radiographic techniques DR.Mufeida Elmusrati Consultant radiation oncology\TUH The human body is a complicated structure, and errors in radiographic positioning or diagnosis can easily occur unless practitioners have a common set of rules that are used to describe the body and its movements.
All the basic terminology descriptions refer to the
patient in the standard reference position, known as the anatomical position . Anatomical terminology Patient aspect • Anterior aspect that seen when viewing the patient from the front. • Posterior (dorsal) aspect: that seen when viewing the patient from the back. • Lateral aspect: refers to any view of the patient from the side. The side of the head would therefore be the lateral aspect of the cranium. • Medial aspect: refers to the side of a body part closest to the midline, e.g. the inner side of a limb is the medial aspect of that limb. Positioning terminology Planes of the body Three planes of the body are used extensively for descriptions of positioning both in plain-film imaging and in cross-sectional imaging techniques. The planes described are mutually at right angles to each other: • Median sagittal plane: divides the body into right and left halves. Any plane that is parallel to this but divides the body into unequal right and left portions is known simply as a sagittal plane or parasagittal plane. • Coronal plane: divides the body into an anterior part and a posterior part. • Transverse or axial plane: divides the body into a superior part and an inferior part How the patient is positioned for the various radiographic projections Erect: the projection is taken with the patient sitting or standing. In the erect position, the patient may be standing or sitting: • with the posterior aspect against the cassette • with the anterior aspect against the cassette • with the right or left side against the cassette. Decubitus: the patient is lying down. In the decubitus position, the patient may be lying in any of the following positions: • Supine (dorsal decubitus): lying on the back. • Prone (ventral decubitus): lying face-down. • Lateral decubitus: lying on the side. Right lateral decubitus – lying on the right side. Left lateral decubitus – lying on the left side. • Semi-recumbent: reclining, part way between supine and sitting erect, with the posterior aspect of the trunk against the cassette. All the positions may be described more precisely by reference to the planes of the body. Examples: ‘the patient is supine with the median sagittal plane at right- angles to the tabletop’ ‘the patient is erect with the left side in contact with the cassette and the coronal plane perpendicular to the cassette’. positioning for upper-limb projections the patient will often be ‘seated by the table’. This photograph shows the correct position to be used for upper-limb radiography, with the coronal plane approximately perpendicular to the short axis of the tabletop. The patient’s legs will not be under the table, therefore avoiding exposure of the gonads to any primary radiation not attenuated by the cassette or the table Terminology used to describe the limb position
Positioning for limb radiography may include:
• a description of the aspect of the limb in contact with the cassette; • the direction of rotation of the limb in relation to the anatomical position, e.g. medial (internal) rotation towards the midline, or lateral (external) rotation away from the midline; • the final angle to the cassette of a line joining two imaginary landmarks; • the movements, and degree of movement, of the various joints concerned. • Extension: when the angle of the joint increases. • Flexion: when the angle of the joint decreases. • Abduction: refers to a movement away from the midline. • Adduction: refers to a movement towards the midline. • Rotation: movement of the body part around its own axis, e.g. medial (internal) rotation towards the midline, or lateral (external) rotation away from the midline. • Pronation: movement of the hand and forearm in which the palm is moved from facing anteriorly (as per anatomical position) to posteriorly. Supination is the reverse of this. Other movement terms applied to specific body parts are described in the diagrams Projection terminology A projection is described by the direction of the central ray relative to aspects and planes of the body • Antero-posterior :The central ray is incident on the anterior aspect, passes along or parallel to the median sagittal plane, and emerges from the posterior aspect of the body. • Postero-anterior :The central ray is incident on the posterior aspect, passes along or parallel to the median sagittal plane, and emerges from the anterior aspect of the body. • Lateral The central ray passes from one side of the body to the other along a coronal and transverse plane. The projection is called a right lateral if the central ray enters the body on the left side and passes through to the image receptor positioned on the right side. A left lateral is achieved if the central ray enters the body on the right side and passes through to the image receptor, which will be positioned parallel to the median sagittal plane on the left side of the body. In the case of a limb, the central ray either is incident on the lateral aspect and emerges from the medial aspect (lateromedial), or is incident on the medial aspect and emerges from the lateral aspect of the limb (medio- lateral). Beam angulation Radiographic projections are often modified by directing the central ray at some angle to a transverse plane, i.e. either caudally (angled towards the feet) or cranially/cephalic angulation (angled towards the head). The projection is then described as, for example, a lateral 20- degree caudad or a lateral 15-degree cephalad Oblique The central ray passes through the body along a transverse plane at some angle between the median sagittal and coronal planes. For this projection, the patient is usually positioned with the median sagittal plane at some angle between zero and 90 degrees to the cassette, with the central ray at right-angles to the cassette. If the patient is positioned with the median sagittal plane at right- angles to or parallel to the cassette, then the projection is obtained by directing the central ray at some angle to the median sagittal plane. A. Anterior oblique The central ray enters the posterior aspect, passes along a transverse plane at some angle to the median sagittal plane, and emerges from the anterior aspect. The projection is also described by the side of the torso closest to the cassette. In the diagram below, the left side is closest to the cassette, and therefore the projection is a described as a left anterior oblique. B. Posterior oblique The central ray enters the anterior aspect, passes along a transverse plane at some angle to the median sagittal plane, and emerges from the posterior aspect. Again, the projection is described by the side of the torso closest to the cassette. The diagram below shows a left posterior oblique C. Oblique using beam angulation When the median sagittal plane is at right-angles to the cassette, right and left anterior or posterior oblique projections may be obtained by angling the central ray to the median sagittal plane. (NB: this cannot be done if using a grid, unless the grid lines are parallel to the central ray.) D. Lateral oblique The central ray enters one lateral aspect, passes along a transverse plane at an angle to the coronal plane, and emerges from the opposite lateral aspect. With the coronal plane at right- angles to the cassette, lateral oblique projections can also be obtained by angling the central ray to the coronal plane. (NB: this cannot be done if using a grid, unless the grid lines are parallel to the central ray.) CONCLUSION
The radiographic projections description is by reference to the
following criteria: The position of the patient relative to the cassette. The direction and centring of the X-ray beam: this is given by reference to an imaginary central ray of the X-ray beam. Beam angulation relative to horizontal or vertical Examples THANK YOU
