Radiographic

Positioning &
Procedure I

NOCHE G. WNDAGAN, RRT

IMAGE RECEPTOR
 In radiography the image receptor (IR) is
the device that receives the energy of
the x-ray beam and forms the image of
the body part. In diagnostic radiology, the
IR will be one of the following four
devices:
Cassette with film
A device that contains
special screens that glow
when struck by x-rays and
imprints the x-ray image
on film. The use of a
darkroom is required
where the film is
developed in a processor.
Afterward the
radiographic film image is
ready for viewing on an
illuminator
Image Plate (IP)
 )-A device similar to a
cassette that contains
special phosphorus that
store the x-ray image.
The IP is inserted into a
reader device, which
does not require a
darkroom. The
radiographic image is
then converted to
digital format and is
viewed on a computer
monitor or printed out
on film
Direct Radiography
 Does not use a
cassette or an IP. A
flat panel detector
built into the x-ray
table or device
captures the x-ray
image and converts
it into digital format.
The image is then
viewed on a
computer monitor or
printed out on film
Fluoroscopic Screen
 The x-rays strike a
fluoroscopic screen
where the image is
formed and the
body part is
transmitted to a
television monitor via
a camera. This is a
"real-time" device in
which the body part
is viewed live on a
television
Radiograph
 Each step in performing a radiographic
procedure mu t be completed accurately to
ensure that the maximal amount of
information is recorded on the image. The
information that results from performing the
radiographic examination generally
demonstrates the presence or absence of
abnormality or trauma. This information assists
in the diagnosis and treatment of the patient.
Accuracy and attention to detail are essential
in every radiologic examination.
Radiographic standpoints
 Superimposition - The relationship of the
anatomic superimposition to size, shape,
position, and angulation must be
reviewed.
 Adjacent structures - Each anatomic
structure must be compared with that of
adjacent structures and reviewed to
ensure that the structure i present and
properly shown.
 Optical density (OD)-Also known as the degree of
film blackening, the optical density of the
radiograph must be within a diagnostic range. If a
radiograph is too light or dark, an accurate
diagnosis becomes difficult or impossible. If a
change in technique is necessary, each of the
following primary factors controlling density must be
considered:
 Milliamperage (mA)
 Exposure time (second)
 Milliampere-second (mAs)
 Contrast -The contrast, or the difference in density
between any two areas on a radiograph, must be
sufficient to allow radiographic distinction of
adjacent structures with different tissue densities. A
wide range of contrast levels is produced among
the variety of radiographic examinations
performed. A low-contrast image display many
density levels, and a high contrast image displays
few density level . The primary controlling factor of
radiographic contrast is kilovoltage peak (kvp).
 Recorded detail-The recorded detail, or
the ability to visualize small structures,
must be sufficient to clearly demonstrate
the desired anatomic part. Recorded
detail is primarily controlled by the
following:
• Geometry
• Film
• Distance
• Screen
• Focal spot size
• Motion
 Magnification - The magnification of the body
part must be evaluated, taking into account
the controlling factors of object-to-image
receptor distance (OlD), or how far the body
part is from the IR, and source-to-image
receptor distance (SID), or how far the x-ray
tube is from the IR. All radiographs yield some
degree of magnification because all body
parts are three dimensional.
 Shape Distortion - The shape distortion of the
body part must be analyzed, and the
following primary controlling factors must be
studied:
• Alignment
• Central ray
• Anatomic part
• IR
• Angulation
An example of shape distortion is when a
bone is projected longer or shorter than it
actually is. Distortion is the misrepresentation
of the size or shape of any anatomic structure.
Identification of Radiographs
 All radiograph must  All radiographs must
to include the be permanently
following identified and should
information contain a minimum
• Date of four identification
• Patient's name or markings.
identification number
• Right or left marker
• Institution identity
Anatomic Markers
 Everyradiograph must include an
appropriate marker that clearly identifies the
patient's right (R) or left ( L) side. Medico legal
requirements mandate that these marker be
present. Both radiographers and physicians
must see them to determine the correct side
of the patient or the correct limb. Markers are
typically made of lead and placed directly
on the IR
 It
is unacceptable to hand-write the "R" or "L"
on a radiograph after processing. The only
exception may be for certain projections
performed during surgical procedures.
Often, and unfortunately, a radiograph that
does not contain an accurate lead marker or
patient identification will have to be repeated.
 BASIC MARKER CONVENTIONS INCLUDE THE
FOLLOWING:
• The marker should never obscure anatomy
• The marker should never be placed over the
patient's identification information
• The marker should always be placed on the
edge of the collimation border
• The marker should always be placed outside
of any lead shielding
SPECIFIC MARKER PLACEMENT RULES
 1.For AP and PA projections that include both
the R and L sides of the body (head, spine,
chest, abdomen, and pelvis), a R marker is
typically used.

 2.For lateral projections of the head and trunk

(head, spine, chest, abdomen, and pelvis),
always mark the side closest to the IR. For
example, if the left side is closest use a L
marker. The marker is typically placed anterior
to the anatomy..
 3. For oblique projections that include both
the R and L sides of the body (spine, chest,
and abdomen) the side down, or nearest the
IR is typically marked. For example, for a right
posterior oblique (RPO) position, mark the R
side.

 4. For limb projections, use the appropriate R

or L marker. The marker must be placed
within the edge of the collimated x-ray
beam.
 5.For limb projections that are done with
two images on one IR. only one of the
projections needs to be marked.

 6.For limb projections where both the R

and L sides are imaged side-by-side on
one IR (e.g., R and L AP knees), both the R
and L markers must be used to clearly
identify the two sides.
 7.For AP. PA or oblique chest projections, the
marker is placed on the upper outer corner so the
thoracic anatomy is not obscured.

 8. For decubitus positions of the chest and

abdomen, the R or L marker should always be
placed on the side up (opposite the side laid on)
and away from the anatomy of interest
NOTE: No matter which projection is performed, and
no matter what position the patient is in, if a R marker
is used it must be placed on the "right" side of the
patient's body. If a L marker is used is must be placed
on the "left” side of the patient's body
SOURCE-TO-IMAGE RECEPTOR
DISTANCE
 SIDis the distance from the anode inside
the x-ray tube to the IR. SID is an important
technical consideration in the production
of radiographs of optimal quality. This
distance is a critical component of each
radiograph because it directly affects
magnification of the body part and the
recorded detail. The greater the SID, the
less the body part is magnified and the
greater the recorded detail will be.
 Collimation of X-ray Beam
 The beam of radiation must be narrow enough to
irradiate only the area under examination. This
restriction of the x-ray beam serves two purposes.
First, it minimizes the amount of radiation to the
patient and reduces the amount of scatter
radiation that can reach the JR. Second, it
produce radiographs that demonstrate excellent
recorded detail and increased radiographic
contrast by reducing scatter radiation, thereby
producing a shorter scale of contrast, and
preventing secondary radiation from
unnecessarily exposing surrounding tissues, with
resultant image fogging.
 External landmarks related to body structures at the same level
Body structures External landmarks
Cervical area
C1 Mastoid tip
C2, C3 Gonion (angle of mandible)
C3. C4 Hyoid bone
C5 Thyroid cartilage
C7. Tl Vertebral prominens
Thoracic area
Tl Approximately 2 in (5 cm) above level of jugular notch
T2. T3 Level of jugular notch
T4. T5 Level of sternal angle
T7 Level of inferior angles of scapulae
T9. TlO Level of xiphoid process
Lumbar area
L2. L3 Inferior costal margin
L4. L5 Level of most superior aspect of iliac crests.
Sacrum and pelvic area
Sl . S2 Level of anterior superior iliac spines (ASIS)
Coccyx Level of pubic symphysis and greater trochanters
BONE VESSELS AND NERVES
 Bones are live organs and must receive a blood supply
for nourishment or they will die. Bones also contain a
supply of nerves. Blood vessels and nerves enter and
exit the bone at the same point, through openings
called the foramina. Near the center of all long bones is
an opening in the periosteum called the nutrient
foramen. The nutrient artery of the bone passes into this
opening and supplies the cancellous bone and
marrow. The epiphyseal artery separately enter the
ends of long bones to supply the area, and periosteal
arteries enter at numerous point to supply the compact
bone. Veins exiting the bones carry blood cells to the
body.
BONE DEVELOPMENT
 Ossification
is the term given to the
development and formation of bones.
Bones begin to develop in the second
month of embryonic life. Ossification
occurs separately by two distinct
processes: intermembranous ossification
and endochondral ossification.
Intermembranous ossification
 Bones that develop from fibrous membrane in
the embryo produce the flat bones such as
those of the skull, clavicles, mandible, and
sternum. Before birth these bones are not
joined. As flat bones grow after birth, they join
and form sutures. Other bones in this
category merge together and create the
various joints of the skeleton.
Endochondral ossification
 Bones created by endochondral
ossification develop from hyaline
cartilage in the embryo and produce the
short, irregular, and long bones.
Endochondral ossification occurs from
two distinct centers of development
called the primary and secondary centers
of ossification.
 Primary ossification begins before birth
and forms the entire bulk of the short and
irregular bones. This process forms the
long central shaft in long bones. During
development only, the long shaft of the
bone is called the diaphysis .
 Secondary ossification occurs after birth when a
separate bone begins to develop at both ends of
every long bone. Each end is called the epiphysis.
At first the diaphysis and epiphysis are distinctly
separate. As growth occurs, a plate of cartilage
called the epiphyseal plate develops between the
two areas. This plate is seen on the long-bone
radiographs of all pediatric patients. The epiphyseal
plate is important radiographically because it is a
common site of fractures in pediatric patients. Near
the age of 21, full ossification occur and the two
areas become completely joined; only a
moderately visible epiphyseal line appears on the
bone
CLASSIFICATION OF BONES
 Long bones are found only in the limb . They
consist primarily of a long cylindric shaft
called the body and two enlarged, rounded
ends that contain a smooth, slippery articular
surface. A layer of articular cartilage cover
this surface. The ends of these bones all
articulate with other long bones. The femur
and humerus are typical long bones. The
phalanges of the fingers and toes are also
considered long bones. A primary function of
long bones is to provide support.
 Short bones consist mainly of cancellous
bone containing red marrow and have a
thin outer layer of compact bone. The
carpal bones of the wrist and the tarsal
bones of the ankles are the only short bones.
They are varied in shape and allow minimum
flexibility of motion in a short distance.
 Flatbones consist largely of two tables of
compact bone. The narrow space
between the inner and outer tables
contains cancellous bone and red
marrow, or diploe a it is called in flat
bones. The bone of the cranium, sternum,
and scapula are example of flat bones.
The flat surfaces of the e bone provide
protection, and their A broad surface
allow muscle attachment.
 Irregular bones are so termed because their
peculiar shape and variety of forms do not
place them in any other category. The
vertebrae and the bone in the pelvis and
face fall into this category. Like other bone ,
they have compact bone on the exterior
and cancellous bone containing red marrow
in the interior. Their shape serves many
function , including attachment for muscles,
tendon , and ligament , or they attach to
other bone to create joints.
 Sesamoid bones are very small and oval.
They develop inside and beside tendon .
Their function is to protect the tendon from
excessive wear. The largest sesamoids bone
is the patella, or the kneecap. Other
sesamoids are located beneath the first
metatarsal of the foot and adjacent to the
metacarpals of the hand. Two small but
prominent sesamoids are located beneath
the base of the large toe. Like all other
bones, they can be fractured.
FUNCTIONAL CLASSIFICATION
 When joint are classified as functional,
they are broken down into three
classification . The e classifications are
based on the mobility of the joint as
follows:
• Synarthroses : immovable joint
• Amphiarthroses: slightly movable
• Diarthroses: freely movable
STRUCTURAL CLASSIFICATION
 The structural classification of joints is
based on the type of tissue that unite or
bind the articulating bone . Structurally,
joint are classified into three distinct group
based on their connective tissues: fibrous,
cartilaginous, and synovial. Within these
three broad categories are the II specific
types of joints.
Fibrous joints
 Fibrousjoints do not have a joint cavity.
They are united by various fibrous and
connective tissues or ligaments. These are
the strongest joints in the body because
they are virtually immovable. The three
type of fibrous joints follow:
 Syndesmosis:
 Suture: an
an immovable immovable
joint or very joint
slightly occurring
movable joint only in the
skull. In this
united by joint the Gomphosis: an
sheets of interlocking immovable joints
fibrous tissue. bone are occurring only in the roots
The inferior held tightly of the teeth. The roots of
together by the teeth that lies in the
tibiofibular strong alveolar sockets are held
joint is an connective in place by fibrous
example. tissues. The periodontal ligaments
sutures of the
skull are an
example
 Cartilaginous joints are similar to fibrous
joints in two way : (I) they do not have a
joint cavity, and (2) they are virtually
immovable. Hyaline cartilage or
fibrocartilage unites these joints. The two
types of cartilaginous joints follow:
 Symphysis: a slightly
movable joint. The  Synchondrosis: an
bones in this joint are immovable joint.
separated by a pad This joint contains a
of fibrocartilage. The
ends of the bones rigid cartilage that
contain hyaline unites two bones.
cartilage. A An example i the
symphysis joint is epiphyseal plate
designed for strength found between the
and shock
absorbency. The joint epiphysis and
between the two diaphysis of a
pubic bones (pubic growing long bone
symphysis) is an
example of a
symphysis joint
 Synovialjoints permit a wide range of
motion, and therefore they are all freely
movable. The e joints are the most
complex joints in the body.
 Gliding (plane): uniaxial movement. This is the
simplest synovial joint. Joints of this type
permit very light movement. They have
flattened or slightly curved surface , and
most glide lightly in only one axis. The
intercarpal and intertarsal joints of the wrist
and foot are example of the gliding joint.
 Hinge (ginglymus): uniaxial movement. A
hinge joint permits only flexion and extension.
The motion is similar to that of a door. The
elbow, knee, and ankle are examples of this
type of joint
 Pivot (trochoid): uniaxial movement. These joints
allow only rotation around a single axis. A rounded or
pointed surface of one bone articulates within a ring
formed partially by the other bone. An example of
this joint is the articulation of the atlas and axis of the
cervical spine. The atlas rotates around the dens of
the axis and allows the head to rotate to either side
 Ellipsoid (condyloid): biaxial movement, primary. An
ellipsoid joint permits movement in two directions at
right angles to each other. The radiocarpal joint of
the wrist is an example. Flexion and extension occur
along with abduction and adduction.
Circumduction, a combination of both movements,
can also occur.
 Saddle (sellar): biaxial movement. This joint
permit movement in two axes, very similar to the
ellipsoid joint. The joint i so named because the
articular surface of one bone i saddle shaped
and the articular surface of the other bone is
shaped like a rider sitting in a saddle.
 Ball and socket (spheroid): multi-axial
movement. This joint permits movement in many
axes: flexion and extension, abduction and
adduction, circumduction, and rotation. In a
ball-and-socket joint the round head of one
bone rests within the cup- shaped depression of
the other bone. The hip and shoulder are
examples.
 Bone Markings and Features The
following anatomic terms are used to describe either
processes or depressions on bones.

PROCESSES OR PROJECTIONS Processes or projections extend

beyond or project out from the main body of a bone and are
designated by the following term :
condyle - Rounded process at an articular extremity
coracoid or coronoid - Beaklike or crown-like process
crest - Ridge like process
Epicondyle - Projection above a condyle
Facet - Small, smooth- surfaced process for articulation
Hamulus - Hook-shaped process
Head - Expanded end of a long bone
Horn - Hornlike process on a bone
Line - Less prominent ridge than a crest; a linear
elevation
Malleolus - Club-shaped process
protuberance - Projecting part or prominence
spine - Sharp process
Styloid - Long, pointed process
Trochanter - Either of two large, rounded, and
elevated processes (greater or major and lesser or
minor) located at junction of neck and shaft of
femur
Tubercle - Small, rounded, and elevated process
tuberosity - Large, rounded, and elevated process
 DEPRESSIONS
 fissure Cleft or deep groove
 foramen Hole in a bone for transmission of blood
vessels and nerves
 fossa Pit, fovea, or hollow space
 groove Shallow linear channel
 meatus Tube like passageway running within a bone
notch Indentation into the border of a bone
 sinus Recess, groove, cavity, or hollow pace such as
(I) a recess or groove in bone, a used to designate a
channel for venous blood on inner surface of
cranium, (2) an air cavity in bone or a hollow space in
other tissue (used to designate a hollow pace within a
bone as in paranasal sinuses), or (3) a fistula or
suppurating channel in soft tissues
 sulcus Furrow, trench, or fissure like depression
Thank you!

Bring out One whole Sheet of yellow pad

Paper please!
INSTRUCTION:
Write your name to the first half of the paper like this
way (LN, FN and MN), beside your name write the date
today. And to the first column write (quiz No. 02)
The questions will be dictated.
QUESTIONS….
1. Differentiate Projection and Position?
2. How Does SID affects Magnification?
3. What is the significant of properly
Identifying the body habitus in taking
Radiograph?
4. On the Radiographic Standpoints,
Differentiate the properties of Optical
Densities and Contrast?
5. Surface Landmarks ( give their appropriate external Landmarks Level)
Body structures External landmarks
Cervical area
C1 _____________
C2, C3 _____________
C3. C4 _____________
C5 _____________
C7. T1 ____________
Thoracic area
T1 _____________
T2. T3 ______________
T4. T5 ______________
T7 ______________
T9. T10 ______________
Lumbar area
L2. L3 ______________
L4. L5 ______________
Sacrum and pelvic area
S1. S2 _______________
Coccyx _______________
6. Enumerate the 5 classification of bones?
7. Enumerate the 3 types of Fibrous Joints?
8. Enumerate/give at least 5 different positions?
9. Identify whether the following is Position or Projection
a. Posterior-Anterior
b. Lateral
c. Supine
d. Left Anterior Oblique LAO
e. Anterior-Posterior Oblique APO
f. Fowlers’
g. AP
h. PA/L
i. Prone
j. Left Lateral Decubitus