X-ray imaging planes and terminologies

Md Kamar Reza

1. X-RAY IMAGING PLANES AND TERMINOLOGIES PRESENTED BY : MD KAMAR REZA : BSC MIT (1 ST YEAR) : ROLL NO -3

2. CONTENTS Anatomical position Anatomical planes Terms of relation Terms of movement Projection terminologies Abbreviations Work drill for radiological technologist Conclusion Questions References

3. ANATOMICAL POSITION Standing upright with head and eyes directed forward focusing on a distant object No facial expression ( neutral facial expression) Upper limbs slightly away from trunk , palm facing forward and thumb pointing away from the body Lower limbs parallel , feet flat on the ground and toes facing forward

4. Front Side Back

5. Anatomical planes Sagittal plane : vertical plane parallel to the median plane  (or mid-sagittal plane) :divides the body into right half and left halves Coronal plane : vertical plane perpendicular to the median plane :divides the body into anterior and posterior parts Transverse plane :horizontal plane perpendicular to the long axis of the body :divides the body into superior and inferior parts Cardinal plane : any plane transverse to the centre of the body

6. TERMS OF RELATION Anterior is towards the front of the body Posterior is towards the back of the body

7. TERMS OF RELATION Superior is towards the top of the body   Inferior is towards the bottom of the body 

8. TERMS OF RELATION  Medial is towards the midline   Lateral is away from the midline 

9. TERMS OF RELATION Proximal is towards the center of the body Distal is away from the center of the body

10. TERMS OF RELATION Superficial is towards the surface of the body   Deep is away from the surface of the body

11. TERMS OF RELATION Ipsilateral is on the same side of the body Contralateral is on the opposite side of the body

12. TERMS OF RELATION Dorsal Surface : Refers to the top or anterior surface of foot and back and posterior     aspect of hand   Planter surface : Refers to the sole or posterior surface of foot   Palmer surface : Refers to the palm of the hand

13. Flexion : decrease in the angle of the joint   Extension : increase in the angle of the joint TERMS OF MOVEMENT

14. TERMS OF MOVEMENT Abduction : movement of limb away from midline   Adduction : movement of limb towards the midline Adduction Abduction

15. TERMS OF MOVEMENT Pronation : movement of hand and forearm to bring the palm   facing posterior   Supination : movement of hand and forearm to bring the palm facing anterior

16. TERMS OF MOVEMENT   Circumduction : circular movement of a joint using a combination of flexion, abduction, extension and adduction such that the distal limb describes a circle

17. TERMS OF MOVEMENT Opposition : thumb brought to oppose another digit      Reposition : thumb repositioned back to the anatomic position

18. TERMS OF MOVEMENT   Elevation : movement of the scapular superiorly   Depression : movement of the scapular inferiorly Elevation of shoulders Depression of shoulders

19. TERMS OF MOVEMENT Eversion : movement of the sole of the foot away from the median plane Inversion : movement of the sole of the foot towards from the median plane

20. TERMS OF MOVEMENT Protrusion : movement of the mandible, lips or tongue anteriorly Retraction : movement of the mandible, lips or tongue posteriorly Protrusion Retraction

21. TERMS OF MOVEMENT Medial rotation is a rotational movement towards the midline. It is sometimes referred to as internal rotation   Lateral rotation is a rotating movement away from the midline. This is in the opposite direction to the medial rotational movements Lateral rotation Medial rotation

22. TERMS OF MOVEMENT Dorsiflexion refers to flexion at the ankle, so that the foot points more superiorly. Dorsiflexion of the hand is a confusing term, and so is rarely used. The dorsum of the hand is the posterior surface, and so movement in that direction is extension. Therefore, we can say that dorsiflexion of the wrist is the same as extension.   Plantarflexion refers extension at the ankle, so that the foot points inferiorly. Similarly, there is a term for the hand, which is palmar flexion.

23. General Body Positions Upright - erect or marked by vertical position Seated - upright position in which the patient is sitting on a chair or stool Recumbent - general term referring to lying down in any position, such as dorsal recumbent bent, ventral recumbent, or lateral recumbent Supine - lying on the back Prone - lying face down

24. Trendelenburg position Supine position with head tilted downward

25. Fowler position supine position with head higher than the feet

26. Sims position recumbent position with the patient lying on the left anterior side (semi-prone) with left leg extended and right knee and thigh partially flexed

27. Lithotomy position supine position with knees and hip flexed and thighs abducted and rotated externally, supported by ankle or knee supports

28. Projection terminology A projection is described by the direction of the central ray relative to aspects and planes of the body. Antero-posterior : The central ray is incident on the anterior aspect, passes along or parallel to the median sagittal plane, and emerges from the posterior aspect of the body. The patient is shown in the supine or dorsal recumbent body position. AP projections can also be achieved with upright, seated, or lateral decubitus positions.

29. Postero-anterior The central ray is incident on the posterior aspect, passes along or parallel to the median sagittal plane, and emerges from the anterior aspect of the body. PA projections can also be achieved with seated, prone (ventral recumbent), and lateral decubitus positions.

30. Lateral The central ray passes from one side of the body to the other along a coronal and transverse plane. The projection is called a right lateral if the central ray enters the body on the left side and passes through to the image receptor positioned on the right side A left lateral is achieved if the central ray enters the body on the right side and passes through to the image receptor, which will be positioned parallel to the median sagittal plane on the left side of the body.

31. Contd…. In the case of a limb, the central ray either is incident on the lateral aspect and emerges from the medial aspect (lateromedial), or is incident on the medial aspect and emerges from the lateral aspect of the limb (medio-lateral). The terms ‘lateromedial’ and ‘medio-lateral’ are used where necessary to differentiate between the two projection.

32. AXIAL PROJECTION In an axial projection, there is longitudinal angulation of the central ray with the long axis of the body or a specific body part This angulation is based on the anatomic position and is most often produced by angling the central ray cephalad or caudad. The longitudinal angulation in some examinations is achieved by angling the entire body or body part while maintaining the central ray perpendicular to the IR.

33. Tangential projection Tangential means touching a curve or surface at only one point. This is a special use of the term projection to describe a projection that merely skims a body part to project that part into profile and away from other body str. This os a specific AP chest projection for demonstrating the apices of the lungs. Also sometimes called ‘the apical lordotic projection’. In this case, the long axis of the body rather than the CR is angled . 12/15/2022 41

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35. Transthoracic lateral projection Lateral projection through the thorax Requires a qualifying positioning term to indicate which shoulder is closest to the IR and is being examined. 12/15/2022 43

36. CONT.. This is a special adaptation of the projection term, indicating that the CR passes through the thorax even though it doesn’t include and entrance or exit side. In practice, this is a common lateral shoulder projection and is referred to as a rt. or lt. transthoracic lateral shoulder 12/15/2022 44

37. Parietoacanthial and acanthioparietal projections The CR enters at the cranial parietal bone and exists at the acanthion for the parietoacanthial projection. The opposite CR direction would describe the acanthioparietal projection. These are also known as PA Waters and AP reverse waters methods and are used to visualize the facial bones 12/15/2022 45

38. Submentovertex (SMV) and verticosubmental (VSM) projections These projections are used for the skull and mandible. CR enters below the chin, or mentum, exits at the vertex or top of the skull for the submentovertex projection. The less common, opposite projection of this would be the verticosubmental projection, entering at the top of the skull and exiting below the mandible. 12/15/2022 46

39. Beam angulation Radiographic projections are often modified by directing the central ray at some angle to a transverse plane, i.e. either caudally (angled towards the feet) or cranially/cephalic angulation (angled towards the head ) Oblique: The central ray passes through the body along a transverse plane at some angle between the median sagittal and coronal planes. For this projection, the patient is usually positioned with the median sagittal plane at some angle between zero and 90 degrees to the cassette, with the central ray at right-angles to the cassette. If the patient is positioned with the median sagittal plane at right-angles to or parallel to the cassette, then the projection is obtained by directing the central ray at some angle to the median sagittal plane

40. Anterior oblique The central ray enters the posterior aspect, passes along a transverse plane at some angle to the median sagittal plane, and emerges from the anterior aspect. The projection is also described by the side of the torso closest to the cassette. If the left side is closest to the cassette, then it is called left anterior oblique and vice versa.

41. Posterior oblique The central ray enters the anterior aspect, passes along a transverse plane at some angle to the median sagittal plane, and emerges from the posterior aspect. If the left side is closest to the cassette, then it is called left posterior oblique and vice versa.

42. Oblique using beam angulation When the median sagittal plane is at right-angles to the cassette, right and left anterior or posterior oblique projections may be obtained by angling the central ray to the median sagittal plane. this cannot be done if using a grid, unless the grid lines are parallel to the central ray .

43. Lateral oblique The central ray enters one lateral aspect, passes along a transverse plane at an angle to the coronal plane, and emerges from the opposite lateral aspect. With the coronal plane at right-angles to the cassette, lateral oblique projections can also be obtained by angling the central ray to the coronal plane. This cannot be done if using a grid, unless the grid lines are parallel to the central ray.

44. Decubitus In radiographic positioning terminology, the term decubitus indicates that the patient is lying down and that the central ray is horizontal and parallel with the floor. Three primary decubitus positions are named according to the body surface on which the patient is lying: lateral decubitus (left or right), dorsal decubitus, and ventral decubitus. Of these, the lateral decubitus position is used most often to show the presence of air-fluid levels or free air in the chest and abdomen .

45. Left lateral decubitus T he patient is placed in the left lateral decubitus radiographic position with the back (posterior surface) closest to the IR. In this position, a horizontal central ray provides an AP projection Alternatively, the patient may be placed with the front of the body (anterior surface) facing the IR, resulting in a PA projection.

46. Dorsal decubitus The patient is shown in a dorsal decubitus radiographic position with one side of the body next to the IR. The horizontal central ray provides a lateral projection. This is correctly described as a lateral projection with the patient placed in the dorsal decubitus position. Either side may face the IR, depending on the examination or the patient’s condition.

47. Ventral decubitus The ventral decubitus also places a side of the body adjacent to the IR, resulting in a lateral projection. the accurate terminology is lateral projection with the patient in the ventral decubitus position. Either side may face the IR.

48. Lordotic Position Lordotic Position The lordotic position is achieved by having the patient lean backward while in the upright body position so that only the shoulders are in contact with the IR An angulation forms between the central ray and the long axis of the upper body, producing an AP axial projection. This position is used for visualization of pulmonary apices and clavicles

49. ABBREVIATIONS ?-Query, #-Fracture, CXR-Chest x-ray,  SXR-skull x-ray, OM, OF, EAM, RBL, abd . L/S- lumber spine, C/S, D/S, T/S, RTA-Road Traffic Accident,  H/O-History of,  C/O-Complains Of, O/E-On Examination,  R/O-Rule Out,

50. CONT.. POP-Plaster Of  Paris, NAD-No Abnormality Detected., I/V-Intravenous  FB- Foreign body, TB- Tuberculosis, PTB-Pulmonary Tuberculosis, Ca-Carcinoma UTI-Urinary Tract Infection GI-Gastro-Intestinal

51. Modalities abbreviation CT-Computed Tomography MRI-Magnetic Resonance Imaging USG-Ultra-Sonography SPECT-Single Photon Emission Computed Tomography PET-Positron Emission Tomography DSA-Digital Subtraction Angiography CR-Computed Radiography DR- Direct Radiography NM- Nuclear Medicine

52. WORK DRILL FOR RADIOLOGICAL TECHNICIAN For all radiographic examination the following routine should be followed 1-Collect the x-ray request form. 2- Call the patient and check that you have the correct patient. 3 -Ask the patient if they have had previous x-ray, and find the old x-ray if possible 4-Give the instruction to the patient about undressing , etc. 5-Prepare the x-ray room, select radiation protection measures. 6- select the cassette and then select the exposure factors. 7-Collect the patients and check that all radiopaque object have been removed from the area to be examined 8- Position the patient and the cassette and tube then collimate the beam. 12/15/2022 68

53. WORK DRILL FOR RADIOLOGICAL TECHNICIAN 8- Give necessary instruction to the patient – about breathing and immobilization etc. 9- Make the exposure. 10- Give instruction to the patient about breathing and what to do next. 11-Send the cassette/image for processing. 12-Check the radiograph (exposure factors, Position, image quality, name , marker, date etc.) 13.If the radiograph is satisfactory ,send the patient away with appropriate instruction. 12/15/2022 69

54. Summary of the potentially misuse positioning terms Position Is a term that is used to indicate the patient’s general physical position such as supine, prone, recumbent, or erect. Is also used to describe specific body positions by the body part closest to the ir , such as lateral and oblique. Should be ‘restricted to discussion of patient’s physical position

55. Projection Is a correct positioning term that describes or refers to the path of the central ray, projecting an image onto an IR Should be restricted to discussion of the path of CR View Is not a correct positioning term. Describes the body part as seen by the IR or other recording medium, such as a fluoroscopic screen Term view should be restricted to discussion of radiograph or image 12/15/2022 71

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58. REFERENCES SNELL CLINICAL ANATOMY BY REGIONS 9TH ED CLINICAL-ANATOMY.ORG PRINCIPLES OF ANATOMY AND PHYSIOLOGY RADIOPAEDIA.ORG CLARK’S POSITIONING IN RADIOGRAPHY MERRIL'S ATLAS OF RADIOGRAPHIC POSITIONING

59. Questions for discussion What is full form of RTA? Difference between dorsiflexion and plantar flexion? Explain left lateral position. The central ray for the decubitus position is……… to the MSP? What is fowlers position? What is simp’s position? Describe anatomical postion . Submentoverticular and verticulosubmental projection is used for? What is cardinal plane?

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