radiographically demonstrate or visualize specific body parts on image receptors (IRs) Terms approved and published by the ARRT.
named positions, named for person who first described a specific position: Towne, Waters, Caldwell
An image produced by x-rays on an image receptor. If produced with film-screen technology - it is stored and displayed on film. If produced digitally, it is viewed and stored on computers.
Process and procedures of producing a radiograph
Radiograph vs. X-ray film:
radiograph - the recording medium AND the image
x-ray film - physical piece of material on which a nonprocessed (latent) radiographic image is stored.
(IR) - the device that captures the radiographic image that exits the patient; film/screen cassettes and digital acquisition devices
(CR) - the center-most portion of the x-ray beam emitted from the x-ray tube; has the least divergence
Radiographic exam 5 functions
1. position body and align with the IR and CR.
2. Select radiation protection measures
3. Select exposure factors (radiographic technique) on the control panel (generator)
4. Patient instructions related to respiration and initiation (making) of the exposure
5. Processing of the IR
Sagittal - divides into right and left parts
midsagittal - equal right and left parts
Coronal - divides into anterior and posterior parts
midcoronal - equal anterior and posterior parts
Horizontal (axial) - transverse plane at right angle - superior and inferior portions
Oblique - longitudinal or transverse plane at an angle or slant - not parallel
Cut or slice image of body part.
Planes of the skull
Body surfaces and parts
Posterior/dorsal - back half
Anterior/ventral - front half, tops of feet, palms
Plantar - surface of foot (sole)
Dorsal foot - top of foot - aka dorsum
Dorsal hand - back of hand
Palmar - palm of hand
the direction or the path of the CR of the x-ray beam as it passes through the pt., projecing an image onto the IR.
Posteroanterior (PA) projection
CR enters at posterior surface and exits at anterior surface
Anteroposterior (AP) projection
CR enters at Anterior surface and exits at posterior surface
AP oblique projection
A projection of a body part that is rotated, shot anterior to posterior (should also contain a qualifying "medial" or "lateral" term)
Mediolateral and lateromedial projections
Medial and lateral sides are determined with the patient in the anatomic position.
Body positions - general
Supine - lying on back facing up
Prone - lying on abdomen, facing down
Erect - stand or sitting erect
Recumbent - reclining
Dorsal recumbent - lying on back
Ventral recumbent - lying face down
Lateral recumbent - lying on side
Trendelenburg - recumbent position with body tilted with head lower than feet
Fowler's position - recumbent position with body tilted with head higher than feet
Sims' position - when on left side, right knee and thigh are flexed and left arm behind back - used for rectal tube insertion for barium enema
Lithotomy position - recumbent with knees and hip flexed and thighs abducted and rotated externally, supported by ankle supports.
Right lateral position is with right side of body closest to the IR in both erect and recumbent body positions.
True positioning is 90 degrees.
Lying down on dorsal (back), front (ventral) or side (lateral). Performed with central ray going horizontal. Essential for detecting air-fluid levels or free air in a body cavity such as the chest or abdomen, where the air rises to the uppermost part of the body cavity.
left lateral decubitus
right lateral decubitus
Any angle of the CR of 10 degrees or more along the long axis of the body or body part
touching a curve or surface at only one point. Skim a body part. zygomatic arch, patella
The body is angled instead of the CR. Lordosis denotes curvature. Special chest projections.
Transthoracic lateral projection
CR passes through thorax even though it does not include an entrance or exit site.
Dorsoplantar (DP) projection
angled CR enters dorsal surface and exits the plantar surface.
CR enters at cranial parietal bone and exits at the acanthion (junction of nose and upper lip) - PA Waters method
CR enters at acanthion and exits at parietal bone - AP reverse Waters method
Submentovertex projection SMV
CR enters below chin, mentum, and exits at vertex or top of skull
Verticosubmental projection VSM
Enters at top of skull and exits below mandible
Proximal interphalangeal joint (PIP)
finger joint closest to the palm
Distal interphalangeal (DIP) joint - joint at distal end of the finger
Toward the head
Toward the feet or away from the head
Acute flexion of wrist
Used for special tangentatial projection for a carpal bridge view of the posterior aspect of the wrist
turn the hand toward the ulna
turn the hand toward the radius
bend a part away from the midline
bend a part toward the midline
as described under radiological criteria
Five parts of critiquing a radiograph
1. Structures shown - describes anatomic parts shown
2. Position - a. placement of body part in relation to the IR and b. positioning factors that are important for the projection.
3. Collimation and CR - how collimation borders should be seen in relation to the body part and location of the CR and center of collimation
4. Exposure criteria - optimum exposure for that body part. No motion is a first priority
5. Image markers or time markers must be placed correctly so not superimposed over anatomy
Two markers that should always be present
1. patient ID and date
2. anatomic side markers
Place where least likely to cover essential anatomy. Place in collimation field so they will be exposed by the x-ray beam.
Time indicators - show elapsed time in intravenous urogram (IVU) procedure, e.g.
Arrow indicating which side is up - for decubitus positions
Inspiration or expiration (INSP) and (EXP) markers for chest.
Internal and external (INT) and (EXT) markers for rotation projections like proximal humerus and shoulder.
Code of ethics
rules of acceptable conduct toward our patients and other health care team members, as well as personal actions and behaviors. ARRT
General rule in diagnostic radiology
minimum of 2 projections should be taken, as near to 90 degrees from each other as possible, except portable chest, single AP abdomen (KUB), and an AP of the pelvis.
3 Reasons to take a minimum of 2 projections
1. superimposition of anatomic structures (may not be able to see everything on one projection).
2. Localization of lesions or foreign bodies - to determine exact location of the "nail" in the photo
3. Determination of alignment of fractures - to visualize full fracture site and to determine alignment of fractured parts
3 projections needed
Joints - AP, PA, lateral and oblique
Fingers, toes, hand, wrist, elbow, ankle, foot, knee
process of applying light pressure with fingertips directly on the pt to locate positioning landmarks. Be gentle. Inform pt. when you are doing of the purpose; obtain permission.
Display so patient is facing the viewer
Can be sagittal, coronal and oblique - sections that run lengthwise in the direction of the long axis of the body or any of its parts, regardless of the position of the body, erect or recumbent.
transverse or axial section
Sections at right angles along any point of the longitudinal axis of the body or its parts. Sagittal, coronal and axial images: CT, MRI and Sonography images are obtained in these 3 common orientations or views.
Sagittal, coronal and axial images
CT, MRI and sonography images
biting surfaces of the upper and lower teeh with jaws closed - cervical spine and skull radiography reference plane. Also known as the Frankfort horizontal plane.
connects lines from infraorbital margins to external auditory meatus (EAM) - AKA Frankfort horizontal plane - orthodontics and carinal topography to measure and locate specific crainal points of structures
lying on back facing up
lying on abdomen, facing down
standing or sitting upright
Dorsal recumbent - lying on back
Ventral recumbent - lying face down
Lateral recumbent - lying on side
recumbent position with body tilted with head lower than feet
Recumbent position with body tilted with head higher than feet
When on left side, right knee and thigh are flexed and left arm behind back - used for rectal tube insertion for barium enema
Recumbent with knees and hip flexed and thighs abducted and rotated externally, supported by ankle supports.
Aangled. Described by part closest to the IR
Left & right posterior oblique (LPO and RPO positions)
Left or right body part and posterior (back) is closest to IR
Right and Left anterior oblique positions
Left or right body part and anterior (front) is closest to IR
Inferosuperior axial projections
performed for shoulder and hip. CR enters below or inferiorly and exits above or superiorly .
Superoinferior axial projections
Nasal bone. CR enters above or superiorlyand exits below or inferiorly.
AP axial projection-lordotic position
Specific AP chest projecting for demonstrating the apices of the lungs. Somes aka apical lordotic projection. In this case, the long axis of the body is angled instead of the CR. (Man leaning funny against the IR)
term that denotes curvature of the cervical and lumbar spine.
A specific position that demonstrates the apices of the lungs, withouth superimposition of the clavicles
Axial plantodorsal (PD) projection
Angled CR enters the plantar surface of the foot and exits the dorsal surface
Inside of something, nearer to the center
Outside of something
Within or inside
Outside or outward
The patients general physical position (supine, rpine, recumbent or erect) and specific body positions closest to the IR (lateral/oblique)
the path or direction of the central ray (CR)
The radiographic image as seen from the vantage of the image receptor.
Pelvic study unless hip injury is suspected
exaggerated lumbar curvature - swayback - increased concavity
abnormal or exaggerated thoracic curvature with increased convexity. humpback
Abnormal lateral curvature of the vertebral column
patient with a thorax that is broad and deep from front to back. Massive build. Shallow in verticial dimension.
Athletic. Elongated abdomen and thorax. Average body habitus.
Patient with a thorax that is narrow in width and slender. Shallow from front to back and long in its vertical dimension.
Nerer average body habitus.
Upper margin of chest, C or T-spine. C7-T1
Chest, sternum, clavicle, T-Spine. T2-3
Raised area of junction of manubrium. Chest and Sternum. T4-5
Distal portion of sternum. Sternum, stomach, GB, T-Spine, upper margin of abdomen. T9-T10
Inferior costal margin
lateral inferior border of rib cage. Stomach, GB and ribs. L2-3
Anterior superior iliac spine
Prominent anterior border of iliac crest. Hipes, pelvis, sacrum. S1-2
Bony process of proximal femur; to locate requires firm palpation while rotating leg and femu) Abdomen, pelvis, hip. Distal coccyx or slightly inferior to.
Anterior junction of pubic bones of pelvis. Lower margin of abdomen, pelvis, hip, sacrum, coccyx. 1 Inch inferior to distal coccyx
Lowermost, posterioroly located bony process of pelvis. Prone abdomen, colon, coccyx. 1-2 inches inferior to distal coccyx.