Radiology Proficiency Exam

Lateral Cervical

Pt Placement:

Measure: C4 from side to side (from behind)

Collimation: 8x10, collimate out eyes

CR Placement: C4 (light just above ear)

Tube tilt: None

SID: 72"

Breathing: Exhale and hold

AP Cervical (PUC is the same)

Pt Placement: sitting, make sure to lift chin slightly but not touching bucky

Measure: C4 level front to back

Collimation: 8x10, to soft tissue side to side

CR Placement: C4

Tube tilt: 15 cephalic

SID: 40"

Breathing: DBDM

APOM

Pt Placement: seated

Measure: corner of mouth to base of skull

Collimation: 8x10, below orbits into mastoids

CR Placement: middle of mouth

Tube tilt: none

SID: 40"

Breathing: DBDM

Flexion/Extension Cervical

Pt Placement: sitting, tuck chin and let head fall forward for flexion

Measure: sides of neck

Collimation: 10x12

CR Placement: C4

Tube tilt: none

SID: 72"

Breathing: DBDM

Anterior Oblique Cervical

Pt Placement: sitting at 45 degree angle

Measure: sides of neck

Collimation: 8x10

CR Placement: C4 (make sure light field goes just above the ear and skims AC joint)

Tube tilt: 15 caudal

SID: 72"

Breathing: DBDM

Swimmer's

Pt Placement: sitting with arm closest to bucky raised, scoot chair closer to bucky to make sure they have good contact

Measure: underneath arms side to side

Collimation: 8x10

CR Placement: C7/T1

Tube tilt: none

SID: 40"

Breathing: DBDM

Lateral Thoracic

Pt Placement: lateral position with side touching bucky, use T-bar with hands in prayer position, light behind their back

Measure: under arms side to side

Collimation: 10x17

CR Placement: T6, top of film 1.5" above VP

Tube tilt: none

SID: 40"

Breathing: Inhale and hold

AP Thoracic

Pt Placement: standing

Measure: over shoulder sternum to spine

Collimation: 7x17

CR Placement: T6, top of film 1.5" above sternal notch

Tube tilt: none

SID: 40"

Breathing: Inhale and hold

Lateral Lumbar

Pt Placement: Standing L or R side touching bucky, arms up together in front (using T-bar or resting on bucky)

Measure: L3 level side to side

Collimation: 10x17

CR Placement: L3 level 1" above crest, crosshairs in midline, light doesn't need to be behind patient

Tube tilt: none

SID: 40"

Breathing: Exhale and hold

APLP

Pt Placement: Standing back against bucky

Measure: front to back widest portion of abdomen

Collimation: 14x17

CR Placement: Men 2" below crest, Women 1" below crest, make sure light covers trochanters, top of light 1 inch below xiphoid

Tube tilt: none

SID: 40"

Breathing: Exhale & hold

Shielding: For females widest portion of heart 1 inch below ASIS, for males top of bell in light field

L5/S1 Lateral spot

Pt Placement: Standing L or R side touching bucky, arms up together in front (using T-bar or resting on bucky)

Measure: Below crest side to side

Collimation: 8x10

CR Placement: L5/S1, 2" below crest and 1" behind midline (top of light field will end up at the crest)

Tube tilt: none

SID: 40"

Breathing: DBDM

PA Chest

Pt Placement: PA, hands on hips, roll shoulders forward

Measure: over shoulder sternum to spine

Collimation: 14x17

CR Placement: top of film 1.5" above VP, have patient AP first to find height

Tube tilt: none

SID: 72"

Breathing: Inhale and hold

Shielding: covering their butt

Lateral Chest

Pt Placement: LEFT side against bucky, arms straight up

Measure: Under arms side to side

Collimation: 14x17

CR Placement: Top of film 1.5" above VP, vertical aspect of CR slightly behind humeral head, look for light in front AND behind patient

Tube tilt: none

SID: 72"

Breathing: Inhale and hold

AP Shoulder internal rotation

Pt Placement: internal rotate arm until epicondyles are perpendicular to the film

Collimation: 12x10

CR Placement: Glenohumeral joint space, top of light 1.5" above the shoulder

Tube tilt: none

SID: 40"

Breathing: DBDM

AP Shoulder external rotation

Pt Placement: AP position, rotate patient away from bucky

Collimation: 12x10

CR Placement: Glenohumeral joint space 1" below coracoid process which puts top of light 1.5" above shoulder

Tube tilt: None

SID: 40"

Breathing: DBDM

PA Shoulder "Y" view

Pt Placement: patient has affected shoulder against bucky and rotated 45 degrees away

Collimation: 10x12

CR Placement: Upper medial border of scapula (CR comes out of humeral head and across AC joint)

Tube tilt: 15 caudal

SID: 40"

Breathing: DBDM

AP Elbow

Pt Placement: AP so wrist, elbow, and shoulder are all in same plane. Humerus and forearm must be flat

Collimation: Part size

CR Placement: Middle of elbow (cubital fossa)

Tube tilt: None

SID: 40" Tabletop

Breathing: DBDM

Lateral Elbow

Pt Placement: Lateral so wrist, elbow, and shoulder are all in the same plane, thumb up

Collimation: Part size, don't collimate too tight or you'll miss the fat pad

CR Placement: Over superimposed epicondyles

Tube tilt: none

SID: 40" tabletop

Breathing: DBDM

AP with external oblique Elbow

Pt Placement: AP so wrist, elbow and shoulder are all in the same plane

Collimation: Part size

CR Placement: Middle of elbow

Tube tilt: None

SID: 40" tabletop

Breathing: DBDM

AP with internal oblique Elbow

Pt Placement: Same as AP with full pronation of hand, epicondyle should be 45 degrees

Collimation: Part size

CR Placement: Middle of elbow

Tube tilt: None

SID: 40" tabletop

Breathing: DBDM

PA Wrist

Pt Placement: PA fingers curled to make a loose fist

Collimation: Part size

CR Placement: Middle of part, lunate

Tube tilt: none

SID: 40" tabletop

Breathing: DBDM

PA Oblique wrist

Pt Placement: Oblique, fingers curled to make a loose fist

Collimation: part size

CR Placement: middle of part, lunate

Tube tilt: none

SID: 40" tabletop

Breathing: DBDM

Lateral wrist

Pt Placement: Arm extended in lateral position with pinky touching film, take pen to straighten out wrist

Collimation: part size

CR Placement: middle of part, scaphoid, proximal row of carpals

Tube tilt: none

SID: 40" tabletop

Breathing: DBDM

PA Hand

Pt Placement: PA hand flat on plate, bring fingers a little together

Collimation: part size, make sure radius and ulna are in the light

CR Placement: 3rd metacarpal head/MCP joint

Tube tilt: None

SID: 40" tabletop

Breathing: DBDM

PA Oblique hand

Pt Placement: Roll hand up and place obliquely.

Collimation: Part size

CR Placement: 3rd metacarpal head (MCP joint)

Tube tilt: none

SID: 40" tabletop

Breathing: DBDM

AP Knee

Pt Placement: Seated, true AP position, dorsiflex foot with toes straight up

Collimation: Part size

CR Placement: 1/2" below apex of knee

Tube tilt: 5 degrees cephalic

SID: 40" tabletop

Breathing: DBDM

Shielding: Place apron on their lap

Lateral Knee

Pt Placement: Supine lying on affected side with knee bent and other leg brought over the affected leg knee flexed 30 degrees, hips perpendicular

Collimation: Part size

CR Placement: On Medial condyle

Tube tilt: 5 degrees cephalic

SID: 40" tabletop

Breathing: DBDM

Holmblad Knee

Pt Placement: Prone and then up on hands and knees so femur forms a 20 degree angle with CR

Collimation: part size

CR Placement: middle of knee joint

Tube tilt: none

SID: 40" tabletop

Breathing: DBDM

Shield: drape over their back

AP Ankle

Pt Placement: True AP position, toes straight in the air

Collimation: Part size

CR Placement: Middle of ankle joint

Tube tilt: None

SID: 40" tabletop

Breathing: DBDM

Oblique Ankle

Pt Placement: True AP position then internally rotate leg 15 degrees, dorsiflex foot, make sure navicular is in the light

Collimation: Part size

CR Placement: Middle of ankle joint

Tube tilt: None

SID: 40" tabletop

Breathing: DBDM

Lateral Ankle

Pt Placement: Supine, lying on the affected side and pinky toe on the plate, dorsiflex foot

Collimation: Part size

CR Placement: Over medial malleolus, include the 1st metatarsal head

Tube tilt: None

SID: 40" tabletop

Breathing: DBDM

AP Foot

Pt Placement: Knee bent, plantar surface of foot on the top of the film

Collimation: Part size

CR Placement: Middle of 3rd to base of 3rd metatarsal

Tube tilt: 10 cephalic

SID: 40" tabletop

Breathing: DBDM

Oblique Foot

Pt Placement: Same as AP except with MEDIALLY oblique foot

Collimation: Part size

CR Placement: Middle of 3rd metatarsal to base of 3rd metatarsal

Tube tilt: 10 cephalic

SID: 40" tabletop

Breathing: DBDM

Lateral Foot

Pt Placement: Put lateral side of foot down on film and foot is parallel to length of the film

Collimation: Part size

CR Placement: Base of the metatarsals

Tube tilt: NONE

SID: 40" tabletop

Breathing: DBDM