Patient Positioning for different exams.

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  1. AP Soft Tissue Neck
    Chin raised until acanthiomeatal line is ┴ to IR
  2. Oblique Thumb
    • Palm flat against cassette
    • Thumb slightly abducted
  3. Lateral Thumb
    • Close fist until thumb in true lateral position
    • Abduct thumb slightly
  4. AP Thumb
    Internally rotate hand until thumb in true AP position
  5. AP Axial Thumb
    Modified Robert's Method
    • Internally rotate hand until thumb is in true AP position
    • CR 15° towards elbow, centered to snuff box
  6. PA Stress Thumb
    Folio Method
    • Position hands side-by-side on cassette
    • Rotate hands 45° internally so that thumbs are adjacent and in true PA position
    • Place spacer ( roll of tape ) between first metacarpals
    • Wrap rubber band around ends of thumbs ( not too tight, not too loose )
    • Roll rotor
    • Immediately before exposure ask patient to pull thumbs apart.
    • Expose
  7. Oblique Hand
    45°
  8. AP Oblique Bilateral Hand
    Norgaard
    Ball Catchers
    • Patient's hands palm sides up, side-by-side
    • Medial aspects of hands adjacent to each other
    • Internally rotate both hands 45°
  9. Scaphoid PA
    • Place palm-side-down flat on cassette
    • Without moving forearm, evert hand as far as possible


    • CR 15° toward elbow
    • centered at snuffbox
  10. PA Scaphoid
    Modified Stetcher Method
    • Hand palm-side-down on 20° angled sponge so that fingertips are higher than carpals.
    • Without moving forearm, have patient evert hand as far as possible
  11. Carpal Tunnel
    Gaynor-Hart Method
    • Pt. Hyperextends / Dorsiflexes wrist to 90°
    • Grabs fingertips with opposite hands to stabilize
    • Pt. internally rotates hand 10°
  12. What is in a navicular Series?
    • PA Wrist
    • Oblique Wrist
    • Lateral Wrist
    • AP Wrist
    • Navicular / Scaphoid
  13. AP Forearm
    • Drop Pt. shoulder to same level as forearm
    • Fully extend arm
    • Pronate hand to true AP, palm-side up
  14. Lateral forearm
    • Pt. shoulder and forearm in same plane
    • Pt. arm flexed 90° at elbow
    • Forearm and hand in true lateral position, thumb-side up
  15. AP Elbow
    • Pt. shoulder and arm in same plane
    • Fully extend arm
    • Suppinate hand to palm-side-up
  16. Cannot bend elbow AP
    Two views:

    1.

    • Humerus AP, flat against IR
    • CR ┴
    • centered to elbow joint

    2.

    • Radius and ulna flat against IR
    • CR ┴
    • Centered to elbow joint
  17. External rotation Elbow
    • Shoulder and forearm in same plane
    • Fully extend arm
    • Externally rotate arm until hand is 45° externally rotated ( may have to lean body back to do this )
  18. Internal Rotation Elbow
    • Shoulder and arm in same plane
    • Arm fully extended
    • Internally rotate hand until 45° to IR
  19. Acute Flexion Axial Elbow
    • Shoulder and elbow in same plane
    • Pt. rests posterior distal humerus on IR
    • Elbow hyper flexed
    • Two views:

    1.

    • CR ┴ to humerus
    • Centered mid-way between epicondyles

    2.

    • CR ┴ to forearm
    • Centered 2" distal to olecranon process
  20. Coyle Method
    Radial Head
    • Shoulder and elbow in same plane
    • Elbow flexed 90°
    • Palm down against table

    • CR 45° toward shoulder along axis of humerus
    • Centered to radial head
  21. Coyle Method
    Coronoid Process
    • Shoulder and elbow in same plane
    • Elbow flexed 80°, palm flat against table

    • CR 45° away from shoulder along axis of humerus
    • Centered to mid-elbow joint
  22. Radial Head Laterals
    • AP Elbow
    • Lateral Elbow
    • External rotation Elbow
    • Internal rotation elbow
  23. Humerus Internal Rotation
    • Pt. AP upright back against IR
    • Internally rotate arm until epicondyles ┴ to IR
    • Partially flex elbow
    • Back of hand against lateral thigh or hip
  24. Transthoracic Humerus
    Lawrence Method
    • Pt. lateral side of interest against IR
    • Affected arm in neutral position
    • IF POSSIBLE - have patient drop shoulder
    • Raise unaffected arm above head
    • Make sure spine does not superimpose humerus
  25. AP Shoulder External Rotation
    • Slightly rotate patient toward affected side to bring scapula flat against IR
    • Abduct arm slightly and externally rotate until epicondyles = to IR
  26. AP Shoulder Internal Rotation
    • Bring forearm across abdomen
    • Pronate hand so palm faces downward
    • Thumb against belly button
    • Epicondyles ┴ to IR
  27. Scapular Y
    • Pt. upright facing IR
    • Rotate Pt. body until 45 - 60° anterior oblique to IR
    • Shoulder of interest closest to IR
    • Abduct arm slightly
  28. Inferiosuperior Axiolateral Projection Shoulder
    Lawrence Method
    • Raise shoulder 2" from table
    • Abduct pt. arm straight out from body
    • Rotate pt. head away from affected shoulder
    • Externaly rotate pt. arm so palm is up
  29. PA Shoulder
    Hobbs Modification
    • Raise arm of affected shoulder as much as straight up as possible
    • Pt. PA erect, anterior aspect of shoulder against IR
    • Rotate pt. entire body 5 - 10° anterior oblique with shoulder of interest against IR
  30. AP Oblique Shoulder 
    Grashey Method
    • Pt. AP erect with posterior aspect of affected shoulder against IR
    • Rotate pt. entire body to 35 - 45° posterior oblique with shoulder of interest against IR
    • Abduct arm slightly with arm in neutral position

    This is to look at glenoid rim
  31. Tangential Projection - Intertubercular Groove
    Fisk Modification
    • Pt. seated or standing at end of table
    • Pt. leans forward onto table with humerus ┴ to table
    • Pt. leans forward more until humerus is 10 - 15° from ┴ to table
    • Elbow back, shoulder forward
    • Pt. holds cassette with non-exposure side flat against anterior forearm

    • CR 10 - 15° downward from horizontal
    • Centered to area of groove
  32. Supraspinatous Outlet
    Neer Method
    • Pt. Pa erect with shoulder of interest centered to IR
    • Rotate body to 45 - 60° anterior oblique to IR, with shoulder of interest against IR
    • Scapular spine ┴ to IR

    • CR 10 - 15° caudad
    • centered to pass through superior margin of humeral head
  33. AP Apical Oblique Axial
    Garth Method
    • Pt. AP erect, shoulder of interest against IR
    • Rotate body until 45° Posterior Oblique to IR, with affected shoulder against IR
    • Flex elbow and bring forearm across abdomen if possible
    • At side in neutral position is ok

    • CR 45° caudad
    • centered to shoulder joint
  34. AP Scalpula
    • Do not oblique pt.
    • Abduct arm 90°
    • bring back of hand against forehead
  35. Lateral Scapula
    • Pt PA erect, shoulder of interest against IR
    • Rotate pt. until 45 - 60° anterior oblique position, shoulder of interest against IR
    • Scapula of interest in true lateral position
    • Pt reaches across chest with affected arm and grasps unaffected shoulder
  36. Oblique Scapula
    Same as Lateral Scapula, but pt. grasps hip opposite of affected shoulder
  37. Oblique Toe
    Rotate leg and foot:

    • 30 - 45° internally for toes 1, 2, 3
    • 30 - 45° externally for toes 3, 4, 5
  38. Oblique foot
    • Internally rotate leg and foot 30 - 45°
    • Dorsiflex foot 90° to lower leg
  39. Lateral ( medolateral lateral ) Foot
    • Pt. in lateral recumbent position
    • Foot in true lateral position
    • Dorsiflex foot 90° to lower leg
  40. AP Ankle
    • Foot and ankle true AP position
    • Do not dorsiflex foot
    • Include 5th metatarsal
  41. Ankle Mortise
    • Pt. Sitting or supine
    • Internally rotate foot 15 - 20° until intermalleolar line is ┴ to IR
    • Do not dorsiflex foot
    • Include 5th metatarsal
  42. Lateral ankle
    • Pt in lateral recumbent position or sitting
    • Dorsflex foot?
    • Include 5th metatarsal
  43. AP Tib-fib
    • Dorsiflex foot 90° to lower leg
    • 44 - 48" SID
  44. Lateral Tib-fib
    • Dosiflex foot 90° to lower leg
    • 44 - 48" SID
  45. Lateral Knee
    Knee flexed 20 - 30°
  46. Sunrise
    • Pt. Supine
    • Knee flexed 45°
  47. Tangential Patellar
    ( alternative to sunrise )
    Hughston Method
    • Knee flexed 20 - 45°
    • CR 10 - 15° to lower leg
  48. Tangential Patellar
    ( alternative to sunrise )
    Settegast
    • Knee flexed 90°
    • CR 10 - 15° to lower leg
  49. Tangential Patellar
    ( alternative to sunrise )
    Hobbs Modification
    • Pt. seated in chair
    • Knees flexed 90°
    • IR on object ( box, stool, etc. ) so that exposure side is just below pt.'s knees
    • 48 - 50" SID to reduce magnification
  50. AP Lower Femur
    • Pt. supine
    • Leg internally rotated 3 - 5°
    • Bottom of cassette 2" below knee
  51. Lateral Lower Femur
    • Pt. in lateral position
    • Knee flexed 45°
    • Bottom of cassette 2" below knee
  52. AP Hip
    • Pt. supine
    • Rotate unaffected leg 15 - 20° internally
    • Top of film 1" above ASIS
  53. Lateral Hip ( mediolateral lateral )
    • Pt. Supine
    • Flex knee
    • Abduct femur 40 - 45°
    • Femoral neck = to IR
  54. Danelius-Miller
    • Pt. supine
    • If possible ( it won't be ) elevate pt.'s hips 2"
    • Raise and support unaffected leg
    • Long edge of IR on table, exposure side against affected hip
    • Short edge of IR above iliac crest
    • Cassette = with femoral neck ( 45° to midsagittal plane )
  55. LPO / RPO SI Joints
    Pt. supine, obliqued 25 - 30°
  56. Pelvis
    • Pt. supine
    • Internally rotate feet 15 - 20° until toes touch
    • IR 1.5" above iliac crest
  57. Modified Cleaves / Frogleg
    • Pt. Supine
    • Knees flexed 90°
    • Legs abducted until femurs are 90° to each other
  58. Pelvic Outlet
    Taylor Method
    Bilateral view of pubis and ischium
    Assessment of pelvic trauma - fx and displacement
    Pt. supine

    • CR 20 - 35° cephalad for males
    • CR 30 - 45° for females
    • CR centered to level of greater trochanters

    Top of film 2" above level of ASIS?
  59. Pelvic Inlet
    • Pt. Supine
    • CR 40° caudad
    • Centered to Midline
    • Centered to level of ASIS

    Top of film 1" above iliac crest?
  60. Judet Method
    Acetabular Fracture
    • Pt. supine
    • Obliqued 45° RPO or LPO
  61. Teufel Method
    Acetabular fracture
    • Pt. prone
    • Obliqued 30 - 45° RAO or LAO
  62. Lateral C-spine
    Shoulders relaxed and dropped forward and downward as much as possible
  63. Odontoid
    • Lower margin of upper incisors are aligned to base of skull and ┴ to IR
    • Open mouth as far as possible
  64. RPO / LPO Axial C-spine
    • Body obliqued 45° posterior oblique to IR
    • Head in true lateral L or R position

    Can also do this view RAO or LAO with 15 - 20° caudad CR angle
  65. Swimmers C-spine
    • Pt upright lateral position
    • L shoulder against IR
    • L arm straight up
    • R arm relaxed as far down and forward as possible
  66. AP T-spine
    Top of IR 1 - 1 1/2" above shoulder
  67. L-spine oblique
    • Pt. supine
    • Obliqued 45° RPO or LPO
  68. Lateral L-spine
    • Pt. lateral position
    • Knees flexed for support
    • Arms out in front of and away from body
  69. RAO sternum
    • Pt. PA upright position
    • Oliqued 15 - 20° RAO
    • Top of film 1.5" above jugular notch
    • Breathing technique
  70. PA SC Joints
    • Pt. PA upright
    • Clavicles as close to IR as possible
    • Chin up
  71. RAO / LAO SC joints
    • Pt. PA upright
    • Clavicles as close to IR as possible
    • Oblique pt. until 15 - 20° RAO or LAO
    • Chin up
  72. Anterior Rib Injury
    • PA chest
    • PA side affected
    • LAO for R side injury
    • RAO for L side injury
  73. Posterior Upper Rib Injury
    • PA chest
    • AP Upper side affected ( 14x17 V ) 
    • AP Lower side affected ( 10x12 T )
    • RPO for R side injury
    • LPO for L side injury
  74. Posterior Lower Rib Injury
    • PA Chest
    • AP upper ribs
    • AP lower ribs ( 10x12 T )
    • RPO Upper and lower for R side injury
    • LPO Upper and lower for L side injury
  75. Esophogram
    • RAO ( 35 - 40° oblique )
    • R Lateral
    • AP or PA
    • LAO
  76. UGI
    • RAO ( 40 - 70° oblique ) 
    • R lateral
    • AP
    • LPO
    • PA ( usually only do AP )
  77. SBFT
    • One image every 15 min.
    • Then every 30 min. if moving slowly

    After 2 hours, if barium not at Ileocecal valve yet, take image every hour
  78. Single Contrast BE
    • AP
    • AP Axial Oblique
    •     35 - 45° pt. oblique
    •     CR  30 - 40° cephalad
    • LPO
    • RPO
    • L lateral Rectum
    • Post Evac
  79. Double contrast BE
    All done for Single Contrast BE, plus...

    • R Lateral decub
    • L lateral decub
    • Cross table rectum
    • AP upright
    • Post evac
  80. BE Butterfly views
    • AP axial butterfly
    • Pt. Supine
    • CR 30 - 40° cephalad
    • Centered 2" inferior to level of ASIS

    • PA Axial Oblique ( RAO oblique ) Butterfly
    • Pt. 35 - 45° RAO
    • CR 30 - 40° caudad

    • PA Axial Butterfly
    • Pt. Prone
    • CR 30 - 40° caudad
    • Exit at level of ASIS
  81. AP Axial Skull
    Townes Method
    • AP Position
    • OML ┴ to IR
    • CR 30° caudad
    • Centered 2.5" above glabella
  82. PA Axial Skull
    Caldwell Method
    • PA Position
    • OML ┴
    • CR 15° caudad
    • Exit Nasion
  83. Lateral Skull
    • True lateral skull
    • IOML ┴ to front edge of cassette
    • CR ┴ to IR
    • Centered 2" above EAM
  84. PA skull
    • PA position
    • OML ┴
    • Exit Glabella
  85. SMV
    • AP Position
    • Tilt head back until IOML = to IR
    • CR ┴
    • Centered 1.5" to mandibular symphisys
  86. PA Axial Skull
    Haas
    • PA Position
    • OML ┴ to IR
    • CR 25° cephalad
    • Exit 2.5" above Glabella
  87. Parietoacanthial Projection
    Waters
    • PA Position
    • Extend neck and head back until MML ┴ to IR
    • OML 37° to IR
    • CR ┴
    • Exit Acanthion
  88. Modified Waters
    • LML ┴ to IR
    • OML 55° to IR
  89. Submentovertex / SMV - Zygomas
    • AP position
    • Extend head and neck back until IOML = to IR
    • CR ┴
    • Centered 1.5" inferior to mandibular sypmphysis
    • Centered 1/2 between zygomatic arches
  90. AP Axial Townes for zygomas
    • AP position
    • OML ┴ to IR
    • CR 30° caudad
    • Centered 1" superior to Glabella
  91. Parieto-orbital
    Rhese Method
    • Pt. upright PA position or prone
    • Turn head so nose, cheek, chin of orbit being imaged are touching IR
    • This will position MSP of head to 53° to IR
    • AML = to floor
    • Eyeball should be centered to "x" of IR
  92. Orbital Floors
    • Pt. PA position
    • OML ┴ to IR
    • CR 30° caudad
    • Centered to exit nasion
  93. PA Mandible
    • PA position
    • Nose and forehead against IR
    • OML ┴ to IR
    • CR ┴ 
    • centered to exit lips
  94. AP Axial Mandible
    Townes
    • AP Position
    • OML ┴ to IR
    • CR 35° caudad
    • Center 1/2 way between Gonion and EAM
    • Light at top of TEA
  95. Axiolateral Mandible
    • Pt AP position
    • Oblique pt.'s entire body toward side to be imaged
    • Rotate pt. head to true lateral and as close as possible to IR
    • Extend chin

    • CR 25° cephalad
    • Centered to mandible nearest IR

Card Set Information

Author:
Ghoelix
ID:
320333
Filename:
Patient Positioning for different exams.
Updated:
2016-05-22 02:10:56
Tags:
patient positioning
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Description:
Patient positioning for different exams. Mostly just the ones I find difficult to remember for some reason.
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