All radiograph of skull are undertaken with reference to a series of palpable landmarks and recognized lines or planes of the skull.
Landmarks:
Lines:
Plane:
Clinical indication:
Skull fracture, trauma
Region:
Cranial vault, maxilla
Patient’s Position:
The patient is supine of upright straight depending on the case; in trauma cases the preferable position should be supine.
The back side of patient’s head is against the cassette
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed to glabella and parallel to the radiographic baseline (OML)
Grid:
Yes
Respiration:
Not related
Exposure factors:
75kVp 8-10mAs
Collimation:
Collimate laterally to all the skin margins, superiorly to include the skull and inferiorly to include maxilla.
Clinical indication:
Skull fracture, neoplastic processes and pagets disease
Region:
Frontal lobe, frontal and anterior ethmoid sinuses, internal auditory canals
Patient’s Position:
Erect:
The patient is standing or sitting facing the upright detector
Tell patient to touch his nose and forehead to the bucky
The OML and mid sagittal plane is perpendicular to the bucky
Make sure that there is no rotation of the head
Prone:
Place patient in position to the xray table
Rest the patient’s forehead & nose against the table
Align the mid sagittal plane perpendicular to the table
Make sure that there is no rotation of the head
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed perpendicular to the IR and centered to just after glabella
Grid:
Yes
Respiration:
Not related
Exposure factors:
75kVp 20mAs
Collimation:
Collimate laterally to all the skin margins, superiorly to include the skull and inferiorly to include maxilla
Clinical indication:
Skull fracture, neoplastic processes and pagets disease
Region:
Frontal bone, superior orbital fissure, frontal and anterior ethmoid sinuses, crista galli, superior orbital margins
Patient’s Position:
Erect:
The patient is standing or sitting facing the upright detector
Tell patient to touch his nose and forehead to the bucky
The OML and mid sagittal plane is perpendicular to the bucky
Make sure that there is no rotation of the head
Prone:
Place patient in position to the xray table
Rest the patient’s forehead & nose against the table
Align the mid sagittal plane perpendicular to the table
Make sure that there is no rotation of the head
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is angled 15° cauded and center towards the nasion exit
Grid:
Yes
Respiration:
Not related
Exposure factors:
75kVp 20mAs
Collimation:
Collimate laterally to all the skin margins, superiorly to include the skull and inferiorly to include maxilla
Clinical indication:
Skull fracture
Region:
Frontal lobe, superior orbital fissure, superior orbital margins, greater and lesser sphenoid wings, frontal and anterior ethmoid sinuses, crista galli
Patient’s Position:
Erect:
The patient is standing or sitting facing the upright detector
Tell patient to touch his nose and forehead to the bucky
The OML and mid sagittal plane is perpendicular to the bucky
Make sure that there is no rotation of the head
Prone:
Place patient in position to the xray table
Rest the patient’s forehead & nose against the table
Align the mid sagittal plane perpendicular to the table
Make sure that there is no rotation of the head
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is angled 25°-30° cauded and center towards the nasion exit
Grid:
Yes
Respiration:
Not related
Exposure factors:
75kVp 20mAs
Collimation:
Collimate laterally to all the skin margins, superiorly to include the skull and inferiorly to include maxilla
Clinical indication:
Skull fracture, pathology of the skull
Region:
Skull and foramen magnum
Patient’s Position:
Patient is in erect position or in supine in trauma cases
Place the patient so that their posterior skull touch the bucky
Patient’s chin is down until the OML is parallel to the floor and perpendicular to the IR
Mid sagittal plane is perpendicular to the IR
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is angled 30° caudal and is directed about 6cm superior to the glabella
Grid:
Yes
Respiration:
Not related
Exposure factors:
80kVp 20mAs
Collimation:
Collimate laterally to all the skin margins, superiorly to include the skull
Clinical indication:
Pathology of base of skull and sphenoid sinuses
Region:
Base of skull, sutures sphenoid sinus
Patient’s Position:
The patient is sitting AP position.
The infra-orbitalmeatal line should be parallel to the IR by vertex of the skull is centered to the IR by raising the patient’s head & chin.
The mid sagittal plane is perpendicular to the IR.
Cassette:
Size: 10’’x12’’ Orientation: Landscape
FFD/SID:
100cm
Central ray:
Central ray is towards the point midway between external auditory meatus and the point midway between angles of mandible.
The central ray is perpendicular to IR.
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 16-20mAs
Collimation:
Collimate laterally to include soft tissues and lateral border of skull, superiorly include mandible and inferiorly include occiput of the skull
Clinical indication:
Enlargement of sella turcica, empty sella syndrome, pituitary adenomas, non-pituitary tumors of sella turcica
Region:
Sella turcica
Patient’s Position:
The patient’s head is placed in true lateral position
Align the interpupillary line perpendicular to IR
Align mid sagittal plane parallel to the xray table
Place interorbitalmeatal line perpendicular to the front edge of IR
Cassette:
Size: 8’’x10’’ Orientation: Landscape
FFD/SID:
100cm
Central ray:
Central ray is towards the point between 2cm above and 2cm below to external auditory meatus (EAM)
The central ray is perpendicular to IR.
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 16-20mAs
Collimation:
Collimate to field size of approx. 4 inches /10cm square
Clinical indication:
Fracture, mastoiditis, tumor
Region:
Mastoid process, mastoid air cells
Patient’s Position:
Ask the patient to lie in prone position.
Place the patient’s head in true lateral position.
The inter-orbital line lies at right angle with the cassette.
The auricle of the ear near the film is folded forward.
Cassette:
Size: 8’’x10’’ Orientation: Landscape
FFD/SID:
100cm
Central ray:
The central ray is directed at an angle of 30° towards the feet. The central ray enters the skull above the ear at parietal region and passes through external auditory meatus proximal to film.
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 16-20mAs
Collimation:
Include all structures of temporal bone around mastoid process.
Clinical indication:
Inflammation of petrous ridge and mastoid air cell, tumor, foreign body
Region:
Temporal bone, mastoid air cells, internal auditory meatus, petrous ridge
Patient’s Position:
Patient is placed in erect or semi prone position.
Place the patient’s head in true lateral position.
The inter-pupillary line is perpendicular to IR.
Cassette:
Size: 8’’x10’’ Orientation: Landscape
FFD/SID:
100cm
Central ray:
The central ray is projected 12° cephaled towards the EAM
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 16-20mAs
Collimation:
Include all structures of temporal bone from petrous ridge to mastoid process.
Clinical indication:
Fractures, lesion
Region:
Foot
Patient’s Position:
The patient is seated on the xray table with, with the affected knee and hip flexed.
The sole of affected foot is placed on the cassette.
Cassette:
Size: 10”x12” Orientation: Portrait
FFD/SID:
100cm
Central ray:
The central beam is directed over the base of third metatarsal.
The xray tube is angulated 10°-15° cranially when the cassette is flat on the table.
Respiration:
Normal
Exposure Exposure factors:
60kVp 4mAs
Collimation:
Include proximal ankle and outer skin margins of foot.
Clinical indication:
Fracture, lesion
Region:
Foot
Patient’s Position:
The patient is seated on the xray table with, with the affected knee and hip flexed.
Rotate the patient’s leg medially until the plantar surface of the foot forms an angle of 30° to the plane of the IR.
Cassette:
Size: 10”x12” Orientation: Portrait
FFD/SID:
100cm
Central ray:
The central beam is perpendicular to the base of 3rd metatarsal.
Grid:
No
Respiration:
Not related.
Exposure Exposure factors:
60kVp 4mAs
Collimation:
Include proximal ankle and outer skin margins of foot.
Clinical indication:
Injury, mid foot non traumatic pain, fracture, dislocation, foreign body, effusion
Region:
Ankle
Patient’s Position:
The patient is supine or seated on the xray table with the affected limb fully extended.
Cassette should be placed under the ankle.
Flex the ankle and foot enough to place the long axis of foot in the vertical position.
Cassette:
Size: 10”x12” Orientation: Portrait
FFD/SID:
100cm
Central ray:
The central beam is perpendicular through the ankle joint at a point midway between the malleoli.
Grid:
No
Respiration:
Not related.
Exposure Exposure factors:
60kVp 1-2mAs
Collimation:
Collimate to the lateral skin margins, superiorly to the distal third of tibia fibula and inferiorly to the proximal aspect of metatarsals.
Clinical indication:
Injury, fracture, dislocation, foreign body, effusion
Region:
Ankle
Patient’s Position:
Patient is in recumbent position of affected side until the malleoli are superimposed vertically and tibia is parallel to the cassette.
Cassette:
Size: 10”x12” Orientation: Portrait
FFD/SID:
100cm
Central ray:
The central beam is perpendicular to the axis of the tibia.
Grid:
No
Respiration:
Not related.
Exposure factors:
60kVp 3-4mAs
Collimation:
Include the distal third of tibia and fibula and calcaneus and proximal metatarsal and also include the anterior and posterior skin margins.
Clinical indication:
Reduced joint spaces
Region:
Ankle
Patient’s Position:
The patient is supine or seated on the xray table.
Assist the patient by internally rotating the entire leg and foot together 15°-20° until the internal malleolar plane is parallel to IR.
Cassette should be placed under the ankle.
Grasp the distal femur area with one hand and the foot with other.
Cassette:
Size: 10”x12” Orientation: Portrait
FFD/SID:
100cm
Central ray:
The central beam is perpendicular to the ankle joint at a point midway between the malleoli.
Grid:
No
Respiration:
Not related.
Exposure factors:
60kVp 1-2mAs
Collimation:
Collimate to the lateral skin margins, superiorly to the distal third of tibia fibula and inferiorly to the proximal aspect of metatarsals.
Clinical indication:
Fractures, lesions
Region:
Calcaneus bone
Patient’s Position:
The patient is seated on the xray table with the affected leg is rotated medially until both at malleoli are equidistant from the film.
The ankle is dorsiflexed. The position maintained by bandage strap.
Cassette:
Size: 8’’x10” Orientation: Portrait
FFD/SID:
100cm
Central ray:
The central beam is directed to the midpoint of IR at a cephalic angle of 40° to the long axis of the foot. The central ray entered to the base of the 3rd metatarsal.
Grid:
No
Respiration:
Not related.
Exposure factors:
60-65kVp 10mAs
Collimation:
Include calcaneus bone.
Clinical indication:
Fractures, lesion, trauma, swelling, heel pain
Region:
Calcaneus bone
Patient’s Position:
The patient’s leg is rotated until the medial and lateral malleoli are superimposed vertically.
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Center 2.5cm distal to the medial and lateral with the vertical central ray perpendicular to the cassette.
Grid:
No
Respiration:
Not related.
Exposure factors:
60-65kVp 10mAs
Collimation:
Collimate to the lateral skin margins, superiorly to the distal third of tibia fibula and inferiorly to the proximal aspect of metatarsals.
Clinical indication:
Fractures, lesion
Region:
Leg
Patient’s Position:
The patient is either supine or sitting upright with both legs straight on the xray table. The ankle is dorsiflexed. The limb is rotated medially until the medial and lateral malleoli are equidistance from the cassette.
Cassette:
Size: 14’’x17’’ Orientation: Portrait or diagonal as per length of limb
FFD/SID:
100cm
Central ray:
Centering is towards the middle of the cassette with the central ray at 90° angle to both the long axis of the tibia and an imaginary line joining the malleoli.
Grid:
No
Respiration:
Not related.
Exposure factors:
60-65kVp 8-10mAs
Collimation:
Collimate laterally to the skin margins, superiorly to the knee joint and inferiorly to the ankle joint.
Clinical indication:
Fractures, lesion
Region:
Leg
Patient’s Position:
The patient lies laterally towards the affected side. The leg is rotated until the malleoli are superimposed vertically. The tibia may parallel to the cassette.
Cassette:
Size: 14’’x17’’ Orientation: Portrait or diagonal as per length of limb
FFD/SID:
100cm
Central ray:
The central ray is the midpoint of the ankle joint and knee joint.
Grid:
No
Respiration:
Not related.
Exposure factors:
60-65kVp 8-10mAs
Collimation:
Collimate laterally to the skin margins, superiorly to the knee joint and inferiorly to the ankle joint
Clinical indication:
Trauma, pain, patella tenderness, patient is unable to weight bearing, suspected osteoarthritis, joint effusion, injection.
Region:
Knee joint
Patient’s Position:
The patient is placed in supine position. Make sure that there is no rotation of the pelvis.
Place the cassette under the patient’s knee.
Flex the joint slightly.
As the patient extends the knee center the cassette about half inch below the apex of patella.
Adjust the leg in true AP position.
The patella is slightly off center to the medial side.
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Center of the knee 1.5cm distal to the patella apex and may be directed perpendicular to the joint.
Grid:
No
Respiration:
Not related.
Exposure factors:
60-70kVp 7-10mAs
Collimation:
Collimate laterally to the skin margins, superiorly to the distal femur, inferiorly to the proximal tibia-fibula and medially include the medial skin margin.
Clinical indication:
Ligament injury, fracture, degenerative joint disease and arthritis of knee joint
Region:
Knee joint, proximal tibia/ fibula, distal femur.
Patient’s Position:
Turn the patient to the affected side flexed and extend other extremity behind it.
A flexion of 20°-30° is performed as this position relaxes the muscle and shows the maximum volume of joint cavity. Patient is placed in lateral decubitus position. Place the opposite leg of filming slide in front in flexion state. While flexing the filming knee 15°-20° placed bilateral condyles of femur to be perpendicular to IR.
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Project 5° cephalic toward knee joint.
Grid:
No
Respiration:
Not related.
Exposure factors:
60-70kVp 7-10mAs
Collimation:
Include distal portion of femur, tibia and proximal of fibula.
Clinical indication:
Fracture, dislocation of patella
Region:
Patella, Knee joint
Patient’s Position:
The patient may lie in the semi recumbent position, holding cassette superior the patella and in the landscape orientation.
Patient’s feet are closed to tube side of the table.
The knee should bent close to 30°
Assist the patient to maintain this position by placing a pillow behind the patient.
Cassette:
Size: 14’’x17’’ Orientation: landscape
FFD/SID:
100cm
Central ray:
The central ray will be angled 30°from horizontal, shooting inferior-superior towards the patella. This will require the tube to lie below the level of the examination table; hence the patient should be as possible
The apex of the patella
Grid:
No
Respiration:
Not related.
Exposure factors:
60-70kVp 7-10mAs
Collimation:
Collimate laterally to the knee skin margins, superiorly to the medial skin margin, inferiorly to the femoropatellar joint space.
Clinical indication:
Trauma, obvious deformities, suspected foreign body, inability to weight bear osteomyelitis, infections.
Region:
Femur
Patient’s Position:
The patient is lying in supine position. Make sure there is no pelvic rotation. Internally rotate the affected leg 15° to get true AP position.
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed to mid femur and perpendicular to the IR.
Grid:
No
Respiration:
Not related.
Exposure factors:
70kVp 16mAs
Collimation:
Include the anterior iliac spine superiorly and skin margins laterally.
Clinical indication:
Trauma, obvious deformities, suspected foreign body, inability to weight bear osteomyelitis, infections.
Region:
Femur including hip joint and knee joint
Patient’s Position:
Patient may lie in the supine position. Rotate the patient on affected side until the femur is against the table and the femoral epicondyles should be perpendicular to the table. The pelvis should be 10°-15° posterior from the lateral position.
Cassette:
Size: 14’’x17’’ Orientation: Portrait or diagonal
FFD/SID:
100cm
Central ray:
Central ray is directed to mid femur and perpendicular to the IR.
Grid:
No
Respiration:
Not related.
Exposure factors:
70kVp 16mAs
Collimation:
Collimate laterally to the skin margins, superiorly to the hip joint and inferiorly to the knee joint.
Radiograph of wrist:
Clinical indication:
Fracture, osteoarthritis of ulnar and radius
Region:
Carpal bone, wrist joint
Patient’s Position:
Patient is in sitting position. Place the patient’s hand on pronation state on IR.
Place the wrist joint on the center of IR.
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is projected toward the wrist joint.
Grid:
No
Respiration:
Not related.
Exposure factors:
50-55kVp 2-3mAs
Collimation:
Include all structures from proximal portion of metacarpal bones to distal portion of radius and ulna.
Clinical indication:
Fracture, osteoarthritis of ulnar and radius
Region:
Carpal bone, wrist joint
Patient’s Position:
Patient is in sitting position. Place the patient’s hand on IR in lateral position.
Pose the 2nd and 5th finger to be 90° to IR and overlap each finger.
Place radial styloid process perpendicular to IR.
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is projected toward the mid carpal region.
Grid:
No
Respiration:
Not related.
Exposure factors:
50-60kVp 3-5mAs
Collimation:
Collimate antero-posterior to the skin margins, include mid distal metacarpals and proximal to distal radius and ulnar bone.
Clinical indication:
Fracture of scaphoid, ligament injury of radius
Region:
Carpal bone
Patient’s Position:
Patient is in sitting position. Place the patient’s hand on pronation state on IR.
Place the wrist joint on the center of IR.
Adhere the hand on IR and pose flexion position towards ulnar bone
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central towards the scaphoid
Grid:
No
Respiration:
Not related.
Exposure factors:
50-60kVp 3-4mAs
Collimation:
Include all structures from proximal portion of metacarpal bones to distal portion of ulna.
Clinical indication:
Fracture
Region:
Carpals, metacarpals, phalanges, distal phalanges
Patient’s Position:
Patient is in sitting position.
Rest the affected arm on the table and flexed at 90°
The hand is placed in pronation position on the table.
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Center towards the third metacarpal
Grid:
No
Respiration:
Not related.
Exposure factors:
50-55kVp 2-3mAs
Collimation:
Collimate laterally to skin margins, inferiorly include distal phalanges and superiorly include distal radio ulnar joint.
Clinical indication:
Fracture
Region:
Hand
Patient’s Position:
Patient is sitting along the table.
The hand may externally rotated 90° from PA position so that the palm may perpendicular to the cassette.
Fingers should be extended with abducted thumb.
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Center over the head of second metacarpal
Grid:
No
Respiration:
Not related.
Exposure factors:
50-60kVp 3-5mAs
Collimation:
Collimate anteroposteriorly to the margins of the skin, distal to the finger tips and proximally include one third of distal radius and ulna.
Clinical indication:
Fracture of radius and ulnar bone, soft tissue swelling
Region:
Radius, ulna, carpals, distal humerus
Patient’s Position:
The patient may sit alongside of xray table.
Place the arm of the patient on the table in supine position with straight elbow.
The upper arm, elbow, and forearm all are resting on the table, ideally.
The humeral epicondyles are equal distances from the IR.
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is perpendicular to the image receptor at the middle portion of forearm.
Grid:
No
Respiration:
Not related.
Exposure factors:
50-55kVp 3-4mAs
Collimation:
Collimate anteroposteriorly to the margins of the skin, distal to the finger tips and proximally include one third of distal radius and ulna.
Clinical indication:
Fracture of radius and ulnar bone, dislocation, foreign body
Region:
Radius, ulna, carpals, distal humerus
Patient’s Position:
The patient may sit close to the table.
The elbow is flexed 90°
Hand and wrist should be in lateral position.
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed to the mid forearm.
Grid:
No
Respiration:
Not related.
Exposure factors:
55-60kVp 4-5mAs
Collimation:
Collimate anteroposteriorly to the margins of the skin, include elbow joint to the base of first metacarpal.
Clinical indication:
Fracture, joint effusion, dislocation, bone lesions, foreign bodies
Region:
Distal humerus, elbow joint space, proximal radius and ulna
Patient’s Position:
The patient may sit close to the table.
The affected arm is fully extended with shoulder and elbow on same horizontal plane.
Supinate the hand and align the forearm to the longitudinal axis of cassette.
Place the elbow in true AP position.
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed to the mid of the elbow, perpendicular to IR.
Grid:
No
Respiration:
Not related.
Exposure factors:
50-55kVp 2-3mAs
Collimation:
Collimate to sides of soft tissue borders, include proximal radius and ulna distally and distal humerus proximally.
Clinical indication:
Fracture of radius and ulnar bone, dislocation, foreign body
Region:
Distal humerus, proximal radius and ulna, elbow joint
Patient’s Position:
The patient may sit close to the table.
The elbow is flexed 90°
Hand and wrist should be in true lateral position.
Forearm is parallel to IR.
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is perpendicular to IR.
Grid:
No
Respiration:
Not related.
Exposure factors:
50-55kVp 4-5mAs
Collimation:
Include the entire elbow joint.
Clinical indication:
Fracture, bone lesion, foreign body osteoarthritis
Region:
Entire humerus
Patient’s Position:
The patient is in standing position with back against the upright Bucky.
The affected arm is abducted and centered to the upright detector.
The arm is slight rotated externally to get the true anatomical position, if possible.
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray towards mid of the humerus
Grid:
Yes (but this may vary)
Respiration:
Not related.
Exposure factors:
60-70kVp 7-15mAs
Collimation:
Collimate superiorly to the skin margins above the glenohumeral joint, inferior to the distal humerus including elbow joint and laterally to skin margins
Clinical indication:
Bowel obstruction, inflammatory bowel diseases, volvulus, organomegaly, pneumoperitoneum, tumor and ascites
Region:
The diaphragm, abdomen, pubic symphysis
Patient’s Position:
Patient may lie supine on the table.
Arms should be slightly abducted from the torso.
Make sure there is no rotation of pelvis.
Ensure that there are no artifacts such as metallic button, zips etc.
Center the mid sagittal plane of the patient to the midline of the IR.
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed to the mid sagittal plane at the level of iliac crest and perpendicular to IR.
Grid:
Yes
Respiration:
Suspended on expiration
Exposure factors:
70-80kVp 30-120mAs
Collimation:
Superior to the diaphragm, inferior to the inferior pubic rami and laterally to the abdominal wall
Clinical indication:
Bowel obstruction, inflammatory bowel diseases, volvulus, organomegaly, pneumoperitoneum, tumor and ascites
Region:
The diaphragm, abdomen
Patient’s Position:
Patient may be in sitting or standing position
Arms should be abducted from the torso.
Make sure there is no rotation of torso.
Ensure that there are no artifacts such as metallic button, zips etc.
Center the mid sagittal plane of the patient to the midline of the IR.
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed to the mid sagittal plane at the level of iliac crest and perpendicular to IR.
Grid:
Yes
Respiration:
Suspended on expiration
Exposure factors:
70-80kVp 30-120mAs
Collimation:
Superior to the diaphragm, inferior include as much as possible and laterally to the abdominal wall
The chest radiograph is the most commonly performed diagnostic xray examination. A chest xray produces image of heart, lungs, airways, blood vessels and the bones of spine and chest.
Clinical indication:
Lung disease, heart disease, bronchitis, mediastinum disease
Region:
Lungs, trachea, bronchus, heart, diaphragm, mediastinum, costophrenic angle
Patient’s Position:
Patient is in the erect position.
Lift and place the chin on vertical image receptor device. Put shoulder close to IR by having the hands on the bilateral hip regions or having both arms around vertical IR device.
Place the mid sagittal plane of the body in the middle of IR and make sure the chest is not rotated.
Cassette:
Size: 14’’x17’’ Orientation: Portrait / landscape
FFD/SID:
180cm
Central ray:
Central ray is perpendicular towards the center of the chest with height of 7th thoracic or lower end of scapula.
Grid:
Yes
Respiration:
Suspended with deep inspiration
Exposure factors:
60-80kVp 12-16mAs
Collimation:
Collimate superiorly to the cervical 7, include the apex inferiorly to the end of 12th rib laterally to the acromioclavicular joints.
Clinical indication:
Pleural effusion, pneumothorax, injury and ascites
Region:
Lungs, trachea, bronchus, heart, diaphragm, mediastinum, costophrenic angle
Patient’s Position:
Place the patient in supine position.
Place upper edges of the IR to be 5cm above bilateral shoulders and match its centerline with mid sagittal plane of chest.
By flexing bilateral arms, if possible, place bilateral shoulder in front.
Cassette:
Size: 14’’x17’’ Orientation: Portrait / landscape
FFD/SID:
100cm
Central ray:
Central ray is perpendicular towards the center of the chest with height of 7th thoracic, perpendicular to the sternum
Grid:
Yes
Respiration:
Suspended with deep inspiration
Exposure factors:
60-80kVp 12-16mAs
Collimation:
Superior 5cm above the shoulder joint, inferior to inferior border of 12th rib and lateral to the level of the acromioclavicular joint
Clinical indication:
Lower-lobe lung disease, pleural effusions, and anterior mediastinal masses.
Region:
Lungs, trachea, bronchus, mediastinum, costophrenic angle
Patient’s Position:
The patient may sit erect or stand straight with the chin up and their left side against the film image receptor.
A left lateral projection should be performed (because it gives more anatomical details) unless a right lateral projection is specifically requested by the physician.
Tell the patient to raise both arms above the head to prevent their superimposition on the chest field.
Make sure the patient is not leaning sideways, forward or backward
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray towards the center of the chest with height of 7th thoracic
Grid:
Yes
Respiration:
Suspended with deep inspiration
Exposure factors:
60-80kVp 16-20mAs
Collimation:
Superiorly to above the shoulders, inferiorly to the 12th rib and laterally include skin margins
Clinical indication:
It is usually requested for the patients who are unable to sit or stand and it also demonstrate air-fluid levels in case of pathology, mediastinitis, pleural effusion, and pneumothorax
Region:
Lung apices, trachea, bronchus, mediastinum, costophrenic angle, ribs
Patient’s Position:
Place a support with thickness of 5-10cm on filming table and place the patient on support in lateral decubitus position.
Place the cassette on front of patient’s chest and put arm around cassette
Cassette:
Size: 14’’x17’’ Orientation: Portrait / landscape
FFD/SID:
100cm
Central ray:
Central ray towards the center of the chest with height of 7th thoracic
Grid:
Yes
Respiration:
Suspended with deep inspiration
Exposure factors:
60-80kVp 12-16mAs
Collimation:
Superiorly to above the shoulders, inferiorly to the 12th rib and laterally include skin margins
Clinical indication:
Pneumonitis
Region:
Lung apices
Patient’s Position:
Patient is in standing position with feet approximately 30cm away from the IR, with back arched until appear back, shoulder and head are against the image receptor.
The shoulder and elbow are rolled anteriorly
The angle formed between mid-coronal body plane and image receptor should be 45°
Cassette:
Size: 14’’x17’’ Orientation: Portrait / landscape
FFD/SID:
180cm
Central ray:
Central ray towards the mid sagittal plane, halfway between the manubrium and xiphoid process
Grid:
Yes
Respiration:
Suspended with deep inspiration
Exposure factors:
60-80kVp 12-16mAs
Collimation:
Superiorly to 5cm above the shoulder joint, inferiorly to the inferior border of 12th rib
Clinical indication:
Cervical pain, dizziness, vertigo, fracture
Region:
Cervical spine
Patient’s Position:
Patient is positioned erect in AP position.
The head is facing straight forward
To avoid rotation, patient shoulders should be at equidistance from the cassette
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
The central ray is at the level of C4, just below the hyoid bone
15° cephaled
Grid:
Yes
Respiration:
Not related
Exposure factors:
65-75kVp 8-12mAs
Collimation:
Include entire cervical spine laterally, C2 and T2 superiorly and inferioly
Clinical indication:
Cervical pain, dizziness, vertigo, fracture
Region:
Cervical spine
Patient’s Position:
The patient may erect or supine depending on the case
The cassette is placed parallel to the long axis of cervical spine on left side of the patient
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
150-180cm
Central ray:
The central ray projected 2.5cm above the jugular notch at the C4 level
Grid:
Yes
Respiration:
Not related
Exposure factors:
50-75kVp 20-50mAs
Collimation:
Collimate superior to C1 inferior to T1 anterior and posterior to include soft tissue
Clinical indication:
Trauma, pain
Region:
Cervical spine
Patient’s Position:
The patient is erect, left side against the upright detector,
The cassette is placed in portrait position parallel to the long axis of the cervical spine on patient’s left side
The neck of the patient is extended (chin up) or flexed (chin down) position according to the projection directed by physician
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
150-180cm
Central ray:
The central ray projected 2.5cm above the jugular notch at the T1 level
Grid:
Yes
Respiration:
Not related
Exposure factors:
50-75kVp 20-50mAs
Collimation:
Collimate superior to C1 inferior to T1 anterior and posterior to include soft tissue
Clinical indication:
Fracture, trauma
Region:
C7/T1 junction
Patient’s Position:
The patient may erect or supine depending on the case
The cassette is placed parallel to the long axis of the cervical spine
The arm closer to the detector is placed on the patient’s head
The other arm is placed by patient’s side, as posterior as possible
Cassette:
Size: 10’’x12’’ Orientation: Landscape
FFD/SID:
100cm
Central ray:
The central ray projected 2.5cm above the jugular notch at the T1 level
Grid:
Yes
Respiration:
Suspended expiration
Exposure factors:
80-90kVp 120-150mAs
Collimation:
Collimate superior to C1 inferior to T3 anterior to the extent of vertebral bodies and posterior to spinous process
Clinical indication:
Scoliosis, fracture
Region:
C7 to L1
Patient’s Position:
The patient lies supine on the xray table
The arms are placed at their sides
Align the mid sagittal plane so it is in line with the midline of the IR
Ensure the patient should not rotate
Position the top of cassette at 5cm above the shoulders
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
110cm
Central ray:
The central ray projected at the level of T7, perpendicular to IR
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 25-40mAs
Collimation:
Superiorly include the C7/T1 junction/hyoid bone, inferiorly include T12/L1 junction and laterally include the costotransverse joints and left and right paraspinal lines
Clinical indication:
Scoliosis, fracture
Region:
C7 to L1
Patient’s Position:
The patient is placed in lateral recumbent position, with both humeri at right angles to the chest and elbow flexed.
Support patient so that thoracic spine is parallel to the table.
Ensure that there is no rotation of spine, shoulder and pelvis.
Make patient more comfortable by flexing patient’s knee towards the chest.
Align the mid coronal plane to the midline of the IR.
Place the top of the cassette 5cm above the shoulder.
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
The central ray projected at the level of T7, perpendicular to thoracic spine
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 30-50mAs
Collimation:
Include C7/T1 superiorly, T12/L1 inferiorly and anteriorly and posteriorly to include all margins of the thoracic vertebrae.
Clinical indication:
Scoliosis, fracture and neoplastic processes
Region:
T11 to distal sacrum, lumbar spine, SI joints and sacrum, spinous and transverse processes
Patient’s Position:
The patient lies supine on the xray table
Knees should be flexed to open intervertebral disk spaces
Place the patient arms on the chest
Ensure there is no rotation of pelvis or torso
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
The centering is towards the umbilicus, at the level of L3
The central ray is perpendicular to IR
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 40-60mAs
Collimation:
Superiorly include the T12/L1 junction, inferiorly include sacral region and lateral to include the transverse processes of sacroiliac joints
Clinical indication:
Fracture, spondylolisthesis, bone lesion, osteoporosis, foreign body
Region:
Intervertebral foramina L1 to L4, vertebral bodies, intervertebral joints, spinous processes, and L5 to S1 junction
Patient’s Position:
Position the patient in lateral recumbent position.
Place a pillow below the patient’s head and knee flexed
Both hands are flexed at right angle to the chest
Make sure that there is no rotation of pelvis and torso
Align mid coronal plane to the midline of the table
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is 2.5cm above the iliac crest and perpendicular to IR
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 60-90mAs
Collimation:
Superiorly include the T12/L1 junction, inferiorly include sacral region and anteriorly to include the anterior border of lumbar vertebrae bodies posteriorly include spinous processes
Clinical indication:
LBA, fracture stability
Region:
Intervertebral foramina L1 to L4, vertebral bodies, intervertebral joints, spinous processes, and L5 to S1 junction
Patient’s Position:
Patient is in erect position.
For flexion tell the patient to bend forward from lower back as much as possible by flexing their lower spine
For extension tell the patient to lean backward as much as possible by extending their lower spine
Cassette:
Size: 14’’x17’’ Orientation: Portrait
FFD/SID:
110cm
Central ray:
At the level of iliac crest
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 60-90mAs
Collimation:
Superiorly include the T12/L1 junction, inferiorly include sacral region and anteriorly to include the anterior border of lumbar vertebrae bodies posteriorly include spinous processes
Clinical indication:
LBA, fracture stability
Region:
Sacrum, L5/S1 junction
Patient’s Position:
Patient is supine on the xray table
Place a pillow for patient’s head
Extend the legs by supporting patient’s knee
Align the mid sagittal plane to midline of table
Cassette:
Size: 10’’x12’’ Orientation: Landscape
FFD/SID:
100cm
Central ray:
Central ray is towards the midway between symphysis pubis and ASIS
Central ray is angled 15° cephaled
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 30-40mAs
Collimation:
All sides of collimation closely to include sacrum (region of interest)
Clinical indication:
Pathology of sacrum and coccyx
Region:
Sacrum, L5/S1 junction
Patient’s Position:
Patient is placed in lateral recumbent position on the xray table.
Make sure the pelvis and torso are in true lateral position
Knees are flexed.
Align the long axis of the sacrum and coccyx to the midline of the table and cassette
Place the cassette 8-10cm posterior to the ASIS (anterior superior iliac spine)
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray perpendicular to IR
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 30-40mAs
Collimation:
Include entire sacrum
Clinical indication:
Pathology of coccyx
Region:
Entire coccyx
Patient’s Position:
Patient is supine on the xray table
Place a pillow for patient’s head
Extend the legs by supporting patient’s knee
Align the mid sagittal plane to midline of table
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is projected 5cm superior to symphysis pubis and 10° cauded
Grid:
Yes
Respiration:
Not related
Exposure factors:
60-70kVp 20-30mAs
Collimation:
Collimate closely to the area of interest
Clinical indication:
Pathology of coccyx
Region:
Entire coccyx
Patient’s Position:
Patient is placed in lateral recumbent position on the xray table.
Knees are flexed.
Make sure the pelvis and torso are in true lateral position
Align the long axis of the coccyx to the midline of the table and cassette
Place the cassette 8-10cm posterior to the ASIS (anterior superior iliac spine)
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray perpendicular to IR
Grid:
Yes
Respiration:
Not related
Exposure factors:
60-70kVp 30-40mAs
Collimation:
Collimate closely to include region of interest
Clinical indication:
Fracture, dislocations
Region:
Femoral head and neck, sacrum and coccyx, pelvic girdle
Patient’s Position:
Patient is supine on the xray table.
Place the patient’s hand on the chest.
Make sure that there is no rotation.
Rotate both legs and feet internally 15°-20°
Cassette:
Size: 14’’x17’’ Orientation: Landscape
FFD/SID:
100cm
Central ray:
Central ray is directed towards midway level of ASIS & is perpendicular to IR
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 20mAs
Collimation:
Collimate 2cm superiorly to the iliac crest and laterally to include all the skin margins.
Clinical indication:
Fracture, dislocations, arthritis
Region:
Hip
Patient’s Position:
Patient is supine on the xray table.
Place the patient’s hand on the chest.
Make sure that there is no rotation.
Rotate both legs and feet internally 15°-20°
Cassette:
Size: 10’’x12’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed towards midway between pubis symphysis and ASIS over the femoral head
Grid:
Yes
Respiration:
Not related
Exposure factors:
70-80kVp 20mAs
Collimation:
Collimate to the area of interest by all sides.
Clinical indication:
Fracture, dislocations
Region:
Clavicle, superior scapula, coracoid process, glenohumeral joint, acromioclavicular joint, sternoclavicular joint
Patient’s Position:
Patient is in standing position with back to upright IR.
Mid coronal plane of patient should parallel to IR.
Glenohumeral joint is the center of the IR
Patient is slightly rotated towards the affected side by 5°-10°
Cassette:
Size: 8’’x10’’ Orientation: Landscape
FFD/SID:
100cm
Central ray:
Central ray is directed to the glenohumeral joint, centering at the 2.5cm inferior to the coracoid process.
Grid:
Yes
Respiration:
Not related
Exposure factors:
60-70kVp 10-20mAs
Collimation:
Collimate laterally and superiorly to include all skin margins, inferiorly include one third of proximal humerus and medial to include the sternoclavicular joint.
Clinical indication:
Scapula fracture, dislocations, coracoid acromion process
Region:
Scapula
Patient’s Position:
Patient is in standing or sitting position with facing upright IR.
The patient is rotated in anterior oblique position so the anterior portion of shoulder will touch the IR
Scapula will end on the IR
Cassette:
Size: 8’’x10’’ Orientation: Portrait
FFD/SID:
100cm
Central ray:
Central ray is directed to the glenohumeral joint, centering at the 2.5cm inferior to the coracoid process.
Grid:
Yes
Respiration:
Not related
Exposure factors:
60-70kVp 10-20mAs
Collimation:
Collimate laterally and superiorly to include all skin margins, inferiorly include the angle of the scapula and medially cover the medial scapula.
