Manual of Radiographic Technique

Transcription

1 Manual of Radiographic Technique

2 The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 165 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of health manpower, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; having achieved the eradication of smallpox, promoting mass immunization against a number of other preventable diseases; improving mental health; providing safe water supplies; and training health personnel of all categories. Progress towards better health throughout the world also demands international cooperation in such matters as establishing international standards for biological substances, pesticides and pharmaceuticals; formulating environmental health criteria; recommending international nonproprietary names for drugs; administering the nternational Health Regulations; revising the nternational Classification of Diseases, njuries, and Causes of Death; and collecting and disseminating health statistical information. Further information on many aspects of WHO's work is presented in the Organization's publications.

3 WORLD HEALTH ORGANZATON BASC RADOLOGCAL SYSTEM MANUAL OF RADOGRAPHC TECHNQUE

4 World Health Organization Basic Radiological System Manual of Radiographic Technique by T. Holm University Hospital, Lund, Sweden P.E.S. Palmer University of California, Davis, California, United States of America E. Lehtinen Radiation Medicine, World Health Organization, Geneva, Switzerland WORLD HEALTH ORGANZATON GENEVA 1986

5 SBN World Health Organization 1986 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation of WHO publications, in part or in toto, application should be made to the Office of Publications, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The authors alone are responsible for the views expressed in this publication. PRNTED N SWTZERLAND 85/ Atar

6 CONTENTS Preface.... Radiation protection: the risk of harm from X-rays Reactions to intravenous drugs used for urography First aid and patient care for the BRS operator Explanations Chest... Lungs and heart Ribs.... nfants weighing up to 10 kg-lungs and heart Abdomen General Urinary tract (kidney, ureters, bladder) Gall-bladder (cholecystography) Pregnancy.... nfants and small children weighing up to 15 kg-general Head Skull.... Sinuses, face, and nose Mandible Spine... Cervical spine Cervicothoracic region Thoracic spine.. Lumbosacral spine Arm... Clavicle Scapula Shoulder Humerus Elbow. Forearm. Wrist.. Scaphoid Hand Thumb and fingers Leg.... Pelvis and hip joints Femur Knee Patella Leg Ankle Foot and toes Heel.... nfants and small children-pelvis and hip joints Exposure tables Page

7 7 PREFACE This Manual of Radiographic Technique is for use with the World Health Organization Basic Radiological System. Unlike most books on radiography, it is compiled with the assumption that the person who uses it-usually the BRS operator-has little knowledge of X-ray equipment or experience of how to X-ray a patient. No attempt is made to teach the theory of radiography; rather a visual sequence is presented which should be followed exactly, without deviation or personal variation. Although it can be used with any X-ray equipment, it is specifically designed for use with X-ray machines that comply with the WHO-BRS specification. After a short period of training the operator should be able to use the manual to carry out the techniques it illustrates. The range of basic radiographic techniques described is sufficient to enable more that 90% of the problems diagnosable through radiography to be routinely examined. f the instructions are followed exactly, the resulting radiographs will be in standard projections, easily repeated for comparison, and understood by physicians and health workers throughout the world. Descriptions of how to X-ray the urinary tract and the gall-bladder, both needing the help of a physician, are included. Techniques for fluoroscopy are not included because it is not possible to carry them out with the basic radiological system. Since films and X-ray cassettes vary, the exposures required for each examination must be adjusted to local conditions by a fully qualified radiographer /X-ray technologist when the machine is installed. f the film-cassette combination is changed, readjustment of the exposure will be necessary for the best results. Each technique has been tested on a number of basic radiological system units. Some are easier to carry out than others and it is hoped that all who use this manual will comment on their problems and experiences, particularly if a technique is found to be difficult or cannot be accurately reproduced. Many of the ideas communicated are new. t is, therefore, important for the members of the WHO-BRS Advisory Group 1 who worked on the manual to be informed of successes or failures, so that future editions can be corrected. Comments should be sent to the Chief Medical Officer, Radiation Medicine, World Health Organization, 1211 Geneva 27, Switzerland. When used by trained radiographers, techniques more complex than those shown in this manual can be carried out with the basic radiological system, serving the particular needs of specialists in various fields of medicine. The members of the WHO-BRS Advisory Group are grateful to all those who helped with advice and comments, particularly the staff of the Department of Radiology, University of Lund, Lund, Sweden, and the Department of Radiology, University of California, Davis, CA, United States of America. 1 The members of the WHO-BRS Advisory Group are as follows: Mr. E. Borg. Sana a, Yemen; Professor W. P. Cockshott, McMaster University, Hamilton, Ontario, Canada; Dr. V. Hegedus, University of Copenhagen, Glostrup, Denmark; Dr. T. Holm, University Hospital, Lund, Sweden; Dr. J. J. Lyimo, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania; Professor P. E. S. Palmer, University of California, Davis, CA, United States of America; and Professor E. Samuel, University of Edinburgh, Edinburgh, Scotland. The Group was also responsible for compiling the technical specifications of the BRS, as well as a Manual of Radiographic nterpretation for General Practitioners and a Manual of Darkroom Technique, both published by WHO.

8 9 PLEASE READ THESE YELLOW PAGES AS SOON AS YOU CAN AND BEFORE YOU REQUEST ANY X-RAY EXAMNATON NEEDNG AN NJECTON OF A RADOLOGCAL CONTRAST DRUG The yellow pages contain EMERGENCY instructions. They tell you how to treat any drug reactions that may occur. t is the duty of every health care practitioner to train all BRS operators to recognize and manage any patient who has an adverse reaction to a drug. (The same pages are included in the BRS Manual of Radiographic nterpretation for General Practitioners.) (1) X-RAYS ARE ESPECALLY DANGEROUS FOR THE DEVEL OPNG FETUS. (2) TRY NOT TO X-RAY ANY FEMALE WHO HAS MSSED A MENSTRUAL PEROD OR S KNOWN TO BE PREGNANT, EXCEPT N THE CASE OF ACUTE TRAUMA OR DSEASE. N THAT EVENT ALWAYS SHELD THE ABDOMEN WTH A LEAD APRON, EVEN WHEN X-RAYNG A LMB OR THE SKULL. EVEN WTH THE ABDOMEN SHELDED TAKE AS FEW EXPOSURES AS POSSBLE: TRY NOT TO HAVE TO REPEAT THE EXAMNATON. (3) F A FEMALE OF CHLD-BEARNG AGE S PRESENTED FOR AN X-RAY OF THE PELVS OR ABDOMEN REFER TO THE DOCTOR TO SEE F T S KNOWN WHETHER SHE S PREGNANT OR HAS MSSED A PEROD. F THE ANSWER S "YES" THE DOCTOR DECDES WHETHER THE NECESSTY TO X-RAY OUTWEGHS THE RSK NVOLVED.

9 11 RADATON PROTECTON THE RSK OF HARM FROM X-RAYS X-RAYS ARE ONLY DANGEROUS F YOU ARE CARELESS. Care means adhering to the following rules: Stand behind the control panel when the X-ray exposure is made. Make sure that lead aprons and lead gloves are worn if the patient needs to be held. f possible, do not allow anyone else in the X-ray room. f other persons must be present, keep them behind the control panel when the exposure is made. When supplied, wear your film badge always. Have it checked regularly. Never take an X-ray unless ordered by a DOCTOR or other qualified medical person. X-rays may cause harm. You cannot FEEL OR SEE THEM: you may not know you are in the X-ray beam, but REPEATED exposure to X-rays, even those that are scattered off the patient or the X-ray equipment, and even in small doses, can cause permanent damage to the health of the X-ray operator or anyone else. Remember again, it is not only the direct beam of X-rays that may be harmful, but also the scattered rays. You must NEVER make an X-ray exposure when you are anywhere near the X-ray tube: you must always be behind the control panel. There you are safe. You must NOT allow anyone except the patient to be in the X -ray room, unless the patient needs to be supported or a child needs to be held. When that is necessary, the parent or friend must wear a lead apron and lead gloves whenever he or she is near the patient while the X -ray is being taken. Do NOT let a nurse or any other member of the hospital staff hold a patient while an exposure is being made. The risk for patients being X-rayed is very low because they are exposed to X-rays infrequently, and because only a small part of the body is exposed for each picture. But try to get all the details right the first time so that there is no need for a second exposure. The greatest risk from X-rays is for the operator and the doctor and nurses, who may be exposed repeatedly over the years while they are working. But there is no danger if YOU and THEY ARE CAREFUL X-RAYS MAY CAUSE HARM EVEN THOUGH YOU DO NOT SEE OR FEEL THEM.

10 12 REACTONS TO NTRAVENOUS DRUGS USED FOR UROGRAPHY Contrast drugs are used for urography (the kidneys, ureters, and bladder). THESE DRUGS MUST ONLY BE NJECTED BY A DOCTOR OR WTH THE DOCTOR'S PERMSSON. There must be a doctor in the hospital and immediately available whenever these drugs are given, until the X-ray examination is finished (although, provided the doctor can be reached quickly, he or she need not actually be in the X-ray room). The drugs used in urography must be injected into a vein : they make it possible to see the kidneys, ureters, and bladder, which are normally invisible on radiographs. All these drugs are complex iodine compounds; they can produce reactions in the patient that range from mild to very serious, and can-in rare instances-even cause death. Reactions to drugs can occur at the beginning of the injection, or shortly afterwards, or may even be delayed for minutes after the injection. The reaction does not depend on how much of the drug has - been injected; a small amount may cause as much reaction as a large amount. There is no way to test the patient before the injection. Mild reactions are not uncommon (do not be misled by an epileptic fit), but very serious reactions are fortunately rare. Anyone may react: drug reactions are not specifically associated with any other form of allergy, although patients such as asthmatics may react more readily than those who have no history of allergy. No one can be sure that he will not react. f patients have had this type of X-ray examination before and have reacted, try to find out which drug was used. They are less likely to react a second time if a different contrast drug is injected. But when patients have reacted previously you must be ready for another reaction. APPROPRATE TREATMENT MUST ALWAYS BE READLY AVALABLE (ANT HSTAMNES, STERODS. EPNEPHRNE, A TROPNE, AND NTRA VENOUS SALNE) BEFORE CONTRAST DRUGS ARE NJECTED. THE DRUGS USED FOR NTRA VENOUS CHOLANGOGRAPHY ARE MORE LKELY THAN OTHERS TO CAUSE REACTONS; THE SAME TREATMENT APPLES. TWO BASC RULES: ( 1) MAKE SURE THAT THE DRUGS ARE AVALABLE FOR TREATMENT MMEDATELY BEFORE THE CONTRAST NJECTON. (2) WHEN CONTRAST DRUGS HAVE BEEN NJECTED NTRAVENOUSLY. NEVER LEAVE THE PATENT UNATTENDED UNTL THE EXAMNATON S COMPLETED AND THE PATENT FEELS WELL. NO PATENT WLL HAVE A SEROUS REACTON AFTER 60 MNUTES.

11 13 BE WSE: F THE PATENT HAS A HSTORY OF REACTON TO PREVOUS CONTRAST NJECTONS OR A HSTORY OF SEVERE ALLERGY, REFER HM TO A MAJOR HOSPTAL FOR THE EXAMNATON. MAKE SURE THAT YOU HAVE NTRAVENOUS ATROPNE, ANTHSTAMNE, NTRAVENOUS EPNEPHRNE, AND SOLUBLE STERODS AVALABLE WTH SYRNGES N OR CLOSE TO THE X-RAY ROOM WHENEVER CONTRAST DRUGS ARE BENG GVEN. MLP CONTRAST REACTONS The patient will complain of a sensation of heat and pressure in the abdomen, may sneeze, develop urticaria (raised patches on the skin), feel nauseous, and become restless. Treatment Reassure the patient. Tell him not to worry, the reaction will soon go away. Loosen the patient's clothing if it is tight. Tell the patient to take deep breaths in and out and to relax. Stay with the patient and watch carefully until symptoms diminish. f the reaction does not improve in a few moments, send for a doctor or nurse. STRONGER CONTRAST REACTONS The patient may vomit, become very short of breath (dyspnoea) and the skin may be pale. He may start to sweat and be very restless. The pulse may be rapid. Treatment Keep calm and reassure the patient. Raise the patient's head and shoulders if he is short of breath. f vomiting occurs, turn the patient's head to one side to prevent aspiration of vomit. f there are signs of collapse (pale skin, sweating, rapid pulse) raise the patient's feet and lower the head (if this is possible on the X-ray table). More important, KEEP THE PATENT LYNG DOWN. Stay with the patient all the time. Send for qualified help if symptoms do not improve very quickly (after a few minutes). SEVERE CONTRAST REACTONS Pale skin, sweating, very shallow breathing, rapid and very weak pulse. Loss of consciousness, cardiac arrest. SEVERE CONTRAST REACTONS ARE AN EMERGENCY STUATON. YOU MUST ACT QUCKLY. Call for the doctor and nurse. Keep the patient warm and start artificial respiration if the patient stops breathing. f oxygen is available, give it to the patient if breathing is difficult. Make sure the airway is open. When the doctor and nurse arrive, tell them where the emergency drugs are kept.

12 14 Physician's response Check the general condition of the patient: s the patient breathing 1 s there a good airway? s the hean beating 1 f not, stan cardiopulmonary resuscitation : restore the airway if necessary (see page 17 et seq.). CHECK THE PULSE f EJ l Give intravenous atropine mg for an adult. l Stan an intravenous saline infusion. f very c::j l nject epinephrine, 1:1000, intravenously-up to 1 mi. Stan an intravenous saline infusion. 1 Repeat epinephrine, 1 : 1 000, if necessary-not more than 1 mi. l nject 50 mg dexamethasone intravenously. Continue intravenous saline--~ Return to ward as soon as possible.

13 15 FRST AD AND PATENT CARE FOR THE BRS OPERATOR NTRODUCTON ( 1) Remember - You are responsible for the patient in the X-ray department. (2) You must recognize when the patient's condition is getting worse and - Call immediately for the nurse or doctor (or both). - Until help is available, you must know what to do and what NOT to do, and you must know how to help the nurse and doctor when they arrive. - Always work in a calm and quiet way and alw s reassure the patient. Even ordinary patients who are not very sick rna feel apprehensive in an X-ray room. Children may be very frightened. here is no need for this, because they are in no danger, but they are in strange surroundings and need to be reassured. LOOKNG AFTER THE PATENT - Seriously ill patients must be kept lying down, unless they are very short of breath and are more comfortable sitting up. - f the patient is vomiting, turn him on to his side to keep the throat clear so that he can breathe. Do not move seriously injured patients, but turn their head only. - Do not move accident patients more than is absolutely necessary. f you must move them, be careful not to make their injuries worse. READ THESE NSTRUCTONS. PRACTSE ARTFCAL RESPRATON. PRACTSE MOVNG THE PATENT. - Whenever the patient has had a serious accident, assume that there is internal injury to the brain, chest, spine, or abdomen. Be extra careful and gentle. - Do not let patients get cold. Keep them covered and warm. Try to keep the door shut if it is cold outside the X-ray room. PRORTES s the patient breathing? s the patient conscious? s the patient bleeding?

14 16 DO NOT X-RAY A SEROUSLY LL OR SEVERELY NJURED PATENT ALONE. ALWAYS HAVE QUALFED HELP WTH YOU. NEVER LEAVE A SEROUSLY LL OR NJURED PATENT UNWATCHED WHLE YOU ARE DEVELOPNG THE FLMS OR HAVE TO LEAVE THE X-RAY ROOM FOR ANY OTHER REASON. GET A NURSE, ORDERLY, OR SOME OTHER TRANED PERSON TO STAY WTH THE PATENT ALL THE TME. WHAT TO DO F THE PATENT STOPS BREATHNG - Always check to make sure that an unconscious person is breathing; do this often. He may stop breathing quietly without any cough or other noise. This can happen quite suddenly without warning. - f the patient stops breathing, make sure that the air passage is open. Gently tilt the head backwards and lift the chin upwards (see next page). f the patient is wearing dentures, remove them. - Close the nose with your fingers, and hold the jaw up with the other hand. Give mouth-to-nose or mouth-to-mouth artificial respiration at the rate of breaths per minute (see pages 17-20). - When the patient starts breathing, and if he is not too badly injured, turn him into the lateral safety position (see pages ). MPORTANT RULES (1) TALK TO THE PATENT TO SEE F HE S CONSCOUS BEFORE YOU GVE RESPRATON. (2) CHECK THE MOUTH AND THE THROAT TO MAKE SURE THAT NOTHNG S BLOCKNG THE ARWAY (FOOD, DRT, VOMT). CLEAN THE MOUTH AND THROAT F NECESSARY. (3) F THE PATENT S NOT BREATHNG, START ARTFCAL RESPRATON WHEN YOU HAVE CLEANED THE ARWAY. (4) F YOU CANNOT CLEAN THE ARWAY COMPLETELY, TURN THE PATENT'S HEAD TO ONE SDE, WHCH S USUALLY ENOUGH TO ALLOW AR TO ENTER THE CHEST. (5) CALL FOR HELP-FOR A NURSE AND DOCTOR-MMEDATELY. (6) LOOSEN THE PATENT'S TGHT CLOTHNG.

15 17 ARTFCAL RESPRATON Clearing the Airway The muscles of an unconscious person are completely relaxed. The tongue, being a muscle that is fixed to the lower jaw, will fall back and close the throat if the patient is kept lying on his back. To remove this obstruction : (1) Kneel next to the patient's head. (2) Put one of your hands onto the patient's forehead and the other under the patient's chin. (3) Lift the lower jaw of the patient upwards and tilt the head backwards until the chin is higher than the nose. (4) This gives a free air-passage by lifting the tongue away from the back wall of the throat. (5) Keeping the head in this position, listen and look to check whether breathing has staned again. f breathing stans, turn the patient to the lateral safety position (see pages 22-23). f there is no breathing continue with anificial respiration.

16 18 You can revive a patient by blowing air through his nose into his lungs, or through his mouth into his lungs. For babies and small children (see page 20), this must be done very carefully. You must practise this and know exactly how to carry out artificial respiration. You must also REMEMBER TO CLEAR THE ARWAY befor.e you start (see previous page). Mouth-to-Nose Respiration head tilt-neck lift Tilt the head so that the chin is higher than the nose. Close the mouth of the patient by pushing the lower lip upwards with your thumb. Open your mouth wide, take a deep breath and place your mouth firmly around the patient's nose. Blow air into the patient's lungs. Take your mouth away from the nose. This must be done every 5 seconds until regular breathing is restored. Lift your head, look at the patient's chest to see whether the ribs are moving. f not, take another deep breath and blow once more through the patient's nose. Continue until the patient starts breathing without help. BLOW AR NTO THE PATENT"S LUNGS EVERY 5 SECONDS UNTL REGULAR BREATHNG STARTS AGAN OR UNTL A QUALFED PERSON TELLS YOU TO STOP.

17 19 Mouth-to-Mouth Respiration Put one hand under the patient's neck and the other hand on the patient's forehead. Tilt the patient's head backwards until the chin is higher than the nose, lifting the neck as you push the forehead down. Sometimes the patient will then start breathing. Watch the chest carefully in case this has happened. f the patient has not started breathing, then you must start artificial respiration immediately. Keep the head extended by lifting the neck; pinch the patient's nose with your thumb and forefinger. Take a deep breath and place your mouth firmly over the patient's mouth. Blow air into the patient's lungs. Take your mouth away from the patient and your thumb and forefinger away from the nose. (Keep the other hand under the neck.) WH Look at the ribs. The chest will collapse when you stop blowing air and this will tell you that you have been successful in getting air into the lungs. f the ribs do not move inward, check the airway to make sure that it is not blocked and lift the hand under the neck to make sure that it is sufficiently extended. f the patient does not start breathing again, take another deep breath and start the routine once more. BLOW AR NTO THE PATENT'S LUNGS EVERY 5 SECONDS UNTL REGULAR BREATHNG STARTS AGAN OR UNTL A QUALFED PERSON TELLS YOU TO STOP.

18 20 Artificial Respiration for Babies When you have to help a baby to start breathing, you lift the head back gently, but not as far as for an adult or a large child. A baby's face is so small that you may not be able to close the nose and blow through the mouth alone. You may have to blow through both at the same time. Put your mouth firmly around the baby's mouth and nose and blow gently every 3 seconds (about 20 breaths per minute). Watch to see how the chest moves. Small puffs of air will probably be enough for infants. WHENEVER A PERSON NEEDS ARTFCAL RESPRATON, YOU MUST CALL FOR QUALFED HELP BUT YOU MUST NOT WAT. YOU MUST START ARTFCAL RESPRATON AT ONCE.

19 21 WHEN THE HEART STOPS BEGN AT ONCE: CHECK THE CAROTD (NECK) ARTERY FOR THE PULSE. F THS S ABSENT: (1) Turn the patient on to his BACK-supine. (2) Open the air passages (use an artificial airway and bag and mask with oxygen if available and you are trained to do so). (3) Place both hands flat on the lower end of the sternum (one hand above the other). (4) Keep your arms straight above the sternum. Press straight down. 80 COMPRESSONS PER MNUTE (ADULTS) with full relaxation in between each compression. (5) NFANTS NEED 100 COMPRESSONS PER MNUTE: use fingertips to compress. DO NOT PRESS TOO HARD on a baby or small child. Ventilate (with air or oxygen) after every 5 cardiac compressions (more in children).

20 22 LATERAL SAFETY POSTON When a person is unconscious his muscles are completely relaxed. The tongue (which is also a muscle and is fixed to the lower jaw) falls backwards if the patient is lying on his back and it will block the throat and prevent breathing. To open the airway, turn the patient on to his side, tilting him forward as shown in the drawings. n this position the tongue cannot fall back and any blood, phlegm, or vomit can run out of the mouth without blocking the airway. This is how you move the patient. ( 1) Kneel down on the side to which you are going to turn the patient. (2) Stretch the patient's nearer arm along his body and put the palm of the patient's hand under the buttocks. (3) Bend the leg of the patient that is nearer to you at the hip and the knee, putting your hand under the knee and lifting. At the same time, fold the arm furthest away from you across the chest so that the fingers are close to the side of the patient's head that is nearer to you.

21 23 (4) Put one of your hands on the shoulder of the patient that is further away from you and the other on the hip that is further away from you. Turn the patient toward you, pulling steadily and rolling the patient over the arm that is nearer to you. (5) When the patient is lying on his side (facing you), take your hand off his shoulder and support the head while you move the rest of the body towards you. (6) When the patient is lying on his stomach, pull the lower arm (the arm over which the patient rolled) and let it lie alongside. Put the other hand under the cheek. (7) Then move the patient's head so that it is tilted backwards with the neck extended, to maintain the free air-passage. Adjust the patient's legs, one over the other as shown in the drawing.

22 24 NOTES

23 25 EXPLANATONS 1. The techniques illustrated are: 2. The position of the patient 1 is shown as: 3. Each left-hand pa9e shows: 4..!:ach right-hand page shows: BASC or ADDTONAL An ADDTONAL view is taken only when : (a) the condition of the patient does not permit a basic view; or (b) the diagnostic information provided by the basic view is inadequate. ERECT -standing or sitting up. SUPNE-lying on the back. PRONE-lying on the stomach. OBLQUE-turned a little, usually at a 40 angle. LATERAL-lying with the side close to the cassette. (1) THE POSTON OF THE X-RAY EQUPMENT. (2) THE CASSETTE SZE. (3) THE CASSETTE POSTON 2 WTH AN NDCA TON OF WHETHER A OR LEFT (b) MARKER SHOULD BE USED. (4) THE COLLMATOR SZE. (5) EXPOSURE FACTORS (kv and ma s) N RE LATON TO THE DAMETER-THCKNESS (in em) OF THE PART OF THE BODY TO BE X-RAYED OR, N THE CASE OF THE HEAD, THE SZE OF THE SKULL. ( 1) THE POSTON OF THE PATENT. (2) AN EXAMPLE OF THE RADOGRAPH THAT SHOULD BE OBTANED. AP = antero-posterior PA = postero-anterior 1 For the sake of convenience, the masculine gender has been used throughout this manual when employing a pronoun to refer to "'the patient", except where it is obvious that the patient is a woman. 2 A horizontal arrow - indicates that the cassette is placed within the cassette holder; otherwise the cassette is placed directly underneath or against the part of the body to be x~rayed.

24 CHEST

25 29 CHEST LUNGS AND HEART Patient able to stand 1. Chest PA Chest lateral... Patient unable to stand but able to sit 3. Chest AP Chest lateral left Patient lying down, unable to stand or sit 5. Chest AP.... Other additional views 6. Chest apical (lordotic) AP Chest lateral decubitus AP or PA Pages RBS A Chest PA 1, Chest AP 3, or Chest AP 5, as described above, must always be taken first. Patient able to either stand or sit 8. Ribs oblique AP.... Two views to be taken. Patient lying down, unable to stand or sit 9. Ribs oblique AP NFANTS WEGHNG UP TO 10 kg LUNGS AND HEART 10. Chest AP

26 30 CHEST 1 CHEST PA Standing erect FOR NFANTS WEGHNG LESS THAN 10 kg SEE CHEST 10. BASC CHLDREN: use a 24x30cm cassette if it is large enough; and 90 kv. D r , L.J USE OR (b) MARKER kv ma s!> CHEST PA Adults Children em ma-s kv em ma-s kv

27 CHEST 1 31 CHEST PA Standing erect 1. Make sure the patient's shoulders are well pressed forward. 2. Tell the patient to breathe in deeply and hold the breath. 3. Expose. 4. Tell the patient to breathe normally. FOR NFANTS WEGHNG LESS THAN 10 kg SEE CHEST 10.

28 32 CHEST 2 CHEST LATERAL LEFT (OR RGHT) Standing erect ADDTONAL CHLDREN: use a 24x30 em cassette if it is large enough; and 90 kv. >/<:::::::::> >>< : :... ias.5x43 ::-:-:-:-:- -..:.:-:-> em D :_:::::::-:::::::::::::::::::::::::.: #~~x YV.V tm :.-:.:-:-:-:-:-:-..:-:.:.:.:. >>~< : : :<:: :~... : r , L J ~ 120 kv ~ ma s CHEST LATERAL LEFT (OR RGHT) Adults Children em ma-s kv em ma-s kv

29 CHEST 2 33 CHEST LATERAL LEFT (OR RGHT) Standing erect 1. Tell the patient to breathe in deeply and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. TOP (APEX) OF THE LUNGS MUST BE VSBLE. MAKE SURE THE LOWER PART OF THE DAPHRAGM S VSBLE.

30 34 CHEST 3 CHEST AP Sitting erect FOR NFANTS WEGHNG LESS THAN 10 kg SEE CHEST 10. BASC CD CHLDREN: use a 24x30 em cassette if it is large enough; and 90 kv. D ~ r , ~ L J USE OR (b) MARKER t- -r-- -r-- C>-t- - CHEST AP Adults Children em ma s kv em ma-s kv ~ 120 kv~ ma s

31 CHEST 3 35 CHEST AP Sitting erect on a stool or trolley USE THS POSTON ONLY WHEN THE PATENT S UNABLE TO STAND. 1. Tell the patient to breathe in deeply and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. FOR NFANTS WEGHNG LESS THAN 10 kg SEE CHEST 10. KEEP SHOULDERS FORWARD. CHLDREN NEED TO BE HELD FRMLY ERECT WTH SHOULDERS FORWARD. THE PERSON SUPPORTNG THE CHLD SHOULD WEAR A LEAD APRON AND LEAD GLOVES.

32 36 CHEST 4 CHEST LATERAL LEFT Sitting erect ADDTONAL Q) CHLDREN: use a 24x30 em cassette if it is large enough; and 90 kv. D r , kv em C> ma s CHEST LATERAL LEFT Adults Children ma s kv em ma s kv

33 CHEST 4 37 CHEST LATERAL LEFT Sitting erect on a stool, trolley, or bed USE THS POSTON ONLY WHEN THE PATENT S UNABLE TO STAND. UNLESS ASKED TO DO OTHERWSE BY THE DOCTOR ALWAYS USE THE LEFT LATERAL POSTON. 1. Tell the patient to breathe in deeply and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. CHLDREN NEED TO BE HELD FRMLY ERECT. THE PERSON SUPPORTNG THE CHLD SHOULD WEAR A LEAD APRON AND LEAD GLOVES.

34 38 CHEST 5 CHEST AP Supine BASC 1-- (j CHLDREN: use a 24x30 em cassette if it is large enough; and 90 kv s s >>... : < :::>. : : <:_ x43..:: Ctn< >>. >.-... >>>> :-:-:.... < <>.. r'--, ) D >~...'"""'... r , L...J ' A USE AN OR CD MARKER kv C> ma-s CHEST AP Adults Children em ma-s kv em ma s kv

35 CHEST 5 39 CHEST AP Supine USE THS POSTON ONLY WHEN THE PATENT S UNABLE TO ST OR STAND. 1. Tell the patient to breathe in deeply and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. -

36 40 CHEST 6 CHEST APCAL (LORDOTC) AP Sitting reclining backwards ADDTONAL em.. < D r----., 1 L.J 1 ~... ii~. ~~ --r ~ USE OR (b) MARKER kv - +- C>+ -1- ma-s + +- CHEST APCAL (LORDOTC) AP Adults only em ma-s kv

37 CHEST 6 41 CHEST APCAL (LORDOTC) AP Sitting reclining backwards 1. Tell the patient to breathe in deeply and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. RGHT SDE LEFT SDE

38 42 CHEST 7 CHEST LATERAL DECUBTUS AP or PA Lying on the right or left side; horizontal beam ADDTONAL ::;:;:;::::::;::::::::::::;:::::::;:;:;:;:: a4x30 <:m... D r~. r----., L.J l USE OR (b) MARKER r r- r [>r- -rkv ma s -t- -t- CHEST LATERAL DECUBTUS AP or PA em ma s kv

39 CHEST 7 43 CHEST LATERAL DECUBTUS AP or PA Lying on the right or left side; horizontal beam Additional views used to detect fluid in the pleurae Patient must lie against the cassette holder on 2 pillows on the side where the fluid is suspected. 1. Tell the patient to breathe OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. POSTON FOR LEFT LATERAL DECUBTUS. POSTON FOR RGHT LATERAL DECUBTUS.

40 44 CHEST 8 RBS OBLQUE AP Standing or sitting erect; left and right oblique (2 views to be taken) BASC - A CHEST 1, CHEST 3,.OR CHEST 5 MUST ALWAYS BE TAKEN FRST. -;35.5X43 : em... D _-_._-_-_._._._._-_-_-_-_- ::<::::.=:::~::::::..... ::-:::...,:.::. r , L J,_ _ - - USE OR (b) MARKER (\\ 120 <.V ~ ma s - -r- -r- -r- C>-rr -r- -r- RBS OBLQUE AP em ma s kv

41 CHEST 8 45 RBS OBLQUE AP Standing or sitting erect; left and right oblique (2 views to be taken) A CHEST 1, CHEST 3, OR CHEST 5 MUST ALWAYS BE TAKEN FRST. F THE PATENT S UNABLE TO RASE HS ARMS THEY SHOULD BE HELD OUT FROM THE BODY. 1. Tell the patient to breathe in deeply and hold the breath. 2. Expose. 3. Tell the patient to breathe normally.,,.~::1!',, :;:;,:: _;!; LEFT OBLQUE RGHT OBLQUE

42 46 CHEST 9 RBS OBLQUE AP Supine: right or left oblique ADDTONAL A CHEST 1, CHEST 3, OR CHEST 5 MUST ALWAYS BE TAKEN FRST. 1- (j i.35.5x43 em.. r'--, D 35ill5l&,43ttt\! i=::..:.:==='-= = : :.. = = ~.:=:=== r , L...J l 1\ \ USE OR (b) MARKER ~ 120 KV ma s C> - -r RBS OBLQUE AP (supine) em ma s kv

43 CHEST 9 47 RBS OBLQUE AP Supine; right or left oblique A CHEST 1, CHEST 3, OR CHEST 5 MUST ALWAYS BE TAKEN FRST. SUPPORT THE PATENT WTH A PLLOW UNDER THE NORMAL SDE. 1. Tell the patient to breathe in deeply and hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

44 ABDOMEN

45 53 ABDOMEN ABDOMEN: GENERAL X-rays of the abdomen are usually taken with the patient lying down; erect views are taken only when the clinical diagnosis is "acute abdomen" - e.g., intestinal obstruction or perforation of the gut. 1. Abdomen AP Patient, diagnosed as "acute abdomen", able to stand 2. Abdomen PA.... Patient, diagnosed as "acute abdomen", unable to stand 3. Abdomen lateral decubitus.... Two views to be taken. URNARY TRACT X-rays of the urinary tract are always taken with the patient lying down. 4. Urinary tract survey AP Urinary bladder and inner pelvis ntravenous urography.... An examination that involves a contrast drug injection given by a doctor. Follow the instructions on pages GALL-BLADDER (CHOLECYSTOGRAPHY) An examination requiring the administration of a contrast medium, as directed, the day before the following views are taken: 7. Gall-bladder prone Gall-bladder lateral decubitus 9. Gall-bladder erect.... PREGNANCY When obstructed labour (disproportion) is suspected NOT TO BE TAKEN BEFORE THE 37th WEEK OF PREGNANCY 10. Pregnancy lateral erect To view the position of the fetus NOT TO BE TAKEN BEFORE THE 37th WEEK OF PREGNANCY 11. Pregnancy PA To view fetal maturity NOT TO BE TAKEN BEFORE THE 33rd WEEK OF PREGNANCY 12. Pregnancy oblique NFANTS AND SMALL CHLDREN WEGHNG UP TO 15 kg 13. Abdomen AP... Pages

46 54 ABDOMEN 1 ABDOMEN AP Supine FOR NFANTS AND SMALL CHLDREN WEGHNG UP TO 15 kg SEE ABDOMEN 13. BASC CHLDREN: use a 24x30 em cassette if it is large enough; and 70 kv. ) r-., D r , L J USE AN OR CD MARKER A 1 1\ \ (j) l20 k. V ma-s [> Adults em ma-s kv ABDOMEN AP Children em ma-s kv

47 ABDOMEN 1 55 ABDOMEN AP Supine 1. Tell the patient to breath OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. FOR NFANTS AND SMALL CHLDREN WEGHNG UP TO 15 kg SEE ABDOMEN 13. THE DAPHRAGM MUST BE VSBLE; F T S NOT TAKE ANOTHER ABDOMEN 1. THE PUBC SYMPHYSS MUST BE VSBLE; F T S NOT TAKE A URNARY BLADDER VEW (ABDOMEN 5).

48 56 ABDOMEN 2 ABDOMEN PA: "ACUTE ABDOMEN" (e.g., intestinal obstruction or perforation of the gut) Standing erect ADDTONAL FOR NFANTS AND AND SMALL CHLDREN WEGHNG UP TO 15 kg SEE ABDOMEN CHLDREN: use a 24x30cm cassette if it is large enough; and 70 kv..... r._1 D.. r , L J USE OR (b) MARKER (j) l20 k.v ma s - + -r- -r- C>-r- -r- -r- -r- em ABDOMEN PA Adults Children ma-s kv em ma s kv

49 ABDOMEN 2 57 ABDOMEN PA: ACUTE ABDOMEN" Standing erect 1. Press the patient's abdomen against the cassette holder. 2. Tell the patient to hold the breath. 3. Expose. 4. Tell the patient to breathe normally. FOR NFANTS AND SMALL CHLDREN WEGHNG UP TO 15 kg SEE ABDOMEN 13. MAKE SURE THE DAPHRAGM S VSBLE ON BOTH SDES.

50 58 ABDOMEN 3 ABDOMEN LATERAL DECUBTUS: "ACUTE ABDOMEN" (e.g., intestinal obstruction or perforation of the gut) when the patient is unable to stand Lying first on the left side then on the right side (2 views to be taken) ADDTONAL The 24 x 30 em cassette is large enough for most patients even adults. D D [..., em< D r----., :":\ n< il L----.J 1 USE OR (b) MARKER (j) l20 kv ma-s -~ - -- C> r- t- -~ t- ABDOMEN LATERAL DECUBTUS em ma-s kv

51 ABDOMEN 3 59 ABDOMEN LATERAL DECUBTUS Lying first on the left side then on the right side (2 views to be taken) PATENT MUST LE AGANST THE CASSETTE HOLDER ON A MATTRESS. 1. Tell the patient to breathe OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. PATENT LYNG ON A MATTRESS Although the 24 x 30 em cassette is large enough for most patients, even adults, a 35.5 x 43 em cassette was used to produce these radiographs.

52 60 ABDOMEN 4 URNARY TRACT SURVEY AP Supine ALSO USED FOR NTRAVENOUS UROGRAPHY (SEE PAGES 65-71). BASC ~HLDREN: use a 24x30 em ~assette if it is large enough. e5.5x em D r , L...J USE AN OR CD MARKER URNARY TRACT SURVEY (\\ 120 KV~ ma s [> em ma s kv

53 ABDOMEN 4 61 URNARY TRACT SURVEY AP Supine 1. Tell the patient to breathe OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. ::;;: ~...,.., ~ "" -~ ~'!!!'.. ~-

54 62 ABDOMEN 5 URNARY BLADDER AND NNER PELVS Supine; vertical beam angled 20 towards the feet BASC ~:~~~() rt1> D ;;;;:.i.. ;:)... r----, L-----' l USE AN OR CD MARKER URNARY BLADDER NNER PEL VS (\\ 120 <.V ~ ma s [> em ma-s kv

55 ABDOMEN 5 63 URNARY BLADDER AND NNER PELVS Supine; vertical beam angled 20 towards the feet 1. Tell the patient to breathe OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

56 ABDOMEN 6 65 NTRAVENOUS UROGRAPHY: EXAMNATON OF THE KDNEYS, URETERS, AND BLADDER Supine BASC The patient is given an intravenous injection of a contrast drug during the examination. Make sure the syringe, needles, and contrast solution are ready. Now read page 67, which describes the procedure for intravenous urography. ALSO READ THE YELLOW WARNNG PAGES because the patient may have a reaction after the injection and become very ill. YOU MUST KNOW HOW TO DAGNOSE AND TREAT A REACTON TO THE CONTRAST DRUG. MAKE SURE THAT ALL THE DRUGS FOR TREATMENT ARE READY N CASE THE PATENT HAS A REACTON (see page 13). DOSE OF CONTRAST DRUG: ASK THE DOCTOR. THE NORMAL ADULT DOSE S BETWEEN 40 ml AND 1 00 mi. FOR CHLDREN AGED BETWEEN 2 AND 1 5 YEARS THE DOSE S UP TO 1 ml PER KLOGRAM OF BODY-WEGHT.

57 ABDOMEN 6 67 PROCEDUREFORNTRAVENOUSUROGRAPHY READ THS SUMMARY BEFORE YOU START ABDOMEN 6.1 (see page 68) 1. Ask the patient to empty the bladder or, if there is a catheter into the bladder, release the clip and drain the urine into a container. 2. Take a urinary tract survey with the patient lying supine (ABDOMEN 4). Film 1 3. f the pelvis is not completely visible on the radiograph adjust the X-ray machine Film 1 A and take a urinary bladder and inner pelvis view (ABDOMEN 5). ABDOMEN 6.2 (see page 69) 4. When Film 1 (and Film 1 A if taken) have been checked by the doctor, and the X-ray machine has been adjusted if necessary after Film 1 A, the doctor gives the injection. ' 5. YOU MUST NOTE THE TME the injection is given. 6. As soon as the injection is given, take a urinary tract survey with the patient lying Film 2 supine (ABDOMEN 4}. 7. Ten minutes later take another urinary tract survey with the patient lying supine Film 3 (ABDOMEN 4}. ABDOMEN 6.3 (see page 70) 8. f the doctor confirms that the radiographs are SATSFACTORY, proceed directly to point 11 below. f the kidneys, ureters, and bladder are not sufficiently visible, and the doctor confirms that the radiographs are NOT SATSFACTORY, proceed to point Turn the patient into a prone position (lying on the abdomen) and take a prone Film 3A abdomen view (ABDOMEN 6.3} 15 minutes after Film 3; that is 25 minutes after the injection was given. 10. Turn the patient back into the supine position (lying on the back). ABDOMEN 6.4 (see page 71) 11. Take a urinary bladder and inner pelvis view (ABDOMEN 5) with the bladder Film 4 full. 12. Ask the patient to empty the bladder (urinate), or release the catheter, and take a Film 4A second view. 13. Show all the radiographs to the doctor; keep the patient on the X-ray table until they have been checked. REMEMBER, when developing the films, to mark the time on each one so that the interval between the injection and the exposure is clear.

58 68 ABDOMEN 6.1 NTRAVENOUS UROGRAPHY: EXAMNATON OF THE KDNEYS, URETERS, AND BLADDER 1. Ask the patient to empty the bladder. f there is a catheter into the bladder, release the clip and drain the urine into a container. 2. Take Film 1, and Film 1 A if necessary: abdomen and pelvis with the patient lying supine (ABDOMEN 4 and ABDOMEN 5) f\\ 120 KV~ ma s Film 1 Film 1A

59 ABDOMEN ntravenous urography (continued) When Film 1, and Film 1 A if it has been necessary to take it, have been checked by the doctor, the doctor gives the patient the injection. 1. MAKE A NOTE OF THE TME THE NJECTON S GVEN. 2. mmediately after the injection is given make sure the doctor moves behind the control screen or out of the X-ray room. 3. Take Film 2: a urinary tract survey with the patient lying supine (ABDOMEN 4). 4. AFTER 10 MNUTES take Film 3: a urinary tract survey with the patient lying supine (ABDOMEN 4). Film 2 and Film 3 kv ~ 120 ma-s Film 2 Film 3 SHOW FLM 2 AND FLM 3 TO THE DOCTOR. THE KDNEYS, URETERS, AND BLADDER SHOULD BE VSBLE. WHEN THE DOCTOR HAS SEEN THE RADOGRAPHS TURN TO THE NEXT PAGE.

60 70 ABDOMEN 6.3 ntravenous urography (continued) f the doctor confirms that the radiographs (Film 2 and Film 3) are SATSFACTORY turn to the opposite page and take Film 4. f the doctor says the films are NOT SATSFACTORY: 1. Turn the patient over into a prone position (lying on the abdomen with the head pointing in either direction) and make sure the tube is pointing to the centre of the lumbar spine. Do not alter the position of the machine or the exposure. 2. Twenty-five minutes after the injection was given take Film 3A: a PRONE ABDOMEN. 3. Turn the patient back into the supine position (lying on the back) and take Film 4 (see ABDOMEN 6.4). Film3A D D kv ~ 120 ma-s [>

61 ABDOMEN ntravenous urography (continued): bladder film 1. Take Film 4 (ABDOMEN 5). 2. Check the quality of the film. 3. As soon as a SATSFACTORY radiograph is obtained, send the patient to urinate (empty the bladder), or release the catheter. 4. Take Film 4A (ABDOMEN 5). Film 4 and Film 4A D USE OR (b) MARKER (\\ 120 > kv ~ ma s Film4 Film4A

62 ABDOMEN 7-ABDOMEN 9 73 CHOLECYSTOGRAPHY: THE GALL-BLADDER WTH CONTRAST MEDUM The contrast medium is usually in the form of tablets. f it is not in the form of tablets, but in liquid form, the directions on the bottle should be followed. When the contrast medium is in the form of tablets (usually iopanoic acid or equivalent) the patient should take the dose indicated on the package. The tablets should be swallowed with water in the evening, 12 hours before the examination. After that the patient should not eat and should drink only water until after the X-ray films have been taken the next morning. Gall-bladder not visible 12 hours after administration of the tablets f the doctor cannot see the gall-bladder on radiographs taken 12 hours after the tablets were administered, there are several possible explanations. 1. Ask the patient whether the tablets were in fact swallowed. 2. Ask if the patient had diarrhoea or vomiting, as this may have impaired absorption of the tablets. 3. f the first dose has not caused significant upset, ask the doctor if the patient is to take a second dose of tablets the same evening. 4. f a second dose of tablets is taken, take another X-ray 12 hours after the second dose. f the gall-bladder is still not visible it is probably diseased.

63 74 ABDOMEN 7 Cholecystography (continued) GALL-BLADDER PRONE Prone left anterior oblique FRST FLM: 12 HOURS AFTER THE PATENT HAS SWALLOWED THE TABLETS OR, F THE CONTRAST MEDUM S N LQUD FORM, AS DRECTED ON THE BOTTLE. BASC CD ~ (j ~ r-' : D.. r----, L.J :[. USE OR (b) '. ~il.~ ~ 120 <.V GALL -BLADDER f- PRONE -ma s kv em C> ma-s

64 ABDOMEN 7 75 Cholecystography (continued) GALL-BLADDER PRONE Prone left anterior oblique FRST FLM: 12 HOURS AFTER THE PATENT HAS SWALLOWED THE TABLETS OR, F THE CONTRAST MEDUM S N LQUD FORM, AS DRECTED ON THE BOTTLE. 1. Lift the patient's right shoulder as shown. 2. Tell the patient to breathe OUT and hold the breath. 3. Expose. 4. Tell the patient to breathe normally.

65 76 ABDOMEN 8 Cholecystography (continued) GALL-BLADDER LATERAL DECUBTUS Lying on the right side; horizontal beam SECOND FLM BASC D r r----, L----..J GALL-BLADDER LATERAL DECUBTUS ~ 120 KV~ ma-s > em ma-s kv

66 ABDOMEN 8 77 Cholecystography (continued) GALL-BLADDER LATERAL DECUBTUS Lying on the right side; horizontal beam SECOND FLM 1. Tell the patient to breathe OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally. SHOW THE RADOGRAPHS OF ABDOMEN 7 AND ABDOMEN 8 TO THE DOCTOR BEFORE TAKNG ANY FURTHER EXPOSURES.

67 78 ABDOMEN 9 Cholecystography (continued) GALL-BLADDER ERECT Standing left anterior oblique ADDTONAL T S NOT ALWAYS NECESSARY TO TAKE THS VEW. TAKE ONLY F REQUESTED BY THE DOCTOR AFTER THE RADOGRAPHS OF ABDOMEN 7 AND ABDOMEN 8 HAVE BEEN CHECKED. ~~l!liil! c:m: D r----, L----.J - f-- USE AN OR CD MARKER ~ 120 KV [> - - ma-s - -- GALL-BLADDER ERECT em ma-s kv

68 ABDOMEN 9 79 Cholecystography (continued) GALL-BLADDER ERECT Standing left anterior oblique T S NOTAL WAYS NECESSARY TOT AKE THS VEW. TAKE ONLY F REQUESTED BY THE DOCTOR AFTER THE RADO GRAPHS OF ABDOMEN 7 AND ABDOMEN 8 HAVE BEEN CHECKED. 1. Tell the patient to stand with left side against cassette holder, as shown. 2. Tell the patient to breathe OUT and hold the breath. 3. Expose. 4. Tell the patient to breathe normally.

69 80 ABDOMEN 10 PREGNANCY LATERAL ERECT Standing BASC TAKE THS VEW WHEN OBSTRUCTED LABOUR (DSPROPORTON) S SUSPECTED BUT NOT BEFORE THE 37th WEEK OF PREGNANCY. : : : : - ~ : r-) 0 -, r'-1 D r , ~-.. ~ ~ ~ ~ --r (j) l20 KV - r- r- [>r- -rma s -r- -r- PREGNANCY LATERAL ERECT em ma s kv

70 ABDOMEN PREGNANCY LATERAL ERECT Standing TAKE THS VEW WHEN OBSTRUCTED LABOUR (DSPROPORTON) S SUSPECTED BUT NOT BEFORE THE 37th WEEK OF PREGNANCY. F THE ABDOMEN S PROTUBERANT USE A BNDER TO COMPRESS. THE PATENT MUST EMPTY HER BLADDER BEFORE THE X-RAY S TAKEN. 1. Tell the patient to breathe OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

71 82 ABDOMEN 11 PREGNANCY PA Prone with support under the pelvis BASC TAKE THS VEW TO SHOW THE POSTON OF THE BABY (THE FETAL POSTON) BUT NOT BEFORE THE 37th WEEK OF PREG NANCY. L J- tj ~ r-., D.... : : : L r , A 1\ ' USE AN OR CD MARKER (j) l20 k.v - -r -r- -r [>+ -- ma s PREGNANCY PA em ma-s kv

72 ABDOMEN PREGNANCY PA Prone with support under the pelvis (if the patient finds it impossible to lie prone, use the supine position) TAKE THS VEW TO SHOW THE POSTON OF THE BABY BUT NOT BEFORE THE 37th WEEK OF PREGNANCY. THE PATENT MUST EMPTY HER BLADDER BEFORE THE X-RAY S TAKEN. 1. Tell the patient to breathe OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

73 84 ABDOMEN 12 PREGNANCY OBLQUE Prone; with pelvis rotated to either side BASC TAKE THS VEW TO SHOW THE AGE (MATURTY) OF THE BABY OR TO MAKE SURE THE BABY S NORMAL BUT NOT.BEFORE THE 33rd WEEK OF PREGNANCY. r- (j D USE OR (6) MARKER (j) l20 kv ma-s - -r- -r- -r- C>-r -r- -r- -r- PREGNANCY OBLQUE em ma-s kv

74 ABDOMEN PREGNANCY OBLQUE Prone; with pelvis rotated to either side (this is the preferred position; the alternative, with the patient in the supine position, should be avoided if possible) TAKE THS VEW TO SHOW THE AGE (MATURTY) OF THE BABY OR TO MAKE SURE THE BABY S NORMAL BUT NOT BEFORE THE 33rd WEEK OF PREGNANCY. THE PATENT MUST EMPTY HER BLADDER BEFORE THE X-RAY S TAKEN. 1. Tell the patient to breathe OUT and hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

75 86 ABDOMEN 13 ABDOMEN AP: infants and small children weighing up to 15 kg Hanging by the upper arms BASC Q) n~4!~~d effi< /? D j r-----, L J USE OR (b) MARKER r- -r- 55 ~ 120 [>t- - KV ma-s ABDOMEN AP (infants and small children) em ma-s kv

76 ABDOMEN ABDOMEN AP: infants and small children weighing up to 1 5 kg Hanging by the upper arms THE CHLD S HELD HANGNG BY THE UPPER ARMS (F NECESSARY TS FEET CAN BE SUPPORTED BY A STOOL) WTH TS BACK RESTNG AGANST THE FRONT OF THE CASSETTE HOLDER. THE PERSON HOLDNG THE CHLD, PREFERABLY ONE OF TS PARENTS, MUST WEAR A LEAD APRON AND LEAD GLOVES. 1. Centre to the navel. 2. Expose when the child is not moving.... PERSON SUPPORTNG THE CHLD MUST WEAR A LEAD APRON AND LEAD GLOVES. a... a For the sake of clarity, the gloves are shown as being transparent.

77 HEAD

78 91 HEAD SKULL X-rays of the skull are always taken with the patient lying down. 1. Skull lateral Skull PA.... NEVER USE this position when there is a possibility that the facial bones may be fractured, or when the patient is unconscious. Pages Skull AP Use when the patient cannot be X-rayed in the prone position (see HEAD 2 above). 4. Skull (occiput) semiaxial (Towne's projection) SNUSES, FACE, AND NOSE Patient sitting 5. Sinuses and face PA Sinuses and face semiaxial, or nose PA 7. Sinuses, face, or nose lateral.... Patient lying down, unable to sit Sinuses, face, or nose AP Sinuses, face, or nose lateral MANDBLE Patient sitting 8. Mandible P A 9. Mandible oblique lateral... Patient lying down, unable to sit 10. Mandible AP Mandible oblique lateral.... Use Skull AP (HEAD 3 above) Use Skull lateral (HEAD 1 above)

79 92 HEAD 1 SKULL LATERAL Supine; horizontal beam BASC 24><30 em D 24)00....,., _rrr ,_... i < j:.:... r----., L.J L 1- --~--t> ~ 120 K. V ma s [> ~ -f SKULL LATERAL Size of ma s kv skull Small Medium Large 40 70

80 HEAD 1 93 SKULL LATERAL Supine; horizontal beam THE PATENT'S HEAD SHOULD BE RASED ON A FOAM RUBBER PAD. REMOVE DENTURES, HAR-GRPS, OR ANYTHNG ELSE N THE HAR.

81 94 HEAD 2 SKULL PA Prone; vertical beam angled 20 towards the feet BASC NEVER USE WHEN THERE S A POS SBLTY THAT THE FACAL BONES MAY BE FRACTURED OR WHEN THE PATENT S UNCONSCOUS; USE HEAD 3 NSTEAD. 24><.30 c.m D r-----, 24~0 em...;,.,._,:, L..J USE AN OR CD MARKER (\\ 120 KV ~ ma-s C> Size of skull SKULL PA ma s kv Small Medium Large

82 HEAD 2 95 SKULL PA Prone; vertical beam angled 20 towards the feet NEVER USE WHEN THERE S A POS SBLTY THAT THE FACAL BONES MAY BE FRACTURED OR WHEN THE PATENT S UNCONSCOUS. REMOVE DENTURES, HAR-GRPS, OR ANYTHNG ELSE N THE HAR. NOSE AND FOREHEAD SHOULD BE AGANST THE TABLE AND HANDS UNDER THE CHEST.

83 98 HEAD 4 SKULL (OCCPUT) SEMAXAL (TOWNE'S PROJECTON) Supine: vertical beam angled 30 towards the feet ADDTONAL ~~~it> :> ;: D,-----, L l USE OR C1) MARKER (\\ 120 KV ~ ma s [> SKULL (OCCPUT) SEMAXAL Size of skull ma s kv Small Medium Large

84 HEAD 4 99 SKULL {OCCPUT) SEMAXAL (TOWNE'S PROJECTON) Supine; vertical beam angled 30 towards the feet THE PATENT'S HEAD SHOULD BE RASED ON A FOAM RUBBER PAD. REMOVE DENTURES, HAR-GRPS, OR ANYTHNG ELSE N THE HAR. Centre to the top of the head 7-8 em from the nasion (root of the nose).

85 100 HEAD 5 SNUSES AND FACE PA Sitting erect BASC r----, ltbx24 em...,. L---.J USE AN OR CD MARKER (/) 120 kv SNUSES AND FACE PA Size of ma s kv skull [> Small Medium Large ma s

86 HEAD SNUSES AND FACE PA Sitting erect REMOVE DENTURES, HAR-GRPS, OR ANYTHNG ELSE N THE HAR. R = THE RGHT SDE OF THE HEAD.

87 102 HEAD 6 SNUSES AND FACE SEMAXAL, OR NOSE PA Sitting erect; if the patient is unable to sit, use the supine position (HEAD 3) BASC Q) l 8X24 r---., em...,. L---.J USE AN OR CD MARKER (j) l20 K.V ma-s [> SNUSES AND FACE SEMAXAL, OR NOSE PA Size of skull ma-s kv Small Medium Large 40 90

88 HEAD SNUSES AND FACE SEMAXAL, OR NOSE PA Sitting erect; if the patient is unable to sit, use the supine position (HEAD 3). REMOVE DENTURES, HAR-GRPS, OR ANYTHNG ELSE N THE HAR. 1. Tell the patient to open the mouth as widely as possible and place the chin against the cassette holder. 2. Tilt the patient's head back Expose.

89 104 HEAD 7 SNUSES, FACE, OR NOSE LATERAL DO NOT USE FOR CHLDREN Sitting erect; if the patient is unable to sit, use the supine position (HEAD 1 ). ADDTONAL (sinuses and face) BASC (nose) 1'1~~~1 l8x24 r---., em...,- L.J (\\ 120 [> SNUSES, FACE, OR NOSE 8 LATERAL Size of skull ma s kv Small Medium Large k.v ~ ma s 8 For the NOSE use 16 ma s and 55 kv for all sizes of skull.

90 HEAD SNUSES, FACE, OR NOSE LATERAL Sitting erect; if the patient is unable to sit, use the supine position (HEAD 1 ). DO NOT USE FOR CHLDREN REMOVE DENTURES, HAR-GRPS, OR ANYTHNG ELSE N THE HAR. RGHT SDE OF THE PATENT'S HEAD NEXT TO THE CASSETTE HOLDER. USE THE SAME PROJECTON FOR THE NOSE BUT WTH 16 ma s AND 55 kv.

91 106 HEAD 8 MANDBLE PA Sitting erect BASC '-- ~ ~--,.--- ~J 0~ u ~ h 1\ ~ ~8X24 em , L.J USE OR (b) MARKER (\\ 120 KV~ (> ma-s + -- MANDBLE PA Size of skull All ma-s kv 63 70

92 HEAD MANDBLE PA Sitting erect REMOVE DENTURES, HAR-GRPS, OR ANYTHNG ELSE N THE HAR. 1. Tell the patient to open the mouth as widely as possible and place the forehead and nose against the cassette holder. 2. Expose.

93 108 HEAD 9 MANDBLE OBLQUE LATERAL Sitting erect BASC Q) r---., ~X24 em..., L.J USE OR (b) MARKER (\\ 120 MANDBLE OBLQUE LATERAL Size of skull ma s kv All KV ~ ma-s

94 EXHBTON OF MODERN LLUSTRATED SCENTFC AND SCHOLARLY publcatons conditions for participation 1. The exhibition will take place in Leyden University Library from October 30, January 17, 1988 on the occasion of the fourth centenary of this library. 2. Only one publication of each publisher will be exhibited in principle. 3. Submitted works must be illustrated scientific or scholarly publications, published after 1983, in which image and text must form a functional unity, aimed at the transfer of scientific and scholarly knowledge. No limitations are put on the kind of illustrative material: photographs, drawings, graphics, diagrammes etc. etc. are all permitted. University course books will be considered a scientific or scholarly publication for the purposes of this exhibition. 4. The publisher is requested to provide an explanation of his reasons for choosing the particular publication. Relevant, factual details must be provided: personal details of designer, illustrator, author etc. etc.; details about the origination and production of the work, typeface etc. 5. The publisher will receive three copies of the catalogue free of charge. 6. f the publisher so requests, the publication will be returned after the end of the exhibition. All other submitted works will be kept in the University Library in a separate collection, not available for normal loan purposes. 7. Submissions and correspondence to be sent to: Leiden University Library att. mr. A.J.M. Linmans P.O. Box RA LEDEN The Netherlands 8. Submissions must be received before July 31, 1987 at the above-mentioned address.

95 HEAD MANDBLE OBLQUE LATERAL Sitting erect REMOVE DENTURES AND EARRNGS. 1. Angle the beam at 15 as shown. 2. Ask the patient to sit with the side of the head to be X-rayed nearest to the cassette holder. 3. Tilt the head inwards 15 as shown, so that the head and shoulder rest against the cassette holder. 4. Expose.

96 110 HEAD 10 MANDBLE AP Supine; vertical beam angled 30 towards the feet ADDTONAL D r-----, L.J USE OR <1) MARKER (\\ 120 MANDBLE AP Size of skull ma-s kv All KV ~ ma s

97 HEAD MANDBLE AP Supine; vertical beam angled 30 towards the feet REMOVE DENTURES, HAR-GRPS, AND ANYTHNG ELSE N THE HAR. 1. f the patient is unable to keep the mouth open place a wedge of soft wood or cork between the jaws. 2. Expose.

98 112 HEAD 11 MANDBLE OBLQUE LATERAL Lying on the right (or left) side; vertical beam angled 15 towards the head ADDTONAL r----, 8X24 em -.- L.J USE OR (b) MARKER f\\ 120 KV~ ma s MANDBLE OBLQUE LATERAL Size of skull ma-s kv All

99 HEAD MANDBLE OBLQUE LATERAL Lying on the right (or left) side; vertical beam angled 1 5 towards the head REMOVE DENTURESAND EARRNGS. 1. Place the patient with the side to be X-rayed nearest to the table. 2. Tilt the patient's head 15 towards the table. 3. Expose.

100 SPNE

101 117 SPNE CERVCAl SPNE Patient able to sit 1. Cervical spine PA 2. Cervical spine lateral 3. Cervical spine oblique Patient lying down, unable to sit 4. Cervical spine AP: after injury Cervical spine lateral: after injury Odontoid process AP: first and second cervical vertebrae Pages CERVCOTHORACC REGON 7. Cervicothoracic region lateral When an injury is involved the same view can be achieved with the patient lying supine. THORACC SPNE X-rays of the thoracic spine are always taken with the patient lying down. 8. Thoracic spine AP Thoracic spine lateral. lumbosacral SPNE X-rays of the lumbosacral spine are always taken with the patient lying down. 10. Lumbar spine AP Lumbar spine lateral: no injury. 12. Lumbar spine lateral: after injury Use ONLY after injury. 13. Sacrum AP: lumbosacral junction and sacroiliac joints 14. Lumbosacral junction lateral

102 118 SPNE 1 CERVCAL SPNE PA Sitting erect BASC '- ~ r-) 0 '---1 r- --- u r-- i \\ r. 1 8X24 <:._m.- r----, L..J ~~r- 85 = j.. ffi$ ~ ~ ~ ~~~ s~ t- '-----' USE AN OR CD MARKER ~ 120 K.V ma-s r t C> - r r + CERVCAL SPNE PA em ma-s kv

103 SPNE CERVCAL SPNE PA Sitting erect REMOVE HAR-GRPS AND ANYTHNG ELSE N THE HAR. 1. Tell the patient to place the chin against the cassette holder. 2. Tell the patient to hold the breath. 3. Expose. 4. Tell the patient to breathe normally.

104 120 SPNE 2 CERVCAL SPNE LATERAL Sitting erect BASC r----, L...J CERVCAL,_ SPNE LATERAL r- em ma s kv -r ~ 120 KV ma s [> r f r-

105 SPNE2 121 CERVCAL SPNE LATERAL Sitting erect THE PATENTS SHOULDERS SHOULD BE AS RELAXED AS POSSBLE WTH THE ARMS AGANST THE SDES. REMOVE HAR-GRPS AND EARRNGS. 1. Tell the patient to hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

106 122 SPNE 3 CERVCAL SPNE OBLQUE DO NOT USE FOR CHLDREN Sitting erect ADDTONAL... 24?<30 em D 24)( em ::~ ~: :.... : r-----, 1 L----..J L_ ---~-- :=::==::=::::::::::: ~""'""" \- USE OR (b) MARKER ~ 120 KV r- r- -r- [>+ -rma s -r- -f- CERVCAL SPNE OBLQUE em ma s kv

107 SPNE CERVCAL SPNE OBLQUE Sitting erect DO NOT USE FOR CHLDREN ROTATE THE PATENT SO THAT HE S STTNG AT A 45 ANGLE TO THE CASSETTE HOLDER. 1. Tell the patient to hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

108 124 SPNE 4 CERVCAL SPNE AP: after injury Supine; vertical beam angled 1 5 towards the head ADDTONAL CD CHLDREN: use an 18x24 em cassette. ::::::::::::::::::::::::::::::::::::::::::::. :r.m ~~~ ~~~~~~ ~ ~~~~~::~::~: :~:~:: :j::::: D r----, L J USE OR (b) MARKER (\\ 120 ~V ~ ma-s [> CERVCAL SPNE AP (after injury) em ma-s kv

109 SPNE CERVCAL SPNE AP: after injury Supine; vertical beam angled 1 5 towards the head 1. Tell the patient to hold the breath if possible. 2. Expose. 3. Tell the patient to breathe normally. R =THE RGHT SDE OF THE SPNE.

110 126 SPNE 5 CERVCAL SPNE LATERAL: after injury Supine; horizontal beam ADDTONAL D r-----, L.J 1 CERVCAL SPNE LATERAL (after injury) (\\ 120 KV~ ma s > em ma s kv

111 SPNE CERVCAL SPNE LATERAL: after injury Supine; horizontal beam SUPPORT THE HEAD WTH A PAD F THE NJURY S NOT TOO SEROUS. F A NECK FRACTURE S SUSPECTED THE HEAD SHOULD NOT BE LFTED ONTO A PAD BY THE OPERA TOR WTHOUT THE DOCTOR'S PERMSSON. 1. Tell the patient to hold the breath if possible. 2. Expose. 3. Tell the patient to breathe normally.

112 128 SPNE 6 ODONTOD PROCESS AP: first and second cervical vertebrae Supine; vertical beam angled 1 oo towards the head ADDTONAL r---, L.J USE OR (b) MARKER ODONTOD PROCESS AP (\\ 120 KV~ ma s [> em ma s kv

113 SPNE ODONTOD PROCESS AP: first and second cervical vertebrae Supine; vertical beam angled 1 oo towards the head 1. f the patient is unable to keep the mouth open place a wedge of soft wood or a cork between the jaws. 2. Tell the patient to hold the breath. 3. Expose. 4. Tell the patient to breathe normally.

114 130 SPNE 7 CERVCOTHORACC REGON LATERAL Sitting erect ADDTONAL D *30.._._.. em > ~ /~< r-----, 1 L.J CERVCOTHORACC REGON LATERAL fl\ 120 kv \1_) ma s C> em ma s kv

115 SPNE CERVCOTHORACC REGON LATERAL Sitting erect THE SAME VEW CAN BE ACHEVED WTH AN NJURED PATENT LYNG SUPNE.

116 132 SPNE 8 THORACC SPNE AP Supine BASC >::::.><<><> ' 8 al~ D ~ r'--'1 r )(43 em ,..,... :: L.J USE OR (b) MARKER ~ 1\ " \ THORACC,... SPNE AP em ma s kv f r C>._ ~ r KV ma s r f-

117 SPNE THORACC SPNE AP Supine 1. Tell the patient to hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

118 134 SPNE 9 THORACC SPNE LATERAL lying on the left (or right) side BASC l J- tj >>>) 18)(~3. coon ) b D $X43 C>rll... S... >""" / t..... >, L.J 1\ " ~ 120 KV ma s C> t t- -t- -t- THORACC SPNE LATERAL em ma s kv

119 SPNE THORACC SPNE LATERAL Lying on the left {or right) side 1. Tell the patient to breathe N gently during the exposure. 2. Expose while the patient is breathing in. 3. Tell the patient to breathe normally.

120 136 SPNE 10 LUMBAR SPNE AP Supine BASC 1 r- d.. <.... <.:. :: << <<...: : r'--'1 D ----, 18X43 em,... L.J A 1\ \ USE AN OR CD MARKER -r- 'J LUMBAR SPNE AP -- em ma-s kv C> ~ r <.V ma-s r r-

121 SPNE LUMBAR SPNE AP Supine THE PATENT'S KNEES SHOULD BE BENT SO THAT THE BACK S FLAT ON THE TABLE. AFTER NJURY X-RAY N ETHER THE AP OR THE PA POS TON WTH AS LTTLE MOVEMENT AS POSSBLE. DO NOT TURN THE PATENT OVER. 1. Tell the patient to hold the breath if possible. 2. Expose. 3. Tell the patient to breathe normally. R =THE RGHT SDE OF THE SPNE.

122 138 SPNE 11 LUMBAR SPNE LATERAL: no injury USE 70 kv FOR CHLDREN Lying on the left (or right) side BASC ~ SX4~ em> r'--1 D, SX43 em...;;._..,. L.J l 1\ ' C>+ 55 (]) KV ma s LUMBAR SPNE LATERAL em ma s kv Use 70 kv for children.

123 SPNE LUMBAR SPNE LATERAL: no injury Lying on the left (or right) side 1. Tell the patient to hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

124 140 SPNE 12 LUMBAR SPNE LATERAL: after injury Supine; horizontal beam USE ONLY AFTER NJURY USE 70 kv FOR CHLDREN ADDTONAL -..., - ~~0 - ~~lia > 1:: D r----, 1 L----.J !>r- 55 (j) l20 -- KV ma s LUMBAR SPNE LATERAL (after injury) em ma-s kv a Use 70 kv for children.

125 SPNE LUMBAR SPNE LATERAL: after injury Supine; horizontal beam USE ONLY AFTER NJURY 1. Tell the patient to hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

126 142 SPNE13 SACRUM AP: LUMBOSACRAL JUNCTON AND SACROLAC JONTS DO NOT USE FOR CHLDREN Supine; vertical beam angled towards the head at 1 ao for men and 1 5 for women BASC --- men -----women D 21~0 :::::=:~:::::=:==:: r-----, L J USE OR (b) MARKER (j) l20 kv ma s f> SACRUM AP LUMBOSACRAL JUNCTON SACROLAC JONTS em ma s kv

127 SPNE SACRUM AP: LUMBOSACRAL JUNCTON AND SACROLAC JONTS Supine; vertical beam angled towards the head 1 Oo for men and 1 5 for women 1. Tell the patient to hold the breath. 2. Expose. 3. Tell the patient to breathe normally.

128 144 SPNE 14 LUMBOSACRAL JUNCTON LATERAL DO NOT USE FOR CHLDREN Lying on the left (or right) side BASC l 1- d fll] 0 l A 1\ r---., \ L---.J ~.~ LUMBOSACRAL JUNCTON LATERAL em ma s kv C>t (j) l k.v ma s

129 SPNE LUMBOSACRAL JUNCTON LATERAL Lying on the left (or right) side 1. Tell the patient to hold the breath. 2. Expose. 3. Tell the patient to breathe normally. THE LAC~ CREST

130 ARM

131 148 ARM CLAVClE 1. Clavicle AP Pages SCAPULA 2. Scapula AP 3. Scapula lateral SHOUlDER JONT X-rays of the shoulder joint are taken with the patient lying down, unless there is pain. 4. Shoulder AP Two views to be taken with different rotations of the arm. 5. Shoulder AP abducted.... Patient with the arm in pain (after injury) 6. Shoulder AP.. 7. Shoulder lateral HUMERUS X-rays of the humerus are taken with the patient lying down, unless there is pain. 8. Humerus AP and lateral Two views to be taken with different rotations of the arm. Patient with the arm in pain (after injury) 9. Humerus AP Humerus lateral ElBOW 11. Elbow AP Elbow lateral Elbow AP semiflexed: after injury Two views to be taken FOREARM Forearm AP Forearm lateral Forearm PA: after injury Forearm lateral : after injury WRST 18. Wrist PA and ulnar deviation Two separate views. 19. Wrist lateral Scaphoid: after injury

132 149 ARM (continued) HAND 21. Hand PA and obliques Three separate views. 22. Thumb AP Thumb laterap Single finger lateral Pages One film divided in two may be used to take this view.

133 152 ARM 2 SCAPULA AP Supine BASC - t) 1 il!l!i.l: e=rn=: = D r----, L..J USE OR (b) MARKER (\\ 120 KV~ ma s C> SCAPULA AP em ma S kv

134 ARM SCAPULA AP Supine F THE PATENT S N PAN USE THE POS TON SHOWN N ARM 6.

135 154 ARM 3 SCAPULA LATERAL DO NOT USE FOR CHLDREN Sitting erect BASC - - ~~~i<i n tt,> D r----, L----.J -- f--- USE OR (b) MARKER SCAPULA ~ LATERAL -r- em ma-s kv ~ 120 KV ma s - -- [>

136 ARM SCAPULA LATERAL Sitting erect UNLESS THE PATENT S N PAN RASE THE ARM WTH THE HAND BEHND THE HEAD. SEE LAST 2 PHOTOGRAPHS FOR AN ALTERNATVE POSTON WHEN THE ARM S PANFUL. AN ALTERNATVE POSTON WHEN THE ARM S PANFUL.

137 156 ARM 4 SHOULDER AP Supine; vertical beam angled 1 Oo towards the feet (2 views to be taken) BASC!-JJ NFANTS AND SMALL CHLDREN: lie in the supine position directly on the cassette on top of the cassette holder. 18X24 c;.m.. r. r---., L.J USE AN OR CD MARKER ~ 120 KV ma s r- -- -r- [> r em l l /'i\ ~~~- SHOULDER AP nfants and Adults small children ma-s kv em ma-s kv

138 ARM SHOULDER AP Supine; vertical beam angled 1 oo towards the feet (2 views to be taken) 1. Place a pillow under the NORMAL shoulder. 2. Turn the patient so that the shoulder to be X-rayed lies flat on the table. 3. Rotate the arm outwards palm of the hand facing up. 4. Expose. 5. Rotate the arm inwards palm of the hand facing down. 6. Expose. PALM FACNG UP PALM FACNG DOWN

139 158 ARM 5 SHOULDER AP ABDUCTED Supine ADDTONAL r 1-- (j ) r'-, '() f~1 4 1 NFANTSANDSMALLCHLDREN: lie in the supine position directly on the cassette on top of the cassette holder. 11$)(24 2m.. i - ~ r---., L.J i.l\ T USE OR (0 MARKER (\\ 120 KV~ ma s [> SHOULDER AP ABDUCTED nfants and Adults small children em ma s kv em ma s kv

140 ARM SHOULDER AP ABDUCTED Supine

141 160 ARM 6 SHOULDER AP: after injury Sitting erect ADDTONAL ~~~~~ > e.m.:\ D r----., L----..J USE OR (b) MARKER SHOULDER AP (after injury) (\\ 120 KV~ ma s C> em ma s kv

142 ARM SHOULDER AP: after injury Sitting erect THE PATENT'S FOREARM SHOULD BEAT RGHT ANGLES TO THE CASSETTE HOLDER.

143 162 ARM 7 SHOULDER LATERAL: after injury Sitting erect ADDTONAL CD ~~)(j(). :n,:n D r----, 1 L----.J USE OR MARKER (\\ 120 KV ~ ma s [> SHOULDER LATERAL (after injury) em ma-s kv

144 ARM SHOULDER LATERAL: after injury Sitting erect THE PATENT'S FOREARM SHOULD BE PARALLEL TO THE CASSETTE HOLDER.

145 164 ARM 8 HUMERUS AP AND LATERAL Supine (2 views to be taken) BASC D USE OR (6) MARKER KV~ ma-s C> HUMERUS AP AND LATERAL em ma-s kv

146 ARM HUMERUS AP AND LATERAL Supine (2 views to be taken) 1. Rotate the arm outwards, palm of the hand facing up. 2. Expose. 3. Rotate the arm inwards, palm of the hand angled downwards (see photograph). 4. Expose. AP: PALM OF THE HAND FACNG UP. LATERAL: PALM OF THE HAND ANGLED DOWNWARDS.

147 166 ARM 9 HUMERUS AP: after injury Sitting erect ADDTONAL CD D ---.., 8X43 em... ::, _::::,,. L.J USE OR (D MARKER HUMERUS AP (after injury) (\\ 120 KV~ ma-s [> em ma s kv

148 ARM HUMERUS AP: after injury Sitting erect THE PATENT'S FOREARM SHOULD BE AT RGHT ANGLES TO THE CASSETTE HOLDER.

149 168 ARM 10 HUMERUS LATERAL: after injury Sitting erect ADDTONAL CD D SX43 em<, L J USE AN MARKER (\\ 120 KV ~ ma s [> HUMERUS LATERAL (after injury) em mas kv

150 ARM HUMERUS LATERAL: after injury Sitting erect THE PATENT'S FOREARM SHOULD BE AGANST THE CASSETTE HOLDER.

151 170 ARM 11 ELBOWAP Sitting, with the arm in supination BASC ~ (j CHLDREN: 18x43 em if the arm is not long enough for the elbow to reach the centre point of the cassette. f:llll.... i.l\ l USE OR (b) MARKER ss s l20 K.V ma s [> ELBOW AP em ma s kv

152 ARM ELBOWAP Sitting, with the arm in supination THE PALM OF THE PATENT'S HAND SHOULD BE FACNG UP. N THE CASE OF A CHLD, F THE ARM S NOT LONG ENOUGH FOR THE ELBOW TO REACH THE CENTRE PONT OF THE CASSETTE, USE SZE 18x43 em.

153 172 ARM 12 ELBOW LATERAL Sitting BASC CD L J- tj CHLDREN: 18x43 em if the arm is not long enough for the elbow to reach the centre point of the cassette. l'irlll 11r~111 USE OR (b) MARKER s l20 KV ma-s r [> ELBOW LATERAL em ma s kv

154 ARM ELBOW LATERAL Sitting N THE CASE OF A CHLD, F THE ARM S NOT LONG ENOUGH FOR THE ELBOW TO REACH THE CENTRE PONT OF THE CASSETTE, USE SZE 18 x 43 em.

155 174 ARM 13 ELBOW AP SEMFLEXED: after injury Sitting, with the arm in supination (2 views to be taken) ADDTONAL (i) r- (j CHilDREN: 18x43 em if the arm is not long enough for the elbow to reach the centre point of the cassette. r~~~~.l r'---'"1 ~[(111 USE OR ([) MARKER C\ 120 KV~ ma s -r- -r -r- - C> ELBOW AP SEMFLEXED (after injury) em ma s kv

156 ARM ELBOW AP SEMFLEXED: after injury Sitting, with the arm in supination (2 views to be taken) ALWAYS TAKE 2 VEWS, WTH THE ARM N THE POSTONS SHOWN N THE PHOTO GRAPHS. N THE CASE OF A CHLD, F THE ARM S NOT LONG ENOUGH FOR THE ELBOW TO REACH THE CENTRE PONT OF THE CASSETTE, USE SZE 18 x 43 em.

157 176 ARM14 FOREARM AP Sitting, with the arm in supination BASC CHLDREN: when possible use a smaller cassette, 24 x 30 em or 18x24cm. D USE OR (b) MARKER ~ 120 KV ~ ma s FOREARM AP em ma s kv

158 ARM FOREARM AP Sitting, with the arm in supination THE PALM OF THE HAND SHOULD BE FACNG UP. F THE ARM S NJURED USE THE POS TON SHOWN N ARM 16.

159 178 ARM 15 FOREARM LATERAL Sitting BASC 1- (j CHLDREN: when possible use a smaller cassette, 18x24 em ><:30 em D. :.. ::::::... ::::;:::;:::; ::. 30': : :.. c.r:tl USE OR (b) MARKER ~ 120 KV~ ma s -r > r- -1- FOREARM LATERAL em ma s kv

160 ARM FOREARM LATERAL Sitting THE THUMB SHOULD BE UPPERMOST, AS SHOWN. F THE ARM S NJURED USE THE POS TON SHOWN N ARM 17.

161 180 ARM 16 FOREARM PA: after injury Sitting, with the arm in pronation and the elbow flexed ADDTONAL CHLDREN: when possible use a smaller cassette, 18x24 em. ~4~~() c~> < <.... D (";:\f the arm is in plaster; cassette in the ~cassette holder. USE OR (b) MARKER FOREARM PA (after injury) C\ 120 KV \::!!! ma-s [> em ma s kva a Use 70 kv if the arm is in plaster.

162 ARM FOREARM PA: after injury Sitting, with the arm in pronation and the elbow flexed THE PALM OF THE HAND SHOULD BE FACNG DOWN. F THE ARM S N PLASTER PUT THE CASSETTE N THE CASSETTE HOLDER AND USE 70 kv.

163 182 ARM 17 FOREARM LATERAL: after injury Standing or sitting (whichever is more comfortable for the patient) ADDTONAL CHLDREN: when possible use a smaller cassette, 18x24 em ~~~i~b. crrl D lfthe arm is in plaster; cassette in the cassette holder. USE AN OR CD MARKER FOREARM LATERAL (after injury) em ma s kva C\ 120 KV~ ma s C> a Use 70 kv if the arm is in plaster.

164 ARM FOREARM LATERAL: after injury Standing or sitting (whichever is more comfortable for the patient) THE THUMB SHOULD BE UPPERMOST. F THE ARM S N PLASTER PUT THE CASSETTE N THE CASSETTE HOLDER AND USE 70 kv.

165 184 ARM 18 WRST PA AND ULNAR DEVATON Sitting BASC (wrist P A) ADDTONAL (ulnar deviation) t~m~:j J l.. USE AN OR CD MARKER ss s l20 KV ma s !> WRST PA AND ULNAR DEVATON em ma s kv

166 ARM WRST PA AND ULNAR DEVATON Sitting 2 SEPARATE VEWS WRST PA: HAND SHOULD BE STRAGHT WTH THE PALM FACNG DOWN. ULNAR DEVATON: TAKE ONLY WHEN REQUESTED BY THE DOCTOR; HAND SHOULD BE TURNED OUTWARDS WTH THE PALM FACNG DOWN. WRST PA BASC ULNAR DEVATON ADDTONAL ON REQUEST OF THE DOCTOR

167 188 ARM 20 SCAPHOD: after injury Sitting ADDTONAL L r Cj fm11l ~[~ J /i1\ USE OR (b) MARKER -r- SCAPHOD -r- em ma s kv r s l K. V ma-s C>- --

168 ARM SCAPHOD: after injury Sitting

169 190 ARM 21 HAND PA AND OBLQUES Sitting BASC (PA) ADDTONAL (obliques) 1- (j lilllil llrfl~l J~.l\ USE OR (b) MARKER C>+ - K.V ~ ma-s - -- HAND PA AND OBLQUES em ma s kv

170 ARM HAND PA AND OBLQUES Sitting 3 SEPARATE VEWS THE PA VEW S THE BASC VEW. TAKE AN OBLQUE VEW ONLY WHEN REQUESTED BY THE DOCTOR. F A SNGLE FNGER LATERAL VEW S TAKEN (ARM 24), A HAND PA VEW SHOULD ALSO BE TAKEN; AND OBLQUES F REQUESTED BY THE DOCTOR. PA BASC PA OBLQUE ADDTONAL AP OBLQUE ADDTONAL

171 192 ARM 22 THUMB AP Standing BASC CD D The cassette may be divided into two; one half to be used for this view and the other for the lateral view (see ARM23) ~ 120 K.V ~ ma s C> THUMB AP em ma-s kv

172 ARM THUMB AP Standing HALF THE CASSETTE MAY BE USED FOR THE THUMB AP; THE OTHER HALF FOR THE THUMB LATERAL (SEE ARM 23). SAVE FLM BY DONG THS WHENEVER POSSBLE.

173 194 ARM 23 THUMB LATERAL Sitting BASC D The cassette may be divided into two; one half to be used for this view and the other for the AP view (see ARM 22). This diagram shows how it can be divided, using the lead strip provided. USE OR (b) MARKER THUMB LATERAL K.V ~ ma s C> em ma s kv

174 ARM THUMB LATERAL Sitting HALF THE CASSETTE MAY BE USED FOR THE THUMB LATERAL AND THE OTHER HALF FOR THE THUMB AP (SEE ARM 22). SAVE FLM BY DONG THS WHENEVER POSSBLE. THUMB LATERAL (ARM 23) THUMB AP (ARM 22)

175 196 ARM 24 SNGLE FNGER LATERAL Standing BASC CD ~ (j f~1lil r'--"1 USE AN OR CD MARKER K.V ~ ma s -r -r -- - [> SNGLE FNGER LATERAL em ma s kv

176 ARM SNGLE FNGER LATERAL Standing EXTEND THE FNGER TO BE X-RA YEO HORZONTALLY. WHEN THS VEW S TAKEN A HAND PA VEW (ARM 21) SHOULD ALSO BE TAKEN; AND OBLQUES (ARM 21) F REQUESTED BY THE DOCTOR. THE RADOGRAPHS BELOW SHOW SEPARATE VEWS OF THE 2nd AND 4th FNGERS. 2nd FNGER 4th FNGER

177 leg

178 201 LEG With some exceptions X-rays of the leg are taken with the patient lying supine. PELVS AND HP JONTS 1. Pelvis AP Hip joint AP Hip joint lateral: no injury. 4. Hip joint lateral: if a fracture is suspected FEMUR 5. Femur AP Femur lateral: no injury. 7. Femur lateral: after injury KNEE Knee AP Knee lateral: no injury.. Knee lateral: after injury Knee intercondylar space Patella axial LOWER LEG 13. Leg AP Leg lateral: no injury 15. Leg lateral: after injury 16. Ankle joint: internal oblique and AP 17. Ankle joint: lateral and external oblique FOOT 18. Foot and toes AP 19. Foot lateral Foot AP oblique Foot PA oblique. 22. Heel semiaxial: supine 23. Heel semiaxial: prone. Pages NFANTS AND SMALL CHLDREN 24. Pelvis and hip joints AP

179 202 LEG 1 PELVS AP Supine BASC AFTER NJURY A SUPNE VEW OF THE NNER PELVS (ABDOMEN 5) SHOULD ALSO BE TAKEN CHLDREN: USE LEG 24 WHEN THE SZE 18 x 24 em CASSETTE S LARGE ENOUGH 1 r- d

180 leg PELVS AP Supine 1. f the patient is NOT NJURED, turn the feet with heels apart and toes together, as shown below. f the patient is NJURED, DO NOT turn the feet to this position. 2. Expose.

181 204 LEG 2 HP JONT AP Supine BASC CD L J- [j CHLDREN: use an 18 x 24 em cassette. ~= ~ r'-'"1 0.. : : D r----, :=:""'-!-:.:=: ::::::::::::::: ::::::::::::::: L.J A " ' USE AN OR CD MARKER ~ 120 ~v - r- r- [>-r- -r- -r- -r- ma-s HP JONT AP em ma-s kv

182 LEG HP JONT AP Supine 1. f the patient is NOT NJURED, turn the feet with heels apart and toes together, as shown below. f the patient is NJURED, DO NOT turn the feet to this position. 2. Expose.

183 206 LEG 3 HP JONT LATERAL: no injury Supine BASC 1- [j D r----, L.J A 1\ \ USE OR (b) MARKER (\\ 120 KV ~ ma s ~ [> HP JONT LATERAL em ma s kv

184 LEG HP JONT LATERAL: no injury Supine 1. Turn the patient carefully on to the affected side so that the leg is flat on the table. 2. Expose.

185 208 LEG 4 HP JONT LATERAL: if a fracture is suspected Supine; X-ray beam angled at 65 from the vertical position ADDTONAL jijilll.!ib. : Eli D r----, :::::: L----.J USE AN OR CD MARKER (\\ 120 <.V~ ma s C> HP JONT LATERAL (suspected fracture) em ma s kv

186 LEG HP JONT LATERAL: if a fracture is suspected Supine; X-ray beam angled at 65 from the vertical position POSTON FOR THE LEFT HP JONT. POSTON FOR THE RGHT HP JONT.

187 210 LEG 5 FEMUR AP Supine BASC t r- d CHLDREN: use a 24x30 em cassette ~~~~~ r'--1 D CHLDREN: place the 24x30 em cassette directly under the leg..... ~X43 ern ~.. ~. i r '--f, , L.J 1\ \ USE OR (b) MARKER - -r r- 55 ~ 120 C>+ -- KV ma-s em Adults ma-s FEMUR AP Children kv em ma-s kv

188 LEG FEMUR AP Supine NCLUDE THE HEAD OF THE FEMUR.

189 212 LEG 6 FEMUR LATERAL: no injury lying on the right (or left) side BASC CHLDREN: use a 24x30cm cassette. D r L.J USE OR (b) MARKER (\\ 120 KV ~ ma s C> FEMUR LATERAL em ma s kv

190 LEG FEMUR LATERAL: no injury Lying on the right (or left) side 1. Place the patient with the leg to be X-rayed underneath. 2. Bend the normal leg. 3. Expose. NCLUDE THE LOWER END OF THE FEMUR.

191 214 LEG 7 FEMUR LATERAL: after injury Supine; horizontal beam ADDTONAL r-- CHLDREN: use a 24x30 em cassette.... D CHLDREN: use the 24x30 em cas~:tte in the same pos1t1on. l ~ r t.. : >: :.... :... :~ :,,. <... E...)f :u,. Cl) ~.:-:" '..,.,,,.,. : : :., '..... '.::.. : l,.:,.,,! (';'\ Always use a 35 x 43 em \:::!) collimator. USE AN OR CD MARKER - FEMUR LATERAL (after injury) (\\ 120 KV~ ma s -t- -f- -t- C>+ -f- -f- -- em ma s kv

192 LEG FEMUR LATERAL: after injury Supine; horizontal beam 1. Support the cassette so that it is straight. 2. Place the patient so that the injured leg is nearest to the cassette. 3. Bend the UNNJURED leg. 4. Expose.

193 216 LEG 8 KNEE AP Supine BASC 1- tj l 1':11111

194 LEG KNEE AP Supine TO FND SMALL FRACTURES ADDTONAL OBLQUE VEWS MAY BE USED.

195 218 LEG 9 KNEE LATERAL: no injury Lying on the right (or left) side BASC 1-- tj J r'-, j..... :.. USE OR (6) MARKER s l20 KV r- -f- f- [>rf- ma-s -f- -f- KNEE LATERAL em ma-s kv

196 LEG KNEE LATERAL: no injury Lying on the right (or left) side 1. Place the patient with the leg to be X-rayed underneath. 2. Bend the normal leg. 3. Expose.

197 220 LEG 10 KNEE LATERAL: after injury Supine; horizontal beam ADDTONAL t:-::_::.= =.==:::,:)-: :. : 0 [) r'-'1 D The cassette is turned horizontally against the Collimator size: 18 x 24 em. l i ~ t \ - - PF- t- USE OR (b) MARKER s 120 K.V ma s + -~ - 1>- -- _,... -r- -r- KNEE LATERAL (after injury) em ma-s kv

198 LEG KNEE LATERAL: after injury Supine; horizontal beam 1. Support the cassette so that it is straight. 2. Place the patient so that the injured leg is nearest to the cassette. 3. Raise the UNNJURED leg, as shown, so that it is higher than the cassette. 4. Expose.,-- 1 L --- _j

199 222 LEG 11 KNEE NTERCONDYLAR SPACE Supine: vertical beam angled 30 towards the head ADDTONAL USE OR (b) MARKER k.v ~ ma-s C> KNEE NTERCONDYLAR SPACE em ma s kv

200 LEG KNEE NTERCONDYLAR SPACE Supine; vertical beam angled 30 towards the head PLACE THE CASSETTE UNDER THE KNEE ON A FRM SUPPORT em HGH

201 224 LEG 12 PATELLA AXAL Standing BASC ' ~---, , t :CD l J- tj r"-, A 1\ ' USE OR (!) MARKER -~ C'\ 120 kv~ -- - C>- - ma s -- PATELLA AXAL -- em ma s kv f-

202 LEG PATELLA AXAL Standing 1. Place the cassette on top of the cassette holder on a stool as shown. 2. Expose.

203 226 LEG 13 LEG AP Supine BASC J :>:. 18X : :.:-:.::-:-:... c m.... ::. f:;::::.:::::... ~... ~... :: i: ~: D 1\ \ USE OR (b) MARKER ~ 120 K.V ~ ma s - -f- -f- C>f- -r- -f- -f- LEG AP em ma s kv

204 LEG AP Supine

205 228 LEG 14 LEG LATERAL: no injury Lying on the right (or left) side BASC CD l J- tj r'---, ~) D?. >< < tskc\3... em<.::>::}> :_::>>...../> >>> A 1\ ' USE OR (b) MARKER ~ 120 KV~ -- -t- -t- ma s - LEG LATERAL em ma-s kv

206 LEG LEG LATERAL: no injury Lying on the right (or left) side 1. Place the patient with the leg to be X-rayed underneath. 2. Bend the normal leg. 3. Expose.

207 230 LEG 15 LEG LATERAL: after injury Supine: horizontal beam ADDTONAL D r t : ' _l USE OR (b) MARKER USE A 35 x 43 em COLLMATOR ~ 120 KV~ ma s C> LEG LATERAL (after injury) em ma s kv

208 LEG LEG LATERAL: after injury Supine; horizontal beam 1. Support the cassette so that it is straight. 2. f there are splints on the injured leg, leave them on. 3. Bend the UNNJURED leg. 4. Expose.

209 232 LEG 16 ANKLE JONT: NTERNAL OBLQUE AND AP Sitting on the table BASC (internal oblique) ADDTONAL (AP) CD ~ (j ) f~~ 4 1 :.. A 1\ \ USE OR (b) MARKER KV~ -,_ -~ -- C>-- ~ ma-s -~ ~ ANKLE JONT: NTERNAL OBLQUE AND AP em ma-s kv

210 LEG ANKLE JONT: NTERNAL OBLQUE AND AP Sitting on the table 2 SEPARATE VEWS THE NTERNAL OBLQUE VEW S THE BASC VEW. TAKE A PA VEW ONLY WHEN REQUESTED BY THE DOCTOR. F T S NECESSARY TO TAKE AN ANKLE JONT LATERAL VEW (LEG 17) AS WELL AS AN NTERNAL OBLQUE VEW, USE A 24 x 30 em CASSETTE DVDED BY MEANS OF THE LEAD STRP PROVDED: ONE HALF FOR THS VEW AND THE OTHER HALF FOR THE LEG 17. NTERNAL OBLQUE: REST THE PATENT'S HEEL ON THE CASSETTE AND TURN THE FOOT NWARDS AT A 15 ANGLE. AP: REST THE PATENT'S HEEL ON THE CASSETTE AND KEEP THE FOOT STRAGHT. NTERNAL OBLQUE BASC AP ADDTONAL ON REQUEST OF THE DOCTOR

211 234 LEG 17 ANKLE JONT: LATERAL AND EXTERNAL OBLQUE Sitting or lying on the table BASC (lateral) ADDTONAL (external oblique) r (j fbifl fill A 1\ \ USE OR (b) MARKER ANKLE JONT: - LATERAL AND -- EXTERNAL OBLQUE em ma s kv 55 s l C> KV ma s f-

212 LEG ANKLE JONT: LATERAL AND EXTERNAL OBLQUE Sitting or lying on the table THE LATERAL VEW S THE BASC VEW. TAKE AN EXTERNAL OBLQUE ONLY WHEN REQUESTED BY THE DOCTOR. F T S NECESSARY TO TAKE AN ANKLE JONT NTERNAL OBLQUE (LEG 16) AS WELL AS A LATERAL VEW, USE A 24 x 30 em CASSETTE DVDED BY MEANS OF THE LEAD STRP PRO VDED: ONE HALF FOR THS VEW AND ONE HALF FOR THE LEG 16. LATERAL: TURN THE PATENT'S FOOT OUT WARDS SO THAT T RESTS AGANST THE CASSETTE. EXTERNAL OBLQUE: REST THE PATENT'S HEEL ON THE CASSETTE AND TURN THE FOOT OUT WARDS AT A so ANGLE. LATERAL BASC EXTERNAL OBLQUE ADDTONAL ON REQUEST OF THE DOCTOR

213 236 LEG 18 FOOT AND TOES AP Supine; vertical beam angled 1 oo towards the head BASC - )-, 1 11il 1 A 1\ \ USE OR (b) MARKER \ C\ 120 KV~ -r- -r- -r- - C>- -- ma-s FOOT AND TOES AP em ma s 8 kv a Use half these values for the toes alone.

214 LEG FOOT AND TOES AP Supine; vertical beam angled 1 Oo towards the head PATENT'S LEG TO BE BENT SO THAT FOOT RESTS FLAT ON THE CASSETTE. F ONLY THE TOES ARE TO BE X-RA YEO, USE HALF THE ma s VALUES GVEN FOR THE FOOT. THE DFFERENT VALUES HAVE BEEN USED FOR THE TWO RADOGRAPHS ON THS PAGE. TAKEN WTH THE CORRECT EXPOSURE FOR THE TOES. TAKEN WTH THE CORRECT EXPOSURE FOR THE METATARSAL AND TARSAL BONES.

215 238 LEG 19 FOOT LATERAL Lying on the left (or right) side ADDTONAL l J- (j When the size of the foot allows it use the smaller, 18 x 24 em, cassette. ) r"---'1 ~).. : D A 1\ ' USE OR (b) MARKER n.., C\ 120 K.V ~ ma s C> ~ -~ FOOT LATERAL em ma s kv

216 LEG FOOT LATERAL Lying on the left (or right) side

217 240 LEG 20 FOOT AP OBLQUE Sitting on the table; vertical beam angled 15 towards the head BASC.. USE OR (b) MARKER ~ 120 K.V ~ ma s FOOT AP OBLQUE em ma s kv

218 LEG FOOT AP OBLQUE Sitting on the table; vertical beam angled 1 5 towards the head

219 242 LEG 21 FOOT PA OBLQUE Prone ADDTONAL l }- 0 til ~l11l A H_l \ USE OR (b) MARKER r J \ FOOT PA OBLQUE -- em ma s kv s <.V ma-s [>-c- -r

220 LEG FOOT PA OBLQUE Prone

221 244 LEG 22 HEEL SEMAXAL Supine: vertical beam angled 30 towards the head FOR A LATERAL VEW USE LEG 17 BUT CENTRE OVER THE HEEL BASC 1111 f;llill USE OR (b) MARKER ~ 120 K.V ~ ma s > HEEL SEMAXAL (supine) em ma-s kv

222 LEG HEEL SEMAXAL Supine: vertical beam angled 30 towards the head WHEN THE PATENT S NJURED USE ETHER THS POSTON OR THAT SHOWN FOR LEG 23, WHCHEVER CAUSES THE LEAST PAN. THE FOOT SHOULD BE KEPT FLEXED BY MEANS OF A SLNG HELD BY THE PATENT.

223 246 LEG 23 HEEL SEMAXAL Prone ADDTONAL Q) r---, L---.J USE OR (b) MARKER (\"\ 120 KV ~ ma s C> HEEL SEMAXAL (prone) em ma s kv

224 LEG HEEL SEMAXAL Prone WHEN THE PATENT S NJURED USE ETHER THS POSTON OR THAT SHOWN FOR LEG 22, WHCHEVER CAUSES THE LEAST PAN.

225 248 LEG 24 PELVS AND HP JONTS AP: infants and small children Supine BASC 1- CJ Use a larger cassette for a taller child. _r---]_ USE OR (b) MARKER s l20 - [>-- -- KV ma s PEL VS AND HP JONTS (infants and small children) em ma s kv

226 LEG PELVS AND HP JONTS AP: infants and small children Supine THE CHLD MUST BE SUPPORTED BY THE LEGS AND ETHER THE ARMS OR THE TORSO. THOSE SUPPORTNG THE CHLD, PREFERABLY THE PARENTS, MUST WEAR A LEAD APRON AND LEAD GLOVES. 1. Place the cassette on top of the cassette holder. 2. Lie the child on its back on the cassette. 3. Flex the knees and abduct the hips. 4. Centre a little above the pubic symphysis. 5. Expose when the child is not moving. USE A LEAD APRON AND LEAD GLOVES. a 8 For the sake of clarity, the gloves are shown as being transparent.

227 EXPOSURE TABLES

228 253 EXPOSURE TABLES N RELATON TO THE DAMETER-THCKNESS-OF THE PART OF THE BODY TO BE X-RAYED For the WHO Basic Radiological System with a 1 0: 1 lead/aluminium grid, using standard blue-sensitive X-ray film in aluminium cassettes with fast calcium-tungstate screens (0.5 mr exposure) THE PARTS OF THE BODY WTHN THE THORACC CHEST kv em ma-s Position of cassette kv em ma s Position of cassette CHEST Adults RBS Erect and OBLQUE supine n the cassette holder n the CHEST Children cassette THORACC holder SPNE CHEST nfants Directly under LATERAL weighing the patient up to 10 kg on the cassette holder AND CERVCO THORACC SPNE LATERAL THE HEAD kv Size of Position of Size of Position of ma-s kv ma-s skull cassette skull cassette SKULL LATERAL 70 Small 25 SNUSES AND FACE 70 Small 16 Medium 32 LATERAL Medium 16 Large 40 Large 25 n the SKULL PA AND 70 Small 63 NOSE LATERAL 55 All 16 cassette AP SEMAXAL Medium 80 MANDBLE 70 All 63 holder Large 100 n the PA AND AP cassette SNUSES AND 90 Small 25 MANDBLE OBLQUE holder FACE PA Medium 25 LATERAL 70 All 12.5 Large 32 SNUSES AND FACE 90 Small 25 SEMAXAL AND Medium 32 NOSE PA Large 40 THE LEG: SPECAL EXPOSURES kv em ma-s Position of cassette kv em ma-s Position of cassette KNEE Directly under HEEL Supine Directly under the NTERCONDYLAR the knee or SEMAXAL heel SPACE 10 4 patella Prone n the AND HEEL 13 SEMAXAL cassette PRONE 8 10 holder PATELLA AXAL a Focus film distance;;; 100 em.

229 254 ALL OTHER VEWS Diameter (thickness) Cassette directly under the patient on top of the cassette holder Cassette in the cassette holder 55 kv 70 kv 70 kv 90 kv 120 kv em ma s ma s ma s ma s ma s

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