Principles and Positioning Reader

Question 1

What is the sequence suggested for taking X-rays?

Answer 1

pg 4

Question 2

What are some of the aspects that you can critique on an image?

Answer 2

pg 12, 13

Question 3

PA Lumbosacral Spine/ AP lumbopelvic view 
Cassette size 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 3

pg 23

Question 4

Lateral Lumbar 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 4

25

Question 5

Anterior Oblique (lumbar)
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 5

26

Question 6

PA angulated lumbosacral Spot view 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 6

27

Question 7

Lateral lumbosacral spot view 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 7

28

Question 8

AP sacrum/ Coccyx 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 8

29

Question 9

Lateral Sacrum
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 9

30

Question 10

PA chest 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 10

32

Question 11

Lateral Chest 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing:

Answer 11

34

Question 12

Apical Lordotic Chest 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
35

Answer 12

35

Question 13

Rib Views 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations

Answer 13

37

Question 14

AP Thoracic
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations:
38

Answer 14

38

Question 15

Lateral Thoracic
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations:
39

Answer 15

39

Question 16

Swimmers view 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations:
40

Answer 16

40

Question 17

AP Open mouth 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations:
41

Answer 17

41

Question 18

AP lower cervical 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations:
43

Answer 18

43

Question 19

Lateral cervical 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations:
44

Answer 19

44

Question 20

R and left Anterior obliques cervical 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations:
pg 45

Answer 20

45

Question 21

Flexion, extension, lateral Cervical 
SID
kVp
Grid
Central Ray 
Tube tilt: 
Breathing: 
special considerations:
47

Answer 21

47

Question 22

Standard Hip Views:
AP Pelvis
Cassette 
SID: 100cm 
kVp: 80
Grid: Yes 
Central Ray:
Breathing: 
Special considerations:
Shielding? 
48

Answer 22

AP Pelvis
Cassette: 35 x 43  
SID: 100cm 
kVp: 80
Grid: Yes 
Central Ray: midline between ASIS and pubic symphysis 
Breathing: Suspended respiration 
Special considerations: Leg internally rotated 10 degrees 
Shielding? Yes

Question 23

AP Spot Hip 
Cassette Size: 
SID: 100 
kvP: 80
grid: Yes 
Central Ray: 
Tube tilt:
Breathing:
Special considerations: 
49

Answer 23

Cassette: 24 x 30 
SID: 100
KvP: 80
Grid: Yes 
Central Ray: 5-7cm below mid point between ASIS and pubis on that side 
Tube tilt: none
Breathing: Suspended respiration 
Special considerations: 
Internal rotation of femurs 10deg 
Gonadal shielding

Question 24

Frog leg Hip View: 
Cassette Size: 
SID
kVp: 
Grid:
Central Ray:
Tube tilt:
Breathing:
Special Considerations 
50

Answer 24

Cassette Size: 24 x 30 
SID: 100 
kVp: 80
Grid: Yes 
Central Ray: Same as AP spot 
Tube tilt: none 
Breathing: Suspended respiration 
Special Considerations: 
lower part of knee on same leg should be as close to table as possible, if cant touch have a padded support 
If pt cant get within 10c, of table top, elevate patients opposite side untill knee contacts table, elevate pts opposite side untill knee contacts table, and place foam pad under elevated hip.

Question 25

``` AP Knee (pg 52) Cassette size: SID: kVp: Grid: Central Ray: Tube tilt: Breathing: Special considerations: ```

Answer 25

``` Cassette size: lil one portrait (18 x 24) SID: 100 kVp: 60 Grid: NO Central Ray: 1 cm below apex of patella Tube tilt: 10 deg cephalad Breathing: suspended Special considerations: Might need to internally rotate knee to ensure AP orientation. -knee should be fully extended SHILEDING USE ON ALL KNEES AND ANKLES ```

Question 26

``` Lateral Knee: 53 Cassette Size: SID: kvP: Grid: Central Ray: Tube Tilt: Breathing: Special considerations ```

Answer 26

``` Cassette: Small one portrait SID: 100 kvP: 60 Grid; NO Central Ray: Joint space Tube tilt: 5deg cephalad Breathing: suspended Special considerations: knee bent at 45 deg Lateral side of knee contacting table ```

Question 27

``` Intercondylar View (TUNNEL) View 54 Cassette Size: SID: kVP: Grid: None s Central Ray: Tube Tilt: breathing: Special considerations: ```

Answer 27

54 Intercondylar View (TUNNEL) View Cassette Size: 18 x 24 SID: 100 kVP: 60 Grid: None (unles knee measures greater than 14cm- then use a grid and multiply mAs by 3 x Central Ray: Popliteal fossa Tube Tilt: 45deg Caudal breathing: Suspended respiration Special considerations: Patient prone, knee flexed to 45 -Increase mAs 50% from AP view (so measure AP) -remember to account for a large tube tilt -patella should contact upper half of cassette to allow for imageprojection into centre.

Question 28

``` Tangential (Sunrise) View - 55 Cassette size: SID kVP Grid: Central ray: Tube tilt: breathing: Special considerations: ```

Answer 28

``` Tangential (Sunrise) View - 55 Cassette size: 18 x 24 SID: 100 kVP: 60 Grid: non (unless etc) Central ray: Patellofemoral joint Tube tilt: breathing: Special considerations: Knee should be fully flexed, may need assistance if cant reach -if they have patella trauma, rule out fx before performing this view. -Increase 1.5 x from AP (so measure AP) and collimate area of interest. ```

Question 29

``` AP and Lateral Leg view 56 Cassette size: SID kVP Grid: Central ray: Tube tilt: breathing: Special considerations: ```

Answer 29

56 Cassette size: 35 x 43 oblique SID: 100 kVP: 60 Grid: none Central ray: mid shaft Tube tilt: non breathing: suspended Special considerations: -AP position without rotation -lateral position without rotation, lateral side contacting cassette -must attempt to include joints at each end of leg -If leg too long, can plave leg diagonal and increase SID to 110cm -can take both views on one large cassette if legs fit -Use 1/3 mAs of AP knee (because fo switch from detail to regular speed cassette) -Measure CR

Question 30

``` AP Ankle 57 Cassette size: SID kVP Grid: Central ray: Tube tilt: breathing: Special considerations: ```

Answer 30

``` 57 Cassette size: 24 x 30 SID: 100 kVP: 55 Grid: None Central ray: Between malleoli Tube tilt: none breathing: suspended Special considerations: -divide a cassette in half by placing lead strip over half not being used. -Foot facing straight up neutral, close to perpendicular to the cassette (relaxed but not plantar flexed) ```

Question 31

``` Medial Oblique Ankle 58 Cassette size: SID kVP Grid: Central ray: Tube tilt: breathing: Special considerations: ```

Answer 31

``` 58 Cassette size: 24 x 30cm (one half- landscape) SID: 100cm kVP: 55 Grid: None Central ray: Between malleoli Tube tilt: none breathing: suspended Special considerations: -leg and ankle medially rotated 45 deg -ankle dorsiflexed if possible ```

Question 32

``` Lateral ankle 59 Cassette size: 24 x 30cm detail portrait or landscape SID: 100 kVP Grid: Central ray: Tube tilt: breathing: Special considerations: ```

Answer 32

``` Lateral ankle- 59 Cassette size: 24 x 30 SID: 100 kVP: 55 Grid: non Central ray: Medial Malleolus Tube tilt: None breathing: Suspended respiration Special considerations: -ankle is placed lateral side down -position ankle in 90deg dorsiflexion -collimate to the ankle/ hindfoot region- this is not a lateral foot view. ```

Question 33

Mortise | 60

Answer 33

Similar to AP, but medially rotate 15deg- best to evaluate mortise joint

Question 34

``` FOOT VIEWS DP foot -61 Cassette size: SID: Grid: Central Ray: Tube tilt: Breathing: Special considerations: ```

Answer 34

``` 61 Cassette size: 24 x 30 (1/2 cassette) SID: 100 kvP: 55 Grid: 55 Central Ray: base of 3rd metatarsal Tube tilt: 10degrees CEPHALAD!!! Breathing: suspended Special considerations: -foot must be flat against cassette -measure at mid foot and use compensatory filters to avoid burnt out toes MUST include toes on film- legal ```

Question 35

``` Medial Oblique Foot: 62 Cassette size: SID: kVp: Grid: Central Ray: Tube tilt: Breathing: Special considerations: ```

Answer 35

``` Cassette size: 24 x 30 (half) SID: 100 kvp: 55 Grid: None Central Ray: Base of 3rd metatarsal Tube tilt: none Breathing: suspended Special considerations: -lateral side of foot is elevated (medial side down) -use foam wedge to help hold position (under foot or knee) ```

Question 36

``` Lateral Foot: 63 Cassette size: SID: kVp: Grid: Central Ray: Tube tilt: Breathing: Special considerations: ```

Answer 36

``` Cassette size: 18x 24 (detail) SID: 100 kVp:55 Grid: non Central Ray: base of 3rd metatarsal Tube tilt: none Breathing: suspended Special considerations: -lateral side of foot against cassette for patient comfort -must include toes and calcaneus -make sure plantar surface is perpendicular to cassette and ANKLE IS DORSIFLEXED to 90 deg. -For larger feet, use a 24 x 30cm cassette ```

Question 37

``` Axial calcaneus View: 64 Cassette size: SID: kVp: Grid: Central Ray: Tube tilt: Breathing: Special considerations: ```

Answer 37

``` Cassette size: 18 x 24 (detail) SID: 100 kVp: 55 Grid: non Central Ray: mid calcaneus Tube tilt: 40 deg cephalad Breathing: suspended Special considerations: ```

Question 38

``` ALL AP shoulder Views 67 Cassette size: SID: kVp: Grid: Central Ray: Tube tilt: Breathing: Special considerations: ```

Answer 38

Cassette size: 24 x 30 SID: 100 kVp: 70 Grid: yes Central Ray: 2.5cm below coracoid process (about 5cm below top of clavicle Tube tilt: non Breathing: suspended respiration Special considerations: -pt back flat against the grid holder -head turned away from the x-ray (to protect eyes) Collimation should be to just beyond the outer soft tissue edges. -can place a filter over the 'dead space' above the shoulder to reduce back scatter and AC region over exposure. AP external rotation arm slightly abducted AP internal rotation: - arm slightly abducted and palms facing - ENSURE pt doesnt hunch shoulder forward.

Question 39

``` AP Shoulder- Weight Bearing All factors same as AP views humerus in neutral position -pt holds weighted object (3-10kgs) with relaxed shoulder to assess stability of AC and GH joints 68 ```

Answer 39

a

Question 40

SHoulder posterior oblique (Grashey) 69 ``` Cassette size: SID: kVp: Grid: Central Ray: Tube tilt: Breathing: Special considerations: ```

Answer 40

Cassette size: 24 x 30 SID: 100 kVp: 70 Grid: Yes Central Ray: 2.5cm below coracoid process Tube tilt: non Breathing:suspended respiration Special considerations: -pts scapular body placed flat against the grid cabnet (about 30-40deg of body rotation) -arm slightly abducted in neutral Purpose: to see directly through glenohumeral joint.

Question 41

``` Trans-scapular View: 70 Cassette size: SID: kVp: Grid: Central Ray: Tube tilt: Breathing: Special considerations: ```

Answer 41

``` Cassette size: 24 x 30 SID: 100cm kVp: 70 Grid: Yes Central Ray: plane of scapulocostal articulation, mid scap body (measure through central ray) Tube tilt: none Breathing: suspended respiration Special considerations: -stand pt in anterior oblique position -arm across body anteriorly -generally requires 45-60deg of obliquity, depending on humeral position. ```