Country Health SA Medical Imaging REMOTE OPERATORS POSITIONING GUIDE
Contents Image Evaluation Page 4 Positioning Guides Section 1 - THORAX 1.1 Chest Page 5 1.2 Bedside Chest Page 7 1.3 Ribs Page 8 Section 2 UPPER EXTREMITY 2.1 Hand Page 10 2.2 Thumb Page 13 2.3 Wrist/Scaphoid Page 16 2.4 Forearm Page 20 2.5 Elbow Page 22 2.6 Humerus Page 25 2.7 Shoulder/Clavicle Page 27 Section 3 LOWER EXTREMITY 3.1 Foot Page 30 3.2 Ankle Page 33 3.3 Tibia/Fibula Page 36 3.4 Knee Page 38 Section 4 PELVIC GIRDLE 4.1 Pelvis/Hip Page 40 Page 2
Section 5 SPINAL COLUMN 5.1 Cervical Spine Page 42 5.2 Thoracic Spine Page 44 5.3 Lumbar Spine Page 46 Section 6 ABDOMEN 6.1 Abdomen Page 48 THIS DOCUMENT IS TO BE USED AS A GUIDE ONLY FOR RADIOGRAPHIC PROJECTIONS. REMOTE OPERATORS MUST OPERATE WITHIN THEIR RADIATION LICENCE CONDITIONS, AS SET BY THE EPA. Copyright 2014. All rights reserved. Page 3
Image Evaluation For every image produced PACEMAN should be used to evaluate image quality. Positioning Is the part being imaged in the correct position? Is the image rotated? Area Covered Has the area in question been covered adequately? Has an area been exposed that is not required? Collimation Could the collimation be smaller? Are all collimation lines evident? Exposure Is the image underexposed or overexposed? Does the image show correct contrast and density? Is the exposure index adequate? Markers Have markers been correctly used? Should be placed on the lateral aspect of the patient for AP/PA images. Should be placed on the anterior aspect of the patient for Lateral images. Aesthetics/ Does the image look diagnostic? Artifacts Is the image displayed correctly? Are there any artifacts that may cover pathology? Name Is the patient s name/dob entered correctly? Page 4
Section 1 THORAX 1.1 CHEST - PA Detector/Cassette: 35x43cm Orientation: Landscape for men, portrait for women FFD: 180cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce collimation to only include area of interest Centre Point: T6/T7 1. Patient s chest against bucky 2. Patient s backs of hands on back of hips, ensuring scapula are rolled forward off the lung fields Respiration: Inspiration +/- Expiration for pneumothorax 1. Lung apices & bases included 2. No rotation medial clavicle equidistant from sternum 3. Adequate inspiration Page 5
Section 1 - THORAX 1.1 CHEST LATERAL Detector/Cassette: 35x43cm FFD: 180cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce collimation to only include area of interest Centre Point: Middle of lungs at level of T6/T7 1. Patient s left side against bucky 2. Patient s hands on head, elbows in front of face 3. Right shoulder slightly further forward than left shoulder Respiration: Inspiration 1. Lung apices & bases included 2. No rotation lung bases superimposed 3. Adequate inspiration Page 6
Section 1 - THORAX 1.2 BEDSIDE CHEST - AP Detector/Cassette: 35x43cm Orientation: Landscape FFD: 180cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce collimation to only include area of interest Centre Point: Lower third of sternum 1. Back of bed moved to upright position 2. Cassette placed behind patient s back 3. X-ray tube angled to match angle of patient s chest Respiration: Inspiration +/- Expiration for pneumothorax 1. Lung apices & bases included 2. No rotation medial clavicle equidistant from sternum 3. Adequate inspiration Page 7
Section 1 - THORAX 1.3 RIBS Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce collimation to only include area of interest Area Covered: Upper ribs - 1 st rib down. Lower ribs - 12 th rib up. Include spine & lateral aspect of rib cage 1. Patient s back against bucky, rotated 30 towards affected side - affected side down 2. Arm on affected side placed on patient s head Respiration: Inspiration for upper ribs. Expiration for lower ribs 1. Ribs appear elongated 2. Must include at least the 1 st rib or 12 th rib 3. Good contrast between ribs and lung Page 8
Section 1 - THORAX 1.3 RIBS Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce collimation to only include area of interest Area Covered: Upper ribs - 1 st rib down. Lower ribs - 12 th rib up. Include spine & lateral aspect of rib cage 1. Patient s back against bucky, rotated 30 away from affected side affected side up 2. Arm on affected side placed on patient s head Respiration: Inspiration for upper ribs. Expiration for lower ribs 1. Ribs appear shortened 2. Must include at least the 1 st rib or 12 th rib 3. Good contrast between ribs and lung Page 9
Section 2 UPPER EXTREMITY 2.1 HAND - PA Detector/Cassette: 18x24cm Collimation: To include entire hand and distal radius/ulna Centre Point: 3 rd metacarpal-phalangeal joint 1. Place hand with palm down against cassette 2. Fingers as straight as possible and slightly separated 1. X-ray viewed with fingers at top of film, not anatomically 2. All fingers included 3. Distal radius/ulna included Page 10
Section 2 UPPER EXTREMITY 2.1 HAND - OBLIQUE Detector/Cassette: 18x24cm Collimation: To include entire hand and distal radius/ulna Centre Point: 3 rd metacarpal-phalangeal joint 1. Place hand with palm down against cassette 2. Fingers as straight as possible and slightly separated 3. Whole hand angled 30 with thumb raised 1. X-ray viewed with fingers at top of film, not anatomically 2. All fingers included 3. Distal radius/ulna included 4. Metacarpals slightly overlapping Page 11
Section 2 UPPER EXTREMITY 2.1 HAND LATERAL Detector/Cassette: 18x24cm Collimation: To include entire hand and distal radius/ulna Centre Point: Metacarpal-phalangeal joints 1. Place hand ulna side down 2. Thumb and forefinger pinched together 3. All other fingers fanned out 1. X-ray viewed with fingers at top of film, not anatomically 2. All fingers included 3. Distal radius/ulna included 4. Wrist lateral Page 12
Section 2 UPPER EXTREMITY 2.2 THUMB - PA Detector/Cassette: 18x24cm Collimation: To include whole thumb and carpal bones Centre Point: Proximal inter-phalangeal joint 1. Hand in lateral position ulna side down 2. Thumb flat in front of hand, parallel to cassette 3. Thumb will not be touching cassette 1. X-ray viewed with distal thumb at top of film, not anatomically 2. Entire thumb visualised including adjacent carpal bones 3. No rotation equal concavity on each side of both phalanges Page 13
Section 2 UPPER EXTREMITY 2.2 THUMB - OBLIQUE Detector/Cassette: 18x24cm Collimation: To include whole thumb and adjoining carpal bones Centre Point: Proximal inter-phalangeal joint 1. Hand palmar surface flat against cassette 2. Thumb extended slightly from other fingers 1. X-ray viewed with distal thumb at top of film, not anatomically 2. Entire thumb visualised including adjacent carpal bones 3. Anterior aspect of proximal phalanx and metacarpals should appear slightly more concave than posterior aspect Page 14
Section 2 UPPER EXTREMITY 2.2 THUMB - LATERAL Detector/Cassette: 18x24cm Collimation: To include whole thumb and adjoining carpal bones Centre Point: Proximal inter-phalangeal joint 1. Hand palmar surface initially flat against cassette 2. Thumb extended slightly from other fingers 3. Lift hand off cassette while keeping thumb against cassette, pivoting onto lateral portion of thumb 1. X-ray viewed with distal thumb at top of film, not anatomically 2. Entire thumb visualised including adjacent carpal bones 3. Anterior aspect of proximal phalanx and metacarpals should appear concave 4. Posterior aspect of proximal phalanx and metacarpals should appear straight Page 15
Section 2 UPPER EXTREMITY 2.3 WRIST - PA Detector/Cassette: 18x24cm Collimation: To include all carpal bones and distal third of radius/ulna Centre Point: Midway between styloid process of radius and ulna 1. Place anterior surface of wrist flat against cassette 1. X-ray viewed with fingers at top of film, not anatomically 2. Distal radius and ulna are free of superimposition 3. Mid metacarpals and distal third of radius/ulna visualised Page 16
Section 2 UPPER EXTREMITY 2.3 WRIST - OBLIQUE Detector/Cassette: 18x24cm Collimation: To include all carpal bones and distal third of radius/ulna Centre Point: Midway between styloid process of radius and ulna 1. Place anterior surface of wrist flat on cassette 2. Raise thumb approx. 30 while keeping ulna aspect against cassette 1. X-ray viewed with fingers at top of film, not anatomically 2. Distal radius and ulna are slightly superimposed 3. 3 rd to 5 th metacarpal bases are slightly superimposed 4. Mid metacarpals and distal third of radius/ulna visualised Page 17
Section 2 UPPER EXTREMITY 2.3 WRIST - LATERAL Detector/Cassette: 18x24cm Collimation: To include all carpal bones and distal third of radius/ulna Centre Point: Distal end of radius 1. Place wrist with ulna aspect against cassette 2. Superimpose radial and ulna styloid processes (HINT: Hand slightly rotated posteriorly for true lateral position) 3. Thumb against 2 nd metacarpal-phalangeal joint 1. X-ray viewed with fingers at top of film, not anatomically 2. Distal radius and ulna superimposed 3. Metacarpals superimposed 4. Mid metacarpals and distal third of radius/ulna visualised Page 18
Section 2 UPPER EXTREMITY 2.3 SCAPHOID Detector/Cassette: 18x24cm Central Ray: 30 uptilt (angled up the forearm) Collimation: To include all carpal bones and distal end of radius/ulna Centre Point: Carpal bones 1. Place anterior surface of wrist flat against cassette 2. While keeping forearm still, ulnar deviate the hand as much as possible 1. X-ray viewed with fingers at top of film, not anatomically 2. All carpal bones and distal radius/ulna included 3. Scaphoid will appear elongated 4. All other carpal bones will appear more superimposed Page 19
Section 2 UPPER EXTREMITY 2.4 FOREARM - AP Detector/Cassette: 24x30cm forearm diagonally across cassette Collimation: To include elbow joint and wrist joint Centre Point: Mid forearm 1. Place forearm with anterior surface facing up 2. Arm straight 1. X-ray viewed with wrist at top of film, not anatomically 2. AP view of elbow and AP view of wrist 3. Entire radius/ulna visualised Page 20
Section 2 UPPER EXTREMITY 2.4 FOREARM - LATERAL Detector/Cassette: 24x30cm Orientation: Landscape forearm diagonally across cassette Collimation: To include elbow joint and wrist joint Centre Point: Mid forearm 1. Elbow and wrist in lateral positions elbow flexed 90 with wrist straight 2. Ulna aspect of forearm against cassette 1. X-ray viewed with wrist at top of film, not anatomically 2. Lateral view of elbow and lateral view of wrist 3. Entire radius/ulna is visualised Page 21
Section 2 UPPER EXTREMITY 2.5 ELBOW - AP Detector/Cassette: 18x24cm Collimation: To include elbow joint, distal third of humerus and proximal third of radius/ulna Centre Point: Centre on elbow joint 1. Elbow as straight as possible 2. Posterior surface against cassette 1. Entire elbow joint with distal third of humerus and proximal third of radius visualised 2. Bilateral epicondyles seen in profile 3. Radial head and ulna slightly superimposed Page 22
Section 2 UPPER EXTREMITY 2.5 ELBOW - OBLIQUE Detector/Cassette: 18x24cm Collimation: To include elbow joint, distal third of humerus and proximal third of radius/ulna Centre Point: Centre on elbow joint 1. Elbow as straight as possible 2. Posterior surface against cassette 3. Instruct patient to rotate entire arm laterally so anterior surface of elbow is approx. 45 to cassette 4. Patient will need to lean into affected shoulder 1. Entire elbow joint with distal third of humerus and proximal third of radius visualised 2. Radial head and ulna will not be superimposed 3. Lateral epicondyle will appear more in profile and elongated Page 23
Section 2 UPPER EXTREMITY 2.5 ELBOW - LATERAL Detector/Cassette: 18x24cm Orientation: Landscape Collimation: To include elbow joint, distal third of humerus and proximal third of radius/ulna Centre Point: Ensure centred over elbow joint 1. Elbow and wrist in lateral positions elbow flexed 90 with wrist straight 2. Ensure cassette is raised to a level in line with patient s shoulder, brings the humerus parallel to the cassette 3. To align epicondyles, wrist will need to be slightly elevated off cassette while maintaining elbow contact with cassette sponge support advised 1. Entire elbow joint with distal third of humerus and proximal third of radius visualised 2. Both epicondyles superimposed 3. Olecranon process seen in profile Page 24
Section 2 UPPER EXTREMITY 2.6 HUMERUS - AP Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: To include shoulder and elbow joints. Twist collimators to run along humerus Centre Point: Mid humerus 1. Posterior aspect of humerus against bucky 2. Entire arm slightly abducted away from body 3. Palmar surface of hand facing forward 1. Entire humerus included 2. Ensure both shoulder and elbow joints are visualised in AP projections 3. Greater tubercle seen in profile Page 25
Section 2 UPPER EXTREMITY 2.6 HUMERUS - LATERAL Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: To include shoulder and elbow joints. Twist collimators to run along humerus Centre Point: Mid humerus 1. Patient facing bucky 2. Instruct patient to flex elbow and place hand on lower abdomen 3. Arm slightly abducted away from body 4. Humerus touching bucky 1. Entire humerus included 2. Ensure both shoulder and elbow joints are visualised in lateral projections 3. Epicondyles of elbow superimposed Page 26
Section 2 UPPER EXTREMITY 2.7 SHOULDER - AP Detector/Cassette: 24x34cm Orientation: Landscape Central Ray: Perpendicular to bucky Collimation: To include proximal third of humerus and entire clavicle and scapula Centre Point: 2.5cm inferior to coracoid process 1. Posterior aspect of shoulder against bucky 2. Clavicle should run parallel to bucky 3. Hand externally rotated Respiration: Suspend respiration 1. Proximal third of humerus, entire clavicle and scapula visualised 2. Adequate external rotation of hand is demonstrated by greater tubercle on lateral aspect of humeral head viewed in full profile Page 27
Section 2 UPPER EXTREMITY 2.7 SHOULDER - LATERAL Detector/Cassette: 24x30cm Central Ray: Perpendicular to bucky Collimation: To include entire shoulder joint and scapula. Twist collimators to run along humerus Centre Point: Mid scapula 1. Patient facing bucky 2. Instruct patient to flex elbow and place hand on lower abdomen 3. Arm slightly abducted away from body 4. Palpate medial border of scapula, rotate patient so scapula is perpendicular to bucky Respiration: Suspend respiration 1. Entire scapula visualised in Y position indicating true lateral 2. Humeral head superimposed on body of scapula 3. Proximal third of humerus Page 28
Section 2 UPPER EXTREMITY 2.7 CLAVICLE AP UPTILT Detector/Cassette: 24x30cm Orientation: Landscape Central Ray: 20-30 uptilt Collimation: To include entire clavicle Centre Point: Mid clavicle 1. Posterior aspect of shoulder against bucky 2. Clavicle should run parallel to bucky Respiration: Suspend respiration 1. Entire clavicle visualised 2. Most of clavicle should be projected above scapula and ribs Page 29
Section 3 LOWER EXTREMITY 3.1 FOOT - DP Detector/Cassette: 24x30cm Central Ray: 15 uptilt Collimation: To include all toes and metatarsals Centre Point: Mid 3 rd metatarsal 1. Patient supine with knee flexed 2. Plantar surface of foot against cassette 1. X-ray viewed with toes at top of film, not anatomically 2. No rotation equidistant between 2 nd -5 th metatarsals 3. All toes and tarsal bones visualised Page 30
Section 3 LOWER EXTREMITY 3.1 FOOT - OBLIQUE Detector/Cassette: 24x30cm Collimation: To include all toes and metatarsals Centre Point: Mid 3 rd metatarsal 1. Patient supine with knee flexed 2. Dorsal surface of foot against cassette 3. Entire leg internally rotated until plantar surface approx. 30-40 to cassette 1. X-ray viewed with toes at top of film, not anatomically 2. Correct obliquity demonstrated when 2 nd -5 th metatarsals are free of superimposition of each other 3. All toes, tarsal bones and calcaneum visualised Page 31
Section 3 LOWER EXTREMITY 3.1 FOOT LATERAL Detector/Cassette: 24x30cm Orientation: Landscape Collimation: To include toes to calcaneum and distal tibia/fibula Centre Point: Base of metatarsals 1. Patient supine and rolled slightly onto affected side 2. Knee flexed with lateral aspect of foot against cassette 3. Ensure the plantar aspect is perpendicular to cassette 1. X-ray viewed with toes at top of film, not anatomically 2. Metatarsals superimposed on each other 3. Toes to calcaneum and distal tibia/fibula must be visualised Page 32
Section 3 LOWER EXTREMITY 3.2 ANKLE - AP Detector/Cassette: 18x24cm Collimation: To include distal tibia/fibula and proximal half of metatarsals Centre Point: Midway between malleoli 1. Foot flexed with plantar surface perpendicular to cassette 2. Leg in true AP position 1. Medial mortise joint should be open, and the lateral closed 2. Some superimposition of the distal tibia and fibula Page 33
Section 3 LOWER EXTREMITY 3.2 ANKLE - OBLIQUE Detector/Cassette: 18x24cm Collimation: To include distal tibia/fibula and proximal half of metatarsals Centre Point: Midway between malleoli 1. Foot flexed with plantar surface perpendicular to cassette 2. Internally rotate entire leg until 5 th toe lines up with middle of heel 1. Both medial and lateral mortise joints will be open 2. Less superimposition of distal tibia and fibula than AP projection 3. Malleoli will be visualised in profile Page 34
Section 3 LOWER EXTREMITY 3.2 ANKLE - LATERAL Detector/Cassette: 18x24cm Collimation: To Include base of 5 th metatarsal, calcaneum and distal tibia/fibula Centre Point: Medial malleolus 1. Patient supine, rolled slightly onto affected side 2. Foot flexed to 90 3. Plantar surface perpendicular to cassette 1. Distal tibia/fibula superimposed 2. No rotation tibiotalar joint will be uniformly open 3. Ensure base of 5 th metatarsal is included Page 35
Section 3 - LOWER EXTREMITY 3.3 TIBIA / FIBULA - AP Detector/Cassette: 35x43cm tibia diagonally across cassette Collimation: To include knee and ankle joint. Twist collimators to run along tibia Centre Point: Mid tibia/fibula 1. Patient supine with leg extended 2. Posterior aspect of calf against cassette 1. Entire tibia/fibula visualised with knee and ankle joints in AP position Page 36
Section 3 LOWER EXTREMITY 3.3 TIBIA / FIBULA - LATERAL Detector/Cassette: 35x43cm tibia diagonally across cassette Collimation: To include knee and ankle joint. Twist collimators to run along tibia Centre Point: Mid tibia/fibula 1. Patient supine rolled slightly onto affected side 2. Knee flexed 3. Lateral aspect of leg against cassette 1. Entire tibia/fibula visualised with knee and ankle joints in lateral position 2. Proximal and distal portion of tibia/fibula will be superimposed on each other Page 37
Section 3 LOWER EXTREMITY 3.4 KNEE - AP Detector/Cassette: 24x30cm Collimation: To include knee joint and patella, distal femur and proximal tibia/fibula Centre Point: 1cm below patella 1. Patient supine with leg extended 2. Posterior aspect of leg against cassette 3. Ensure patella is centred to femur for true AP position 1. Femoral condyles in profile 2. No rotation intercondylar eminence central to femur 3. Head of fibula will be partially superimposed by tibia Page 38
Section 3 LOWER EXTREMITY 3.4 KNEE - LATERAL Detector/Cassette: 24x30cm Collimation: To include knee joint and patella, distal femur and proximal tibia/fibula Centre Point: 1cm below patella, along midline axis of leg 1. Patient lying completely on affected side 2. Other leg brought up and over affected leg. Patient ends up laying in a recovery position 1. Patella in profile 2. Medial and lateral femoral condyles superimposed 3. Fibula head partially superimposed by tibia Page 39
Section 4 PELVIC GIRDLE 4.1 PELVIS / HIP AP Detector/Cassette: 35x43cm Orientation: Landscape Collimation: Collimate to cassette size. Do not increase collimation greater than cassette size. Centre Point: Midway between ASIS and pubic symphysis, along patient midline 1. Patient supine 2. Heels hip width apart 3. Feet internally rotated so toes touch pigeon toed (if fracture suspected, don t internally rotate) Respiration: Suspend respiration 1. Must include iliac crests, greater trochanters and proximal third of femurs 2. No rotation iliac wings and obturator foramen will appear same size 3. Correct internal rotation will hide lesser trochanters behind femurs and bring greater trochanters into profile Page 40
Section 4 PELVIC GIRDLE 4.2 HIP LATERAL (PERFORM ONLY IF NO FRACTURE) Detector/Cassette: 24x30cm, use 35x43cm if for THR follow-up Collimation: Collimate to cassette size. Twist collimators to run along femur Centre Point: Level of pubic symphysis, along axis of femur of affected side 1. Patient supine, roll patient 30 onto affected hip with support under back 2. Flex hip and knee slightly 3. Keep knee slightly raised off bed to keep Neck Of Femur elongated Respiration: Suspend respiration 1. Must include entire hip joint, acetabulum and proximal third of femur 2. Lesser trochanter visualised in profile 3. Obturator foramen adjacent to affected hip will be closed 4. If prosthesis, must include entire prosthesis Page 41
Section 5 SPINAL COLUMN 5.1 CERVICAL SPINE - AP Detector/Cassette: 24x30cm Central Ray: 15-20 uptilt Collimation: To include mastoid air cells of skull and sternal notch Centre Point: Adam s apple - to pass through C4 1. Patient s back against bucky 2. Chin slightly raised 3. No rotation of the head 1. Ensure C3-T1 are visualised in AP projection 2. No rotation spinous process of each vertebra should appear in the middle of each vertebra, Sterno-clavicular joints equal size 3. Mandible and skull base superimposed on each other and over C1 and C2 Page 42
Section 5 SPINAL COLUMN 5.1 CERVICAL SPINE - LATERAL Detector/Cassette: 24x30cm Collimation: Collimate to cassette size. Position with upper border of collimation just above top of ear Centre Point: Level of C4 1. Patient in lateral position with left shoulder against bucky 2. Shoulders relaxed 3. Chin slightly raised Respiration: Expiration this will relax patient s shoulders 1. Visualise C1 to upper border of T1 2. C1 and C2 free of superimposition from mandible 3. All spinous processes 4. Anterior soft tissue structures Page 43
Section 5 SPINAL COLUMN 5.2 THORACIC SPINE - AP Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce lateral borders to approximately 15cm wide Centre Point: Level of T7, entering through lower third of sternum 1. Patient supine 2. Chin slightly raised Respiration: Inspiration 1. Ensure C7 to L1 visualised 2. No rotation spinous process of each vertebra should appear in the middle of each vertebra, Sterno-clavicular joints equal size Page 44
Section 5 SPINAL COLUMN 5.2 THORACIC SPINE - LATERAL Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce lateral borders to approximately 20cm wide Centre Point: T7, along axis of spine 1. Patient lies on left side in lateral position 2. Both hands resting on pillow in front of face 3. Ensure upper and lower back are in lateral position Respiration: Inspiration 1. Ensure T3 to L1 is visualised (T1 and T2 usually aren t seen) 2. All intervertebral disc spaces open 3. Spinous processes in profile 4. No rotation posterior aspects of all vertebra should be superimposed Page 45
Section 5 SPINAL COLUMN 5.3 LUMBAR SPINE - AP Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce lateral borders to approximately 20cm wide Centre Point: 3cm above iliac crest, along axis of spine 1. Patient supine or prone if possible (prone will allow all intervertebral disc spaces to be seen) Respiration: Expiration 1. Ensure T12 to sacrum is visualised, including SI joints 2. No rotation spinous process of each vertebra should appear in the middle of each vertebra Page 46
Section 5 SPINAL COLUMN 5.3 LUMBAR SPINE - LATERAL Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: Collimate to cassette size. Reduce lateral borders to approximately 20cm wide Centre Point: 3cm above iliac crest, along axis of spine (spine falls midway between ASIS and PSIS) 1. Patient lies on left side in lateral position 2. Ensure upper and lower back are in lateral position 3. Both legs resting on top of each other, knees slightly bent Respiration: Expiration 1. Ensure T12 to sacrum is visualised 2. All intervertebral disc spaces open 3. Spinous processes in profile 4. No rotation posterior aspects of all vertebra should be superimposed Page 47
Section 6 - ABDOMEN 6.1 ABDOMEN AP SUPINE Detector/Cassette: 35x43cm Central Ray: Perpendicular to bucky Collimation: Collimate to film size. Do not increase collimation greater than film size. Centre Point: Iliac crest, along midline 1. Patient supine 2. For erect AXR patient s back against upright bucky Respiration: Inspiration 1. Pubic symphysis at bottom of image 2. Soft tissue shadow of liver visualised at top of film 3. No rotation iliac wings equal size Page 48