All technique sum-2006

1

f: TEC-SUM-2006 Reference: K L Bontrager (4th Ed.).

PROJECTION PART EXAMINED/BEST SHOWN POSITIONING C. P. C.R. DIRECTION

PA fingers (2nd – 4th), (Basic).

#s, dislocations, pathology: Osteoarthritis (OA), osteoporosis (OP), and opaque foreign bodies (FBs).

Pt. sits at end of couch, elbow flexed 90, hand pronated, fingers extended, sound fingers separated from affected ones.

Proximal I.P.J. 90 to film center.

PA index finger, (Basic).

#s, dislocations, pathology: OA, OP., and opaque foreign bodies (FBs).

Pt. sits at end of couch, elbow flexed 90, hand pronated, fingers extended, sound fingers separated from affected ones.

Proximal I.P.J. 90 to film center.

Lat index finger, (Basic).

#s, dislocations, pathology: OA, OP. Hand in lateral (thumb side up), index finger fully extended and centered to film supported by a radiolucent pad, sound fingers flexed.

Proximal I.P.J. of index. 90 to film center.

AP thumb, (Basic).

#s, dislocations, pathology: OA, OP., and opaque foreign bodies (FBs).

Pt. sits facing away from couch, hand extended backward and medially rotated, pt. leans forward to bring shoulder to table level. N.B./ PA thumb only done in case pt. cannot position for AP. It is not recommended because of the distortion caused by the increased O.F.D.

1st M.P.J. 90 to film center.

AP thumb (Robert’s method), (Special).

#s, dislocations, OA, OP, Foreign Bodies (FBs), and to rule out a Bennett’s # (at base of 1st MC).

Pt. sits parallel to end of couch, arm internally rotated till thumb’s back rests on film, fingers extended and held together with the other hand.

1st carpometacarpal joint (C.M.J).

90 to film center.

Lat thumb, (Basic).

#s, dislocations, Foreign Bodies (FBs), and to rule out a Bennett’s # (fracture at base of 1st MC).

Pt. sits parallel to end of couch, elbow flexed 90, hand pronated, thumb abducted, fingers slightly arched, hand then medially rotated so that thumb is in true lateral and supported by radiolucent pads.

1st M.P.J. 15 proximally toward the wrist joint.

PA hand, (Basic).

#s, dislocations, OA, OP, FBs, and for the assessment of bone age (PA left hand for wrist + elbow or shoulder)

Pt. sits at end of couch, elbow flexed 90, hand pronated, fingers spread. AP hand: Is a special position only done in case of trauma.

3rd M.P.J. (or head of the 3rd M.C.).

90 to film center.

Lat hand (extension), (Basic) and as alternative to ‘fan lateral’ .

For OA, OP, F.Bs., displacement of #s, dislocations, + localization of F.B.s. It is alternative position for the ‘fan lateral).

Pt. sits at end of couch, elbow flexed 90, hand rotated in true lateral (thumb up), fingers extended and supported on a step block (radiolucent block).

2nd M.P.J. (or head of the 2rd M.C.).

90 to film center.

Lat hand (fan lateral), (Basic).

For OA, F.Bs., displacement of fractures, and dislocations. It is a preferred lateral if phalanges are of interest.

Pt. sits at end of couch, elbow flexed 90, hand rotated into true lateral, fingers spread into ‘fan’ shape with each digit supported on the radiolucent block.

2nd M.P.J. (or head of the 2rd M.C.).

90 to film center.

Upper Limb Locomotor system

2


AP 45 Bilateral Oblique (Ball-catcher’s), (Special).

Best for rheumatoid arthritis (RA) at 2nd – 5th M.P.Js and at phalanges. Also for # base of 5th M.C.

Pt. sits at end of couch, hands extended and supinated, both

medial aspects at film center, hands then rotated internally 45 on radiolucent blocks, fingers separated, thumbs abducted.

Level of 5th M.P.Js , just between both hands

90 to film center.

PA wrist, (Basic).

#s of carpals, distal radius and ulna, dislocation, OA, OM. Intercarpal spaces not well shown. An AP wrist must be done as alternative.

Pt. sits at end of couch, elbow flexed 90, palm down and slightly arched to bring the wrist in contact with film.

Midcarpal area: Midway between radial and ulnar styloid processes.

90 to film center.

Lat (lateromedial) wrist, (Basic).

OA, OP, dislocations, distal radius and ulna fractures (anteriorly displaced Barton’s, Colles, and Smith) fractures.

Hand in lateral (thumb up) with ulnar and styloid processes superimposing each other, 5 degrees posterior rotation to superimpose styloid processes..

Midcarpal area: To radial styloid process.

90 to film center.

Oblique wrist, (Basic).

OA, OP, dislocations, distal radius and ulna fractures (anteriorly displaced Barton’s, Colles, and Smith) fractures.

Elbow flexed 90, palm laterally rotated 45 and supported with radiolucent pads.

Midcarpal area: To radial styloid process.

90 to film center.

PA scaphoid (ulnar deviation) (Special).

#s of the scaphoid. Arm partially abducted, forearm pronated (PA), hand deviated

toward ulna and well immobilized. CR range can be from 90 – 30 to show obscure fractures. N.B./ Radial deviation shows other 7 bones.

Scaphoid (2 cm distal to the radial styloid process).

90-10 proximally.

(10-30) is better to show obscure #s.

PAO wrist for scaphoid, (Special). #s of the scaphoid. Hand laterally rotated 45, hand supported with pad under thumb. To ulnar styloid process. 90 to film center.

Tangential inferosuperior wrist (Gaynor-Hart) method, (Special).

For the carpal tunnel carpal sulcus). Wrist/hand dorsiflexed (M.Cs 90 to forearm), wrist/hand then

rotated 10 toward radius.

Midcarpal area: The center of the palm.

25-30 inferosuperior to long axis of hand.

Tangential carpal bridge, (Special). For carpal bridge. Pt. leans over, wrist flexed with dorsum on film (palm up), hand and

forearm 90.

1.5 inch (4 cm) proximal to wrist joint.

45 to forearm.

AP forearm, (Basic).

#s, pathology. Forearm supinated and extended across couch, thumb touching the film for a true AP position.

Midshaft: Between the elbow/wrist joints.

90 to film center.

Lat forearm, (Basic). #s, pathology. Elbow flexed 90, hand in true lateral and supported by sand-bags. Midshaft: Between elbow and wrist joints.

90 to film center.

AP elbow joint (full extension), (Basic).

#s, dislocation, subluxation, pathology. Forearm supine (palm up), arm adjusted so that medial and lateral epicondyles are equidistant from couch.

Midelbow joint: 2.5 cm inferior to a line between epicondyles.

90 to film center.

AP elbow joint (partial flexion), (basic).

#s, dislocation, subluxation, pathology: OA, OM. If patient cannot fully extend the elbow, do the 45 equal angles (olecranon on film, with CP at elbow crease) , or do the two partial flexion views:

(a) With forearm parallel. (b) With humerus parallel.

Midelbow. 2.5 cm inferior to a line between epicondyles.

90 to the elbow joint.

3


AP elbow joint acute flexion (Jones method), (Special - trauma case).

#s, dislocation, and subluxation, pathology: OA, OM, proximal radioulnar joint, and evidence of a supracondylar fracture.

Elbow fully flexed, palm over shoulder, arm moved so that epicondyles are equidistant. Two projections done:

(a) CR 90 to humerus, with arm over shoulder.

(b) CR 90 to forearm, with arm over shoulder.

* For humerus: Midway between epicondyles (for distal humerus). * For forearm: 5 cm distal to olecranon process (for fractures and dislocations of proximal radius and ulna and evidence of supracondylar #).

90 to film center.

Lateral (lateromedial), (Basic).

#s, dislocation, subluxation, pathology (OA, OM) of radial head and neck.

Arm abducted, elbow flexed 90, palm 90 on film with shoulder at level with the film.

Midelbow joint (the Lateral epicondyle of humerus): 4 cm medial to posterior angle of olecranon process.

90 to film center.

Lateral elbow (head and neck of radius), (Special).

Small # of radial head. Elbow in true lateral, hand moved in various degrees of rotation to show various aspects of radial head rotation:

(a) Palm supine (external rotation). (b) Hand in lateral (thumb up). (c) Palm prone (internally rotated).

Radial head (2.5 cm to distal lateral epicondyle).

90 to film center.

Oblique proximal radioulnar joint (Basic).

#s, dislocation, subluxation, pathology. Humerus rotated from AP till interepicondylar line is 20 to film. 2.5 cm to midpoint between epicondyles.

90 to film center.

AP humerus (Basic).

#s, pathology. Patient erect or supine, body rotated so that affected arm is in contact with film, arm slightly abducted and fully extended and supinated, arm then adjusted so that epicondyles are equidistant (palm up), exposure during arrested respiration.

Midshaft. 90 to film center.

Lateromedial humerus (Basic).

#s, pathology. Pt. erect or supine, elbow flexed 90, arm abducted and medially

rotated, epicondyles must be 90 to film.


Mediolateral humerus (Basic).

#s, pathology. Pt. stands oblique (20-30), rotated from AP till lateral aspect of affected arm is in contact with film (humerus should be clear of

ribs), elbow flexed 90.


PTO/ ..

4


AP Shoulder and AP proximal humerus (external rotation) * , (Basic).

- AP proximal humerus + AP humeral head. - 2/3rd of clavicle. - Glenoid cavity.

Patient supine or erect, body rotated slightly toward affected side, extended arm abducted slightly, then externally rotated (hand supinated), epicondyles parallel to the film.

Mid Scapulohumeral head (2 cm inferior and slightly lateral to coracoid process).

90 V/H

AP Shoulder and lateral proximal humerus (internal rotation), (Basic).

- Lat. proximal humerus + AP humeral head. - 2/3rd of clavicle. - Glenoid cavity.

Patient supine or erect, body rotated slightly toward affected side, extended arm abducted slightly, then internally rotated (hand pronated), epicondyles parallel to the film.

Mid Scapulohumeral head (2 cm inferior and slightly lateral to coracoid process).

90 V/H

Inferosuperior axial shoulder, Lawrence method, (Special).

- Lat of humeral head and neck and proximal humerus. Also shows Hill-Sachs Defect with exaggerated limb rotation.

Patient supine, shoulder raised 5 cm on support, head rotated toward opposite side, film vertically close to the

neck, arm abducted 90 with palm up for external rotation.

Horizontally to axilla and humeral head.

25 - 30 medially.

APO Glenoid cavity, Grashey method, (Special).

- Glenoid cavity in profile. - Open scapulohumeral joint.

Patient erect or supine, body rotated 35 - 45 toward affected side.

Scapulohumeral joint (5 cm inferior, 5 cm medial to scapulohumeral border)

90 V/H

Tangential bicipital groove, Fisk method, (Special).

_ Humeral tubercles and intertubercular (bicipital) groove in profile.

Patient stands leaning over end of table (15 - 20 from vertical), elbow flexed, posterior surface of forearm rests on table, hand supine holding film, lead shield between back of film and forearm to reduce back scatter to film.

Groove at (mid anterior margin of humeral head).

90 V

Lateral shoulder (scapular Y), (PAO), (Basic)

- Proximal humerus over a lateral view of the scapula. - Humeral head relationship to glenoid cavity.

Patient erect or recumbent facing the film, rotated 45 -

60 into AO for a lateral scapula.

Scapulohumeral joint (5– 6 cm below the top of the shoulder)

90 V/H

Transthoracic lateral shoulder, Lawrence method, (Basic).

- Lat proximal humerus and scapulohumeral joint to rule-out fracture or dislocation of proximal humerus.

Patient in erect lateral or supine, film vertically by the table side, affected arm down close to film in neutral rotation, opposite arm raised and placed and placed over head.

Surgical neck through the thorax.

90 V/ H, (Breathing technique is recommended)

NB/ Above projections are for non-trauma. For trauma case, AP neutral (no) rotation should be applied to show frontal oblique view of proximal humerus, lateral 2/3rds of clavicles, Upper scapula, humeral head, and glenoid.

Shoulder Girdle

5


AP clavicle, (Basic)

- Clavicle and ACJs. - SCJs.

Patient erect or supine, arms at the sides, chin raised,

MSP: 90 MCP: Parallel

Midclavicle. 90 V/H

AP axial clavicle, (Basic).

- Clavicle, ACJs projected above scapula and ribs.

Patient erect or supine, arms at the sides, chin raised,

MSP: 90 MCP: Parallel

Midclavicle. 15 - 30 cephalad.

Bilateral ACJs, (Basic).

- Both ACJs spaces for comparison (with and without stress using 9 pounds* weight per limb).

Patient erect with posterior shoulders against film carrying equal weights on both hands, removing the weights in the next phase.

Midpoint between ACJs (2.5 cm above jugular notch), slender cone used

90 H

AP scapula, (Basic)

- AP of scapula. Patient supine or erect, posterior of shoulder in contact with film, top of film 5 cm above shoulder, arm abducted

90 with hand supinated (salutation).

Midscapula (5 cm inferior to coracoid process) or, to level of axilla.

90 V/H

Lateral scapula, (Basic).

Lat scapula clear of rib cage. Patient erect facing the film: (1) Required side arm moved across chest front and grasp opposite shoulder (for body scapula). (2) Affected arm dropped, elbow flexed with arm Behind lower back (for acromion and coracoid process).

Midscapula (5 cm inferior to coracoid process) or, to level of axilla.

90 V/H

10 – 15 pounds for larger adult patients.

PTO/ ..

Clavicle / Scapula

6


AP (dorsiplanter) toes, (Basic).

- Fractures, dislocation, pathology. - Shows phalanges of digits, metatarsals, and joints.

Pt. supine or sitting, knee flexed, planter aspect resting on film. MTPJ requested (head of the requested toe).

10-15 toward the calcaneus (heel).

Lat toes (Mediolateral/lateromedial), (Basic).

- Fractures, dislocation, pathology. - Phalanges of digits not superimposed.

Affected leg or foot rotated lateromedially (for 1st, 2nd, and 3rd toes) and mediolaterally for 4th and 5th toes). Laterals are done on dental films. Tape is used to flex and separate individual unaffected toes to prevent superimposition.

Big toe: I.P.J. (head of 1st toe). Others: Proximal I.P.J.

90 V.

AP (dorsiplanter) foot, (Basic).

- Fractures, dislocation, pathology. - Shows phalanges, metatarsals, cuneiforms, cuboid, and navicular.

Pt. supine, pillow for head, knee flexed, sole on film, sandbags used to prevent film slipping.

Base of 3rd M.T. 10 posteriorly toward calcaneus for average patient.

* ( 5 for low arch, 15

for high arch, 90 for F.B. or for a flat foot).

Lat foot (Mediolateral or lateromedial), (Basic).

- Fractures, dislocation, pathology. - Shows tarsals, ankle joint, subtalar joint, metatarsals, and phalanges. - Mediolateral is more comfortable to patient.

Pt. in lateral recumbent, foot dorsiflexed for a true lateral, support

under leg/knee so that sole is 90 to film.

Medial cuneiform (base of 3rd metatarsal).

90 V.

AP foot weight-bearing, (Special).

Pathology (to show the condition of arches under full-body weight).

Pt. stand erect, full weight evenly distributed on both feet, feet directed straight ahead.

Midpoint between feet (base of M.Ts.)

15 posteriorly between both feet.

Lat foot weight-bearing, (Special). Pathology (to show the condition of arches under full-body weigh)t.

Pt. stand erect, full weight evenly distributed on both feet, feet directed straight ahead.

Mid point between the feet (level of base of 3rd M.T.)

90 Horizontally to base of 3rd MT.

Axial plantodorsal calcaneus (heel), (Basic).

Axial view of calcaneus (os calcis). Pt. supine or sitting, foot dorsiflexed, sole 90, cotton ribbon around foot pulled by patient.

Base of 3rd M.T. (middle of planter side of foot).

40 cephalad from long axis of foot (or from the vertical).

Mediolateral calcaneus, (Basic). Profile (lateral view) of the calcaneus (heel), talus, and talocalcaneal joint.

Pt. in lateral recumbent with affected side down, knee flexed

45, opposite leg behind affected limb.

3.5 cm inferior to medial malleolus (to talocalcaneal jt)

90 V.

AP ankle, (Basic).

- Fractures, dislocation, subluxation, and pathology. Shows AP of ankle joint, distal tibia and fibula and proximal talus.

Pt. supine, legs fully extended, support under knees, ankle and foot adjusted for a true AP position.

Midway between malleoli. 90 V.

Lower Limb Locomotor system

7


Lateral ankle (Mediolateral or lateromedial), (Basic).

- Fractures, dislocation, subluxation, and pathology. Shows lateral of distal tibia and fibula, talus, calcaneus, and tarsals.

Pt. in lateral recumbent, affected knee flexed 45, opposite leg behind affected limb

Medial malleolus. 90 V.

AP leg (tibia and fibula), (Basic).

#s, pathology. See notes. Mid-shaft (between ankle and knees).

90 to the film center.

Lat leg (tibia and fibula), (Basic). #s, pathology. See notes. Mid-shaft. 90 to the film center.

AP knee joint, (Basic).

- Fractures, dislocation, subluxation, OA. - Shows distal femur, proximal tibia and fibula, knee and patella.

Pt. supine, leg fully extended and rotated 3 to 5 internally for a true AP position till intercondylar line is parallel to film.

2 cm below apex of patella. * Average thigh/buttocks:

90 to film center.

* Thin thigh: 5caudad.

* Thick thigh: 5 cephalad.

Lateral (mediolateral) knee, (Basic).

#s, dislocation, subluxation, OA. Bilateral view knees can rule out osteochondritis of tibial tuberosity

Pt. in lateral recumbent, affected side down, opposite limb behind

affected one, leg adjusted in true lateral, knee flexed 15-20.

2 cm distal to the medial epicondyle.

5 cephalad for tall patient. (7-

10 cephalad for short patient with wide pelvis).

AP bilateral knee (Weight-bearing), (Special).

Joint spaces shown for cartilage degeneration and other types of knee deformities (AP preferred).

Pt. erect standing on step stool, feet straight ahead, weight evenly distributed on both feet.

Midpoint between the knee joints (2 cm below apex of patellae).

90 Horiz for average

patient, 5-10 caudal on thin patients.

PA axial (tunnel view) knee (Camp-Coventry method). (Basic).

Intercondylar fossa in profile, and articular tibial facets.

Pt. prone with a lead shield over gonads, knee flexed 40-50, support under the ankle.

1 cm below apex of patella. 90 to lower leg.

PA patella, (Basic).

#s, dislocation, subluxation. Pt. prone, legs extended, small support under femur to reduce

pressure on the patella, knee then internally rotated 5 for a true lateral patella.

Midpatella area (to the skin crease behind the knee).

90 to the film center. NB/ Increase kV by 10 to 15 from AP knee.

Mediolateral patella, (Basic).

#s, dislocation, subluxation. Pt. in lateral recumbent, leg and knee in true lateral, knee flexed

5 or 10.

Distal aspect of the patello-femoral joint

90 V.

Tangential (sunrise or skyline view) (Settegast method), (Special).

Shows bilateral axial inferosuperior view of both patellae.

Pt. prone, film under knee, knee flexed to 90, patient holds a cotton tape to maintain position.

Midpatellofemoral joint. 15-20 tangentially to the joint.

AP femur, (Basic). #s, pathology. Pt. supine, leg rotated 10 – 15 internally for a true AP proximal femur, lower film margin 5 cm below knee.

Midshaft. 90 to the film center.

Lateral recumbent femur, (Basic).

#s, pathology. Pt. lie on affected side, knee flexed 45, femur to midline of couch, unaffected leg behind the affected one, film 5 cm below knee.

Midshaft. 90 to the film center.

Lateromedial (trauma) femur, (Basic).

#s, pathology. Support under affected leg, foot in true AP, vertical film against medial aspect of affected thigh including the knee, beam horizontal.

Midshaft (film vertical) 90 to the film center.

8


AP neck and upper airways: pharynx, larynx, and upper trachea, (Basic).

Air-filled trachea, larynx.

N.B./ Upper esophagus, the thyroid and thymus

glands can also show if opacified with a

contrast medium (barium sulphate is generally

used).

Pt. sits or stands erect, back of head and shoulders against film,

- MSP: 90 . - MML: Parallel.

- AML: 90 (chin raised) - Top of film 4 cm below EAM.

T1–T2 (2.5 cm above the jugular notch).

90 H. Exposure during the Valsalva maneuver.

Lat upper airways, (Basic).

Air-filled trachea, larynx, thyroid region.

N.B./ Upper esophagus, the thyroid and thymus

glands can also be shown if opacified with a

contrast medium (barium sulphate is generally

used).

- MSP: Parallel. Pt. sits or stands erect in right or left lateral, shoulders rotated posteriorly, arms hanging down clasping behind back, chin raised.

C6 or C7 (midway between laryngeal prominence and the thyroid cartilage). * Lower CP by 4 cm if the trachea is of interest.

90 H. - FFD: 180 cm. - Exposure during the Valsalva maneuver.


PA chest (ambulatory and stretcher patients), (Basic).

- Lungs and apices. - Air-filled trachea, bronchi. - Heart and great vessels (aorta, etc ..) - Diaphragm and bony thorax.

Patient erect, arms over lower back hips.

MSP: 90 MCP: Parallel (no rotation of thorax).

T7 (18 – 20 cm) below the vertebra prominens.

90 V/H. FFD: 180 cm.

Lateral chest (ambulatory and cart/wheelchair patients), (Basic).

- Lungs and apices. - Air-filled trachea, bronchi. - Heart and great vessels (aorta, etc ..) - Diaphragm and bony thorax.

Patient erect (left side against film).

MCP: 90 MSP: Parallel.

Mid-thorax through axilla (at level of T7), or 10 cm below jugular notch).

90 H. FFD: 180 cm.

Upper Airways The Neck Soft tissues

Chest The Lung fields

9


AP supine/semi-erect for bed-side and ward patients, (Special).

- Lungs and apices. - Air-filled trachea, bronchi. - Heart and great vessels (aorta, etc ..) - Diaphragm and bony thorax. * Mainly for pathology posterior to the heart when patient cannot stand erect.

Patient supine on stretcher or bed, then raised in a semi-erect position, shoulders rolled forward, cross-wise film behind patient, top of film 5 cm above shoulders.

MSP: 90

T7 (8 to 10 cm below the jugular notch).

+ (or -) 5 caudal to throw clavicles up. FFD: 150 – 180 cm.

Lateral decubitus (AP projection), (Special).

- Air-fluid levels in pleural space (a small pleura effusion). - Air in pleural cavity (pneumothorax).

Pt. lying on a radiolucent pad on his left or right side, both arms raised above head, back of patient against a vertical film, knees flexed slightly, thorax centered to a vertical film behind the patient.

MSP: 90

T7 (8 to 10 cm below the jugular notch).

90 H. FFD: 180 cm.

AP lordatic, (Special). N.B./ Apical view is dropped.

- Apices not superimposed by clavicular Shadows, calcifications/masses below the clavicles. - Interlobar effusions.

Pt. stands in AP 1 foot away from film, leans back with shoulders and neck against film, both hands resting on hips, palms out, shoulders rolled out, film 8 – 10 cm above shoulders.

MSP: 90

Mid-sternum ( 9 cm below jugular notch).

90 H (15 - 20 cephalad if patient is in a supine position.

LAO chest, (Special).

For right lung, trachea, bony thorax, heart and aorta.

Pt. erect, rotated 45 (60 for the heart) with left anterior shoulder against film, opposite arm raised over head, chin raised.

T7 (8 – 10 cm below vertebra prominens).

90 horizontally to the film center.

RAO chest, (Special).

For left lung, trachea, bony thorax, heart and aorta.

Pt. erect, rotated 45 with right anterior shoulder against film, opposite arm raised over head, chin raised.

* 60 LAO rotation best shows air-filled trachea, great vessels and heart.

* Less rotation (90 - 90) shows general pathology of Pulmonary fields.

T7 (8 – 10 cm below vertebra prominens).

90 H.

PTO/ ..

10


AP plain supine abdomen (K.U.B), (Basic).

For pathology: Diseases of liver, spleen,

kidneys, pelvis, lumber spine, and ribs,

abnormal masses. Also as a SCOUT film pre

to contrast studies.

Pt. supine, legs extended, support under knees, exposure at end of full expiration. For asthenic or hyposthenic (tall) patients two lengthwise films used: One centered lower to include symphysis pubis, other centered higher for upper abdomen and diaphragm.

MSP: 90 MCP: Parallel.

L4 (level of the iliac crests). 90 to the film center.

AP erect abdomen, (Special).

Liver, spleen, kidneys, masses.

- Mainly for air-fluid level, accumulation

of gas and free intra-abdominal air.

Pt. erect, top of film at level of the axilla.


3 - 5 cm above iliac crest. Top of film at the level of axilla.

90 H.

Lateral erect abdomen, (Special).

Calcified abdominal aorta, umbilical hernia,

fluid/air levels, and aneurysms

Pt. stands in true lateral. MSP: Parallel.

MCP: 90

5 cm above iliac crest. 90 H.

Lateral decubitus abdomen, (AP projection), (Special).

Liver, spleen, kidneys, masses, air and fluid

level, accumulation of gas and free

intraperitoneal air. Patient must be on his side

at least 5 minutes before exposure for

intraperitoneal free air to rise, or for abnormal

fluids to start to accumulate.

Pt. in lateral recumbent on radiolucent pad, patient’s back against a vertical film, knees partially flexed, arms near the head, top of film at level of axilla. It is done when the patient is too ill to stand for the erect.


5 cm above level of iliac crests to include diaphragm. Top of film at level of axilla.

90 H.

Dorsal decubitus abdomen, (Special).

Masses, accumulated gas, air-fluid levels,

aneurysms (widening of wall, artery, vein, or

heart), umbilical hernia, and calcification of

aorta or other vessels.

Pt. supine on radiolucent pad against a vertical film, diaphragm included. MSP: Parallel.

MCP: 90

5 cm above level of iliac crests. 90 H.

Acute-abdomen series, (Special).

Ileus, Ascites, perforated stomach or bowels,

intra-abdominal mass, and post-operative.

Positions to be done: (1) AP supine abdomen. (Basic). (2) AP erect abdomen. (Basic). (3) PA (or AP) erect chest. (Basic). (4) Left lateral decubitus abdomen (Special), if patient

cannot stand for erect abdomen.

Plain / acute abdomen

( K . U . B )

11


AP C1 – C2 (dens), (Open mouth), (Basic).

C1 and C2, and dens (the odontoid process). Pt. supine or erect, arms by the side, mouth opened so that a

line from lower margin of upper incisors to mastoid tips is 90 to film, secondary radiation grid used.

Center of open mouth. 90 to the film center.

PA Judd method for C1-C2 (dens), Reverse of Fuch method. (Special).

Shows the odontoid process (dens) and C1 – C2 through foramen magnum.

Pt. prone, chin resting on couch and extended so that: MSP:

90, MML: 90 to the film. This view produces less radiation dose to the thyroid.

Through mid-occipital bone (2.5 cm infero-posterior to mastoid tips).

90 parallel to MML.

AP Fuch method for C1-C2 (dens), (Special).

Better shows dens if not well shown by the open-mouth method.

Pt. supine, chin elevated so that:

MSP: 90,

MML: 90 approx. to the couch, CR parallel to MML.

To inferior tip of mandible. 90 parallel to MML.

AP axial (C3 – T3), (Basic).

C3 – T3 pathology. Pt. supine or erect, arms by the side, a line from the occlusal

plane to mastoid tips is 90 to film, film top 5 cm above level of EAMs.

C5 – C6 (level of the lower margin of thyroid cartilage).

15-20 cephalad

Lat cervical spine, (Basic).

Lateral cervical vertebral bodies and the inter-vertebral joint spaces + the spinous processes.

Pt. stands or sits erect in lateral, affected shoulder depressed (using equal weights)and against vertical film, top of film 3 – 5 cm above EAM, other shoulder forward and depressed, chin extended forward. Exposure at end of full arrested expiration for maximum shoulder depression.

C4 – C5 (level of the upper margin of thyroid cartilage).

90 H. FFD: 150-180 cm. No grid if the Air-gap technique is used.

Lat cervical (trauma case), (Basic). Lateral cervical vertebral bodies and the inter-vertebral joint spaces + the spinous processes.

Pt. supine on stretcher or table, film vertically supported against shoulder, top of film 3 – cm above EAM.

C4 – C5 (level of the upper margin of thyroid cartilage.

90 H. FFD 180 cm

Cervicothoracic lateral spine (Swimmer’s view, Twining method), (Basic).

C4 – T3 structures. Better shows C7 + T1 if not well shown on the lateral view of the cervical.

Pt. sits/stands erect, arm and shoulder nearest film raised up, elbow flexed, forearm rested on the head, body slightly anterior to push humeral head anterior to vertebrae. Exposure during quiet breathing at low mA and long time (3-4 seconds).

T1 (2.5 cm above level of jugular notch) or at level of vertebra prominens..

90 V/H.

Cervical Spine

12


Lateral cervical (Hyperflexion and hyperextension), (Special).

To rule out a whip-lash injury, and functional study (dynamics) of the vertebrae.

Pt. sits or stands erect in true lateral, arms at side, shoulders depressed using weights. Hyperflexion: Chin depressed till it touches the chest. Hyperextension: Chin raised and head leaned back as far as possible.

C4 – C5 (level of upper margin of thyroid cartilage, FFD 180 cm

90 H. FFD: 150-180 cm.


PAO sternum, (Basic).

Entire sternum. Pt. erect or semiprone and slightly oblique 15 to 20 toward the right side, right arm down by the side, left arm up, sternum centered to the film, top of film 4 cm above jugular notch.

Center of the sternum, midway between the xiphoid process and jugular notch).

90 V/H.

Lateral sternum, (Basic).

Entire sternum. Pt. sands or sits erect or recumbent in true lateral, arms drawn back, top of film 4 cm above jugular notch. * Recumbent requires a vertical film on the side of table.

Center of sternum (midway between the xiphoid process and the jugular notch).

90 V/H.


RA sternoclavicular joint (SCJ), (Basic).

PA of medial aspects of both clavicles and SCJs to rule-out possible joint separation or pathology.

Pt. prone, head turned to one side, arms up beside head. T2 – T3 (7 cm distal to the vertebra prominens).

90 V..

RAO, LAO SCJs, (Basic).

Oblique of SCJs away from the vertebrae. Pt. oblique 15 – 20, spinous process centered 5 cm lateral (toward upside) to film center.

T2 – T3 (7 cm distal to the vertebra prominens).

90 V..

The sternum

Sternoclavicular Jts . (SCJs)

13


AP posterior ribs (above diaphragm), (Basic)

Posterior ribs above diaphragm. Patient in AP erect.


Level of T7 ( 8 – 10 cm below jugular notch), as for the chest.

90 H.

AP posterior ribs (below diaphragm), (Basic)

Posterior ribs below diaphragm. Patient in AP supine.


Midway between xiphoid process and lower rib cage.

90 V. Exposure at end of an inspiration (for above diaphragm) and end of expiration (for the below diaphragm).

PA anterior ribs (above diaphragm), (Basic)

Anterior ribs above diaphragm. Patient erect (or prone) in PA.


T7 (18 – 20) cm below the vertebra prominens, as for the chest.

90 V/H. Exposure at end of an inspiration (for above diaphragm) and end of expiration (for the below diaphragm).

AO/PO axillary ribs (above/below), (Basic).

Axillary margin of ribs on side of interest. Patient erect (above diaphragm) or supine (for below the

diaphragm). Patient rotated 45 APO or PAO. AO: Injured side away from film. PO: Injured side close to film.

Above diaphragm: T7 Below diaphragm: Midway between xiphoid process and rib cage.

90 V/H. Exposure at end of an inspiration (for above diaphragm) and end of expiration (for the below diaphragm).

PTO/ ..

The Ribs

14


AP thoracic (dorsal) spine, (Basic)

AP thoracic (dorsal) vertebral bodies, spinous and transverse processes, the intervertebral bodies, posterior ribs.

Pt. supine with head under anode side, arms at side, knees and hip flexed.

MSP: 90

T7 (8 – 10 cm below jugular notch – as in the chest), or 3 – 5 cm below the sternal angle.

90 V. Exposure at end of expiration.

Lateral thoracic (dorsal) spine, (Basic)

Lateral thoracic (dorsal) vertebral bodies, spinous and transverse processes, posterior ribs and intervertebral bodies.

Pt. in lat recumbent, arms raised 90 to body, elbows flexed, support under waist, hips/knees flexed with support under knees. Exposure at end of arrested expiration, or breathing technique to blur out rib and lung markings. Lead blocker behind patient’s back to stop scatter radiation from reaching the film. MSP: Parallel.

T7 (8 – 10 cm below jugular notch – as in the chest), or 3 – 5 cm below the sternal angle.

90 V. Exposure at end of normal quiet breathing (breathing technique).


AP lumbar spine, (Basic)

AP Lumbar vertebral ) vertebral bodies, spinous and transverse processes, posterior ribs and intervertebral bodies.

Pt. supine with head under anode side, arms on the chest, knees and hip flexed.

MSP: 90

* For 34x35 cm film: L4 – L5 (level of iliac crest). * For 24X30 cm film: L3 (at lower costal margin).

90 V/H. Exposure at end of expiration.

Lateral lumbar spine, (Basic)

Lateral lumbar vertebral ) vertebral bodies, spinous and transverse processes, posterior ribs and intervertebral bodies.

Pt. in lateral recumbent, knees and hips flexed, support under knees and ankles, radiolucent support under waist, pelvis in true AP position (no rotation). Lead blocker behind patient’s back to stop scatter radiation from reaching the film. MSP: Parallel.

* For 34x35 cm film: L4 – L5 (level of iliac crest). * For 24X30 cm film: L3 (at lower costal margin).

90 V.

* Breathing technique for lateral spine is commonly adopted: Low mA at long exposure times ( 3 – 4 seconds).

Thoracic Spine

Lumbar spine/ sacrum

15


AP axial lumbosacral articulation (L5 – S1), (Special)

L5 – S1 joint space and sacroiliac joints pathology. Pt. supine, legs extended, support under knees, arms on the chest.

Level of ASIS. Males: 30 cephalad.

Fem. : 35 cephalad.

Lat lumbosacral articulation (L5 – S1), (Basic)

- L5 – S1 joint space. - To rule out spondylolisthesis involving the (L4 – L5), or (L5 – S1) articulations.

Pt. in lateral recumbent, both knees and hips flexed, support under knees and ankles. Lead blocker behind patient’s back to stop scatter radiation from reaching the film.

4 cm below the iliac crest, 4 cm anterior to the posterior surface of the body.

* Waist supported:

90 V. * No support:

8 caudal.

AP axial sacrum, (Basic)

- Sacrum, S.I.Js, L5 – S1 joint. The urinary bladder should be fully emptied before this examination. Also bowel preparation using a cleansing enema.

Pt. supine, legs extended, support under knees. Midway between ASIS and symphysis pubis.

15-20 cephalad.

Lat sacrum, (Basic)

- Sacrum in profile. - L5 - S1.

Pt. in lateral recumbent, knees and hips flexed, support under waist and between knees and ankles.

5 cm anterior to the posterior surface of sacrum at level of ASIS.

90 V.

AP axial coccyx, (Basic).

#s, pathology. The urinary bladder should be emptied before this examination. Also bowel preparation using a cleansing enema.

Pt. supine, legs extended, support under knees. 5 cm above symphysis pubis. 10 caudad.

Lateral coccyx, (Basic).

#s, pathology. The urinary bladder should be emptied before this examination. Also bowel preparation using a cleansing enema.

Patient in lat recumbent. 3 cm distal to level of ASIS, 5 cm anterior to posterior surface of sacrum and coccyx.

90 V.

PTO/ ..

16


AP bilateral hips, (Basic).

- AP Pelvic girdle: fractures, dislocation, subluxation. pathology. - L5, sacrum, coccyx, femoral heads, and necks are shown.

Pt. supine, arms over chest, support under the knees, pelvis not rotated, legs and feet separated then internally rotated 15 – 20, top of feet tightened together with a tape.

Midway between ASIS and symphysis pubis (5 cm superior to the symphysis pubis or 5 cm inferior to ASIS).

90 V.

AP bilateral (frog-leg), (Basic).

AP femoral heads and necks to rule-out congenital hip dislocation (CHD).

Pt. supine, arms over chest, pelvis not rotated, both hips and

knees flexed (soles together), both femurs abducted 40 –

45 from vertical.

2.5 cm superior to symphysis pubis. 90 V.

Unilateral mediolateral (frog-leg), (Special).

Lateral femoral neck and acetabulum for non-trauma situations.

Pt. supine, affected hip and knee flexed, femur abducted 40

– 45 from vertical.

Mid-femoral neck (2.5 cm medial to ASIS, or 2.5cm above symphysis pubis).

90 V.

AP unilateral hip joint, (Basic).

Post-operative (or follow-up) to show AP acetabulum, femoral head and neck and condition of an orthopedic device.

Pt. supine, arms across the chest, affected leg rotated 15 -

20 internally.

Mid-femoral neck (2.5 cm medial to ASIS, or 2.5 cm above symphysis pubis).

90 V.

Axilateral inferosuperior hip (Miller method)- trauma case, (Basic).

Lateral femoral neck and acetabulum for a trauma hip situation.

Pt. supine, pelvis elevated 5 cm by supports, sound limb flexed and elevated so thigh is near vertical position and outside the x-ray field, film placed n crease above iliac crest,

leg of affected side internally rotated 15 - 20 unless a fracture is eminent.

Femoral neck. 90 V.

AP axial sacroiliac joints, (SIJs), (Special).

- Subluxation, pathology. - Sacroiliac joints, L5 – S1, sacrum, and coccyx are shown.

Pt. supine, legs extended, support under knee. Midway between SIS and the symphysis pubis.

Males: 30 cephalad.

Fem. : 35 cephalad.

LPO, RPO sacroiliac joints, (SIJs), (Special).

- Subluxation, pathology. - Sacroiliac joint farthest from film is shown. Both sides done for comparison.

Pt. supine, turned 25 – 30 posterior oblique (side of interest up).

N.B./ * LPO: Shows the right SIJ.

* RPO: Shows the left SIJ.

2.5 cm medial to the upside ASIS.

90 V.

The pelvis, S. I . Js

All technique sum-2006

Health & Medicine

Transcript of All technique sum-2006