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99 Cards in this Set
- Front
- Back
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ROUTINE POSITIONS: AP (K.U.B., Flatplate)
AP Abdomen (K.U.B.) |
AP Abdomen (K.U.B.)
1. 14 X 17 film 2. Patient supine 3. Cassette is placed so that the pubic bone is at the bottom of the film. 4. Bucky or grid if patient is unable to be moved. 5. 40" SID 6. Central Ray is perpendicular to the film. 7. Expiration ADDITIONAL VIEWS: Upright, Decubitus, Lateral |
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Upright Abdomen
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1. 14 x 17 film
2. Patient is in an AP ERECT POSITION (allow time for free air to rise). 3. Place top of cassette to the axilla (diaphragms must be demonstrated). 4. Bucky 5. 40" SID 6. Central Ray: horizontal, parallel with the fluid level, even if patient isn't completely 90 degrees upright. 7. Expiration |
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Decubitus Abdomen
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1. 14 x 17 film
2. Patient is placed in a recumbent left lateral position (allow time for free air to rise). 3. Place the top of film at axilla (diaphragms must be demonstrated). 4. Upright bucky or grid. 5. 40" SID 6. Central Ray: perpendicular to film. 7. Expiration |
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Lateral Abdomen
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1. 14 x 17 film
2. Patient is placed in a recumbent left lateral position. 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film. 6. Centering point - level of crest. 7. Expiration |
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ACUTE ABDOMINAL SERIES (A.A.S.)
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ROUTINE POSITIONS: PA chest, AP abdomen, AP upright
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AIR CONTRAST BARIUM ENEMA (ACBE)
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SUPPLIES: Air Contrast Bag with 500 cc of heavy barium (Polibar).
VIEWS: K.U.B. (Scout) * CHECK WITH RADIOLOGIST BEFORE CONTINUING* Right Lateral Decubitus Left Lateral Decubitus Cross Fire Lateral Recto-Sigmoid Area PA AP 30 degree Cephalic PA 30 degree Caudal AP RPO 45 degrees LPO 45 degrees Post Evac ALL FILMS ON 14 X 17, EXCEPT RECTUM VIEWS, 10 X 12 FILMS. ALL FILMS TAKEN ON EXPIRATION |
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Prelim K.U.B.
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1. Patient supine
2. Bucky 3. 40" SID 4. Center at crest |
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Abdomen Right Lateral Decubitus
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1. Patient recumbent in right lateral position.
2. Horizontal beam 3. Grid 4. Center to iliac crest. 5. 40" SID 6. Center beam to grid. |
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PA Abdomen
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1. Patient prone
2. Bucky 3. 40" SID 4. Center at crest. |
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AP 30 Degree Cephalic (Up-Shot) Abdomen
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1. Patient supine
2. Central Ray: angled 30 degree cephalic, center to ASIS 3. Bucky 4. 40" SID 5. To demonstrate sigmoid colon. |
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PA 30 Degree Caudal (Down-Shot)Abdomen
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1. Patient is prone
2. Central Ray: angled 30 degree caudal, center to ASIS 3. Bucky 4. 40" SID 5. To demonstrate sigmoid colon |
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AP Abdomen
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AP
1. Patient supine 2. Bucky 3. 40" SID 4. To demonstrate transverse colon and flexures. 5. Center to iliac crest. |
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RPO Abdomen
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1. Patient recumbent in a 45 degree RPO position.
2. Bucky 3. 40" SID 4. To demonstrate splenic flexure 5. Center at crest |
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LPO Abdomen
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1. Patient recumbent in a 45 degree RPO position.
2. Bucky 3. 40" SID 4. To demonstrate splenic flexure 5. Center at crest |
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Lateral Rectum Cross-Fire
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1. Patient prone
2. Horizontal beam 3. Grid (10 x 12) 4. 40" SID 5. Film to include Recto-Sigmoid area. 6. *Deflate balloon on enema tip before exposure. 7. Center midaxillary plane midway between ASIS and posterior sacrum. |
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Post Evac
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Position the same as Scout.
*110 KVP should always be used on adults. ** 90 KVP should always be used on infants. ***Always check films with Radiologist before patient is allowed to evac. |
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AC JOINTS (ACROMIOCLAVICULAR JOINTS)
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FILM SIZE: 14 x 17 crosswise or (2) 10 x 12 films
1. Patient is placed in an AP upright position. 2. Both shoulder joints need to be included. 3. First position made with patient's arms relaxed without weights. 4. Second exposure made with patient holding 10 lb. weights in each hand and bearing equal weight on both feet. 5. 72" SID 6. Centering point is at suprasternal notch. 7. Suspended respiration. THE FILMS MUST BE MARKED "WITH" AND "WITHOUT WEIGHT"If checking for fracture of AP shoulder to include clavicle must be taken prior to weight bearing film. ROUTINE POSITIONS: AP upright without weights and AP upright with weights |
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ROUTINE POSITIONS: AP upright without weights and AP upright with weights
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FILM SIZE: 14 x 17 crosswise or (2) 10 x 12 films
1. Patient is placed in an AP upright position. 2. Both shoulder joints need to be included. 3. First position made with patient's arms relaxed without weights. 4. Second exposure made with patient holding 10 lb. weights in each hand and bearing equal weight on both feet. 5. 72" SID 6. Centering point is at suprasternal notch. 7. Suspended respiration. THE FILMS MUST BE MARKED "WITH" AND "WITHOUT WEIGHT" |
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ANKLE
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ROUTINE POSITIONS: AP, Internal oblique, Lateral
*NOTE: It is very important that the foot be flexed for all views to open up the space between foot and ankle if patient is able to tolerate it. |
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AP ANKLE
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1. 10 x 12 extremity cassette (divide in half)
2. Patient supine with foot flexed up. 3. Table top exposure 4. 40" FFD 5. Central Ray: mid ankle joint |
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Internal Oblique (mortis view)
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1. 10 x 12 extremity cassette (divide in half)
2. Patient supine with foot rotated in 5-15 degree to place intermalleolar line parallel to film with foot flexed. 3. Table top exposure 4. 40" FFD 5. Central Ray: mid-ankle joint |
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Lateral Ankle
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1. 8 x 10 extremity cassette
2. Patient lateral turned toward affected side until leg and foot are in a true lateral position (may need knee support). 3. Table top exposure 4. 40" FFd 5. Central ray: mid-ankle joint |
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STRESS VIEWS
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Radiologist is to do ALL stress views.
ROUTINE POSITIONS: Per Radiologists, need comparison views. RADIOLOGIST WILL APPLY STRESS TO AREA |
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APPENDIX STUDY
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SCOUT FILM MUST BE TAKEN
PA ABDOMEN 1. 14 x 17 film 2. Patient prone. 3. Central Ray: perpendicular to film 4. Bucky 5. 40" SID 6. Center at iliac crest 7. Expiration *NOTE: Patient must be given 6 oz. barium sulfate orally the night prior to exam. After obtaining scout film, check film with Radiologist. |
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BARIUM ENEMA
FULL COLUMN |
VIEWS:
K.U.B. (Scout) RPO 45 degree LPO 45 degree Left Lateral Abdomen for Flexures Left Lateral Abdomen for Rectum PA PA Sigmoid 30 degree Caudal Tube Angle, (or) due to patient condition A.P. 30 degree Cephalic. Post Evac |
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BARIUM ENEMA
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GASTROGRAFIN INFORMATION
Gastrografin does not contain Iodine!!!!! There are limitations on how much to administer!!!!! ENEMA ADMINISTRATION OF GASTROGRAFIN: Adults 240 ML in 1,000cc's tap water Children >5 yrs 90 ML in 500cc's tap water Children <5 yrs A 1:5 dilution is suggested. Total amount neede depends on the size of the child ... however, the ratio of 1:5 remains constant. DO NOT DEVIATE FROM THIS UNLESS YOU CONSULT THE RADIOLOGIST FIRST QUESTIONS REGARDING THE AMOUNT TO USE CONSULT THE RADIOLOGIST FIRST |
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BONE AGE SURVEY
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To check stage for maturation at epiphysis.
ROUTINE VIEWS: P.A. Hand and Wrist 1. 10 x 12 2. Have patient place both hands and wrists on film 3. Table top with detail cassette 4. 40" SID 5. Central Ray: perpendicular to film |
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BONE LENGTH STUDY
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To measure the difference in the length of the legs.
ROUTINE POSITIONS: AP Hips AP Knees AP Ankle 1. The lead, numbered ruler, is place under the patient's pelvis so that it extends down between patient's legs. Secure legs with tape. 2. Patient supine 3. Patient's feet are 7" apart. 4. Using one 14 x 17 film take AP hips, AP knees, AP ankle joints coned down. 5. Bucky 6. 40" SID 7. Central Ray: perpendicular to table. 8. Patient MUST NOT be moved between exposures. |
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CHEST
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CHEST
ROUTINE POSITIONS: PA, Lateral ADDITIONAL POSITIONS: Lordotic, Decubitus, Expiration, 45 degree RAO and LAO |
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PA Chest
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PA Chest
1. 14 x 17 film 2 Patient upright 3. Patient's chin is extended and with their hands on hips have them roll shoulders forward. 4. 72" SID 5. Central Ray: perpendicular to film. 6. Deep inspiration |
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Lateral Chest
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Lateral Chest
1. 14 x 17 film 2. Patient is upright in a true left lateral (right lateral must be specifically ordered). 3. Patient instructed to raise arms over head out of the area of interest. 4. 72" SID 5. Deep inspiration |
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LORDOTIC Chest
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LORDOTIC
1. 14 x 17 film 2. Patient is place din an upright AP position. 3. Instruct patient to take two (2) steps forward, then lean back so only their shoulders are touching the cassette. 4. 72" SID 5. Central Ray: perpendicular to film. 6. Deep inspiration *IF PATIENT IS UNABLE TO LEAN BACKWARD, ANGLE TUBE 15-20 DEGREE CEPHALIC. |
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AP DECUBITUS Chest
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AP DECUBITUS - TO SHOW FLUID IN DEPENDENT SIDE
1. 14 x 17 film 2. Patient is in a recumbent lateral position (side down as ordered). 3. Have patient raise arms out of chest area. 4. 72" SID 5. Central Ray: perpendicular to film. 6. Deep inspiration EXPIRATION Patient positioned the same as PA chest except exposure is made on complete expiration. |
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45 DEGREE LAO AND 45 DEGREE RAO
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45 DEGREE LAO AND 45 DEGREE RAO
1. 14 x 17 film 2. Patient placed in 45 degree LAO or 45 degree RAO position. 3. 72" SID 4. Central Ray: perpendicular to film. 5. Deep inspiration |
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O.R. CHOLANGIOGRAM WITH C-ARM
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1. Position c-arm as soon as PT is positioned on OR table.
2. Position c-arm monitor for physician. 3. Make sure monitor is on "auto" for filming. 4. Have cassettes ready. 5. Mark intensifier with right marker. 6. When ready to film make sure camera is at # 0 image. 7. Once surgeon begins to inject contrast, they will tell you when to "shoot". 1-2 films will be taken during injection. Films should be brought to the department and run as soon as possible. 8. Mark films in order of filming sequence. 9. Show films to radiologist for approval. Radiologist will advise the surgeon for interpretation of films. 10. Films are to be put with patient's jacket and given to the Radiologist for a dictated report. |
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CLAVICLE
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CLAVICLE
ROUTINE POSITIONS: AP, AP Axial |
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AP Clavicle
AP AXIAL 1. 10 x 12 crosswise 2. Position same as AP except tube is angles 10-20 degree cephalad. 3. Bucky 4. 40" SID 5. Central Ray: center to include all of clavicle. |
AP
1. 10 x 12 film crosswise 2. Patient supine 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film, center mid-clavicle |
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Coccyx
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COCCYX
ROUTINE VIEWS: AP, Lateral AP 1. 8 x 10 film 2. Bucky 3. Center midsagittal and 2" above symphysis pubis 4. 40" SID 5. 10 degree caudal tube angle LATERAL 1. 8 x 10 film 2. Bucky 3. Palpate bottom of coccyx to center 4. 40" SID |
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CERVICAL SPINE WITH OBLIQUES (NON-TRAUMA)
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ROUTINE POSITIONS:
AP Open Mouth Flexion and Extension Laterals Left Lateral Obliques (RPO, LPO) AP 1. 8 x 10 film 2. Patient supine or erect with chin extended. 3. Bucky 4. 40" SID 5. Tube angled 20 degree cephalad 6. Centering Point: thyroid cartilage. OPEN MOUTH 1. 8 x 10 film 2. Patient supine or erect, adjust head so that the upper occlusal plane is perpendicular to table, have patient open mouth. 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film, thru opened mouth LEFT LATERAL 1. 10 x 12 film 2. Patient sitting or standing at upright film holder with cervical vertebrae centered on film. 3. 72" SID 4. Central Ray: perpendicular to film 5. Centering point: center to neck with film 2" above E.A.M. 6. Shoulders depressed (hold weights) 7. Must see C-7 LATERAL FLEXION/EXTENSION Same as left lateral except have patient depress chin to chest (flexion), hyperextend chin (extension). OBLIQUES (RPO, LPO) 1. Patient sitting or standing with back against upright film bucky. 2. Rotate patient so that they are 45 degrees away from film for each side. 3. Angle tube 15 degree cephalad. 4. 40" SID *A swimmer''s view may be utilized to demonstrate C-7. See trauma C-spine for positioning. |
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Elbow
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ROUTINE POSITIONS: AP, External Oblique, Internal Oblique, Lateral
AP 1. 10 x 12 detail film divide in half crosswise. 2. Patient seated with palm up and arm fully extended. 3. Table top 4. 40" SID 5. Central Ray: center to joint EXTERNAL OBLIQUE 1. 10 x 12 detail film divide in half crosswise. 2. Patient seated with palm up and arm fully extended laterally, rotate entire arm so that anterior surface of elbow joint is 45 degrees to film. 3. Patient will need to lean over and drop shoulder onto table top. 4. Table top 5. 40" SID 6. Central Ray: center of joint 7. This will demonstrate radial head and neck free of super imposition. INTERNAL OBLIQUE 1. 10 x 12 detail film divide in half crosswise. 2. Patient seated with palm up and arm fully extended medially, rotate elbow no more than 45 degrees. 3. Table top 4. 40" SID 5. Central Ray: center to joint 6. This demonstrates the coronoid process of ulna. LATERAL 1. 10 x 12 detail film divide in half crosswise. 2. Patient seated with elbow flexed 90 degrees. Forearm and Humerus in same place. Thumb must be up. Wrist and elbow in true lateral position. 3. Table top 4. 40" SID 5. Central Ray: center of joint 6. This demonstrates olecranon process. *NOTE: THE HUMERUS AND FOREARM MUST BE IN CONTACT WITH CASSETTE FOR ALL VIEWS. |
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ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHIC PANCREATOGRAPHY
(E.R.C.P.) |
Must have a signed consent form.
SUPPLIES: Conray-43 Glucagon Suction Physician & his assistant will bring all other supplies. VIEWS K.U.B. (prelim) check with Radiologist FILMS AS ORDERED BY RADIOLOGIST AFTER INJECTION OF CONTRAST. PRELIM K.U.B. 1. Patient is placed in supine position. 2. Bucky 3. 40" SID 4. Center at iliac crest NOTE: 1. Put a cart pad on table for patient's comfort. 2. The patient will be on the table oriented to the physicians preference. 3. The patient will start the exam on his left side and then roll prone. 4. Radiologist will perform this procedure. |
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FACIAL BONES
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ROUTINE VIEWS:
PA Waters Lateral of Affected Side BE SURE AND CLEAN TABLE BEFORE PUTTING PATIENT'S FACE ON IT. PA 1. 8 x 10 film 2. Patient in prone position 3. Position patient' head so that the CML is perpendicular to table (nose and forehead on table). 4. Bucky 5. 40" SID 6. Central Ray: exits nasion WATERS 1. Patient in prone position 2. Position head so that chin is resting on table. Be sure to extend chin enough to throw petrous ridges out of the maxillary sinuses. OML form 37o angle with table. 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film 6. Exit Point: acanthion LATERAL 1. 8 x 10 film 2. Patient prone with affected side of face closest to film. 3. Position patient's head so that the intra pupillary line is perpendicular to film. 4. Bucky 5. 40" SID 6. Central Ray: perpendicular to film 6. Centering Point: prominence of cheek MUST INCLUDE MANDIBLE ON ALL VIEWS FILMS MAY BE DONE UPRIGHT OR ON THE TABLE |
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Femur
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ROUTINE VIEWS:
AP Lateral AP 1. 14 x 17 film 2. Patient supine 3. Femur centered on film 4. Table top of bucky 5. Central Ray: mid shaft LATERAL (DISTAL FEMUR) 1. 14 x 17 film 2. Patient positioned don side with affected side closest to film 3. Opposite leg is pulled up and over affected leg. 4. Table top or bucky 5. 40" SID 6. Central Ray: mid shaft LATERAL (PROXIMAL FEMUR) See positioning for Hip IF FILM DOES NOT INCLUDE BOTH JOINTS, AN ADDITIONAL FILM MUST BE TAKEN OF SEPARATE JOINT. |
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Foot
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ROUTINE VIEWS:
AP Internal Oblique Lateral Additional film of toe sometimes needed. AP 1. 10 x 12 detail film divided lengthwise. 2. Table top 3. Patient's foot plantar surface (sole) of foot resting on film. Angle 10o toward the heel. 4. 40" SID 5. Central Ray: perpendicular to metatarsals INTERNAL OBLIQUE 1. 10 x 12 detail film divided lengthwise. 2. Table top 3. Rotate foot medially 45o 4. 40" SID 5. Central Ray: centered to base of 3rd metatarsals LATERAL 1. 10 x 12 detail film or 8 x 10 detail film 2. Table top 3. Turn toward lateral side (true lateral). Support under knee. 4. 40" SID 5. Central Ray: centered to base of 3rd metatarsals |
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FOREARM (RADIUS AND ULNA)
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ROUTINE VIEWS:
AP Lateral AP 1. 11 x 14 divided in half extremity cassette 2. Patient seated 3. Affected arm extended with palm facing up. 4. Table top with detail cassette 5. Central Ray: perpendicular to film 6. 40" SID 7. Center midshaft LATERAL 1. 11 x 14 divided in half extremity cassette 2. Patient seated 3. Affected arm positioned on cassette so that if forms a 90o angle with the Humerus and hand and wrist in a lateral position. 4. Both the Humerus and forearm should make contact with the cassette. 5. Table top with detail cassette. 6. 40" SID 7. Central Ray: perpendicular to film 8. Center midshaft MUST INCLUDE BOTH JOINTS ON BOTH VIEWS |
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GALLBLADDER
(GB, ORAL CHOLECYSTOGRAM) |
GALLBLADDER
(GB, ORAL CHOLECYSTOGRAM) ROUTINE PRELIMINARY VIEWS: PA-Abdomen survey, RAO LAO PA 1. 14 x 17 film 2. Patient placed in prone position. 3. Film placed in such a way to include upper abdomen and top of pelvis. 4. Bucky, on 14 x 17 film 5. 40" SID 6. Central Ray: perpendicular to film 7. Expiration LAO 1. 10 x 12 film 2. Patient placed in an LAO position. 3. Degree of rotation depend on patient habitus: Thin patients - more rotation Heavy patients - less rotation Center to area of 10th rib approximately same level as patient's elbow. 4. Bucky on 10 x 12 film 5. 40" SID 6. Central Ray: perpendicular to film 7. Expiration POST FATTY MEAL Same views. SCOUT MUST BE CHECKED WITH RADIOLOGIST. PATIENT WILL BE FLUROED IN UPRIGHT POSITION. |
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Hand
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HAND
HAVE PATIENT REMOVE RINGS, WATCHES AND BRACELETS. ROUTINE VIEWS: PA External Oblique Lateral *FINGERS* Routine hand films Coned down view of affected finger in lateral position. PA HAND 1. 10 x 12 divided 2. Table top extremity cassette 3. 40" SID 4. Palm flat on cassette, fingers straight. 5. Center to third metacarpophalangeal joint. EXTERNAL OBLIQUE 1. 10 x 12 divided 2. Table top extremity cassette 3. 40" SID 4. Center to third MCP joint. 5. From the PA position externally rotate the hand 45o. Separate the fingers and allow them to rest against the cassette. LATERAL 1. 8 x 10 extremity cassette 2. Table top extremity cassette 3. 40" SID 4. Hand in true lateral position and separate fingers. 5. Center to third MCP joint. |
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NON-TRAUMA HIP
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NON-TRAUMA HIP
ROUTINE VIEWS: AP Pelvis - if no previous or recent one has been taken AP Hip Lateral Hip (Frog-Leg) AP PELVIS 1. 14 x 17 film 2. Patient supine with toes rotated inward. 3. Bucky 4. 40" SID 5. Central Ray: midway between symphsis pubis and iliac crest. AP HIP 1. 10 x 12 film 2. Patient supine 3. Foot rotated slightly inward 15o 4. 40" SID 5. Central Ray: through femoral neck LATERAL HIP (FROG-LEG) 1. 10 x 12 crosswise 2. Patient supine 3. Have patient bend knee and allow affected leg to slowly "fall" to side. 4. Bucky 5. 40" SID 5. Central Ray: through femoral neck BOTH VIEWS TO INCLUDE ENTIRE PIN OR PROSTHESIS. |
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HIP ARTHROGRAMS
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HIP ARTHROGRAMS
For examination of hip joint. SUPPLIES: See Arthrogram supplies. SCOUT VIEWS: AP, "Frog Leg" A.P. 1. 10 x 12 film 2. Patient supine 3. Rotate foot of affected leg slightly inward. 4. Bucky 5. 40" SID 6. Central Ray: center 21/2" down from A.S.I.S. "FROG LEG" 1. 10 X 12 film crosswise 2. Patient supine 3. Have patient bend knee and allow affected leg to slowly "fall" to side. 4. Bucky 5. 40" SID 6. Central Ray: Center 21/2" down from A.S.I.S. *Always have radiologist check Scout Films* After injection of contrast, and after Radiologist obtains fluoroscopy spots, repeat all of the views explained previously and marked pre-exercise. After checking pre-exercise films with Radiologist, repeat the same series of films after exercising the hip. Mark these films post exercise. Show films to Radiologist before dismissing patient. To check for pin loosening SCOUT: AP film Position hip as you would a regular Hip Arthrogram, making sure you include entire pin and screw plate. A doctor from the Orthopedic Department or Radiologist will inject patient for this procedure. Once the needle is placed in joint, and before the contrast is injected, the leg must be immobilized with sandbags and a radiograph should be taken. It is very important that the leg does not move from that point up until the completion of exam. After the injection of contrast another radiograph must be taken, in the exact same position as the radiograph with the needle without contrast. After checking your last film you may allow the patient to move leg. |
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NON-TRAUMA HUMERUS
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NON-TRAUMA HUMERUS
ROUTINE VIEWS: AP (internal and external) INCLUDE BOTH JOINTS AP (INTERNAL AND EXTERNAL) 1. 14 x 17 film 2. Bucky, upright or supine 3. 40" SID 4. Rotate affected arm internal and externally. 5. Central Ray: center to mid Humerus *DO NOT ATTEMPT THESE PROJECTIONS IF PATIENT IS IN SEVERE PAIN.* INSTEAD TAKE AP NEUTRAL AND TRANSTHORACIC LATERAL. |
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KNEE
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KNEE
ROUTINE VIEWS: AP Lateral Tunnel Tangential AP 1. Patient supine 2. Knee in true A.P. position. 3. Bucky 4. 40" SID 5. Center to Apex of patella. 6. Angle tube 5-7 degrees cephalad. 7. 10 x 12 film Lateral 1. Patient in true lateral position with affected side closest to film flex knee slightly if possible. 2. Bucky 3. 40" SID 4. Angle tube 5-7 degree cephalad. 5. Center medial epicondyle. 6. 10 x 12 film Tunnel (Homblad) 1. Patient up on knees with femurs forward 20-25 degrees, Central Ray: through bend of leg. 2. Bucky 3. 40" SID 4. 10 x 12 film Transgential (Sunrise) 1. Patient sitting on table. 2. Patient's affected leg is placed so that the foot is flat on table. 3. Patient hold 8 x 10 extremity cassette behind knee. 4. Angle tube approximately 45-50 degrees cephalad to project shadow of knee on film. 5. Film is marked medially and laterally. |
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KNEE ARTHROGRAM
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KNEE ARTHROGRAM
SUPPLIES: See Arthrogram supplies on page 7. SCOUT VIEWS: AP, Lateral, Tunnel, Tangential, Post Contrast AP 1. Patient supine 2. Knee in true A.P. position. 3. Bucky 4. 40" SID 5. Center to Apex of patella. 6. Angle tube 5-7 degrees cephalad. 7. 10 x 12 film Lateral 1. Patient in true lateral position with affected side closest to film flex knee slightly if possible. 2. Bucky 3. 40" SID 4. Angle tube 5-7 degree cephalad. 5. Center medial epicondyle. 6. 10 x 12 film Tunnel (Homblad) 1. Patient up on knees with femurs forward 20-25 degrees, Central Ray: through bend of leg. 2. Bucky 3. 40" SID 4. 10 x 12 film Transgential (Sunrise) 1. Patient sitting on table. 2. Patient's affected leg is placed so that the foot is flat on table. 3. Patient hold 8 x 10 extremity cassette behind knee. 4. Angle tube approximately 45-50 degrees cephalad to project shadow of knee on film. 5. Film is marked medially and laterally. After the injection of double contrast, the Radiologist will take several films with the fluro unit. These films should be numbered or labeled. Upon the completion of fluoroscopy, further instructions will be given. The Radiologist may request a "Hanging Lateral". Hanging Lateral 1. Patient sits on edge of table with knees bent and lower legs hanging down. 2. The patient holds the grid between the knees. 3. The tube is positioned so that the Central Ray is horizontal and passing through the affected knee lateral to medial. 4. The patient is instructed to flex the knee back on a rolled towel placed behind the knee as the exposure is taken. After injection, repeat all the views explained previously and marked pre-exercise. After checking pre-exercise films with radiologist, repeat the same series of films after exercising the knee. Mark these films post exercise. Show films to Radiologist before dismissing patient. |
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LOOPOGRAM
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LOOPOGRAM
NO PREP REQUIRED SUPPLIES: Foley Catheter 12-14FR 100 cc's Conray 43 (may use more) 2-20 ounce catheter tip syringes Sterile 4 x 4's Towels from laundry cart Packet of sterile lubricate (surgilube) Conray 43 ROUTINE VIEWS: Scout film Films for study per Radiologist Post drain film Radiologist/Resident inserts a catheter in the stoma, 4x 4's are layered over the stoma and catheter. Patient will be instructed to "hold" their hand over the 4 x 4's to hold the catheter in place. Contrast is injected into the catheter while the Radiologist takes fluoro spots. After the Radiologist is finished with the fluoro spots they will instruct you as to which "after" films will need to be obtained. You may want to put towels on the side of the patient to keep the contrast from spilling on the table and running under the patient. |
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LUMBAR SPINE WITH OBLIQUES, NON-TRAUMA
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LUMBAR SPINE WITH OBLIQUES, NON-TRAUMA
ROUTINE VIEWS: AP RPO LPO Lateral L5-S1 Spot AP 1. 14 x 17 film 2. Patient supine 3. Film placed so that the center of the film is at crest 4. Bucky 5. 40" SID 6. Central Ray: perpendicular to film 7. Bend knees to reduce curvature of spine RPO-45o 1. 11 x 14 film 2. Patient recumbent rotate left side of body 45o up from table 3. Film is placed so that the center of the film is 1" above crest 4. Bucky 5. 40" SID 6. Central Ray: perpendicular to film 7. Need to visualize right apophysial joints ("scotty dogs"). 8. Mark film side down with Rt. marker LPO 45o 1. 11 x 14 film 2. Patient recumbent rotate right side of body 45o up from table 3. Film is placed so that the center of the film is 1" above crest 4. Bucky 5. 40" SID 6. Central Ray: perpendicular to film 7. Need to visualize left apophysial joints ("scotty dogs"). 8. Mark film side down with Lt. marker Left Lateral 1. 14 x 17 film 2. Patient is on left side in true lateral position 3. Bucky 4. 40" SID 5. Central Ray: centered to iliac crest 6. Disc spaces should be open L5-S1 SPOT 1. 8 x 10 film 2. Patient is on left in true lateral position 3. Bucky 4. 40" SID 5. Central Ray: angled 5-10o caudal angle 6. Cone down to L5-S1, joint space 7. Center film 11/2 inches below crest Flexion and Extension Lumbar Spine (Upon Request 1. Patient standing bearing equal weight on both legs. 2. Have patient lean forward for 1 film - lean backward for 1 film. 3. Central Ray: horizontal beam with film centered 1" above crest |
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BONE SURVEYS
LONG BONE SURVEY: |
BONE SURVEYS
LONG BONE SURVEY: To check for diseases such as lead poisoning that manifest in the epiphysis. 1. AP Humerus 2. AP Forearm 3. AP femur 4. AP Lower Leg *INCLUDE BOTH JOINTS ON ALL FILMS |
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BONE SURVEYS
METASTATIC SURVEY: |
BONE SURVEYS
METASTATIC SURVEY: To check for metastasis, the spread of cancer. AP and Lateral 1. Routine Thoracic Spine 2. AP and Lateral Lumbar 3. AP Pelvis 4. Left Lateral Skull *NOTE: DO NOT COLLIMATE |
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DEGLUTITION STUDY (Modified Barium Swallow)
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DEGLUTITION STUDY (Modified Barium Swallow)
When doing this exam, the fluoroscopy unit and VCR/TV/Audio are used (must have VCR remote). Have ready before exam time. Each case must be put on a separate VHS tape and labeled with the patient's name and/or patient's x-ray number, DHON. This can be labeled permanently on VCR film. Be sure to include fluorscopy time on patient's history sheet. See below programming of VCR: This procedure must be done with a Speech Pathologist and a Radiologist. The technologist is to assist. An assortment of thin/thick/paste barium needs to be ready. The Speech Pathologist will bring in additional supplies if needed. |
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NASAL BONES
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NASAL BONES
ROUTINE VIEWS: Waters PA Right and Left Lateral of Nasal Bones Waters 1. 8 x 10 film 2. Patient prone or upright 3. Patient positioned with chin on table, O.M.L. forms 37o angle with plane of film 4. Bucky 5. 40" SID 6. Central Ray: passes through acanthion 7. This view can demonstrate a deviated nasal septum PA 1. 8 x 10 film 2. Patient prone 3. Patient positioned with forehead on table, O.M.L. perpendicular to plane of film 4. Angle 15o caudal 5. Central Ray: exits nasion 6. 40" SID 7. Bucky Right and Left Lateral of Nasal Bones 1. 8 x 10 detail film divided in half for each side 2. Patient prone 3. Head in true lateral position, interpupillary line is perpendicular to the film 4. Table top - detail cassette 5. 40" SID 6. Central Ray: perpendicular to film and centered to bridge of nose 7. Must include to anterior nasal spine 8. Use finger technique |
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ORBITS
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ORBITS
ROUTINE VIEWS: Waters PA Lateral Bilateral Rheses' Views Waters 1. 8 x 10 film 2. Patient prone or upright 3. Patient positioned with chin on table, O.M.L. forms 37o angle with plan of film 4. Bucky 5. 40" SID 6. Central Ray: exits acanthion, mentomeatal is perpendicular to film 7. This view can demonstrate blow out fracture PA 1. 8 x 10 film 2. Patient prone or upright 3. Position head so that O.M.L. and midsagital plane is perpendicular to table 4. Bucky 5. 40" SID 6. Central Ray: angled 25o caudal exits nasion Lateral (of affected side) 1. 8 x 10 film 2. Patient in true lateral position, interpapillary line is perpendicular to film 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film enter bony lateral margin of outer canathus Bilateral Rheses 1. 8 x 10 film 2. Patient's head rests in 3 point landing (chin, cheek and nose). 3. Patient is rotated 37o from true PA. Center to orbit down. * Forehead should not touch table 4. Central ray exits at center of orbit nearest table 5. Bucky 6. 40" SID 7. When positioned correctly, optic foramen should be projected in lower, outer quadrant of orbit examined. Rhese Suggestions -If optic foramen is in rim of orbit, patient is positioned too lateral. -If optic foramen is in middle of orbit, patient is positioned to P.A. |
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INSERTION OF PERMANENT PACEMAKER IN RADIOLOGY UNDER FLUOROSCOPY
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INSERTION OF PERMANENT PACEMAKER IN RADIOLOGY UNDER FLUOROSCOPY
Everyone needs appropriate attire. Radiology One technologist in the room at all times to operate x-ray equipment. Supplies: lead aprons in rooms at all times. Need to have housekeeping clean room prior to operative procedure - 2 IV poles in room. Nursing Obtain patient consent - patient needs IV and pole - take to x-ray on a cart. Send a nurse to monitor patient vitals and assist the patient during the procedure, monitors and assists patient as needed. Gets defibrillator from third floor and emergency drug box from the Emergency Room. Notify CCU, patient will go there following procedure. |
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PELVIS
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PELVIS
ROUTINE VIEWS: AP AP Pelvis 1. 14 x 17 film transverse 2. Patient supine 3. Feet internally rotated to project the greater trochanters 4. Central Ray: perpendicular to film 5. Expiration 6. Bucky or grid 7. 40" SID |
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POSTURAL STUDY
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POSTURAL STUDY
ROUTINE VIEWS: AP Erect Lumbar Lateral Aspect Lumbar AP 1. 14 x 17 film 2. Patient standing in AP position 3. Center at level of L4-L5 4. 40" SID 5. Bucky 6. Expiration FILMS SHOULD BE DONE WITHOUT SHOES, UNLESS PATIENT WEARS LIFTS, THEN REPEAT AP VIEW WITH THE LIFT ON AND MARK THE FILM AS SUCH. *Femoral heads must be included as well as L3. Lateral 1. 14 x 17 film 2. Patient standing in lateral position 3. Left side against Bucky 4. Have patient raise arms up out of the way of lumbar area 5. Have patient bear weight evenly on both feet 6. Center at L4-L5 7. 40" SID 8. Bucky 9. Expiration |
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RETROGRADE URETHROGRAM (DOUBLE BALLOON)
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RETROGRADE URETHROGRAM (DOUBLE BALLOON)
This procedure is done on female patients to check for urethral diverticula. A scout film (KUB) must be taken to include the area just below the pubic symphisis. Items needed for study: Urethral cath tray 1 catheter tip syringe 1 60 cc Luer LOC syringe 2 bottles of Conray 43 50 cc's sterile saline (to dilute 1 of the bottles of Conray 43) 19 gauge Angio cath double balloon catheter The catheter has two balloons, the upper balloon is fixed and the lower balloon is a sliding balloon. Before placing the catheter in the urethra, put a very small amount of water soluble lubricant near the lower sliding balloon and slide it down to approximately the middle of the catheter. Place as small amount of water soluble lubricant needed on the end of the catheter for insertion (too much could possibly "clog" the side holes of the catheter or "fill in" the diverticula). After the catheter is placed into the bladder, fill the upper balloon with 30 cc's of 50% Conray - 50% saline mixture. After that is completed, slide the lower uninflated balloon up (while pulling down on the catheter to pull the upper balloon against the bladder) until the lower balloon is against the outside of the urethra. Using the "soft" part of the Angio cath, inflate the lower balloon with 30 cc's of the diluted Conray mixture. Insert the cath tip syringe into the end of the catheter. It is not unusual that the contrast will go up into the bladder. If this happens, the catheter will need to be pulled down tighter against the bladder. If the contrast leaks out distally, the lower balloon will need to be slid up even more. ***DO NOT USE AIR TO INFLATE THE BALLOONS*** |
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RIBS
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RIBS
ROUTINE VIEWS: *PA Chest to R/O Pneumothorax POSTERIOR RIB PAIN: AP Upper AP Lower LPO RPO ANTERIOR RIB PAIN: AP Upper AP Lower LAO RAO * Can be done supine or upright. PA Upper 1. 14 x 17 film 2. Affected side centered to film 3. Bucky 4. 40" SID 5. Deep inspiration PA Lower 1. 10 x 12 2. Affected side centered to film 3. Bucky 4. 40" SID 5. Deep expiration Posterior and Anterior Obliques 1. 14 x 17 film 2. Patient positioned either for or posterior or anterior rib pain putting affected area against film. 3. Center over affected side 4. Deep inspiration 5. Bucky 6. 40" SID * May need to do lower Obliques for better visualization of ribs, especially if this is the affected area. |
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SACRUM
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SACRUM
ROUTINE VIEWS: AP Lateral AP Sacrum 1. 10 x 12 film 2. Patient supine 3. Bucky 4. Center halfway crest and pubis and midline 5. 40" SID 6. Tube angled 15o cephalad 7. Expiration Lateral 1. 10 x 12 film 2. Bucky 3. Center ASIS and 3" posterior to midaxillary 4. 40" SID 5. Expiration 6. Use lead glove behind patient to absorb scatter |
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SMALL BOWEL FOLLOW THROUGH (SBFT)
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SMALL BOWEL FOLLOW THROUGH (SBFT)
If no UGI is being done with this study, a scout abdomen must be taken. Patient ingests 600 ml of entero-vu and water mixed thoroughly. See packet for further instructions. 15 minutes after ingestion, a prone abdomen film is taken and shown to Radiologist. Films should be taken at 15 minute intervals for the first hour and then every 30 minutes after. Each film must be shown to a Radiologist. * The Radiologist may want to fluoro this patient once the small bowel is full. |
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SCANOGRAM FOR ROD LENGTH (PRE SURG)
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SCANOGRAM FOR ROD LENGTH (PRE SURG)
To check rod length with the length of the patient's femur or Tib/Fib. ROUTINE POSITION: AP Femur or AP Tib/Fib A surgical rod is used in this procedure. This is brought to the department of Radiology by the Orthopedic Department. 1. The lead numbered ruler is placed beside the "good" leg. 2. Patient supine 3. Film placed beneath patient's "good" leg. 4. The surgical rod is taped to side of the "good" hip at the same level as the bone. 5. 40" SID 6. Central Ray: perpendicular to film. |
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SCOLIOSIS STUDY
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SCOLIOSIS STUDY
All views done at upright Bucky standing with shoes off. Patient should bear equal amount of weight on both feet. ROUTINE POSITIONS: 1. AP thoracic spine to include lower cervical vert. 14 x 17 film. 2. AP lumbar spine centering at 4th-5th lumbar. 14 x 17 film. *FILM IS TO INCLUDE FEMORAL HEADS* 3. Lateral lumbar spine centering at 4th-5th lumbar vert. 14 x 17 film. *FILM IS TO INCLUDE FEMORAL HEADS* If curvature of spine is seen partially on Athoracic film and partially on AP lumbar films, do Pre AP film to include the entire curvature. A RADIOLOGIST MUST BE PRESENT!! CHECK FILMS WITH RADIOLOGIST BEFORE PATIENT LEAVES!! |
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NON-TRAUMA SHOULDER
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NON-TRAUMA SHOULDER
ROUTINE POSITIONS (non-trauma): AP External AP Internal Rotation ADDITIONAL VIEW: True AP AP External 1. 10 x 12 crosswise 2. Patient supine or standing 3. Rotate arm externally (palm up) 4. Bucky 5. 40" SID 6. Central Ray: perpendicular to film, centered to coracoid process. 7. Expiration AP Internal Rotation Position same as external except have patient rotate arm internally (pronate hand). ADDITIONAL VIEW *If joint is not open on AP external or AP internal. Must include this view* True AP (Glenohumeral Joint Space) 1. 10 x 12 crosswise 2. Patient supine or upright 3. Rotate body approximately 35o toward side of interest, posterior aspect of arm and shoulder should be in contact with table. 4. Bucky 5. 40" SID 6. Expiration |
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TRAUMA SHOULDER
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TRAUMA SHOULDER
ROUTINE POSITIONS (trauma): "Y" view True AP AP Neutral ADDITIONAL VIEW: Axillary "Y" View 1. 10 x 12 lengthwise 2. Patient supine or upright 3. Palpate the borders of the scapula and rotate the patient until the scapula is in true lateral position. 4. Bucky 5. 40" SID 6. Central Ray: direct to midvertebral border of scapula, film placed 2 inches above shoulder. 7. Used to demonstrate dislocation 8. Expiration True AP 1. 10 x 12 crosswise 2. Patient supine or upright 3. Rotate body approximately 35o toward side of interest, posterior aspect of arm and shoulder should be in contact with table. 4. Bucky 5. 40" SID 6. Expiration AP Neutral 1. 10 x 12 crosswise 2. Patient supine or standing 3. Do not rotate patient's arm 4. Bucky 5. 40" SID 6. Central Ray: perpendicular to film, center to coracoid process 7. Expiration ADDITIONAL VIEW *Done only after routine trauma series completed and checked with ordering physician* Axillary (transaxillary lateral) 1. 8 x 10 crosswise 2. Patient supine 3. Ordering physician or his designee must abduct patient's arm 90o from body. Place support under patient's wrist and hand if needed. 4. Rotate patient's head from affected side. Rest film holder on table surface as close to neck as possible. 5. Table top 6. 40" SID 7. Central Ray: horizontally to axilla |
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SHOULDER ARTHROGRAM
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SHOULDER ARTHROGRAM
SUPPLIES: See Arthrogram supplies on page 7. SCOUT VIEWS: AP External and Internal Rotation, Axillary AP (External) 1. 10 x 12 film 2. Patient supine 3. Have patient turn palm of affected arm up. 4. Bucky 5. 40" SID 6. Central Ray: 1" inferior to coracoid process. AP (Internal) Position same as above except palm is facing downward. Axillary View 1. 10 x 12 film 2. Patient sitting at end of table with cassette under arm-pit. 3. Central Ray: joint space 4. Place x-ray tube so that it is perpendicular to the film. 5. 40" SID and tabletop exposure. After injection, repeat all of the views explained previously and marked pre-exercise. After checking pre-exercise films with Radiologist, repeat the same series of films after exercising the arm. mark these films post exercise. Show films to Radiologist before dismissing patient. |
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SIALOGRAM (not sailogram)
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SIALOGRAM (not sailogram)
*Need consent form signed. SUPPLIES: Overhead light Rabinov catheter Reno-M-60 Lemon juice packet 20 cc syringe 16 G needle Extension set Surgical gloves tape Tongue blades 4x4's ROUTINE VIEW: AP Oblique of affected side Lateral of affected side Submentovertex AP 1. Patient supine or upright 2. Center to include entire mandible 3. 40" SID 4. Bucky 5. Central Ray: perpendicular to film Oblique 1. Patient supine 2. Rotate head with affected side down about 30o 3. Central Ray: perpendicular to film 4. 40" SID 5. Bucky 6. Center to include entire mandible Lateral Survey (with patient's finger inside mouth depressing side of involvement to display calculi) 1. Patient supine 2. Turn head to put patient as lateral as possible with affected side down. 3. 40" SID 4. Bucky Submentovertex 1. Patient supine or upright 2. Adjust head so that the vertex of the skull rests on the table 3. Position head so that the medial plane of the skull is perpendicular to middle of table. 4. Extend chin parallel with the plane of the film. 5. Direct central ray at right angles to IOML & center midway between E.A.M. 6. Bucky 7. 40" SID |
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Femur
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ROUTINE VIEWS:
AP Lateral AP 1. 14 x 17 film 2. Patient supine 3. Femur centered on film 4. Table top of bucky 5. Central Ray: mid shaft LATERAL (DISTAL FEMUR) 1. 14 x 17 film 2. Patient positioned don side with affected side closest to film 3. Opposite leg is pulled up and over affected leg. 4. Table top or bucky 5. 40" SID 6. Central Ray: mid shaft LATERAL (PROXIMAL FEMUR) See positioning for Hip IF FILM DOES NOT INCLUDE BOTH JOINTS, AN ADDITIONAL FILM MUST BE TAKEN OF SEPARATE JOINT. |
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Foot
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ROUTINE VIEWS:
AP Internal Oblique Lateral Additional film of toe sometimes needed. AP 1. 10 x 12 detail film divided lengthwise. 2. Table top 3. Patient's foot plantar surface (sole) of foot resting on film. Angle 10o toward the heel. 4. 40" SID 5. Central Ray: perpendicular to metatarsals INTERNAL OBLIQUE 1. 10 x 12 detail film divided lengthwise. 2. Table top 3. Rotate foot medially 45o 4. 40" SID 5. Central Ray: centered to base of 3rd metatarsals LATERAL 1. 10 x 12 detail film or 8 x 10 detail film 2. Table top 3. Turn toward lateral side (true lateral). Support under knee. 4. 40" SID 5. Central Ray: centered to base of 3rd metatarsals |
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FOREARM (RADIUS AND ULNA)
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ROUTINE VIEWS:
AP Lateral AP 1. 11 x 14 divided in half extremity cassette 2. Patient seated 3. Affected arm extended with palm facing up. 4. Table top with detail cassette 5. Central Ray: perpendicular to film 6. 40" SID 7. Center midshaft LATERAL 1. 11 x 14 divided in half extremity cassette 2. Patient seated 3. Affected arm positioned on cassette so that if forms a 90o angle with the Humerus and hand and wrist in a lateral position. 4. Both the Humerus and forearm should make contact with the cassette. 5. Table top with detail cassette. 6. 40" SID 7. Central Ray: perpendicular to film 8. Center midshaft MUST INCLUDE BOTH JOINTS ON BOTH VIEWS |
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GALLBLADDER
(GB, ORAL CHOLECYSTOGRAM) |
GALLBLADDER
(GB, ORAL CHOLECYSTOGRAM) ROUTINE PRELIMINARY VIEWS: PA-Abdomen survey, RAO LAO PA 1. 14 x 17 film 2. Patient placed in prone position. 3. Film placed in such a way to include upper abdomen and top of pelvis. 4. Bucky, on 14 x 17 film 5. 40" SID 6. Central Ray: perpendicular to film 7. Expiration LAO 1. 10 x 12 film 2. Patient placed in an LAO position. 3. Degree of rotation depend on patient habitus: Thin patients - more rotation Heavy patients - less rotation Center to area of 10th rib approximately same level as patient's elbow. 4. Bucky on 10 x 12 film 5. 40" SID 6. Central Ray: perpendicular to film 7. Expiration POST FATTY MEAL Same views. SCOUT MUST BE CHECKED WITH RADIOLOGIST. PATIENT WILL BE FLUROED IN UPRIGHT POSITION. |
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Hand
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HAND
HAVE PATIENT REMOVE RINGS, WATCHES AND BRACELETS. ROUTINE VIEWS: PA External Oblique Lateral *FINGERS* Routine hand films Coned down view of affected finger in lateral position. PA HAND 1. 10 x 12 divided 2. Table top extremity cassette 3. 40" SID 4. Palm flat on cassette, fingers straight. 5. Center to third metacarpophalangeal joint. EXTERNAL OBLIQUE 1. 10 x 12 divided 2. Table top extremity cassette 3. 40" SID 4. Center to third MCP joint. 5. From the PA position externally rotate the hand 45o. Separate the fingers and allow them to rest against the cassette. LATERAL 1. 8 x 10 extremity cassette 2. Table top extremity cassette 3. 40" SID 4. Hand in true lateral position and separate fingers. 5. Center to third MCP joint. |
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NON-TRAUMA HIP
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NON-TRAUMA HIP
ROUTINE VIEWS: AP Pelvis - if no previous or recent one has been taken AP Hip Lateral Hip (Frog-Leg) AP PELVIS 1. 14 x 17 film 2. Patient supine with toes rotated inward. 3. Bucky 4. 40" SID 5. Central Ray: midway between symphsis pubis and iliac crest. AP HIP 1. 10 x 12 film 2. Patient supine 3. Foot rotated slightly inward 15o 4. 40" SID 5. Central Ray: through femoral neck LATERAL HIP (FROG-LEG) 1. 10 x 12 crosswise 2. Patient supine 3. Have patient bend knee and allow affected leg to slowly "fall" to side. 4. Bucky 5. 40" SID 5. Central Ray: through femoral neck BOTH VIEWS TO INCLUDE ENTIRE PIN OR PROSTHESIS. |
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HIP ARTHROGRAMS
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HIP ARTHROGRAMS
For examination of hip joint. SUPPLIES: See Arthrogram supplies. SCOUT VIEWS: AP, "Frog Leg" A.P. 1. 10 x 12 film 2. Patient supine 3. Rotate foot of affected leg slightly inward. 4. Bucky 5. 40" SID 6. Central Ray: center 21/2" down from A.S.I.S. "FROG LEG" 1. 10 X 12 film crosswise 2. Patient supine 3. Have patient bend knee and allow affected leg to slowly "fall" to side. 4. Bucky 5. 40" SID 6. Central Ray: Center 21/2" down from A.S.I.S. *Always have radiologist check Scout Films* After injection of contrast, and after Radiologist obtains fluoroscopy spots, repeat all of the views explained previously and marked pre-exercise. After checking pre-exercise films with Radiologist, repeat the same series of films after exercising the hip. Mark these films post exercise. Show films to Radiologist before dismissing patient. To check for pin loosening SCOUT: AP film Position hip as you would a regular Hip Arthrogram, making sure you include entire pin and screw plate. A doctor from the Orthopedic Department or Radiologist will inject patient for this procedure. Once the needle is placed in joint, and before the contrast is injected, the leg must be immobilized with sandbags and a radiograph should be taken. It is very important that the leg does not move from that point up until the completion of exam. After the injection of contrast another radiograph must be taken, in the exact same position as the radiograph with the needle without contrast. After checking your last film you may allow the patient to move leg. |
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NON-TRAUMA HUMERUS
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NON-TRAUMA HUMERUS
ROUTINE VIEWS: AP (internal and external) INCLUDE BOTH JOINTS AP (INTERNAL AND EXTERNAL) 1. 14 x 17 film 2. Bucky, upright or supine 3. 40" SID 4. Rotate affected arm internal and externally. 5. Central Ray: center to mid Humerus *DO NOT ATTEMPT THESE PROJECTIONS IF PATIENT IS IN SEVERE PAIN.* INSTEAD TAKE AP NEUTRAL AND TRANSTHORACIC LATERAL. |
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KNEE
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KNEE
ROUTINE VIEWS: AP Lateral Tunnel Tangential AP 1. Patient supine 2. Knee in true A.P. position. 3. Bucky 4. 40" SID 5. Center to Apex of patella. 6. Angle tube 5-7 degrees cephalad. 7. 10 x 12 film Lateral 1. Patient in true lateral position with affected side closest to film flex knee slightly if possible. 2. Bucky 3. 40" SID 4. Angle tube 5-7 degree cephalad. 5. Center medial epicondyle. 6. 10 x 12 film Tunnel (Homblad) 1. Patient up on knees with femurs forward 20-25 degrees, Central Ray: through bend of leg. 2. Bucky 3. 40" SID 4. 10 x 12 film Transgential (Sunrise) 1. Patient sitting on table. 2. Patient's affected leg is placed so that the foot is flat on table. 3. Patient hold 8 x 10 extremity cassette behind knee. 4. Angle tube approximately 45-50 degrees cephalad to project shadow of knee on film. 5. Film is marked medially and laterally. |
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KNEE ARTHROGRAM
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KNEE ARTHROGRAM
SUPPLIES: See Arthrogram supplies on page 7. SCOUT VIEWS: AP, Lateral, Tunnel, Tangential, Post Contrast AP 1. Patient supine 2. Knee in true A.P. position. 3. Bucky 4. 40" SID 5. Center to Apex of patella. 6. Angle tube 5-7 degrees cephalad. 7. 10 x 12 film Lateral 1. Patient in true lateral position with affected side closest to film flex knee slightly if possible. 2. Bucky 3. 40" SID 4. Angle tube 5-7 degree cephalad. 5. Center medial epicondyle. 6. 10 x 12 film Tunnel (Homblad) 1. Patient up on knees with femurs forward 20-25 degrees, Central Ray: through bend of leg. 2. Bucky 3. 40" SID 4. 10 x 12 film Transgential (Sunrise) 1. Patient sitting on table. 2. Patient's affected leg is placed so that the foot is flat on table. 3. Patient hold 8 x 10 extremity cassette behind knee. 4. Angle tube approximately 45-50 degrees cephalad to project shadow of knee on film. 5. Film is marked medially and laterally. After the injection of double contrast, the Radiologist will take several films with the fluro unit. These films should be numbered or labeled. Upon the completion of fluoroscopy, further instructions will be given. The Radiologist may request a "Hanging Lateral". Hanging Lateral 1. Patient sits on edge of table with knees bent and lower legs hanging down. 2. The patient holds the grid between the knees. 3. The tube is positioned so that the Central Ray is horizontal and passing through the affected knee lateral to medial. 4. The patient is instructed to flex the knee back on a rolled towel placed behind the knee as the exposure is taken. After injection, repeat all the views explained previously and marked pre-exercise. After checking pre-exercise films with radiologist, repeat the same series of films after exercising the knee. Mark these films post exercise. Show films to Radiologist before dismissing patient. |
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SACROILIAC JOINTS (SI JOINTS)
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SACROILIAC JOINTS (SI JOINTS)
ROUTINE VIEWS: AP RPO LPO AP 1. 10 x 12 film 2. Patient supine 3. Bucky 4. 40" SID 5. Central Ray: 15o cephalic angle, enter halfway between A.S.I.S. and symphysis pubis. 6. Suspended respiration Obliques (RPO and LPO) 1. 10 x 12 film 2. Patient recumbent 3. Patient rotated 30o from AP position 4. Bucky 5. 40" SID 6. Central Ray: enters 1" medial A.S.I.S. of side up. 7. Suspended respiration |
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SINUSES
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SINUSES
ROUTINE VIEWS: PA (Caldwell) Waters Open Mouth Waters Lateral of Affected Side CLEAN TABLE BEFORE PUTTING PATIENT'S FACE ON IT. FILMS MUST BE DONE ERECT TO SEE FLUID LEVEL. PA 1. 8 x 10 film 2. Patient seated or standing with forehead and tip of nose resting on upright Bucky. 3. Central Ray: angled 15o caudally and passes through nasion. The O.M.L. is perpendicular to table. 4. Bucky 5. 40" SID 6. Central Ray: to exit nasion Waters 1. 8 x 10 film 2. Patient seated or standing with chin resting on upright Bucky so that the mentomeatal line is perpendicular to film. 3. Bucky 4. 40" SID 5. Central Ray: to exit acanthion Open Mouth Waters Patient positioned same as waters view, but with mouth opened. This view must DEMONSTRATE SPHENOID SINUS THROUGH THE OPEN MOUTH (Patient's mouth is placed on table). Lateral of Affected Side 1. 8 x 10 film 2. Patient sitting or standing 3. Have patient put affected side against Bucky. 4. Bucky 5. 40" SID 6. Head in true lateral with interpupillary line and O.M.L. perpendicular to front edge of film. 7. Centering Point: outer canthus of eye |
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BONE SURVEY
SKELETAL SURVEY: |
BONE SURVEY
SKELETAL SURVEY: A basic total body exam to rule out abuse or disease affecting the bones in general. 1. AP Entire Torso 2. Lateral Skull 3. AP Long Bones |
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STERNUM
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STERNUM
ROUTINE VIEWS: RAO Lateral RAO 1. 10 x 12 film 2. Patient prone 3. Rotate patient so that they are in a 15-20o anterior oblique position; heavy patients rotate less and thin patients rotate more. 4. Bucky 5. 30" SID 6. Central Ray: perpendicular to film, enters slightly left of vertebral column and is centered midway between suprasternal notch and xiphoid process. 7. Breathing technique Lateral 1. 10 x 12 film 2. Patient in true lateral position 3. Hand pulled behind patient to pull shoulders back 4. Bucky 5. 40" SID 6. Central Ray: perpendicular to film, top of film 11/2 inches above suprasternal notch. |
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TIB-FIB
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TIB-FIB
ROUTINE VIEWS: AP LAT INCLUDE BOTH JOINTS AP 1. 14 x 17 film 2. Table top 3. 40" SID 4. Central Ray: center to mid leg LAT 1. 14 x 17 film 2. Table top 3. 40" SID 4. Central Ray: center to mid leg |
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TEMPERO-MANDIBULAR JOINTS (TMJ'S)
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TEMPERO-MANDIBULAR JOINTS (TMJ'S)
ROUTINE POSITIONS: Townes (Occipital) Laws (Bilateral) with open and closed mouth Townes (Occipital) 1. 8 x 10 crosswise 2. Patient supine 3. Position O.M.L. perpendicular to table 4. Central ray angled 30o caudal enters at glabella 5. Bucky 6. 40" SID Laws (Bilateral) 1. 8 x 10 crosswise 2. Patient prone with head in true lateral, then rotate face toward table 15o with side of interest closest to film. Interpupillary line is perpendicular to table. 3. Bucky 4. 40" SID 5. Central Ray exits downside T.M.J. (1 cm anterior to EAM) 6. Need bilateral with open and closed mouth 7. Mark film open or closed |
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CERVICAL SPINE (E.R. OR TRAUMA)
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CERVICAL SPINE (E.R. OR TRAUMA)
Trauma with collar do lateral, AP, and odontoid, either supine or if on backboard move patient to table on board and shoot through, then get cleared. Once cleared ER is to remove c-collar then do the following films: Neutral Lateral both Obliques or both Pillars AP Odontoid If E.R./OP trauma (no collar) do: Neutral Lateral both Obliques or both pillars AP Odontoid *NO FLEXION AND EXTENSION ARE TO BE DONE UNLESS SPECIFICALLY ORDERED. X-FIRE LEFT LATERAL 1. 10 x 12 film L.W. 2. Patient supine with collar ON. 3. 72" SID 4. Central Ray: center to neck with film 2" above EAM. 5. Shoulders depressed 6. Must see C-7 AP 1. 8 x 10 2. Patient supine with collar ON. 3. 40" SID 4. Central Ray: thyroid cartilage 5. Tube angled 20 degree cephalad ODONTOID (OPEN MOUTH) 1. 8 x 10 2. Patient supine with collar ON, open mouth as wide as possible. 3. 40" SID 4. Central Ray: perpendicular to film, through opened mouth. After E.R. has cleared films and collar is removed do the following: Left Lateral 1. 10 x 12 film 2. Patient sitting or standing at upright film holder. 3. 72" SID 4. Central Ray: center to neck with film 2" above EAM. 5. Shoulders depressed (hold weights) 6. Must see C-7 Obliques (RPO, LPO) 1. Patient sitting or standing with back against upright film holder. 2. Rotate patient so that they are 45 degrees away form film for each side. 3. Angle tube 15 degree cephalad. 4. 40" SID USE MARKERS ACCORDING TO SIDE DOWN. AP 1. 8 x 10 film 2. Patient supine or erect with chin extended. 3. Bucky 4. 40" SID 5. Tube angled 20 degree cephalad. 6. Center Point: thyroid cartilage Odontoid (open-mouth) 1. 8 x 10 film 2. Patient supine or erect, adjust head so that upper occlusal plane is perpendicular to table, have patient open mouth. 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film, through opened mouth. -24- DOCTORS HOSPITAL OF NELSONVILLE Cervical Spine (E.R. or Trauma) Page 3 OPTIONAL VIEW: Swimmers 1. 10 x 12 film 2. Patient supine or on left lateral with one arm extended above head and one at side. 3. X-fire or Bucky 4. 40" SID 5. Central Ray: enters C-4 |
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TRAUMA HIP
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TRAUMA HIP
ROUTINE VIEWS: AP Pelvis AP Hip Cross-fire Lateral Hip AP PELVIS 1. 14 x 17 film 2. Patient supine with toes rotated inward. 3. Bucky 4. 40" SID 5. Central Ray: Midway between symphsis pubis and iliac crest. AP HIP 1. 10 x 12 film 2. Patient supine 3. Foot rotated slightly inward 15o 4. Bucky 5. 40" SID 6. Central Ray: through femoral neck CROSS-FIRE LATERAL HIP 1. 10 x 12 grid 2. Patient supine 3. Unaffected leg is up and out of the way. 4. 40" SID 5. Central Ray: Centered through femoral neck 6. Horizontal beam is directed cross table through affected hip. |
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TRAUMA HUMERUS
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TRAUMA HUMERUS
ROUTINE VIEWS: AP Neutral Transthoracic Lateral AP NEUTRAL 1. 14 x 17 film 2. Bucky or table top 3. 40" SID 4. Upright or supine. Place proximal Humerus in contact with film. 5. Central Ray: surgical neck TRANSTHORACIC LATERAL 1. 14 x 17 film 2. Bucky 3. 40" SID 4. Patient upright (seated or standing) in lateral position with affected arm in neutral position. Raise the opposite arm; rest hand on top of head. 5. Central Ray: throughout thorax to surgical neck with 10-15o cephalic angle. |
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TRAUMA SHOULDER
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TRAUMA SHOULDER
ROUTINE POSITIONS (trauma): "Y" view True AP AP Neutral ADDITIONAL VIEW: Axillary "Y" View 1. 10 x 12 lengthwise 2. Patient supine or upright 3. Palpate the borders of the scapula and rotate the patient until the scapula is in true lateral position. 4. Bucky 5. 40" SID 6. Central Ray: direct to midvertebral border of scapula, film placed 2 inches above shoulder. 7. Used to demonstrate dislocation 8. Expiration True AP 1. 10 x 12 crosswise 2. Patient supine or upright 3. Rotate body approximately 35o toward side of interest, posterior aspect of arm and shoulder should be in contact with table. 4. Bucky 5. 40" SID 6. Expiration AP Neutral 1. 10 x 12 crosswise 2. Patient supine or standing 3. Do not rotate patient's arm 4. Bucky 5. 40" SID 6. Central Ray: perpendicular to film, center to coracoid process 7. Expiration |
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DORSAL SPINE (THORACIC)
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DORSAL SPINE (THORACIC)
ROUTINE POSITIONS: AP Lateral Breathing Lateral Swimmer's View AP 1. 14 X 17 films 2. Patient supine 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film 6. Place top of film 2" above shoulder. 7. Center tube to film 8. Suspend respirations LATERAL 1. 14 X 17 films 2. Patient placed in left lateral position. 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film 6. Center at T7 7. Suspended respiration BREATHING LATERAL 1. 14 X 17 films 2. Patient placed in left lateral position. 3. Bucky 4. 40" SID 5. Central Ray: perpendicular to film 6. Center at T7 7. Taken while patient taking rapid respiration during exposure time. SWIMMER'S VIEW 1. 10 x 12 film 2. Patient in left lateral position. 3. Patient's dependent arm should be in front of him and his top arm should be bent at the elbow with his hand on his hip and his shoulder rotated back. 4. Bucky 5. 40" SID 6. Central Ray: centered to C6-C7 7. Angle caudal as needed. |
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T-TUBE CHOLANGIOGRAM
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T-TUBE CHOLANGIOGRAM
*Consent form needs to be signed. SUPPLIES: Conray - 43 50 cc syringe (several) 21GF "butterfly" needle (several) 18G 1 1/2" needle 3-way stopcock tube clamp 60 cc catheter trip syringe A scout film is always taken before exam. Clamp off tube prior to injection. After injection of contrast, the Radiologist will take several fluoro spots. After the Fluoroscopy is complete the Radiologist will instruct the technologist on what views need to be taken. *Views may vary per Radiologist. * Leave tube clamped off until the patient is ready to leaves the department. *Radiologist will extract residual contrast before patient leaves the department. ROUTINE FILMS: ABD, Scout, AP, RPO, LPO, 10 Minute Delay AP Film ABDOMEN SCOUT 1. Patient supine 2. Center film to include entire Hepatic and Biliary System. 3. Central Ray: perpendicular to film. 4. 40" SID AP AND 10 MINUTE DELAY Patient positioned the same as scout, although a smaller size film may be utilized. RPO AND LPO 1. Patient recumbent in RPO and LPO position. 2. Film placed to include the entire Biliary System. 3. Central Ray: perpendicular to film. 4. 40" SID |
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VOIDING CYSTOURETHROGRAM (VCU)
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VOIDING CYSTOURETHROGRAM (VCU)
SUPPLIES: Urinals - for males Cysto-Aid - for adult females Towels Reno-M-Dip I.V. Tubing for Reno-M-Dip Urethral Catheterization Tray Urethral Catheter Lidocaine Jelly - for males ROUTINE VIEWS: K.U.B. (Scout) Upright Abdomen Scout K.U.B. (full bladder) Lateral (full bladder) Upright Lateral Standing (full bladder & catheter) AP (voiding) RPO (voiding) LPO (voiding) Lateral (voiding) Post Void Films may be done upright (or) supine, depending on patient condition and preference of Radiologist. ALL FILMS ON A LARGE ENOUGH FILM TO INCLUDE URETHRA, BLADDER, AND BOTH KIDNEYS K.U.B. (SCOUT) 1. 14 x 17 film 2. Patient is placed in supine position. 3. Film placed to include bottom of bladder as well as top of kidneys. 4. Bucky 5. 40" SID 6. Show film to Radiologist before proceeding. The Radiologist will fill the patient's bladder with contras under fluoroscopy. AFTER FILLING PATIENT'S BLADDER WITH CONTRAST VIA CATHETER, THE FOLLOWING FILMS ARE TAKEN: K.U.B. (FULL BLADDER) Positioned same as Scout. LATERAL (FULL BLADDER) 1. Patient placed in left lateral position. 2. Film positioned to include entire bladder. 3. Bucky 4. 40" FFD *WHEN DOING FEMALE PATIENT TO RULE OUT CYSTOCELE, DO LATERAL STANDING TO INCLUDE PUBIS AND SACRUM ON FILM. *REMOVE CATHETER BEFORE VOIDING FILMS. ALWAYS ANGLE THE TABLE HEAD UP OR STAND THE PATIENT ERECT FOR VOIDING FILMS. LATERAL VOIDING 1. 14 x 17 films 2. Patient placed in lateral position. 3. Film placed to include entire bladder and urethra. 4. Patient instructed to void while film taken. 5. Bucky 6. 40" SID *MALES - DO LATERAL VOIDING FIRST. *FEMALES WITH INCONTINENCE OF TO RULE OUT CYSTOCELE - DO ERECT LATERAL VOIDING TO INCLUDE PUBIS AND SACRUM ON FILM FOLLOWED BY BOTH OBLIQUES VOIDING. RPO AND LPO VOIDING 1. 14 x 17 films 2. Patient placed in 30 degree posterior oblique position. 3. Film placed to include entire bladder and urethra. 4. Patient instructed to void while film is taken. 5. Bucky 6. 40" SID *FEMALES WITH UTI OR RULE OUT REFLUX - DO BOTH OBLIQUES VOIDING FIRST FOLLOWED BY LATERAL VOIDING. POST VOID Positioned same as K.U.B. *FILM SIZE AND VIEWS MAY VARY DEPENDING ON RADIOLOGIST. BLADDER VOLUME: < 1 year - weight in Kg x 7cc/Kg > 1 year - (age in year) + 2 x 30cc |
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VENOGRAM
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VENOGRAM
SUPPLIES: Consent form Optiray IV bags with tubing Extension sets Tourniquets Assortment of butterfly needles Tape Overhead light Handles and Veno block Gloves SCOUT FILMS: AP Femur to include hips AP Lower Leg to include knee AP Pelvis centered as for Vena Cava film ALL FILMS ON 14 X 17 FILM OVERHEADS DURING INJECTION WITH TABLE ELEVATED 15-20o HEAD UP. AP and Lateral Lower Leg AP and Lateral and External Oblique Knee AS Distal Femur AP Proximal Femur Vena Cava ("Dump") film - table horizontal with Radiologist holding leg up. AFTER COMPLETION OF INJECTION, A 10 MINUTE DELAY FILM NEEDS TO BE TAKEN. THIS VIEW CONSISTS OF A.K.U.B. A Venous Doppler Exam is required prior to Venogram |
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WRIST
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WRIST
Have patient remove rings, watches and bracelets. ROUTINE VIEWS: PA RPO LPO Lateral ADDITIONAL VIEW: Navicular (Scaphoid) PA 1. 1/2 - 10 x 12 detail cassette 2. Table top 3. 40" SID 4. Curl hand into fist to flatten wrist 5. Center to radioulnar joint RPO 1. 1/2 - 10 x 12 detail cassette 2. Table top 3. 40" SID 4. Put palm flat on table and rotate wrist up laterally 45o 5. Center to radioulnar joint LPO 1. 1/2 - 10 x 12 detail cassette 2. Table top 3. 40" SID 4. Put palm flat on table and rotate wrist up medially 45o 5. Center to radioulnar joint Lateral 1. 1/2 - 10 x 12 detail cassette 2. Table top 3. 40" SID 4. Place hand laterally with fingers straight and thumb pointing up 5. Center to radioulnar joint ADDITIONAL VIEW: Navicular * Radial deviation/ulnar flexion Position patient with arm straight and fingers deviated out from body. Angle tube 20o toward the elbow. Central ray enters navicular area. |
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ZYGOMA (ZYGOMATIC-ARCH)
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ZYGOMA (ZYGOMATIC-ARCH)
ROUTINE VIEWS: Waters SMV Bilateral Basiliar Obliques Waters 1. 8 x 10 crosswise 2. Patient prone 3. Position head so that chin is resting on table. Be sure to extend chin enough to throw petrous ridges out of maxillary sinuses. OML for 37 angle with table. 4. Bucky 5. 40" grid 6. Central Ray: perpendicular to film, exits acanthion Submentovertex (SMV) 1. 8 x 10 crosswise 2. Patient supine 3. Position patient's head so that Reid's baseline is perpendicular to film. I.O.M.L. parallel to film. May be necessary to build up shoulders to achieve this. 4. Bucky 5. 40" SID 6. Central Ray enters inferior to chin and exits at vertex Bilateral Basiliar Obliques (Oblique Axial Position) 1. 8 x 10 crosswise 2. Patient supine 3. Patient's head is positioned so that the I.O.M.L. is parallel to film. Tilt head 15 degrees toward side to be examined. 4. Bucky 5. 40" SID 6. Central Ray: Skims parietal eminence and body of mandible 7. Both sides are done separately |
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Barium Enema
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SUPPLIES: Enema bag mixed with room temperature water.
VIEWS: K.U.B. (Scout) RPO 45 degree LPO 45 degree Left Lateral Abdomen for Flexures Left Lateral Abdomen for Rectum PA PA Sigmoid 30 degree Caudal Tube Angle, (or) due to patient condition A.P. 30 degree Cephalic. Post Evac All films in 14 x 17 except rectum views 10 x 12. All films taken on expiration. Scout K.U.B. 1. Patient supine 2. Bucky 3. 40" SID 4. Center at iliac cres 5. Include Symphysis Pubis RPO 45 degree 1. Patient recumbent, rotated 45 degrees with right side down. 2. Bucky 3. 40" SID 4. To demonstrate splenic flexure 5. Center iliac crest. L.P.O. 45 degree 1. Patient recumbent, rotated 45 degrees with left side down. 2. Bucky 3. 40" SID 4. To demonstrate splenic flexure 5. Center iliac crest. Left Lateral for Flexures 1. Patient recumbent in left lateral position. 2. Bucky 3. 40" SID 4. Center to include flexures. 5. Center at iliac crest. Left Lateral Rectum 1. Patient recumbent in left lateral position. 2. Bucky 3. 40" SID 4. Center to include rectum 5. Deflate tip, midaxillary plane between ASIS and posterior sacrum PA 1. Patient prone 2. Bucky 3. 40" SID 4. Center to include flexures as well as rectum. 5. Center at iliac crest PA Sigmoid (Can be done A.P. due to patient condition) 1. 11 x 14 film 2. Patient prone or supine. 3. Bucky 4. 40" SID 5. Center to include sigmoid colon, PA exits ASIS, AP enters ASIS 6. Central Ray: PA 30 degree caudally, AP 30 degree cephalic Post Evac Position the same as the scout. *110 KVP should be used on adults. **90 KVP should be used on infants. ***Always check films with radiologist before allowing patient to evac. GASTROGRAFIN INFORMATION Gastrografin does not contain Iodine!!!!! There are limitations on how much to administer!!!!! ENEMA ADMINISTRATION OF GASTROGRAFIN: Adults 240 ML in 1,000cc's tap water Children >5 yrs 90 ML in 500cc's tap water Children <5 yrs A 1:5 dilution is suggested. Total amount neede depends on the size of the child ... however, the ratio of 1:5 remains constant. DO NOT DEVIATE FROM THIS UNLESS YOU CONSULT THE RADIOLOGIST FIRST QUESTIONS REGARDING THE AMOUNT TO USE CONSULT THE RADIOLOGIST FIRST |
