Name of Projection

7/31/2019 Name of Projection

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Name of projection Chest - PA Erect

Area Covered Lung fields, apices, costophrenic angles, heart

Pathology shown Pleural effusions, pneumothorax, signs of infection, masses, nodules, atelectasis

Radiographic Anatomy Chest Radiographic Anatomy

IR Size & Orientation 35 x 43 cm

Landscape usually, but may be portrait depending on body habitusD.R. may cover 43 x 43 cm

Film / Screen Combination Regular

(CR and DR as recommended by manufacturer)

Bucky / Grid Moving or Stationary Grid

Filter Decubitus filter for women with large breasts, particularly for non-digital imaging

Exposure 100 kVp

4 mAs

FFD / SID 180 cm

Central Ray Directed to the midsaggital plane at the level of T7

Perpendicular to the IR

Collimation Centre: T7, or the inferior border of the scapula

Shutter A: Open to approximately 5cm (2 inches) above the shoulder to include upper airwayShutter B: Open to the level of the acromioclavicular joints (AC joints) laterally. This will include the

lung fields laterally.

Markers Superior and Lateral

Marker orientation PA

Shielding Gonadal

(check your department's policy guidelines)

Respiration On suspended deep inspiration

Exposure may be taken on suspended full expiration when pneumothorax is suspected.

Positioning Patient erect, standing or seated, facing the bucky

Arms relaxed at the sides

Centre the midsaggital plane of the patient to the midline of the IR

Have the patient relax their shoulders and rolled forward to touch the bucky

Adjust the height of the bucky so that the upper border of the IR is 5cm (2 inches) above the shoulders

Raise the chin and rest on or above the bucky

Clear the scapulae off the lung fields by getting the patient to either

A. "Hug" the bucky by bringing the forearms behind the bucky (some buckys have purpose built

handles for the patients to hold)

OR

B. Place the back of their hands against their lower hips

Name of projection Chest - Left Lateral (Erect)

Area Covered Lung fields, apices, costophrenic angles

Pathology shown Pathology posterior to the heart, great vessels and sternum



Portrait




Filter No

Exposure 110 kVp
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8 mAs

FFD / SID 180 cm

Central Ray Directed to the mid coronal plane at the level of T7


Collimation Centre: The mid coronal plane at the level of T7

Shutter A: Open to include the skin margins anteriorly and posteriorly

Shutter B: Open to include lung apices superiorly (this is at the C7 level) and to include the diaphragminferiorly

Markers Use a left "L" marker to indicate the side closest to the IR

Superior and Anterior

Marker orientation AP

Shielding Gonadal


Respiration On suspended inspiration, (gives full lung aeration)

Positioning Patient erect, standing or seated, their left side touching the bucky

Ensure the midsaggital plane is parallel to the IR, that is, the patient does not lean towards the IR

Ensure the mid coronal plane is perpendicular to the IR, to avoid rotation of the thorax

To prevent the humeri from superimposing over the lung fields either;

raise the arms above the patient's head,getting them to grasp the opposite elbow with each hand, orhave the patient place their hands on their head, with their elbows pointing forward, or

use the purpose built support arm that attaches to the bucky being used and have the patient hold to

the bar

Ensure that the chin is up away from the patient's chest

Name of projection Chest - Lordotic Apical

Area Covered Apices of the lungs, clavicles, the upper two-thirds of the lung fields show foreshortened

Pathology shown Lesions of the lung apices, such as tumour and infection


IR Size & Orientation 24 x 30 cm or 30 x 40cm

Landscape



Bucky / Grid Yes

Filter No

Exposure 100 kVp

4 mAs

FFD / SID 180 cm

Central Ray Directed to the midsagittal plane, at the level of the manubrium

The angle of the central ray differs depending on the positioning method used

Method 1: central ray is 30 cephalad

Method 2: central ray is perpendicular to the IR

Collimation Centre: Directed to the midsagittal plane, to the manubrium

Shutter A: Open to film size or to include anatomy of interest

Shutter B: Open to the level of the acromioclavicular joints (AC joints) laterally. This will include the




Shielding Gonadal (check your department's policy guidelines)


Method 1:
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PositioningPosition the patient AP with their back to the bucky

Centre the midsaggital plane to the midline of the bucky

Adjust the film height so that the clavicles are in the horizontal midline of the IR

Angle the central ray 30 cephalad

Method 2:

Position the patient either standing or sitting AP with their back to the upright bucky

Their back should be 30 cm away from the upright bucky

Centre the midsaggital plane to the midline of the bucky

Have the patient lean back so that their shoulders, neck and head are resting on the bucky

Ask the patient to put the back of their hands against their lower hips (to help clear the lung fields of

the scapula)

Adjust the IR to 8 cm above the shoulders

The central ray is perpendicular to the IR

Name of projection Chest - Lordotic

Area Covered Entire lung fields, posterior ribs, clavicles

Pathology shown Rule out calcifications and masses behind the clavicles



Portrait




Filter No

Exposure 100 kVp

4 mAs

FFD / SID 180 cm

Central Ray CR perpendicular to IRCR centred to mid sternum (approximately 9cm below sternal notch)

Collimation Centre: To the midsagittal plane, to T7

Shutter A: Open to 5 cm above the shoulders

Shutter B:Open to the level of the acromioclavicular joints (AC joints) laterally. This will include the




Shielding Gonadal



Positioning The patient may be standing or sitting with their back to the upright bucky

Their back should be 30 cm away from the buckyCentre the midsaggital plane to the midline of the bucky

Have the patient lean back so that their shoulders, neck and head are resting on the bucky

Adjust the IR to 8 cm above the shoulders

Name of projection Chest - Lordotic Right Middle Lobe (RML)

Area Covered The right middle lobe of the lung is the area of particular focus, however include the entire lung fields

for comparison


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Pathology shown Collapse and consolidation & various other pathologies


IR Size & Orientation 35 x 43cm

Landscape



Bucky / Grid Yes

Filter No

Exposure 100 kVp

4 mAs

FFD / SID 180 cm

Central Ray Directed to T7 to include all chest anatomy


Collimation Centre: T7

Shutter A: Open to 5cm above the shoulders




Marker orientation either AP or PA depending on patient positioning

Shielding Gonadal



Positioning Can be performed AP or PA

AP Method

Patient is leaning back against the upright bucky at an angle of approximately 45 .

centre to include the RML and any other anatomy of interest

PA Method

Patient is leaning back 45 holding onto the upright bucky/IR

centre to include the RML and any other anatomy of interest

Name of projection Chest - Lateral Decubitus (either AP or PA)


Pathology shown This projection is used to detect any air and fluid levels present in the pleural cavity. Air in the case of a

pneumothorax or fluid in the case of pleural effusions. It also shows changes in fluid position from

PA/AP view and reveals any previously obscured pulmonary areas



Usually portrait (the long axis of the IR is parallel to the long axis of the torso)

D.R. may cover 43 x 43 cm



Bucky / Grid Moving or Stationary Grid, portable X-ray may be done without grid

Filter No

Exposure 85 kVp 2.5 mAs no grid

100 kv 4 mAs with grid

FFD / SID 180cm


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Collimation Centre: T7 or the inferior border of the scapula

Shutter A: Open to approximately 5cm above the shoulder to include upper airway




Marker orientation either AP or PA, depending on the patient's positioning

Marker indicating the side which is up



Positioning Position the patient in the lateral decubitus position

usually AP, as this is often easier for the patient

with either the left or right side up (see Special Notes below)

ensure that the side that is touching the bed or table is slightly raised, perhaps using a sponge, so that

the entire lungs fields are included on the image and are not 'cut off'.

If possible, wait at least 5 minutes before taking the image to allow gas fluid levels to form

Bring the patient's arms above their head so they do not superimpose over the thorax

Check that the patient is in a true lateral position, and that the coronal plane is parallel to the IR

Critique

PACEMAN

Positioning

No rotation as evidenced by

the medial ends of the clavicles equidistant from the spine

the clavicles are in the same horizontal plane

The lungs fields are clear of the scapulae

The 10th posterior ribs will be visualised above the diaphragm on full inspiration

Area Covered

Lungs fields, apices, costophrenic angles, heart

Collimation

Centre: T7 Thoracic vertebra

Shutter A: Open to show the lung apices superiorly and the costophrenic angles inferiorlyShutter B: Open to show the lung fields laterally

Exposure

There should be adequate exposure so that

the ribs and thoracic vertebrae are seen faintly through the heart

vascular lungs markings are shown

air and fluid levels are able to be seen

Name of projection Chest - Dorsal Decubitus


Pathology shown Pathologies involving the lung fields, changes in fluid position from PA/AP view and reveals any

previously obscured pulmonary areas



Landscape




Filter No
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Exposure 110 kVp

8 mAs

FFD / SID 180cm




Shutter A: Open to include the skin margins anteriorly and posteriorlyShutter B: Open to include lung apices superiorly (this is at the C7 level) and to include the diaphragm

inferiorly

Markers Superior and Anterior


Marker the side closest to the IR



Positioning Patient supine on the X-ray table

Raise the thorax off the table 5 to 8cm using a firm mattress (to prevent cutting off essential anatomy)

Keep patient in position for 5 minutes prior to exposure to allow air to rise and fluid to settle

Adjust body into true supine position and extend arms above the head

Place affected side next to upright bucky / vertically placed IRCR directed to the mid coronal plane at the level of T7, perpendicular to the IR

Name of projection Chest - Ventral Decubitus


Pathology shown Pathologies involving the lung fields, changes in fluid position from PA/AP view and reveals any

previously obscured pulmonary areas



Landscape




Filter No

Exposure 110 kVp

8 mAs

FFD / SID 180cm




Shutter A: Open to include the skin margins anteriorly and posteriorly

Shutter B: Open to include lung apices superiorly (this is at the C7 level) and to include the diaphragm

inferiorly

Markers Superior and AnteriorMarker orientation AP



Positioning Patient prone on the X-ray table

Raise the thorax off the table 5 to 8cm using a firm mattress (to prevent cutting off essential anatomy)

Keep patient in position for 5 minutes prior to exposure to allow air to rise and fluid to settle

Adjust body into true prone position and extend arms above the head


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Place affected side next to upright bucky / vertically placed IRCR directed to the mid coronal plane at the level of T7, perpendicular to the IR

Name of projection Chest - Anterior Oblique (preferred over Posterior Obliques)

Area Covered Lung fields, apices, costophrenic angles, cardiac shadow and mediastinal structures, trachea

Pathology shown Pathologies involving the lung fields, abnormal cardiac shadows and mediastinal structures



Portrait





Filter No

Exposure 100 kVp

5 mAs

FFD / SID 180 cm

Central Ray Directed to the level of T7 (for Anterior Obliques)

Directed 10 cm inferior to the jugular notch (for Posterior Obliques)


Collimation Centre: T7 (the level of the inferior border of the scapula)

Shutter A: Open to approximately 5 cm above the shoulder to include the upper airway

Shutter B: Open to include soft tissue borders laterally


Marker orientation for Anterior Obliques - PA, for Posterior Obliques - AP



Positioning Anterior Oblique

Patient erect, standing or seated, facing the bucky

From this PA position, rotate the patient 45, the shoulder maintaining contact with the bucky (the side

of interest is further from the bucky)

Centre the chest to the IR

Remove the arms from the area of interest by

placing the hand on the side closest to the bucky on the patient's hip

Raise the arm on the side away from the bucky to shoulder level and rest their hand on the top of the

bucky for support

Ensure shoulders are in the same horizontal plane

Posterior Oblique

Patient erect, standing or seated, with their back to the buckyFrom this AP position, rotate the patient 45, the shoulder maintaining contact with the bucky (the side

of interest is closer to the bucky)

Centre the chest to the IR

Remove the arms from the area of interest by

Raising the arm on the side closest to the bucky to shoulder level

placing the hand on the side further from the film on the patient's hip

Ensure shoulders are in the same horizontal plane


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Name of projection Ribs - PA Chest. (See "Special Notes" below).

Area Covered This view best shows the anterior ribs. It also shows the lung fields, mediastinal structures and

diaphragm.

Pathology shown Pathologies of the ribs, particularly, fractures of the anterior ribs.

This view may also show related pathologies, such as a pneumothorax resulting from trauma to the

ribs



Landscape usually, but may be portrait depending on body habitus






Exposure 100 kVp

4mAs

FFD / SID 180cm






lung fields and ribs laterally.





This ensures the diapragm is as low as possible, allowing as many ribs as possible to be seen

Positioning If the patient's condition allows, perform the views with the patient erect, standing or seated, facing

the bucky

Centre the midsaggital plane of the patient to the midline of the IRBring the patient's chest so that it is touching the bucky

Have the patient relax their shoulders and rolled forward to touch the bucky

Adjust the height of the bucky so that the upper border of the IR is 5cm above the shoulders

Raise the chin and rest on or above the bucky

Clear the scapulae off the lung fields and ribs by getting the patient to either

A. "Hug" the bucky by bringing the forearms behind the bucky (some buckys have purpose built

handles for the patients to hold)

OR

B. Place the back of their hands against their lower hips

Name of projection Ribs - AP Upper (1-8)

(See "Special Notes" below).

Area Covered This view best shows the posterior ribs. It also shows the lung fields, mediastinal structures and

diaphragm.

Pathology shown Pathologies of the ribs, particularly, fractures of the upper posterior ribs.

Radiographic Anatomy Ribs radiographic anatomy




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Exposure 65 kVp

16 mAs

FFD / SID 100 cmCentral Ray Directed to the midsaggital plane at the level of T7





lung fields and ribs laterally.





This ensures the diapragm is as low as possible, allowing as many upper ribs as possible to be seen

Positioning If the patient's condition allows, perform the views with the patient erect, standing or seated, with

their back touching the bucky


Ensure the midsaggital plane is perpendicular to the IR, that is, the patient is not rotated


If possible, pronate hands and bring elbows away from the sides of the body to help clear the

scapulae of the lung fields

Adjust the height of the IR to 5cm above the shoulders

Raise the chin if this is superimposing over the chest

Name of projection Ribs - AP Lower (9-12)

(See "Special Notes" below).

Area Covered This view best shows the posterior ribs. It also shows the diaphragm.

Pathology shown Pathologies of the ribs, particularly, fractures of the lower posterior ribs.

Radiographic Anatomy Ribs radiographic anatomy







Filter No

Exposure 75 kVp

30 mAs

FFD / SID 100 cm

Central Ray Directed to the midsaggital plane at the level of the midpoint between the xiphoid process and the

level of the lower costal margins.


(Ensuring the level of the iliac crests is aligned with the inferior border of the IR will ensure the lower

ribs will be included in the image).

Collimation Centre: At the midsaggital plane, at the level of the midpoint between the xiphoid process and the

level of the lower costal margins

Shutter A: Open to include the iliac crests inferiorly

Shutter B: Open to include the lung fields and ribs laterally.
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Markers Inferior and Lateral



Respiration On suspended expiration

This ensures the diapragm is as high as possible, allowing as many lower ribs as possible to be seen

Positioning This view can be performed with the patient either erect or supine

Position the patient so that their back is touching the buckyCentre the midsaggital plane of the patient to the midline of the IR

Ensure the midsaggital plane is perpendicular to the IR, that is, the patient is not rotated

Arms relaxed and slightly abducted from the sides of the thorax

Adjust the lower border of the IR so that it is at the level of the iliac crests

Name of projection Ribs - Oblique (Posterior or Anterior Obliques)

Area Covered Upper Ribs view shows ribs 1 through to 10

Lower Ribs view shows rib 8 through to 12

Pathology shown Fractures, benign and malignant tumours, rib notching, congenital abnormalities

Radiographic Anatomy Ribs Radiographic Anatomy


Portrait




Filter No

Exposure 66 kVp, 16 mAs for Upper Ribs

75 kVp, 30 mAs for Lower Ribs (to penetrate the abdomen)

(can use long exposure time on table bucky)

FFD / SID 100 cm

Central Ray Posterior Obliques

Directed to the centre of the IR, in line with the mid-clavicular line and so that the top of the IR is

approximately 4 cm above the patient's shoulder


Anterior Obliques

Directed to the centre of the IR, to the point midway between the vertebral bodies and the lateral rib

margins and so that the bottom of the IR is at the level of the Iliac Crest.


Collimation Upper Ribs

Centre: Halfway between jugular notch and xiphoid sternum, approximately 1/4 of the way across

from the midline towards the lateral rib margin

Shutter A: Open to include from the vertebral bodies to the lateral rib margin

Shutter B: Open to the film size superiorly and inferiorly

Lower Ribs

Centre: Place the lower margin of the IR at the level of the Iliac Crest, approximately 1/4 of the way

across the patient from the midline to towards the lateral rib margin

Shutter A: Open to include from the vertebral bodies to the lateral rib marginShutter B: Open to the film size superiorly and inferiorly

Markers Posterior Obliques

Superior and Lateral

Indicate the side closest to the bucky (which is the affected side)

Marker orientation is AP

Anterior Obliques

Superior and Lateral

Indicate the side closest to the bucky (which is the affected side)
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Marker orientation is PA


Respiration Upper Ribs on suspended inspiration

Lower Ribs on suspended expiration

Positioning Posterior Oblique view

Position the patient so that their back is against the bucky

Rotate the patient so they are angled 45 with the affected side touching the bucky (use a 45 degree

sponge for support if the patient is supine)

Position the arm on the affected side so that it is away from the area of interest (either out to the side,

over the patient's head, or resting on top of the bucky)

Align the mid-clavicular line of the side being imaged to the midline of the IR

Anterior Oblique view

Position the patient so that they are facing the bucky

Rotate the patient so they are angled 45 with the affected side away from the bucky and the non

affected side touching the bucky

Position the arm on the affected side so that is away from the area of interest (either out to the side,

over the patient's head, or resting on top of the bucky)

Align the patient so that mid-clavicular line of the side being imaged (between the lateral rib margin

and the spine) to the midline of the IR

Name of projection Sternum - RAO

Area Covered Entire sternum including sterno-

clavicular joints

Pathology shown Pathologies of the sternum, for

example, fractures,

Radiographic Anatomy Sternum Radiographic Anatomy


Portrait


(CR and DR as recommended by

manufacturer)


Filter No

Exposure Breathing technique used

70 kVp

25 mA

3 seconds

FFD / SID 100 cm

Central Ray Directed to the level of the mid

sternum and slightly left of the midline


Collimation Centre: Mid sternum (mid way

between the jugular notch and the

xiphoid process)

Shutter A: Open to collimate to film

size lengthwise, ensuring the jugular

notch is included superiorly

Shutter B: Open laterally to

approximately 13 cm

Markers Superior and Laterally
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Marker orientation PA (unless patient

is supine, then marker is AP)

Shielding Gonadal (check your department's

policy guidelines)

Respiration No suspension of breath - use the

Breathing Technique to blur the lung

markings. The exposure is taken whilethe patient is taking shallow breaths.

Positioning The patient's presentation may dictate

the method for positioning, for

example

Upright Patient (preferred method)

Patient is erect with chest touching the

bucky

From this PA position, oblique the

patient 15 in an Right Anterior

Oblique (RAO) position, right shoulder

touching the bucky

Centre the sternum to the IR

Supine Patient

Patient supine on the table bucky

Angle the central ray 15 from right to

left across the patient

Patient (effectively) prone

this projection has the patient bending

from the waist so that their

sternum/chest is touching the table

bucky. However, first.....

place the film in the table bucky

angle the X-ray tube 15 degrees so that

is will be going from left to right across

the patient

collimate light field to the film size

have the patient bend from the waist

so that their sternum is flat resting on

the table (adjust the table height so

this is comfortable)

align the long axis of the sternum to

the long axis of the film, with the

jugular notch at the top

Name of projection Sternum - Lateral (Left or Right)

Area Covered Entire length of sternum in profile

Pathology shown Fractures

Radiographic Anatomy Sternum Radiographic Anatomy


Portrait




Filter No

Exposure 75 kVp
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25 mAs

FFD / SID 100 cm

Central Ray Directed to the sternum, midway between the jugular notch and the xiphoid process

Collimation Centre: Mid sternum (midway between the jugular notch and the xiphoid process)

Shutter A: Open to the film lengthwise, ensuring the jugular notch is included superiorly

Shutter B: Open to include whole of sternum, collimate tightly. Note: take care to suspend respiration

to keep the sternum within the tightly collimated field.

Markers Superior and Anterior (optional)

Marker indicates the side closest to the IR or bucky


Shielding Gonadal(check your department's policy guidelines)

Respiration On suspended inspiration

Positioning Patient erect, with either side touching the bucky

Have the patient bring their hands together behind their back and push their chest out ('pigeon

chested' position)

Ensure the patient is not rotated and the sternum is in a true lateral position

Name of projection Sternoclavicular - PA

Area Covered Lateral aspect of the manubrium and the medial portion of the clavicles visualised lateral to the

vertebral column through superimposing ribs and lung

Pathology shown Separation of sternoclavicular joint or other pathology

Radiographic Anatomy Sternoclavicular Radiographic Anatomy


Landscape




Filter No

Exposure 65 kVp20 mAs

FFD / SID 100cm

Central Ray CR perpendicular to IR

CR centred to level of T2 to T3 (7cm distal to vertebral prominens)

Collimation Four sides of collimation

Closely collimate to area of interest

Markers Lateral



Respiration suspended on expiration for a more uniform density

Positioning Patient prone on table

Cushon for patients head

Align midsagittal plane to CR and midline of table

Ensure no rotation of shoulders

CR perpendicular to IR

CR centred to level of T2 to T3 (7cm distal to vertebral prominens)

can be performed erect against the vertical bucky

Name of projection Sternoclavicular - Oblique
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Area Covered The manubrium, medial portion of the clavicles and sternoclavicular joint closer to the IR

Pathology shown Separation of sternoclavicular joint or other pathology, best visualising the sternoclavicular joint closer

to the IR, the other SC joint will be foreshortened

Radiographic Anatomy Sternoclavicular Radiographic Anatomy


Landscape




Filter No

Exposure 65 kVp

25 mAs

FFD / SID 100cm


CR centred to level of T2 to T3 (7cm distal to vertebral prominens) and 5cm lateral (toward upside) to

midsagittal plane

Collimation Four sides of collimation

Closely collimate to area of interest

Markers Lateral


Mark joint closer to IR ie: RAO best demonstrates the right SC joint


Respiration suspended on expiration for a more uniform density

Positioning Patient prone on table

Patients head on pillow

Patient obliqued on the table 15


CR centred to level of T2 to T3 (7cm distal to vertebral prominens) and 5cm lateral (toward upside) to

midsagittal plane

can be performed erect against the vertical bucky

Name of projection Chest - AP Supine (when not able to sit or stand)


Pathology shown The placement of various medical equipment can be seen, such as, Central Venous Catheters (CVC),

Nasogastric Tubes (NGT), Chest Tubes, Endotracheal Tubes, Swan-Ganz catheters and Pacemakers

It is important to note that pleural effusions are best seen in an Erect Chest X-ray. In a Supine Chest X-

ray the fluid is dispersed evenly through the lung fields, and so air-fluid levels will not show.


IR Size & Orientation 35 x 43 cm Landscape usually, but may be portrait depending on body habitus


Film / Screen Combination Regular(CR and DR as recommended by manufacturer)

Bucky / Grid Moving or Stationary Grid /not for most portable CXR's

Filter No

Exposure 85 kVp 2 mAs no grid

100 kVp 4 mAs with grid

FFD / SID As large as possible up to 180 cm

This may be helped by having the bed as low as possible and the X-ray tube as high as you can, giving

an FFD/SID up to 180 cm
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Central Ray Directed to the midsaggital plane, approximately 10 cm inferior to the jugular notch. (This is at the

level of T7).

Perpendicular to the coronal plane and the IR

Collimation Centre: 10 cm inferior to the jugular notch








Positioning Centre the midsaggital plane of the patient to the midline of the IR

Ensure the midsaggital plane is perpendicular to the IR, that is, the patient is lying flat and is not

rotated

If possible, move aside as many artifacts (tubes etc.) that may be lying over the chest


If possible, pronate hands and bring elbows away from the sides of the body to help clear the scapulae

of the lung fields

Adjust the height of the IR to 5cm (2 inches) above the shoulders

Raise the chin if this is superimposing over the chest

Name of projection Abdomen - Supine

Area Covered The diaphragm, abdomen, pubic symphysis

Pathology shown Bowel obstruction, inflammatory bowel disease, volvulus, organomegaly, pneumoperitoneum, tumour

and ascities

Radiographic Anatomy Abdomen Radiographic Anatomy


Portrait


Some obese patients will require two 35 x 43 cm landscape to cover the abdominal area. (sometimes 4

films required)Film / Screen Combination Regular



Filter No

Exposure 75 kVp

35 mAs

FFD / SID 100 cm

Central Ray Directed to the midsaggital plane at the level of the iliac crests


Collimation Centre: To the midsaggital plane at the level of the iliac crests

Shutter A: Open to include the pubic symphysis inferiorly

Shutter B: Open to include the lateral skin margins



Shielding Gonadal for males (check your department's policy guidelines)

Respiration Suspended on expiration - this lifts the diaphragm and presents the abdominal contents in a more

relaxed state. (check your departmental technique protocol)

Positioning Patient is supine on the table

Cushion for head
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Patient's arms slightly abducted from the torsoPositioned without rotation of the pelvis and torso

Ensure there are no artefacts such as zips or buttons over the area being imaged


CR directed to the midsaggital plane at the level of the iliac crests

Name of projection Abdomen - Prone

Area Covered The diaphragm, abdomen, pubic symphysis

Pathology shown Bowel obstruction, inflammatory bowel disease, volvulus, organomegaly, pneumoperitoneum, tumour

and ascities



Portrait





Filter No

Exposure 75 kVp

35 mAs

FFD / SID 100 cm

Central Ray CR directed to the midsaggital plane at the level of the iliac crests




Shutter B: Open to include the lateral skin margins






Positioning Patient is prone on the table

Cushion for head

Patient's arms slightly abducted from the torso

Positioned without rotation of the pelvis and torso



CR directed to the midsaggital plane at the level of the iliac crests

Name of projection Abdomen - Dorsal Decubitus

Area Covered Diaphragm and as much of the lower abdomen as possible

Pathology shown Air-fluid levels, aneurysms, calcification of aorta and umbilical hernia



Landscape


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Filter No

Exposure 85 kVp

40 mAs

FFD / SID 100 cm

Central Ray CR horizontalCentre to midcoronal plane - 5cm above iliac crest

Collimation Collimate closely to upper and lower abdomen soft tissue borders

Close collimation is needed because of the increased scatter and the need for soft tissue visibility

Markers Anterior and Inferior





Positioning Patient is supine on the table

Cushion for head

Patient's arms up above the head

Positioned without rotation of the pelvis and torsoEnsure there are no artefacts such as zips or buttons over the area being imaged

CR horizontal

Centre to midcoronal plane - 5cm above iliac crest

Name of projection Abdomen - Lateral

Area Covered Diaphragm and as much of the lower abdomen as possible

Pathology shown Abnormal soft tissue masses, umbilical hernia, aneurysm of aorta, calcification of vessels



Portrait




Filter No

Exposure 85 kVp

40 mAs

FFD / SID 100 cm



Collimation Collimate closely to upper and lower abdomen soft tissue borders

Close collimation is needed because of the increased scatter and the need for soft tissue visibility



Shielding Gonadal on males (check your department's policy guidelines)



Positioning Patient lateral recumbent position (laying on their side)

Make sure there is no rotation of the torso

Ensure there are no artefacts, such as zips or buttons over the area being imaged

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Name of projection Abdomen - Lateral Decubitus

Area Covered The abdomen, from the diaphragm downwards

Pathology shown Air-fluid levels, pneumoperitoneum, bowel obstruction,Radiographic Anatomy Abdomen Radiographic Anatomy


Portrait





Filter Yes, a decubitus filter can be used, except in slim patients. This will help to even out the soft tissue of

the abdomen which gravity will move closer to the table bucky.

Exposure 80 kVp

40 mAs

FFD / SID 100 cm

Central Ray Directed to the midsaggital plane, 5cm superior to the level of the iliac crests


Collimation Centre: To the midsaggital plane, 5cm superior to the level of the iliac crests

Shutter A: Open to IR size inferiorly and superiorly to include the diaphragm and as much of the

abdomen as possible

Shutter B: Open to include the lateral skin margins if possible


Marker orientation AP or PA, depending on the patient's position

Shielding Gonadal for males


Respiration On suspended expiration- check your department's technique protocol

Positioning

If possible, the patient should be in the decubitus position for at least 10 minutes prior to the imagebeing taken to best show any free gas

Patient lateral recumbent position (laying on their left side with their back to the wall bucky)

Make sure there is no rotation of the torso

Ensure there are no artefacts, such as zips or buttons over the area being imaged


Bring both hands above the head to remove the arms from the field of view

Name of projection Abdomen - Erect

Area Covered From the diaphragm downwards

Pathology shown Air-fluid levels, air under the diaphragm



Portrait





Filter No

Exposure 80 kVp
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40 mAs

FFD / SID 100 cm

Central Ray Directed to the midsaggital plane, 5cm superior to the level of the iliac crests


Collimation Centre: To the midsaggital plane, 5cm superior to the level of the iliac crests

Shutter A: Open to IR size inferiorly and superiorly to include the diaphragm and as much of the

abdomen as possibleShutter B: Open to include the lateral skin margins if possible



Shielding Gonadal on males, if possible


Respiration On suspended expiration or inspiration - check your department's technique protocol

Positioning If possible, the patient should be in the AP erect position for at least 10 minutes prior to the image

being taken so that any intraperitoneal free air can be demonstrated under the diaphragm. (AP/PA

chest radiography is more sensitive for pneumoperitoneum)

Patient is erect with their back to the wall bucky

There is no rotation of the torso

Ensure there are no artefacts, such as zips or buttons over the area being imagedCentre the midsaggital plane of the patient to the midline of the IR

Arms slightly abducted from the torso

Name of projection Renal - Supine Abdomen

Area Covered Kidneys, Ureters, bladder

Pathology shown radioopaque renal stones ( PT Should have CT scan on initial presentation to prove stones are radio-

opaque, when lloking for stones, role of plain xray is to monitor position of stones only, not initial

diagnosis)


IR Size & Orientation 35 x 43 cm Portrait



(CR and DR if available)


Filter No

Exposure 75 kVp

35 mAs

FFD / SID 100 cm

Central Ray Directed to the midsaggital plane at the level of the iliac crests




Shutter B: Open to include the lateral skin margins if possible




Respiration On suspended inspiration

(check your departmental technique protocol)

Positioning Patient is supine and positioned without rotation of the torso

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Centre the midsaggital plane of the patient to the midline of the IRPatient's arms slightly abducted from the torso

Name of projection Renal - AP Renal Area

Area Covered Kidneys, proximal ureter

Pathology shown opaque renal stones, hydronephrosis



Landscape




Filter No

Exposure 75 kVp

35 mAS

FFD / SID 100 cm

Central Ray Directed to the midsaggital plane at the midpoint between the distal sternum and the lower costal

margins


Collimation Centre: To the midsaggital plane at the midpoint between the distal sternum and the lower costal

margins

Shutter A: Open to include renal outline superiorly and inferiorly

Shutter B: Open to include the renal outlines laterally




Respiration On suspended expiration

(check departmental technique protocol)

Positioning Patient is supine and positioned without rotation of the torsoEnsure there are no artefacts such as zips or buttons over the area being imaged


Name of projection Cervical Spine - Lateral supine or erect

Area Covered The cervical spine from C1 down to the C7-T1 joint space and approximately one-third of T1 the first

thoracic vertebra

Pathology shown Disruption to the 5 lines of stability, indicating possible fracture, arthritis

Radiographic Anatomy Cervical Spine Radiographic Anatomy

IR Size & Orientation 24cm X 30cm

Portrait



Filter Can be used when using film

Exposure 70 kVp

20 mAs

FFD / SID 180 cm

This larger distance helps overcome the OID (object to image receptor distance) to reduce

magnification and improve the sharpness of the image.
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Central Ray Directed to the level of C4


If the patient has torticollis, a wry neck, then direct the central ray to the inner, concave side to use the

diverging rays to help penetrate the intervertebral joint spaces

Collimation Centre: C4

Shutter A: Open to include the top of the ear superiorly

Shutter B: Open to include the soft tissue of the neck anteriorly

The collimation may be angled to match the slope of the neck. For example, when the patient stands,C1 is usually more anterior than C7, so the collimation square may be tilted to match this slope.

Markers Anterior to Cervical Spine clear of perivertebral soft tissues



Respiration Suspended respiration on expiration.

The shoulders are able to relax downwards on expiration which will maximise the chances of being

able to visualise the C7-T1 junction on the image.

Positioning Ensure the removal of artefacts that may superimpose the anatomy of interest, such as earrings and

other jewellery

If the patient is erect,

The patient is side on to the bucky/IR (usually left side is closest to the IR, however if the patient hastorticollis, a wry neck, then direct the central ray to the inner, concave side)

Position the midsagittal plane so that it is parallel to the IR

Position the interpupillary line so that it is perpendicular to the IR (in an erect patient, this will also be

parallel to the floor)

Raise the chin slighlty, so that the mandible does not superimposed the cervical spine

If the patient is supine,

Position the patient so that the bucky/IR is along one side (usually the left side is closest to the IR)

Position the midsagittal plane so that it is parallel to the IR. If the patient is on a barouche, then this is

easily achieved by moving the bed.

Position the interpupillary line so that it is perpendicular to the IR

Only raise the chin slightly if the possibility of spinal injury has been ruled out, so that the mandible

does not superimpose over the cervical spine

Traction on arms may be required to see T1Where possible ask the patient to relax their shoulders down and move their finger tips in the direction

of their toes on expiration, so that as you expose you have the best chance of penetrating the lower

cervical spine area

Name of projection Cervical - Lateral (Hyper Flexion)


thoracic vertebra

Pathology shown A functional study to demonstrate motion or lack of motion of cervical vertibra, done in conjunction

withneutral andhyper extensionview they demonstrate natural spinal curvature, range of spinal

motion and ligament stability


IR Size & Orientation 24cm x 30cm

Portrait





Exposure 70 kVp

20 mAs
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FFD / SID 180 cm






Shutter A: Open to include the top of the ear superiorlyShutter B: Open to include the soft tissue of the neck anteriorly

The collimation may be angled to match the slope of the neck. For example, when the patient stands,

C1 is usually more anterior than C7, so the collimation square may be tilted to match this slope.







Positioning Ensure the removal of artefacts that may superimpose the anatomy of interest, such as earrings and

other jewellery

Patient erect,

The patient is side on to the bucky/IR (usually left side is closest to the IR, however if the patient has

torticollis, a wry neck, then direct the central ray to the inner, concave side)


Chin should be depressed until it touches the chest or as much as the patient tolerates

Where possible ask the patient to relax their shoulders down and move their finger tips in the direction


cervical spine area

Name of projection Cervical - Lateral (Hyper Extension)


thoracic vertebra

Pathology shown A functional study to demonstrate motion or lack of motion of cervical vertebra, done in conjunctionwith aneutral andhyper flexionview view they demonstrate natural spinal curvature, range of spinal

motion and ligament stability


IR Size & Orientation 24cm x 30cm

Portrait





Exposure 70 kVp

20 mAs

FFD / SID 180 cmThis larger distance helps overcome the OID (object to image receptor distance) to reduce





Shutter A: Open to include the top of the ear superiorly

Shutter B: Open to include the soft tissue of the neck anteriorly

The collimation may be angled to match the slope of the neck. For example, when the patient stands,

C1 is usually more anterior than C7, so the collimation square may be tilted to match this slope.
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Positioning Ensure the removal of artefacts that may superimpose the anatomy of interest, such as earrings andother jewellery

Patient erect,

The patient is side on to the bucky/IR (usually left side is closest to the IR, however if the patient has

torticollis, a wry neck, then direct the central ray to the inner, concave side)


Chin should be raised and head leaned back as much as possible

Where possible ask the patient to relax their shoulders down and move their finger tips in the direction


cervical spine area

Name of projection Cervical Spine - Oblique

Area Covered Vertebrae of the cervical spine, C1 through to C7, as well as the thoracic vertebra T1, the soft tissues of

the neck

Pathology shown Pathologies of the cervical spine,


IR Size & Orientation 18cm X 24 cm

Portrait




Filter No


FFD / SID 150 - 180 cm




Anterior Obliques - 15 degrees caudad (down)

Posterior Obliques - 15 degrees cephalad (up)

Collimation Centre: C4, collimate to the 18 x 24cm film size

Shutter A: Open so that the light of the collimated field just includes the top of the ear.

Shutter B: Open to include the soft tissue of the neck laterally


Marker orientation

- Posterior Obliques is AP

- Anterior Obliques is PA


Respiration Suspended

Positioning Note that the patient should not be moved or asked to move into position in the case of trauma until

the possibility of spinal injury has been ruled out.

For Anterior Obliques,

Position the patient against the upright bucky in a PA position
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Angle the patient so that their chest and neck make a 45 degree angle with the buckyEnsure the chin is up slightly to avoid superimposition over the cervical spine

For Posterior Obliques,

Position the patient in an AP position against the upright bucky

Angle the patient so that their back and neck make a 45 degree angle with the bucky

Ensure the chin is up slightly to avoid superimposition over the cervical spine

Name of projection Cervical Spine - AP

Area Covered The cervical vertebrae from C3 down to approximately T2

Pathology shown Some pathologies of the cervical vertebrae C3 through to C7



Portrait




Filter No

Exposure 65 kVp

16 mAs

FFD / SID 100 cm

Central Ray Directed to the level of C4, which is approximately the level of the angle of the mandible

15 degrees cephalad. (to match the lordotic curve of the cervical spine, to penetrate the intervertebral

disc spaces)


Shutter A: Open so that the light of the collimated field just includes the top of the ear. The light will

appear to bend around due to the central ray being angled cephalad


Markers Lateral



Respiration Suspended respiration

Positioning In general,

Ensure the removal of artefacts that may superimpose the anatomy of interest

Only request the patient move into position if the possibility of spinal injury has been ruled out

Take care to ensure no rotation of either the head, neck or torso.


Using the upright bucky, position the patient in an AP position. (This allows the patient to rest their

back against the bucky, and may help to minimise patient movement)

Position the midsagittal plane so that it is perpendicular to the IR

Position the interpupillary line so that it is parallel to the IR (in an erect patient, this will also be parallelto the floor)

Raise the chin slighlty, so that the line of the occlusal plane superimposes the base of the skull


Position the IR patient so that it is either in the table bucky, or is on the barouche posterior to the

cervical spine


Position the interpupillary line so that it is parallel to the IR


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Name of projection Cervical - AP ("Wagging Jaw")

Area Covered Entire cervical spine with the mandible blurred

Pathology shown Some pathologies of the entire cervical vertebrae including dens and surrounding bony structures of

the C1 ring


IR Size & Orientation 18 x 24 cmPortrait




Filter No

Exposure 65 kVp 8 mA x 2 seconds - exposure time must be long enough to cover several complete excursions of

the mandible to enable it to be blurred out

FFD / SID 100 cm


Directed to the level of C4


Shutter A: Open so that the light of the collimated field just includes the top of the ear. The light willappear to bend around due to the central ray being angled cephalad


Markers Lateral












Position the interpupillary line so that it is parallel to the IR (in an erect patient, this will also be parallel

to the floor)

Raise the chin slighlty, so that the line of the occlusal plane superimposes the base of the skull

Mandible must be in continuous motion during exposure

Ensure that only the mandible moves ( the head must not move and the teeth must not make contact)



cervical spine


Position the interpupillary line so that it is parallel to the IR

Mandible must be in continuous motion during exposure

Ensure that only the mandible moves ( the head must not move and the teeth must not make contact)

Name of projection Cervical - AP Vertibral Arch

Area Covered Cervical vertebra from C4 to C7. Posterior elements of mid and distal cervical and proximal thoracic

vertebrae


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Pathology shown Pathology of posterior vertebral arch aspects of C4 to C7 or spinous processes of cervicothoracic

vertebra



Portrait




Filter No

Exposure 65 kVp

16 mAs

FFD / SID 100 cm

Central Ray CR angled 20 to 30 caudal

CR directed to enter at lower margin of thyroid cartilage

Collimation Centre: lower margin of thyroid cartilage, collimate to the 18 x 24cm film size



Markers Lateral








Patient is supine with arms at side,


cervical spine


Hyperextend the neck (if patient is able)

CR angled 20 to 30 caudal

CR directed to enter at lower margin of thyroid cartilage

Name of projection Cervical - Oblique Vertebral Arch

Area Covered C1 to C7

Pathology shown Pathology of the vertebral arches or pillars



Portrait



Filter No

Exposure 65 kVp

16 mAs

FFD / SID 100 cm

Central Ray CR angled 30 to 40 caudal
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CR directed to exit the seventh cervical vertebra

Collimation Collimate to the 18 x 24cm film size




Marker orientation is AP

Mark the side being demonstrated (side that is up is demonstrated ie head turned to the leftdemonstrates the right side)



Positioning Patient supine on the table

Rotate the head 45 to 50 towards the unaffected side

A 45 to 50 degree rotation shows second to seventh cervical vertebrae and first thoracic vertebra, a

rotation as much as 60 to 70 is sometimes required for demonstration of the processes of the sixth

and seventh vertebra and of the first to fourth thoracic vertebra

Side that is up is demonstrated (mark the side being demonstrated accordingly eg head turned to the

left demonstrates the right side, head turned to the right demonstrated the left side)

CR angled 30 to 40 caudal

CR directed to exit the seventh cervical vertebra

Name of projection Cervical Spine - Odontoid (Peg)

Area Covered Cervical vertebra C1 - Lateral masses, transverse processes

Cervical vertebra C2 - Odontoid process, body of C2

Zygopophyseal joints

Pathology shown Pathologies of C1 and C2, including Jefferson fractures and odontoid fractures



Portrait




Filter No

Exposure 65 kVp

16 mAs

FFD / SID 100 cm

Central Ray Directed to the centre of the open mouth

Parallel/along the line of the occlusal plane of the top teeth and the base of skull (the angle may be

cephalad, caudal or perpendicular depending on the patient presentation)

Collimation Centre: The centre of the open mouth

Shutter A: Open to include the acanthion superiorly

Shutter B: Open to include the corners of the open mouth laterally

Markers Lateral





Ensure the removal of artefacts that may superimpose the anatomy of interest, such as dentures or

tongue jewellery



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Take care to ensure no rotation of either the head, neck or torso.If the patient is erect,




Position the interpupillary line so that it is parallel to the IR (in an erect patient, this will also be parallel

to the floor)

Have the patient open their mouth as wide as possible

Raise or lower the chin so that the occlusal plane of the upper teeth and the base of the skull are in

line and are perpendicular to the IR/bucky

The central ray will then be perpendicular to the IR/bucky


Often this may be the case due to trauma, in which case do not move the patient, work around them

Position the IR so that it is either in the table bucky, or is on the barouche posterior to the upper

cervical spine

Angle the central ray along the line of the occlusal plane of the upper teeth and the base of skull

Name of projection Cervical - Odontoid Peg AP (Fuch Method) or (Judd Method) when performed PA

Area Covered Dens (Odontoid Process) and other structures of C1 to C2 within the foramen magnum

Pathology shown Pathology involving dens and and surrounding bony structures of the C1 ring



Portrait




Filter No

Exposure 65 kVp

16 mAs

FFD / SID 100 cm

Central Ray CR is parrallel to MML (mentomeatal line) , directed to the inferior tip of mandible

Collimation Four sides of close collimation to C1 to C2 region

Markers Lateral



Respiration Suspended respiration on expiration

Positioning Fuch method performed AP

Patient supine on table with midsagittal plane aligned to CR and midline of table

Elevate chin to bring MML (mentomeatal line) near perpendicular to table top

Ensure that no rotation of the head (angles of mandibles equidistant to tabletop)

CR is parrallel to MML (mentomeatal line) , directed to the inferior tip of mandible

Centre IR to CR

Additionally this view may be performed PA known as the (Judd Method)

This the reverse of the AP Fuch method

Patient prone on table

Chin resting on table top and is extended to bring MML (mentomeatal line) near perpendicular to

table


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Ensure that there is no rotation of the headEnsure that CR is parrallel to MML

Centre to midoccipital bone about 2.5cm inferoposterior to mastoid tips and angles of mandible

Name of projection Cervical - Cervicothoracic (Swimmers) (Pawlow Method)

Area Covered Lower cervical and upper thoracic (C4 - T3 region) - vertebral bodies, intervertebral disk spaces and

zygapophyseal joints

Pathology shown Payhology involving the inferior cervical spine, superior thoracic spine and adjacent soft tissue

structures



Portrait




Filter No


FFD / SID 150 - 180 cm

Central Ray CR 3 to 5 caudad

CR centred to T1 - approximately 2.5cm above sternal notch

Collimation Four sides of close collimation to area of interest approximately 10 x 15cm in size




Respiration Suspended respiration on expiration - the shoulders are able to relax downwards on expiration

Positioning Ensure the removal of artefacts that may superimpose the anatomy of interest, such as necklaces and

other jewellery

The patient is on the table in a lateral recumbent position with the head elevated on the patients arm,

sandbags of small pillow/sponge

Centre median coronal plane of the body to the midline of the grid

Adjust the support under the head and place another support under the lower thorax so that the long

axis of the cervicothoracic vertebrae is horizontal

Extend the arm which the patient is lying on above the head. Move the humeral head anteriorly or

posteriorly

Place the top arm at the patients side

Adjust the body onto an exact lateral position

Centre the cassette at the level of the jugular notch

CR 3 to 5 caudad, CR centred to T1 - approximately 2.5cm above sternal notch

Suspended respiration on expiration

Name of projection Cervical - Cervicothoracic (Swimmers) (Twining Method)

Area Covered Lower cervical and upper thoracic (C4 - T3 region) - vertebral bodies, intervertebral disk spaces and

zygapophyseal joints

Pathology shown Payhology involving the inferior cervical spine, superior thoracic spine and adjacent soft tissue

structures

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Portrait




Filter No

Exposure 80 kVp

60 mAs

FFD / SID 150 - 180 cm


CR centred to T1 - approximately 2.5cm above sternal notch

Collimation Four sides of close collimation to area of interest approximately 10 x 15cm in size




Respiration Suspended respiration on expiration - the shoulders are able to relax downwards on expiration

Positioning Ensure the removal of artefacts that may superimpose the anatomy of interest, such as necklaces and

other jewellery


The patient is erect and side on to the vertical bucky / IR


Place patients arm and shoulder closest to IR up, flexing elbow and resting forearm on head for

support

Position arm and shoulder away from IR down and slightly anterior to place humeral head anterior to

vertebrae

Maintain thorax and head in as true lateral position as possible


The patient is supine on the table side on to the vertical bucky / IRPosition the midsagittal plane so that it is parallel to the IR

Place patients arm and shoulder closest to IR up, flexing elbow and resting forearm on head for

support

Position arm and shoulder away from IR down and slightly anterior to place humeral head anterior to

vertebrae

Maintain thorax and head in as true lateral position as possible

Where possible ask the patient to relax their shoulder down and move their finger tips in the direction


cervical spine area

Name of projection Thoracic Spine - AP

Area Covered C7 to L1

Pathology shown Fractures, scoliosis/kyphosis, tumour, infection, congenital abnormality

Radiographic Anatomy Thoracic Spine Radiographic Anatomy

IR Size & Orientation 35 x 43 cm Portrait




Filter Decubitus filter over the superior thoracic spine when using film, not required with DR CR
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Exposure 66 kVp 20 mAs or 66 kVp 20mA 1sec for breathing technique

FFD / SID 100 cm

Central Ray Directed to T7 (to the midsaggital plane, midway between the jugular notch and the xiphoid process)


Collimation Centre: To the midsaggital plane, midway between the jugular notch and the xiphoid process

Shutter A: Open to include the hyoid bone

Shutter B: Open approximately 10 - 12 cm to include the paraspinal soft tisues (this may need to beopen wider in the case of scoliosis)

Markers Superior

Name of Projection

Documents

Transcript of Name of Projection