Semester 1 Rad LAB Positioning Demos

Chest (2 views)

Location: Erect at wall bucky + detent (unless trauma)

Distance: 72 in

Pt. change into hospital gown with everything off from waist up (clothes, jewelry) hair up or out of way; L marker on upper left (real left)

Film size: 14×17 lengthwise or crosswise depending on pt size

Views (2):

1. PA = pt facing wall bucky, shoulder rolled forward and arms hugging lower part of bucky; CR at T6-7

• PA Breathing instructions: deep breath in, deep breath out, deep breath in and hold (2nd inspiration)

• PA technique: 2 outer AEC cells @ 117 kVp

1. Left lateral = pt facing the left with left side against IR (avoid magnification of heart) with arms up on head with elbows slightly inward or holding handlebars on wall bucky; CR T6-T7

• LAT Breathing instructions: deep breath in and hold (inspiration)

• LAT technique: 1 inner AEC cell @ 117 kVp

Trauma:

1. AP = slide IR underneath pt

Abdomen KUB (1 view), Complete (2 views), Series (3 views)

Order types: 1) Abd KUB 2) Abd Complete 3) Abd Series

Location: wall and table bucky

Distance: 40 in

Pt. remove all clothes/jewelry but underwear/wear johnny

XR Abdomen KUB (1 view)

1. Supine Abdomen = CR @ iliac crest, include kidneys, ureters, bladder + pubis symphysis; marker R on right hip

• Supine ABD Film size = 14×17 lengthwise (or 2)

• Supine ABD technique =20-32 mAs @ 70-80 kVp

• Supine ABD breathing instructions = taken on expiration “take deep breath in, blow it all the way out and hold it out”

XR Abdomen Complete (2 views)

1. Supine abdomen = same as KUB

2. Upright abdomen = CR @ 2 in. above iliac crest, include diaphragm; L marker on lower right (anatomical left) (behind hip bone)

• Upright ABD Film size = 14×17 lengthwise

• Upright ABD technique = 20-32 mAs @ 70-80 kVp

• Upright ABD breathing instructions = taken on expiration “take deep breath in, blow it all the way out and hold it out”

3. (accommodation) Left lateral decub. = (if pt cannot stand for upright) CR @ 2 in. above iliac crest, include diaphragm

• LLD Film size = 14×17 lengthwise

• LLD technique = 20-32 mAs @ 70-80 kVp

• LLD breathing instructions = taken on expiration “take deep breath in, blow it all the way out and hold it out”

XR Abdomen Series (3 views)

1. Supine abdomen = same as above

2. Upright abdomen or LLD = same as above

3. PA chest = pt facing wall bucky, shoulder rolled forward and arms hugging lower part of bucky; CR at T6-7; L marker on upper left (real left)

• PA Chest Film size = 14×17 lengthwise (or cross depending on body habitus)

• PA Chest technique = 2 AEC cells @ 117 kVp

• PA Chest breathing instructions = taken on 2nd inspiration “take deep breath out deep breath in x2 and hold”

Hand (3 views)

Location: table top + non detented

Distance: 40 in

Pt. change remove rings, bracelets, ensure sleeve is out of the way; sit on affected side against the table

Film size: 8×10 crosswise (collimate to part)

Arrow: use arrow on most relevant view to indicate location of pain

Views (3):

1. PA = prone hand/wrist flat (palm down) on IR with fingers extended/slightly spread; CR 3rd MCP (metacarpophalangeal joint); marker on lateral side - pinky side

• PA pt. instructions: hold still

• PA technique: 0.5-0.8 mAs @ 58-60 kVp

2. Oblique = rotate radial side of wrist 45 degrees from IR keeping fingers slightly spread (prevent superimposition); CR 3rd MCP; marker on lateral side - pinky side

• Oblique instructions: hold still

• Oblique pt. technique: 0.5-0.8 mAs @ 58-60 kVp

3. Lateral = hand/wrist at 90 degree angle to IR ulnar side down (pinky), fingers spread in fan like manner w/ thumb projecting away from palm (okay sign) CR 2nd metacarpal (knuckle); marker on lateral side - backside of hand

• LAT pt. instructions: hold still

• LAT technique: 0.8-1 mAs @ 58-62 kVp

Finger (3 views)

Location: table top + non detented

Distance: 40 in

Pt. change remove rings, bracelets, ensure sleeve is out of the way; sit on affected side against the table

Film size: 8×10 crosswise (collimate to finger, not on hand PA)

Arrow: use arrow on most relevant view to indicate location of pain

Views (3):

1. PA = prone hand/wrist flat (palm down) on IR with fingers extended/slightly spread; CR 3rd MCP (metacarpophalangeal joint); marker on lateral side - pinky side

• PA pt. instructions: hold still

• PA technique: 0.5-0.8 mAs @ 58-60 kVp

2. Oblique = rotate radial side of wrist 45 degrees from IR keeping fingers slightly spread (prevent superimposition); CR PIP of finger; marker on lateral side - pinky side

• Oblique instructions: hold still

• Oblique pt. technique: 0.5-0.6 mAs @ 58 kVp

3. Lateral = roll finger onto side mediolaterally (thumb side) and curl other fingers out of the way; CR PIP of finger; marker on lateral side - backside of finger

• LAT pt. instructions: hold still

• LAT technique: 0.5-0.6 mAs @ 58 kVp

Thumb (3 views)

Location: table top + non detented

Distance: 40 in

Pt. change remove rings, bracelets, ensure sleeve is out of the way; sit on affected side against the table

Film size: 8×10 crosswise (collimate to thumb, not on hand PA)

Arrow: use arrow on most relevant view to indicate location of pain

Views (3):

1. PA hand but Oblique thumb = prone hand/wrist flat (palm down) on IR with fingers extended/slightly spread; CR 3rd MCP (metacarpophalangeal joint); marker on lateral side - pinky side

• PA (Oblique) pt. instructions: hold still

• PA (Oblique): 0.5-0.8 mAs @ 58-60 kVp

2. Lateral = curl hand into loose fist to turn thumb onto its side + collimate; CR 1st MCP; marker lateral border - backside of thumbnail side

• Lateral instructions: hold still

• Lateral pt. technique: 0.5-0.6 mAs @ 58 kVp

3. PA thumb = roll thumb onto the nail side mediolaterally (thumb side) and curl other fingers out of the way; CR 1st MCP; marker on lateral side - beside thumb

• PA pt. instructions: hold still

• PA technique: 0.5-0.6 mAs @ 58 kVp

Wrist (4 views)

Location: table top + non detented

Distance: 40 in

Pt. change remove rings, bracelets, ensure sleeve is out of the way; sit on affected side against the table

Film size: 8×10 lengthwise (collimate properly)

Arrow: use arrow on most relevant view to indicate location of pain

Views (4):

1. PA = prone hand/wrist flat (palm down) on IR with fingers extended/slightly spread; CR mid carpal; marker on lateral side - pinky side

• PA pt. instructions: hold still

• PA technique: 0.8-1 mAs @ 60 kVp

2. OBL = rotate wrist/hand at 45 degrees (thumb up); CR mid carpal; marker pinky side

• Oblique instructions: hold still

• Oblique pt. technique: 0.8-1 mAs @ 60 kVp

3. LAT = rotate wrist 90 degrees (karate chop); CR mid carpal; marker on lateral side - back of hand/wrist

• LAT pt. instructions: hold still

• LAT technique: 1-1.2 mAs @ 62 kVp

4. Ulnar deviation = deviate wrist toward ulna without moving forearm, collimate to scaphoid; CR scaphoid angle tube 20 degrees; marker beside scaphoid

• Ulnar dev pt. instructions: hold still

• Ulnar dev technique: 0.8-1 mAs @ 60 kVp

Forearm (2 views)

Location: table top + non detented

Distance: 40 in

Pt. change remove rings, bracelets, ensure sleeve is out of the way; sit with affected side to table

Film size: 10×12 lengthwise (collimate)

Views (2):

1. AP = supinate hand (palm up) include wrist/elbow joints, humerus on same plane as radius/ulna; CR at mid-forearm; marker on lateral border - thumb side

• AP pt. instructions: dont move

• AP technique: 1-1.2 mAs @ 62 kVp

2. Lateral = flex elbow 90 degrees (thumbside up karate chop), include wrist/elbow joint, humerus as same plane as radius/ulna; CR at mid-forearm; marker on back of arm

• LAT pt. instructions: dont move

• LAT technique: 1.2-1.6 mAs @ 64 kVp

Elbow

table top 40 SID

8 × 10, collimate so 1/3rd of forearm/humerus

Pt. instructions = DONT MOVE

1. AP view = supinate hand + extend elbow; CR at mid elbow; marker on thumbside

• AP view technique: 1-1.8 mAs @ 62-64 kVp

1. Oblique view = rotate arm 45 degrees toward thumb, use pt’s shoulder; CR at mid elbow; marker on thumbside

• Oblique view technique = 1-1.8 mAs @ 62-64 kVp

1. Lateral view = arm at 90 degree angle, epicondyles superimposed; CR at mid elbow; marker on backside of elbow

• Lateral view technique = 1-1.8 mAs @ 62-64 kVp

Humerus

wall bucky 40 SID

14×17 lengthwise (collimate in)

Pt. instructions = dont move dont breathe

1. AP = outstretch arm supinate hand, epicondyles parallel to IR; CR @ mid humerus and turn tube to match arm (diagonal); correct marker for the side its on - L

• AP technique: (wall bucky) 3.2-5 mAs @ 70 kVp

1. Lateral view = turn hand inwards so back of hand rests on hip, epicondyles perpendicular to IR; CR @ mid humerus and keep tube to match arm (diagonal); correct marker for the side its on - L

• Lateral technique: (wall bucky) 3.2-5 mAs @ 70 kVp

Non-Trauma Shoulder

Location: Erect at wall bucky 40 SID

Pt. remove bra/move strap out of way and remove necklace

Size: 10×12 crosswise

Views (2):

1. External = externally rotate arm and supinate hand (palm up) with epicondyles parallel to IR; shows greater tubercle best; CR 1in below coracoid process; marker L lateral border

• External technique: 4-8 mAs @ 70-72 kVp

• External pt instructions: dont move dont breathe

2. Internal = internally rotate arm with back of hand against thigh with epicondyles perpendicular to the IR; shows lesser tubercle best; CR 1in below coracoid process; marker L lateral border

• Internal technique: 4-8 mAs @ 70-72 kVp

• Internal pt instructions: dont move dont breathe

Trauma Shoulder

Location: erect at wall bucky

Distance: 40 in

Pt. remove bra/move strap and necklaces

Film size: varies between views

Views (3):

1. AP Grashey view = rotate affected side toward IR with scapula parallel to IR, 35-40 degrees oblique; CR @ coracoid process; best shows glenoid fossa

• AP Grashey film size = 10×12 crosswise (erect at wall bucky or supine)

• AP Grashey technique = 6-8 mAs @ 70-72 kVp

2. Y-view = rotate affected side away from film with scapula perpendicular to IR, 45-60 degrees oblique; CR @ upper 1/3rd of humerus; best shows anterior/posterior dislocation

• Y-view film size = 10×12 lengthwise (erect or supine)

• Y-view technique = 8-14 mAs @ 78 kVp

3. (LAB version) Axillary view = arm with elbow at 90 degrees with pt. leaning over IR with green (right side) against their side, head facing other shoudler; CR at perpendicular to b8 fossa, angle tube 5-15 degrees toward elbow if needed

• LAB axillary film size = 10×12 crosswise at table top

• LAB axillary technique = 2.5-4 mAs @ 70 kVp

4. (lying down) Axillary view = pt. laying down with sponge under affected shoulder with arm abducted 90 degrees and palm up; CR cassette close to neck; best shows head/neck in lateral position

note: dont forget to change technique between EACH view

Scapula

Location: erect at wall bucky

Distance: 40 in

Pt. remove bra/move strap remove necklaces

Film size: 10×12 lengthwise

Views (2):

1. AP view = erect or recumbent, pt. back facing IR and abducts arm 90 degrees with palm up (flex!); CR @ 2 in. below coracoid process (axilla level) and 2 in. medially; L marker on pt. left

• AP view technique: 4-8 mAs @ 72 kVp

• AP pt. instructions: don’t move don’t breathe

1. Y-view = erect or recumbent, pt. rotated away from IR 45 degrees and bring arm across lower chest (prevents overlap of humerus on scapula); CR @ mid-scapula (around upper 1/3rd of humerus); L marker on pt. left

• Y-view technique: 8-14 mAs @ 78-80 kVp

• Y-view pt. instructions: don’t move don’t breathe