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NYCC xray posit.

xray positioning

QuestionAnswer
APOM 8 by 10 inch casette, @ 40 inches, no tube tilt, collimation is approx 4 by 4 inches, central ray thru mid portion of pts lips when mouth closed, then thru the midpoint of the open mouth/posterior tongue. Palpate occiput to make sure lower incisors level
pt instructions for apom open mouth, dont breath, and do not swallow
AP Cervical 10 x 12, or 8 x 10 cassette, 37 inches away with 15 cephalad tube tilt, collimate between chin and upper lip, and mid of 1st rib. Central ray @ thyroid cartilage (palpate)
Pt instructions for ap cervical remain still, hold breath, do not swallow
Lateral Cervical 10 x 12 inches, OUTSIDE BUCKEY, 72 inches. Collimate to aove the ears, behind eyes - with all ant and post soft tissues, palpate c7. Central ray @ angle of mandible
Pt instructions for lateral cervical remain still, hold breath, do not swallow.
oblique cervicals 10 by 12 inches - 37 inches away. If anterior 15 caudad, posterior 15 cephalad. Collimate to middle ear, and palpate c7. Central ray @ angle of mandible (C4).
Pt instructions for oblique cervicals 45 degrees off bucky, with head parallel to bucky. Remain still, hold breath, and do not swallow.
Where does marker go in cev obliques must be placed over whatever shoulder it's over!!! Not the shoulder touching the bucky
swimmers view 8 by 10, 40 inches, collimate to area of interest - but must have ant and post soft tissues. Locate c7-t1 and put central ray 1-1/2 inch anterior to SPs.
pt instructions for swimmers view arms up in the poisition, remain still, take a breath in, breath out and hold breath, and do not swallow.
Ap thoracic 14 x 17 in, 40 inches away, First put cassette 1.5 inches above T1, then move tube to center xray. Collimate to 1 inch sup and inf from cassette, and mid clav line.
Pt instructions for ap thoracic remain still, take a deep breath in and hold your breath, do not swallow
lat thoracic 14 x 17, 40 inches away, 1st have pt ap, put cassette 1 inch above T1, move tube to be centered with cassette. Sup and inf margins 1 inch inward, limit anterior aspect of pts body.
What are the pt instructions for lat thoracic arms out in front of body, remain still, take a deep breath in and hold your breath, do not swallow
AP lumbopelvic 14 x 17 in, 40 in away, central ray placed 1 inch below iliac crest. Collimate superior and inferior margins and lat margins 1 inches inward from cassette
what are pt instructions for ap lumbopelvic? feet aligned posteriorly, remain still, take a deep breath in, then breathe out and hold your breath.
lat lumbar 14 x 17 in, 40 in away. Central ray @ 1 inch above iliac crest (usually a little behind axilla). Collimate as per pt size.
pt instructions for lat lumbar pt as close to bucky as possible, pts arms out in front of body. remain still, take a deep breath in then breathe out and hold your breath.
oblique lumbar 14 by 17, 40 inches, CR: 1 in above iliac crest. collimate sup and inf margins as well as lateral margins 1 inch inward from film margin. Pt @ 45 degrees with arms in front of body.
Line up for posterior vs anterior lumbar obliques Posterior: palp l3 sp with line up with vertical bucky line then move pt 1 inch post so that the central ray is directed thru the l3 vert body. anterior" palp l3 sp then move pt aprox 1 in post so that the central ray is intersecting l3 vert body
pt instructions for oblique lumbar stay still, deep breath in then breathe out and hold breath.
AP pelvis 14 by 17 in HORIZONTAL. 40 inches, Central Ray: top of cassette 1 in aove iliac crest. Collim: sup and inf and lat margins approx 1 inch inward from film.
pt positioning during AP pelvis have pt internally rotate their ft approx 10 degrees.
pt instructions for ap pelvis remain still, deep breath in then out and hold breath.
PA Lumbosacral spot 8 x 10 in. 34 inches away! TUBE tilt @ 30 CAUDAD. Central ray thru lumbosacral junc, around superior aspect of L5 SP. Collimate to area of interest
pt instructions for PA lumbosacral spt/ferguson view remain still, take deep breath in, breath out and hold your breath.
lateral lumbosacral spot 8 by 10 in, 40 inches, central ray thru ls junc found by intersection b/w iliac crest and asis. collimate 5 by 5, or 6 by 6.
Pt instructions of lat ls spot remain still, take deep breath in then breath out and hold.
AP sacrum 10 by 12. @ 37 inches, 15 degree cephalad tilt. Central ray center 1 in below ASIS in the mid line of the body. Collimate 9 by 11 inches. Sacrum must be in contact with the sacrum.
PA sacrum 10 by 12 inches, 37 inches away. 15 degrees caudad tilt. Central ray on the s2 tubercle. 9 by 11 collimate max. Pt's abdomen should be in contact with the bucky (hands on wall).
pt instructions for both ap and pa sacrum remain still, take deep breath in and breath out and hold your breath
Where do you measure for Ap sacrum? 1 inch below the ASIS
Lateral Sacrum 10 by 12 in, 40 in away. Central ray @ PSIS (s2 tubercle). Collimate 9 by 11 max. (line up s2 to line going down bucky, then move back slightly)
pt instructions for lateral sacrum remain still, take breath in and breath out and hold it.
AP coccyx 8 by 10 inches. @ 39 inches away. Tube tilt 5-10 degrees CAUDAD. Central ray just above the pubic symphysis. Collimate to area of interest.Center the coccyx to the buccky, in the midline.
PA coccyx 8 by 10 inches. @ 39 inches away. 5-10 degrees CEPHALAD. Central RAY: palpate and center just below the sacrococcygeal joint. Center coccyx to the bucky, in the midline.
pt instructions for pa and ap coccyx remain still, deep breath in then breath out and hold it.
lateral coccyx 8 by 10 inches, 40 inches away. CRay: just below the sacrococcygeal joint. Collimate to area of interest. Center coccyx to the bucky, in the midline.
Pt instructions for lateral coccyx remain still, take deep breath in then breath out and hold breath.
AC joint projection 8 by 10 inches, spine cassette, 39 inches away. Tube tilt 5-10 degrees cephalad. Central ray thru AC joint space (pt in anatomical position). Collimate to area of interest.
Pt instructions for AC joint projection stand in anatomical position, remain still, hold breath.
AP Clavicle projection 10 by 12 HORIZONTAL, spine cassette. 40 inches away. Central ray at middle of clavicle Collimate SC joint to AC joint.
Pt instructions for AP Clavicle pt against bucky, remain still, hold breath.
PA Clavicle projection 10 by 12 inches, sideways, spine cassette. 40 inches away. Central Ray to middle of clavicle. Line up clav to middle of cassette, and then put central ray in the center.Collimate Sc to AC . Pt must have their head rotated away to contralateral side.
pt Instructions for PA Clavicle pt standing against bucky, head rotated away. remain still and hold breath
AP semiaxial clavicle prjection 10 by 12in (sideways, spine cass). Tube tilt 10 degrees cephalad - 38 inches away. Central Ray thru undersurface of the center of the clavicle. Collimate SC joint to AC joint.
pt instructions for semiaxial clav pt against bucky, hand in anatomical positon, remain still, hold breath.
Internal rotation of the shoulder projection 10 by 12 in, spine cassette, 40 in away. Central Ray thru the GH joint. Collimate to include all shoulder and soft tis out to deltoid tuberosity. Hand int rotated, with wrist on hip.
Pt instructions for int rotation hand int rotated, with dorsum on hand. Remain still, hold breath.
Ext rotation of the shoulder projection 10 by 12 inches, spine cassette.40 inches away. Central ray thru the GH joint. Collimate shoulder and all soft tissues out to include deltoid tuberosity. Arm ext rotated so elbow epicondyles perpendicular to bucky.
Pt instructions for ext rot of shoulder arm ext rotated to orient eblow epicondyles perpendicular to bucky. Remain still, hold breath.
AP elbow projection Half (cover other half with shield) of a 10 by 12 in HORIZONTAL (ext cass). ON TABLE. 40 inch away. Cen ray - thru elbow joint. Collim: elbow joint including dist humerus and prox radius & ulna. Sup & inf margins 1 in inward, med & lat just off soft tis
Ap elbow projection pt instructions elbow fully extended over cassette in ant-post position. Remain still.
Ext (lat) oblique elbow projection. half 10x12 horizontal table top, ext cass. 40 in away. Cen ray: thru elbow joint. Collim: sup and inf margins aprrox 1 in inward, med and lat margins off soft tis. elbow extended, and ext rot to 45 degrees.
Pt instructions for ext oblique elbow elbow fully extended and ext rotated to 45 degrees, remain still
Lat elbow projection 8 by 10 in. table, ext cass. 40 in. CR: thru elbow joint. Collim: elbow joint including dist humerus and prox rad and ulna. Elbow flexed to 90 with inner hum and ulna flat on cassete, with thumb up.
PA wrist projection 1/3rd of 10x12, horizontal, table, ext cass. 40 in. Cen ray: just prox to styloid processes of radius and ulna. Collim: mid-metacarpals as well as dist shaft of radius and ulna and all soft tis. Pt makes a fist and places wrist on cassette.
Medial(int) oblique wrist projection. 1/3rd of 10x12 horizontal, tab, extrem cass. 40 in, Cen ray: prox to styloid proc of rad and ulna. Collim: mid-metacarpals as well as dist shaft of radius and ulna. Pt must make an ok sign with thumb and index finger, and place wrist on cassette.
Lat wrist projection 1/3rd 10x12 horizontal, ext, table. 40 in, cen ray: just prox to styloid process of rad and ulna. Collim: mid metacarpals as well as dist shaft of rad and ulna. Elbow flexed @ 90 degrees and thumb is pointed upwards.
PA hand projection 1/2 10x12 horizontal -ext-tab. 40 in, Cen Ray: thru the head of the third metacarpal. Collim: beyond soft tissues, try to include the styloid processes of rad and ulna. Hand placed palm down on the cassette with fingers approximated.
Medial (int) oblique hand 1/2 10x12 in, horizontal, ext, tab. 40 in. Central ray: thru head of 3rd metacarpal. Collim: just beyond all soft tis, with styloid processes. Pt makes an ok sign with thumb and index finger approximated (not touching) and places wrist on cassette.
lateral hand projection 8x10 extrem table. 40 in. central ray thru metacarpal heads. collimate beyond soft tissues, including styloid processes. Have ulnar side of hand down, then fan all the other digits anterior to the 5th digit.
AP Hip 10x12, spine cassette. 40 in. central ray: thru FA joint - find by bisecting pubic symp and ASIS. Collimate half in borders. 10-15 degrees of int rotation!!! Make sure arms out of way.
Frog-leg Lateral Projection 10x12 spine cass. 40 in. CR: thru FA joint found by bisecting ASIS and pub symph. Have pt put their leg abducted onto a stool's bottom ring. Collimate 9x11.
AP Knee 10x12 ext, table. 5 degree tube tilt, therefore 39 in. CR: thru femurotibial joint space. Collimate: sup and inf margins 1 in in from film. Include dist femur diaphys, and prox tibfib diaphy. Make sure knee is fully extended, with foot dorsiflexed!
Medial (internal) oblique knee 10x12 ext, table. 40 in. CR: thru femurotibial joint. Collimate: 1 inch borders, include dist diaphy femur and prox tib fib diaphy. Make sure femur, tib fib and foot all rotated internally @ 45 degrees. Measure: Like a lateral knee!!!
Lateral Knee 10x12, ext, tab. 40 in. CR: thru femurotibial joint. Collimate: dist femur and prox tibfib. Pt is sidelying, with affected knee on cassette, and unaffected knee over anteriorly. Make sure bottom knee is flexed 20-30 degrees.
AP Ankle half 10x12 horizontal orient, ext, tab. 40 in. CR: thru ankle mortise, just prox to malleoli. Collim: include dist diaphy tibfib. Foot dorsiflexed, and make sure leg follows down black line on table if there. Cover other half of cassette with shield.
Medial (int) oblique ankle projection half 10x12, horizontal, ext cas. 40 in. CR:thru ankle mortise which is prox to malleoli. Collim: include dist diaphy of tibfib. Rotate ankle and foot 30-45 degrees medially, with foot dorsiflexed to 90 degrees.
Lateral ankle projection 8x10 ext cass. 40in. CR: prox to malleoli. Collim: include dist diaphy of tibfib to just beyond heel pad soft tis. Sidelying, with anterior leg over bottom leg. Foot dorsiflexed to 90 degrees. Lateral aspect of bottom foot on cassette.
AP Foot - dorsiplantar view half 10x12, vertical, ext. 10-15 degree tube tilt, 38-39 in. CR: base of 2nd/3rd metatarsal. Collim: include calcaneus, and distal phalanx to just beyond all soft tissues. Pt should have a flexed knee to 90 degrees with ft on cassette.
Medial(int) oblique foot half 10x12, vert, ext. 40 in. CR: base of 2nd/3rd metatarsal. Collim: calcaneus and dist phalanx to just beyond all soft tis. Pt puts ft on cassette, then rotates tibfib and foot 35-45 degrees inward, with lat aspect of foot off cassette, and medial on it
Lateral foot projection 8x10(10x12 if ft large) horizontal orientation. 40 in. CR: thru medial aspect of metatarsals. Collimate: include dist tibfib, calcaneus, dist phalanx and their soft tis. Lateral aspect of foot on cass. Dorsiflexion of ft.
Created by: margaretrhager on 2012-06-01



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