FISK MODIFICATION): Elbow UPRIGHT: flexed; Posterior surface - 40” – perp. – of forearm against table; INTERTUBERCULAR Patient GRASPS the IR; GROOVE – CENTER sandbag under hand; IR IR horizontal; Patient LEAN forward; Humerus 10-15° from vertical Suspended Respiration - GREATER OID FERN DIMACALI | 8 RADIOGRAPHIC POSITIONING PA PROJECTION (BLACKETT-HEALY METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: PRONE - Prone; Arms along sides 8X10 CW - Tangential image of the head rested on - 40” – perp. – HEAD OF Insertion of Teres Minor chin/cheek of affected HUMERUS – CENTER side IR This position rotates the humeral - Arm in extreme internal head so that the greater rotation; Elbow flexed tubercle is brought anteriorly hand at the back; IR Respiration: Suspend at center 1” inferior to the end of exhalation (for coracoid process a more uniform density) AP PROJECTION (BLACKETT-HEALY METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Arms along sides; 8X10 CW - Image of the Subscapularis Unaffected Shoulder - 40” – perp. – Insertion at the lesser tubercle elevated 15° with SB SHOULDER JT. – - Abduct the Affected Arm; CENTER IR Elbow flexed, Hand pronated (arm rotated internally) Suspended Respiration AP AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Affected Arm at 8X10 CW - Profile the Greater Tubercle the sides - 40” – 25° CAUDAD – - Site of Infraspinatus Tendon  Arm in external rot. (To CORACOID P. – - Opens Subacromial Space open the subacromial CENTER IR space)  Arm rot. In neutral position  In complete internal rot. (Full evaluation of humeral head) S H O U L D E R G I R D L E: ( A C R O M I O C L A V I C U L A R J T.) BILAT. AP PROJECTION (PEARSON METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SEATED UPR. - Upright/seated-upright; 14X17 CW - BILAT. AC JOINTS Arms hanging at sides - 72” – perp. – b/n level (unsupported) of AC JTS. – CENTER USED TO DEMO. DISLOCATION, - 2 exposures: With & IR SEPARATION & FXN OF THE Without weights (5-10 ACJ lbs.); Affix the weights to - 2 exposures with & patients wrist without weights (5-8 lbs) - Affix the weights to Pt. wrist Unilat: Rp- AC jts. Suspended Respiration AP AXIAL PROJECTION (ALEXANDER METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SEATED UPR. - Upright/seated-upright; 8X10/ 10X12 L - AC Joints Above Acromion Coracoid Process - 40” – 15° CEPHALAD centered to IR – CORACOID P. – For demonstration of suspected CENTER IR AC subluxation or dislocation Suspended Respiration FERN DIMACALI | 9 RADIOGRAPHIC POSITIONING PA AXIAL OBLIQUE PROJECTION (ALEXANDER METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT - Upright; RAO/LAO; MCP 8X10/ 10X12 L - Relationship of the bones of RAO/LAO 45-60° from IR; Scapula - 40” – 15° CAUDAD – the shoulder ┴ to IR; Lean affected AC JTS. – CENTER IR shoulder against IR; Arm pulled firmly across the chest (draws scapula laterally & forward & Suspended Respiration places joint close to IR) S H O U L D E R G I R D L E: ( C L A V I C L E ) AP PROJECTION + (PA) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - Supine/upright; Arms 10X12 CW - Frontal image of Clavicle (SUPINE: Reduces the along the sides; Clavicle - 40” – perp. – possibility of fragment center to IR MIDSHAFT OF displacement/ additional CLAVICLE- CENTER PA PROJECTION injury) IR OID & improved image contrast Suspended Respiration AP AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: LORDOTIC POSITION - Upright: 1 foot in front; 10X12 CW - Clavicle projected above the lean backward (lordotic); Thinner patients (more Ribs; Neck & Shoulder against angulation) - True/Exact Axial Projection of IR; Neck in extreme To project clavicle off the Clavicle flexion scapula and ribs - Slightly distorted image - Medial end overlapping 1st & 2nd - Supine: cannot assumed UPRIGHT ribs lordotic position - 40” – 0-15° CEPHALAD – MIDSHAFT OF CLAVICLE- CENTER SUPINE IR SUPINE - 40” – 15-30° CEPHALAD – MIDSHAFT OF CLAVICLE- CENTER IR Suspend at end of full inspiration (To further elevate and angle the clavicle) PA AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: PRONE/ STANDING - Prone/standing 10X12 CW - Clavicle projected above the - 40” – 15-30° CAUDAD Ribs; axial image of clavicle – MIDSHAFT OF CLAVICLE- CENTER IR Suspended Respiration FERN DIMACALI | 10 RADIOGRAPHIC POSITIONING TANGENTIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Arms along sides; 10X12 CW - Inferosuperior image of the Shoulder depressed; - 40” – 25-40° Clavicle Head turn away from side CEPHALAD – B/N - Clavicle projected free of the of interest CLAVICLE & CHEST chest wall WALL- CENTER IR Suspended Respiration TANGENTIAL PROJECTION (TARRANT METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: SEATED - Seated patient lean 10X12 CW - Clavicle above the Thoracic slightly forward - 40” – 25-35° Cage ANTEROINFERIORLY – MIDSHAFT OF CLAVICLE – CENTER Useful with patients who cannot IR assume lordotic or recumbent position Suspended Respiration S H O U L D E R G I R D L E: ( S C A P U L A ) AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE/ UPRIGHT - Supine/upright; Arm 10X12 L - Scapula abducted 90° w/ the body - 40” – perp. – 2” (I) TO Lateral portion of scapula free of (draw scapula laterally); CP – CENTER IR superimposition Elbow flexed Slow Breathing to obliterate lung detail LATERAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SEATED - Upright/seated; RAO/LAO 10X12 L - Lateral image of Scapula RAO/LAO (more difficult to perform); - 40” – perp. – 45-60° from IR; RPO/LPO MIDMEDIAL BORDER No superimposition of scapular (magnified scapula) OF PROTRUDING body on ribs SCAPULA – CENTER Arm Placement: IR Superimposed lateral and medial - Elbow flexed & Arm on Border posterior chest (Demo. Acromion & CP) - Arm extended upward & Forearm rested on head or across upper chest Suspended Respiration (Demo. Scapular body) Mazujian Suggestion: Arm across the upper chest (grasping opposite shoulder) – (Demo. Scapular body) PA OBLIQUE PROJECTION (LORENZ & LILIENFIELD METHODS) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ LAT. RECUM. - Upright/lateral recum. 10X12 L - Oblique image of Scapula Lorenz Lorenz Method: Arm of - 40” – perp. – B/W affected side 90° to long CHEST WALL & Medial border adjacent to the axis of body; Elbow MIDAREA OF ribs flexed; Hand rested PROTRUDING Lilienfeld against head SCAPULA – CENTER Acromion process and inferior Lilienfeld Method: Arm of IR angle affected side obliquely upward; Head rested against head Suspended Respiration FERN DIMACALI | 11 RADIOGRAPHIC POSITIONING AP OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE/ UPRIGHT - Supine/upright; 10X12 L - Oblique image of Scapula free RPO/ LPO RPO/LPO; Shoulder - 40” – perp. – LAT. (moderate) or nearly free rotate 15-25° (moderate BORDER OF RIB (steeper) of rib SI. oblique) away from CAGE affected side or 25-35° MIDSCAPULAR (steeper oblique) AREA- CENTER IR - Arm extended superiorly; Elbow flexed; Hand supinated under head; Arm of affected side Suspended Respiration across anterior chest CORAOID PROCESS: AP AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Arm of affected 10X12 CW - Coracoid Process with minimal side slightly abducted; - 40” – 15-45° self-superimposition Hand supinated CEPHALAD – (Slight elongated) CORACOID P.- CENTER IR Kwak-Espiniella-Kattan Recommendation: CR 30° Respiration: Suspend at the end of exhalation (for a more uniform density) SCAPULAR SPINE: TANGENTIAL PROJECTION (LAQUERRIERE-PIERQUIN METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Scapular body // 8X10 CW - Scapular Spine in profile free of to IR; Head turned away - 40” – 45° CAUDAD – superimposition from side of interest SCAPULAR SPINE (P)(S) Region of Funke: use of 15° shoulder – CENTER radiolucent wedge for IR patient with small breast (prevent clavicular SI) Suspended Respiration TANGENTIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: PRONE/ UPRIGHT Prone: 8X10 CW - Scapular Spine free of - Arms along sides; Head PRONE: superimposition rested on chin/cheek of - 40” – 45° CEPHALAD affected side; hand – SCAPULAR SPINE supinated; scapular // to (P)(S) Region of IR shoulder – CENTER IR Upright: - Back rested against the UPRIGHT end of table; IR placed - 40” – 45° (P)(S) – 45° from table (wedge SCAPULAR SPINE support) (P)(S) Region of shoulder – CENTER IR FERN DIMACALI | 12 RADIOGRAPHIC POSITIONING B O N Y T H O R A X: ( S T E R N U M ) PA OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: PRONE - Prone or upright (trauma 10X12 L - Best projection to demonstrate RAO patient); RAO; Body - 30” – perp. – T7 Sternum rotated 15-20° (prevents (ELEV. SIDE (P) superimposition of THORAX & 1” LAT. Sternum free of superimposition sternum & vertebrae) MSP) – CENTER IR from Vertebral Column - Place the top of IR about 1.5” above JN Sternum projected over the Heart LONG EXPOSURE TIME: slow, shallow breaths during exposure SHORT EXPOSURE TIME: suspend breathing at the end of expiration A 30-inch (76-cm) (SID) is recommended to blur the posterior ribs. PA OBLIQUE PROJECTION (MOORE METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: MOD. PRONE - Modified prone position; 10X12 L - Sternum free of superimposition Tube positioned over the - 30” – 25°. – LVL T7 & from vertebral column patient’s right side; patient APPROX. 2” TO THE stand at the side of table; RIGHT OF SPINE – Perform on an ambulatory patient bend at the waist; Arms CENTER IR who is having acute pain to above shoulders; palms provide comfort & to produce down on table high-quality sternum image Shallow breathing tech. A 30-inch (76-cm) (SID) is recommended to blur the posterior ribs. LATERAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ LAT. RECUM./ - Lateral recumbent/upright 10X12 L - Best demonstrate the entire DORSAL DECUM. or dorsal decubitus (for - 72” – perp. – LAT. length of Sternum & its patient with severe injury); BORDER OF surrounding tissue Patient in true lateral MIDSTERNUM – position; Broad surface of CENTER IR A lateral projection the sternum and sternum ┴ to IR; the sternoclavicular region Suspend deep inspiration (This provides sharper contrast between the posterior surface of the sternum and the adjacent structures) FERN DIMACALI | 13 RADIOGRAPHIC POSITIONING B O N Y T H O R A X: ( S C A ) PA PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: PRONE/ UPRIGHT - Prone or upright (trauma 8X10/ 10X12 CW - Sternoclavicular joints patient); Arms along the - 40” – perp. – T3 – sides; Palms facing CENTER IR A PA projection demonstrates the upward; Head turned sternoclavicular joints and the facing the affected side medial for unilateral examination (rotates the spine slightly away from side of interest); Head rested on Suspend at the end of chin for bilateral Expiration examination PA OBLIQUE PROJECTION (BODY ROTATION METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: PRONE/ SEATED UPR. - Prone or seated-upright 8X10/ 10X12 CW - Sternoclavicular joints near the RAO/ LAO (trauma patient); - 40” – perp. – (SC JT. spine RAO/LAO; Body rotated CLOSEST TO IR) – 10-15° toward affected LVL. T2-T3 (3” RAO: side (projects vertebrae DISTAL TO Demo. I or Downside SC JT well behind the SC joint) VERTEBRAL PROMINENS) & 1-2” LAO: LAT FROM MSP – Demo. (L) SC JT. CENTER IR Suspend at the end of Expiration PA OBLIQUE PROJECTION (CENTRAL RAY ANGULATION METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: PRONE/ SEATED UPR. - Prone or seated-upright 8X10/ 10X12 CW - Sternoclavicular joints of (trauma patient); Chin - 40” – 15° TOWARDS interest directly in front of rested on table or rotated MSP – LVL. T2-T3 (3” vertebral column with minimal toward the side of interest DISTAL TO obliquity VERTEBRAL PROMINENS) & 1-2” LAT FROM MSP – CENTER IR Suspend at the end of Expiration AXIOLATERAL PROJECTION (KURZBAUER METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: LAT. RECUMBENT - Lateral recumbent (on the 8X10 L - Shows an unobstructed Axiolat. affected side); Fully - 40” – 15° CAUDAD– Projection of the extend the Arm of aff. SC JT. CLOSEST TO Sternoclavicular Articulation Side THE IR – CENTER IR (Closest to the IR) - Place the Pt’s other Arm along the side of the body Suspend at the end of Full Inspiration FERN DIMACALI | 14 RADIOGRAPHIC POSITIONING B O N Y T H O R A X: ( R I B S ) PA PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ PRONE - Upright/prone; Hands 14X17 L - Anterior ribs (1st-9th) above rested against hips; - 40” – perp. – T7 – the diaphragm Palms turned outward; CENTER IR Chin rested on chin 10-15° CAUDAD (Diaphragm BELOW affected RIB) (Demo. 7th-9th ribs) Suspend at Full Inspiration (Depresses Diaphragm) AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE Upright: 14X17 L - Posterior ribs above the - To image ribs above ABOVE DIAPHRAGM: diaphragm (1st-10th) & below the Diaphragm; IR top board (UPPER RIBS) diaphragm (8th-12th) 1.5” above shoulder; - 40” – perp. – T7 – Shoulder rotated forward CENTER IR Suspend at full inspiration (to depress diaphragm) BELOW DIAPHRAGM: Supine: (LOWER RIBS) - To image ribs below - 40” – perp. – XIPHOID diaphragm; Shoulder in PROCESS or T10 – the same transverse CENTER IR plane Suspend at full expiration (to elevate diaphragm) AXILLARY: AP OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - RPO/LPO; Body rotated 14X17 L - Axilliary ribs closest from IR RPO/ LPO 45° (affected side down); ABOVE DIAPHRAGM: Arm of affected side (UPPER RIBS) - Posterior-lateral injury – abducted; opposite hand - 40” – perp. – T7 – Posterior oblique positions, on hip CENTER IR affected side towards IR Upright: To image ribs above diaphragm; Hand BELOW DIAPHRAGM: AXILLARY PORTION rested on head (LOWER RIBS) RPO (RIGHT RIBS) Suspend at full inspiration - 40” – perp. – XIPHOID LPO (LEFT RIBS) (to depress diaphragm) PROCESS or T10 – CENTER IR Supine: To image ribs below diaphragm; Hip elevated Suspend at full expiration (to elevate diaphragm) AXILLARY: PA OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - RAO/LAO; Body rotated 14X17 L - Axilliary ribs away from IR RAO/ LAO 45° (affected side up) ABOVE DIAPHRAGM: (UPPER RIBS) - Anterior-lateral injury – Anterior Upright: above diaphragm; - 40” – perp. – T7 – oblique positions, affected side Forearm of affected side CENTER IR away from IR rested on grid device Suspend at full inspiration BELOW DIAPHRAGM: (to depress diaphragm) (LOWER RIBS) AXILLARY PORTION - 40” – perp. – XIPHOID LAO (RIGHT RIBS) Supine: below diaphragm; PROCESS or T10 – RAO (LEFT RIBS) patient rested on forearm; CENTER IR knee of elevated side flexed Suspend at full expiration (to elevate diaphragm) FERN DIMACALI | 15 RADIOGRAPHIC POSITIONING COSTAL JOINTS: AP AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Head rested 14X17 L - Costal joints directly on table (to avoid - 40” – 20° CEPHALAD accentuating the dorsal – 2” XIPHOID Costovertebral & kyphosis); Arms along PROCESS – CENTER Costotransverse joints sides of the body IR 5-10° Recommended for demonstration (Patient w/ pronounced of the costal joints in patients with dorsal kyphosis) rheumatoid spondylitis. End of Full Inspiration (Lung markings are less prominent at this phase of breathing) S P I N E: ( A T L A N T O – O C C I P I T A L ) AP OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE (R/L HEAD ROT.) - Supine; Head rotated 45- 8X10 CW - Atlanto-occipital joints b/n orbit 60° away from side of - 40” – perp. – 1” (A) TO & ramus of mandible interest; IOML ┴ to IR EAM – CENTER IR Dens is well demonstrated Alternative projection when a patient cannot be adjusted in Suspended Respiration the open-mouth position PA PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: PRONE - Prone; Forehead & Nose 8X10 CW - Atlanto-occipital joints on table; OML ┴ to IR - 40” – perp. – projected through the maxillary INFRAORBITAL sinuses MARGIN – CENTER IR Suspended Respiration S P I N E: ( D E N S – A T L A S (C1) & A X I S (C2) ) AP PROJECTION (FUCHS METHODS) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Chin extended; 8X10/ 10X12 CW - Dens w/in foramen magnums Chin tip & Mastoid tip ┴ to - 40” – perp. – DISTAL IR; MSP ┴ to IR TO CHIN TIP – Recommended when upper half of CENTER IR dens is not clearly shown in open- mouth position Suspended Respiration PA PROJECTION (JUDD METHODS) Pt. POS’N: PP: CRD: OBJECTIVES: PRONE - Prone; Neck extended; 8X10 CW - Dens and Atlas w/n foramen Chin against the table; IR - 40” – perp. – DISTAL magnum centered to throat (level of TO THE LVL. upper margin of thyroid MASTOID TIP – cartilage) CENTER IR - OML 37° to IR; MSP ┴ to IR; Chin & Mastoid ┴ Suspended Respiration AP AXIAL OBLIQUE PROJECTION (KASABACH METHODS) Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE (R/L HEAD ROT.) - Supine; Head rotated 40- 8X10 CW - Dens 45°; IOML ┴ - 40” – 10-15° – MIDWAY B/N OUTER Recommended in conjuction with CANTHUS & EAM – AP & lateral projections CENTER IR Suspended Respiration FERN DIMACALI | 16 RADIOGRAPHIC POSITIONING OPEN MOUTH: AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; MSP ┴; Occlusal 8X10/ 10X12 CW - Atlas & axis plane ┴ IR; open mouth - 30” – perp. – as wide as possible MIDPOINT OF OPEN MOUTH – CENTER IR Instruct the patient to keep the mouth wide open and A 30-inch SID may be to phonate “ah” softly used for this projection during the exposure (To increase the field of (To place tongue in the floor view of the odontoid of the mouth preventing area) SI and avoid movement of the mandible) Instruct the patient to keep the mouth wide open and to phonate “ah” softly during the exposure (To place tongue in the floor of the mouth preventing SI and avoid movement of the mandible) LATERAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE (R/L DORSAL - Supine (dorsal decubitus); 8X10/ 10X12 CW Atlas & axis; atlanto-occipital DECUB.) IR vertical; MSP // to IR; - 40” – perp. – 1” joints MSP ┴ to table; Neck DISTAL TO MASTOID slightly extended TIP – CENTER IR Pancoast, Pendergrass & (mandibular rami does not Schaeffer recommended Head overlap atlas or axis) Suspended Respiration rotated slightly (To prevent superimposition of laminae & atlas) FERN DIMACALI | 17 RADIOGRAPHIC POSITIONING CERVICAL VERTEBRAE AP AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ SUPINE - Supine/upright; Chin 8X10/ 10X12 L - C3-T2 extended; Occlusal Plane - 40” – 15-20° Interpediculate spaces ┴ to IR (prevents CEPHALAD – C4 – IV disk spaces superimposition of CENTER IR SI Transverse & Articular mandible & midcervical processes vertebrae) Used to demonstrate the presence or absence of cervical ribs Suspended Respiration LATERAL PROJECTION (GRANDY METHOD) Pt. POS’N: PP: CRD: OBJECTIVES: SEATED/ UPRIGHT (R/L) - Seated/upright; Patient in 8X10/ 10X12 L - C1-C7 true lateral position; - 60 or 70” – perp. – C4 Articular pillars Shoulder rotated (P) or (A) – CENTER IR Zygapophyseal joints (C3- (round shouldered); Chin C7) slightly elevated (prevents A 60- to 72-inch SID is Spinous processes superimposition of recommended because mandibular rami & spine); of the increased (OID) MSP // to IR (A longer distance helps show C7) Suspend Respiration at the End of full expiration (To obtain maximum depression of the shoulders) LATERAL PROJECTION: HYPERFLEXION & HYPEREXTENSION Pt. POS’N: PP: CRD: OBJECTIVES: SEATED/ UPRIGHT - Seated/upright; Patient in 10X12 L - IV disks & zygapophyseal joints true lateral position; - 60 or 70” – perp. – C4 MSP // to IR – CENTER IR HYPERFLEXION: C1-C7 Hyperflexion: Head drop A 60- to 72-inch SID is Elevated & widely separated forward; draw Chin as recommended because Spinous Processes close as possible to the of the increased (OID) chest HYPERFLEXION: (A longer distance helps C1-C7 Hyperextension: Chin show C7) Depressed Spinous elevated as much as Processes possible Suspended Respiration For functional studies (motility) of cervical vertebrae Demo. Normal AP Movement or Absence of Movement AP AXIAL OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE/ UPRIGHT - Supine or upright (more 8X10/ 10X12 L - Intervertebral foramina & RPO/ LPO comfortable); RPO/LPO; - 60 or 70” – 15-20° pedicles (farthest from IR) Body rotated 45°; Chin CEPHALAD. – C4 – protruded/elevated CENTER IR Barsony & Koppenstein: described this projection A 60- to 72-inch SID is recommended because of the increased (OID) Boylston Suggestion: Functional Studies in OBLIQUE PROJECTION Suspended Respiration (Demo. Fx of Articular process discoloration/ subluxation FERN DIMACALI | 18 RADIOGRAPHIC POSITIONING PA AXIAL OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: PRONE/ UPRIGHT - Prone or upright (more 8X10/ 10X12 L - Intervertebral foramina & RAO/LAO comfortable); RAO/LAO; - 60 or 70” – 15-20° pedicles (closest to IR) Body rotated 45°; CAUDAD. – C4 – Shoulder rested against CENTER IR IR; Chin protruded/elevated A 60- to 72-inch SID is recommended because of the increased (OID) Suspended Respiration AP PROJECTION (OTONELLO METHOD); WAGGING JAW TECHNIQUE Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; MSP ┴ to IR; 8X10/ 10X12 L - Entire cervical column Chin elevated; Upper - 40” – perp. – C4 – Incisors & Mastoid Tips ┴ CENTER IR To blurred the mandibular shadow to to IR; Mandible in chewing demonstrate all cervical vertebrae motion during exposure Suspended Respiration V E R T E B R A L A R C H ( P I L L A R S): LAT. MASS PROJ. CERVICAL & UPPER THORACIC VERTEBRAE AP AXIAL PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE - Supine; Shoulder 8X10/ 10X12 L - Vertebral arch structures depressed; MSP ┴ to IR; - 40” – 25° CAUDAD, Superior & inferior articular Neck hyperextende [20-30° CAUDAD] – C7 processes (pillars) – CENTER IR Zygapophyseal joints b/n articular processes PA AXIAL is possible Upper three of thoracic 8X10/ 10X12 L vertebrae - 40” – 40° CEPHALAD, Laminae [35-45° CEPHALAD] – Spinous processes C7 – CENTER IR (Vertebral arch Useful for demonstrating the structures) Cervicothoracic Spinous Processes in patients with Suspended Respiration whiplash injury AP AXIAL OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE (R/ L HEAD ROT.) - Supine; Head rotated 45- 8X10/ 10X12 L - Vertebral arch structures 50° (C2-C7 articular - 40” – 35° CAUDAD, processes) or 60-70° (C6- [30-40° CAUDAD] – C7 Used to demonstrate vertebral T4 articular processes) – CENTER IR arches when the Patient cannot - Turn Jaw away from side hyperextend head for AP/PA of interest axial projection Suspended Respiration PA AXIAL OBLIQUE PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: PRONE - Prone; Head rotated 45°; 8X10/ 10X12 L - Vertebral arch structures Flexed the patient’s Neck - 40” – 35° CEPHALAD, (for C2-C5); Extend the [30-40° CEPHALAD] – Neck moderately (for C6- C7 – CENTER IR T4) Suspended Respiration FERN DIMACALI | 19 RADIOGRAPHIC POSITIONING SWIMMER’S TECHNIQUE: LATERAL PROJECTION (TWINNING & PAWLOW M.) Pt. POS’N: PP: CRD: OBJECTIVES: UPRIGHT/ LAT. RECUMBENT - Humeral head moved 10X12 L - Cervicothoracic region (C7-T1) anteriorly or posteriorly; WELL DEPRESSED depress Shoulder away SHOULDER: Performed when shoulder from IR; MSP // to IR - 40” – perp. – C7-T1 superimposition obscures C7 on a INTERSPACE – lateral cervical spine projection Lateral recumbent CENTER IR (Pawlow): Head elevated on patient’s arm. CAN’T BE DEPRESSED Monda Recommendation: SUFFICIENTLY: CR 5-15° CEPHALAD Upright (Twinning): Arm - 40” – 3-5° – C7-T1 To better demonstrate IV disk closes to IR extended; INTERSPACE – spaces Elbow flexed; Forearm CENTER IR rested on head Suspend; or if patient can cooperate and can be immobilized, a breathing technique can be used (to blur the lung anatomy) THORACIC VERTEBRAE AP PROJECTION Pt. POS’N: PP: CRD: OBJECTIVES: SUPINE/ UPRIGHT - Supine/upright; MSP ┴ t