XRAY POSITIONING PROCEDURES Flashcards
PA CHEST
-SID:- 72’ inches
-CR:- perpendicular to center of IR & enters at MSP and level T7
-Patient position:- upright, chin up,weight equally distributed on both feet, flex elbow and rest back of hands low on the hips, depress shoulder rolled forward. -Exposure should be made at the end of second deep inspiration.
-IR size- CR plate 14*17 inch lengthwise(cross wise for hypersthenic patient), Top of IR 1.5-2 inches above shoulder
-part position:-patient face vertical to grid device with MSP centered to film at level of T7
Tube angle: 90°
-Structures: lung apices, 10 posterior ribs above diaphragm, scapula rotated lateral to the lung field. Costophrenic angles visible
Lateral (upright) Chest
SID:-72 inches.
-CR:- 90°, directed perpendicularly to IR, CR enters patient on MCP at T7. true lateral position, MSP parallel with IR, MCP perpendicular to IR
-Patient position:-erect, left lateral is routinely used to minimize magnification of heart, shoulder in contact with grid, extend arm over head, flex elbow, rest for arms on head, make sure patient in not leaning side way or bending forward to ensure no rotation of thorax and hips.
-IR:-CR plate 14*17inch lengthwise, top of IR 1.5-2 inch above shoulder.
-part position: Midcoronal plane centered to film at level of T7.
-Tube angle: 90°
-Exposure made at the end of second deep inspiration.
-Structures: apices and costophrenic angles, sternum laterally, right and left posterior ribs superimposed, hilum in center of film
PA OBLIQUE CHEST
RAO & LAO
-SID:-72 inches
-CR:- 90° ,enters midway between the elevated side and spine at level of T7 (inferior angle of scapula)
-IR: 14x17 LW, top of IR 1.5”-2” above depressed vertebra prominens.
-Patient position:- upright ,PA position,Rotate pt’s left side 45 away from IR for RAO and right side away from IR for LAO
-Part position: Center thorax to IR to ensure both left and right sides of the chest are included on IR. Back of hand on hip of side closest to IR, raise arm to shoulder level on side away from IR
-Exposure is made after second full inspiration.
-Structures: lung field of side furthest from IR:
–RAO: left lung
–LAO: Right lung
Side closest to the IR is superimposed by spine
AP OBLIQUE
RPO & LPO
-SID: 72”
-CR: 90°, entering at the level of T7 which is approx. 3” below the jugular notch.
-IR: 14x17 LW, top of IR 1.5”-2” above depressed vertebra prominens.
-Patient Position: Erect, AP position, rotate pt’s left side 45 away from IR for RPO. Rotate pt’s right side 45 away from IR for LPO.
-Part position: Center thorax to IR to ensure both left and right sides of the chest are included on IR. Back of hand on hip of side closest to IR, raise arm to shoulder level on side away from IR
-Structures: the lung field closest to the IR:
–RPO: right lung-right lung wide
–LPO: left lung-left lung wide
Side farthest to the IR is superimposed by the spine
AP OR PA DECUBITUS CHEST
-SID: 72”
-IR: 1.5”-2” inches beyond shoulder.
-CR- 90°, horizontal and perpendicular to center of IR, enter MSP at 3” below jugular notch for AP, OR T7 for PA
-Patient position:- lateral on right or left decubitus with thorax elevated on a radiolucent sponge., to demonstrate fluid , pt. Should lie on affected side(for free air on unaffected side), patient needs to be in position for 5 min to allow fluid to settle, air to rise,
-Part position- knees together with arms extended above the head. elevate body 2-3 inches if lying on affected side , extend arms over head, surface of chest or back against vertical grid
-Exposure made on second full inspiration
-Structures: Both lungs include apices and costopherenic angles.
To rule out free air: side up is side of interest
To rule out fluid: side down is side of interest.
AP CHEST
-SID: 72” if possible to MSP at level 3” below jugular notch
-CR:- perpendicular to long axis of sternum and center of IR, enters 3 inches below jugular notch
-IR: 14”X17” LW, top of IR 1.5”-2” above depressed shoulders.
-Patient position:- supine , seated , upright, when patient is too ill to stand. Shoulders in same plane and depressed. flex elbow, pronate hand, place hand on the hips to draw scapula laterally, adjust shoulder into same transverse plane.
-Part position:- center MSP to IR.
-Exposure is made after second full inspiration.
-Structures: INCREASED MAGNIFICATION OF THE HEART AND FORESHORTENED LUNGS. lung apices, 10 posterior ribs above diaphragm, scapula rotated lateral to the lung field. Costophrenic angles visible
AP LINDBLOM/APICAL LORDOTIC
-SID:-72”
-CR:- 90°, perpendicular to IR, enters MSP at mediastinum 3-4 inches below jugular notch.
-IR: 14”X17” LW, top of IR 3” above the shoulders.
-Patient position:-upright facing tube, approximately 1 foot in front of grid, top of IR 3” above shoulder
-Parts position:-MSP centered to midline of grid, patient lean backward until shoulder rest on grid
-Exposure made after second full inspiration
-Structures: clavicles projected superiorly to better demonstrate the apices. Clavicles and posterior ribs appear horizontal.
AP AXIAL CHEST
-CR: 15°-20° cephalad entering the level of the IR at T2
-IR: 14”x17” LW, IR centered to level of T2 (sternal notch)
-Patient position: erect, facing xray tube.
-Part-Position: MSP centred to IR at level of T2.
-Structures: superior lung field with clavicles projected superior to better demonstrate the apices. Clavicles and posterior ribs appear horizontal.
AP ABDOMEN KUB
-SID: 40”
-CR: 90° to center of IR, approx. at level of Iliac crest (L4-L5)
-IR: 14”x17” LW, Right marker on lower Right.
-Patient Position: Supine, MSP centered to table, arms at patient’s sides, away from the body to avoid casting shadows.
-Part Position: place support under knees, Center the IR at level of iliac crest.
-Exposure: at end of expiration.
-Structures: right and left iliac crest, pubic symphysis to past T12, all 5 vertebrae, psoas muscle, size and shape of liver, spleen, kidneys and intraabdominal calcifications or tumor masses.
Upright Abdomen
-SID: 40”
-CR: 90° horizontal beam to the MSP, approx. 2” above level of Iliac crest (L4-L5)
-IR: 14”x17” LW
-Patient Position: erect, legs slightly spread, distribute the weight of body equally on both feet. Place back against grid . arms at sides away from body.
-Part Position: MSP centered to the IR. No rotation of shoulders or pelvis.
-Exposure: at end of expiration.
-Structures:Diaphragm, abdominal masses, air fluid levels, accumulation of intraperitoneal air under the diaphragm are best demonstrated in this position.
Abdomen Lateral Decubitus-both sides should be imaged. Left SIDE ONLY
-SID: 40”
-CR: 90° Horizontal beam to the MSP, approx. level of the iliac crest.
-IR: 14”x17” CW
-Patient Position: Place pt on radiolucent pad to elevate torso. Pt lying on left side. Back against grid, raise arms away from body and knees slightly flexed.
-Part Position: Adjust pt to the center of IR. Make sure there is no rotation of the torso. If possible, pt should be in left lateral decubitus position for at least 5 min to image any free gas.
-Structures: Liver, spleen, kidneys, Left lateral decubitus is most valuable for demonstrating air or fluid levels. Lateral decubitus is performed when the pt is unable to stand for the upright abdomen xray.
PA fingers 2-5 (ROUTINE FINGERS 2-5)
-SID: 40” table top
-CR: 90° to the PIP (proximal interphalangeal joints) of the affected finger
-IR: 10”x12” LW. Collimate on 4 sides to area of interest.
-Patient position: Seat pt. at end of table. Pt. sits sideways w/affected forearm on table. Elbow flexed 90°. Pronate hand, separate and extend fingers.
-Part position: Center the PIP (Proximal interphalangeal Joint) of affected finger to center of unmasked portion of the IR.
-Structures: Entire finger to include
-distal
-proximal
-phalanges
-distal adjoining metacarpal.
-open DIP(distal interphalangeal joint),PIP(proxiaml interphalangeal joint) and MCP(metacarpophalangeal joint) joints
Lateral 2nd finger; internally rotate for a mediolateral projection
(ROUTINE FINGERS 2-5)
-SID: 40”
-CR: 90° to PIP of 2nd digit
-IR: 10”x12” LW. Collimate on 4 sides to area of interest.
-Patient position: Seat pt. at end of table. Pt. sits sideways w/affected forearm on table, support elbow on sponge. Internally rotate hand, radial side down, extend 2nd finger, fold others into fist.
-Part position: Center the PIP 2nd finger to center of unmasked portion of IR
-Structures: Entire 2nd finger to include
-Distal
-Middle Proximal phalanges with open DIP,PIP,MCP joint spaces in true lateral position.
PA HAND (ROUTINE HAND)
-SID: 40”
-CR: 90° to 3rd MCP (metacarpophalangeal joint)
-IR: 10”x12” LW. Collimate on 4 sides to area of interest.
-Patient Position: Seat pt. at end of table w/elbow flexed 90°; affected hand pronated on IR w/fingers separated, center 3rd MCP to IR
-Part Position: FIngers extended w/palmar surface of hand flat on IR
-Structures: All phalanges to distal radius & ulna
PA OBLIQUE HAND (ROUTINE HAND)
-SID: 44”
-CR: 90° to 3rd MCP (metacarpophalangeal joint)
-IR: 10”x12” LW. Collimate on 4 sides to area of interest.
-Patient position: Seat pt. at end of table w/elbow flexed 90°; pronate hand, then rotate laterally 45°. Center 3rd MCP to IR.
-Part Position: Fingers extended on step block sponge opens PIP & DIP. Fingers in “OK” position demonstrates metacarpals.
-Structures: All 5 phalanges to distal radius & ulna
LATERAL HAND/LATEROMEDIAL PROJECTION/FAN LATERAL (ROUTINE HAND)
-SID: 40”
-CR: 90° to 2nd MCP (metacarpophalangeal joint)
-IR: 10”x12” LW. Collimate on 4 sides to area of interest.
-Patient position:Seat pt. at end of table w/elbow flexed 90°; affected hand resting on ulnar surface, center 2nd MCP to IR.
-Part position: Extended fingers, thumb abducted & parallel to IR to R/O foreign body or metacarpal fx. Fan lateral optional for phalanges.
-Structures: Superimposed phalanges, metacarpals, distal radius and ulna. Fan lateral demonstrates the phalanges.
AP THUMB (ROUTINE THUMB)
-CR: 90° TO 1ST MCP
-IR: 8”X10” CW, Divided for 2 or 3 views
-Patient Position: seat pt. at end of table w/hand in extreme internal rotation, support elbow. Have pt. hold extended digits 2-5 & 5th metacarpal back w/opposite hand.
-Part position: Center long axis of thumb w/midline of field of interest in true AP position. Center 1st MCP to IR
-Structure: Include from the distal phalanx to the trapezium..
LATERAL THUMB (ROUTINE THUMB)
-CR: 90° TO 1ST MCP
-IR8”X10” CW DIVIDED FOR 2 OR 3 VIEWS
-Patient Position: Seat pt. at end of table w/hand pronated on IR. Place midline of IR parallel w/long axis of thumb
-Part position: Flex fingers 2-5 to place the thumb in a true lateral position. Center 1st MCP to IR
-Structure: Include from the distal phalanx to the trapezium
PA OBLIQUE THUMB (ROUTINE THUMB)
-CR: 90° TO 1ST MCP
-IR: 8”X10” CW Divided for 2 or 3 views
-Patient position: Seat pt. at end of table w/hand pronated on IR. Place midline of IR parallel w/long axis of abducted thumb.
-Part position: Normal position of thumb is in an oblique position. Center 1st MCP to IR.
-Structures: Include from the distal phalanx to the trapezium.
PA WRIST ( ROUTINE WRIST)
-CR: 90° To Midcarpal area.
-IR: 10”x12” LW. Collimate on 4 sides to area of interest.
-Patient Position: seat pt. at end of table w/elbow flexed 90°. Hand pronated, midcarpal area centered to IR.
-Part position: Flex fingers to place in contact with the IR.
-Structures: Proximal 1/2 of metacarpals, all 8 carpal bones, distal radius & ulna.
LATERAL WRIST LATEROMEDIAL PROJECTION
(ROUTINE WRIST)
-CR: 90° To midcarpal area
-IR: 10”x12” LW, Collimate on 4 sides to area of interest.
-Patient Position: Seat pt. at end of table w/elbow flexed 90°, Hand resting on ulnar surface w/midcarpal area centered to IR.
-Part position: Extend relaxed fingers. Thumb abducted & parallel to IR, rotate wrist 5° posteriorly for true lateral.
-Structure: Superimposed distal 1/2 of metacarpals, radius & ulna. Trapezium,lunate & pisiform best demonstrated.
PA OBLIQUE WRIST (ROUTINE WRIST)
-CR: 90° to midcarpal area
-IR: 10”x12” LW. Collimate 4 sides to area of interest.
-Patient Position: Seat pt. at end of table w/elbow flexed 90°. Rotate radial side laterally 45° from pronated position. Midcarpal area centered to IR.
-Part position: Fingers extended on step block sponge opens PIP,DIP. Fingers in “OK” position demonstrates metacarpals.
-Structures: Proximal 1/2 of metacarpals, distal radius & ulna. Trapezium & Scaphoid best demonstrated on lateral side of wrist.
