EXAMINATION PROJECTION CASSETTE SIZE NOTES PRINT ORIENTATION A-C Joints without weights with weights 14x17 CW* One 14x17 divided; both shoulders on one exposure. *If part does not fit, do 10x12s CW. Both shoulders 1 *One exp / Exposure Abdomen, single Must include kidneys and bladder. Abdomen, series erect abdomen supine abdomen erect must include diaphragms; get as much abdomen below diaphragm as possible. supine must include symphasis. Do left lateral decubitus if unable to stand for upright. Abdomen, series Acute erect abdomen supine abdomen PA Chest erect must include diaphragms; get as much abdomen below diaphragm as possible. supine must include symphasis. Do left lateral decubitus if unable to stand for upright. Aneurysm series abdomen Left lateral abdomen LPO abdomen Ankle, survey Ankle, trauma Both obliques (mortise view) Internal oblique flex foot to see tip of lateral malleolus or oblique more if unable to flex foot. Bone Age PA hand & wrist Hand and wrist on one film. Both hands if growth disparity. 1 of 10
Cervical Spine (Routine) Odontoid * Need tip of T-1 on lateral film. Cervical Spine (Trauma) Cervical spine, limited Chest, 2 view Odontoid Both obliques Swimmers, if needed Odontoid Swimmers, if needed PA, left * * * Swimmers if for C-7 if not otherwise seen or if patient is for thoracic spine also. * may be used if they fit in upright bucky. Need tip of T-1 on lateral film. Label obliques PA or. Need tip of T-1 on lateral film. If for R/O penumothorax, add PA expiration view. * Can use cross-wise film for large patient. Clavicle Tangential Tangential with 20 o cephalic angle. * If exposed CW If exp LW Elbow, survey Elbow, trauma Both obliques Be sure to oblique whole arm, not just forearm. must show area of posterior fat pad. Eye for foreign body Modified Water s Caldwell Clean cassettes before beginning exam. If for MRI, delete caldwell. 2 of 10
Facial bones Femur Fingers Water s Modified Water s Caldwell Henderson or base for arches proximal (at hip) distal (from knee up) distal (from knee up) proximal (Frog or medial lateral) PA hand fingers Oblique fingers * If three or more fingers, do complete hand series. * Split cassette lengthwise. Proximal (frog or med-lat) 14x17 Femurs Foot Oblique * * * * Can use if part will fit. Can shoot cadi-corner. Hand PA, separate fingers Oblique use sponge Noorgard view* * For arthritis, do Noorgard view (bowl view). Hip, congenital Van Rosen Bilateral frog 8x10 CW* 8x10 CW* * Film size that is appropriate to child size will be used, not to exceed. Hip, complete (For patients who have had previous hip films) & hip If in ED and hip is fractured, do chest x-ray. (Do x-table hip if suspicious for fx.) Pelvis & Lat Hip Pelvis Lat Hip 3 of 10
Hip, prosthesis (10X12 if possible) Include prosthesis (both ends) on both views. Hip, trauma, children hip * * * Film size that is appropriate to child size. Use gonadal shielding. hips Humerus Knee, survey in 15 degree flexion Knee, trauma Cross- table lateral Both obliques Routine lateral On the cross-table lateral, flex the knee between 15 and 30 degrees no more. KUB abdomen Must include bladder; add projection over kidneys if needed. Lumbar spine (Trauma) Lumbar spine, routine sacrum spot L5-S1 Both obliques sacrum spot L5-S1 * * Center obliques on L5. * A spot will produce an image that is close in size to the full lateral L-spine. 10x12s 14x17s Sacrum/L5-S1 & Lat 4 of 10
Mandible Mastoids PA straight Both obliques Towne s or PA cephalic angle Towne s Both Stenvers Both Rhumstrom** Show condyles and head on oblique views. ** Schuller s with mouth open. All views must be coned. Nasal bones Water s, bilateral * **Split LW, 2 views on 1 cassette. Optic foramen Bilateral Rhese s Orbits (trauma) Os Calcis Modified Water s Caldwell Bilateral Rhese s Tangential Oblique NOTE: On the lateral, print one raw data image and one windowed image. Raw data image is to allow visualization of nasal spine. Paranasal sinuses Water s * Caldwell * * Paranasal sinuses, limited 8X10 LW *Caldwell, Water s and lateral must be erect. Base view, sinus technique Water s * Water s must be erect. cassette may be used if anatomy fits. Patella knee knee Sunrise Pelvis with toes inverted 14x17 CW 5 of 10
Post cast affected area affected area Varies Varies Radius/Ulna forearm forearm 8x10 and 14x17 Long 10x12s bones Ribs, bilateral Ribs, unilateral S-C joints PA chest ribs, upper ribs, lower Oblique uppers Oblique lowers PA chest ribs, upper ribs, lower Oblique uppers Oblique lowers Angle view of s-c joint Tomogram 14x17 CW 14x17 CW Mark points of injury with aluminum spot marker or with QC monitor annotation arrow. Should be printed exactly as they are exposed. Mark points of injury with aluminum spot marker or with QC monitor annotation arrow. Sacroiliac joints 25 o cephalic angle Both obliques at 30 o Obliques must include both joints on each film. If needed, 20 o cephalic angle. Sacrum & coccyx sacrum coccyx sacrum * coccyx * Do lateral coccyx if needed. Scapula 10x12LW 10x12LW 6 of 10
Scoliosis standing with no shoes. standing with no shoes. Scoliosis Cassette Use breast and gonadal shielding. Film processed in mammo darkroom. Sella turcica straight True Auditory canals should be in the orbits of the view Shoulder Skull, internal rotation, external rotation Axillary view Caldwell Towne s Both laterals * * LW with long axis of humerus. If unable to do axillary view due to trauma, do a Y view. Axillary Inter/Exter Soft tissue neck with chin extended Upright with filter. Print raw data. s Sternum Oblique RAO Thoracic spine Swimmer s (Center on T-1) Thoraco-lumbar Includes T-10 to L-2. Swimmers & Lat Tibia-fibula (Kitty-corner) (Kitty-corner) If knee or ankle is ordered, do separate study of affected joint(s). 7 of 10
TMJs Tomograms opened & closed mouth Should be done in exposure room 3 or 4. Toes Foot Obliques * * Split LW, 2 views on 1 cassette. If 3 or more toes, do complete foot examination. Wrist, survey PA Wrist, trauma PA Oblique Navicular When needed, ulnar deviation with 20 o degrees cephalic angulation. Place two views on one film. Zygomatic arches Base or Henderson If not demonstrated as above, do individual oblique views. Complete spine (pathology) cervical spine cervical spine Both obliques, cervical spine thoracic spine thoracic spine lumbar spine lumbar spine 8x10s, 10x12s LW 14x17s LW Complete spine (trauma) cervical spine Open mouth odontoid cervical spine Both obliques, cervical spine, thoracic spine, thoracic spine Swimmers, lumbar spine sacrum, lumbar spine Spot lateral, L5-S1 * A spot will produce an image that is close in size to the full lateral L-spine. is also acceptable. 8x10s, 10x12s LW 14x17s LW 8 of 10
Bone survey (metastatic) Leg length Lower extremities cervical spine cervical spine thoracic spine thoracic spine lumbar spine lumbar spine skull ribs pelvis Long Bones (all) Skull Center over hip, bilateral Center over knee, bilateral Center over ankle joints, bilateral and lateral of lower extremities to include hips to ankles 14x17 CW Long bones include tib-fib and forearm. Use Bell Thompson ruler. 8x10s, 10x12s LW 14x17s LW Bone survey, infant (child abuse) skull skull from neck down to include all upper and lower extremities to ankle ** LW ** CW **LW ** Film size appropriate to child size. 8x10s, 10x12s LW 14x17s LW MAGNIFICATION FACTORS To determine the actual size of the anatomy using CR equipment, you need to know two factors: (1) the size of the cassette used for the procedure and (2) the print orientation. Tools needed: (1) film of the part to be measured; (2) viewbox; (3) ruler which measures in centimeters. Procedure: (a) Measure the part of interest. (b) Consult this routine guide to determine the cassette size used & the table below for the print orientation used. (c) Multiply the measurement obtained in (a) above by the magnification factor located immediately below the picture. The product will be the actual size of the part. Example: Procedure: PA Chest. Size of part measured on the film: 10 cm. Actual size: 10cm x 1.15 = 11.5cm. NOTE: The distance measurement functions on the MagicView workstations are accurate. If the study is still on the hard drive, you can request the technologist to electronically measure the part to be annotated on the printed film. Ignore the incremental scale routinely printed on the film. 9 of 10
Exposure Exposure 14x17 CW Exposure Exposure Exposure 14x17 CW Exposure 1.08 (-7%) 1.35 (-26%) 1.15 (-13%) 1.35 (-26%) 1.15 (-13%) 1.33 (-25%) 10 of 10