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Central Ray Flashcards

1
Q

PA/AP/PA oblique/Lateral - Finger

A

Perpendicular to the PIP joint

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2
Q

PA/AP/PA oblique/Lateral - Thumb

A

Perpendicular to the MCP joint

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3
Q

PA/AP/PA oblique/Lateral - Hand

A

Perpendicular to the third MCP joint

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4
Q

AP obliques (bilateral) - Hand

A

Midway between the hands and at the level of the MCP joints

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5
Q

PA/PA oblique/Lateral - Wrist

A

Perpendicular to the midcarpal area

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6
Q

PA w/ ulnar deviation - Scaphoid

A

Perpendicular to the scaphoid – Clear delineation sometimes requires a CR angulation of 10-15 degrees proximally or distally

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7
Q

AP/Lateral - Forearm

A

Perpendicular to the midpoint of the forearm

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8
Q

AP/AP oblique (medial & lateral rotation)/Lateral - Elbow

A

Perpendicular to the elbow joint

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9
Q

Lateral (radial head) - Elbow

A

Directed toward the shoulder at an angle of 45 degrees to the radial head. The central ray enters the joint at mid-elbow

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10
Q

Acute flexion - Elbow

A

Perpendicular to the humerus, approximately 2 inches (5cm) superior to the olecranon process.

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11
Q

AP/Lateral/Transthoracic - Humerus

A

Perpendicular to the midportion of the humerus and the center of the IR

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12
Q

AP (neutral, external, internal) - Shoulder

A

Perpendicular to a point 1-inch (2.5cm) inferior to the coracoid process

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13
Q

AP oblique (glenoid); Grashey - Shoulder

A

Perpendicular, the CR should be at a point 2 inches (5 cm) medial and 2 inches (5cm) inferior to the superolateral border of the shoulder.

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14
Q

PA/AP oblique (Y) - Shoulder

A

Perpendicular to the scapulohumeral joint

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15
Q

Inferosuperior axial - Shoulder

A

Horizontally through the axilla to the region of the AC articulation. Degree of angulation depends on the degree of abduction of the arm. The degree of medial angulation is often between 15 – 30 degrees. The greater the abduction, the greater the angle.

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16
Q

Superoinferior axial - Shoulder

A

Angled 5 – 15 degrees through the shoulder joint and toward the elbow. A greater angle is required when the patient cannot extend the shoulder over the IR.

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17
Q

AP - Clavicle

A

Perpendicular to the midshaft of the clavicle

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18
Q

AP axial - Clavicle

A

Perpendicular to the midshaft of the clavicle. Cephalic central ray angulation can vary from the long axis of the torso. Thinner patients require more angulation to project the clavicle off the scapula and ribs. For the standing lordotic position, 0- 15 degrees is recommended. For the supine position, 15-30 degrees is recommended.

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19
Q

AP w/ & w/o weights - AC joints

A

Perpendicular to the midline of the body at the level of the AC joints for a single projection; directed at each respective AC joint when two separate exposures are necessary for each shoulder in broad-shouldered patients.

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20
Q

AP - Scapula

A

Perpendicular to the midscapular area at a point approximately 2 inches (5cm) inferior to the coracoid process

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21
Q

Lateral - Scapula

A

Perpendicular to the midmedial border of the protruding scapula

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22
Q

AP - Toes

A

Perpendicular through the third (or digit in question) MTP joint when demonstration of the joint spaces is not critical. To open the joint spaces, either direct the central ray 15 degrees posteriorly though the third MTP joint, or if the 15-degree foam wedge is used, direct the central ray perpendicularly.

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23
Q

AP oblique - Toes

A

Perpendicular and entering the third (or digit in question) MTP joint

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24
Q

Lateral - Toes

A

Perpendicular, entering the IP joint of the great toe or the proximal IP joint of the lesser toes

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25
AP axial - Foot
10 degrees toward the heel entering the base of the third metatarsal
26
AP oblique (medial rotation)/Lateral - Foot
Perpendicular to the base of the third metatarsal
27
AP axial WB - Foot
Angled 10 degrees toward the heel is optimal. A minimum of 15 degrees is usually necessary to have enough room to position the tube and allow the patient to stand. The central ray is position between the feet and at the level of the base of the third metatarsal.
28
Lateral - Foot
Perpendicular to a point just above the base of the third metatarsal
29
AP/AP oblique (medial rotation)/Lateral - Ankle
Perpendicular through the ankle joint at a point midway between the malleoli
30
Plantodorsal axial - Calcaneus
Directed at a cephalic angle of 40 degrees to the long axis of the foot. The central ray enters the base of the third metatarsal
31
Lateral - Calcaneus
Perpendicular to the calcaneus. Center about 1 inch (2.5cm) distal to the medial malleolus. This will place the central ray at the subtalar joint
32
AP/Lateral - Tib/Fib
Perpendicular to the center of the leg
33
AP/AP oblique (medial & lateral rotation) -Knee
Directed to a point ½ inch (1.3cm) inferior to the patellar apex. Variable depending on the measurement between ASIS and the tabletop, as follows: <19cm – 3 to 5 degrees caudad 19 to 24 cm – 0 degrees >24cm – 3 to 5 degrees cephalad
34
PA/PA oblique (medial/lateral) - Knee
Directed at an angle of 5 to 7 degrees caudad to exit a point ½ inch (1.3cm) inferior to the patellar apex. Because the tibia and fibula are slightly inclined, the central ray will be parallel with the tibial plateau
35
Lateral - Knee
Directed to the knee joint 1 inch (2.5cm) distal to the medial epicondyles at an angle of 5-7 degrees cephalad.
36
AP WB - Knee
Horizontal and perpendicular to the center of the IR, entering at a point ½ inch (1.3cm) below the apices of the patellae
37
AP (intercondyloid fossa) - Knee
Perpendicular to the long axis of the lower leg, entering the knee joint ½ inch (1.3cm) below the patellar apex
38
PA axial (intercondyloid fossa) - Knee
Perpendicular to the lower leg, entering the midpoint of the IR
39
AP/PA/Lateral - Patella
Perpendicular through the patella
40
Tangential - Knee/Patella
Angled 45 degrees cephalad and directed through the patellofemoral joint
41
AP/Lateral - Femur
Perpendicular to the midfemur and centered to IR
42
AP - Hip
Perpendicular to the femoral neck; place the CR approximately 2.5 inches (6.4cm) distal to a line drawn between the ASIS and the pubic symphysis
43
AP (frog legs) - Hip
Parallel with the femoral shafts. According to the Cleaves method the angle may vary between 24-45 degrees depending on how vertically the femora can be placed
44
Lateral (Lauenstein) - Hip
Perpendicular through the hip joint, which is located midway between the ASIS and the pubic symphysis
45
Axiolateral (X-table) - Hip
Perpendicular to the long axis of the femoral neck. The CR enters the groin at a point midway between the anterior and posterior surfaces of the upper thigh and passes through the femoral neck, which is about 2.5 inches (6.4cm) below the point of intersection of the localization lines described previously
46
AP - Pelvis
Perpendicular to the midpoint of the IR. Adjust the position of the IR so that its upper border projects 1- 1 ½ inches (2.5-3.8cm) above the crest
47
AP axial (inlet & outlet) - Pelvis
Inlet: Directed 40 degrees caudad, entering the midline at the level of ASIS Outlet: Directed 20-35 degrees cephalad (for men) or 30-45 degrees cephalad (for women) and entering the midline at a point 2 inches (5 cm) inferior to the superior border of the pubic symphysis
48
Acetabulum AP obliques (Judet) - Pelvis
Perpendicular to the IR and entering at the pubic symphysis.
49
AP (C1-C2 open mouth) - C-spine
Perpendicular to the center of the IR and entering the midpoint of the open mouth. Center the IR at the level of the axis
50
AP axial - C-spine
Directed through C4 at an angle of 15-20 degrees cephalad. The CR enters at or slightly inferior to the most prominent point of the thyroid cartilage.
51
Lateral - C-spine
Horizontal and perpendicular to C4
52
AP/PA axial obliques (LPO/RPO & LAO/RAO) - C-spine
Directed to C4 at a cephalad angle of 15-20 degrees so that the central ray coincides with the orientation of the foramina
53
Lateral hyperflexion/extension - C-spine
Horizontal and perpendicular to C4
54
Lateral cervicothoracic (Swimmer) - C/T-spine
Directed to C7-T1 intervertebral disk-space. Perpendicular if the shoulder away from the IR is well depressed or at a caudal angle of 3-5 degrees when the shoulder is immobile
55
AP - T-spine
Perpendicular, center of the CR should be approximately halfway between the jugular notch and the xiphoid process. Place the superior edge of the IR 1 ½ - 2 inches (3.8 – 5 cm) above the shoulders on the average patient
56
Lateral - T-spine
Perpendicular at the level of T7. The CR enters the posterior half of the thorax. Place the superior edge of the IR 1½ - 2 inches (3.8 – 5 cm) above the relaxed shoulders
57
AP - L-spine
Perpendicular to the IR at the level of the iliac crests (L4) for a lumbosacral examination. Center at L3 for the lumbar spine alone (3.8cm above iliac crests)
58
Lateral - L-spine
Perpendicular at the level of the crest at the ilium (L4) if we want to include both lumbar spine and sacrum or 1.5 inches (3.8cm) above iliac crests (L3) when we want only the lumbar spine.
59
PA obliques (LAO/RAO) - L-spine
Perpendicular to enter L3 (1-1.5 inches [2.5 – 3.8cm] above the crest of the ilium). The CR enters the elevated side approximately 2 inches (5 cm) lateral to the palpable spinous process (for the lumbar region) or perpendicular to enter the elevated side 2 inches (5 cm) lateral to the palpable spinous process and to a point midway between the iliac crest and the ASIS
60
AP obliques (LPO/RPO) - L-spine
Perpendicular to enter 2 inches (5cm) medial to the elevated ASIS and 1 to 1.5 inches (2.5-3.8 cm) above the iliac crest (for the lumbar region) or perpendicular to enter 2 inches (5cm) medial to the elevated ASIS and then up to a point midway between the iliac crest and the ASIS (for L5 – S1)
61
Lateral L5-S1 - L-spine
Center 2 inches (5cm) posterior to the ASIS and 1.5 inches (3.8cm) inferior to the iliac crests
62
AP axial - SI joints
Center midline at a level 1.5 cm below the crest with an angulation of 30-35 degrees
63
AP obliques (LPO/RPO) - SI joints
Perpendicular, entering 1 inch (2.5cm) medial to the elevated ASIS
64
AP axial - Sacrum
Direct the CR 15 degrees cephalad and center it to a point 2 inches (5cm) superior to the pubic symphysis
65
Lateral - Sacrum
Perpendicular and directed to the level of the ASIS and to a point 3.5 inches (9cm) posterior
66
AP axial - Coccyx
Direct the CR 10 degrees caudad and center it to a point about 2 inches (5cm) superior to the pubic symphysis
67
Lateral - Coccyx
Perpendicular and directed toward a point 3.5 inches (9cm) posterior to the ASIS and 2 inches (5cm) inferior
68
PA oblique (RAO) - Sternum
Perpendicular to the IR. The CR enters the elevated side of the posterior thorax at the level of T7 and approximately 1inch (2.5cm) lateral to the midsagittal plane
69
Lateral - Coccyx
Perpendicular to the center of the IR and entering the lateral border of the midsternum
70
AP - Ribs
Perpendicular to the center of the IR. Place the IR lengthwise 1 ½ inches (3.8cm) above the upper border of the relaxed shoulders
71
PA - Ribs
Perpendicular to the center of the IR. If the IR is positioned correctly, the CR is at the level of T7
72
PA/AP obliques - Ribs
Perpendicular to the center of the IR. Center IR with the top 1 ½ inches (3.8cm) above the upper border of the shoulder to image ribs above the diaphragm or to a point halfway between the xiphoid process and the lower rib margin to image ribs below the diaphragm
73
PA - SC joints
Perpendicular to the center of the IR and entering T3
74
PA obliques - SC joints
Perpendicular to the sternoclavicular joint closest to the IR. The CR enters at the level of T2-3 (about 3 inches [7.6cm] distal to the vertebral prominens) and 1-2 inches (2.5-5cm) lateral from the midsagittal plane.
75
AP axial (Towne) - Skull
Directed through the foramen magnum at a caudal angle of 30 degrees to the OML or 37 degrees to the IOML. The CR enters approximately 2 ½ inches (6.3cm) above the glabella and passes through the level of the EAM
76
PA axial (Caldwell) - Skull
Direct the CR to exit the nasion at an angle of 15 degrees caudad
77
Lateral - Skull
Perpendicular, entering 2 inches (5 cm) superior to the EAM
78
Parietoacanthial (Waters) - Sinuses
Horizontal to the IR and exiting the acanthion
79
PA axial (Caldwell) - Sinuses
Directed horizontal to exit the nasion. The 15 degrees relationship between the CR and the OML remains the same for both techniques.
80
Lateral - Sinuses
Directed horizontal, enter the patient’s head ½ - 1inch (1.3 – 2.5cm) posterior to the outer canthus
81
PA axial (Caldwell) - Facial bones
Directed the CR to exit at the nasion at an angle of 15 degrees caudad.
82
Parietoacanthial (Waters) - Facial bones
Perpendicular to exit the acanthion
83
Acanthioparietral (Reverse Waters) - Facial bones
Perpendicular to enter the acanthion and centered to the IR
84
Lateral - Facial bones
Perpendicular and entering the lateral surface of the zygomatic bone hallway between the outer canthus and the EAM
85
PA axial - Orbits
Directed through the center of the orbits at a caudal angle of 30 degrees. This angulation is used to project the petrous portions of the temporal bones below the inferior margin of the orbits
86
Parietoacanthial (modified Waters) - Orbits
Perpendicular through mid-orbits
87
Lateral - Orbits
Perpendicular through the outer canthus
88
Parietoacanthial (modified Waters) - Nasal bones
Perpendicular to enter just above the base of the skull and exit at the nose
89
Lateral - Nasal bones
Perpendicular to the bridge of the nose at a point ½ inch (1.3cm) distal to the nasion
90
AP axial (modified Towne) - Mandible
Directed 35 degrees caudad, centered midway between the TMJs, and entering at a point approximately 3 inches (7.6cm) above the nasion
91
PA axial - Mandible
Directed midway between the TMJs at an angle of 30 degrees cephalad
92
AP - Mandible
Perpendicular to enter the acanthion
93
PA - Mandible
Rami: Perpendicular to exit the acanthion Body: Perpendicular to the level of the lips *Position of head varies between the two
94
Axiolateral/Axiolateral obliques - Mandible
Directed 25 degrees cephalad to pass directly through the mandibular region of interest
95
AP supine - Abdomen
Perpendicular to the IR at the level of the iliac crests for the supine position
96
AP erect - Abdomen
Horizontal and 2 inches (5 cm) above the level of the iliac crests to include the diaphragm
97
L Lateral decubitus - Abdomen
Horizontal and perpendicular to the midpoint of the IR. Adjust the height of the IR to include side down when intraperitoneal fluid is suspected and to include side up when pneumoperitoneum is suspected.
98
AP - Soft tissue neck
Perpendicular to the laryngeal prominence
99
Lateral - Soft tissue neck
Perpendicular to the IR, center at the level of the laryngeal prominence.
100
AP - Chest
Perpendicular to the long axis of the sternum and the center of the IR. The CR should enter about 3 inches (7.6cm) below the jugular notch.
101
PA - Chest
Perpendicular to the center of the IR. The CR should enter at the level of T7 (inferior angle of scapula)
102
Lateral - Chest
Perpendicular to the center of the IR. The CR should enter at the level of T7 (inferior angle of scapula)
103
AP - KUB
Perpendicular to the IR at the level of the iliac crests

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