Anatomical Position

A person in the anatomical Directional Terms

position is standing erect with Lateral - Away from the midline of the body (On the
the head, eyes and toes outer side of) e.g. the arms are lateral to the chest.
pointing forward, feet together
with arms by the side. The Medial - Near to the midline of the body (On the
palms of the hands are also Inner side of) e.g. the chest is medial to the arms
pointed forward.
Superior (cephalic/ cranial) - Towards the head
Body Planes end or towards the upper part of a structure
A plane is a flat surface passed (above) e.g. The head is superior to the chest.
through the body or a portion
of the body. Inferior (Caudal) - Away from the head end or
towards the lower part of a structure (Below) e.g.
the abdomen is inferior to the chest.

Anterior ( ventral ) - Towards or at front of the

body (in front of) e.g. The sternum is anterior to the
spine.

Posterior (Dorsal) - Towards or at the back of the

body (Behind) e.g. The heart is posterior to the
sternum.

Proximal - Close to the origin of the body part or

the point of attachment of a limb to the trunk e.g.
The knee is proximal to the ankle.

Body planes are divided into: Distal - Farther or away from the origin of the body
●​ Longitudinal planes part or the attachment of a limb to the trunk e.g.
○​ Coronal The forearm is distal to the arm.
○​ Sagittal
●​ Horizontal plane Superficial - Towards or at the body surface e.g.
○​ Transverse The skin is superficial to the skeletal muscles

Sagittal Plane (Median plane) - A vertical plane Deep - Away from the body surface (more internal)
running from front to back; divides the body or any e.g. The skeletal muscles are deep to the skin
of its parts into right and left sides.
Joints Movement Terms
Coronal Plane (Frontal) - A vertical plane running Abduction - movement away from the midline of
from side to side; divides the body or any of its the body or body part.
parts into anterior and posterior portions.
Adduction - Movement toward the midline of the
Axial Plane (Transverse Plane) - A horizontal body or body part.
plane; divides the body or any of its parts into
upper and lower parts. Flexion - Decrease in the angle of a joint by bending

Oblique Plane - An oblique plane is a longitudinal Extension - Increase in the angle of joint or
or transverse plane that is at an angle or slant and straightening of a joint
is not parallel to the sagittal, coronal, or horizontal
plane. Inversion - Turning of foot inward at the ankle
joint.
Eversion - Turning of the foot outward at the ankle Decubitus - general meanings are the same "LYING
joint. DOWN" but in radiography, decubitus has a special
meaning, patient is lying down & the x-ray beam is
Pronation - Turning the hand so that the palm is parallel to the horizon
down or onto one's stomach -​ In radiographic positioning, decubitus is
always performed with the central ray
Supination - Turning the hand so the palm is facing horizontal.
upward or turning onto one's back. -​ designated according to the surface on
which the body is resting.
Body Position Terms
Describe the overall placement of the body in the Decubitus Positions
desired position. Ventral Decubitus - patient is prone, Cassette (IR)
is vertical & a horizontal beam is used
Erect "upright" - Position when the Sagittal and
coronal planes of the body are perpendicular to the Dorsal Decubitus - patient is supine, Cassette (IR)
horizon is vertical & a horizontal beam is used

Recumbent "lying down" - Position when the Lateral Decubitus (Right or Left) - patient lying on
transverse plane of the body is perpendicular to the left lateral side, Cassette (IR) is vertical & a
the horizon horizontal beam is used

Fowler's Position - A person in the Oblique (Erect or Recumbent)

Fowler's position is sitting leaning slightly ●​ Position when the body is rotated so that
back 45°- 90°, legs may either be straight the MSP is neither nor to the film but at an
or bent. angle.
●​ Exact position is indicated by the surface
Trendelenburg Position - A person in the closest to the film and the angle of rotation.
Trendelenburg position is lying supine with ●​ May be erect or recumbent.
their head slightly lower than their feet.
Abbreviations: RPO, LPO, RAO, LAO
Sim's Position - A near lateral Left anterior
oblique (Left Sim's) OR right anterior Erect Positions
oblique with the top leg in front the lower Surface of body closest to the film used to
leg. give a more specific description

Lithotomy Position - knees and hip flexed Examples:

and thighs abducted and rotated externally, Posterior erect -- patient is standing with
supported by ankle supports. the posterior surface of the body next to the
cassette
Recumbent Positions
Supine (dorsal recumbent position) Recumbent - Left lateral erect -- patient is standing with
Lying down on the back the left side of the body next to the cassette

Prone (ventral recumbent position) Recumbent - Projection

Lying face down Refers to the path the x-ray beam takes through
part
Lateral Recumbent - lying down on the side
Anteroposterior Projection (AP) - Beam enters
Decubitus vs. Recumbent the front surface and exits the back surface of the
Recumbent - general meanings are the same part
"LYING DOWN"
Posteroanterior Projection (PA) - Beam enters the
back and exits the front of the part Asthenic
●​ Exaggeration of Hyposthenic type
Lateral Projections ●​ Thorax narrow and shallow
●​ Torso (Trunk) and head ●​ Heart longer and narrow
●​ Right to left lateral projection ●​ Thoracic cavity longer
●​ Left to right lateral projection ●​ Diaphragm is very low
●​ Extremities (Limbs) ●​ Stomach and GB very lower, vertical and
●​ Mediolateral projection near midline.
●​ Lateromedial projection
Topographic Landmarks
Special Projections
Axial Projection
●​ Right to left lateral projection
●​ Left to right lateral projection

Tangential projection
Mediolateral projection
Lateromedial projection

Classification of Body Habitus

A.​ Cervical Region

C1 - level of Mastoid tip
Hypersthenic C2 - level of Gonion
●​ Deep broad thorax C3 - level of Hyoid bone
●​ Short thoracic cavity C4/C5 - level of Thyroid cartilage
●​ Short wide heart C7 - level of vertebra prominens
●​ Elevated diaphragm B.​ Thoracic Region
●​ Stomach and GB very high T1 - 2 inches above jugular notch
●​ Colon high and wide T2/T3 - level of jugular notch
T4/T5 - level of sternal angle
Sthenic T7 - level of inferior angle of scapula
●​ Lightly longer and shallow thorax T9/T10- level of xiphoid tip
●​ Ribs more vertical C.​ Lumbar Region
●​ Heart narrow and longer L2/L3 - level of inferior coastal margin
●​ Thoracic cavity longer L4/L5 - level of iliac crests
●​ Diaphragm is not as high D.​ Sacrum and Pelvic Region
●​ Colon slightly lower and more centrally S1/S2 - level of ASIS
located. COCCYX- level of pubic symphysis and
greater trochanters
Hyposthenic
●​ Thorax longer
●​ Diaphragm lower
●​ Stomach and GB lower and close to midline.
●​ Colon lower and close to midline of
abdomen
1.​ For the examination mentioned above, what
body plane is placed (a) perpendicular to
the IR? (b) parallel to the IR?
a. Sagittal plane
b. Coronal plane
2.​ What surface landmarks are used for this
type of examination?
a. Jugular notch (anterior)
b. Vertebra prominens (posterior)
c. Both topographic landmarks will
be used for centering and edging of
the cassette for an Apicolordotic
position
3.​ If an AP examination of the patient is
requested while lying down, what is the
general body position?
ANS: Supine
4.​ If the patient is lying down on his back on
the table and the central ray is directed
horizontally, (a) what is the specific body
position? (b) what is the projection?
a. Dorsal decubitus
b. Lateral projection
5.​ Describe the patient body habitus in term of
organs involved. ANS: (refer to Body
Habitus discussion)
Immobilization Techniques abdomen to enhance diagnostic information in
Velcro Straps. Although often not considered a certain procedures.
form of restraint, Velcro straps can be effective as -​ When performing gastrointestinal
restraining or positioning devices. A good example procedures—for example, placing the
of the use of straps is provided by an upright lateral patient in the semi-erect position—may be
chest position. The patient should be standing for a desirable. In these circumstances, when a
chest examination if at all possible. Although patient is too weak to stand unassisted,
capable of standing, a patient who has not been Velcro strap restraints can be applied across
regularly ambulatory for a time may be unsteady the patient’s upper and lower abdomen to
when standing at the upright cassette holder. support the patient firmly during the
Placing Velcro straps across the upper portion of procedure. This precaution helps reassure
the patient’s chest can help the patient hold still the patient that he or she will not fall.
and also provides a sense of security. Holding the
arms up out of the way when positioning for a Sandbags. Sandbags are useful positioning and
lateral chest radiograph raises the center of balance immobilization devices and can be used in a variety
and can cause slight swaying even in the steadiest of ways. By themselves or in combination with
subject. positioning sponges, sandbags are extremely
-​ Velcro straps also can be used in helpful in reducing voluntary motion. Sandbags,
immobilizing only the area of interest unlike radiolucent positioning sponges, are
during the procedure. For example, an axial radiopaque (i.e., radiation does not pass through
projection of the calcaneus requires easily). As a result, they cannot be placed in such a
extreme dorsiflexion of the ankle to produce way that diagnostic information is obscured within
an optimally diagnostic image. The use of the anatomic area of interest. They must be placed
the strap beneath the plantar surface of the gently on or against the areas adjacent to the
foot allows the patient to maintain the anatomic area of interest so as not to injure or
extreme flexion required and at the same cause further damage.
time reduces the possibility of motion that -​ A common use of sandbags as positioning
may result from maintaining an aids is in performing examination of a
uncomfortable position. lateral cervical spine or of the
-​ Velcro straps can serve as a safety acromioclavicular joints. Both examinations
precaution when performing a procedure require that the shoulders lie in the same
on a patient who is not completely transverse plane and that the patient hold
cognizant, such as those who are heavily sandbags of equal weight. For the lateral
medicated or intoxicated or who have cervical spine, the patient must depress the
diminished mental capacities. This type of shoulders as much as possible to
patient should never be left unattended; the demonstrate the lower cervical vertebrae.
straps serve only to facilitate protection of
the patient from injury. With straps in place, Head Clamps. Head clamps can be attached to
sudden or unexpected movement by the radiographic imaging devices (e.g., radiographic
patient would not result in injury to the table, upright cassette holder) and are designed
patient and would allow the attendant to strictly for use in positioning various projections of
respond to the situation. the skull. When applied safely and appropriately,
head clamps serve more as positioning aids than as
Velcro Strap Restraints. Velcro strap restraints are immobilization devices. A patient so desiring can
designed to be attached easily to the radiography easily pull away from the head clamps. Head clamps
table. These types of restraints include two brackets serve as a reminder to the patient of the importance
that mount to each side of the table with a strap of remaining as still as possible, and they ensure the
that is adjustable for any size patient. It can be reduction of voluntary movement on the part of the
adjusted to cover any part of the body, such as the patient.
chest, abdomen, or legs. These restraints also can
be used for compression. Tightening the strap a Special Application. Immobilization techniques
little further applies gentle pressure to the are often required for use with trauma, pediatric,
and geriatric patients. Each type of patient provides comfort for the patient are enhanced if two
unique opportunities to apply immobilization people, working together, remove
techniques. immobilization devices.

Trauma Applications. Methods for safely and Spinal Trauma. The most common spinal trauma
expeditiously performing examinations on badly traction device encountered by a technologist is
traumatized patients involve entirely different probably the cervical collar. This device is designed
concepts. Immobilization is one of the most critical to place traction on the cervical spine to prevent
considerations when working with seriously further life-threatening movement in this vital area.
injured patients. In these instances, the technologist The cross-table lateral, anteroposterior (AP), and
is faced with immobilization devices that have AP open-mouth positions may be used to evaluate
already been applied to the trauma patient by the the cervical spine during a cervical trauma
emergency medical team to stabilize the area of examination. After evaluating the images, the
injury and to facilitate safe transport to the trauma attending physician or neurosurgeon can
center. The technologist must be familiar with the determine the next step in treatment. All
various types of traction and immobilization projections can be produced with the cervical collar
techniques and devices used by emergency medical in place, and it will be removed only after the
personnel. This familiarity must include knowledge physician has reviewed the radiographic images
of which devices are radiolucent, which must be left and determined that it is safe to move the patient
in place for initial examinations, and when these without the collar.
devices can safely be removed for more detailed -​ The backboard, or spineboard, is another
procedures. spinal immobilization device often seen in
-​ In many situations the technologist must trauma situations. Although the backboard
consider performing the initial examination is mentioned here under spinal trauma
with immobilization devices left in place. In considerations, its uses are by no means
fact, more often than not, the technologist limited to spinal injury. It is used to
has no choice but to perform the procedure immobilize and support the victim’s entire
in this manner. Fortunately, manufacturers body. A backboard can be used if the
of emergency traction devices are designing thoracic or lumbar spine is involved.
equipment to use radiolucent materials Additional trauma situations in which the
whenever possible. This equipment permits backboard is used include injuries to the
initial studies to result in increased pelvis, hips, and lower extremities and
diagnostic information without endangering when multiple injuries in addition to spinal
the trauma patient by necessitating the trauma are present.
removal of immobilization devices. -​ Most backboards are made from radiolucent
-​ In most instances, initial images can and materials (e.g., wood, plastic), making
should be produced without removing radiography of patients relatively easy. With
immobilization devices. Only after a assistance, one end of the backboard can be
radiologist or an attending physician has lifted and a cassette placed under the area
read the initial images and approval has of interest beneath the board. All AP
been given should the technologist remove projections from head to toe can be
the immobilization device for a more accomplished in this manner.
complete examination. -​ Another advantageous purpose for the
-​ Immobilization devices should be removed backboard is to transport a stable trauma
gently while maintaining patient comfort patient to the radiology department for the
and safety by immobilizing the injured area initial examination. Moving the patient onto
above and below the device. Positioning the table by sliding the entire backboard
sponges should be placed to support the onto the examination table is relatively easy
anatomic area of interest. Depending on his for the movers and comfortable for the
or her condition, the patient may be moved patient. Once the radiologist has evaluated
or rolled slightly to facilitate removal of the the initial images, the backboard can be
device. If help is available, safety and moved from under the patient for further
projections. Conversely, if the findings
indicate the presence of fracture or other
traumatic involvement, the patient can be
safely moved back onto a stretcher for
transport to surgery, the emergency
department, or the appropriate treatment
area.
1.​ In the figure above, (a) what device is used
to limit the motion of the patient? (b) Can
this device be used for adults?
a.​ The Pigg-O-Stat - It seems that these
were used a lot more in decades
past. The Pigg-O-Stat has been used
successfully all over the world, by
doctors, clinics and radiographers
for over 40 years. The Pigg-O-Stat
was originally designed by a
technician with many years of
experience with the problems
encountered in immobilizing and
positioning infants and children.
They are great in a pinch when
nobody is around to help and if the
baby is calm, but they are not
effective for babies who are
motivated to squirm out of it. The
Pitt-O-Stat has fallen out of favor
probably due mostly to the
proliferation of velcro and
radioluscent foam allowing it to be
replaced by papoose style
restrainers.
2.​ If the patient presented above is to undergo
chest examination (a) is the 6 feet SID
acceptable? (b) should a caliper be used? (c)
is there a need for any protective device?
a.​ For chest AP (child) radiography, A
40 inches (3 feet) SID is commonly
used, this would result to slight
magnification of the cardiothoracic
ratio to an acceptable value of 0.55
CTR.
3.​ For the mentally challenged patients, what
devices can be used to limit their motion?
How about for the geriatric patients?
a.​ Any of the immobilization devices
mentioned above can be used when
necessary and applicable.
4.​ List other devices that can be used during a
radiographic examination.
a.​ Refer to the discussion above.