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X-ray Views

Radiograph of skull:

All radiograph of skull are undertaken with reference to a series of palpable landmarks and recognized lines or planes of the skull.

Landmarks:

  • Outer canthus of eye: The point where upper and lower eyelids meet laterally.
  • Infra orbital margin/point: The inferior rim of the orbit, with the point being located at its lowest point.
  • Nasion: The articulation between nasal and frontal bones.
  • Glabella: A bony prominence found on the frontal bone immediately superior to the nasion.
  • Vertex: The highest point if the skull in the median sagittal plane.
  • External occipital protuberance (Inion): A bony prominence found on the occipital bone usually, coincident with the median sagittal plane.
  • External auditory meatus: The opening within the ear that leads into the external auditory canal.

Lines:

  • Inter-orbital (inter-pupillary) line: Join the center of the two orbits or the center of two pupils when the eyes are looking straight forward.
  • Infra-orbital line: Joints the two infra-orbital points.
  • Anthropological baseline: Passes from the infra-orbital point to the upper border of the external auditory meatus (also known as frankfurter line).
  • Orbito-meatal baseline/radiographic baseline: Extends from the outer canthus of the eye to the center of external auditory meatus. This line is aligned approx. 10° to the anthropological baseline.

Plane:

  • Median sagittal plane: Divides the skull into right and left halves. The landmarks on this plane are nasion anteriorly and the occipital protuberance (inion) posteriorly.
  • Coronal planes: there are at right angles to the median sagittal plane and divides the head into anterior and posterior parts.
  • Anthropological plane: A horizontal plane containing the two anthropological baseline and infra-orbital line. It is an example of an axial plane. Axial planes are parallel with this plane.
  • Auricular plane: Perpendicular to the anthropological plane. Passes through the center of the two external auditory meatuses. It is an example of a coronal plane.

Skull AP view

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.

Skull PA Caldwell (0°) view

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

Skull PA Caldwell (15°) view

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

Skull PA Caldwell (25°-30°) view

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

Skull AP axial view / Skull Townes view

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

Skull Submentovertex (SMV) view

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

Sella Turcica lateral view

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

Lateral oblique view / Mastoid Sculler’s view

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.

Stenver’s view of temporal bone

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.

Radiograph of lower extremities:

Radiograph of foot

AP/dorsi planter projection:

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.

AP oblique projection medial rotation:

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.

Radiograph of ankle:

AP projection:

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.

Lateral projection:

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.

AP projection (mortise view):

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.

Calcaneus AP projection / axial view

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.

Calcaneus lateral projection

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.

Leg radiograph:

Leg/tibia & fibula AP projection

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.

Leg/tibia & fibula lateral projection

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

Knee radiograph

Knee AP projection:

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.

Knee lateral projection:

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.

Knee/ skyline view

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.

Femur radiograph:

Femur AP projection

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.

Femur lateral projection

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 upper extremity:

Radiograph of wrist:

Wrist PA projection:

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.

Wrist lateral projection:

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.

Wrist ulnar deviation projection:

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.

Hand AP projection:

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.

Hand lateral projection:

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.

Forearm AP projection:

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.

Forearm lateral projection:

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.

Elbow AP projection:

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.

Elbow lateral projection:

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.

Humerus AP projection:

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

Radiograph of abdomen:

Abdomen AP supine projection:

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

Abdomen AP erect projection:

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

Radiograph of thorax:

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.

Chest PA projection:

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.

Chest AP projection:

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

Chest lateral projection:

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

Chest lateral decubitus projection/cross table lateral chest view

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

Chest AP lordotic view/Apicogram

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

Radiograph of spine:

Cervical spine radiograph

Cervical spine AP view

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

Cervical spine lateral view

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

Cervical spine flexion and extension view

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

Cervical spine swimmer’s lateral view

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

Thoracic spine radiograph

Thoracic spine AP view

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

Thoracic spine lateral view

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.

Lumbar spine radiograph

Lumbar spine AP view

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

Lumbar spine lateral view

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

Lumbar spine lateral (flexion and extension) view

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

Sacrum AP view

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)

Sacrum lateral view

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

Coccyx AP view

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

Coccyx lateral view

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

Radiograph of pelvis & hip

Pelvis AP view

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.

Hip AP view

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.

Radiograph of shoulder

Shoulder AP view

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.

Shoulder/Scapula lateral “Y” view

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.