Cervicals basic X-ray positioning rules
A. Choose a cassette that fits the anatomy
B. Put the part in the middle of the film
C. Direct the CR towards the middle of the anatomy
Cervical SID
Every view is done at 72”
EXCEPT: (40”)
- AP
- APOM
- Swimmer’s
Cervical Trauma series views in order
-Lateral
-APOM
-AP
-Obliques
-Flexion/Extension
(Least invasive to most invasive yielding the most information)
Cervical view collimation
Every view is collimated to 8x10
EXCEPT:
- APOM = below orbits and into mastoids
- Flexion/extension = 10x12
Cervical tube tilts
15 degree cephalic
- AP cervical
- Posterior obliques
15 degrees caudal
-Anterior obliques
5 degree caudal
-Swimmer’s view
Cervical CR placement
Every view is directed at C4 (middle of anatomy)
EXCEPT:
- APOM = between C1/C2
- Swimmer’s = between C7/T1
Anatomy visualized for cervical views
- Lateral = Base of skull to C7, T1
- APOM = C1,C2
- AP = C3-C7 (include lung apices)
- Obliques = RAO and LPO (Right IVF), LAO and RPO (Left IVF)
- Flexion/Extension = Base of skull to C7 (done to evaluate range of motion and to check for ligamentous stability)
Routine thoracic views
- if patient is over 50?
- over 60?
AP, Lateral
- > 50 add PA chest
- > 60 add a Left Lateral chest x ray
Film placement for thoracic views
Top of film 1.5 inches above the VP
Thoracic collimation views
AP = 7x17 Lateral = 10x17
CR Thoracic views
T6
-It is easier to place the top of the film first and then align the CR to the film
Lateral Thoracic spine CR placement
Place the long axis of the CR an inch behind the humeral head at T6
Breathing instructions for thoracic views
Inhale and hold
SID for thoracic and ribs
40”
Routine views for ribs
- AP or PA unilateral or bilateral above diaphragm or below diaphragm (depends on patients injury)
- Posterior obliques only (allows you to shoot into the concavity and elongates the ribs for better visualization)
- PA chest to check for a punctured lung
Collimation for ribs views
Film size
Rib CR placement
Middle of the desired anatomy
-Better to place the first first and then align the CR to your film
Unilateral Rib film placement
Above the diaphragm = top of film 1.5 inches above VP (vertical film)
Below the diaphragm = bottom of the film at iliac crest (film is vertical)
Bilateral Rib film placement
Above the diaphragm = top of film just above the shoulders (film is transverse)
Below the diaphragm = bottom of film at the iliac crest (film is transverse)
Breathing instructions for rib films
Above diaphragm = inhale and hold
Below diaphragm = exhale and hold
CR placement APLP
Men = 2" below crest Women = 1" below crest
CR placement for lumbar views besides APLP
- Lateral = 1” above crest on midline
- Anterior oblique = 1” above crest and lateral to spine on side up
- L5/S1 = 2-3” below crest just behind midline
- AP sacrum = Mid pelvis
- Lateral sacrum = 3” below crest and just behind greater trochanter
Lumbar tube tilts
- AP sacrum = 15 degree cephalic
- AP coccyx = 10 degree caudal
Lumbar LAO/RPO is used to see what anatomy?
Right pars
RAO/LPO = left pars
