Radiographic Positioning Summary (Basic Projections RAD 331) (Cervical Spine):

Projection AP C3-C7 SID (FFD) 40 inches Filament size Pat. and part Position Seated or standing line from the Occlusal plane to the mastoid tips must be 90 to the couch Seated or standing / no rotation / relax shoulder Central ray and center point 15- 20. Cephalic Level of the thyroid cartilage (C4) 90 to IR center Through C4 Grid Yes ( Rested Respiration) ( Rested Expiration) ( Rested Expiration) Yes C1 to C7 = visualized Mandibular rami should be superimposed over each other C1 to C7 = visualized RPO show L foramina LPO show R foramina Breathing instructions Remarks C3 to T1 = visualized

Lateral Cervical C1-C7 R or L Oblique C1-C7

72 inches Small focal spot

40 inches

Center spine to midline of table or For PO : Bucky Pt. angled 45 / shoulder touching 15- 20 cephalic Bucky For AO : 15- 20 Caudal Through C4 Pat. and part Position Central ray and center point

(Thoracic spine):
Projection A-P Thoracic SID (FFD) Filament size large focal spot Grid Breathing instructions ( Rested Inspiration) Remarks C7 to T12 = centered in the midline Pt. is standing or supine facing the x-ray tube with the midsagittal plane centered to the Center of Bucky or IR and central ray 90 to IR center Level of T.7 Pt. is standing or lying down in lateral position with mid-coronal plane centered to the Bucky / have pt. place hands on top of the head. A lead blocker sheet near patients back helps minimize scattered rays Pat. and part Position Pt. is supine with midsagittal plane centered to Bucky with arms hang comfortably at side Flex knees partially with support under knees Pt. is lying down recumbent with Midcoronal plane centered to Bucky, arms folded on chest, elevate elbow Pt. is supine with midsagittal plane centered to table, place arms at side or folded upon chest. Flex knees partially with support Pt. is standing or lying down at 45 angle with supporting shoulder and pelvis that are off the table place arm across chest out of collimated field / Central ray 90 to IR center Large IR L4 L5 (Level of iliac crest). Small IR L3 (level of lower costal Margins). ( Rested Expiration) Cephalic (30 males), (35 females). to mid line at level of ASIS 90 to IR center L3 (level of lower costal margin) Yes L5 / S1 joint space should be clearly seen

Lateral Thoracic

40 inches

Small focal spot

Yes (expose during exhalation)

C7 to T12 = centered in the midline

(Lumbar Spine):
Projection A-P Lumbar Supine SID (FFD) Filament size Grid Breathing instructions Remarks T11 through sacrum should be visible Collimation through spine Transverse processes should be visualized

Lateral Lumbar A-P L5/S1 Spot Shot R or L Posterior Oblique Or Anterior Oblique 40 inches Small focal spot

T1 through sacrum should be visible

spinal column from T11 - S1 should be visible / Scotty Dogs should be seen on all 5 L/S vertebra LPO has L side closest RPO has R side closest

Chest:
Projection SID (FFD) Filament size Pat. and part Position Patient erect with feet separated slightly Align MSP to center and midline of IR Elbows partially flexed Shoulders rotated forward against IR ( to allow scapulae to move laterally clear of lung fields) Central ray and center point Grid Breathing instructions 90 to IR center Level of T7(Inferior angle of scapula Yes End of second full inspiration Remarks The lung apices, Costophrenic angles, and lateral margin of the ribs should be included in the film. The scapulae should be moved lateral to the lung fields The spine should be centered on the film Sternoclavicular joints should be equal in both sides. 10 posterior ribs should be demonstrated above the diaphragm. The lung apices, Costophrenic angles, spine and sternum should be included in the film. The heart should adequately penetrate showing sharp outlines, with vascular markings behind the sternum and heart. The heart should adequately penetrate showing sharp outlines

P-A Chest Erect

Lateral Chest

72 inches

Large focal spot

Patient erect left side against Bucky unless patient complaint is on right side. Hands raised above head with chin up coronal plane is perpendicular and sagittal plane is parallel to IR

Oblique Chest

Patient erect, rotated 45 (left anterior shoulder against film for LAO, and right anterior shoulder against film for RAO). Hands raised above head with chin up

Abdomen:
Projection SID (FFD) Filament size Pat. and part Position Central ray and center point Grid Breathing instructions Remarks Appropriate markers should be placed indicating R and L The image should include the area from the upper border of the pubic symphysis to the diaphragm. No rotation Spinous processes in the center of the vertebral column Symmetric iliac wings No motion The diaphragm should appear sharp in an upright film. Soft tissues visualization :faintly visualize the lower liver margin, and kidneys outline, The lateral borders of psoas muscles Transverse processes of L. vertebrae.

Large focal spot Abdomen Supine Or Erect 40 inches

Patient Supine or erect with arms placed at sides away from body or above head For supine position Legs extended with support under knees to keep patient back close contact with table MSP centered to midline of IR Center of IR to level of iliac crest No rotation of pelvis or Shoulders

90 to IR center L4-5 (Level of iliac crest) for supine Level of lower costal margin (5 cm above Level of iliac crest) for erect position

Yes

End of second full Expiration

*Note about AP Abdomens: -Standing film taken at high KVp to shorten exposure time, to look for air-fluid levels or free intraperitoneal air -Patient should be standing for at least 5 minutes, if possible -Recumbent film taken at low KVp (70) for higher contrast to find small kidney stones

Skull Radiography:
Projection PA Skull 0 Occipital frontal projection PA Skull 15 Caldwell projection AP Axial Townes projection Submentove rtex (SMV) SID (FFD) Filament size Pat. and part Position Patient nose and forehead against the table (IR) center OML is 90 to the couch, MSP 90 to IR center, head not rotated EAMS equidistant from the couch top. Patient supine, or AP sitting, Chin is depressed (OML 90 to film), No rotation of the head Patient supine or sitting, chin raised, and neck hyper extended till IOML is parallel to film, MSP 90 to couch top. A pillow under patients back allows for sufficient extension Patient in a semi prone or sitting. Head in a true lateral. MSP parallel and IPL 90 to couch top. Required side close to the film. Central ray and center point 90 to IR center Exits at the glabella 90 to IR center Exits at nasion 30 caudad to OML 2 cm superior to level of EAMs 90 to IOML Midway between angles of mandible Grid Breathing instructions Remarks

Best demonstrate the frontal bone

Best demonstrate the petrous ridges

40 inches

Small focal spot

Yes

N/A

Best demonstrate the occipital bone

Best demonstrate the skull base

Lateral Skull cranium

90 to IOML 2 inches superior to EAM 90 to IOML Zygoma 90 to IOML Exit at achanthion

Lateral Skull Facial (OM) Waters for sinuses Patient erect or seated. Chin and nose against couch MML is 90 to the film, OML makes 37 with film. (Open mouth) patient drops his jaw without moving the head).

Best demonstrate superimposed cranial bones Vertex-occipital and frontal bones should be included Mandibles should be superimposed Best demonstrate superimposed Facial bones All facial bones should be included Mandibles should be superimposed Best demonstrate maxillary , frontal sinuses and nasal Fossa.

*Note about skull: Lateral skull with patient seated is essential for PNS to show fluid level Lateral Sella require:Examining both sides ( Rand L) A long narrow cone should be used C.P 2 cm anterior and 2 cm superior to EAM