Merrillâ€™s Pocket Guide to Radiography

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The Following Abbreviations Are Used Throughout the Pocket Guide

Abbreviation Definition Abbreviation DefinitionAC Acromioclavicular MCP Metacarpophalangeal

AML Acanthomeatal line MTP Metatarsophalangeal

AP Anteroposterior OID Object–to–image-receptor distance

ASIS Anterior superior iliac spine(s) OML Orbitomeatal line

C Cervical spine PA Posteroanterior

cm Centimeters PIP Proximal interphalangeal

EAM External acoustic meatus RAO Right anterior oblique

in Inches RPO Right posterior oblique

IOML Infraorbitomeatal line RUQ Right upper quadrant

kVp Kilovolt (peak) S Sacrum

L Lumbar spine SID Source–to–image-receptor distance

LAO Left anterior oblique T Thoracic spine

LPO Left posterior oblique TMJ Temporomandibular joint










M E R R I L L ’ S

Pocket Guide to RadioGRaPhy










M E R R I L L ’ S

Pocket Guide

to RadioGRaPhyFourteenth Edition










MERRILL’S POCKET GUIDE TO RADIOGRAPHY ISBN: 978-0-323-59703-6

Copyright © 2019 Elsevier, Inc. All rights reserved.Previous editions copyrighted 2016, 2012, 2007, 2003, 1999 and 1995.

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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

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Notices

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verifi cation of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

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vIntroduction

Merrill’s Pocket Guide to Radiography concisely pres-ents essential positioning information for the most frequently requested projections in a format designed for quick reference. This edition offers step-by-step explana-tions of methods to position the patient and body part for more than 150 of the most commonly requested radiog-raphy projections, including mobile.

Its format makes the Pocket Guide particularly easy to use, with each projection presented in a broadside, two-page spread. Each projection presentation includes the following information:• Patient position• Part position• Central ray angulation• Collimation• kVp• Photograph of properly positioned patient

• Footnote that references information in the 14th edition of Merrill’s Atlas

• Exposure technique chart with space for writing manual and automatic exposure control (AEC) technical factors (a sample of this chart with instructions for completion may be found on the next page after the contents)

• Competency check-off for students—blank lines are present on each projection page for the instructor to sign and date after the student has demonstrated com-petency for that projection

• Specific collimation sizing for use with DR systemsFeatures designed to enhance the utility of the Pocket

Guide include section dividers with tabs, which make finding the beginning of each section easier, and abbre-viations and external landmarks printed on the inside of the covers for quick reference.










Part ThicknessA given technique always depends on the thickness of the body part.

mASet an mA that enables use of the small focal spot whenever possible.

kVpThe kVp should be set to penetrate the body part, ensure optimum image quality at the lowest dose.

TimeTime always varies with part thickness and respiration considerations.

CR, DR Exposure IndicatorIndicate the exposure index, S number, or REX number.

HF, 1Ø, or 3ØAlways indicate the generator phase. A 3Ø 12p requires 50% less mAs than a 1Ø 2p. A 1Ø 2p requires 50% more mAs than a 3Ø 12p.*

Manual FactorsPart

Thickness (cm) mA kVp Time mAs SID

ImageReceptor

Size

CR, DR Exposure Indicator Grid

HF 1 , or 3

21 200 80 0.30 60 40 14 17 400 12:1 3 12p

How to Use the Technical Factors Chart










DetectorsShade in the detector or detectors used for the body part.

AEC FactorsPart

Thickness (cm) mA kVp

AEC Detector

Density Comp. SID IR Size


HF 1Ø or 3Ø

21 200 80 0 48 14 17 400 12:1 3 12p

Density CompensationIndicate if a 1 or 2 or a 1 or

2 compensation is required for the exposure.

Example of the way technical factors would be entered for an AP projection of the pelvis in two different rooms. One room uses AEC, and the other uses manual technical factors.

*See imaging textbooks for other 1Ø and 3Ø variables.

Digital IndicatorThe exposure index for the system in use and projection should be entered here.

ix










This page intentionally left blank










Upper Extremity

Second Through Fifth Digits:PA, 2Lateral, 4PA oblique (lateral rotation), 6

First Digit (Thumb):AP, 8Lateral, 10PA oblique, 12

Hand:PA, 14PA oblique (lateral rotation), 16Lateral, 18

Wrist:PA, 20Lateral, 22PA oblique (lateral rotation), 24PA: ulnar deviation, 26PA axial; STECHER METHOD, 28

Carpal Canal:Tangential; GAYNOR-HART

METHOD, 30Forearm:

AP, 32Lateral, 34

Elbow:AP, 36Lateral, 38AP oblique (medial rotation), 40AP oblique (lateral rotation), 42AP partial flexion, 44

Humerus:AP, 46Lateral, 48

Proximal Humerus/Shoulder:Transthoracic lateral; LAWRENCE

METHOD, 50

Shoulder:AP, 52

Shoulder Joint:AP oblique; GRASHEY METHOD, 54

Shoulder:Inferosuperior axial; LAWRENCE

METHOD, 56Scapular Y: PA oblique, 58

Acromioclavicular Articulations:AP; PEARSON METHOD, 60

Clavicle:AP, 62AP axial, 64

Scapula:AP, 66Lateral, 68










Patient Position•Seatpatientatendofradiographictable.

Part Position•Placeextendeddigitofinterestwithpalmarsurfaceofhanddown

ontheIR.•Separatedigitsslightly,andcenterthedigitunderexaminationtothe

centeroftheIR.•Shieldgonads.

Central Ray•Perpendicular,enteringPIPjointofdigitbeingexamined

Collimation:1inch(2.5cm)allsidesofdigit,including1inch(2.5cm)proximaltoMCPjoint.Placesidemarkerinthecollimatedexposurefield.

Second Through Fifth DigitsPA

kVp: 63 Reference: 14th edition ATLAS p. 1:154.

5 3










Upper Extremity3

Part Thickness

(cm) mA kVp Time mAs SID

Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors

Notes: _________________________________________________________________________ Competency: _________/____/____

_______________________________________________________________________________ Instructor: ___________________











Part Position•Demonstratepositionforpatient.Askpatienttoextenddigit

ofinterestandtocloserestofdigitsintoafist.•AdjustdigitofinterestparalleltoIRplane.•Restdigitonlateralormedialsurfaceasneededtoobtain

smallestpossibleOID.•Immobilizeextendeddigit.(Usecottonswabortape.)•Shieldgonads.

Central Ray•Perpendicular,enteringPIPjoint

Collimation:1inch(2.5cm)allsidesofdigit,including1inch(2.5cm)proximaltoMCPjoint.Placesidemarkerinthecollimatedexposurefield.

Second Through Fifth DigitsLateral











Upper Extremity5


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Placepatient’shandinlateralposition,ulnarsidedownandcentered

toIRarea.•Rotatepalm45degreestowardIRuntildigitsarerestingonsponge

support.•Immobilizeseparateddigits.•Shieldgonads.

Central Ray•Perpendicular,enteringPIPjoint

Collimation:1inch(2.5cm)onallsidesofdigit,including1inch(2.5cm)proxi-maltoMCPjoint.Placesidemarkerinthecollimatedexposurefield.

Second Through Fifth DigitsPA oblique (lateral rotation)

3











Upper Extremity7


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Placeaffectedhandinextremeinternalrotation,withfirstdigitcen-

teredtoIRarea.•AdjustpositionofhandtoensuretrueAPprojectionoffirstdigit.•Extendandsecuredigitstwothroughfivetoeliminatesuperimposi-

tionoverfirstdigit.•Shieldgonads.

Central ray•Perpendicular,enteringMCPjointoffirstdigit

Collimation:1inch(2.5cm)onallsidesofdigit,including1inch(2.5cm)proxi-maltoCMCjoint.Placesidemarkerinthecollimatedexposurefield.

First Digit (Thumb)AP











Upper Extremity9


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•HavepatientrestpalmarsurfaceofhandonIR.•Adjustarchingofhanduntiltruelateralpositionoffirstdigitis

achieved.•Shieldgonads.

Central Ray•Perpendicular,enteringMCPjointoffirstdigit


First Digit (Thumb)Lateral











Upper Extremity11


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Abductfirstdigit.•PlacepalmarsurfaceofhandfirmlyagainstIR,andadjustfirstdigit

toobliqueposition.•Shieldgonads.

Central Ray•Perpendicular,enteringMCPjointoffirstdigit


First Digit (Thumb)PA oblique











Upper Extremity13


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•RestforearmontablewithpalmarsurfaceofhandagainstIR.•Spreaddigitsslightly.•Shieldgonads.

Central Ray•PerpendiculartothirdMCPjoint

Collimation:1inch(2.5cm)allsidesofhandincluding1inch(2.5cm)proximaltoulnarstyloid.Placesidemarkerinthecollimatedexposurefield.

HandPA











Upper Extremity15


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•RestforearmontablewithpalmarsurfaceofhandagainstIR.•Rotatehandlaterally(externally),andplacedigitson45-degree

radiolucentsupporttoshowinterphalangealjoints.AdjustdigitsparallelwithIR.

•Whenmetacarpalsareareaofprimaryinterest,rotatehandlaterallysothatfingertipstouchIR.

•Shieldgonads.

Central Ray•PerpendiculartothirdMCPjoint

Collimation:1inch(2.5cm)onallsidesofhandincluding1inch(2.5cm)proximaltoulnarstyloid.Placesidemarkerinthecollimatedexposurefield.

HandPA oblique (lateral rotation)











Upper Extremity17


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•Restulnarsurfaceofforearmontablewithhandintruelateral

position.•Extenddigitswithfirstdigit(thumb)placedatrightanglestopalm

ofhand.Asanoption,havepatient“fan”fingersandplaceonposi-tioningspongetoreducesuperimpositionofphalanges(asillus-trated).

•CenterMCPjointstoIR,andadjustpalmarsurfaceofhandperpen-diculartoIR.

•Shieldgonads.

Central Ray•PerpendiculartosecondMCPjoint

Collimation:1inch(2.5cm)onallsidesofshadowofhandandthumb,including1inch(2.5cm)proximaltoulnarstyloid.Placesidemarkerinthecollimatedexposurefield.


HandLateral










Upper Extremity19


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Seatpatientatendoftablewithaxillaincontactwithtable.

Part Position•Havepatientrestforearmontable.•CenterwristtoIRarea.•FlexdigitsslightlytoplacewristincontactwithIR.•Shieldgonads.

Central Ray•Perpendiculartomidcarpalarea

Collimation:2.5inches(6cm)proximalanddistaltowristjointand1inch(2.5cm)onthesides.Placesidemarkerinthecollimatedexposurefield.

WristPA











Upper Extremity21


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•Flexelbow90degrees,withforearmandarmincontactwithtable.•CentercarpalstoIR,andadjusthandsothatwristisintruelateral

position.•Shieldgonads.

Central Ray•Perpendiculartowristjoint

Collimation:2.5inches(6cm)proximalanddistaltowristjointand1inch(2.5cm)onpalmaranddorsalsurfaces.Placesidemarkerinthecollimatedexposurefield.

WristLateral











Upper Extremity23


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•RestanteriorsurfaceofwristonIR.•CenterwristtoIRarea.•Rotatewristapproximately45degreeslaterally(externally)and

supportonsponge.•Shieldgonads.

Central Ray•PerpendiculartoIR,enteringmidcarpalareajustdistaltoradius

Collimation:2.5inches(6cm)proximalanddistaltowristjointand1inch(2.5cm)onsides.Placesidemarkerinthecollimatedexposurefield.

WristPA oblique (lateral rotation)











Upper Extremity25


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•Flexelbow90degrees,withforearmandarmincontactwithtable.•CenterwristtoIRarea.•Withoutmovingtheforearm,turnthehandoutwarduntilwristisin

extremeulnardeviation.•Shieldgonads.

Central Ray•PerpendiculartoscaphoidNOTE:Ifnecessarytodelineatefracture,anglecentralray10to15degreesproximally(towardelbow)ordistally.

Collimation:2.5inches(6cm)proximalanddistaltowristjointand1inch(2.5cm)onsides.Placesidemarkerinthecollimatedexposurefield.

WristPA: ulnar deviation











Upper Extremity27


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Seatpatientwitharmandaxillaincontactwithtable.

Part Position•PlaceoneendofIRonasupport,andadjustsothatfingerendis

elevated20degrees.•AdjustthewristforaPAprojection,andcenterwristtoIR.•Shieldgonads.

Central Ray•Perpendiculartotable,andpositiontoenterscaphoid

Collimation:2½inches(6cm)proximalanddistaltowristjointand1inch(2.5cm)onsides.Placesidemarkerinthecollimatedexposurefield.

WristPA axial STECHER METHOD

20°











Upper Extremity29


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Seatpatientwithforearmparallelwithlongaxisoftable.

Part Position•Hyperextendwrist,andcenterittocenterofIR.•Place¾-inchradiolucentpadunderlowerforearmforsupport,

ifneeded.•Adjusthandpositiontomakelongaxisofhandasverticalas

possible.•Havepatientgraspdigitswithoppositehandtoholdinextended

position,orpullwithaband(asshown).•Shieldgonads.

Central Ray•Directtopalmofhand1inch(2.5cm)distaltobaseofthird

metacarpalat25-to30-degreeangle

Collimation:1inch(2.5cm)onthethreesidesofshadowofwrist.Placesidemarkerinthecollimatedexposurefield.


Carpal CanalTangential GAYNOR-HART METHOD 25°–30°










Upper Extremity31


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Seatpatientatendoftablewitharmextendedandentireextremity

insameplane.

Part Position•Supinatehand,andcenterforearmtoIRtoincludejointorjointsof

interest.•AdjustrotationtoplacehumeralepicondylesequidistantfromIR.•Shieldgonads.

Central Ray•Perpendiculartomidpointofforearm

Collimation:2inches(5cm)distaltowristjointandproximaltoelbowjoint,and1inch(2.5cm)onsides.Placesidemarkerinthecollimatedexposurefield.

ForearmAP











Upper Extremity33


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Seatpatientatendoftablewithhumerusandforearmincontact

withtable.

Part Position•Havepatientflexelbow,andpositionentireextremityinsameplane.•Flexelbow90degrees,andadjusthandtolateralposition(thumb

up).•CenterforearmtoIRtoincludejointorjointsofinterest.•Shieldgonads.

Central Ray•Perpendiculartomidpointofforearm

Collimation:2inches(5cm)distaltowristjointandproximaltoelbowjoint,and1inch(2.5cm)onsides.Placesidemarkerinthecollimatedexposurefield.

ForearmLateral











Upper Extremity35


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











insameplane.

Part Position•Extendelbow,supinatehand,andcenterelbowjointtoIR.•AdjusthumeralepicondylestobeequidistantfromIR.•Havepatientleanslightlylaterallyifnecessarytoensure

APalignment.•Shieldgonads.

Central Ray•Perpendiculartoelbowjoint

Collimation:3inches(8cm)proximalanddistaltoelbowjointand1inch(2.5cm)onsides.Placesidemarkerinthecollimatedexposurefield.

ElbowAP











Upper Extremity37


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Seatpatientatendoftablewithelbowflexed90degrees.

Part Position•Havepatientresthumerusandforearmontable,andpositionentire

extremityinsameplane.•Center90-degreeflexedelbowjointtoIR,andadjustwristandhand

inlateralposition.•AdjusthumeralepicondylesperpendiculartoIR.•Shieldgonads.

Central Ray•Perpendiculartoelbowjoint

Collimation:3inches(8cm)proximalanddistaltoelbowjoint.Placesidemarkerinthecollimatedexposurefield.

ElbowLateral











Upper Extremity39

Manual Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











insameplane.

Part Position•Extendelbow,supinatehand,andcenterelbowjointtoIR.•Rotatearmmedially.•Adjustanteriorsurfaceofelbow(epicondyles)to45degreestoIR.•Shieldgonads.

Central Ray•PerpendiculartoIR,enteringelbowjoint


ElbowAP oblique (medial rotation)











Upper Extremity41


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











insameplane.

Part Position•Extendelbow,supinatehand,andcenterelbowjointtoIR.•Rotatearmlaterally.•Adjustanteriorsurfaceofelbow(epicondyles)to45degreestoIR.•Shieldgonads.

Central Ray•PerpendiculartoIR,enteringelbowjoint


ElbowAP oblique (lateral rotation)











Upper Extremity43


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Seatpatientatendoftablewithhumerusrestingontableforone

imageandforearmrestingontablefortheotherimage.

Part PositionDistal humerus:•Placehumerusontable,andsupporttheelevatedforearm.•Supportforearm.•Supinatehandifpossible.•PlaceIRunderelbowandcentertocondyloidareaofthehumerus.

Proximal forearm:•Placedorsalsurfaceofforearmontable.•PlaceIRunderelbowandcenterapproximately1inchdistalto

humeralepicondyles.•Shieldgonads.

Central Ray•DirectperpendiculartoIR,enteringappropriateportionofelbowjoint


kVp: 70 Reference: 14th edition ATLAS pp. 1:200-201.

ElbowAP partial flexion










Upper Extremity45


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientuprightorsupine.

Part Position•Unlesscontraindicated,supinatehand.•AdjusthumeruswithepicondylesparallelwithIR.•Ifpatientisrecumbent,elevateandsupportoppositeshoulder,if

needed.•CenterhumerustoIR.•Shieldgonads.

Respiration:•Obtainradiographduringsuspendedrespiration.

Central Ray•Perpendiculartomidpointofhumerus

Collimation:2inches(5cm)distaltoelbowjointandsuperiortoshoulderand1inch(2.5cm)onsides.Placesidemarkerinthecollimatedexposurefield.

kVp: 70 (non-grid) 75 (grid) Reference: 14th edition ATLAS p. 1:211.

HumerusAP










Upper Extremity47


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•Unlesscontraindicated,slightlyabductarm.•CenterarmtoIR.•MediallyrotatearmuntilepicondylesareperpendiculartoIR.•Shieldgonads.

Respiration:•Suspend.

Central Ray•Perpendiculartomidpointofhumerus

Collimation:2inches(5cm)distaltoelbowjointandsuperiortoshoulderand1inch(2.5cm)onsides.Placesidemarkerinthecollimatedexposurefield.

HumerusLateral

R

kVp: 70 (non-grid) 75 (grid) Reference: 14th edition ATLAS p. 1:214.










Upper Extremity49


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness

(cm) mA kVpAEC

Detector mAsDensity Comp.

Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•Raiseuninjuredarm,andrestitonorbesidehead.•Elevateuninjuredshoulderasmuchaspossible.•Adjustpatienttoprojecthumerusbetweenvertebralcolumnand

sternum.•Unlesscontraindicated,adjusthumeralepicondylesperpendiculartoIR.


Central Ray•Perpendiculartomidcoronalplane,exitingsurgicalneckofaffected

humerus.Ifpatientcannotelevateunaffectedshoulder,anglecentralray10to15degreescephalad.

Collimation:Adjustto10312inches(24330cm).Placesidemarkerinthecol-limatedexposurefield.


Proximal Humerus/ShoulderTransthoracic lateral LAWRENCE METHOD










Upper Extremity51

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•Centerapoint1inch(2.5cm)inferiortocoracoidprocesstoIR.•Adjusthandin(1)externalrotation:humeralepicondylesparallel

toIR,(2)neutralrotation:epicondylesabout45degreestoIR,or(3)internalrotation:epicondylesperpendiculartoIR,dependingondepartmentprotocol.

•Shieldgonads.


Central Ray•Directperpendiculartopoint1inch(2.5cm)inferiortocoracoid

process

Collimation:Adjustto10312inches(24330cm).Placesidemarkerinthecollimatedexposurefield.

COMPENSATING FILTER•Shoulderfiltergreatlyimprovesimagequality.


ShoulderAP










Upper Extremity53

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientuprightorrecumbent.

Part Position•CenterIRtoscapulohumeraljoint.Thejointis2inches(5cm)me-

dialand2inches(5cm)inferiortosuperolateralborderofshoulder.•Rotatebody35to45degreestowardaffectedside.(Note:Greater

rotationmaybeneededtoplaceplaneofscapularbodyparalleltoIRifpatientisrecumbent.)

•Abductarmslightlywithpalmofhandonabdomen.•Shieldgonads.


Central Ray•PerpendiculartoIR

Collimation:Adjustto8310inches(24330cm).Placesidemarkerinthecolli-matedexposurefield.


Shoulder JointAP oblique GRASHEY METHOD










Upper Extremity55

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupinewithhead,affectedshoulder,andelbow

elevated3inches(8cm).

Part Position•Abductaffectedarm90degreesfrombody,ifpossible.•Keeparminexternalrotation,andsupportonpilloworsandbags.•PlaceverticallyorientedIRaboveshoulderasclosetoneckaspossible.•Turnpatient’sheadawayfromsidebeingexamined.•Shieldgonads.


Central Ray•Horizontallythroughaxillatoexitregionofacromioclavicularjoint.

Direct15to30degreesmedially.

Collimation:Adjust12inches(30cm)inlengthand1inch(2.5cm)aboveanteriorshadowofshoulder.Placesidemarkerinthecollimatedexposurefield.


ShoulderInferosuperior axial LAWRENCE METHOD










Upper Extremity57

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientuprightorprone.Uprightpositionispreferredwhen

shoulderistender.

Part Position•CenteranteriorsurfaceofaffectedshouldertoIR.•Palpatescapularborders,androtatepatientsothatmidcoronalplane

forms45-to60-degreeanglefromIR.(Note:PlaneofscapularbodywillbeperpendiculartoIR.)

•Shieldgonads.


Central Ray•Perpendiculartoshoulderjointatlevelofscapulohumeraljoint

Collimation:Adjustto12inches(30cm)inlengthand1inch(2.5cm)tolateralshadow.Placesidemarkerinthecollimatedexposurefield.

COMPENSATING FILTER•Shoulderfiltergreatlyimprovesradiographicquality.


Shoulder (Scapular Y)PA oblique










Upper Extremity59

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientuprightifconditionpermits.

Part Position•AdjustmidpointofIRtolevelofacromioclavicular(AC)joints.•CentermidsagittalplaneofbodytomidlineofIRifbothACjoints

canbeshownononeradiograph.Otherwise,centertoeachindivid-ualACjointfortwoseparateexposures.

•ToshowACseparation,attachsandbagsofequalweight(5–10lb)toeachwristandalsoobtainasecondradiographwithoutweightsforcomparison.


Central Ray•PerpendiculartoIRmidwaybetweenACjoints(foroneexposure)

orperpendiculartoeachACjoint(fortwoexposures)

Collimation:Adjustto6317inches(15343cm)forsingleexposureor3.533.5inches(939cm)fortwoexposures.Placesidemarkerinthecol-limatedexposurefield.


Acromioclavicular ArticulationsAP PEARSON METHOD










Upper Extremity61

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•CenterclavicletocenterofIR,midwaybetweenmidlineofbody

andlateralborderofshoulder.•Turnpatient’sheadawayfromaffectedside.•Shieldgonads.


Central Ray•PerpendiculartomidshaftofclavicleNOTE:Ifnecessarytodecreasepart-IRdistanceandtoimproverecordeddetail,obtainPAclavicle.Placepatientfacinggridusingperpendicularcentralray,andpositionusingabove-mentionedlandmarks.



ClavicleAP










Upper Extremity63

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











Part Position•CenterclavicletolowerthirdofIR,midwaybetweenmidsagittal

planeandlateralborderofshoulder.•Turnpatient’sheadawayfromaffectedsideifnecessary.•Shieldgonads.


Central Ray•Angled15to30degreescephaladcenteredtomidshaftofclavicleNOTE:Ifnecessarytodecreasepart-IRdistanceandtoimprovere-cordeddetail,obtainPAaxialclavicle.Placepatientfacinggridusing15to20degreescaudalcentralrayangulation.

Collimation:Adjustto8312inches(18330cm).Placesidemarkerinthecolli-matedexposurefield.


ClavicleAP axial










Upper Extremity65

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupineorupright.Uprightpositionispreferred

whenshoulderistender.

Part Position•Abductarmtoarightangletobody,flexelbow,andsupporthand.•CenterpalpatedscapularareatoIRapproximately2inches(5cm)

inferiortocoracoidprocess.•Shieldgonads.

Respiration:•Slowbreathing.

Central Ray•PerpendiculartoIRatmid-scapularareaapproximately2inches

(5cm)inferiortocoracoidprocess



ScapulaAP










Upper Extremity67

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientproneorupright.Uprightpositionispreferredwhen

shoulderistender.Part Position•Placepatientinobliqueposition45to60degrees,andcenteraf-

fectedscapulatoIR.•Extendaffectedarmacrossanteriororposteriorthoraxorabove

headtoshowappropriateportionofscapula.•Palpatemedialandlateralbordersofscapula,andadjustbodyrota-

tionsothatscapulaislateralandisprojectedfreeofribcage.•Shieldgonads.Respiration:•Suspend.Central Ray•PerpendiculartoIR,andpositiontomedialborderofprotrudingscapulaCollimation:Adjustto12inches(30cm)inlengthand1inch(2.5cm)tolateralshadow.Placesidemarkerinthecollimatedexposurefield.

COMPENSATING FILTER•Shoulderfiltergreatlyimprovesradiographicquality.


ScapulaLateral










Upper Extremity69

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Lower Extremity

Toes:AP or AP axial, 72AP oblique (medial rotation), 74Lateral, 76

Foot:AP or AP axial, 78AP oblique (medial rotation), 80Lateral (mediolateral), 82

Calcaneus:Axial (plantar dorsal), 84Lateral, 86

Ankle:AP, 88Lateral (mediolateral), 90AP oblique (medial rotation), 92

Ankle (Mortise Joint):AP oblique (medial rotation), 94AP stress studies, 96

Leg:AP, 98Lateral, 100

Knee:AP, 102AP weight-bearing, 104Lateral, 106AP oblique (lateral rotation), 108AP oblique (medial rotation), 110

Intercondylar Fossa:PA axial; HOLMBLAD METHOD, 112PA axial; CAMP-COVENTRY

METHOD, 114Patella:

PA, 116Lateral (mediolateral), 118Tangential; SETTEGAST

METHOD, 120

Femur:AP, 122Lateral, 124

Femoral Necks:AP oblique; MODIFIED CLEAVES

METHOD, 126Hip:

AP, 128Lateral; LAUENSTEIN AND HICKEY

METHODS, 130Axiolateral; DANELIUS-MILLER

METHOD, 132Pelvis and Upper Femora:

AP, 134










Patient Position•Positionpatientsupineorseatedontable,kneesflexedwithfeet

separated.

Part Position•CentertoeswithplantarsurfaceflatagainstIR.•Shieldgonads.

Central Ray•Angle15degreesposteriorlytoshowjointspaces.•PositionsothatcentralrayentersthirdMTPjoint.•Useperpendicularcentralraywhenjointspacesarenotcrucial.

Collimation:1inch(2.5cm)onallsidesoftoesincluding1inch(2.5cm)proximaltoMTPjoint.Placesidemarkerinthecollimatedexposurefield.

COMPENSATING FILTER•Imagecanbeimprovedsignificantlywithuseoffilter.

ToesAP or AP axial











Lower Extremity73


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











separated.

Part Position•CentertoesoverIRarea,andmediallyrotatelegandfootuntil

30-to45-degreeangleisformedfromIRtoplantarsurfaceoffoot.•Shieldgonads.

Central Ray•Perpendicular,enteringthirdMTPjoint

Collimation:1inch(2.5cm)onallsidesoftoesincluding1inch(2.5cm)proximaltoMTPjoint.Placesidemarkerinthecollimatedexposurefield.

ToesAP oblique (medial rotation)











Lower Extremity75

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Positionpatientonunaffectedside(forgreatandsecondtoes)

oraffectedside(forthirdthroughfifthtoes).

Part Position•AdjustfoottoplaceaffectedtoeparalleltoIRandintruelateral

position.•Usegauze,tape,orotherpositioningaidtoseparatetoes.•Shieldgonads.

Central Ray•PerpendiculartoIPjointofgreattoeorPIPjointofsecondthorough

fifthtoes

Collimation:1inch(2.5cm)onallsidesoftoeincluding1inch(2.5cm)proximaltojoint.Placesidemarkerinthecollimatedexposurefield.

ToesLateral











Lower Extremity77

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Manual Factors











separated.

Part Position•PlaceplantarsurfaceoffootincenterofIR,andadjustmidlineof

footparalleltolongaxisofIR.•Shieldgonads.

Central Ray•Angle10degreestowardtheheel(posteriorly),enteringbaseof

thirdmetatarsal.•Directperpendicularly,ifdictatedbydepartmentprotocol.

Collimation:1inch(2.5cm)onsidesand1inch(2.5cm)beyondthecalcaneusanddistaltipoftoes.Placesidemarkerinthecollimatedexposurefield.



FootAP or AP axial

10°










Lower Extremity79

Manual Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø











separated.

Part Position•CenterfoottoIR.•Rotatelegmediallyuntilplantarsurfaceoffootformsangleof

30degreestoIR.•Shieldgonads.

Central Ray•Perpendiculartobaseofthirdmetatarsal

Collimation:1inch(2.5cm)onsidesand1inch(2.5cm)beyondthecalcaneusanddistaltipoftoes.Placesidemarkerinthecollimatedexposurefield.

FootAP oblique (medial rotation)











Lower Extremity81


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientonaffectedside.

Part Position•CenterfoottoIRandadjustplantarsurfaceperpendiculartoIR.•Adjustlegandfootinlateralpositionwithpatellaperpendicular

totable.•Dorsiflexfoottoform90-degreeanglewithlowerleg.•Shieldgonads.

Central Ray•PerpendiculartomidpointofIR,enteringlevelofbaseofthird

metatarsal

Collimation:1inch(2.5cm)onallsidesofshadowoffoot,including1inch(2.5cm)abovemedialmalleolus.Placesidemarkerinthecollimatedexposurefield.

FootLateral (mediolateral)











Lower Extremity83

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Positionpatientsupineorseatedwithlegfullyextended.

Part Position•CenterIRtoankle.•Havepatientdorsiflexfoottoplaceplantarsurfaceperpendicularto

IR.•Shieldgonads.

Central Ray•Angle40degreescephaladtolongaxisoffootsothatcentralray

entersplantarsurfaceoffootatbaseofthirdmetatarsal.

Collimation:1inch(2.5cm)onthreesidesofshadowofcalcaneus.Placesidemarkerinthecollimatedexposurefield.


CalcaneusAxial (plantodorsal)

40°











Lower Extremity85

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Manual Factors











Part Position•CentercalcaneustocenterofIR.•Adjustlegandfootinlateralpositionwithpatellaperpendicularto

table.

Central Ray•Perpendiculartomidportionofcalcaneus,about1inch(2.5cm)

distaltomedialmalleolus.

Collimation:1inch(2.5cm)pastposteriorandinferiorshadowofheel;includemedialmalleolusandbaseoffifthmetatarsal.Placesidemarkerinthecollimatedexposurefield.

CalcaneusLateral











Lower Extremity87

Manual Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupineorseatedontablewithaffectedlegextended.

Part Position•CenterankletoIR.•AdjustanklejointinanatomicpositiontoobtaintrueAPprojection.•Havepatientflexfoot,andadjustanklewithtoespointingvertically.

Central Ray•Perpendiculartoanklejoint,enteringmidwaybetweenmalleoli.

Collimation:1inch(2.5cm)onsidesofankleand8inches(18cm)lengthwise,includingheel.Placesidemarkerinthecollimatedexposurefield.

AnkleAP











Lower Extremity89

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Positionpatientsupine,thenrollontoaffectedside.

Part Position•CenterankletoIR.•Dorsiflexankleto90-degreeangle,andadjustfootinlateral

position.

Central Ray•Perpendiculartoanklejoint,enteringmedialmalleolus.

Collimation:1inch(2.5cm)onsidesofankleand8inches(18cm)lengthwise,includingheelandfifthmetacarpalbase.Placesidemarkerinthecollimatedexposurefield.

AnkleLateral (mediolateral)











Lower Extremity91

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Positionpatientsupineorseatedontable.

Part Position•CenterankletoIR.•Dorsiflexfoot,placingankleatnearright-angleflexion.•Internallyrotateentirelegandfoottogetheruntil45-degreerotation

isachieved.



NOTE:Obtainlateralrotationobliquebyrotatinglegandfoot45degreeslaterally,asdescribedin14theditionATLASp.1:xxx.

AnkleAP oblique (medial rotation)











Lower Extremity93

Manual Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupineorseatedontable.

Part Position•CenterankletoIR.•Dorsiflexfoot,placingankleatnearright-angleflexion.•Mediallyrotateentirelegandfoottogether15to20degreesuntil

intermalleolarplaneisparalleltoIR.

Central Ray•Perpendicular,enteringanklejointmidwaybetweenmalleoli.


Ankle (Mortise Joint)AP oblique (medial rotation)











Lower Extremity95

Manual Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupineorseatedontablewithsmallsupportunder

knee.

Part Position•CenterankletoIR.•PositionankleforAPprojection.•Stressjointbyplacingitinpositionofextremeinversionor

eversion,thenimmobilizingit.



AnkleAP stress studies

Moderate inversion stress using tape; lead glove recommended for increased stress.











Lower Extremity97

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Positionpatientsupinewithlegextended.

Part Position•CenterlegtoIR,andadjustlegsothatfemoralcondylesareparallel

toIRandfootisvertical;flexankleto90degrees.•Includebothjoints.

Central Ray•Perpendiculartomidpointofleg.

Collimation:1inch(2.5cm)onsidesand1.5inches(3.8cm)beyondtheankleandkneejoints.Placesidemarkerinthecollimatedexposurefield.

LegAP

kVp: 70 (non-grid), 80 (grid) Reference: 14th edition ATLAS p. 1:336.










Lower Extremity99

Manual Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupineonaffectedside.

Part Position•CenterlegtoIR.•Adjustlegtolateralposition(patellaperpendicular).•Includebothjoints.

Central Ray•Perpendiculartomidpointofleg.

Collimation:1inch(2.5cm)onsidesand1.5inches(3.8cm)beyondtheankleandkneejoints.Placesidemarkerinthecollimatedexposurefield.

LegLateral











Lower Extremity101

Manual Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupinewithlegextended.•Adjustpatient’sbodysothatpelvisisnotrotated.

Part Position•CenterkneetoIRatlevel½inch(1.3cm)belowpatellarapex.•AdjustlegsothatfemoralcondylesareparalleltoIR.

Central Ray•Enterspoint½inch(1.3cm)inferiortopatellarapex.•DependingonASIS-to-tabletopmeasurement,directcentralrayas

follows:

,19cm 3to5degreescaudad(thinpelvis)19to24cm 0degrees.24cm 3to5degreescephalad(largepelvis)

Collimation:Adjustto8310inches(18324cm).Adjustto1inch(2.5cm)beyondthesides.Placesidemarkerinthecollimatedexposurefield.


KneeAP










Lower Extremity103


_______________________________________________________________________________ Instructor: ___________________

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientuprightfacingx-raytubewithweightequally

distributedonfeet.

Part Position•AdjustcenterofIR½ inch(1.3cm)belowlevelofpatellarapices.•Havepatientpointtoesstraightaheadandslightlyseparateknees.

Central Ray•HorizontalandperpendiculartoIR,enteringmidwaybetweenknees

atlevel½inch(1.3cm)belowpatellarapices.


KneeAP weight-bearing











Lower Extremity105

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Positionpatientrecumbentonaffectedside.

Part Position•Havepatientflexknee20to30degrees,andcenterIRtokneejoint,

justbelowpatellarapex.•PositionpatellaperpendiculartoIR.

Central Ray•Angle5to7degreescephalad,enteringkneejoint1inch(2.5cm)

distaltomedialepicondyle.

Collimation:Adjustto8310inch(18324cm).Adjustto1inch(2.5cm)anteriortothepatellaand1inch(2.5cm)beyondtheposteriorshadow.Placesidemarkerinthecollimatedexposurefield.

KneeLateral 5°–7°











Lower Extremity107

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupinewithaffectedkneeextended.

Part Position•Rotateaffectedextremitylaterallyuntil45-degreerotationis

achieved.•CenterkneetoIRatlevel½inch(1.3cm)belowapexofpatella.

Central Ray•Direct½inch(1.3cm)inferiortopatellarapex.•Anglevariesasfollows,dependingonASIS-to-tabletop

measurement:

,19cm 3to5degrees(caudad)19to24cm 0degrees.24cm 3to5degrees(cephalad)

Collimation:Adjustto8310inch(18324cm).Adjustto1inch(2.5cm)beyondthesides.Placesidemarkerinthecollimatedexposurefield.


KneeAP oblique (lateral rotation)










Lower Extremity109

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupinewithaffectedkneeextended.

Part Position•Rotateextremitymediallyuntil45-degreerotationisachieved.•CenterkneetoIRatlevel½inch(1.3cm)belowapexofpatella.

Central Ray•Direct½inch(1.3cm)inferiortopatellarapex.•Anglevariesasfollows,dependingonASIS-to-tabletop

measurement:

,19cm 3to5degrees(caudad)19to24cm 0degrees.24cm 3to5degrees(cephalad)

Collimation:Adjustto8310inch(18324cm)onthecollimator.Adjustto1inch(2.5cm)beyondthesides.Placesidemarkerinthecollimatedexposurefield.


KneeAP oblique (medial rotation)










Lower Extremity111

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Havepatientkneelonradiographictablewithaffectedkneein

contactwithIR.

Part Position•CenterkneetoIRbyplacingatlevelofpatellarapex.•Flexknee70degreesfromfullextension.

Central Ray•Perpendiculartolongaxisoflowerleg,enteringmidpointofIR.


Intercondylar FossaPA axial HOLMBLAD METHOD*

kVp: 70� *See ATLAS for alternate body positions.� Reference: 14th edition ATLAS p. 1:352.










Lower Extremity113

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientpronewithhipsequidistantfromtable.

Part Position•Flexaffectedknee40to50degrees,andrestonsuitablesupport.•Adjustlegsothatnomedialorlateralrotationoccurs.

Central Ray•Perpendiculartolongaxisofleg,enteringkneejointatpopliteal

depression(withcentralrayangled40to50degreesfromvertical).


Intercondylar FossaPA axial CAMP-COVENTRY METHOD 40°











Lower Extremity115

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientpronewithkneeextended.

Part Position•CenterpatellaandadjustlegtobeparalleltoIRplane.•Heelistypicallyrotated5to10degreeslaterally.

Central Ray•Perpendicular,enteringmidpoplitealarea.


PatellaPA

kVp: 85 (grid) Reference: 14th edition ATLAS p. 1:357.










Lower Extremity117

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Manual Factors











Part Position•Adjustaffectedkneetobeflexed5to10degrees.•CenterIRtopatella.•AdjustbodyrotationsothatpatellaisperpendiculartoIR.

Central Ray•PerpendiculartoIR,enteringkneeatmidpatellofemoraljoint.•Collimatetopatella.


PatellaLateral (mediolateral)











Lower Extremity119

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Positionpatientpronewithfootrestingontable.

Part Position•Havepatientflexaffectedkneeslowlyuntilpatellaisperpendicular

toIR,ifconditionpermits.•Adjustlegsothatnorotationoccurs,andimmobilize.

Central Ray•Perpendiculartojointspacebetweenpatellaandfemurifpatella

isperpendicular.•Ifpatellaisnotperpendicular,angulationdependsondegreeof

flexionofknee,usually15to20degrees.


PatellaTangential SETTEGAST METHOD 15°–20°











Lower Extremity121

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupinewithtoesup.•AdjustpelvistoplaceASISequidistantfromtable.

Part Position•Centeraffectedfemurtomidlineofgrid.•ImagedistalfemurbyplacingbottomofIR2inches(5cm)below

kneejoint.•Rotateextremityinternallytoplaceitintrueanatomicposition.•Applygonadshielding.

Central Ray•PerpendiculartomidfemurandcenterofIR.

Collimation:1inch(2.5cm)onsidesofshadowofthighand17inches(43cm)inlength.Placesidemarkerinthecollimatedexposurefield.

FemurAP*

kVp: 85 *See ATLAS p. 1:364 for proximal femur instructions. Reference: 14th edition ATLAS p. 1:364.










Lower Extremity123

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•Positionpatientonaffectedside,withkneeflexedabout45degrees.

Part Position•Centeraffectedfemurtomidlineofgrid.•Imagedistalfemurbydrawinguppermostextremityforwardand

supportingitathiplevel.•Adjustfemursothatepicondylesareperpendiculartotabletop.•PlacebottomofIR2inches(5cm)belowkneejoint.•Applygonadshielding.

Central Ray•Perpendiculartomidfemur.

Collimation:1inch(2.5cm)onsidesofshadowofthighand17inches(43cm)inlength.Placesidemarkerinthecollimatedexposurefield.

FemurLateral*

kVp: 85 *See ATLAS p. 1:366 for proximal femur instructions. Reference: 14th edition ATLAS p. 1:366.










Lower Extremity125

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupine.

Part Position•Adjustpelvissothatnorotationoccurs.•Havepatientflexhipsandknees.•Abductthighstoapproximately45degreesfromvertical;brace

solesoffeettogether.•Shieldgonads.

Respiration:Suspend.

Central Ray•Perpendicular,enteringmidlineapproximately1inch(2.5cm)

superiortosymphysispubis.•Perpendiculartofemoralneckforunilateral.

Collimation:Adjustto14317inches(35343cm).Forsmallerpatients,collimate1inch(2.5cm)beyondtheskinshadowonthesides.Placesidemarkerinthecollimatedexposurefield.NOTE: Adaptforunilateralexaminationbyflexingandabductingaffectedextremity.kVp: 85 Reference: 14th edition ATLAS p. 1:394.

Proximal Femora and Femoral NecksAP oblique MODIFIED CLEAVES METHOD










Lower Extremity127

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientsupine.•AdjustASISequidistantfromtable.

Part Position•Rotateaffectedextremity15to20degreesmedially;centerhipto

IR.•Shieldgonads.


Central Ray•Perpendiculartopoint2½ inches(6cm)distalonlinedrawnperpen-

diculartomidpointoflinebetweenASISandpubicsymphysis.


HipAP











Lower Extremity129

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Startwithpatientsupine,andturnpatientslightlytowardaffected

sidetoposteriorobliquebodyposition.

Part Position•Flexaffectedkneeandhipandrestontable;centeraffectedhipto

midlineofgrid.•Havepatientextendunaffectedknee.•Shieldgonads.


Central Ray•PerpendiculartohipatpointmidwaybetweenASISandpubic

symphysisforLauensteinmethodandatcephalicangleof20to25degreesforHickeymethod.



HipLateral LAUENSTEIN AND HICKEY METHODS










Lower Extremity131

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientsupinewithlevelofgreatertrochanterelevatedto

centerofIR.

Part Position•Havepatientflexkneeandhipofunaffectedside.•Elevatepatient’sfoot,andrestonsuitablesupport.•Adjustpelvissothatnorotationoccurs.•Rotateaffectedlegmedially15to20degreesunlesscontraindicated.


Central Ray•PerpendiculartolongaxisoffemoralneckandIR.


COMPENSATING FILTER•Imageisimprovedandcanbeperformedwithoneprojectioniffilter

isused.


HipAxiolateral DANELIUS-MILLER METHOD










Lower Extremity133

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Centermidsagittalplanetogrid;adjustsothatASISareequidistant

fromtable.•Rotatefeetandlowerextremitiesmedially15to20degreesunless

contraindicated.•CenterIRapproximately2inches(5cm)superiortopubicsymphy-

sisand2inches(5cm)inferiortoASIS.•Usegonadshieldingasappropriate.


Central Ray•PerpendiculartomidpointofIR.

Collimation:Adjustto14317inches(35343cm).Forsmallerpatients,colli-mate1inch(2.5cm)beyondtheskinshadowonthesides.Placesidemarkerinthecollimatedexposurefield.


Pelvis and Proximal FemoraAP










Lower Extremity135

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


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Size


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Atlas and Axis:AP (open mouth), 138

Dens:AP; FUCHS METHOD, 140

Cervical Vertebrae:AP axial, 142Lateral; GRANDY METHOD, 144Flexion and extension lateral,

146AP axial oblique (RPO and LPO),

148PA axial oblique (RAO and LAO),

150Trauma lateral (dorsal decubitus),

152Trauma AP axial oblique, 154

Cervicothoracic Region:Lateral; SWIMMER’S TECHNIQUE,

156Thoracic Vertebrae:

AP, 158Lateral, 160

Lumbar-Lumbosacral Vertebrae:AP, 162Lateral, 164

L5-S1 Lumbosacral Junction:Lateral, 166

Lumbar Zygapophyseal Joints:AP oblique (RPO and LPO), 168

Lumbosacral Junction and Sacroiliac Joints:

AP axial; FERGUSON METHOD, 170

Sacroiliac Joints:AP oblique (RPO and LPO), 172

Sacrum:AP axial, 174Lateral, 176

Coccyx:AP axial, 178Lateral, 180

Thoracolumbar Spine: ScoliosisAP, PA, or lateral; FERGUSON

METHOD, 182

Vertebral Column











Part Position•Centermidsagittalplanetomidlineoftable,armsatsides,shoulders

insameplane.•CenterIRatlevelofaxis.•Openmouthwide;adjustheadsothatlinefromloweredgeofupper

incisorstomastoidprocessisperpendiculartoIR.•Shieldgonads.

Respiration:Havepatientphonate“ah”duringexposure.

Central Ray•PerpendiculartocenterofIR,enteringopenmouth.


Atlas and AxisAP (open mouth)











Vertebral Column139

Manual Factors

Part Thickness

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Image Receptor

Size


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AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


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Part Position•AdjustheadsothatmidsagittalplaneisperpendiculartoIR.•Extendchinuntilalinebetweenchinandtipofmastoidprocessis

perpendiculartoIR.•CenterIRtoleveloftipsofmastoidprocess.•Shieldgonads.


Central Ray•PerpendiculartocenterofIR,enteringmidsagittalplanejustdistal

totipofchin.


DensAP FUCHS METHOD











Vertebral Column141

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Manual Factors











Part Position•CentermidsagittalplanetoIR.•Havepatientplacearmsatsides.•CenterIRatlevelofC4,andadjustalinebetweenupperocclusal

planeandmastoidtipperpendiculartoIR.•Shieldgonads.


Central Ray•Angle15to20degreescephalad,enteringslightlyinferiortothyroid

cartilageandexitingC4.

Collimation:Adjust10inches(24cm)lengthwiseand1inch(2.5cm)beyondskinshadowonsides.Placesidemarkerinthecollimatedexposurefield.

Cervical VertebraeAP axial

15�-20�











Vertebral Column143

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientseatedorstandinginlateralposition.

Part Position•CentercoronalplanethroughmastoidprocessestoIR.•Adjustshoulderstosamehorizontallevelandbodytotruelateral

position.•Havepatientelevatechinslightlyandrelaxshoulders.Ifnecessary,

attachweightstowriststohelplowershoulders.•Shieldgonads.


Central Ray•HorizontalandperpendiculartoIR,enteringC4.•SIDof72inches(180cm)isrecommended.


Cervical VertebraeLateral GRANDY METHOD











Vertebral Column145

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Cervical VertebraeFlexion and extension lateral

Patient Position•Positionpatientseatedorstandinginlateralposition.

Part Position•CenterspinetoIR.•KeepmidsagittalplaneofheadandneckparalleltoplaneofIRand

askpatienttodothefollowing:(1)Dropheadforwardanddrawchinascloseaspossibletochesttoplacecervicalvertebraeinfullflexion—expose—and(2)elevatechinasmuchaspossibletoplacecervicalvertebraeinfullextension.

•Shieldgonads.


Central Ray•HorizontalandperpendiculartoIR,enteringC4.•SIDof72inches(180cm)isrecommended.












Vertebral Column147

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Cervical VertebraeAP axial oblique (RPO and LPO)

15�-20�

Patient Position•Positionpatientseatedorstanding.

Part Position•Rotatebodyto45degrees,withsideofinterestfartherfromIR.•Havepatientextendchinslightlywhilelookingforward.•CenterspinetoIR.•CenterIRtoC3.•Shieldgonads.•Takebothobliqueprojections.


Central Ray•Angle15to20degreescephalad,enteringC4.•SIDof60to72inches(152to183cm)isrecommended.

Collimation:Adjustto10312inch(24330cm).Placesidemarkerinthecollimatedexposurefield.











Vertebral Column149

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Cervical VertebraePA axial oblique (RAO and LAO)

15�-20�Patient Position•Positionpatientuprightorprone.

Part Position•Rotatebody45degreeswithsideofinterestclosertoIR.•Extendchinslightly.•CenterspinetoIR.•CenterIRtoC5.•Shieldgonads.•Takebothobliqueprojections.


Central Ray•Angle15to20degreescaudad,enteringC4.•SIDof60to72inches(150to180cm)isrecommended.












Vertebral Column151

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Cervical VertebraeTrauma lateral (dorsal decubitus)

Patient Position•Positionpatientsupine.•Donotmovepatientorremovecervicalcollarwithoutconsulting

physician.

Part Position•PlaceIRnexttopatient’sshoulder,andcenteratlevelofC4.•Donotrotateorextendneck.•Depressshouldersasmuchaspossible.Ifnecessary,loopabandage

aroundpatient’sfeetandaffixendstowristssothatextendingkneesdepressesshoulders.

•Shieldgonads.


Central Ray•Anglehorizontalandperpendicular,enteringC4.•SIDof60to72inches(150to180cm)isrecommended.












Vertebral Column153

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Cervical VertebraeTrauma AP axial oblique

Patient Position•Positionpatientsupine.•Donotmovepatientorremovecervicalcollarwithoutconsulting

physician.

Part Position•BraceheadandneckandliftonlyenoughtoslideIRunderneck.•PlaceIRunderbackboardifpatientisonbackboard.•CenterIRtomastoidonsideoppositex-raytube.(Thisallows

angledcentralraytoprojectimageofsideofinterestincenterofimage.)

•Shieldgonads.

Central Ray•Adjust45degreesmedialand15to20degreescephalad,entering

levelofC4.

Collimation:Adjustto10312inch(24330cm).Placesidemarkerinthecolli-matedexposurefield.











Vertebral Column155

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Cervicothoracic RegionLateral SWIMMER’S TECHNIQUE

Patient Position•Positionpatientseated,standing,orinlateralrecumbentposition.Part Position•CentermidcoronalplanetoIR.•ElevatearmadjacenttoverticalIRholder,andrestitonhead.•Rotatethisshoulderforwardorbackwardaccordingtopatient’s

condition.Rotateoppositeshoulderinoppositedirection.•AdjustheadandbodysothatmidsagittalplaneisparalleltoIR.•Shieldgonads.Respiration:Suspend.Central Ray•PerpendiculartoC7-T1interspace.•Use5-degreecaudalangulationifshoulderfarthestfromIRcannot

beadequatelydepressed.Collimation:Adjustto10312inches(24330cm).Placesidemarkerinthecollimatedexposurefield.

COMPENSATING FILTER•Useofaspeciallydesignedcompensatingfilterwillimproveimagequality.











Vertebral Column157

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Thoracic VertebraeAP

Patient Position•Positionpatientsupineorupright.Ifpossible,orientthepatientso

thelowerthoraxisatthecathodeendofthex-raytube.

Part Position•CentermidsagittalplanetoIR.•PositiontopofIR1½ to2inches(3.8to5cm)aboveshoulders.•Havepatientholdarmsatsides,shouldersinsameplane.•Flexhipsandkneestoreducedorsalkyphosisifpatientissupine.•Shieldgonads.

Respiration:Suspendedatendoffullexpiration.

Central Ray•PerpendiculartoIR.Thecentralrayshouldbeapproximately

midwaybetweenjugularnotchandxiphoidprocess.


COMPENSATING FILTER•Useofspeciallydesignedcompensatingfilterwillimproveimagequality.











Vertebral Column159

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Thoracic VertebraeLateral

Patient Position•Positionpatientinlateralrecumbentpositionorupright.

Part Position•Centerposteriorhalfofthoraxtomidlineofgrid.•PlacetopofIR1½to2inches(3.8to5cm)aboverelaxedshoulders.•Elevateheadtospinelevel.Extendarmsforward.•Placeradiolucentsupportunderlowerthoracicregionuntilspineis

horizontaltotabletop.•Shieldgonads.

Respiration:Theexposurecanbemadewhilethepatientcontinuestobreathnor-mally,the“breathingtechnique,”toblurthepulmonaryvascularmark-ingsandribsorafterbreathingissuspendedattheendofexpiration.

Central Ray•PerpendiculartocenterofIRatlevelofT7.Centralrayenters

posteriorhalfofthorax.












Vertebral Column161

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Lumbar-Lumbosacral VertebraeAP


Part Position•Centermidsagittalplanetogrid.•Flexkneesandhipsenoughtoplacebackinfirmcontactwithtable.•CenterIRatiliaccrests(L4).•Shieldgonads.

Respiration:Suspendattheendofexpiration.

Central Ray•PerpendiculartocenterofIR,enteringatlevelofiliaccrests












Vertebral Column163

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Lumbar-Lumbosacral VertebraeLateral

Patient Position•Positionpatientlateral,withhipsandkneesflexed.

Part Position•CenterIRtolevelofiliaccrests.•Centermidcoronalplaneofbodytogrid.•Extendarmsforward.•Placeradiolucentsupportunderlowerthorax;adjustspineparallelto

table.•Placeleadrubberbehindpatienttoabsorbradiation.•Shieldgonads.

Respiration:Suspendattheendofexpiration.

Central Ray•PerpendiculartoIR,enteringmidcoronalplaneatlevelofiliac

crests.












Vertebral Column165

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










L5-S1 Lumbosacral JunctionLateral

Patient Position•Positionpatientlateral,withhipsandkneesextendedorslightlyflexed.

Part Position•Extendarmsforward.•Placeradiolucentsupportunderlowerthorax;adjustspineparalleltotable.•Adjustthemidcoronalplaneofthebody(passingthroughthehips

andshoulders)sothatitisperpendiculartotheIR.•Shieldgonads.


Central Ray•Oncoronalplane2inches(5cm)posteriortoASISand1½inches

inferiortocrest.•Havecentralrayparalleltointeriliacline;caudalorcephalic

angulationof5to8degreesmayberequired.












Vertebral Column167

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Lumbar Zygapophyseal JointsAP oblique (RPO and LPO)

Patient Position•Positionpatientposterioroblique,withsideofinterestclosertoIR.

Part Position•Adjustandsupportbodyobliquityto45degrees.•Havepatientplacearmsinacomfortableposition,andcenterspine

tomidlineofgrid.•Shieldgonads.•Takebothobliqueprojections.

Respiration:Suspendatendofexpiration.

Central Ray•Perpendicular,entering2inches(5cm)medialtoelevatedASISand

1½inches(3.8cm)aboveiliaccrest(L3).•CenterIRtocentralray.












Vertebral Column169

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










30°-35°

Lumbosacral Junction and Sacroiliac JointsAP axial FERGUSON METHOD

Patient Position•Positionpatientsupine,lowerlimbsextended.

Part Position•Centermidsagittalplanetogrid.•Extendlowerlimbsorflexhipsandabducttoremovefrompathof

centralray.•Shieldgonads.


Central Ray•Angle30to35degreescephaladthroughlumbosacraljointso

thatcentralrayentersabout1½inches(3.8cm)superiortopubicsymphysis.

•CenterIRtocentralray.












Vertebral Column171

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Sacroiliac JointsAP oblique (RPO and LPO)


Part Position•Elevateandsupportsideofinterest25to30degreesfromtable.•Alignsagittalplane,passing1inch(2.5cm)medialtoelevated

ASIS,andcentertogrid.•CenterIRatlevelofASIS.•Shieldgonads.•Takebothobliqueprojections.


Central Ray•PerpendiculartoIR,entering1inch(2.5cm)medialtoelevated

ASIS.












Vertebral Column173

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










15�

SacrumAP axial


Part Position•Centermidsagittalplanetocenterofgrid.


Central Ray•Angle15degreescephaladandcenteronpoint2inches(5cm)

superiortopubicsymphysis.•CenterIRtocentralray.












Vertebral Column175

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










SacrumLateral


Part Position•Supportbodytoplacelongaxisofspinehorizontal.•Prepareforpositioningofcentralraybycenteringsacrumtomidline

ofgrid.


Central Ray•PerpendiculartolevelofASISandatapoint3½inches(9cm)

posterior.•CenterIRtocentralray.












Vertebral Column177

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










10�

CoccyxAP axial


Part Position•Centermidsagittalplanetocenterofgrid.


Central Ray•Angle10degreescaudadand2inches(5cm)superiortopubic

symphysis.•CenterIRtocentralray.












Vertebral Column179

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










CoccyxLateral


Part Position•Supportbodytoplacelongaxisofspinehorizontal.•Prepareforpositioningofcentralraybycenteringcoccyxtomidline

ofgrid.


Central Ray•Perpendiculartoapoint3½inches(9cm)posteriortoASISand

2inches(5cm)inferior.•CenterIRtocentralray.












Vertebral Column181

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Thoracolumbar Spine: ScoliosisAP, PA, or lateral FERGUSON METHOD

Patient Position•Positionpatientupright,seated,orstanding.

Part Position•PositionbottomofIRtoincludeapproximately1inch(2.5cm)

ofiliaccrests.•Adjustmidsagittalplaneperpendiculartomidlineofgrid.•Havepatientrelaxarmsatsides.•Obtainfirstimagewithpatientinnormaluprightposition.•Elevatefootorhipofconvexsideofcurve3to4inches

(8to10cm)forsecondimage.•Donotsupportpatientinthisposition.














Vertebral Column183

Manual Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Thorax

ChestPA, 186Lateral, 188PA oblique (LAO and RAO),

190AP oblique (RPO and LPO),

192AP, 194

Pulmonary ApicesAP axial (lordotic); LINDBLOM

METHOD, 196Lungs and Pleurae

AP or PA (lateral decubitus), 198

Lateral (dorsal or ventral decubitus), 200

RibsPA, 202AP, 204AP oblique (RPO or LPO), 206PA oblique (RAO or LAO), 208

SternumPA oblique (RAO), 210Lateral, 212










Patient Position•Positionpatientstandingorseateduprightwithbackofhands

onhips.

Part Position•Centermidsagittalplanewithchinextendedandeyesstraightahead.•Havepatientrollshouldersforward.•PlacetopofIR1½to2inches(3.8to5cm)aboverelaxed

shoulders.•Havepatientflexarmsandrestbacksofhandsonhips.•Shieldgonads.

Respiration:Suspendedfullinspiration(aftersecondinspiration).

Central Ray•PerpendiculartothecenteroftheIR.UseSIDof72inches(183cm).



ChestPA










Thorax187

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors


_______________________________________________________________________________ Instructor: ___________________

Manual Factors










Patient Position•PositionpatientstandingorseateduprightwithsideagainstIR.

Part Position•PlacemidsagittalplaneparalleltoIR.•HavepatientrestadjacentshoulderagainstIRholder,witharms

raisedandcrossedoverhead.•PlacetopofIR1½to2inches(3.8to5cm)aboveshoulder.•CenterthoraxtoIR.•Shieldgonads.


Central Ray•DirectperpendiculartoIR,enteringpatientatlevelofT7.UseSID

of72inches(183cm).



ChestLateral










Thorax189

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientstandingorseatedupright.SidefartherfromIRis

usuallythesideofprimaryinterest.

Part Position•Adjustcoronalplane45degreesfromplaneofIR.•PlacetopofIR1½to2inches(3.8to5cm)aboveshoulders.•HavepatientrollshouldernearestIRposteriorlyandplacehandon

hip.•HavepatientplacearmfartherfromIRontopofIRholder.•CenterthoraxtoIR.Both45-degreeobliquesmaybetaken.•Shieldgonads.


Central Ray•PerpendiculartoIRatlevelofT7.UseSIDof72inches(183cm).



ChestPA oblique (LAO and RAO)










Thorax191

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientuprightorsupine.SideclosertoIRisusuallyside

ofprimaryinterest.

Part Position•Adjustcoronalplane45degreesfromplaneofIR.•PlacetopofIR1½to2inches(3.8to5cm)aboveshoulders.•HavepatientrollshouldernearestIRanteriorlyandplacehandonhead.•HavepatientplacearmfartherfromIRonhip.•CenterthoraxtoIR.Both45-degreeobliquesmaybetaken.•Shieldgonads.


Central Ray•PerpendiculartocenterofIRatalevel3inches(8cm)below

jugularnotch(levelofT7).UseSIDof72inches(183cm),whichisrecommendedmeasure.



ChestAP oblique (RPO and LPO)










Thorax193

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientsupineorupright,armsatsides.

Part Position•CenterIRtomidsagittalplane,andadjustupperbordertobe1½to

2inches(3.8to5cm)aboveshoulders.•Ifpossible,havepatientflexelbows,pronatehands,andplacehands

onhips.•Shieldgonads.


Central Ray•PerpendiculartocenterofIRatlevel3inches(8cm)belowjugular

notch(levelofT7).UseSIDof72inches(183cm).


ChestAP

0o

Horizontalclavicle

R

Scapularimage

kVp: 90 (40” SID, non-grid), 105 (40”, grid), 120 (72”, grid) Reference: 14th edition ATLAS p. 1:119.










Thorax195

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientstanding,approximately1ft(30cm)infront

ofIR.Whenpatientisproperlypositioned,topofIRshouldbeapproximately3inches(8cm)aboveshoulders.

Part Position•Centermidsagittalplanewithnorotation.•Havepatientflexelbows,handswithpalmsoutonhips.•Havepatientleanbackwardinextremelordoticposition.•Shieldgonads.


Central Ray•PerpendiculartoIR.UseSIDof72inches(183cm).


Pulmonary ApicesAP axial (lordotic) LINDBLOM METHOD











Thorax197

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientinlateralrecumbentposition.

Part Position•Positionpatientonaffectedorunaffectedsidedependingon

condition.•Elevatethechestonfirmpad(typically“fluiddown”or“free-air

orpneumothoraxup”).•Havepatientextendarmsabovehead;adjustthoraxintruelateral

position.•PlacetopofIRapproximately1½to2inches(3.8to5cm)above

shoulders.•Shieldgonads.Respiration:Suspendedfullinspiration(aftersecondinspiration).Central Ray•HorizontalandperpendiculartocenterofIRatlevel3inches

(8cm)belowjugularnotch(atT7forPA).Collimation:Adjustto14317inches(35343cm).Placesidemarkerinthecollimatedexposurefield.kVp: 120 Reference: 14th edition ATLAS p. 1:125.

Lungs and PleuraeAP or PA (lateral decubitus)










Thorax199

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientproneorsupine.

Part Position•Elevatethorax2to3inches(5to8cm)onfirmpad,andcenterwith

affectedsideclosertoIR.•Havepatientextendarmsabovehead.•PlacetopofIR1½to2inches(3.8to5cm)abovetopofshoulders.•Centermidcoronalplanetocenterofgrid.•Shieldgonads.


Central Ray•HorizontalandcenteredtoIRatlevelofmidcoronalplaneand

3inches(8cm)belowjugularnotch(T7forventraldecubitus)



Lungs and PleuraeLateral (dorsal or ventral decubitus)










Thorax201

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientuprightorprone.

Part Position•Centermidsagittalplanetogridwithchinextendedandeyesstraight

ahead.•PlacetopofIRapproximately1½inches(3.8cm)aboveshoulders.•Havepatientrollshouldersforwardandrestbackofhandsonhips.•Shieldgonads.

Respiration:Suspendedfullinspirationtodepressdiaphragm.

Central Ray•PerpendiculartocenterofIR.Thisplacesthecentralrayatlevel

ofT7.


RibsPA











Thorax203

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Centermidsagittalplanetomidlineofgrid.•Above diaphragm:PlacetopofIR1½inches(3.8cm)aboverelaxed

shoulders.•Below diaphragm:CenterthoraxwithbottomofIRnearlevelof

iliaccrests.•Rotateshouldersanteriorly.•Shieldgonads.

Respiration:Above diaphragm:Suspendedfullinspiration.Below diaphragm:Suspendedfullexpiration.

Central Ray•PerpendiculartocenterofIR.

Collimation:Adjustto14317inches(35343cm).Placesidemarkerinthecol-limatedexposurefield.


RibsAP










Thorax205

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Rotatepatient’sbody45degreeswithaffectedsidetowardIR.•Centeraplanemidwaybetweenmidsagittalplaneandlateralsurface

ofbody.•Positionarmsclearofthorax.CentertopofIR1½inches(3.8cm)

aboverelaxedshoulder(forabovediaphragm)andwithloweredgeofIRnearlevelofiliaccrest(forbelowdiaphragm).

•Shieldgonads.





RibsAP oblique (RPO or LPO)










Thorax207

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientuprightorprone.

Part Position•Rotatepatient’sbody45degreeswithaffectedsideawayfromIR.•Centeraplanemidwaybetweenmidsagittalplaneandlateralbody

surface.•Positionarmsclearofthorax.CentertopofIR1½inches(3.8cm)

aboverelaxedshoulder(forabovediaphragm)andwithloweredgeofIRnearlevelofiliaccrest(forbelowdiaphragm).

•Shieldgonads.





RibsPA oblique (RAO or LAO)










Thorax209

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•PositionpatientproneforRAO(rightPAoblique).

Part Position•Centersternumtogrid.•Rotatepatient’sbody15to20degreestopreventsuperimposition

ofvertebralandsternalimages.•CenterIRmidwaybetweenjugularnotchandxiphoidprocessat

levelofT7.•Shieldgonads.

Respiration:Shallowbreathingorsuspendedexpiration.

Central Ray•PerpendiculartoT7.Centralrayenterselevatedsideofposterior

thoraxapproximately1inch(2.5cm)lateraltomidsagittalplane.



SternumPA oblique (RAO)










Thorax211

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientseated,standinglateral,orrecumbent.

Part Position•PlacetopofIR1½inches(3.8cm)abovejugularnotch.•Havepatientrotateshouldersandarmsposteriorlyforupright

positioning;placearmsaboveheadforrecumbentpositioning.•Centersternumtogrid.Adjusttotruelateralposition.•Shieldgonads.

Respiration:Suspendeddeepinspiration.

Central Ray•PerpendiculartocenterofIR,enteringlateralborderofmidsternum.

UseSIDof72inches(183cm).


SternumLateral











Thorax213

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Abdomen

Abdomen:AP (supine), 216AP (upright), 218AP (lateral decubitus), 220Lateral, 222Lateral (dorsal decubitus), 224

Esophagus:AP or PA, 226PA oblique (RAO), 228Lateral, 230

Stomach and Duodenum:PA, 232PA oblique (RAO), 234

AP oblique (LPO), 236Lateral, 238AP, 240

Small Intestine:AP or PA, 242

Large Intestine:PA, 244PA axial, 246PA oblique (LAO and RAO),

248Lateral, 250AP, 252AP axial, 254

AP oblique (LPO and RPO), 256

AP or PA (lateral decubitus), 258Lateral, AP or PA, oblique

(upright), 260Urinary System:

AP oblique (RPO and LPO), 262Bladder:

AP or PA axial, 264AP oblique (RPO or LPO), 266Lateral, 268











Part Position•Centermidsagittalplanetogrid.•Maintainshouldersinsametransverseplane.•Supportunderknees.•CenterIRatlevelofiliaccrests,andensurethatpubicsymphysis

isincluded.•Applygonadshieldingasappropriate.


Central Ray•PerpendiculartoIRmidlineatlevelofiliaccrests.


AbdomenAP (supine)











Abdomen217

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientupright.

Part Position•Centermidsagittalplanetogriddevice.•Maintainshouldersinsametransverseplane.•CenterIR2inches(5cm)aboveiliaccreststoincludediaphragm.•Applygonadshieldingasappropriate.


Central Ray•Horizontaland2inches(5cm)superiortoiliaccreststocenter

ofIR.


AbdomenAP (upright)











Abdomen219

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientinlateralrecumbentposition(usuallyleftside

down)onpad.•Placepatient’sarmsabovelevelofdiaphragm,withkneesslightly

flexed.

Part Position•Adjustmidsagittalplaneperpendiculartoandcenteredtogriddevice.•CenterIRatlevelofiliaccrests.•Center2inches(5cm)aboveiliaccrestsifdiaphragmistobeincluded.•Applygonadshieldingasappropriate.


Central Ray•HorizontalandperpendiculartomidpointofIR.NOTE:Showsideupforairandsidedownforfluid.



AbdomenAP (lateral decubitus)










Abdomen221

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientinlateralrecumbentpositionorupright.

Part Position•Centermidcoronalplanetogrid.•Havepatientflexelbowsandplacehandsunderhead.•CenterIRatlevelofiliaccrestsorapproximately2inches

(5cm)superiortocrestsifdiaphragmistobeincluded.•Shieldgonads.




AbdomenLateral











Abdomen223

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Havepatientplacearmsacrossupperchestorunderhead.Patient

mayslightlyflexknees.•Centerverticalgriddevicetomidcoronalplaneatlevel2inches

(5cm)superiortoiliaccrests.•Shieldgonads.


Central Ray•HorizontalandperpendiculartocenterofIR,enteringmidcoronal

plane2inches(5cm)aboveiliaccrests.


AbdomenLateral (dorsal decubitus)











Abdomen225

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientsupineorprone.

Part Position•Centermidsagittalplanetogrid.•Havepatientplacearmsabovetheheadinacomfortableposition.•Adjustshouldersandhipsequidistantfromtable.•PlacetopofIRatlevelofmouth.•Turnheadslightlytofacilitatedrinkingbariummixture,andgive

bariumtopatient.


Central Ray•PerpendiculartomidpointofIRatlevelofT5-T6.


EsophagusAP or PA











Abdomen227

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientrecumbentwiththeside-downarmattheside

andtheside-uparmonthepillow.

Part Position•Elevateleftsidetoobliquityof35to40degrees.•Supportpatientonflexedkneeandelbow.•PlacetopofIRatlevelofmouth.•Alignesophagusandcenterelevatedsidethroughplane2inches

(5cm)lateraltomidsagittalplane;givebariumtopatient.•Shieldgonads.


Central Ray•PerpendiculartomidpointofIRatlevelofT5orT6.NOTE:Ifpatientcannotassumeproneposition,asimilarimagecanbeobtainedbyusingLPOposition,modifiedasdescribedpreviously.



EsophagusPA oblique (RAO)










Abdomen229

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Placepatient’sarmsforward,withforearmonthepillownear

thehead.

Part Position•Centermidcoronalplanetogrid.•Havepatientbringarmsforwardandslightlyflexhipsandknees.•Placetopoffilmatlevelofmouth.•Givebariummixturetopatient.•Shieldgonads.


Central Ray•PerpendiculartomidpointofIRatlevelofT5-T6.


EsophagusLateral

Esophagus

Thoracicvertebra

L











Abdomen231

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Stomach and DuodenumPA

T12

Patient Position•Positionpatientprone.

Part Position•CenterIRatestimatedlevelofL1-L2.•Center(1)halfwaybetweenmidlineandleftlateralborderof

abdominalcavityfor10-312-inch(24-330-cm)IRor(2)inmidsagittalplanefor14-317-inch(35-343-cm)IR.

•Shieldgonads.


Central Ray•PerpendiculartoIRatlevelofL1-L2.

Collimation:Adjustto10312inches(24330cm)or11314inches(28336cm).Placesidemarkerinthecollimatedexposurefield.











Abdomen233

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientrecumbentwiththerightarmatthesideandleft

armbythehead.

Part Position•Elevateleftside,andsupportpatienttoobliquityof40to

70degrees.(Hypersthenicpatientsrequirethegreatestrotation.)•CenterIRatlevelofL1-L2.•Positionpatientsothatasagittalplanepassingmidwaybetween

vertebraeandlateralborderofelevatedsideiscenteredtogrid.•Shieldgonads.


Central Ray•PerpendiculartocenterofIRmidwaybetweenvertebralcolumnand

lateralborderofabdomenatlevelofL1-L2.



Stomach and DuodenumPA oblique (RAO)










Abdomen235

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientrecumbentwithleftarmbyheadandrightarm

behindbody.

Part Position•Elevaterightside,andsupportpatienttoobliquityof30to

60degrees.(Hypersthenicpatientsrequirethegreatestrotation;45degreesissufficientforasthenicpatients.)

•PositionpatientsothatsagittalplanepassingmidwaybetweenvertebraeandleftmarginofabdomeniscenteredtoIR.

•CenterIRatlevelofL1-L2.•Shieldgonads.


Central Ray•PerpendiculartocenterofIRmidwaybetweenvertebralcolumn

andleftlateralborderofabdomenatlevelofL1-L2.



Stomach and DuodenumAP oblique (LPO)










Abdomen237

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientrecumbent(rightlateral)orupright(leftlateral).

Part Position•Adjustbodysothatplanepassingbetweenmidcoronalplaneand

anteriorabdominalsurfaceiscenteredtogrid.•CenterIRatlevelofL1-L2.•Adjusttotruelateral.•Shieldgonads.


Central Ray•PerpendiculartocenterofIRmidwaybetweenmidcoronalplane

andanteriorsurfaceofabdomenatlevelofL1-L2forrecumbentorL3foruprightposition.


Stomach and DuodenumLateral











Abdomen239

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Adjustpatientsothatmidlineofgridcoincides(1)halfway

betweenmidlineandlateralborderofabdomenfor10-312-inch(24-330-cm)IRor(2)atmidsagittalplanefor14-317-inch(35-343-cm)IR.

•CenterIRatlevelofL1-L2.•Shieldgonads.


Central Ray•PerpendiculartoIRatlevelofpylorus(L1-L2).


Stomach and DuodenumAP











Abdomen241

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientsupineorprone.

Part Position•Centermidsagittalplanetogrid.•CenterIRatlevelofiliaccrests(maybeslightlyhigherforearly

timeexposures).•Shieldgonads.


Central Ray•PerpendiculartoIR,enteringlevelofiliaccrests(orslightlyabove).


Small IntestineAP or PA











Abdomen243

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Centermidsagittalplanetogrid.•CenterIRatlevelofiliaccrests.•Shieldgonads.


Central Ray•PerpendiculartoIR,enteringlevelofiliaccrests.


Large IntestinePA











Abdomen245

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•CentermidsagittalplanetogridwithcenterofIRatlevelofiliac

crests.•Shieldgonads.


Central Ray•Angle30to40degreescaudad.Toshowretrosigmoidareausing

smallerIR,directcentralraysothatitentersmidlineatlevelofASIS.


Large IntestinePA axial 30� -40�











Abdomen247

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•PositionpatientPAoblique.

Part Position•Rotatepatient35to45degreeseitherrightorleftsideup.•Flexkneeforstability.•Centerbodytomidlineofgrid.•AdjustcenterofIRatlevelofiliaccrests.•Shieldgonads.

Respiration:Suspendedexpiration.

Central Ray•PerpendiculartoIR,enteringelevatedside1to2inches(2.5to

5cm)lateraltomidlineofbodyonelevatedsideandatlevelofiliaccrests.


Large IntestinePA oblique (LAO and RAO)











Abdomen249

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientinlateralrecumbentposition.

Part Position•Adjustbodytotruelateralposition(rightorleftsidedown).•Centermidcoronalplaneofabdomentocenterofgrid.•CenterIRtoASIS.•Havepatientflexkneesandhipsslightlyandbringarmsforward.•Shieldgonads.


Central Ray•PerpendiculartoIR,enteringmidcoronalplaneatlevelofASIS.


Large IntestineLateral











Abdomen251

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Centermidsagittalplanetogrid.•CenterIRatlevelofiliaccrests.•Shieldgonads.


Central Ray•PerpendiculartoIR,enteringmidsagittalplaneatlevelofiliaccrests.


Large IntestineAP











Abdomen253

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Centermidsagittalplanetogrid.•CenterIR2inches(5cm)aboveiliaccrests.•Shieldgonads.


Central Ray•Angle30to40degreescephalad,enteringapproximately2inches

(5cm)belowlevelofASIS.(Whenretrosigmoidisofinterest,centralrayentersinferiormarginofpubicsymphysis.)


Large IntestineAP axial











Abdomen255

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•PositionpatientAPoblique.

Part Position•Rotatepatient35to45degreesfromAPpositioneitherrightorleft

sideup.•Centerabdomentogrid.•AdjustcenterofIRtolevelofiliaccrests.•Shieldgonads.


Central Ray•Perpendicular,enteringelevatedside1to2inches(2.5to5cm)

lateraltomidlineofbodyatlevelofiliaccrests.


Large IntestineAP oblique (LPO and RPO)

kVp: 120 Reference: 14th edition ATLAS pp. 2:258-259.










Abdomen257

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientrecumbentoneitherrightorleftside.•Elevatedependentsideonfirmpad.

Part Position•Placearmsabovehead,withkneesslightlyflexed.•Centermidsagittalplanetogrid.•CenterIRtomidsagittalplaneatlevelofiliaccrests.•Shieldgonads.


Central Ray•HorizontalandperpendiculartoIRatlevelofiliaccrests.


Large IntestineAP or PA (lateral decubitus)











Abdomen259

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientupright—frontal,lateral,oroblique.

Part Position•Adjustarmstoremovefromareaofinterest,anddistributeweight

equallyonfeet.•CenterIRatlevelofiliaccrestsand(1)midsagittalplaneforAP

orPAprojection,(2)midwaybetweenmidsagittalplaneandlateralaspectofsideofinterestforobliquepositions,or(3)midcoronalplaneforlateralposition.

•Shieldgonads.


Central Ray•PerpendiculartoIRat level of iliac crests.


Large IntestineLateral, AP or PA oblique (upright)











Abdomen261

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Rotatepatient30degreesfromIRplane.•Placesupportunderelevatedsideasneeded.•Adjusthipsandshoulderstobeinsameplanes.•Centerspinetogrid.•CenterIRatlevelofiliaccrests.•Shieldgonads.


Central Ray•Perpendiculartolevelofiliaccrests,enteringelevatedside

approximately2inches(5cm)lateraltomidline.NOTE:ForAP,PA,lateral,anddecubituspositioningfortheurinarysystem,seesimilarabdomenpositionsinthissection.



Urinary SystemAP oblique (RPO and LPO)










Abdomen263

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Centermidsagittalplanetogrid(1)2to3inches(5to7.5cm)above

pubicsymphysistoshowthebladderor(2)atpubicsymphysisforvoidingstudies.

•AdjustshouldersandhipstobeequidistantfromIR.•Havepatientplacearmsacrossupperchestoratsides.•Havepatientextendlegs.


Central Ray•Adjust10to15degreescaudad(1)atlevel2to3inches(5to7.5cm)

abovepubicsymphysistoshowbladderor(2)atpubicsymphysisforvoidingstudies.



BladderAP or PA axial

10� -15�










Abdomen265

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position•Rotatepatient40to60degreesfromsupine.•CenterIR2to3inches(5to7.5cm)aboveupperborderofpubic

symphysisand2inches(5cm)medialtoASIS.•Havepatientabductuppermostthightopreventitssuperimposition

onbladderarea.


Central Ray•Perpendicular,enteringelevatedside2inches(5cm)medialto

midsagittalplane(1)at2to3inches(5to7.5cm)superiortopubicsymphysisor(2)atpubicsymphysisforvoidingstudies.

NOTE:RPOpositionisalsousedformalecystourethrography.



BladderAP oblique (RPO or LPO)










Abdomen267

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position•Positionpatientlateralrecumbent(eitherleftorright).

Part Position•Centermidcoronalplanetogrid.•Havepatientflexhipsandknees.•Adjustpatient’sarmsforwardwithhandsunderhead.•CenterIR2inches(5cm)abovepubicsymphysis.


Central Ray•PerpendiculartoIR,entering2inches(5cm)abovepubicsymphysis.


BladderLateral











Abdomen269

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Cranium

Cranial Lines, Planes, and Abbreviations, 272

Cranium:PA and PA axial; CALDWELL

METHOD, 274AP and AP axial, 276Lateral, 278AP axial; TOWNE METHOD, 280PA axial; HAAS METHOD, 282Submentovertical; SCHÜLLER

METHOD, 284Facial Bones:

Lateral, 286Parietoacanthial; WATERS

METHOD, 288Acanthoparietal; REVERSE WATERS

METHOD, 290

Nasal Bones:Lateral, 292

Zygomatic Arches:Submentovertical, 294

Zygomatic Arches:Tangential, 296

Zygomatic Arches:AP axial; MODIFIED TOWNE

METHOD, 298Mandibular Rami:

PA, 300PA axial, 302

Mandible:Axiolateral and axiolateral

oblique, 304Temporomandibular Articulations:

AP axial, 306

Temporomandibular Articulations:Axiolateral oblique, 308

Paranasal Sinuses:Lateral, 310

Frontal and Anterior Ethmoidal Sinuses:

PA axial; CALDWELL METHOD, 312

Maxillary Sinuses:Parietoacanthial; WATERS

METHOD, 314Ethmoidal and Sphenoidal Sinuses:

Submentovertical, 316










Midsagittal plane

Glabella

Interpupillary line

Inner canthus

Nasion

Acanthion

Mental point

Angle of mandible(gonion)

Infraorbital margin

Outer canthus

Abbreviations Used in This SectionAML: acanthomeatal lineEAM: external acoustic meatusIOML: infraorbitomeatal lineOML: orbitomeatal line

Cranial Lines, Planes, and Abbreviations

Reference: 14th edition ATLAS p. 2:29.










Cranium273

Gla

be

lloa

lve

ola

r lin

e

Glabella

Nasion

Acanthion

Mental pointAngle of mandible(gonion)

External acousticmeatus

Glabellomeatal line

Acanthiomeatal lineMentomeatal line

Infraorbitomeatal lineOrbitomeatal line

Top of earattachment










Patient Position• Position patient seated upright or prone.

Part Position• Have patient rest head on forehead and nose.• Position midsagittal plane perpendicular to midline of grid device.• OML is perpendicular to IR.


Central Ray• PA: Perpendicular to IR, exiting nasion.• Caldwell method: Angle 15 degrees caudad, exiting nasion.• Center IR to central ray.

Collimation:Adjust radiation field to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the skin line of the skull. Check for light at vertex and on both sides. Place side marker in the collimated exposure field.

CraniumPA and PA axial CALDWELL METHOD

15°











Cranium275

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient supine.

Part Position• Position midsagittal plane and OML perpendicular to IR.• Place arms at sides or across chest.


Central Ray• AP: Perpendicular to nasion.• AP axial: Angle 15 degrees cephalad.• Center IR to central ray.

Collimation:Adjust radiation field to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the skin line of the skull. Check for light at vertex and on both sides. Place side marker in the collimated exposure field.

CraniumAP and AP axial











Cranium277

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright or semiprone.

Part Position• Position midsagittal plane parallel to IR.• IOML is perpendicular to front edge of IR.• Interpupillary line is perpendicular to IR.


Central Ray• Perpendicular entering 2 inches (5 cm) superior to EAM.• Center IR to central ray.

Collimation:Adjust radiation field to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the skin line of the skull. Check for light at vertex, anterior, posterior, and base of the skull borders. Place side marker in the collimated exposure field.

CraniumLateral











Cranium279

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright or supine.

Part Position• Center midsagittal plane to midline of grid device, and adjust to

make perpendicular.• Have patient flex neck, and adjust OML perpendicular to IR.• When patient cannot flex neck, place IOML perpendicular.• Place top of IR at level of cranial vertex.


Central Ray• Direct through foramen magnum with caudal angle of 30 degrees to

OML or 37 degrees to IOML. Central ray enters approximately 2 ½ inches (6.4 cm) superior to glabella and passes through level of EAM.

Collimation:Adjust the radiation field to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the skin line of the skull. Check for light at the vertex and on both sides. Place side marker in the collimated exposure field.


CraniumAP axial TOWNE METHOD

30�










Cranium281

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Have patient rest head on forehead and nose.• Place arms in comfortable position.• Adjust shoulders to lie in same transverse plane.• Adjust head so that midsagittal plane and OML are perpendicular to IR.


Central Ray• Direct 25 degrees cephalad, entering 1½ inches (3.8 cm) inferior

to external occipital protuberance (inion) and exiting 1½ inches (3.8 cm) superior to nasion.

Collimation:Adjust the radiation field to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the skin line of the skull. Check for light at the vertex and on both sides. Place side marker in the collimated exposure field.


CraniumPA axial HAAS METHOD

25�










Cranium283

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright at head unit or supine on elevated

table support.

Part Position• Have patient extend neck and rest head on vertex.• Center and adjust midsagittal plane perpendicular to IR.• Adjust IOML parallel to plane of IR if possible.• Immobilize head.


Central Ray• Direct through sella turcica perpendicular to IOML entering between

angles of mandible.• Central ray passes through a point ¾ inch (1.9 cm) anterior to level

of EAM.

Collimation:Adjust the radiation field to extend ½ inch (1.3 cm) beyond the shadow of the tip of the nose and 1 inch beyond the lateral borders. Place side marker in the collimated exposure field.


CraniumSubmentovertical SCHÜLLER METHOD










Cranium285

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Position zygomatic bone to center of grid.• Adjust midsagittal plane parallel to IR.• IOML is parallel to transverse axis of IR.• Interpupillary line is perpendicular to IR.


Central Ray• Perpendicular entering lateral surface of zygomatic bone halfway

between outer canthus and EAM.• Center IR to central ray.

Collimation:Adjust to extend ½ inch (1.3 cm) beyond the shadow of the tip of the nose, superiorly to ½ inch (1.3 cm) above the supraorbital margins, inferiorly to the gonion, and posteriorly to the EAM. The exposure field should be set no larger than 6 3 10 inches (15 3 24 cm). Place side marker in the collimated exposure field.


Facial BonesLateral










Cranium287

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Center and adjust midsagittal plane perpendicular to IR, and have

patient rest head on extended chin.• Hyperextend neck and adjust OML to form 37-degree angle to IR plane.• Mentomeatal line is approximately perpendicular to IR.• Usually patient’s nose is about ¾ inch (1.9 cm) from grid device.• Center IR to acanthion.


Central Ray• Perpendicular, exiting acanthion.

Collimation:Adjust to ½ to 1 inch (1.3 to 2.5 cm) beyond the shadows of the lateral sides of the face, superiorly to include the supraorbital margins and inferiorly to the level of the chin. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Facial BonesParietoacanthial WATERS METHOD










Cranium289

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient supine.

Part Position• Center and adjust midsagittal plane perpendicular to IR.• Adjust extension of neck so that OML forms 37-degree angle with

plane of IR. If necessary, place a support under patient’s shoulders to help extend the neck.

• Mentomeatal line is approximately perpendicular to plane of IR.• Adjust head so that midsagittal plane is perpendicular to plane of IR.


Central Ray• Perpendicular to enter acanthion.• Center IR to central ray.

Collimation:Adjust to extend about ½ to 1 inch (1.3 to 2.5 cm) beyond the lateral sides of the face, superiorly just to the skin shadow, and inferiorly to the chin. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Facial BonesAcanthoparietal REVERSE WATERS METHOD










Cranium291


_______________________________________________________________________________ Instructor: ___________________

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø

AEC Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Center nasion to IR.• Adjust midsagittal plane parallel to IR.• IOML is parallel to transverse axis of IR.• Interpupillary line is perpendicular to IR.


Central Ray• Perpendicular, entering ½ inch (1.3 cm) distal to nasion.• Ensure that collimation is extremely close.

Collimation:Adjust to extend from the glabella to 1 inch (2.5 cm) inferior to the acanthion and ½ inch (1.3 cm) beyond the tip of the nose. The exposure field should be no larger than 3 3 3 inches (8 3 8 cm). Place side marker in the collimated exposure field.


Nasal BonesLateral










Cranium293

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright or supine on elevated table support.

Part Position• Hyperextend neck, and have patient rest head on vertex.• Center and adjust midsagittal plane perpendicular to IR.• Adjust IOML parallel to IR if possible.


Central Ray• Perpendicular to IOML, entering midway between zygomatic

arches.• Central ray enters approximately 1 inch (2.5 cm) posterior to outer

canthi.

Collimation:Adjust to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the lateral sides of the face, superiorly to the chin, and inferiorly to the gonions. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Zygomatic ArchesSubmentovertical










Cranium295

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright or supine on elevated table support.

Part Position• Hyperextend neck, and have patient rest head on vertex.• Center zygomatic arch and adjust midsagittal plane perpendicular to IR.• Adjust IOML as parallel as possible to IR.• Rotate midsagittal plane 15 degrees toward side being examined,

then tilt top of head approximately 15 degrees away from side being examined so that central ray is tangent to zygomatic arch.


Central Ray• Perpendicular to IOML, entering affected zygomatic arch at a point

1 inch (2.5 cm) posterior to outer canthus

Collimation:Adjust to ½ inch (1.3 cm) beyond the skin shadow of the affected cheek, superiorly to the tip of the nose, and inferiorly to the gonion. The expo-sure field should be no larger than 6 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Zygomatic ArchesTangential










Cranium297

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Center midsagittal plane to grid device, and adjust to perpendicular

position.• Flex neck, and adjust OML perpendicular to IR.


Central Ray• Angle 30 degrees caudad, entering glabella approximately 1 inch

(2.5 cm) superior to nasion. (Direct 37 degrees caudad if IOML is perpendicular to IR.)

• Center IR to central ray.

Collimation:Adjust to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the lateral sides of the face, superiorly to the top of the forehead, and inferiorly to the chin. The exposure field should be no larger than 10 3 8 inches (24 3 18 cm). Place side marker in the collimated exposure field.


Zygomatic ArchesAP axial MODIFIED TOWNE METHOD

30�










Cranium299

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Have patient rest forehead and nose on grid device.• Adjust head so that midsagittal plane is perpendicular to IR.• OML is perpendicular to IR.


Central Ray• Perpendicular to exit acanthion.• Center IR to central ray.

Collimation:Adjust to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the lateral sides, above the TMJs and below the chin. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Mandibular RamiPA










Cranium301

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Position midsagittal plane perpendicular to IR.• OML is perpendicular to IR.• Have patient rest forehead and nose on IR holder.


Central Ray• Angle 20 to 25 degrees cephalad, exiting at acanthion.• Center IR to central ray.

Collimation:Adjust to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the lateral sides, above the TMJs and below the chin. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Mandibular RamiPA axial

20�










Cranium303

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright, semisupine, or semiprone.Part Position• Place head in lateral position with interpupillary line perpendicular.• Extend neck enough that long axis of mandibular body is parallel to

transverse axis of IR, preventing superimposition of cervical spine.• If projection is being performed on tabletop, position IR so that

complete body of mandible is positioned on IR.• Adjust rotation of head so that area of interest is parallel to IR as follows:

(1) for ramus, keep head in true lateral position; (2) for body, rotate head 30 degrees toward IR; (3) for symphysis, rotate head 45 degrees toward IR.

Respiration:Suspend.Central Ray• Angle 25 degrees cephalad to pass directly through mandibular region

of interest.Collimation:Adjust to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the anterior and inferior skin shadows and above the TMJ. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.kVp: 80 Reference: 14th edition ATLAS p. 2:85.

MandibleAxiolateral and axiolateral oblique










Cranium305

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Adjust head so that midsagittal plane is perpendicular to IR.• Flex neck to place OML perpendicular to IR.• After first exposure with patient’s mouth closed, do not permit patient

to move. Change IR, and make second exposure with mouth fully open.


Central Ray• Angle 35 degrees caudal, centered to temporomandibular joints and

entering approximately 3 inches (7.6 cm) superior to nasion.• Center IR to central ray.

Collimation:Adjust to extend ½ inch to 1 inch (1.3 to 2.5 cm) beyond the lateral sides, superiorly to the glabella, and inferiorly to the lips. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Temporomandibular ArticulationsAP axial










Cranium307

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors











Part Position• Center a point ½ inch (1.3 cm) anterior to EAM to IR.• Rotate midsagittal plane 15 degrees toward IR.• Adjust AML parallel to transverse axis of IR.• Interpupillary line is perpendicular to IR.• After first exposure, do not permit patient to move. Change IR, and

make second exposure with mouth fully open.


Central Ray• Angle 15 degrees caudad, exiting temporomandibular joint closer to IR.• Central ray enters about 1½ inches (3.8 cm) superior to upside EAM.

Collimation:Adjust to extend from the outer canthus to the posterior edge of the auricle and from the midparietal region to the inferior edge of the auricle. The exposure field should be no larger than 5 3 5 inches (12.5 3 12.5 cm). Place side marker in the collimated exposure field.


Temporomandibular ArticulationsAxiolateral oblique 15�










Cranium309

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright.

Part Position• Adjust head to true lateral position.• Midsagittal plane is parallel to (and interpupillary line is perpendicular

to) IR.• Adjust IOML horizontal and parallel to transverse axis of IR.


Central Ray• Horizontal and perpendicular, entering ½ to 1 inch (1.3 to 2.5 cm)

posterior to outer canthus.• Center IR to central ray.

Collimation:Adjust to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the tip of the nose, superiorly to 3 inches above the nasion, inferiorly to the occlusal plane, and posteriorly to the auricle. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Paranasal SinusesLateral










Cranium311

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright.Part Position• Tilt vertical grid device down 15 degrees.• Have patient rest head on forehead and nose.• Position midsagittal plane perpendicular to midline of IR.• OML is perpendicular to IR.• This positioning places OML 15 degrees from horizontal central ray.Respiration:Suspend.Central Ray• Horizontal to center of IR, exiting nasion.NOTE: If grid device cannot be tilted, place a radiolucent sponge between forehead and grid so that OML remains 15 degrees from horizontal x-ray beam.Collimation:Adjust to extend 1 inch (2.5 cm) beyond the lateral skin shadows, superi-orly to include just the shadow of the top of the head, and inferiorly to the occlusal plane. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Frontal and Anterior Ethmoidal SinusesPA axial CALDWELL METHOD

R










Cranium313

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright.

Part Position• Center and adjust midsagittal plane perpendicular to IR, and have

patient rest head on extended chin.• Adjust OML to form 37-degree angle to IR. Mentomeatal line is

approximately perpendicular to IR.• Center IR to acanthion.• Open mouth option: Have patient fully open mouth to show the

sphenoid and maxillary sinuses.


Central Ray• Horizontal and perpendicular to IR, exiting acanthion

Collimation:Adjust to extend 1 inch (2.5 cm) beyond the lateral skin shadows, superi-orly to include just the shadow of the top of the head, and inferiorly to the occlusal plane. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Maxillary SinusesParietoacanthial WATERS METHOD










Cranium315

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Patient Position• Position patient seated upright at head unit.

Part Position• Extend head, and have patient rest it on vertex.• Center and adjust midsagittal plane perpendicular to IR.• Adjust IOML parallel to IR.


Central Ray• Horizontal and perpendicular to IOML.• Central ray enters approximately ¾ inch (1.9 cm) anterior to level

of EAM.

Collimation:Adjust to extend ½ to 1 inch (1.3 to 2.5 cm) beyond the tip of the nose and on the lateral sides. The exposure field should be no larger than 8 3 10 inches (18 3 24 cm). Place side marker in the collimated exposure field.


Ethmoidal and Sphenoidal SinusesSubmentovertical

R










Cranium317

AEC Factors

Part Thickness

(cm) mA kVpAEC


Image Receptor

Size


HF, 1Ø or 3Ø


_______________________________________________________________________________ Instructor: ___________________

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø

Manual Factors










Mobile Radiography

Chest:AP, 320AP or PA (right or left lateral

decubitus), 322Abdomen:

AP, 324AP or PA (left lateral decubitus),

326

Pelvis:AP, 328

Femur:AP, 330Lateral (dorsal decubitus), 332

Cervical Spine:Lateral (right or left dorsal

decubitus), 334

Chest and Abdomen: Neonate:AP, 336Lateral (right or left dorsal

decubitus), 338










Patient Position•Positionpatientuprightortogreatestangletolerated.•Positioncriticallyillorinjuredpatientssupine.

Part Position•CentermidsagittalplanetoIR.•PositionIRunderpatientwithtopabout2inches(5cm)above

relaxedshoulders.•Internallyrotatepatient’sarmstopreventscapularsuperimposition

oflungfield,ifnotcontraindicated.•Ensurethatpatient’suppertorsoisnotrotated.•Shieldgonads

Respiration:Inspiration.



kVp: 90 (40˝ SID, non-grid), 105 (40˝ grid) Reference: 14th edition ATLAS p. 3:10.

ChestAP










Mobile Radiography321


_______________________________________________________________________________ Instructor: ___________________

Manual Factors

Part Thickness


Image Receptor

Size


HF, 1Ø or 3Ø










Patient Position•Positionpatientinlateralrecumbentposition.•Placefirmsupportunderpatienttoelevatebody2to3inches

(5to7.5cm).•Raisebotharmsupandawayfromchestregion.•Ensurethatpatientcannotfalloutofbed.

Part Position•PerformAPprojectionwheneverpossible.•Adjustpatienttoensuretruelateralposition.•PlaceIRbehindpatientandbelowsupport.•Adjustgridsothatitextends2inches(5cm)aboveshoulders.•Shieldgonads.


Central Ray•HorizontalandperpendiculartocenterofIR.


kVp: 105 (40˝ grid) Reference: 14th edition ATLAS p. 3:12.

ChestAP or PA (right or left lateral decubitus)








