Radiographic Projections
&
Positioning Guide
Imaging Procedures
Olive Peart M.S. R.T. (R) (M)
Peltrovijan Publishing
P.O. Box 738
Greenbelt, MD 20768-0738
[Link]
The author does not guarantee and assumes no
responsibility on the accuracy of any websites, links or
other contacts contained in this book.
Radiographic Projections & Positioning
Imaging Procedures
All rights reserved.
Copyright © 2023 by Olive Peart
PRINTING HISTORY
Peltrovijan Publishing/2023
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ISBN: 979-8-387594-09-0
Books by Olive Peart
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A comprehensive review for the mammography ARRT
registry examination including the history of breast
imaging, breast cancer detection, and treatment.
Lange Q & A Mammography Examination.
Everything you need to ace the ARRT Mammography
Exam in one complete study package. Includes 450
ARRT-style questions plus two complete practice exams.
Mammography and Breast Imaging: Just the Facts.
The perfect review tool for radiologic technologists
certifying or recertifying. The book includes all breast
imaging modalities and techniques as well as questions
for self-assessment.
Life After High School: Traits that Help and Traits that
Hurt.
This no-nonsense text explains positive and negative
traits that can help or hinder teens in their post high school
life. The guide gives readers strategies, helping them to
identify the path to success and to avoid the route that
often leads to failure.
The Dangers of Medical Radiation
How to protect yourself from medical radiation!
Spanish for Radiology Professionals: An
English/Spanish Pocket Guide
Spanish for Radiology Professionals is an English to
Spanish translations of often-used, technical terms and
radiological instructions. This book is easy to use, even
for someone with limited Spanish. The Spanish includes
a phonetic spelling guide for easy pronunciation.
Table of Content
ACKNOWLEDGMENT ----------------------------------------------- 11
PREFACE --------------------------------------------------------------- 12
Radiographic Policies and Procedures -------------------- 14
Importance of Standard Precautions -------------------------- 14
Clinical History Documentation --------------------------------- 16
General Imaging Rules --------------------------------------------- 17
Imaging Information ----------------------------------------------- 20
Factors Controlling Image Quality–Digital ------------------- 21
Limiting Radiation to Patients ----------------------------------- 25
Anatomical Position ------------------------------------------------ 27
Radiographic Planes ------------------------------------------------ 28
Body Habitus and Pathology ------------------------------------- 29
Radiographic Terms ------------------------------------------------ 31
Radiographic Body Positions ------------------------------------- 32
Radiographic Projections ----------------------------------------- 32
Projection Terminology ------------------------------------------- 33
Specific Body Positions -------------------------------------------- 33
Relationship Terms ------------------------------------------------- 34
Terms Related to Movement ------------------------------------ 35
External Body Landmarks ----------------------------------------- 36
Chest and Upper Airway Imaging -------------------------- 38
Anatomy of Respiratory System -------------------------------- 39
Upper Airway–AP projection ------------------------------------ 40
Upper Airway–Lateral---------------------------------------------- 42
Chest–PA projection------------------------------------------------ 44
Chest–Lateral projection ------------------------------------------ 46
Chest Oblique–Right Anterior Oblique position ------------ 48
Chest–Lordotic position ------------------------------------------- 52
Chest–Decubitus ---------------------------------------------------- 54
Abdomen Imaging -------------------------------------------------- 56
Divisions of the Abdomen ---------------------------------------- 57
Abdomen Positioning Considerations ------------------------- 59
Abdomen–Supine, AP projection ------------------------------- 60
Abdomen–Prone, PA projection -------------------------------- 62
Abdomen–Erect, PA projection --------------------------------- 64
Abdomen–Lateral projection ------------------------------------ 66
Abdomen–Lateral Decubitus position ------------------------ 68
Abdomen–Dorsal Decubitus ------------------------------------- 70
Abdomen–AP Oblique projections, ---------------------------- 72
Upper Extremity Imaging ------------------------------------ 74
Bones of Upper Extremity ---------------------------------------- 75
Finger–PA ------------------------------------------------------------- 76
Finger–Oblique ------------------------------------------------------ 78
Finger–Lateral ------------------------------------------------------- 80
Thumb–PA ------------------------------------------------------------ 82
Thumb–AP ------------------------------------------------------------ 84
Thumb–PA Oblique ------------------------------------------------ 86
Thumb–Lateral ------------------------------------------------------ 88
Hand–PA -------------------------------------------------------------- 90
Hand–PA Oblique --------------------------------------------------- 92
Hand–AP Oblique --------------------------------------------------- 94
Hand–Lateral, (fan lateral) --------------------------------------- 96
Hand–Lateral, (extension lateral) ------------------------------ 98
Hand–Lateral, (natural flexion lateral)----------------------- 100
Wrist–PA ------------------------------------------------------------- 102
Wrist–PA oblique -------------------------------------------------- 104
Wrist–AP oblique -------------------------------------------------- 106
Wrist–Lateral ------------------------------------------------------- 108
Wrist–PA with Ulnar deviation -------------------------------- 110
Wrist–PA with Radial Deviation ------------------------------- 112
Wrist–PA Scaphoid ------------------------------------------------ 114
Wrist–Carpal Canal, Tangential Inferosuperior ------------ 116
Forearm–AP projection ------------------------------------------ 118
Forearm–Lateral --------------------------------------------------- 120
Elbow–AP ------------------------------------------------------------ 122
Elbow–Lateral ------------------------------------------------------ 124
Elbow–Medial Oblique (internal rotation)------------------ 126
Elbow–Lateral Oblique (external rotation) ----------------- 128
Elbow–AP Partial Flexion ---------------------------------------- 130
Elbow–Acute Flexion --------------------------------------------- 134
Elbow–Radial head Rotational Projection ------------------ 136
Elbow–Radial Head Projection -------------------------------- 144
Elbow–Coronoid Process Projection ------------------------- 146
Humerus–AP-------------------------------------------------------- 148
Humerus–Lateral (mediolateral) ------------------------------ 150
Humerus–Lateral (lateromedial) ------------------------------ 152
Shoulder Girdle ----------------------------------------------- 154
Anatomy of the Shoulder --------------------------------------- 155
Shoulder–Transthoracic Lateral projection ---------------- 162
Shoulder–Inferosuperior Axial projection ------------------ 166
Shoulder – Supraspinatus “Outlet” projection, Neer.--- 174
Clavicle–AP projection ------------------------------------------- 176
Clavicle–AP Axial projection ----------------------------------- 178
Acromioclavicular (AC) Joint–AP projection --------------- 180
Scapula–AP --------------------------------------------------------- 184
Scapula–Lateral, RAO or LAO positions --------------------- 186
Scapula–Lateral, RPO or LPO positions---------------------- 188
Lower Extremity Imaging ---------------------------------- 190
Bones of the Lower Extremity --------------------------------- 190
Toes–AP dorsoplantar ------------------------------------------- 192
Toes –AP Oblique ------------------------------------------------- 194
Toes–Mediolateral or Lateromedial ------------------------- 196
Sesamoid bones–Tangential projection--------------------- 198
Foot–AP Axial ------------------------------------------------------ 200
Foot–Medial Oblique (medial rotation)--------------------- 202
Foot–Lateral (mediolateral and lateromedial) ------------ 204
Foot–Lateral, Weight Bearing---------------------------------- 206
Calcaneus—Axial -------------------------------------------------- 208
Calcaneus–Lateral ------------------------------------------------- 210
Ankle–AP projection --------------------------------------------- 212
Ankle–Oblique, Mortise 15-20 degree (medial rotation) 214
Ankle–Oblique, 45-degree (medial rotation) -------------- 216
Ankle–Lateral------------------------------------------------------- 218
Ankle–AP Stress/subtalar projection ------------------------ 220
Tibia & Fibula–AP projection----------------------------------- 222
Tibia & Fibula–Lateral projection ----------------------------- 224
Knee–AP projection ----------------------------------------------- 226
Knee–Lateral (mediolateral) projection --------------------- 228
Knee–AP Oblique projection, medial/internal rotation-- 230
Knee–PA Axial intercondylar fossa projection ------------- 234
Knee–PA axial, superoinferior intercondylar fossa ------- 236
Knee–Posteroanterior (AP) axial, superoinferior --------- 238
Knee–AP weight-bearing projection, bilateral ------------- 240
Knee–PA weight-bearing projection, bilateral------------- 242
Patella–PA projection -------------------------------------------- 244
Patella–Lateral (mediolateral) projection------------------- 246
Patella–Tangential Axial projection or sunrise/skyline -- 248
Patella–Tangential Axial Hughston --------------------------- 250
Patella–Tangential Axial projection or sunrise/skyline -- 252
Femur–AP projection --------------------------------------------- 254
Femur–Lateral projection --------------------------------------- 256
Femur–Lateral projection --------------------------------------- 258
Bone leg length study (bilateral scanograms) ------------- 260
Bone leg length study (bilateral) ------------------------------ 262
Bones of the Hip & Pelvis------------------------------------ 264
Appearance of proximal femur with the leg rotation: --- 265
Hip–AP projection ------------------------------------------------- 266
Hip–Lateral (mediolateral) projection ----------------------- 268
Hip–Axiolateral inferosuperior projection ----------------- 270
Hip–Modified Axiolateral trauma projection -------------- 272
Acetabulum–Internal Oblique, LPO or RPO positions ---- 274
Acetabulum–External Oblique, LPO or RPO positions --- 276
Ilium–AP Oblique projection, RPO & LPO positions ------ 278
Ilium–PA Oblique projection, RAO & LAO positions ------ 280
Pelvis–AP projection (bilateral hips) -------------------------- 282
Pelvis–AP projection, unilateral or bilateral ---------------- 284
Pelvis–AP axial projection, Outlet----------------------------- 286
Pelvis–AP axial projection, Inlet ------------------------------- 288
Imaging the Bony Thorax ----------------------------------- 290
Considerations When Imaging the Sternum --------------- 291
Sternum–PA Oblique projection, RAO position ----------- 292
Sternum–Lateral projection, right or left ------------------- 294
Sternoclavicular (S/C) joint–PA projection ----------------- 296
Sternoclavicular (S/C) joint– PA Oblique projections, -- 298
Ribs–AP or PA projection --------------------------------------- 300
Ribs–PA Oblique projection, RAO or LAO positions ------ 304
Ribs–AP Oblique projection, RPO or LPO positions ------ 306
Imaging the Vertebral Spine------------------------------- 308
The Vertebral Column ------------------------------------------- 311
Cervical Spine, C1-2–AP projection--------------------------- 312
Cervical Spine, C1-2–AP or PA projection ------------------ 314
Cervical Spine–AP Axial projection --------------------------- 316
Cervical Spine–Lateral ------------------------------------------- 318
Cervical Spine–AP Oblique projections,--------------------- 320
Cervical Spine–PA Oblique projections,--------------------- 322
Cervical Spine–Hyperflexion Lateral ------------------------- 324
Cervical Spine–Hyperextension Lateral --------------------- 326
Cervical Spine–Lateral Cervicothoracic (C7-T1) ----------- 328
Thoracic spine–AP projection ---------------------------------- 330
Thoracic Spine–Lateral projection ---------------------------- 332
Thoracic Spine– AP Oblique projections, ------------------- 334
Lumbar Spine–AP or PA projection -------------------------- 336
Lumbar Spine–AP or PA oblique projections, ------------- 338
Lumbar Spine–PA or AP oblique projections, ------------- 340
Lumbar Spine–Lateral -------------------------------------------- 342
Lumbosacral junction (L5/S1)–Lateral projection -------- 344
Lumbosacral junction (L5/S1) & ------------------------------- 346
Sacroiliac joint AP axial projection --------------------------- 346
Lumbosacral junction (L5/S1) & ------------------------------- 348
Sacroiliac joint–PA axial projection -------------------------- 348
Sacro-Iliac (S/I) Joint–AP Oblique projections, ------------ 350
Sacrum–AP axial projection ------------------------------------ 352
Coccyx–AP projection -------------------------------------------- 354
Sacrum & Coccyx–Lateral projection ------------------------ 356
Scoliosis–PA projection ------------------------------------------ 358
Scoliosis–Lateral projection ------------------------------------ 360
Scoliosis–PA projection, Right and left Bending ---------- 362
Scoliosis–Lateral hyperflexion projection ------------------ 364
Scoliosis–Lateral hyperextension projection --------------- 366
Imaging the Skull, Sinuses and Facial Bones ----------- 368
Skull–Planes and Baselines-------------------------------------- 371
Skull–BASELINES --------------------------------------------------- 372
Skull–LANDMARKS ------------------------------------------------ 373
Skull–Lateral -------------------------------------------------------- 374
Skull–PA axial projection ---------------------------------------- 376
Skull–PA projection ----------------------------------------------- 378
Skull–AP axial projection ---------------------------------------- 380
Skull–PA axial projection ---------------------------------------- 382
Imaging the Sinuses ----------------------------------------------- 384
Sinuses–Lateral projection -------------------------------------- 386
Sinuses–PA axial projection------------------------------------- 388
Sinuses–Parietoacanthial projection ------------------------- 390
Sinuses–Parietoacanthial, Open Mouth projection ------ 392
Sinuses–Submentovertex (SMV) projection---------------- 394
Facial Bones–Lateral projection ------------------------------- 396
Facial Bones–Parietoacanthial projection ------------------ 398
Facial Bones–Acanthioparietal (AP) Axial projection ---- 400
Facial Bones– Parietoacanthial projection ------------------ 402
Facial Bones–PA 30-degree Axial projection --------------- 404
Facial Bones, Zygomatic Arches– ------------------------------ 406
Facial Bones, Zygomatic Arches–Oblique ------------------- 408
Facial Bones, Mandible–PA projection ---------------------- 410
Facial Bones, Mandible–PA axial projection --------------- 412
Facial Bones, Mandible–Axiolateral Oblique projection 414
Facial Bones, Nasal–Lateral projection ---------------------- 420
Facial Bones, AP axial) -------------------------------------------- 422
Facial Bone, Axiolateral projection --------------------------- 424
Facial Bones, Axiolateral Oblique projection -------------- 426
Facial Bones, Parieto-orbital projection --------------------- 428
Bibliography --------------------------------------------------------- 430
Works of Fiction by Olive Peart writing as Jo Dinage ---- 431
ACKNOWLEDGMENT
I would like to recognize my relatives, friends and many
of the past students from the Stamford Radiology
Program who helped me with patient positions. These
include Kari Adams, Jennifer Ayaso, Yvonne Bijarro,
Gregory Parry, George Peart, Jalal Shirazifard and Kevin
Smith. I am extremely grateful for your help.
Thanks also to my husband, family and friends for their
help and support.
Special thanks to Nupur Chakma, graduate of the
Program in Radiology, Fortis College – Landover, class of
2021 ̶ cohort 2. Her timely suggestions and editing were
greatly appreciated.
I also wish to acknowledge the help I received from the
current students in the Fortis College-Landover radiologic
technology program. These willing and understanding
models are Fransesco Bonilla, Lise Bosquet, Edna
Brizuela, Keiry Castellon, Brittney Cooper, Ena Davis,
Brian Dye, Kelly Fuentes and Hector Anderson Ortiz.
PREFACE
From its earliest beginning after its discovery in 1895, x-
rays were recognized for their amazing ability to penetrate
the human body and visualize the skeletal system. Since
then, diagnostic imaging has undergone numerous
changes in the methods of imaging, developing the
image, image display, and image storage. However,
throughout the ages there has been little change in the
patient positioning aspect of diagnostic radiography.
Despite the increasing importance of imaging modalities,
such as CT, ultrasound, magnetic resonance (MR) and
other molecular imaging studies, it is still essential to
visualize the bones, joints and to image the contents of
the thorax or abdomen on a two-dimensional image.
General radiography often remains the first line of
defense in medical diagnosis.
Radiographic imaging typically requires specific skills and
positioning techniques. It is the effective use of these
positioning skills that makes general radiography such a
challenging and rewarding career option. In fact, poor
image quality or poor positioning skills is sometimes a
factor in the inability of radiographic imaging to diagnosis
pathology, leading radiologists or physicians to seek
alternative imaging modalities.
Turning to an alternative imaging modality should not be
the result of poor image quality or poor positioning skills.
It is understood that significant inaccuracies that can
occur when the central ray is not perpendicular to the part,
the image receptor (IR), the detector or cassette. In
trauma situations, or if the patient cannot move, it is the
responsibility of the imager to manipulate the central ray
and the IR or cassette to produce an accurate
representation of the part.
The desired outcome is a quality image and major
contributing factor is the imager's competency and
positioning skills. However, in addition to knowledge of
positioning, another important role of the imaging
professional is effective communication. The field of
diagnostic radiography can be stimulating, especially
from the patient care aspect. Specific verbal skills are
necessary and required when interacting with the trauma
or seriously ill patient, the intoxicated or mentally
challenged patient, and even the overly anxious or the
pediatric patient.
Finally, imaging professionals must use radiation wisely,
practicing ALARA (As Low As Reasonably Achievable) at
all times.
The positioning and procedure guide can help educators,
students, recent graduates and experienced imagers with
a comprehensive overview of routine imaging procedures
and positioning terminology.
The guide includes is a summary of patient care in
radiology, infection control, patient communication and
digital technology.
Images and details of the fluoroscopy studies, Upper GI
series, Barium Enema, Esophagram, Cystogram, ERCP,
Myelogram, Arthrogram and Hysterosalpingogram are
covered in the companion book, Radiographic
Projections and Positioning Guide – Fluoroscopy
studies.