Radiographic Techniques and Patient Assessment

Settings for PA chest X-ray.

110 kVp @ 1.5 mAs

Settings for lateral chest X-ray.

110 kVp @ 4 mAs

Settings for pelvic X-ray.

80 kVp @ 12 mAs

Centering point for pelvic X-ray.

2" below ASIS, internally rotate 15-20 degrees putting greater trochanter in profile

Settings for KUB X-ray.

80 kVp @ 10 mAs

Upright KUB

CR centered 2" above iliac crest.

Supine KUB

CR centered at iliac crest level.

Settings for foot X-ray.

60 kVp @ 1.25 mAs

AP Axial Foot

CR 10 degrees towards heel, centered at base of 3rd metatarsal.

Obl Foot

Medial rotation of 30-40 degrees for imaging. CR perpendicular to IR

UGI

Upper Gastrointestinal series imaging.

Settings for AP UGI X-ray

80 kVp @ 3.5 mAs

Centering point for AP UGI X-ray.

Between the vertebral border and lateral border and 1-2” above lower rib margin (L1-2). Barium filled fundus and doudenal bulb

Settings for lower leg (tib-fib) X-ray.

75 kVp @ 2.5 mAs

Settings for pediatric chest X-ray.

80 kVp @ 0.5 mAs

PA CALDWELL Sinuses

80 kVp @ 8 mAs

CR perpendicular to IR

CR exits at nasion. GAL parallel to IR

Petrous ridges lower 1/3 of orbits, OML 15 degrees from horizontal

Frontal and anterior ethmoid sinus view

Parietoacanthial WATERS Sinuses

80 kVp @ 8 mAs

CR perpendicular to IR

CR exits at acanthion. MML parallel to IR

Petrous ridges below maxillary sinuses, OML 37 degrees from IR

Maxillary sinus view

Submentovertex (SMV) sinuses X-ray.

80 kVp @ 12 mAs

CR perpendicular to IR

CR entering between gonions, IOML parallel to IR

GAL perpendicular to IR

Ethmoid and sphenoid in view

Peds KUB

75 kVp @ 2 mAs

LATERAL sinuses X-ray

80 kVp @ 3 mAs

CR perpendicular to IR

CR centered between EAM and outer canthus, IOML parallel to floor

IPL perpendicular to IR

Demonstrated all 4 sinuses

Knee PA Axial Weight Bearing (Rosenberg Method)

Uses 40" SID with 10° caudad CR. Knees flexed 45°; patella on bucky

Knee Intercondylar Fossa Tunnel

rosenberg, beclere, holmblad, camp coventry

Camp Coventry Method

Prone position, 40-50° flexion, 40-50° caudad CR. (PA Axial)

Holmblad Method

Kneeling position, 60-70° flexion, perpendicular CR. (PA)

Beclere Method

Supine, 40-45° flexion, 40-45° cephalic CR. (AP Axial)

UGI RAO Projection

Prone, 40-70° rotation, CR above lower rib margin.

Barium filled body and pylorus

Gastric Peristalsis

More active in RAO position.

LPO Projection

30-60° posterior oblique, CR above lower rib margin.

Barium

Right Lateral UGI

Recumbent, CR at L1-2 level.

Right retrogastric space

LGI PA Axial Projection

Prone, 30-40° caudad CR enters at crest level and exits at ASIS.

Rectosigmoid with less superimposition than PA

LGI PA Oblique RAO

35-45° oblique, CR lateral to midline at crest level.

Visualized in LGI PA Oblique RAO projection.

Opened Right “Hepatic” Colic Flexure

LGI PA Oblique LAO

35-45° oblique, CR lateral to midline.

Visualized in LGI PA Oblique LAO projection.

Opened Left “Splenic” Colic Flexure

AP Axial LGI

Supine, 30-40° cephalad CR enters below ASIS.

Rectosigmoid with less superimposition than PA

Decubitus Position

Horizontal beam for air fluid levels.

Upside of both ascending and descending colon

Body Habitus Types

Sthenic, Hypersthenic, Asthenic, Hyposthenic classifications.

Sthenic Habitus

Average body type, 50% of population.

Hypersthenic Habitus

Overweight, stomach high and horizontal. 5%

Asthenic Habitus

Very thin, stomach low and vertical. 10%

Hyposthenic Habitus

Thin, stomach 'J' shaped, lower placement. (35%)

Grid Usage

Used for parts 10cm (4”) thick, 70+ kVp.

Patient Immobilization Devices

Cervical collar, backboard, air splint, traction splints.

Shock Pants

Used to slow hemorrhage in trauma patients.

Contrast Media for UGI

Barium sulfate

Water soluble iodinated contrast for perforation.

Water soluble

Contrast medium requiring 80-90 kVp for imaging.

Barium

Contrast medium requiring 110-125 kVp for imaging.

CR for Sthenic UGI RAO

Center CR to duodenal bulb at L1 level. 45-55 degree

CR for Asthenic UGI RAO

Center CR 2 inches below L1, 40-degree oblique.

CR for Hypersthenic UGI RAO

Center CR 2 inches above L1, 70-degree oblique.

Evaluation criteria for UGI RAO

Duodenal bulb in profile, stomach and duodenum visible.

Barium filled body and pylorus

Respiration during exposure UGI RAO

Suspend respiration and expose on expiration.

Indications for UGI RAO

Used for diagnosing polyps and ulcers.

PA Projection UGI RAO

Patient prone with arms beside head, MSP aligned.

CR for PA Sthenic

Center CR at pylorus, 1 inch left of vertebral column.

CR for PA Asthenic

Center CR 2 inches below L1.

CR for PA Hypersthenic

Center CR 2 inches above L1, nearer midline.

Evaluation criteria for PA

Entire stomach and duodenum in profile.

Indications for PA

Used for polyps, diverticula, gastritis, bezoars.

Right Lateral Position

Patient recumbent, shoulders and hips in true lateral.

CR for Right Lateral Sthenic

Center at duodenal bulb, 1-1.5 inches anterior to MCP.

CR for Right Lateral Hypersthenic

Center about 2 inches above L1.

CR for Right Lateral Asthenic

Center 2 inches below L1.

Evaluation criteria for Right Lateral

Retrogastric space demonstrated, pylorus well visualized.

LPO position

Patient rotated 30-60 degrees from supine position.

CR for LPO Sthenic

Center CR at level of L1, 45-degree oblique.

Indications for LPO

Used for gastritis and ulcers.

AP Projection

Patient supine, MSP aligned to midline of table.

CR for AP Sthenic

Center at L1, midway between xiphoid and ribs.

Indications for AP

Demonstrates hiatal hernia, diaphragm, and lung fields.

Additive diseases

Increase tissue thickness, atomic number, or density.

Destructive diseases

Decrease tissue thickness, atomic number, or density.

kVp Increase

Required increase of 5-15% for certain diseases.

Empyema

Pus in thoracic cavity increases tissue density.

Pleural Effusions

Fluid in pleural cavity displaces lung tissue density.

Pneumoconiosis

Dust inhalation causes fibrotic lung tissue changes.

Pneumonectomy

Lung removal increases density on affected side.

Pneumonia

Lung inflammation fills alveoli with denser fluid.

Pulmonary Edema

Fluid in lungs increases density, common in heart failure.

Tuberculosis

Mycobacterial infection increases lung fluid density.

Aortic Aneurysm

Dilation of aorta increases affected area's thickness.

Ascites

Fluid in peritoneal cavity increases abdominal tissue thickness.

Calcified Stones

Calcium deposits in organs increase tissue atomic number.

Cirrhosis

Liver fibrosis leads to enlargement and ascites.

Osteoblastic Metastases

Cancer spread to bone causes new bone growth.

Osteochondroma

Tumor in bone/cartilage increases bone thickness.

Paget's Disease

Increased bone cell activity leads to thickened bones.

Sclerosis

Chronic inflammation hardens bone, increasing density.

Destructive Diseases

Conditions that decrease tissue thickness and density.

Emphysema

Lung over-distention decreases tissue density.

Pneumothorax

Free air in pleura decreases lung tissue density.

Aerophagia

Abnormal air swallowing dilates stomach, reducing density.

Bowel Obstruction

Air/fluid accumulation decreases bowel tissue density.

Osteolytic Metastases

Malignancies destroy bone, reducing density.

Osteomalacia

Bone mineralization defect decreases bone density.

Osteoporosis

Failure of osteoblasts reduces bone matrix density.

Multiple Myeloma

Plasma cell tumor causes osteolytic bone areas.

Patient Assessment

Evaluate patient status before starting exams.

Radiation Protection

Minimize radiation exposure to patients and staff.

ALARA Principle

Keep radiation exposure As Low As Reasonably Achievable.