Positions

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1. DR/ABDALLAH NAZEER. MD. Radiography positions.

2. Para-Nasal Sinuses: Occipito-mental view with open mouth(Water View) : To show maxillary antra, frontal, anterior ethmoid and sphenoid sinuses. Caldwell view is called occipito-frontal view or nose-head view. Lateral view : To show the nasal sinuses both sides superimposed. Submento-vertical view: To show sphenoid and ethmoid sinuses.

3. SINUSES 1. Frontal sinus 2. Ethmoid Sinus 3. Nasal Septum (bony) 4. Zygomatical -Frontal Suture 5. Maxillary Sinus 6. Zygoma 7. Zygomatic Arch 8. Mandible 9. Inferior orbital margin 10. Left orbit 8 1 2 5 7 9 10 3 4 AP WATERS VIEW 6

4. SINUSES PA view Nasal Septum Frontal Sinus Maxillary Sinus Ethmoid Sinus Inferior Turbinate Odontoid process Superior orbital fissure 2 1 4 3 5 6 7

5. 1. Frontal Sinus 2. Maxillary Sinus 3. Ethmoid Sinus 4. Spenoid Sinus 5. Sella Turcica 6. Occipital Bone 7. Mastoid Air Cells 8. Floor of posterior fossa 9. Anterior arch of C-1 10. Mandible 11.Coronal Suture 10 9 1 2 3 4 5 6 7 8 11 Lateral Sinus & Skull

6. Facial Bones Radiographic Position. Adult Facial Bones - PA Caldwell

7. Adult Facial Bones - PA 30° (Modified Parietocanthial)

8. Adult Facial Bones - Occipito Mental (OM) (Waters) View

9. Adult Facial Bones - Occipito Mental 30° (OM30) View

10. Adult Facial Bones - Lateral View

11. Adult Facial Bones - Submentovertex (SMV) / Slit Basal / Jughandles View

12. Adult Facial Bones - Slit Townes.

13. Sella Turcica

14. Orbits

15. Temporo-mandibular Joint. AP axial projection. Axiolateral oblique projection.

16. 3 2 4 6 1. Lat. & Med. ptyergoid plate 2. Ethmoid Sinus 3. Odontoid Process 4. Sphenoid Sinus 5. Foramen ovale 6. Maxillary Sinus 7. Mastoid air cells 8. Ant arch of C-1 9. Margin of foramen magnum 10. Ext. auditory canal 7 9 1 5 8 10 BASE OF SKULL

17. Lateral neck Sit the patient beside the chest holder as for lat chest. Position Cassette to include nasopharynx and trachea. Two assistants are necessary - one to hold child's arms and pull down on shoulders and one to hold the child's head still in lateral position with neck slightly extended. Expose in inspiration. Alternatively you can lie patient on side

18. Adenoids /Nasopharynx Patient positioned as above but exposure centered on and coned to nasopharynx and more penetrated than lat neck Cassette should be positioned at side of head but do not turn the neck to achieve this, elevate chin instead. Expose on normal inspiration, if possible breathing through nose, with mouth closed NOT VALSALVA N.B: a lateral chest exposure at 180cm FFD is appropriate for lat neck.

19. Normal Adult.

20. Cervical spine. Anter0-posterior view: Lateral view: Oblique views: Lateral view in flexion and extension: P-A view with open mouth for C1 vertebra.

21. ARTICULAR PROCESSES PROJECT SUPERIORLY AND INFERIORLY FROM EACH LAMINA. ARTICULAR FACETS ON THESE PROCESSES FACE POSTERIORLY ON THE SUPERIOR FACET OND ANTERIORLY ON THE INFERIOR FACET

22. PARS INTERARTICULARIS IT THE BONY JUNCTION BETWEEN THE SUPERIOR AND INFERIOR ARTICULAR PROCESSES

23. Chest x ray positioning.

24. AP View.

25. Chest X-ray. PA & AP View.

26. Chest X-ray. Breath: Inspiration Expiration .

27. Mediastinum and Heart. Heart size on PA. With good centering film: 2/3 heart is to left and 1/3 to right of midline. TV cardiac diameter 14.5 females. 15.5 Males. Cardiothoracic ratio less than 50%.

28. Position – Patient is supine with large cassette beneath upper thorax, shoulders and neck. X-Ray Beam – Directed anterior to posterior, angled 40-degrees cephalad and centered on the sternum. Voltage should be the same as for standard AP chest radiograph. Demonstrates – Medial clavicle fractures, SCJ dislocations, SCJ arthrosis. Serendipity (40-Degree Cephalic Tilt) Sternoclavicular View.

29. Wrist joint:

30. Positioning PA view should be taken with the wrist and elbow at shoulder height. This means that the wrist, elbow and shoulder are all in the transverse plane, perpendicular to the x-ray beam. Only in this position, the radius and the ulna are parallel. Lowering the arm makes the radius cross the ulna and become relatively shorter resulting in improper measurement of the length of the radius. Lateral view is taken with the elbow adducted to the side. Shoulder, elbow and wrist are again in one plane, i.e. the sagittal plane. This positioning will make the lateral view exactly perpendicular to the PA view.

31. The Hand PA view is part of a two view series metacarpals, phalanges, carpal bones and distal radial ulnar joint. Patient position patient is seated alongside the table The affected arm if possible is flexed at 90° so the arm and hand can rest on the table The affected hand is placed, palm down on the image receptor shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam. The hand series consists of a posteroanterior, oblique, and a lateral projection.

32. The elbow AP view is part of the two view elbow series, examining the distal humerus, proximal radius and ulna. Patient position Patient is seated alongside the table The fully extended arm and forearm, in a supinated position, are kept in contact with the table by lowering the shoulder joint to the level of the table they all must be in the same plane as the detector. Technical factors: Anteroposterior, Lateral and obliques projection Centering point Mid elbow which is approximately the midpoint between the epicondyles collimation Superior to the distal third of the humerus Inferior to include one-third of the proximal radius and ulna orientation exposure 50-60 kVp 2-5 mAs Grid: No

33. Frontal View

34. Lateral View.

35. Radial head View.

36. ELBOW AP OBLIQUE.

37. Shoulder Views:

38. Clavicle Imaging Two anteroposterior (AP) radiographs of the clavicle (with x-ray beam directed at different angles) are appropriate to assess clavicle mid-shaft fractures acutely and to follow these fractures during healing. The clavicle series includes AP in the frontal or thoracic plane and AP with 20 to 30-degrees cephalic tilt. Technical details of these radiographs are described below. AP Clavicle View Position – Patient erect with arm at side. X-ray cassette behind patient parallel to thorax. X-Ray Beam – Directed anterior to posterior, perpendicular to cassette and centered on mid-clavicle. Demonstrates – Clavicle shaft fractures, non-unions.

39. AP Clavicle View

40. 30 - Degree Cephalic Tilt AP Clavicle View

41. Acromioclavicular Joint / Distal Clavicle AP View Position – Patient is erect with arms relaxed and hanging freely at the side. X-ray cassette is behind the patient parallel to thorax. X-Ray Beam – Directed anterior to posterior, perpendicular to cassette (or angled 10-degrees cephalad) and centered at the coracoid. Voltage of the x-ray beam should be reduced by 50% relative to glenohumeral radiographs to avoid over penetrating the distal clavicle. Demonstrates – Distal clavicle fractures, ACJ dislocations, ACJ arthrosis.

42. Scapula. Indications Scapula radiographs are performed for a variety of indications including: trauma suspected primary or metastatic lesions Projections Standard projections AP view a specialized view that demonstrates the scapula in the anteroposterior plane similar position to an AP shoulder, however, limb placement and breathing technique differ lateral or scapular Y view orthogonal view to the AP projection profile 'end on' view of the scapula ideal projection to assess displacement of scapula fractures

43. Scapular Y lateral with CR perpendicular

44. Basic view for the hip joint. Antero-posterior view-Both Hips. Antero-posterior view –Single hip.

45. SACROILIAC JOINTS (SI JOINTS) ROUTINE VIEWS: AP, RPO, LPO AP 1. 10 x 12 film 2. Patient supine 3. Bucky 4. 40" SID 5. Central Ray: 15o cephalic angle, enter halfway between A.S.I.S. and symphysis pubis. 6. Suspended respiration Obliques (RPO and LPO) 1. 10 x 12 film 2. Patient recumbent 3. Patient rotated 30o from AP position 4. Bucky 5. 40" SID 6. Central Ray: enters 1" medial A.S.I.S. of side up. 7. Suspended respiration

46. AP Axial Sacroiliac joints Patient's position, Respiration, Pathology demonstrate shielding and shielding.

47. Sacroiliac Joints - Oblique

48. Femur AP Cassette Size: 14x17 lengthwise bucky Position of Patient: supine on the table. Position of Part: center the injured femur to the midline of the table, invert the foot 15 degrees to get the hip in the ap position, place the top of the film two inches below the iliac crest for upper femur, lower femur place the bottom of the film two inches below the knew joint Central Ray: Vertically to the level of the midcassette Structures Shown: AP projection of either the upper or lower femur.

49. KNEE AP Purpose and Structures Shown To get clear image of open joint spaces and soft tissue around the knee joint, and bony detail surrounding patella. Position of patient Supine. Adjust body so pelvis is not rotated. Position of part Flex joint slightly, locate apex of patella. Adjust patient’s leg by placing femoral epicondyles parallel with IR for true AP projection. Central ray Directed to a point 1.3 cm inferior to patellar apex.

50. KNEE PA. Purpose and Structures Shown To demonstrate PA image of knee. To get clear image of open joint spaces and soft tissue around the knee joint, and bony detail surrounding patella. Position of patient Prone position with toes resting on radiographic table, or place sandbags under ankle for support. Position of part Center a point 1.3 cm below patellar apex to center of IR. Femoral epicondyles parallel with tabletop. Central ray Perpendicular to exit a point 1/2 inch (1.3 cm) inferior to patellar apex. Since tibia and fibula are slightly inclined, the CR will be parallel with the tibial plateau.

51. KNEE LATERAL MEDIOLATERAL. Purpose and Structures Shown To get clear image of patella in lateral profile. Structures shown are the distal end of femur, patella, knee joint, proximal ends of tibia and fibula, and adjacent soft tissue. Position of patient lying on affected side. Pelvis not rotated. Affected knee forward and extend other limb behind it. Position of part Epicondyles perpendicular to IR. Patella will be perpendicular to plane of the IR. For new or unhealed patellar fractures; knee should usually not be flexed more than 10 degrees. Check with your medical director. Knee flexion of 20 to 30 degrees is usually preferred – this position relaxes muscles and shows maximum volume of the joint cavity. Central ray 5 to 7 degrees cephalad at knee joint 1 inch (2.5 cm) distal to medial epicondyle. Slight angulation of CR will prevent joint space from being obscured by magnified image of medial femoral condyle. In lateral recumbent position, medial condyle will be slightly inferior to lateral condyle.

52. KNEE AP WEIGHT BEARING STANDING BILATERAL KNEE PA WEIGHT BEARING STANDING.

53. KNEE AP OBLIQUE LATERAL ROTATION. KNEE AP OBLIQUE MEDIAL ROTATION. KNEE PA OBLIQUE LATERAL ROTATION. KNEE PA OBLIQUE MEDIAL ROTATION.

54. KNEE PA AXIAL HOLMBLAD METHOD. KNEE PA AXIAL CAMP-COVENTRY METHOD (TUNNEL VIEW). KNEE AXIAL BECLERE METHOD.

55. PATELLA TANGENTIAL PROJECTION HUGHSTON METHOD. PATELLA TANGENTIAL PROJECTION SETIEGAST METHOD (SUNRISE).

56. TIB FIB AP OBLIQUE MEDIAL OR LATERAL ROTATIONS Purpose and Structures Shown Oblique view of entire tibia and fibula. Position of patient Supine on radiographic table. Position of part Perform oblique projections of leg by alternately rotating limb 45 degrees medially or laterally. For medial rotation, ensure that the whole leg is turned inward and not just foot. Place support under greater trochanter if needed. Central ray Perpendicular to IR at midpoint of shin.

57. TIB FIB LATERAL MEDIOLATERAL OR LATEROMEDIAL. Purpose and Structures Shown Lateral view of entire tibia and fibula. Position of patient Supine. Position of part Patient toward affected side with leg on IR. Adjust body’s rotation to place patella perpendicular to IR. Use supports where needed for patient’s comfort and to maintain body position. Lift leg enough for assistant to slide rigid support under patient’s leg. IR may be placed between legs and CR directed from lateral side. Central ray Perpendicular to IR at midpoint of shin. Include proximal and distal ends of tibia and fibula. If patient must remain supine, the image may be taken cross-table using horizontal CR.

58. Thank You.