X-RAY
POSITIONING LAB MANUAL
RDT 113, 114, 210, 212, &
215
Roane State Community College
2014 – 2015
ORBC
Student Name_________________
Lab Manual 2014-2015
Table of Contents
RDT 113 – Radiographic Procedures I
1.
2.
3.
4.
5.
6.
7.
8.
Positioning Lab Requirements and Policies…………………………….
Terminology and Equipment……………………………………………
Chest…………………………………………………………………….
Abdomen………………………………………………………………..
Fingers, Thumb, Hand, and Wrist ………………………………………
Forearm, Elbow, and Humerus…………………………………………
Shoulder Girdle…………………………………………………………
Toe, Foot, Heel, and Ankle……………………………………………..
4
5
6
9
11
15
18
22
RDT 114 – Radiographic Procedures II
9.
10.
11.
12.
13.
14.
15.
Lower Leg, Knee, Patella, and Femur………………………………….
Pelvic Girdle……………………………………………………………
Cervical and Thoracic Spine……………………………………………
Lumbar Spine, Sacrum, and Coccyx…………………………………...
Upper GI………………………………………………………………..
Lower GI……………………………………………………………….
Urinary System…………………………………………………………
26
29
32
36
38
41
43
RDT 210 – Radiographic Procedures III
16.
17.
18.
19.
Skull and Cranial Bones………………………………………………..
Facial Bones, Nasal Bones, and Zygomatic Arches……………………
Optic Foramina, Mandible, and Sinuses…………….……………........
Bony Thorax……………………………………………………………
45
47
49
52
2
Lab Manual 2014-2015
3
Safety Guidelines for the Energized Lab
The energized lab provides the radiology technology student with the opportunity to develop
skills in imaging anatomical structures and to perform exposure experiments to assess equipment
operation and radiographic techniques. The energized lab requires following special rules to
ensure safety for both you and your fellow classmates. The lab will be used for exposures only
during the second year of study.
Energized Lab (X-Ray Unit):
1. You must always wear the radiation monitoring dosimeter provided by the program.
2. No open toed shoes are allowed in the x-ray lab (this includes flip flops and sandals). If
footwear is not in compliance, you will be counted as absent and asked to leave.
3. The tube can and will only be energized in the presence of a Rad Tech faculty member.
4. Before making a radiation exposure, be sure the door to the x-ray room is closed tightly,
locked, and the control panel is set correctly. Failure to do so will result in disciplinary
action.
5. Be sure to turn the appropriate positioning locks off on the tube stand before attempting
to move the unit. This will help to prolong the life of the locks.
6.
If you notice anything unusual in the operation of the unit or its appearance (i.e., loose
wire), please report it to the instructor. The x-ray unit is calibrated by a physicist to
ensure the unit meets federal and state guidelines for ionizing radiation units.
7. Do not eat or drink in the x-ray room or at the operating console.
8. While positioning the phantom can be fun, do not lose sight of the fact that you are
working with heavy electrical equipment and injuries can occur (i.e., hitting head on
tube). Therefore, good conduct is required when operating the unit. Should an injury
occur, please report it to the instructor at that time.
Lab Manual 2014-2015
4
Positioning Lab Requirements and Rules for Marking Image Receptor (IR)
1. Read lab instructions before lab demonstration.
2. If a student fails a lab exam, then they must repeat it in the presence of two instructors.
Failure to achieve a passing score on the repeat lab exam results in a D in the course and
the student will be dismissed from the program at the end of the semester. A maximum of
three failed lab exam repeats are allowed each semester.
3. If you miss a scheduled lab exam, it will be performed according to the make-up schedule
at the end of the semester or at the discretion of the lab instructor. If a lab demonstration is
missed, you are responsible for the material covered and should be prepared for the lab
exam the following week. Two or more unexcused lab absences in a semester will result in
an “F” for your final semester grade. If a student is more then 20 minutes late to a
laboratory session, then it will be considered as an absence and they must attend a different
lab section (if one is available).
4. Refer to attached lab competency objectives for IR sizes & placement.
5. Place lead markers to correspond to the correct side of the patient!
a. Lateral positions - mark the side closest to the IR.
b. Obliques - mark according to your clinical protocol. However, right markers
should correspond to the right side of the patient’s body; left markers should
correspond to the patient’s left side of the body.
c. Extremities and decubitus projections - mark according to clinical protocol, but
lead markers must always correspond to correct side of patient.
d. Be certain that the lead marker is not in the anatomical area of interest. If placed
incorrectly, ten points will be deducted from the lab exam grade.
e. Be certain the lead marker is within the coned field. If not included in the
collimated field, the position will be considered unmarked and ten points will be
deducted from the lab exam grade.
6. Lab exams are timed. Each student has 20 minutes to complete the exam from start to
finish. If not completed in 20 minutes, the instructor will stop the exam and unfinished
items will be deducted from the lab exam score.
7. Communication Skills are included into the lab exam grade. The display of excellent
communication skills consists of the student providing clear and concise instructions to the
patient. The student must behave professionally at all times. Some examples of
unacceptable behavior from the student include excessive talking, lack of focus, absence of
professional demeanor, and patient confusion due to unclear presentation of instructions.
8. Patient care skills – The student must demonstrate all of these skills:
a. Appropriate introduction to the patient.
b. Two patient identifiers are checked on the wrist band (e.g. name & DOB).
c. Pleasant and helpful manners exhibited toward patient.
d. Attends to patient safety and comfort at all times.
i. This includes asking females about pregnancy in a way that does not
violate HIPAA, assuring that the patient is not left standing alone while
setting up equipment, verifying that the x-ray tube is not in the way when
patient gets on/off the table, providing the patient a clean pillow when
possible, and etc.
Lab Manual 2014-2015
RDT 113 - Terminology and Equipment
Demonstration, Practice and Testing:
The student will demonstrate knowledge of:
A.
Position terms
AP & PA
Rt lateral & Lt lateral
Trendelenburg
Supine & Prone
Anatomical position
RAO
LAO
RPO
LPO
Rt. lateral decubitus
Lt. lateral decubitus
Dorsal decubitus
Ventral decubitus
B.
Equipment
Moving tabletop
Bucky tray
Tube-to-bucky centering
Distance indicator
Collimator
Tube angle
Upright bucky
Main wall switch
Control panel
On and off switch
Milliamperage
Kilovoltage
C.
Cassette size (in our labs, we will be using only 14x17 and 10x12 cassettes)
14 x 17
7 x 17
11 x 14
10 x 12
8 x 10
D.
Accessories
Grid cassettes
Radiolucent sponges
Sandbags
Calipers
Gonadal shield
Markers
E.
Lab manual including exam grade sheet
5
Lab Manual 2014-2015
RDT 113 – Chest Laboratory Competencies
Instructor Demonstration:
PA
Lateral – erect and stretcher
Wheelchair or stretcher AP Chest
Decubitus chest
Obliques (R or L)
Portable chest (using stretcher as “bed”)
AP axial lordotic
Student Practice and Test
The student will demonstrate positioning of:
1. PA Projection – 14x17 LW (or CW)
2. Lateral - 14x17 LW
3. AP and Lateral WC or Stretcher Chest – 14x17 CW and 14x17 LW
4. Portable AP Chest (using stretcher as “bed”)
Note:
Use 72” SID
Expose on Full inspiration
Use L & R markers
Shield gonads
110 to 125 kV range
6
Lab Manual 2014-2015
7
Chapter 3 – Chest
Name
IR
SID
Centering
Patient Instructions
PA Chest
14x17 LW
or CW
depending
on patient
width
72”
Perpendicular to T-7 and MSP.
(To ascertain location of T7, the
rule of thumb is 7-8” below
vertebral prominence. Or you
can approximately measure
from thumb to 5th digit).
Shield gonads.
Marker on R or L side of patient.
Roll shoulders forward and depress
downwards.
Back of hands on hips.
Weight evenly distributed on both
feet.
Chin is raised.
Check for thorax rotation.
Collimate as needed.
Expose on 2nd deep inspiration.
Another rule of thumb is that
the IR will be ~1 ½--2” above
shoulder level.
Same as PA chest, but patient is
sitting on side of stretcher.
PA
Stretcher
Left Lateral
Chest
14x17 LW
72”
Perpendicular to chest midthorax at level of T7 (3-4”
below jugular notch).
Often need to lower bucky
about 1” from PA position
location.
Shield gonads.
Use a left marker.
Left side of patient is against IR in a
true lateral position.
Center thorax to IR and CR.
Coronal plane is perpendicular &
sagittal plane parallel to IR.
Patient’s arms are raised above head
and chin is elevated.
Collimate as needed.
Expose on 2nd deep inspiration.
Wheelchair
or Stretcher
AP
(Portable
AP)
14x17 CW
72”, if
possible
CR angled caudad to be
perpendicular to sternum at
3-4” below jugular notch.
Shield gonads.
Use marker on R or L side.
Roll patient’s shoulders forward by
rotating arms medially.
Chin is elevated.
No rotation of the thorax.
Collimate.
Expose on deep inspiration.
Left Lateral
Wheelchair
or Stretcher
14x17 LW
72”
CR perpendicular to level of
T7.
Shield gonads.
Use a left marker.
Arms are raised above head and chin
is elevated.
Remove armrests, if possible, from
lateral wheelchair.
Place support sponges behind
patient’s back.
Expose on 2nd deep inspiration.
Lab Manual 2014-2015
8
Chapter 3 – Chest
Name
IR
SID
Centering
Patient Instructions
Lateral
Decubitus
Chest X-Ray
14x17 Grid
CW to
Patient
72”
CR horizontal to center of IR,
3-4” below level of jugular
notch.
Patient is lying on their right or left
side and a radiolucent pad or cardiac
board is placed underneath.
Chin and arms are raised.
Patient’s back is against IR with no
rotation and the stretcher locked.
Adjust patient and cart so MSP is
centered to IR (top of IR is 1” above
the vertebra prominens).
14x17 LW
72”
CR perpendicular to level of
T7.
Shield gonads.
Use Rt marker adjacent to Rt side.
Pt. rotated 45° with Rt posterior
shoulder against IR.
Right arm raised with hand on back of
head.
Left arm flexed and hand on hip,
palm out.
Center thorax to CR and IR.
(Reverse for LPO).
14x17 LW
72”
CR perpendicular to level of
T7.
Shield gonads.
Pt. rotated 45°, with Rt anterior
shoulder against IR for RAO.
Flex right arm and put right hand on
hip, palm out.
Raise opposite arm and place on head.
Chin is raised.
Center patient to CR and to IR (top of
IR will usually be about 1” above
vertebra prominens).
Place marker on right or left side.
Collimate as needed.
(Reverse for LAO).
14x17 LW
72”
Perpendicular to IR and
centered at mid-sternum.
Shield gonads.
Patient stands about 1 ft away from
IR; leans back with shoulders, neck
and head against IR.
Hands on hips, palm out; shoulders
rolled forward.
Expose on 2nd deep inspiration.
If patient unable to assume lordotic
position, do AP semi-axial projection
with CR angled 15-20° cephalad to
mid-sternum.
Demo Only
RPO/LPO
Oblique
Chest
Demo Only
RAO/LAO
Oblique
Chest
Demo Only
AP Lordotic
Demo Only
Lab Manual 2014-2015
RDT 113 – Abdomen Laboratory Competencies
Instructor Demonstration:
AP (KUB)
Upright (to include diaphragm)
Left lateral decubitus
Dorsal decubitus
Portable abdomen (using stretcher as “bed”)
Student Practice and Test:
The student will demonstrate positioning of:
1. AP – 14x17 LW
2. Upright – 14x17 LW
3. Lateral decubitus – 14x17 LW to patient (CW to bucky)
4. Portable abdomen
Note:
Use 40” SID
Full expiration
Grid technique
Use L & R markers
Shield gonads of males only
70-80 kV range
9
Lab Manual 2014-2015 10
Chapter 4 – Abdomen
Name
IR
SID
Centering
Patient Instructions
AP (KUB)
14x17 LW
40”
CR directed perpendicular to
MSP at level of iliac crests.
Patient supine.
No rotation of pelvis or shoulders.
*Check that ASIS’s are equidistant
to table.
Use marker on R or L side.
Shield gonads of males only.
Some patients require 2 projections
with IR CW to demonstrate entire
abdomen.
Collimate on 4 sides if possible.
AP Upright
(to include
diaphragm)
14x17 LW
40”
CR is perpendicular and
directed to MSP—2” above
level of crests.
Patient erect.
No rotation.
Shield gonads of males only.
Use marker on R or L side.
Top of IR at level of axilla
usually.
Collimate on 4 sides if possible.
Left Lateral
Decubitus
14x17
40”
Grid or
Bucky
LW to
patient
Dorsal
Decubitus
Position –
R or L
Lateral
14x17
CR is perpendicular and
directed to MSP 2” above level
of crests.
Collimate on 4 sides if possible.
40”
Grid or
bucky LW
to patient
CR is perpendicular and
directed to MSP 2” above level
of crests.
Collimate on 4 sides if possible.
Patient recumbent on left side.
Patient can be placed on a radiolucent
pad to center abdomen to the grid or
bucky.
No rotation.
If patient is not centered to the grid or
bucky, be sure the upside of abdomen
is included on the film and within
collimation field.
Shield gonads of males only.
Patient supine with side of interest
closest to grid or bucky.
Side closest to the film determines
which marker is used.
Ensure no rotation.
Shield gonads of males only.
Demo Only
Portable
Abdomen
14x17 Grid
LW
40”
Perpendicular to MSP at level
of iliac crest for general
abdomen study.
*If exam is for
feeding tube placement,
center to include diaphragm.
Patient supine on stretcher or bed.
Place film under patient in the bed.
Use marker on R or L side.
Ensure no patient rotation.
Shield gonads of males only.
Determine if patient will require one
projection LW or 2 projections CW.
Lab Manual 2014-2015 11
RDT 113 – Fingers, Thumb, Hand, and Wrist Laboratory Competencies
Instructor Demonstration:
Fingers
PA
Oblique
Lateral
Thumb
AP
Oblique
Lateral
Hand
PA
Oblique
Lateral (flexion and extension)
Fan lateral
Wrist
PA
Oblique
Lateral
Scaphoid – Ulnar deviation
Student Practice and Test:
The student will demonstrate all positioning of:
1. Fingers – 10x12 LW or CW
2. Thumb – 10x12 LW or CW
3. Hand – 10x12 LW or CW
4. Wrist – 10x12 LW or CW
Note:
Use 40” SID
Use L & R markers
Shield gonads
Closely collimate
Detail (extremity cassette) technique
Immobilize part as necessary
kV ranges vary (refer to Bontrager)
Lab Manual 2014-2015 12
Chapter 5 - Fingers, Thumb, Hand, and Wrist Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Finger – PA
10x12 CW
or LW
40” to IR
CR directed perpendicular to
PIP.
Collimate on 4 sides to area of
interest.
Patient is seated at end of table.
Rest hand and forearm on table,
pronate hand, spread fingers apart.
Use L or R marker.
Shield gonads.
Finger –
Oblique
10x12 CW
or LW
40” to IR
CR directed perpendicular to
PIP.
Patient is seated at end of table.
Rest hand and forearm on table.
Place hand with fingers extended
against a 45° foam block with thumb
side up.
2nd digit can be performed as a medial
rotation.
Make sure finger is parallel to IR.
Use L or R marker.
Shield gonads.
Collimate on 4 sides to area of
interest.
Finger –
Lateral
10x12 CW
or LW
40” to IR
CR directed perpendicular to
PIP.
Collimate on 4 sides to area of
interest.
Patient is seated at end of table.
Rest hand and forearm on table.
Place hand in lateral position (thumb
side up), finger fully extended.
Perform a lateromedial for 3-5th digits
and a mediolateral for the 2nd digit.
Use L or R marker.
Shield gonads.
*Remember “anatomic position”
determines lateral vs. medial.
Thumb – AP
10x12 CW
or LW
40” to IR
CR directed perpendicular to
1st MCP joint.
Collimate on 4 sides to include
entire 1st metacarpal.
Thumb –
Oblique
10x12 CW
or LW
40” to IR
CR directed perpendicular to
1st MCP joint.
Collimate on 4 sides to include
entire 1st metacarpal.
Patient is seated at end of table.
Hand is rotated internally; supinate
thumb for AP (posterior surface of
thumb is in contact with IR).
Hold other fingers back with other
hand.
Use L or R marker.
Shield gonads.
Patient is seated at end of table.
Abduct thumb slightly with palmar
surface of hand against cassette.
Thumb will be in 45° position.
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 13
Chapter 5 - Fingers, Thumb, Hand, and Wrist Laboratory Competencies
Thumb –
Lateral
10x12 CW
or LW
40” to IR
CR directed perpendicular to
1st MCP joint.
Collimate on 4 sides to include
entire 1st metacarpal.
Patient is seated at end of table.
Fingers and hand slightly arched.
Rotate hand medially until thumb is
in true lateral.
Use L or R marker.
Shield gonads.
Hand – PA
10x12 CW
or LW
40” to IR
CR directed perpendicular to 3rd
MCP.
Patient is seated at end of table.
Hand is pronated with palmar surface
on IR.
Use L or R marker.
Shield gonads.
Collimate on 4 sides to outer
margins of the hand and wrist.
Hand –
Oblique
10x12 CW
or LW
40” to IR
CR directed perpendicular to 3rd
MCP.
Collimate on 4 sides to outer
margins of the hand and wrist.
Patient is seated at end of table.
Rest hand and forearm on table,
elbow flexed about 90°.
Rotate entire hand and wrist laterally
so digits are separated and parallel to
IR; support with 45° foam block.
Use L or R marker.
Shield gonads.
*Alternate method - when
metacarpals are the area of interest
then the thumb and fingertips
touch IR.
Hand –
Lateral
10x12 CW
or LW
40” to IR
CR directed perpendicular to
2nd MCP.
Collimate on 4 sides to area of
interest.
Patient is seated at end of table.
Use L or R marker.
Shield gonads.
“Fan” lateral - hand and wrist in
lateral position, each digit supported
on foam step block. All digits
separated and parallel to IR;
metacarpals in true lateral.
Lateral in extension or flexion Extend fingers and thumb,
superimposed, and support them
against foam block.
Lateral in flexion - flex fingers in
natural flexed position, thumb lightly
touching first finger.
Lab Manual 2014-2015 14
Chapter 5 - Fingers, Thumb, Hand, and Wrist Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Wrist – PA
10x12 CW
or LW
40” to IR
CR directed perpendicular to
mid-carpal area.
Patient is seated at end of table.
Forearm placed on table and elbow is
flexed 90°.
Hand is pronated and slightly arched
to place carpals in contact with IR.
Use L or R marker.
Shield gonads.
Collimate on 4 sides to include
mid metacarpals and distal
radius and ulna.
Wrist –
Oblique
10x12 CW
or LW
40” to IR
CR directed perpendicular to
mid-carpal area.
Collimate on 4 sides to include
mid metacarpals and distal
radius and ulna.
Wrist –
Lateral
10x12 CW
or LW
40” to IR
CR directed perpendicular to
mid-carpal area.
Collimate on 4 sides to include
mid metacarpals and distal
radius and ulna.
Wrist –
Scaphoid
with Ulnar
Deviation
and CR angle
10x12 CW
or LW
40” to IR
Angle CR 10-15° proximally
or toward elbow and center to
scaphoid (3/4” distal and
medial to radial styloid
process).
Patient is seated at end of table.
Forearm placed on table, elbow is
flexed 90°.
From pronated position, rotate hand
and wrist laterally 45°.
Rest against 45° foam block.
Use L or R marker.
Shield gonads.
Patient is seated at end of table.
Forearm placed on table and elbow is
flexed 90°.
Wrist and hand in true lateral
position, thumb up, fingers flexed or
extended.
If extended, use support to stabilize.
Use L or R marker.
Shield gonads.
Position as for PA wrist except,
without moving forearm.
Evert hand (move toward ulnar side)
as much as patient can tolerate
without lifting or obliquing distal
forearm.
Lab Manual 2014-2015 15
RDT 113 – Forearm, Elbow, and Humerus Laboratory Competencies
Instructor Demonstration:
Forearm
AP
Lateral
Elbow
AP
Internal oblique (medial oblique)
External oblique (lateral oblique)
Lateral
AP (2 images; when elbow cannot be extended)
Humerus
AP
Rotational lateral
Student Practice and Test:
The student will demonstrate positioning of:
1. Forearm – AP and lateral (14x17 LW)
2. Elbow – AP, internal oblique, external oblique, and lateral (10x12 LW or CW)
3. Humerus – AP and rotational lateral (14x17 LW)
Note:
Use 40” SID to IR
Use L & R markers
Shield gonads
Closely collimate
Detail (extremity cassette) technique
Immobilize part as necessary
kV range varies for thickness of part (refer to Bontrager)
Lab Manual 2014-2015 16
Chapter 5 – Forearm, Elbow, and Humerus Laboratory Competencies
Name
IR
SID
Centering
Forearm –
AP
14x17 LW
40” to IR
CR directed perpendicular to
mid-forearm.
40” to IR
CR directed perpendicular to
mid-forearm.
40” to IR
CR directed perpendicular to
mid-elbow joint.
Child 10x12 CW
Forearm –
Lateral
14x17 CW
Child 10x12 CW
Elbow – AP
10x12 CW
or LW
Patient Instructions
Patient is seated at end of table.
Entire limb is on same horizontal
plane.
Collimate on 4 sides, both
Hand and arm fully extended with
lateral borders to the actual
hand supinated.
forearm area. Also, collimate at Instruct patient to lean laterally to
both ends to include wrist and
place entire wrist, forearm, and elbow
elbow joints.
in true AP position.
Use L or R marker.
Shield gonads.
Patient is seated at end of table.
Entire limb is on same horizontal
plane.
Collimate on 4 sides, both
Flex elbow 90° with hand and wrist in
lateral borders to the actual
true lateral position.
forearm area. Also, collimate at Use L or R marker.
both ends to include wrist and
Shield gonads.
elbow joints.
Positioning is the same as the AP
forearm.
Collimate on 4 sides to area of
interest.
Elbow –
Medial
(Internal)
Oblique
10x12 CW
or LW
Elbow –
Lateral
(External)
Oblique
10x12 CW
or LW
40” to IR
CR directed perpendicular to
mid-elbow joint.
Collimate on 4 sides to area of
interest.
40” to IR
CR directed perpendicular to
mid-elbow joint.
Collimate on 4 sides to area of
interest.
Patient is seated at end of table.
Entire limb is on same horizontal
plane.
Hand and arm fully extended with
hand pronated.
Palpate epicondyles to ensure 45°
rotation.
Use L or R marker.
Shield gonads.
Patient is seated at end of table.
Entire limb is on same horizontal
plane.
Hand and arm fully extended with
hand supinated.
Palpate epicondyles to ensure 45°
entire arm lateral rotation (patient
must lean laterally).
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 17
Chapter 5 – Forearm, Elbow, and Humerus Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Elbow –
Lateral
10x12 CW
or LW
40” to IR
CR directed perpendicular to
mid-elbow joint.
Positioning is the same as for the
lateral forearm.
Collimate on 4 sides to area of
interest.
Elbow –
(special
projection if
patient
unable to
extend arm).
AP with
Forearm
Parallel
Demo Only
Elbow –
(special
projection if
patient
unable to
extend arm).
AP with
Humerus
Parallel
Demo Only
Humerus –
AP
10x12 CW
or LW
40” to IR
Place partially flexed forearm on IR
with elbow region in center.
Note: If patient’s elbow
remains flexed near 90°, then
angle the CR 10-15° into
elbow joint.
Collimate on 4 sides to area of
interest.
10x12 CW
or LW
40” to IR
CR directed perpendicular to
mid-elbow joint.
Place humerus on IR with elbow
region in center.
Note: If patient’s elbow
remains flexed near 90°, then
angle the CR 10-15° into
elbow joint.
Collimate on 4 sides to area of
interest.
14x17 LW
40”
Child 10x12
Humerus –
Rotational
Lateral
CR directed perpendicular to
mid-elbow joint.
14x17 LW
Child 10x12
CR perpendicular to mid-point
of humerus.
Collimate on sides to soft-tissue
borders of humerus and
shoulder.
Both shoulder and elbow
joints should be included.
40”
CR perpendicular to mid-point
of humerus.
Position patient erect or supine.
Extend limb; abduct arm slightly and
gently supinate hand so that the
epicondyles of elbow are equidistant
from IR.
Patient’s body may need to be rotated
toward affected side as needed to
bring shoulder and proximal humerus
in contact with IR.
Position patient erect or supine.
Extend limb; internally rotate limb to
place epicondyles perpendicular to
IR.
Lab Manual 2014-2015 18
RDT 113 – Shoulder Girdle Laboratory Competencies
Instructor Demonstration:
Shoulder
AP internal rotation
AP external rotation
AP neutral rotation (Demo Only)
Inferosuperior axial projection (Lawrence Method)
Inferosuperior axial projection (Clement’s Modifcation Method)
Superoinferior axial projection
Transthoracic lateral (trauma)
Scapular Y lateral
Scapula
AP
Lateral
Clavicle
AP axial
AC joints
AP upright with and without weights (Demo Only)
Student Practice and Test:
The student will demonstrate positioning of:
1. Shoulder
a. AP internal rotation (10x12 CW)
b. AP external rotation (10x12 CW)
c. Inferosuperior axial projection (Student may choose to do Lawrence Method,
Clement’s Modifcation Method, or Superoinferior axial); (10x12 CW to patient)
d. Transthoracic lateral (trauma); (10x12 LW)
e. Scapular Y lateral (10x12 LW)
2. Clavicle
a. AP axial (10x12 CW)
3. Scapula
a. AP (10x12 LW)
b. Lateral (10x12 LW)
Note:
Use 40” SID
Use L & R markers
Shield gonads
Closely collimate
Suspend respiration
Grid cassette
65-75 kV range
Lab Manual 2014-2015 19
Chapter 6 – Shoulder Girdle Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Shoulder –
Internal
Rotation
10x12 CW
Bucky
40”
CR directed perpendicular to 1”
inferior to coracoid process
which is about ¾” inferior to
acromial end of clavicle.
Patient may be erect or supine.
Abduct arm slightly, rotate arm
internally (pronate hand) until
epicondyles are perpendicular to IR.
Use L or R marker.
Shield gonads.
Shoulder –
External
Rotation
Shoulder –
Neutral
Rotation
10x12 CW
Bucky
10x12 CW
Bucky
40”
40”
Collimate on 4 sides to area of
interest.
CR directed perpendicular to 1”
inferior to coracoid process
which is about ¾” inferior to
acromial end of clavicle.
Collimate on 4 sides to area of
interest.
CR directed perpendicular to 1”
inferior to coracoid process
which is about ¾” inferior to
acromial end of clavicle.
Demo Only
Shoulder –
Inferosuperior
axial projection
(Lawrence
Method)
10x12
Portable
Grid-CW
to patient
40”
or
10x12 CW
non-grid
IR
Shoulder –
Inferosuperior
axial
(Clement’s
Modification)
10x12
Portable
Grid-CW
to patient
or
10x12 CW
non-grid
IR
40”
Collimate on 4 sides to area of
interest.
Direct CR medially about
25-30° centered horizontally to
axilla and humeral head.
Patient may be erect or supine.
Abduct arm slightly, rotate arm
externally (supinate hand) until
epicondyles are parallel to IR.
Use L or R marker.
Shield gonads.
Patient may be erect or supine.
Do not move arm; radiograph of
shoulder will be exposed as patient
presents “as is”.
Use L or R marker.
Shield gonads.
Patient is supine.
Move patient close to front edge of
tabletop and place arm support
against front edge of table to support
Note: Make sure you center to abducted arm.
grid correctly to avoid grid
Rotate head to opposite side and
cutoff.
place vertical cassette on table as
close to neck as possible.
Collimate on 4 sides to area of
Support grid with sandbags.
interest.
Abduct arm 90° from body if
possible; keep in external rotation
(palm up).
Use L or R marker.
Shield gonads.
Direct CR horizontal to midcoronal plane to enter
midaxillary region of shoulder.
Note: if patient cannot abduct
the arm a full 90°, angle CR
5° to 15°.
Collimate on 4 sides to area of
interest.
Patient is in a lateral recumbent
position, with affected side up.
Place IR against top of shoulder,
using unaffected arm to hold it in
place.
Affected arm is abducted 90°,
pointing toward the ceiling.
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 20
Chapter 6 – Shoulder Girdle Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Shoulder –
Superoinferior
Axial
10x12
Portable
Grid-CW
to patient
40”
CR angled 5-15° through
shoulder joint, toward elbow.
Patient seated high enough at end of
table, so shoulder is over IR.
Patient leans laterally until shoulder
joint is in middle of IR.
Elbow rests on the table.
Flex elbow 90° with hand pronated.
Patient must tilt head away from
affected shoulder.
Use L or R marker.
Shield gonads.
Collimate on 4 sides to area of
interest.
or
10x12 CW
non-grid
IR
Shoulder –
Transthoracic
Lateral
(Lawrence
Method)
10x12 CW to
patient
40”
CR directed perpendicular to IR
at surgical neck.
Note: if patient cannot drop
injured shoulder & raise
unaffected shoulder high
enough to prevent
superimposition, angle CR
10-15° cephalic.
Collimate to area of interest.
Shoulder –
Scapular Y
Lateral
(Anterior
Oblique)
10x12 LW
Bucky
AP Axial
Clavicle
10x12 CW
Bucky
40”
CR directed to the
scapulohumeral joint (2 or 2.5”
below top of shoulder).
Collimate on 4 sides to area of
interest.
40”
CR perpendicular to mid-point
of clavicle.
15-30° cephalic to midclavicle.
Note: asthenic patients
require more angle than
hypersthenic patients.
Collimate on 4 sides to area of
interest.
Patient is erect or supine.
Injured arm is at patient’s side in “as
is” rotation.
Drop injured shoulder if
possible.
Raise unaffected arm and place on top
of head.
Ensure that thorax is in true lateral
position with slight anterior rotation
of unaffected shoulder.
Breathing technique preferred (use
short shallow breaths).
Use L or R marker.
Shield gonads.
Erect if possible.
Rotate patient to anterior oblique
position, about 45-60°.
Palpate scapula borders to place
scapula perpendicular to IR.
Abduct arm slightly if possible so
proximal humerus is away from ribs.
Do not ROTATE arm.
Patient is erect or supine.
Clavicle in center of IR.
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 21
Chapter 6 – Shoulder Girdle Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Scapula – AP
10x12 LW
Bucky
40”
CR perpendicular to
mid-scapula.
Find level of axilla and center
2” medial from lateral border
of patient (This will result in
centering 2” below coracoid).
Position patient erect or supine.
Abduct arm 90° and supinate hand.
Collimate on four sides to area
of the scapula.
Note: top of IR should be about 2”
above shoulder; lateral border of
IR should be about 2” from lateral
margin of rib cage.
Breathing technique preferred
(breathe gently w/out moving
shoulder).
Use L or R marker.
Shield gonads.
Scapula –
Lateral
10x12 LW
Bucky
40”
CR perpendicular to
mid-vertebral border of scapula.
Collimate on four sides to area
of the scapula.
Place patient in a 45-60° anterior
oblique position.
For body of scapula, patient reaches
across front of chest with affected
arm.
Note: For acromion and coracoid
process, place arm behind patient’s
back or hang loose.
Palpate borders of scapula so they
are perpendicular to IR (in true
lateral position).
Use L or R marker.
Shield gonads.
AC Joints –
Bilateral
With and
Without
Weights
Demo Only
14x17 CW
Bucky
72”
CR perpendicular to
midpoint between AC joints
and 1” above jugular notch.
Collimate with a long, narrow
field to area of interest; upper
light border should be to upper
shoulder soft-tissue margins.
Patient erect or seated.
Arms at side and equal weight
distributed on both feet.
No rotation of shoulders or body.
First exposure patient is without
weights.
On second exposure, strap 8-10 lb.
weights to patient’s wrists and allow
them to hang and pull down on each
arm and shoulder.
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 22
RDT 113 – Toe, Foot, Heel, and Ankle Laboratory Competencies
Instructor Demonstration:
Toe
AP
Oblique
Lateral
Foot
AP (dorsoplantar)
Medial oblique
Lateral
Heel
Plantodorsal (axial)
Lateral
Ankle
AP
AP mortise
Medial oblique
Lateral
Student Practice and Test:
The student will demonstrate positioning of:
1. Toe – AP, oblique, and lateral (10x12 LW or CW)
2. Foot – AP, oblique, and lateral (10x12 LW)
3. Heel – Plantodorsal and lateral (10x12 LW or CW)
4. Ankle – AP, oblique, and lateral (10x12 LW or CW)
Note:
Use 40” SID to IR
Use L & R markers
Shield gonads
Closely collimate
Detail (extremity cassette) technique
On lateral exams, the convention is to place marker anterior to the part
50-60 kV range for Toes
55-65 kV range for Foot and Ankle
65-75 kV range for Calcaneus
Lab Manual 2014-2015 23
Chapter 7 – Toe, Foot, Heel, and Ankle Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Toe – AP
10x12 LW
or CW
40” to
IR
10-15° tube angle toward the
calcaneus directed to MTP
joint of affected toe.
Affected foot’s plantar surface on IR.
Note: some department
routines are to radiograph all
five toes on the AP projection;
in this case, you center at 3rd
MTP joint.
May use a 15° wedge sponge instead
of angling central ray
.
Use L or R marker.
Shield gonads.
Collimate on 4 sides to area of
interest.
Toe – Oblique
10x12 LW
or CW
40” to
IR
CR directed perpendicular to
MTP joint of affected toe.
Collimate on 4 sides to area of
interest.
Patient may be erect or supine.
Oblique patient’s affected toe 45°
medially for 1st and 2nd; laterally
for 4th and 5th.
Can do either for 3rd toe.
Use a 45° sponge for immobilization
and accuracy of obliquity.
Use L or R marker.
Shield gonads.
Toe – Lateral
10x12 LW
or CW
40” to
IR
1st toe: CR perpendicular to
IP joint.
2-5th toes: CR perpendicular
to PIP joint.
Collimate on 4 sides to area of
interest.
Position patient lateromedial for 1st,
2nd, and 3rd toes; mediolateral for 4th
and 5th.
Use tape, gauze, or tongue blade to
separate unaffected toes and avoid
superimposition whenever possible.
Use L or R marker.
Shield gonads.
Foot – AP
10x12 LW
40” to
IR
Angle CR 10° toward the heel
and centered at base of 3rd
metatarsal.
Collimate to outer margins of
foot on 4 sides.
Plantar surface of foot flat on film.
Use sandbags if needed to prevent IR
from sliding.
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 24
Name
IR
SID
Centering
Patient Instructions
Foot – Oblique
10x12 LW
40” to
IR
CR perpendicular to base of 3rd
metatarsal.
Oblique foot medially 30-40° to
plane of IR.
Collimate to outer margins of
foot on 4 sides.
Note: some textbooks suggest 30°;
some suggest 45°. Use 30 or 40° for
lab exams.
Use L or R marker.
Shield gonads.
Foot – Lateral
10x12 LW
40” to
IR
CR perpendicular to medial
cuneiform (at level of base of
3rd metatarsal).
Collimate on 4 sides to area of
interest.
Calcaneous or
Os Calcis
(Heel) –
Plantodorsal
Axial
10x12 LW
or CW
40” to
IR
CR angled 40° cephalic to base
of 3rd metatarsal.
Measure SID!
Collimate to area of interest.
Calcaneus –
Lateral
10x12 LW
or CW
40” to
IR
*Make sure heel of foot is
more toward the front of the
cassette instead of in the
middle to accommodate CR
angle.
CR perpendicular to 1” inferior
to medial malleolus.
Collimate on 4 sides to area of
interest.
Mediolateral – patient is lying
laterally with affected foot side down.
Place unaffected leg behind affected
leg; support under affected knee and
leg as needed.
Dorsiflex as needed to place plantar
surface of foot perpendicular to IR.
Don’t over-rotate the foot!
Use L or R marker.
Shield gonads.
Note: can do lateromedial instead;
may get a better lateral, but more
difficult for patient to assume.
Patient supine with plantar surface of
the foot perpendicular to cassette.
Dorsiflex as needed as much as
possible.
Posterior surface of calcaneous
resting on IR.
Can use sheet or gauze looped around
foot and ask patient to pull gently to
assist in achieving plantar surface
perpendicular.
If not possible to achieve, angle may
be slightly increased.
Use L or R marker.
Shield gonads.
Positioning same as for lateral foot.
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 25
Chapter 7 – Toe, Foot, Heel, and Ankle Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Ankle – AP
10x12 LW
or CW
40” to
IR
CR perpendicular to point ½
way between malleoli.
Do not force dorsiflexion.
Adjust foot and ankle for true AP.
Be sure lower leg is not rotated.
Collimate on 4 sides to area of
interest.
Ankle – Lateral
10x12 LW
or CW
40” to
IR
CR perpendicular to medial
malleolus.
Collimate on 4 sides.
Ankle – AP
Mortise
10x12 LW
or CW
40” to
IR
CR perpendicular to point ½
way between malleoli.
Collimate on 4 sides to area of
interest.
Ankle – Medial
Oblique
10x12 LW
or CW
40” to
IR
CR perpendicular to point ½
way between malleoli.
Collimate on 4 sides to area of
interest.
Note: inter-malleolar line will not
be parallel.
Use L or R marker.
Shield gonads.
Positioning same as for lateral foot.
Plantar surface perpendicular to IR.
Use L or R marker.
Shield gonads.
Rotate leg/foot 15-20° so
intermalleolar line is parallel to IR.
Use L or R marker.
Shield gonads.
Rotate leg/foot 45° internally.
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 26
RDT 114 – Lower Leg, Knee, Patella, and Femur Laboratory Competencies
Instructor Demonstration:
Lower Leg
AP
Lateral
Knee
AP
Medial oblique
Lateral
Patella
PA
Tangential (axial) – Inferosuperior and Settegast Method
Femur (to include knee)
AP
Lateral
Student Practice and Test:
The student will demonstrate positioning of:
1. Lower leg – AP and lateral (14x17 LW or diagonally for larger lower leg)
2. Knee – AP, medial oblique, and lateral (10x12 LW)
3. Patella – Tangential (10x12 LW or CW);
*may do Settegast Method or Inferosuperior on lab exam
4. Femur – AP and lateral (14x17 LW)
Note:
Use 40” SID to IR
Use L & R markers
Shield gonads
Closely collimate
Detail (extremity cassette) technique for anatomic parts less than 10 cm
Grids for anatomic parts greater than 10 cm
kV ranges vary depending on thickness and position (refer to Bontrager)
Lab Manual 2014-2015 27
Chapter 8 – Lower Leg, Knee, Patella, and Femur Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
AP – Lower
Leg
14x17
Diagonally
Minimum
40” to IR
(can
increase
SID to
44-48”
as needed
to reduce
divergence
of x-ray
beam &
include
more
anatomy).
CR perpendicular to midpoint
of leg.
Collimate side-to-side to skin
margins. Be sure to include
both ankle and knee joints
(this means both ankle and knee
joints are about 1-2” from ends
of IR).
Adjust patient leg to true AP
position, no rotation.
Lower Leg Lateral
Knee - AP
14x17
Diagonally
10 x 12
LW
(if knee is
over 10
cm, use
bucky or
grid)
Minimum
40” to IR
(can
increase
SID to
44-48”
as needed
to reduce
divergence
of x-ray
beam &
include
more
anatomy).
40” to IR
Note: if impossible for all of
lower leg to be on one IR,
make a 2nd exposure of knee
or ankle (whichever joint is
nearest
area of injury).
CR directed perpendicular to
MTP joint of affected toe.
Collimate side-to-side to skin
margins. Be sure to include
both ankle and knee joints.
Dorsiflex foot if possible.
Use L or R marker.
Shield gonads.
Flex knee approx. 45°.
Use L or R marker.
Shield gonads.
Note: if impossible for all of
lower leg to be on one IR,
make a 2nd exposure of knee
or ankle (whichever joint is
nearest
area of injury).
CR ½” distal to apex of patella.
Collimate side-to-side.
Rotate leg internally about 35°, so interepicondylar line is
parallel to plane of IR to achieve
true AP position.
Use L or R marker.
Shield gonads.
Note: If distance from ASIS is 19
cm or less from table top than
angle 3-5° caudad.
If distance from ASIS is 19-24 cm
from tabletop, then CR is
perpendicular.
If distance from ASIS is 24
cm or more from table top than
angle 3-5° cephalic.
Lab Manual 2014-2015 28
Chapter 8 – Lower Leg, Knee, Patella, and Femur Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Knee –
Medial
Oblique
10 x 12
LW
(if knee is
over 10
cm, use
bucky or
grid)
10 x 12
LW
(if knee is
over 10
cm, use
bucky or
grid)
40” to IR
CR to midpoint of knee at ½”
distal to apex of patella.
10 x 12
LW or CW
40”
Rotate leg internally 45°
(intercondylar line will be 45° to
IR).
Use the same rules for CR angle
as for the AP knee.
Use L or R marker.
Shield gonads.
Patient in lateral recumbent
position, affected side down.
Place unaffected leg behind
affected leg and support with
sponge or pillow.
Insure that epicondyles of femur are
directly superimposed and plane of
patella is perpendicular to IR.
Flex knee only 20-30°.
Use L or R marker.
Shield gonads.
Patient is prone with leg extended.
If patient is in pain, place support
under ankle and under femur to
prevent direct pressure on patella.
Use L or R marker.
Shield gonads.
Patient is prone with IR under knee.
Flex knee slowly to a minimum of
90°. If necessary, have patient hold
tape or gauze to maintain position.
Use L or R marker.
Shield gonads.
Knee –
Lateral
Patella – PA
Collimate side-to-side.
40” to IR
CR 5-7° cephalic to 1” distal to
medial epicondyles.
Collimate side-to-side.
CR perpendicular to popliteal
crease (midpatella).
Demo Only
Collimate on 4 sides to area of
interest.
Patella –
Tangential
10x12 LW
or CW
40”
(Settegast
Method)
CR tangential to patellofemoral
joint space which is about
15 to 20° from lower leg.
Collimate to area of interest.
Distal and
Mid Femur AP
14x17 LW
Distal and
Mid Femur Lateral
14x17 LW
40”
Child 10x12
Child 10x12
CR perpendicular to femur.
Collimate side-to-side only.
40”
CR perpendicular to femur.
Collimate side-to-side only.
Patient is supine.
If non-trauma (no fracture),
internally rotate leg about 5° for
mid and distal femur.
Place IR so that the knee
joint will be included on the
image, about 2” below knee joint.
Use L or R marker.
Shield gonads.
Patient lying on affected side, femur
aligned to midline of table with
unaffected leg behind patient.
Flex knee 45°.
Adjust IR to include knee joint.
Use L or R marker.
Shield gonads.
Lab Manual 2014-2015 29
RDT 114 – Pelvic Girdle Laboratory Competencies
Instructor Demonstration:
Pelvis
AP
Hip
AP
Unilateral (frog-leg) – Modified Cleaves Method
Axiolateral (inferosuperior projection)
SI Joints
AP Axial
Oblique (RPO or LPO)
Student Practice and Test:
The student will demonstrate positioning of:
1. Pelvis
a. AP (14x17 CW)
2. Hip
a. AP (10x12 LW)
b. Frog Lateral (10x12 CW)
c. Axiolateral Inferosuperior (10x12 grid LW)
Note:
Use 40” SID
Use L & R markers
Shield gonads when possible
Suspend respiration
Closely collimate
Grid technique
75-85 kV range
Lab Manual 2014-2015 30
Chapter 9 – Pelvic Girdle Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Pelvis – AP
14x17
CW
40”
Perpendicular to MSP and 2” below
level of ASIS’s.
Patient is supine on table.
No rotation of pelvis (check
ASIS’s)
Use L or R marker.
Rule of thumb: be sure top of IR
is at least 1” above iliac crest.
Non-trauma: rotate both legs
internally 15-20°.
.
Always shield males.
Shield females if possible with special
ovarian shield.
Hip – AP
10x12
LW or
CW
40”
Perpendicular to neck of femur
(femoral neck is about 2” medial
and 4” distal to ASIS).
Note: If there is an orthopedic
appliance in place, include all of it
on image.
Patient supine with no rotation of
pelvis.
Shield males and females.
Use L or R marker.
Non-trauma: rotate affected foot/
leg internally 15-20°.
Collimate to area of interest.
Hip – Lateral
“Frog Leg”
10x12
CW
40”
Perpendicular to neck of femur.
Patient supine with no rotation of
pelvis.
Collimate to area of interest.
(Modified
Cleves)
Non-trauma: abduct affected leg
45° to position femoral neck
parallel to IR.
Use L or R marker.
Shield males and females.
Hip –
Axiolateral
Inferosuperior
Projection
(Trauma)
10 x 12
grid LW
to patient
40”
Perpendicular to neck of femur –
horizontal beam.
Collimate to area of interest.
Elevate unaffected leg and rest
on support (if using tube
housing for support then pad it
with a towel to avoid possible heat
injury to patient).
Collimate carefully.
No shielding is possible.
Note: be sure grid is parallel to
affected femoral neck and CR
perpendicular to grid.
Lab Manual 2014-2015 31
Chapter 9 – Pelvic Girdle Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
SI Joints – AP
Axial
10 x 12
LW or
CW
40”
Angle CR 30° (males) or
35° (females) cephalic to the MSP
and 2” below the level of ASIS’s.
Patient is supine with no rotation of
the pelvis.
Use L or R marker.
Shield males.
Demo Only
Collimate on 4 sides to area of
interest.
SI Joints –
Posterior
Obliques (RPO
or LPO)
Demo Only
10 x 12
LW or
CW
40”
Center about 1” medial to upside
ASIS.
Collimate on 4 sides to area of
interest.
Patient is supine.
Elevate side of interest 25-30° (use a
sponge for support and flex knees).
Use L or R marker.
Shield males.
Shield females with special ovarian
shields if available.
Lab Manual 2014-2015 32
RDT 114 – Cervical and Thoracic Spine Laboratory Competencies
Instructor Demonstration:
Cervical Spine
AP Axial
AP Open-Mouth for C1-C2
Lateral
Cross-Table Lateral (Trauma)
Oblique (Anterior or Posterior)
Swimmer’s Lateral (Twining Method)
Thoracic Spine
AP
Lateral
Student Practice and Test:
The student will demonstrate positioning of:
1.
Cervical Spine:
d. AP Axial (10x12 LW)
e. AP Open-Mouth (10x12 LW or CW)
f. Lateral (10x12 LW)
g. Oblique (10x12 LW)
h. Swimmer’s Lateral (10x12 LW)
2. Thoracic Spine
a. AP (14x17 LW)
b. Lateral (14x17 LW)
Note:
40” SID and 72” SID on Cervical Spine (except AP projections)
Use L & R markers
Shield gonads
Suspend respiration
Closely collimate
Grid technique
65-75 kV range for all positions EXCEPT Swimmer’s
75-85 kV for Swimmer’s
Lab Manual 2014-2015 33
Chapter 9 – Cervical and Thoracic Spine Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Cervical Spine
– AP Axial
10x12
LW
40”
CR directed 15-20° cephalic to
level of C4 (enters at level of lower
margin of thyroid cartilage) and
MSP.
Patient is supine or erect.
Collimate side-to-side to area of
interest.
Cervical Spine
– AP OpenMouth
Odontoid
10x12
LW
40”
CR perpendicular to open mouth.
Collimate on 4 sides to area of
interest (about 4x4).
Adjust head so occlusal plane and
mastoid tips are perpendicular to
the IR (line from tip of chin to base
of skull should be parallel to angled
CR).
Ensure no rotation of head or chest.
Use L or R marker according to
clinical protocol.
Shield gonads.
Patient is supine or erect.
Adjust head so lower margin of upper
incisors lines up with base of skull
(mastoid tips).
Ensure no rotation of head or chest.
Mouth should be wide open during
exposure.
Use L or R marker according to
clinical protocol.
Shield gonads.
Cervical Spine
– Lateral
10x12
LW
72”
CR perpendicular to C4 and midcoronal plane (top of cassette about
1” above EAM).
Collimate side-to-side to area of
interest.
Cervical Spine
– Anterior
Oblique
10 x 12
LW
72”
CR angled 15-20° caudad to pass
through C4 and center of obliqued
plane.
Collimate side-to-side to area of
interest.
Cervical Spine
– Posterior
Oblique
10 x 12
LW
72”
CR angled 15-20° cephalic to pass
through C4 and center of obliqued
plane.
Collimate side-to-side to area of
interest.
Patient erect if possible.
Depress shoulders as much as
possible and rotate forward.
Extend chin forward slightly.
Make exposure on full expiration.
Use L or R marker.
Shield gonads.
Patient’s body and head rotated 45°.
May turn head toward IR to a
near lateral position.
Extend chin slightly.
Use L or R marker according to
clinical protocol.
Shield gonads.
Patient’s body and head rotated 45°.
May turn head toward IR to a
near lateral position.
Extend chin slightly.
Use L or R marker according to
clinical protocol.
Shield gonads.
Lab Manual 2014-2015 34
Chapter 9 – Cervical and Thoracic Spine Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Swimmer’s
Lateral
10x12
LW
72”
CR perpendicular to mid-coronal
plane and T1 (~1 to 1 ½”above
jugular notch anteriorly and
at level of vertebra prominens
posteriorly).
Adjust patient’s arm closest to IR
up, flexing elbow and resting forearm
on head.
Adjust the other arm and shoulder
down and slightly anterior so head
of humerus is anterior to vertebrae.
Keep head and thorax in as true
lateral position as possible.
Use L or R marker.
Shield gonads.
Collimate side-to-side to area of
interest.
Note: This can also be done with
patient arm positions reversed.
Thoracic Spine
– AP
14x17
LW
40”
CR perpendicular to T7 (34” distal to jugular notch) and MSP.
Note: top of cassette should be
about 1 to 1 ½ in. above level of
shoulder with this centering.
Collimate side-to-side to area of
interest (about 7x17).
Thoracic Spine
– Left Lateral
14x17
LW
40”
CR perpendicular to T7 and slightly
posterior to mid-coronal plane.
Note: on an average patient, IR
will be about 2” above level of
shoulders
(patients with very broad
shoulders may require 3-5°
cephalic angle).
Collimate side-to-side to area of
interest (about 7x17, unless patient
is very kyphotic).
Patient is supine.
No rotation of thorax.
Use wedge filter if possible.
Anode heel effect can also be
employed.
Expose on expiration.
Be sure T10-12 are included on IR.
Use L or R marker
Shield gonads.
Patient is in a left lateral recumbent
position.
Place sponge support under waist to
keep spine parallel to table. Flex hips
and knees and place support between
knees.
Ensure no rotation of pelvis and
spine.
Place lead behind patient on table.
Breathing technique preferred.
Use L marker.
Shield gonads.
Lab Manual 2014-2015 35
RDT 114 – Lumbar Spine, Sacrum, and Coccyx Laboratory Competencies
Instructor Demonstration:
Lumbar Spine
AP
AP L5/S1 Spot
Oblique
Lateral
Lateral L5/S1 Spot
Sacrum
AP Axial
Coccyx
AP Axial
Sacrum/Coccyx
Lateral
Student Practice and Test:
The student will demonstrate positioning of:
1.
Lumbar Spine:
a. AP (14x17 LW)
b. AP L5/S1 Spot (10x12 LW or CW)
c. Posterior Oblique (14x17 LW)
d. Lateral (14x17 LW)
e. Lateral L5/S1 Spot (10x12 LW or CW)
2. Sacrum
a. AP Axial (10x12 LW)
b. Lateral Sacrum/Coccyx (10x12 LW)
3. Coccyx
a. AP Axial (10x12 LW)
Note:
40” SID
Use L & R markers
Shield gonads when possible
Expose on expiration
Closely collimate
Grid technique
kV range varies (refer to Bontrager)
Lab Manual 2014-2015 36
Chapter 10 – Lumbar Spine, Sacrum, and Coccyx Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Lumbar Spine
– AP
14x17
LW
40”
Perpendicular to MSP and iliac crest.
.
Patient is supine with knees flexed,
head on pillow, and arms on chest or
by the side.
Ensure no rotation of pelvis or thorax.
Shield males.
Collimate side-to-side to area of
interest (about 7x17).
Expose on expiration.
Lumbar Spine
– AP L5/S1
Spot
10x12
LW or
CW
40”
CR 30-35° cephalad (males is
around 30°) to the MSP at level of
ASIS’s.
Note: Angle tube first and then line
up the tube with the bucky tray.
Lumbar Spine
– Posterior
Oblique
14x17
LW
40”
Collimate on 4 sides to area of
interest (about 8x10).
Perpendicular to iliac crest and 2”
medial to upside ASIS (to place
vertebral column directly in center
of IR).
Collimate side-to-side to area of
interest.
Note: be sure that L or R lead
marker is in collimated field.
Patient is supine with legs extended
and support under knees.
Ensure no rotation of thorax or pelvis.
Use L or R marker.
Shield males.
Patient is rotated 45° with knees
flexed.
Support lower back with 45° sponge
for accuracy of positioning, patient
comfort, and maintenance of oblique
position.
Shield males.
Use L or R marker
Note: place marker in field (~2 ½”
indented).
Lumbar Spine
– Left Lateral
14x17
LW
40”
CR perpendicular to mid-coronal
plane and iliac crest.
Collimate side-to-side to area of
interest (about 7x17).
If necessary, place radiolucent
sponge under patient’s waist with
patient on left side.
Flex knees and ensure true lateral
position of thorax and pelvis.
Shield males.
Use L marker.
Expose on expiration.
Place lead shielding behind patient’s
spine, on the table to reduce scatter
radiation on the IR.
Lab Manual 2014-2015 37
Chapter 10 – Lumbar Spine, Sacrum, and Coccyx Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Lumbar Spine
– Left Lateral
L5/S1 Spot
10 x 12
LW or
CW
40”
CR is angled 5-10° caudad to be
parallel to line between iliac crests.
Center 1 ½” inferior to iliac crest
and 2” posterior to ASIS.
Positioning same as for lateral
lumbar.
Note: CR is perpendicular if the
spine is parallel to IR
Cone more after you have achieved
greater competency.
Use L marker.
Shield males.
Collimate on 4 sides to area of
interest (about 8x10).
Sacrum – AP
Axial
Coccyx – AP
Axial
10x12
LW
40”
8x10 or 40”
10x12
LW
CR angled 15° cephalic to enter MSP
½ way between level of symphysis
pubis and ASIS.
Patient is supine with legs extended
and support under knees.
Ensure no rotation of thorax or pelvis.
Collimate on 4 sides to area of
interest (about 8x10).
Shield males.
Use R or L marker.
CR angled 10° caudad to enter MSP
and 2” superior to symphysis pubis.
Same as AP axial sacrum.
Note: Collimate to 4x4 before
angling the tube.
Collimate on 4 sides to area of
interest (about 4x4).
Lateral Sacrum
and Coccyx
10x12
LW
40”
CR perpendicular to point 3-4”
posterior to ASIS.
Collimate to area of interest.
Same parameters apply as lateral
lumbar exam.
Place lead shielding behind patient’s
backside to absorb scatter.
Lab Manual 2014-2015 38
RDT 114 – Upper GI Laboratory Competencies
Instructor Demonstration:
PA
RAO
Right Lateral
LPO
Esophagram - RAO
Student Practice and Test:
The student will demonstrate positioning of:
1. PA (10x12 LW or 14x17 LW)
2. RAO (10x12 LW or 14x17 LW)
3. Right Lateral (10x12 LW or 14x17 LW)
4. LPO (10x12 LW or 14x17 LW)
5. Esophagram – RAO (14x17 LW)
Note:
40” SID
Use L & R markers correctly
Shield gonads
Closely collimate
Grid technique
100-125 kV range for single contrast studies
90-100 kV range for double contrast studies
Lab Manual 2014-2015 39
Chapter 13 – Upper GI Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
PA
14x17
or
10x12
LW
40”
CR perpendicular to level of L1
(1-2” above lower lateral rib margin
(LLRM)), and 1” left of MSP on the
Sthenic patient.
Patient is prone.
Ensure no rotation.
Use L or R marker.
Note: center 2” above L1 for
hypersthenic patients and 2” below
L1 for asthenic.
RAO
14x17
or
10x12
LW
40”
Collimate to area of around 12x14, if
using a 14x17.
CR perpendicular to level of L1
(1-2” above lower lateral rib margin
(LLRM)), and mid-way between MSP
and upside lateral border of abdomen on
the Sthenic patient.
Note: center 2” above L1 for
hypersthenic patients and 2” below
L1 for asthenic.
Right Lateral
14x17
or
10x12
LW
40”
Collimate to area of around 12x14, if
using a 14x17.
CR perpendicular to level of LLRM and
1-1.5” anterior to MCP. The MCP is
about half-way between vertebrae and
anterior abdomen on the Sthenic
patient.
Note: center 2” above L1 for
hypersthenic patients and 2” below
L1 for asthenic.
LPO
14x17
or
10x12
LW
40”
Collimate to area of around 12x14, if
using a 14x17.
CR perpendicular to about ½ way
between xiphoid tip and LLRM
and ~ ½ way between MSP and left
lateral margin of abdomen on the
Sthenic patient.
Note: center 2” above L1 for
hypersthenic patients and 2” below
L1 for asthenic.
Shield gonads.
.
Patient is in a 40-70° anterior
oblique with right arm down and left
arm up.
Left knee is flexed.
Use of R marker is preferred.
Shield gonads.
Ensure patient is lying in true
right lateral position.
Check shoulders and hips for no
rotation.
Arms are up.
Use R marker.
Shield gonads.
Patient is in a 30-60° posterior
oblique with right arm up and across
chest.
The right knee is flexed (use
sponge if desired).
Use left marker on left side of the
patient.
Shield gonads.
Collimate to area of around 12x14, if
using a 14x17.
Lab Manual 2014-2015 40
Esophagram
– RAO
Oblique
14x17
LW
40”
CR perpendicular to 2”above the
shoulder level and about 1”from MSP
on upside.
Note: Top of cassette should include
the mouth to ensure the entire
esophagus is viewed.
Collimate to area that is ~6-7” wide or
to (7x17) and make sure marker is in
coned field.
Patient is in a 35-40° anterior
oblique.
Use right marker on patient’s right
side.
Shield gonads.
Lab Manual 2014-2015 41
RDT 114 – Lower GI Laboratory Competencies
Instructor Demonstration:
PA (Small Bowel or BE)
Posterior Oblique
Decubitus (Right or Left)
AP or PA Axial (“Butterfly positions”)
Lateral Rectum
Student Practice and Test:
The student will demonstrate positioning of:
1. PA (14x17 LW)
2. Posterior Oblique (14x17 LW)
3. Axials (AP or PA); (14x17 LW)
4. Lateral Rectum (10x12 LW)
Note:
Use 40” SID
Full expiration
Grid technique
Use L & R markers
Shield gonads if possible
Lab Manual 2014-2015 42
Chapter 15 – Lower GI Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
PA
14x17
LW or 2
14x17’s
CW
40”
CR perpendicular to MSP and iliac
crest.
Patient is prone with arms at side or
up on pillow.
Ensure no rotation (ASIS distance to
tabletop is equal).
Use L or R marker.
Shield males.
Note: for a small bowel series 1st
image center 2” above crest to
include stomach.
Collimate side-to-side if asthenic
body habitus.
LPO or
RPO
Oblique
14x17
LW
40”
CR perpendicular to level of iliac
crest and 1” lateral to MSP on upside.
Collimate side-to-side if asthenic
body habitus.
AP Axial
“Butterfly
Position”
14x17
LW
40”
CR angled 30 - 40° cephalic to enter
MSP and 2” inferior to the level of
the ASISs.
Note: center 2” higher on
hypersthenic patients and 2” lower for
asthenic.
PA Axial
“Butterfly
Position”
14x17
LW
40”
Collimate to area of around 10x14.
CR angled 30 – 40° caudad to MSP
and to exit at the level of the ASISs.
Collimate to area of around 10x14.
Left
Lateral
Rectum
14x17 or
10x12
LW
40”
CR perpendicular to level of ASISs
and MCP. MCP is ½ way between
ASIS and posterior sacrum.
Collimate to area of around 10x12, if
using a 14x17.
Left or
Right
Lateral
Decubitus
Demo
Only
14x17
Grid LW
to the
patient
40”
CR perpendicular to MSP and at level
of iliac crests.
Patient is in a 45° posterior oblique.
Use L or R marker.
Shield males.
Note: adjust for asthenic and
hypersthenic body types (don’t want
inches of light on the table).
Patient is supine.
Ensure no rotation.
Arms at sides or high on chest.
Use L or R marker.
No shielding is usually possible.
Patient is prone.
Ensure no rotation.
Arms at sides of high on chest.
Use L or R marker.
No shielding is usually possible.
No shielding possible.
Make certain patient is in a true
lateral position.
Superimpose knees and place arms up
in front of head.
Use L marker.
Patient on R or L side with grid
positioned in grid holder behind
patient. Ensure grid is perpendicular
to table and CR centered to grid
Ensure that patient is not rotated.
Place markers correctly.
Shield males.
Lab Manual 2014-2015 43
RDT 114 – Urinary System Laboratory Competencies
Instructor Demonstration:
IVP
Nephrogram
Posterior Oblique
Cystogram
AP Axial
Posterior Oblique
Cystourethrogram
Males – RPO
Females – AP
Student Practice and Test:
The student will demonstrate positioning of:
1. IVP
a. Nephrogram (10x12 CW or 14x17 CW)
b. Posterior Oblique (14x17 LW)
2. Cystogram
a. AP Axial (10x12 CW or 14x17 CW)
b. Posterior Oblique (10x12 CW or 14x17 CW)
3. Cystourethrogram
a. Male – RPO (10x12 CW)
b. Female – AP (10x12 CW)
Note:
Use 40” SID
Full expiration
Grid technique
Use L & R markers
Shield gonads if possible
kV 70-75 range for all except Lateral which is 80-90 kV
Lab Manual 2014-2015 44
Chapter 16 – Urinary System Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
IVP –
Nephrogram
10x12
or
14x17
LW
40”
CR perpendicular to a point 1/2
Patient is supine (may flex knees and
place support under them to reduce
lordotic curvature).
Ensure no rotation (ASIS distance to
tabletop is equal).
Use L or R marker.
Shield gonads.
way between levels of xiphoid
tip and iliac crest.
Collimate to area of around 12x13,
if using a 14x17.
IVP –
Posterior Oblique
14x17
LW
40”
CR perpendicular to level of iliac
crests
and 2” from MSP on upside:
Patient is in a 30° posterior oblique.
Use L or R marker.
Shield males.
Collimate if possible.
Cystogram – AP
Axial
Cystogram –
Posterior Oblique
14x17
LW
14x17
LW
40”
40”
CR angled to point 2” superior to
symphysis pubis and MSP.
Collimate to area of around 12x13,
if using a 14x17.
CR perpendicular to point 2”
superior to symphysis pubis and 2”
medial to upside ASIS.
Collimate to area of around 12x13.
Patient is supine.
Ensure no rotation.
Use L or R marker.
Shield males.
Patient is in a 45-60° posterior
oblique.
No shielding is usually possible.
Don't flex upside leg too much or it
will overlie the bladder.
Note: if the UV junction is area of
interest, use steep oblique (50-60°).
Use L or R marker.
Cystourethrogram
– Female AP
10x12
LW
40”
Cystourethrogram
– Male RPO
10x 12
LW
40”
CR perpendicular to MSP and
symphysis pubis.
Collimate if possible.
CR perpendicular to MSP and
symphysis pubis.
Collimate if possible.
No shielding possible.
Patient is supine with legs extended.
Use L or R marker.
Patient is in a 30° right posterior
oblique.
Urethra is superimposed over the soft
tissues of thigh.
Place markers correctly.
Shield males.
Lab Manual 2014-2015 45
RDT 210 – Skull Laboratory Competencies
Instructor Demonstration:
AP Axial (Towne Method)
Lateral
PA Axial (Caldwell Method)
PA
SMV
Student Practice and Test:
The student will demonstrate positioning of:
1. AP Axial (Towne Method) – 10x12 LW
2. Lateral – 10x12 CW
3. PA Axial (Caldwell Method) – 10x12 LW
4. PA – 10x12 LW
5. SMV – 10x12 LW
Note:
Use 40” SID
May be done supine or erect.
Grid technique
Use L & R markers
Shield gonads and upper thorax (neck and thyroid whenever possible)
For mastoids, tape ears forward.
kV varies (refer to Bontrager)
Lab Manual 2014-2015 46
Chapter 12 – Skull Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
AP Axial (Towne
Method)
10x12
LW
40”
CR is angle 30° caudad to OML
or 37° to IOML. Center at MSP
and 2 ½” above glabella
OML perpendicular to film (or
IOML).
No rotation or tilt (check EAMs
which must be equidistant to IR).
(CR exits through foramen
magnum).
Suspend Respiration.
Use L or R marker.
Shield gonads, thorax, and thyroid.
Lateral
10x12
CW
40”
CR is perpendicular to 2” superior
to EAM.
Collimate to outer margins of skull.
MSP parallel to IR.
IPL perpendicular to IR.
Adjust neck flexion so IOML
perpendicular to front edge of IR.
Side down is side of interest.
Use L or R marker.
Shield gonads, thorax, and thyroid.
PA Axial (Caldwell
Method)
10x12
LW
40”
CR is angled 15° caudad and
exits MSP and nasion.
Collimate to outer margins of skull.
PA
(No Tube Angle)
10x12
LW
40”
CR is perpendicular to MSP
(parallel to OML) and to exit at
glabella.
Patient is prone or facing IR.
Nose and forehead against IR or
table, then adjust so OML and MSP
perpendicular to IR.
Check EAMs for rotation.
Use L or R marker.
Suspend Respiration.
Shield gonads, thorax, and thyroid.
OML perpendicular to IR.
MSP perpendicular to midline of IR.
No rotation or tilt.
Use L or R marker.
Shield gonads, thorax, and thyroid.
Collimate to outer margins of skull.
Submentovertex
(SMV) Projection
10x12
LW
40”
CR is perpendicular to
infraorbitomeatal line. Center 1 ½”
inferior to the mandibular symphsis
or midway between between the
gonions.
Note: if patient unable to
sufficiently extend the neck,
compensate by angling the CR to
remain perpendicular to IR.
Collimate to outer margins of skull.
IOML is parallel to IR.
MSP is perpendicular to the midline
of the grid.
Lab Manual 2014-2015 47
RDT 210 – Facial Bones, Nasal Bones, and Zygomatic Arches Laboratory
Competencies
Instructor Demonstration:
PA Waters (Parietocanthial)
Modified Waters
Lateral Facial Bones
Lateral Nasal Bones
Oblique Inferosuperior (tangential) for zygomatic arches
AP Axial for Zygomatic Arches (Demo only)
Student Practice and Test:
The student will demonstrate positioning of:
1. PA Waters (Parietocanthial) – 10x12 LW
2. Modified Waters – 10x12 LW
3. Lateral Facial Bones – 10x12 LW
4. Lateral Nasal Bones – 10x12 LW or CW
5. Oblique Inferosuperior (tangential) for zygomatic arches – 10x12 LW
Note:
Use 40” SID
May be done supine or erect.
Grid technique (except for lateral nasal bones – use extremity or detail screen)
Use L & R markers
Shield gonads and upper thorax (neck and thyroid whenever possible)
kV varies (refer to Bontrager)
Lab Manual 2014-2015 48
Chapter 13 – Facial Bones, Nasal Bones, and Zygomatic Arches Laboratory Competencies
Laboratory Competencies
Name
PA (Waters)
Parietoacanthial
IR
SID
Centering
Patient Instructions
10x12
LW
40”
CR is perpendicular to exit at the
acanthion.
MML and MSP perpendicular to IR.
(OML forms 37° angle with
IR).
No rotation or tilt (ensure EAMs are
equidistant to IR).
Use L or R marker.
Shield gonads, thorax, and thyroid.
Collimate to outer margins of skull on
4 sides.
Modified
(Waters)
Parietocanthial
10x12
LW
40”
CR is perpendicular to exit at the
acanthion.
LML and MSP perpendicular to IR
(OML forms 55° angle with
IR).
Collimate to outer margins of skull on Check for rotation or tilt.
4 sides.
Use L or R marker.
Shield gonads, thorax, and thyroid.
Lateral for Facial
Bones
10x12
LW
40”
CR is perpendicular to zygoma (½
way between outer canthus and
EAM).
Collimate to within 1” of facial bones.
Lateral for
Nasal Bones
Oblique
Inferosuperior
for Zygomatic
Arches
(Tangential)
10x12
CW
Detail
Screen
40”
Perpendicular to and ½ ” inferior
to nasion.
Collimate on 4 sides to include
anterior nasal spine.
10x 12 40”
LW
(Portab
le
Grid on
table or
detail
screen)
CR perpendicular to zygomatic arch
of interest (skims parietal eminence
and body of mandible).
Note: if patient cannot extend neck
enough to place IOML parallel to
IR, adjust CR so that it is
perpendicular to IOML.
MSP parallel and IPL perpendicular
to IR. IOML perpendicular to front
edge of cassette.
Check for rotation (ensure inion and
glabella are equidistant to IR).
Use L or R marker.
Shield gonads, thorax, and thyroid.
Positioning is the same as lateral
facial bones.
Mask unexposed side of IR with lead
strip if x-ray are done 2 on 1.
Use L or R marker.
Shield gonads, thorax, and thyroid.
Position as for SMV with IOML
parallel to CR
Rotate head 15° toward side of
interest; then tilt chin 15° toward
side of interest.
Use L or R marker.
Shield gonads, thorax, and thyroid.
Collimate on 4 sides to within 1” of
zygomatic arch.
AP Axial for
Zygomatic
Arches
(Modified
Townes)
Demo Only
10x12
LW
40”
CR angled 30° caudad to OML
or
37° caudad to IOML. Center 1”
superior to glabella
(CR passes through midzygomatic arches).
OML (or IOML) perpendicular to
film.
No rotation or tilt (check EAMs
which must be equidistant to IR
Use breathing technique.
Lab Manual 2014-2015 49
RDT 210 – Optic Foramina, Mandible, TMJs, and Sinuses Laboratory
Competencies
Instructor Demonstration:
Rhese Method (Parietoorbital) for optic foramina
Axiolateral Mandible
PA Mandible
Open-mouth parietoacanthial (Waters) Sinuses
AP Axial Mandible (Demo Only)
SMV Mandible (Demo Only)
PA Caldwell—Sinus
Student Practice and Test:
The student will demonstrate positioning of:
1. Rhese Method (Parietoorbital) for optic foramina – 10x12 CW or LW
2. Axiolateral Mandible – 10x12 CW
3. PA Mandible – 10x12 LW
4. Open-Mouth Parietoacanthial (Waters) Sinuses – 10x12 LW
5. PA Caldwell—Sinus
6. Lateral - Sinus
Note:
Use 40” SID
May be done supine or erect.
Grid technique
Use L & R markers
Shield gonads and upper thorax (neck and thyroid whenever possible)
kV range varies (refer to Bontrager)
Lab Manual 2014-2015 50
Chapter 13 – Optic Foramina, Mandible, TMJs, and Sinuses Laboratory Competencies
Name
Parietoorbital
Projection
(Rhese Oblique)
for Optic
Foramina
IR
SID
Centering
Patient Instructions
10x12
LW or
CW
40”
CR perpendicular to mid-portion of
downside orbit.
Place chin, cheek and nose against
surface of IR (“three-point landing”).
Then, adjust head so MSP forms a
53° angle with IR. Ensure that the
acanthiomeatal line is perpendicular
to IR.
Use L or R marker of eye-side-down
next to nose inside collimation.
Shield gonads, thorax, and thyroid.
Axiolateral
Oblique
Mandible
10x12
CW
Collimate on 4 sides to an area of
about 4x4.
40”
Angle CR 25° cephalad. CR exits
downside mandible.
Collimate to include the mandible.
PA Mandible
10x12
LW
40”
CR is perpendicular and exits at the
junction of the lips.
Collimate to include the mandible.
AP Axial
Mandible
Demo Only
10x12
LW
40”
CR is angled 35-42° caudad center to
glabella to pass through ½ way
between EAMs and gonions of
mandible.
Collimate across the mandible to
include the bilateral TMJs.
Head is in a true lateral position (side
of interest against IR).
Area of interest:
Ramus - No head rotation.
Body - 30° rotation toward IR.
Mentum - 45° rotation toward IR.
General survey of mandible - rotate
head 10-15°.
Use L or R marker for side down in
front of mandible inside collimation.
Shield gonads, thorax, and thyroid.
Position head so OML and MSP are
perpendicular to IR (position is same
as PA skull).
Ensure no rotation (check EAMs for
rotation).
Use L or R marker.
Shield gonads, thorax, and thyroid.
Position as for AP Axial Skull.
Use L or R marker.
Shield gonads, thorax, and thyroid.
Lab Manual 2014-2015 51
Chapter 13 – Optic Foramina, Mandible, TMJs, and Sinuses Laboratory Competencies
Name
SMV for
Mandible
IR
SID
Centering
Patient Instructions
10x12
LW
40”
CR perpendicular to 1 ½” below
mandibular symphysis.
Positioning the same as for SMV
skull.
Use L or R marker.
Shield gonads, thorax, and thyroid.
Collimate on 4 sides to within 1” of
zygomatic arch.
Demo Only
PA Caldwell for
Sinuses
10x12
LW
40”
CR perpendicular and exits nasion.
Place head in PA position as for PA
skull. Then elevate OML 15° from
horizontal (or tilt bucky 15
degrees).
Open-Mouth
Parietoacanthial
(Waters)
10x12
LW
40”
CR perpendicular and exits acanthion.
Lateral for
Sinuses
10x12
LW
Position head same as Waters Method
for facial bones.
Hold patient’s head and ask patient
to open mouth (be sure patient does
not move head when opening the
mouth).
MSP parallel and IPL perpendicular
to IR. IOML perpendicular to front
edge of cassette.
Check for rotation (ensure inion and
glabella are equidistant to IR).
Use L or R marker.
Shield gonads, thorax, and thyroid.
Collimate on 4 sides to an area of
about 8x10.
40”
CR perpendicular and midway
between outer canthus and EAM
Collimate on 4 sides to an area of
about 8x10.
Lab Manual 2014-2015 52
RDT 114 – Ribs and Sternum Laboratory Competencies
Instructor Demonstration:
Sternum
RAO
Lateral
Ribs
AP or PA (above diaphragm)
PA (below diaphragm)
Obliques
Student Practice and Test:
The student will demonstrate positioning of:
1. Sternum
a. RAO – 10x12 LW
b. Lateral – 10x12 LW
2. Ribs
a. AP or PA (above diaphragm) – 14x17 CW
b. PA (above diaphragm) – 14x17 CW
c. Obliques – 14x17 LW
Note:
Use 40” SID
Use 72” SID for lateral sternum
Breathing technique for RAO sternum
Grid technique
Use L & R markers
Shield gonads
kV varies (refer to Bontrager)
Lab Manual 2014-2015 53
Chapter 11 – Ribs and Sternum Laboratory Competencies
Name
IR
SID
Centering
Patient Instructions
Sternum –
RAO
10x12
LW
40”
CR is perpendicular to ½ way
between manubrial notch and xiphoid
tip (or place Place top of IR 1 ½”
above manubrial notch and center
tube to IR) and CR is 1” left of
midline.
Patient is erect in a 15-20° anterior
oblique (erect is preferred).
Use breathing technique.
Use L or R marker.
Shield gonads.
Sternum –
Lateral
10x12
LW
72”
Collimate to area of around 5x12.
CR is perpendicular to ½ way
between manubrial notch and xiphoid
tip (or place Place top of IR 1 ½”
above manubrial notch and center
tube to IR).
Collimate if possible.
Ribs –Above
Diaphragm
(AP or PA)
14x17
LW
40”
CR is perpendicular to T7 (3-4”
below jugular notch) and MSP.
Note: can also place top of IR 1 ½”
above shoulders.
Ribs –Below
Diaphragm
14x17
CW
40”
Collimate if possible.
CR perpendicular to ½ way between
xiphoid tip and lower rib cage at
MSP.
Note: use 20° for “thin” patients
and 15° for “thick” patients.
Patient standing or sitting with
shoulders and arms in “military
posture” (ask patient to stand “at
attention”, with shoulders and arms
back and chest out).
Expose on inspiration.
Use L or R marker.
Shield gonads.
AP or PA depending on area of rib
interest (posterior or anterior).
Erect position is preferred.
Expose on inspiration.
Use L or R marker.
Shield gonads.
Recumbent position preferred.
Expose on expiration.
Shield gonads.
Note: can also place bottom of
cassette at level of iliac crest and
center tube with IR at MSP.
Ribs – Obliques
*Rule of thumb
on rib obliques rotate the spine
away from the
site of the injury
(e.g.
RAO = erect left
anterior ribs
and
LPO = left
posterior ribs).
14x17
LW
40”
Collimate if possible.
CR perpendicular to ½ way between
vertebral column and lateral margin
of affected side.
Note: adjust centering according to
whether injury is above or below
diaphragm.
Collimate if possible.
THE END
Patient is in a 45° posterior oblique or
anterior oblique (depends on injury
site).
On anterior oblique: affected side is
rotated away from site of injury.
Raise arm on elevated side up and
opposite arm down.
Expose “above diaphragm” on
inspiration and “below diaphragm on
expiration”.
Use L or R marker.
Shield gonads.