Radiology Positioning

What are the indications for X-rays?

* Bone pathology
* Joint pathology
* Foreign bodies
* Osseous surgery
* Infection
* Soft tissue

What are the labels needed for a Xray?

* Name
* Date
* Right or left labeling
* Facility
* Weight bearing (WB) or NWB

What are the Pre x-ray checklist?

* Is it needed
* Appropriate view
* Are they pregnant
* Is it label
* Are they wearing a lead apron
* Technical factors

What do you do when you don’t know if your patient is pregnant?

* 10 day rule( once period started)
* Check for visible signs
* Ask
* Have them signed waiver
* Document

What protection should you use when doing a Xray on someone?

* Wear lead apron
* 6ft cord ( Plunger)
* Stay behind primary wall
* Wear lead gloves ( if warranted)

What is the mental checklist you need to check before doing foot Xray?

* Correct foot
* Correct kvp, ma, exposure time
* Correct Position

What is called ?

Tubehead angulation

What is the foot views?

* Dorsoplanar (DP,AP)
* Lateral
* Medial oblique (MO)
* Lateral oblique (LO)
* Sesamoid axial (forefoot axial)
* Calcaneal axial (Ski jump)

Dorsoplanar view?

* Patient stands cassette
* Tubehead at 15 degrees
* Knee slightly flexed
* Central ray at base of 2nd metatarsal

What view is this?

Dorsoplanar View

Lateral View?

* Cassette upright in a shot
* Tube angle 90 degrees
* Medial aspect of ankle against cassette
* Central ray at lateral cuneiform/cuboid

What view is this?

Lateral view

Medial oblique?

* Cassette flat on orthoposer
* Tube angle at 0 degrees
* Foot rotated so medial aspect of foot is on film
* Central ray is directed on the lateral aspect at 3rd metatarsocuneiform joint

What view is this?

Medial oblique View (non wt.bearing)

What does position refer to?

Part of the foot closet to cassette.

What does view refer to?

Image on film

What does projection refers to?

how the ray enters the body part & direction it travels.

What is a dorsoplanar projection?

* Dorsoplanar view of dorsoplanar foot

What can oblique foot view?

* Weight bearing or non bearing
* WT bearing gave magnified view
* Podiatry ( non WT bearing)

A medial oblique position gives?

Medial oblique view

What is a lateral foot?

a lateral to medial projection = lateral view

For oblique view how should the foot be to avoid magnification & distortion of view?

Non weight bearing

What are the steps to take a lateral oblique?

* Cassette upright in slot
* Tubehead 90 degrees
* Foot rotated so lateral aspect is on the cassette
* Central rays entering the medial foot at 1st met cuneiform joint
* Foot rotated 45 degrees

What view is this?

Lateral oblique ( non weight bearing)

What are the steps to take a Sesamopid axial?

* Cassette in upright position
* Toes will be closest to cassette
* Beam directed from behind the patient to bottom of foot
* Central ray directed to 3rd MPJ on bottom of foot
* Tube head 90 degrees

What are the steps to take a Sesamopid axial if axial poser is used?

* Cassette in upright position
* Toes will be closest to cassette
* Beam directed from behind the patient to bottom of foot
* Beam directed to center back of axial poser
* Tube head 90 degrees

What view is this?

Sesamoid Axial

What are the steps to take a Calcaneal Axial?

* Cassette flat orthoposer
* Tubehead 25 degrees directed anterior
* Stand on cassette in ski jump position (knees flexed)
* Central ray between achilles insertion & ankle joint

What view is this?

Calcaneal Axial

What are the types of Ankle views?

* Anteroposterior (AP)
* Mortise
* Medial Oblique (MO)internal
* Lateral oblique (LO) external
* Lateral

What are the steps to take a Anteroposterior ankle?

* Cassette upright in slot
* Tubehead 90 degrees
* Heel against cassette
* Central ray between malleoli

What view is this?

AP Ankle

What are the steps to take a Mortise ankle?

* Cassette in upright position
* Tubehead 90 degrees
* Heel Against cassette
* Foot rotated internally 15 degrees
* Central ray between malleoli

What is view is this?

Mortise ankle

What are the steps to take a lateral ankle?

* Cassette upright in slot
* Cassette turned so long axis is upright
* Tubehead at 90 degrees
* Medial aspect of ankle against cassette
* Central ray center of lateral malleoli

What view is this?

Lateral ankle

What are the steps for a medial oblique of ankle

* Cassette upright in slot
* Cassette placed so long axis is upright
* Tubehead is 90 degrees
* Back of heel against cassette with foot internally rotated 45 degrees.
* Ray enter lateral aspect of the ankle
* Central ray is center of ankle joint between malleoli

What view is this?

Medial oblique Ankle

What are the steps for a lateral oblique of ankle?

* Cassette is upright
* Cassette long axis upright
* Tubehead 90 degrees
* Heel is against cassette
* Foot externally rotated 45 degrees
* Ray hit medial aspect of ankle
* Central ray is center of ankle joint between malleoli

What view is this?

Lateral oblique ankle

Can you take bilateral views on the same film to limit the number of exposer by decreasing number of xrays taken?

No, This increase scatter radiation, which is more dangerous & decreases the quality of the image.

What are the standard foot views?

* Dorsoplanar
* Lateral
* Medial oblique

What are the standard ankle views?

* Anteroposterior
* Lateral
* Mortise