FINAL PRACTICUM Flashcards by Jennifer Sanchez

AP Toes

IR 8x10 portrait, 40 SID
Pt supine or seated on table, knee flexed, plantar surface in IR. Center MTPJ of affected digit to IR.
CR: angle 10-15º toward the calcaneus entering MTPJ in question. Collimation to all four sides, including part of the digits adjacent to one being imaged. Include distal half of MT

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Lateral Toes

IR 8x10 portrait (landscape for more than one image), 40 SID
**- Mediolateral for digits 4-5
Lateromedial for digits 1-3**
Pt supine or seated. Rotate affected leg and foot. Adjust IR to center and align long axis of affected toe to CR & long axis of IR being exposed. Use tape/gauze, or tongue depressor to separate & flex unaffected toes t prevent superimposition.
CR perpendicular directed to IPJ of 1st digit & PIP for digits 2-5

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AP Axial Foot

IR 8x10, 40 SID
Pt seated or supine flex knee rest plantar surface on IR
CR 10-15º angle posteriorly entering 3rd MTP
Collimate 1” on all sides of the toes to include distal ends of metatarsals

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Oblique Foot

IR 10x12 portrait, 40 SID
Pt supine or sitting, flex knee with plantar surface on table with body turned slightly away from side of injury. Align and center ling axis of foot to CR & long axis of IR. Rotate foot medially to place plantar surface 30-40º to plane of IR. The general plane of the dorsal surface of foot should be parallel to IR & perpendicular to CR. Use sandbags or sponge for support if necessary
CR perpendicular to 3rd MT base. Collimate to outer margins of ST on 4 sides (approx. 1” each side)

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Lateral Foot

IR 10x12 portrait (14x17 may be used if patient’s foot is large), 40 SID
Place patient in lateral recumbent position. Flex knee of affected limb about 45º, place opposite leg behind affected leg to prevent over-rotation. Dorsiflex foot for a true lateral foot and ankle. Place leg and knee support so plantar surface is perpendicular to IR (do not over-rotate). Align long axis of foot to long axis of IR center base of MT’s to IR.
CR perpendicular to medial cuneiform (at level of 3rd MT base). Collimate to skin margins & 1” proximal to ankle joint (approx. 1” all sides).

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Plantodorsal Axial Calcaneus

IR 8x10 Portrait, 40 SID
Pt seated or supine with leg fully extended. Center and align ankle joint to CR and portion of IR being exposed. Dorsiflex foot so plantar surface is near perpendicular to IR.
CR angle 40º cephalic to long axis of foot entering base of third MT exiting at level distal to lateral malleolus. Collimate close to region of calcaneus

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Lateral Calcaneus

IR 8x10 portrait, 40 SID
Pt in seated or lateral recumbent position. Place uninjured leg behind injured. Center calcaneus to CR and IR with long axis of foot parallel to plane of IR. Support knee and leg as needed to place plantar surface parallel to IR. Dorsiflex foot so plantar surface is at a right angle to leg
CR perpendicular to IR, directed to a point 1” inferior to medial malleolus. Collimate to include distal ankle joint and all of calcaneus.

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AP Ankle

IR 10x12 IR landscape, 40 SID
Pt supine, legs fully extended. Center ankle joint to CR and long axis of IR. Dorsiflexion. Ensure lower leg is not rotated. Intermalleolar line should not be parallel
CR enters perpendicular to midpoint between malleoli. Collimate to lateral ST margins and include prox. MT and distal tib/fib

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Mortise Oblique Ankle

IR 10x12 portrait, 40 SID
Place pt supine or seated with leg extended. Center and align ankle with CR and IR. Do not dorsiflex unless protocol of site or DR. preference. Internally rotate entire leg and foot about 15-20º until intermalleolar line is parallel with IR.
CR perpendicular to IR midway between malleoli. Collimate to lateral ST and include distal tib/fib and prox. ½ MT

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Lateral Ankle

IR 10x12 IR portrait, 40 SID
Center and align ankle with CR and IR (long axis). Place support under knee for true lateral. Dorsiflex foot.
CR perpendicular to medial malleolus. Collimate to include distal tib/fib and mid MT area (include 5th MT tuberosity)

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AP Tib/Fib

IR 14x17 portrait (or diagonally), 48” SID
Pt supine with leg extended fully. Align pelvis, knee & leg to true AP position (no rotation). Dorsiflex foot 90º. Ensure ankle and knee joints are 1-2” from either end of IR to prevent divergent rays from projecting anatomy off the image. If leg will not fit on IR, do 2 projections, use smaller IR to include other joint.
CR perpendicular to midpoint of lower leg. Collimate to include as much of the knee and ankle joint as possible.

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Lateral Tib/Fib

IR 14x17 portrait or diagonal, 48 SID
Pt in lateral recumbent position on affected side. Place unaffected leg behind (or across) affected leg. (across works well for knee). Ensure true lateral position by evaluating plane of patella & have it perpendicular with IR. Ensure 1”-2” of knee and ankle joint on IR for divergent rays.
CR perpendicular to midpoint of tib/fib

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AP Knee

IR 10x12 portrait, 40 SID
Pt supine with no rotation of pelvis. Align & center leg and knee to CR, and table or IR. Rotate leg internally 3-5º for true AP. Average side patient CR will be perpendicular (19-24 cm measured at ASIS to table top)
**- ASIS to TT <19 cm 3-5º caudal
ASIS to TT >25 cm3-5º cephalic***
CR enters ½” distal to patellar apex (knee joint)

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Lateral Knee (mediolateral projection)

IR 10x12 portrait, 40 SID
Lateral recumbent position. Rotate pt onto affected side and support unaffected leg posterior to affected leg (or cross anterior to affected leg). Flex knee 20-30º. Adjust rotation of body until leg is in true lateral position-femoral epicondyles superimposed. Plane of patella perpendicular to IR. Align and center leg and knee to CR and table or IR
CR 5-7º cephalic directed 1” below medial epicondyle.

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AP Medial Oblique Knee

IR 10x12 portrait, 40 SID
Pt supine with entire body and leg rotated partially away from side of interest. Support under elevated hip. Align and center leg and knee to CR and midline of table or IR. Rotate entire leg internally 45º- interepicondylar line should be 45º to plane or IR.
CR (most likely) 3-5º cephalic entering ½” distal to patellar apex at midpoint of knee. Collimate to ST margins with full collimation at ends to IR borders to include maximum femur and tib/fib.

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Settegast Knee

IR 8x10 portrait, 40 SID
PT prone/supine/ or sitting. Flex knee to a minimum of 90º.
Direct CR tangential (15-20º from lower leg) to patellofemoral joint space. Collimation.

AP Femur

IR 14x17 lengthwise (portrait), 40 SID
Pt supine with femur centered to midline of table or stretcher. Rotate leg internal 5º for distal femur and 15-20º for proximal femur. Condyles should be parallel to IR even if proximal or distal. Ensure knee joint is included on IR (2” of knee joint).
CR perpendicular to IR and femur, direct to midpoint of IR. Overlap 2-3” of shaft. Marker placed lateral, in thinnest area of ST shadow

Lateral Femur

IR 14x17 portrait, 40 SID
Pt in lateral recumbent on affected side (supine if x-table is performed). Flex knee 45º, pt on affected side. Align femur to midline of table or IR. Place unaffected leg behind patient.
CR perpendicular to femur and directed to midpoint of IR
Adjust IR to include 2” of knee joint. Collimate on both sides. MARKER ANTERIOR FOR LATERAL

AP Pelvis

IR 14x17 landscape. Minimum 40 SID (can use more distance for a larger pelvis to project divergent rays & decrease magnification)
Pt supine, arms by side or on chest, can be done upright to evaluate joint spaces. Align MSP of pt to center of bucky/IR. Ensure pelvis is not rotated (ASIS equal). Separate legs and feet, internally rotate WHOLE LOWER EXTREMITY 15-20º. Use support devise if patient can’t hold position (tape/sandbags). Suspend respiration
CR perpendicular to IR directed midway between between the level of ASIS & pubic symphysis (2” below ASIS). Ensure top of crest is in light field. Collimate to 4 sides of anatomy

Bilateral Cleaves- Pelvis

IR 14x 17 landscape, minimum 40 SID
Pt supine, align patient to midline of table/IR. Ensure no rotation by ASIS equal distance to table top. Flex both knees 90º. Place plantar surfaces of feet together and abduct femora 40-45º from vertical. Center CR at level of femoral heads, top of IR 1” above iliac crests. Ensure both femora are abducted equal amounts. Suspend respiration.
CR perpendicular to IR, direvted to a point 3” below level of ASIS (1” below symphysis pubis).

AP Hip

IR 10x12, 40 SID
Pt supine, arms by side or on chest. Locate femoral neck and align to CR and midline of table/IR. Ensure no rotation of pelvis (palpate ASIS). Rotate affected leg 15-20º internally. Suspend respiration.
CR perpendicular to femoral neck (femoral neck 1-2” medial & 3-4” distal to ASIS). 2 sided collimation at least.

Lateral Hip

IR 10x12 landscape (can be done portrait, depending on patient), 40 SID
Pt supine, align affected hip with CR, midline of table or IR. Flex knee and hip of affected side, sole of foot against inside of opposite leg, as near knee as possible. Abduct femur 45º from vertical (optimal is 20-30 º to prevent foreshortening), angle sponge under knee, sole of foot next to other tib/fib. Center affected femoral neck to midline of CR & IR. 1-2” medial, 3-4” distal. Suspend respiration
CR perpendicular to IR, directed to midfemoral neck. Collimate to all 4 sides of interest

AP Axial C-Spine

IR 10x12, 40 SID
Pt supine or upright, arms by sides. Align MSP to CR and IR, TT or bucky. Adjust head so a line from lower margin of upper incisors to mastoid tips are perpendicular to IR. Ensure no rotation of head or thorax. Suspend on exhalation
CR angle 15-20º cephalic to open up joint spaces due to superior vertebral body projecting inferiorly. CR enters C4 (Adams Apple). Collimate to ST margins

AP Axial Oblique C-Spine

IR 10x12 portrait, 72 SID
Pt erect, arms by side. Align MSP to CR, TT, IR, Bucky. Rotate patient 45º (may rotate head more to prevent superimposition of the mandible and upper vertebrae). Elevate chin to prevent mandible from superimposition of vertebrae, (AML) parallel with floor. Suspend respiration
CR: RPO & LPO directed 15-20º cephalic to C4
Collimate to 4 sides of anatomy- soft tissue margins

Lateral C-Spine

IR 10x12 portrait, 72 SID Upright bucky
Position patient in lateral either sitting or standing with left shoulder against IR/bucky. Align MCP to CR and midline of IR- placing top of IR about 1-2” above EAM (top of ear attachment). Have patient relax and depress shoulders. Elevate chin so AML is parallel to floor. Suspend on full expiration
CR perpendicular to center of IR, entering C4 (upper level of thyroid cartilage). Collimate to 4 sides of anatomy (ST margins)

Open Mouth C-Spine

IR 8x10 IR portrait, 40 SID
Patient erect, arms by sides. Align MSP to CR and midline of the table/bucky/IR. Adjust head with mouth open so occlusal plane is perpendicular with IR lower margin of upper incisors to base of skull (mastoid tips). Ensure no rotation, mandibular angles and mastoid tips equidistance from IR
Last step: have patient open mouth by dropping jaw and resting tongue in lower jaw. Suspend on exhalation
CR perpendicular to center of open mouth, Center IR with CR. Tight collimation to all 4 sides approx. 5”x5”

AP Thoracic Spine

IR 14x17 lengthwise, 40 SID
Pt supine, arms by side, head towards anode side of table. Flex knees and hips to reduce thoracic curvature. Upright: arms by side, feet hip width apart, pt AP. Align MSP to TT, bucky, or IR
CR perpendicular to IR. Suspend respiration on expiration
CR directed to T7- 3-4” below jugular notch or 1-2” below sternal angle. Collimate to 2 sides of anatomy minimum.

Lateral Thoracic Spine

IR 14x17 portrait, 40 SID
Lateral recumbent or Erect: Lay patient on left side recumbent with knees and hips flexed, with support between knees. Place sponge under lumbar region for patients with broad shoulders
(or use 10-15º angle of CR)
Upright: have patient place feet hip width apart with left shoulder against bucky. Have patient hold on to devise or bend elbows and rest hands on head. Ensure no rotation of thorax by aligning scapulae and hips (or spinous processes)
CR perpendicular to long axis of thoracic spine directed to T7 (3-4” below jugular notch), can also use inferior angle of scapula. Orthostatic breathing

Swimmers Thoracic Spine

IR 10x12 IR portrait, 72 SID
Pt erect or supine (for trauma). Place patient in preferred erect position. Align MCP to CR and midline of bucky/IR. Place patients arm and shoulder closest to IR up, flexing elbow and resting forearm on head- left side. Position arm furthest from IR down and rotate slightly posterior to place humeral head post to vertebrae. Ensure no rotation of head and thorax. Suspend respiration on full expiration.
CR perpendicular to IR (slight caudal angle of 3-5º if shoulders can’t be separated). CR directed to T1- approx. 1” above jugular notch ant. and C-7 prominens posteriorly. Collimate on all 4 sides of anatomy.

AP Lumbar Spine

IR 14x17 lengthwise/portrait, 40 SID
Supine: lay patient supine on center of table, align MSP to center of IR/table. Flex knees to reduce lordotic curve (will help open intervertebral joint space). Ensure no rotation of pelvis and thorax (palpate ASIS)
Standing: have patient stand at wall bucky with MSP centered to IR, feet hip width apart. Ensure no rotation
CR perpendicular to IR directed to level of iliac crest. Collimate to 4 sides of anatomy. Suspend on expiration

AP Oblique Lumbar Spine

IR 14x17 portrait, 40 SID
Lay patient supine on table (can be done upright) with MSP along midline of IR/ bucky/ TT. Patient 45º rotation LPO/RPO. Place 45º sponge under patient for support. Suspend respiration on expiration
CR perpendicular entering 1-2” above iliac crest, 2” medial to upside ASIS. Collimate to 4 sides of anatomy (often required to include SI joints).

Lateral Lumbar Spine

IR 14x17 portrait, 40 SID
Supine: Patients left side closest to IR, MCP aligned with mid TT, flexed knees with support under knees. Radiolucent sponge under waist to keep spine lateral.
Upright: patient stand with feet hip width apart, ensure hips and thorax are not rotated.
CR level of iliac crest, just posterior to MCP

L5/S1 Lumbar Spine (Spot)

IR 8x10 IR, 40 SID
Use lead behind patient. Patient in left lateral recumbent (or upright) position. Align MCP to midline of TT/IR. Place radiolucent sponge under waist to place spine parallel to IR. No rotation of thorax or pelvis
CR perpendicular to IR if spine is parallel to IR (5-8º caudal if not). Entry point 1½” distal to iliac crest and 2” posterior to ASIS. Collimate to 5”x5”. Suspend respiration

AP Axial SI Joints

IR 10x12 portrait, 40 SID
Pt supine with legs extended and knees supported. Align MSP to CR and midline of TT/IR. Ensure no rotation of pelvis (ASIS equidistance from TT)
CR angle 30-35º cephalad directed 2” below ASIS. Collimate to 4 sides of interest. Suspend respiration

AP Oblique SI Joints

IR 10 x 12 portrait, 40 SID
Pt supine aligned msp to TT. Rotate body 25-30º posterior oblique with side of interest elevated (LPO for rt joint, RPO for left joint). Place angle sponge under elevated hip and flex elevated knee
Cr perpendicular to IR directed 1” medial to upside ASIS. Collimate to anatomy of interest.** Suspend respiration**

AP Axial- Sacrum

IR 10x12 portrait, 40 SID
Patient supine with arms at side (or across chest), legs extended with support sponge under knees. Align MSP to CR and midline of IR/ TT. No rotation by equal levels of ASIS
CR angled 15º cephalic directed 2” inferior to ASIS. Collimate to 4 sides of anatomy. Suspend respiration

Lateral Sacrum

IR 10 x 12 portrait
Lead masking behind patient. Patient in left lateral recumbent position knees flexed, support between knees. Align long axis of sacrum & coccyx to CR & midline of TT/IR
CR perpendicular to IR directed 3-4” posterior to ASIS
Suspend respiration

AP Axial Coccyx

IR 8x10 portrait, 40 SID
Pt supine with arms by side or across chest, legs extended with support under knees. Align MSP to midline of TT or IR, ensure no rotation of pelvis. Center CR to IR
CR 10º caudal directed 2” superior to pubic symphysis. Collimate to all 4 sides of anatomy. Suspend respiration

Lateral Coccyx

IR 8 x 10 portrait, 40 SID
Patient in lateral recumbent position with left side down and knees flexed, support between kneed. Ensure no rotation of pelvis. Align long axis of coccyx with CR & TT/IR
CR perpendicular to IR directed 3-4” posterior and 2” inferior to ASIS (@coccyx). Suspend respiration

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FINAL PRACTICUM Flashcards

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