For Radiographic Technologist students

(MRT Students)

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 Course Title – Radiographic Positioning I
Credit Hour – 3
COURSE OUTLINE: CHAPTER FIVE: LOWER LIMB
CHAPTER- ONE: INRODUCTION 1.Foot
1.Introduction 2.calcaneus
3.Ankle joint
2.General Positioning Terminology
4.Leg
3.Image Quality 5.Knee Joint
4.Radiation Protection and Indication 6.Patella
CHAPTER TWO: THORAX 7.Femur
1. Lung 8.Pelvis and Hip Jo
2. Ribs
Assessment :
3. The sternum Mid_________ 30%
CHAPTER THREE-Abdomen Final—--------- 45%
Atta and Prest. --25%
CHAPTER –FOUR: UPPER LIMB
Reference
1. Hand and Fingers
2. Wrist
3. Forearm
4. Elbow Clark’s (1986): positioning in Radiography (11th edition).
5. Humerus Any radiographic positioning and Anatomy test.
6. Clavicle
7. Scapula

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 UNIT ONE
INTRODUCTION TO POSITIONINIG

Radiographers must possess a

thorough knowledge of anatomy,
pathology and medical terminology

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Radiographic positioning:

-refers to the study of patient

positioning demonstrate or visualize
specific body parts on image receptor.

-Also refers to the specific placement of

the body or part in relation to the table
or IR.

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 Principles
e“x-ray (or
radiological) image”.
The photons are then
converted into a
visual image detector
(image receptor)

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 The most important things that a
radiographer must know are:-
* Patient history and instruction

* anatomy ,pathology and terminology

* correct positioning of the body part

* centering point

* Selection of radiation protection measurements

*Selection of exposure factors

* processing of an image and image evaluation

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 X-RAY TUBE HOUSING
(ASSEMBLY) HIGH VOLTAGE
CABLES

LIGHT
Control panel for an x-ray BEAM
COLLIMATOR

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 Basic system for
general x-ray
examinations

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 Example of a mobile
system for general
radiographic purposes

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 X-ray film
processing

THERMOMETER A simple automatic

TIMER processor

TIME-TEMPERATURE
FILM IN
CHART

FILM OUT

Manual film
processing
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Positioning
Terminology can be:
1. Anatomical Terminology

2.Radiological terminology

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 Anatomical Terminology
Anatomical position is the
description of any region of the
body assumes that the body is
in the anatomic position

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 Anatomical Terminology
When referring to one part of the body in relation
to other parts, the radiographer must be always
think of the person in the anatomic position.
It includes:-
- The subject erect facing the observer
- The feet flat on the floor
- The arms are adducted
- The palms are turned forward

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 Anatomic Relationship Terms
Anterior (ventral)
-Forward or front part of
the body or of a part
-that seen when viewing
the patient from the front.

Posterior (dorsal)
-Back part of body or part
-that seen when viewing the
patient from the back.

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Anatomic Relationship Terms
Caudad (Caudal)
Parts away from the head of
the body or towards feet
Cephalad (Cephalic)
Parts toward the head

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Anatomic Relationship Terms
Trendelenburg’s position –
supine with the head lower than
the feet

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 Anatomic Relationship Terms
Superior
Nearer the head or
situated above
Inferior
Nearer the feet or
situated below

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 Anatomic Relationship Terms
Medial
Toward the median
plane of the body or
toward the middle of a
body part
Lateral
Away from the median
plane or away from the
middle of a part

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 Anatomic Relationship Terms
Distal
Farthest from the point of attachment or origin
Proximal
Nearer to the point of attachment or origin

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Anatomic Relationship Terms
Palmar
-Palm of the hand
Plantar
-Sole of the foot
Dorsum
-Anterior, or top, of the foot
or the back of the hand

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 Foot
Hand - Posterior surface -
- Superior surface -
Dorum of Hand Dorsum of Foot
- Anterior surface -
- Inferior Surface -
Palmar surface Plantar Surface

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From Anatomical pos. Body Movement Terminology

Abduct or abduction
 Movement of a part
away from the central
axis of the body
Adduct or adduction
 Movement of a part
toward the central
axis of the body

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From Anatomical Pos.Body Movement Terminology

Extension
-Straightening of
a joint

Flexion
-Bending of a
joint

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From Anatomical Pos.Body Movement Terminology
Hyperextension
Forced or excessive extension
Hyperflexion
Forced overflexion

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From Anatomical Pos. Body Movement Terminology

Evert/eversion
Outward turning of
the foot at the ankle

Invert/inversion
Inward turning of the
foot at the ankle

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From Anatomical Pos. Body Movement Terminology
Pronate/pronation
-Rotation of forearm so
that the palm is down

Supinate/supination
-Rotation of forearm so
that the palm is up

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From Anatomical Pos. Body Movement Terminology

Deviation
A turning away
from the regular or
standard course

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Planes of the body
Planes are imaginary lines that divide the body into sections
and these help to further identification of specific areas.
The most common planes that we use are:-
•Sagital plane:-divide the body into right and left parts
-mid sagital plane divide the body into right and left equally
•Coronal plane:-divide the body into anterior and posterior
•Transverse plane:-divide the body into upper and lower
body sections
•Oblique plane:-divide the body obliquely into different
sections.

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 Radiological terminology

It describes by:
A) direction of the central ray of the beam.
B) Patient Aspect

Example for A

- AP (antero-posteriorior)-ray enters front and exits back

Example for B

-AP – anterior raised and posterior contact

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 Radiological terminology coun’t

EXAMPLE for ray entry and exit

- PA (postero-anterior):-the ray
enters at the back and exits at the front

EXAMPLE for patient contact

PA- posterior raised and anterior contact

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Radiological terminology coun’t
Lateral
CR enters one side of
the body, passing
transversely along
the coronal plane

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Radiological terminology count's
Oblique

-CR enters from side angle

-Entrance and exit surfaces
still specified, e.g., AP
oblique(APO),RAO,LPO,RAO

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Radiological terminology count's

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Radiological terminology count's
Decubitus position
-Laying position with a
horizontal CR
-Named according to the body
surface on which the patient is
lying and the side of the
patient closest to the IR

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Radiological terminology count's
 Left Lateral Decubitus position
Left Lateral lying position with a
horizontal CR (AP projection)

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Right Dorsal Decubitus position
-Supine lying position with a
horizontal CR (Lateral projection)

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Imaging Quality
Is the exactness of the representation of the
patient’s anatomy

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Four quality factors:

A) Density Radiographic density is the

amount of blackness on the film.
Controlling factors:
-MAS
-distance
•B) contrast is the difference in density
Controlling factors:
- kv
- tissue

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Four quality factors Continued :
C) Resolution is recorded structure on the image.
Controlling factors:
- Focal spot
- Motion
D) Distortion is misrepresentation of object size and
shape.
Controlling factors:
-FOD
-OFD
--Central ray centering(CR)

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Radiation protection
Protect people or environment from harmful
radiation
Radiation protection:
To radiographer
To patient
Public
International commutation on radiological
protection recommended the basic systems of
protection are:
•Justification-advantage greater than
disadvantage(account the benefit and risk)
•Limitation –each individual protected from
radiation(dose limit)
•Optimization-should be apply ALARA

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Radiation protection cont……

Three effective means control the dose of radiation:

-Time
-Distance
-Shielding
Radiographer responsible for controlling and limiting the
radiation by:
- Minimize repetition
-Accurate collimation
-Correct filtration
-Shielding
-Protection of pregnancies-Ten Day Rule and
etc

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Pathology and accident

Pathology is deviation from a normal condition. Cause:

Bacteria
Virus
Air pollution
Uncontrolled cells and etc.

Accident –unplanned event. Cause:

-Traffic accident
-Fall down
-Ingestion poison and etc

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Chapter Two
CHEST RADIOGRAPH

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 CHEST RADIOGRAPH

•It is most common type of radiograph in

every radiology department.

•Chest is the upper part of the trunk

between the neck and abdomen.

•Anatomically divided into three :-

Bony
Respiratory
Mediastinum

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 Bony thorax

•Part of skeletal system.

•Provide protection frame work.
•Anteriorly consist of sternum.
•Superiorly two clavicles.
•12 pairs of ribs antero-laterally.
•Posteriorly thoracic vertebrae.

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Respiratory system
Pharynx, trachea, bronchi and lungs.
Has an important structures of dome shaped
called diaphragm which is a chief muscle for
respiration
Diaphragm divides thoracic cavity and abdominal
cavity.
Each half of diaphragm is hemi diaphragm.
As it goes down it increases the volume of the
thoracic cavity.
Pharynx upper air way both for respiratory and
digestive system

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Parts of lung

Radio graphical important parts of lung

are:-
 Apex of each lung
 Carina
 Base of lung
 Costophrenic angle
 Hilum

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1. Trachea
2. rt sternoclavicular joint
3. rt hilum
4. Right lung
5 Rightt costophrenic
angle
6. Left apex
7. Left clavicle
8. Aortic arch
9. Carinae
10. Left lung
11. Heart
12. Diaphragm

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 Apex of lung
•Rounded upper area above the level of clavicles.
•Extend up in to the lower neck area to the level of
T1.
•It must be included in the radiograph.
Carina

•Is a point of bifurication.

•The lowest margin of the separation of the tracheae
in to the Rt and Lt bronchi.

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Base

•The lower concave area of each lung that rests on the

diaphragm.
Costophrenic angle

•Outer most lower corner of each lung where the

diaphragm meets the ribs.
•It must be sharp and acute.
Hilum

•The root region.

•The central area of each lung.
•Where the bronchi, blood vessels, lymph vessels and
nerves enter and leave the lung

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 Mediastinum
•Medial portion of the thoracic cavity.
Radio graphically there are four
important structures in mediastiunum;

-thymus gland,
- heart and great vessels,
-trachea,
-esophagus.

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 Need to know
Mediastinum: heart
& great vessels

Superior vena cava

(to Rt atrium)
Ascending, descending,
& arch of aorta (from
Lt ventricle)

Pulmonary trunk
(from Rt ventricle)

Rt and Lt hemidiaphragm
(domes of)

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Projection
BASIC PROJECTION Axial/Alter/Suplm.
PA LATERAL
AP

DECUBITUS
APICAL/
LORDOTIC

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PA-CXR

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Some of PA CXR Indication

1/-Pleural Effusion -Fluid in the pleural space,

(between the visceral and parietal pleura)

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2/-COPD-Chronic Obstructive Pulmonary Disease
is a classification of diseases that is primarily seen as bronchitis and
emphysema COPD is the leading cause of hospital admission.

-Irritation to bronchial tubes leads to thickening and swell. Excessive

mucous production restricts airflow and leads to coughing. Chronic
bronchitis leads to emphysema (Alveolar walls stretch and loose their
elasticity)

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3/-Pneumothorax –when air in the piueral cavity,
the vascular marking is absence

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4/-pneumonia -is alveoli replaced
by any inflammation (inflammatory
consolidation –air bronchogramy

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5/-Mass- An unidentified neoplasm (new growth of cells),
that may be benign (not cancer), or malignant
(cancer), is often called a mass.

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Standard PA Positioning
Preparation
1. Evaluate the order
2. Greet the patient
3. Take History
What is pertinent Hx?
4. Remove jewelry, check attire, snaps, pins, NG
tubes, etc.
5. Explain the exam in layman’s terms
6. Questions?
7. Set technique before positioning

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Standard PA Positioning Steps
1. Chest against film or bucky,
shoulders
rolled forward,
dorsum of
hands on hips,
arms away
from thorax.
Criteria
Soft tissue of arm Vertebral
not in thorax border

AB
Vertebral border of
scapula not in thorax

Inferior angle

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 Medial angle

Criteria

With the shoulders

rolled forward, the
Vertebral vertebral border
border
of the scapula can
be projected outside
the thoracic cavity

Inferior angle
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Standard PA Positioning

For stability, arms

may be wrapped
around bucky or
film holder, but in this
position it is difficult
to roll the shoulders
forward

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Standard PA Positioning Steps
2. Adjust height of film to
patient’s chest.

CR to T-7 or 3”-4”
below the jugular
notch, (top of cassette
to vertebral prominens).

Watch that ID marker

Careful centering of
film prevents clipping

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 Critique
criteria
for
clipping
All of apecies
(Above first rib)

All of ribs
(for pleural thickenng)

Costophrenic angles
(for pleural fluid)
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Standard PA Positioning Steps

3. Head straight forward

In addition to the chest

being flat against the film,
and the shoulders rolled
forward, the position of
the head prevents rotation

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―Rotation

*Determine by observing the

equal distance between the
medial clavicular head and the
spinous process of the thoracic
vertebral body.

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Rotation Rotation is best evaluated by the
the sternoclavicular joints being
equal distant from the thoracic
spine

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Standard PA Positioning
Steps

4. “ Take in a deep
breath”

Prior to the exposure, have

the patient take in practice
breaths.

Practice breathing insures

the best possible
inspiration

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Breathing movement
During breathing there is a change of dimension of
thorax.
The volume of thorax increase during inspiration.
During inspiration the diameter of thoracic cavity
increases.

Degree of inspiration
-On PA chest when the patient is inspired minimum 10
ribs above the diaphragm must be seen.
-To determine the degree of inspiration in chest
radiograph, one should be able to identify and count
the rib pairs on a chest radiograph.

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Degree of inspiration Conti…

1st and 2nd rib pairs are the most difficult to locate.
When CXR is taken the patient should takes as deep a
breath as possible and holds it allows for a deeper inspiration.
The best way to determine the degree of inspiration is to
observe how far down the diaphragm has moved by counting
the pairs of rib in the lung area above the diaphragm.
A general rule for average adult patient is to show a
minimum of 10 on a PA CXR.
To determine this start at the top with the 1st rib and count
down to the 10th or 11th rib posterior.
Always the diaphragm is below the level of at least
the 10th rib.

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Inspiration Expiration

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Degree of inspiration Conti…

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 Criteria
for
inspiration

1 10 Posterior ribs
on the right side,
3 showing above the
2 diaphragm. And 5-6
4 anterier ribs
5

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Criteria for PA cont.

5) Minimize breast shadow

Ask the patient to lift the breast up and outward and
remove her hands as she leans against the chest
board to keep them in this position.
Depending on the size and density of the breast,
breast shadow over the lower lateral lung field
cannot be totally eliminated

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 Nipple shadows
- When seen as symmetrical, nipple
shadows rarely cause diagnostic
difficulties.
- Features that suggesta shadow is
due to a nipple are a position
appropriate to the breast shadow and
well-defined margins ononly two sides
usually inferior and lateral
- If uncertainty remains, a repeat
film with the nipples marked by
somethingradio-opaque will resolve the
issue.

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Nipple Markers

On rare occasions
dense areola may
create shadows
that resemble a
mass leision.

Nipple markers are

metallic beads used
to localize the
areola and nipple.

x
spo
t

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 Review of PA
Film Critique
On all films
Patient ID
Rt or Lt marker
Contrast & density
Motion
Artifacts

PA chest criteria
1. Clipping
2. Inspiration
3. Rotation
4. Scapula free
of lung fields
5. Penetration of
mediastinum
(see “exposure
factors” 4 details)

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CP and Technical Factors-set up

Centering point at --T-7

Technical Factors
cassette-35/35,35/43
Grid -----yes
FFD- -----150cm
Anatomical markers ----R/L
Image Evaluation----what are they?

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Radiographic technique quality:
Is it really different?
Changing technique can make disease look better or worse.
Such as:
----Body habitus
--AP or PA
--Pt condiation---lordotic vs kyphotic, uncooperative

--age of pt, etc

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Lateral CXR

- Interested side must be closest to film

-Patient side closest to the film is best
demonstrated on the radiograph
-Left lateral is always done unless any other
pathological problems on the right side or requested
right side.
-Left lateral is chosen because it demonstrates
better the heart region since the heart locates more on
left side.

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The importance of the Lateral Projection

* The lateral, 90 degrees to the PA, localizes leisons

* Lung tissue obscured on the PA is visualized: Behind the
mediastinum and below the hemidiaphragms
R

Rt
hemidiaphragm L Lt
hemidiaphragm
Are these films hung correctly?
Standard Lateral Positioning Steps
1. Left side of thorax against film.
Left marker on film

The left lateral projection minimizes

magnification of the heart shadow,
and maximizes visualization of small
calcifications.

2. Arms are raised above the head,

or are supported on a bar.
Critique criteria: Soft tissue of arms,
or the humerus should not be visible in
the thoracic cavity.
Lateral CXR:-
Side of interest is nearest the film.
oLesions obscured on the PA view are often
clearly demonstrated on the lateral view.
To demonstrate pathological problems situated
posterior to the heart, great vessels and sternum.
Arm must be raised above head and chin up.
Apices, CPA, spine and sternum should be
included with in the collimated area.
The heart will be adequately penetrated; vascular
markings should be seen behind the sternum and
heart

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•Patient arms and/or chin should not be superimposed over the
upper lung field.
• (See the picture below)

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Standard Lateral Positioning Steps
3. Head straight forward.
Spine parallel to film
(patient is not leaning)

4. Plane of posterior ribs

is perpendicular to the
film to prevent rotation

Critique criteria for rotation: Posterior ribs are

superimposed, or separation is no more than
1 cm (1/2”).
 Rotation
Rotation is evaluated by Separation of posterior ribs
the superimposition of
the posterior ribs, or
separation no more than
1 cm (1/2”).

Due to the possibility

of reversed rotations
looking identical,
the direction of rotation
is difficult to ascertain*.
CP and Technical Factors-set
up
Centering point at --T-7

Technical Factors
cassette-35/35,35/43
Grid -----yes
FFD- -----150cm
Anatomical markers ----R/L
Image Evaluation----what are they?

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2
Lateral CXR ……..

1/ Apical superimposed
2/ Aortic arch
3 / Lungs superimposed
4/ Right hemi diaphragm
5/ Sternum
6/ Heart
7 / Left hemi diaphragm

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3
 Review of
Lateral Film
Critique
On all films
Patient ID
Rt or Lt marker
Contrast & density
Motion
Artifacts

Lat chest criteria

1. Clipping
3. Rotation
3. Arms free
of lung fields

What about inspiration? Unlike the PA, ribs cannot

be counted for the evaluation.
 Non routine positions: Axial

Antero-Posterior (AP)
Upright on cart, Wheelchair, Supine
Obliques – Upright, Supine (AP & PA)
Apical Lordotic – AP upright
Lateral Decubitus (Decubs)
Non routine Positioning

When the patient is unable

to stand, but can sit on a
stool, a PA
upright projection is the
next best option.

Any deviation from routine

positioning must be noted on the
film. Why?

Deep inspiration is less likely

when seated – is one reason.
AP Upright Positioning When the patient is unable to stand
or sit PA on a gurney, a seated AP
upright projection is the next best
option.
Setup
ID marker 1. 150 FFD

2. Usually (but not always)

done screen to avoid grid
cutoff
Film carefully centered to
patient, with equal spacing
on either side
3. Positioning and criteria are essentially the
same as the PA, except...
AP Upright Positioning
Because rolling the shoulders forward may be difficult, the sternal ends of the
clavicles raise in relation to the thoracic cavity. To recreate the appearance of
the PA
projection (for purposes of comparison) a 50 caudad angle is placed on the
CR.

When the film cannot be vertical

(such as in a
wheelchair) CR with a 50
Plane of
the angle is added caudad angle
film
to the inclined plane
of the film.
900 to
plane of
film
 AP Supine
When the patient must remain supine, the FFD is 100”, 5o caudad

If done on the x-ray table the film is generally put in the bucky
tray, and is referred to as a “bucky chest.”

The supine position is less

desirable because

1. Inspiration
2. Air fluid levels
not demonstrated
3. enlargement of large pulmonary
vessels, and hyperemia (small
ID vessels).
marker
Lateral decubitus CXR

•In decubitus generally the patient is lying and the tube is horizontal.
( dorsal, ventral or Rt Lt direction)
•Position the patient in the lateral recumbent position on the radiographic
table or patient stretcher.
•To demonstrate fluid levels, the patient should lie on the affected side but
a pneumothorax is best demonstrated the patient lie on the unaffected
side

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 Lateral decubitus Cont..
In either situation, the patient should be
instructed to remain in the lateral position
for at least 10 minutes prier to the exposure.
Extend the patient’s arm above the head
Adjust the thorax to true lateral position.
The patient leg can be flexed for balance

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•Position either the anterior or posterior part of the patent in front of the film.
•The long axis of the cassette should be parallel with the long axis of the body.
•Central ray direct horizontal to the mid line of the cassette at the level of T 7.

Right lateral decubitus

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 AP lordotic CXR
 Patient’s feet should be separated to distribute the
weight equally.
 Support the patient, lean the patient backward until the

patient shoulder are supported by the upright Bucky; the

curvature of the patent’s lower back will be exaggerated.
 Position the back of the patient’s hand on the hips; bring

shoulders and elbow forward to remove scapula from the

lung fields. The shoulder should be relaxed and the
hands should be below the area of the lung field.
 Direct central ray horizontally to the midline of the patient

midsternum or center of the cassette.

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• Apical lordotic projection:
• Designed to demonstrate the apices of the
lungs free of superimposition of the
clavicles, and less superimposition of the
ribs.
• Clavicles are near horizontal and projected
on or above the first ribs

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AP lordotic AP cephalic

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RAD.POST.I, GIZAW NIG 07/12/2023 11
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Upper respiratory tract(URT)
 Basic projection
-Antero-posterior(AP)
-Lateral (thoracic inlet)

Antero-posterior
 Position of patient

• The patient lies supine or erect

• The chin is raised to show the soft tissues
• The cassette is centered at the level of the
fourth cervical

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URT Count.
 Exposure factor
cassette-18/24cm
FFD-100cm
Centering point
- 10 degrees cephalad
and in the midline
at the level of the fourth
cervical vertebra

AP
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8
 URT Count.
Lateral (thoracic inlet)
Position of patient
• The patient stands or sits with either shoulder against a

vertical cassette
• The jaw is raised slightly so that the angles of the

mandible
• The cassette is centered at the level of the prominence of
the thyroid cartilage opposite the fourth cervical vertebra.
• Immediately before exposure, the patient is asked to

depress the shoulders forcibly so that their structures are

projected
below the level of the seventh cervical vertebra.

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URT Count.
 Exposure factor
cassette-18/24cm
FFD-100cm
Centering point
- 10 degrees cephalic and
in the midline
at the level of the fourth
cervical vertebra

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Sternum and Ribs
 (’Sternum and ribs)
Sternum- flat bone with three divisions:
-Manbrium
-Body
-Xiphoid process
 Ribs- having:

The first 7 ribs-true ribs

Ribs 8.910,11 and 12-false ribs
Ribs 11 and 12 –floating ribs
RIBS EXAMI. –THE SAME AS CHEST.

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Sternum Count.
 Sternum-basic – lateral
-oblique
Lateral –
Indication- #, Inflammation, metastases, etc
Patient posting- erect, standing/seated,
arms above the head.
Centering point- center of sternum
Respiration-with inspiration
Cassette-30/40 or 24/30

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Sternum Count.

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Sternum Conut.
Oblique-the same as AP, except patient
posting
.

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 RIBS
Ribs-basic-
AP-abnormality on the posterior ribs
PA- abnormality on the anterior ribs
Oblique- abnormality on the axial ribs
Patient positing and centering point is the
same as chest radiography

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RIBS PA Counts……

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RIBS AP Counts……

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RIBS OBLIQUE Counts……

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PA oblique CXR /RAO or LAO/
•Patient feet should be separated
slightly with weight equally distributed
on both feet.
•Adjust the height of erect bulky so the
top edge of the cassette is
approximately 1.5 – 2 inch above the
top
•. of the patient’s shoulder.
•Rotate the patient 450 so the
midsagital plane becomes oblique to
the film
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9
PA oblique CXR Cont.
Raise the arm farthest from the film and rest
the hand on the top of the bucky.
Flex the arm nearest the film and rest the back
of the hand on the hip below the area of the
lung.
Both obloquies are usually done.
Center direct the central ray horizontal to the
level of T7, approximately at the level of inferior
angle of scapula.
Use 150-180 cm FFD for all CXR.

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LAO

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 Anatomy Heart
The heart is a hollow muscular organ that is enclosed in pericardium. It is
situated mainly to the left of the midline.
The heart has four chambers: the right and left atria and the
right and left ventricles. The atria and the ventricles are separated by
septum. At rest, there are approximately 60–80 beats per minute. The
right side of the heart serves to perfuse the pulmonary circulation,
while the left side perfuse the systemic circulation
The aorta, the largest of the great vessels, consists of three
parts: the ascending aorta, the arch and the descending aorta, which
commences at the level of the fourth thoracic vertebra.
The superior vena cava opens into the upper part of the right
atrium, draining the upper limbs and head and neck. The inferior vena
cava gives venous drainage from the lower limbs and abdomen,
entering the inferior part of the right atrium.

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Count.
Cardiothoracic ratio(CTR)

The size of the heart is estimated from the PA radiograph

of the chest by calculating the CRT. This is the ratio
between the maximum transverse diameter of the heart
and the maximum width of the thorax above the
costophrenic angles, measured from the inner edges of
the ribs. In adults, the normal
CRT is maximally 0.5. In children, however, the CRT is
usually greater.
where a right heart border to midline, b left heart border
to midline, and c maximum thoracic diameter above
costophrenic angles from inner borders of ribs.
CTR=(a+b)/c

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Count.

a
b

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Count.
Basic projection
Postero-anterior – erect
Supplementary
Left lateral
Left anterior oblique
Right anterior oblique

Postero-anterior – erect

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 Count.
Position of patient and cassette
• The patient is positioned erect, facing the cassette and with the
chin extended and resting on the top of the cassette.
•with the patient’s arms encircling the cassette
Direction and centering of the X-ray beam
• The horizontal central beam is directed at right-angles to the
cassette at the level of the seventh thoracic vertebrae T7
• The surface markings of the T7 spinous process can be assessed
by using the inferior angle of the scapula before the shoulders are
pushed forward.
• Exposure is made on arrested full inspiration

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Count.
 The projection of heart
basic and supplementary
-pt positioning
-centering point
The same as lung
-exposure facture
-pt instruction

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 Chapter Three: ABDOMEN
 The most common is an AP supine
abdomen and also sometimes called a
KUB and these are taken without the
use of contrast media.

 Plain radiography of abdomen KUB is

taken before performing abdominal
examination of using contrast media.

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Count.
Acute abdominal x-ray

 This is an emergency condition of the abdomen

may develop from conditions such as bowel
obstruction, perforation involving free intra
peritoneal air(air outside the digestive tract) ,intra
abdominal mass, excessive fluid in the abdomen.
Abdominal muscle
 Many muscles are associated with the abdominal

pelvic cavity; diaphragm and right and left psoas

major

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Count.
Quadrant of abdomen :
 The four quadrant of abdomen are:-

RUQ
 Liver ,gall bladder, hepatic flexure, right

kidney, right supra renal gland

LUQ
 Spleen, stomach, spleenic flexure, tail of

pancreas, left kidney, left supra renal gland

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Count.
RLQ
 Ascending colon, appendix,

ceacum,illeocecal valve
LLQ
 Descending colon, sigmoid colon

Regions of abdomen:-
The nine regions of abdomen are:-
 Right and left hypochondriac, epigastria,

right and left lumbar region, umbilical, right

and left inguinal and hypo gastric region.

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Count.


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Count.
Land marks of the abdomen x-ray
 Xiphoid tip :- superior margins of the abdomen
 Inferior costal margin:- used to locate upper abdominal
organ
 Iliac crest :- at the level of mid abdomen and most
common used land mark
 ASIS
 Greater trochantor
 Symphysis pubis :- inferior margin of abdomen
 Ischial tuberosity for prone position

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General positioning consideration
 Use careful breathing instruction.
 Most abdomen radiograph is taken on

expiration.
 Instruct the patient to take in a deep breath

and let in all out and hold it; don’t breathe

 Side marker is important
 Radiation protection

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Pathological indications:-
AP supine / KUB/ for calculi etc
AP/PA erect for intestinal obstruction,

perforation and pneumo-pertitonium

for free gas in peritoneal cavity.
The KUB is most useful for checking

different conditions of the patient

employed as part of an intravenous
urogram (IVU),Ba. Enema or to follow up
a previously proven calculus.

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 Count.

Taking of KUB film is

important for the following
purpose:-
• To identify stones or calcifications in
the kidneys.
• Check exposure factor.
• To evaluate preparation of the
patient.
• To evaluate bowel gas pattern.
• To assess the size and location of
abdominal organs.
•To see gross abnormality.

Plain abdomen (KUB

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Count.

•Free air can be a result of

recent abdominal surgery,
perforation in the stomach or
bowel.
•An acute abdominal series
may include an upright PA
projection of the chest,
upright and /or decubitus
radiograph of the abdomen
depend on the condition of
the patient.

PA chest x-ray may be a part of acute

abdomen, note the presence of free
air under the Rt hemidiaphragm.

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 Count.
Basic Position
AP supine for KUB
PA or AP erect for abdominal obstruction
AP Abdomen supine for KUB
Patient position:
 The patient supine on the radiographic table.
 Place a pillow under the patient’s head and position a small support

under the patient’s knee for comfort.

Part position
 Center the median plane of the patient’s body to the midline of the

table.
 Check for rotation of the pelvis by palpating the ASIS and ensuring

they are equidistant from the table, use sponges for support and
immobilization if necessary.
Central ray
 Direct the central ray perpendicular to the level of the

umblicus/L2,3.

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Count.
 Breathing instruction
 Instruct the patient to take in a deep breath,

blow it out and hold it out during the

exposure.
 Image evaluation

 The symphysis pubis and lateral margins of

the abdomen should be included.

 The renal shadows, psoas major

muscles ,transverse processes of the

lumbar spine should be clearly visualized on
a properly exposed abdominal radiograph.

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Count.

KUB /supine abdomen

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RAD.POST.I, GIZAW NIG 07/12/2023 15
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Count.
AP /PA erect
Patient position
 Patient erect position the back or front to an

upright table.
 Position the patient’s arm comfortably at the

patient’s sides and out of the collimated area.

Part position
 Center the midsagital plane of the patient to the

midline of the upright bucky.

 Check for rotation of the pelvis by palpating the

ASIS and ensuring they are equidistant from the

table.

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Count.
Central ray
 Direct the central ray to a point approximately 5

to 7.5 cm above the level of the iliac crests.

 Center the cassette to the central ray; the top

edge of the cassette should be at the level of the

axilla.
Breathing instruction
 Instruct the patient to take in a breath, blow it

out and hold it out during the exposure.

Image evaluation
 The diaphragm and lateral margin of the

abdomen should be included.

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Count.

AP erect abdomen

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Collimate to skin borders
if small patient

SID 40
Count.
Alternative positions:-
1)Rt or Lt lateral decubitus
2)Dorsal decubitus
Rt or Lt lateral decubitus
Patient position
 The patient lying on the Left or right lateral.
 One leg directly over the other leg.
 Extend the arms upward so the elbows are

near the face.

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Count.
Part position
 Adjust the thorax and pelvis to a true lateral

position.
 Make sure that the shoulder and hips

superimposed.
 If a grid cassette is used, sponge should be

used to elevate the patient.

Central ray
 Direct the central horizontally to the midline

of the grid device.

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Count.
Breathing instruction
 Instruct the patient to take in a breath, blow

it out, and hold it out during the exposure.

Image evaluation
 Diaphragm, renal shadows and air-fluid

patterns should be illustrated on the

radiograph.
 Air -fluid levels should be adequately

exposed and demonstrated.

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 Count.
 Lt Lateral decubitus

Lt Lateral decubitus

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Count.
Dorsal decubitus
Patient position
 The patient is in supine position on the radiographic

table.
 Place a pillow under the patient’s head and raise the

arms above the head.

 Adjust the long axis of the patient parallel with the

long axis of the table or stretcher.

Part position
 Adjust the abdomen at the center.

Central ray
 Direct the central ray horizontally to the midline of

film.

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Count.
Breathing instruction
 Instruct the patient to take in a breath, blow it

out, and hold it out during the exposure.

Image evaluation
 The diaphragm, spine and anterior margin of the

abdomen should be included within the

collimated area.
 Air-fluid levels should be adequately exposed and

demonstrated on the radiograph.

 Superimposition of the ribs and ilia indicates a

true lateral position.

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Count.

Dorsal decubitus of abdomen

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2