RAD208L Final Practical
hand on its side, fan fingers to separate them, center perpendicular to second mcp
Fan Lateral Hand position
equal concavity of phalangeal shafts
How do we know a PA finger/ AP thumb does not need a repeat?
equal concavity of phalangeal and metacarpal shafts
How do we know a PA hand does not need a repeat?
slight overlap of 3rd, 4th, and 5th metacarpal heads and bases, slight curve on anterior side of digits and metacarpals
How do we know a PA oblique hand does not need a repeat?
shaft of humerus superimposed over body of scapula, acromion projected laterally
How do we know a PA oblique scapular Y view does not need a repeat?
phalanges and soft tissues appear rotated as demonstrated by unequal concavity
How do we know a PA oblique thumb/finger does not need a repeat?
3rd, 4th, 5th metacarpal heads and bases superimposed, unequal concavity of metacarpal shafts, distal radius and ulna slightly superimposed
How do we know a PA oblique wrist does not need a repeat?
equal concavity of metacarpal shafts, radius and ulna touching slightly at distal ends
How do we know a PA wrist does not need a repeat?
pisiform and triquetrum are well visualized
How do we know a PA wrist with radial deviation does not need a repeat?
scaphoid is well visualized
How do we know a PA wrist with ulnar deviation does not need a repeat?
metacarpals superimposed, fingers separated, distal radius and ulna are superimposed
How do we know a fan lateral does not need a repeat?
superimposition of greater trochanter on femoral neck, lesser trochanter in profile
How do we know a frog lateral hip does not need a repeat?
humeral condyles superimposed with trochlear notch of ulna, radial tuberosity projecting anteriorly
How do we know a lateral elbow does not need a repeat?
thumbnail in profile, anterior surface of phalanges appear concave
How do we know a lateral finger/thumb does not need a repeat?
radius and ulna superimposed distally, radial head superimposed partially on coronoid process of ulna, 3 concentric circles
How do we know a lateral forearm does not need a repeat?
lesser tubercle in profile against glenoid cavity, greater tubercle superimposed over proximal humerus, condyles superimposed in trochlear notch of ulna
How do we know a lateral humerus does not need a repeat?
vertebral bodies are boxlike, pedicles are superimposed, intervertebral foramina are superimposed, iliac crests are nearly superimposed
How do we know a lateral lumbar spine does not need a repeat?
proximal radius projected free from ulna, olecranon process of ulna in olecranon fossa of humerus
How do we know a lateral oblique elbow does not need a repeat?
greater sciatic notches and femoral heads are superimposed
How do we know a lateral sacrum and coccyx do not need a repeat?
lateral and medial borders superimposed, scapular body is not superimposed on ribcage
How do we know a lateral scapula does not need a repeat?
distal radius and ulna superimposed, metacarpals 2-5 superimposed
How do we know a lateral wrist does not need a repeat?
coronoid process projected free of radial head, radial head superimposed over ulna, radius and ulna crossed
How do we know a medial oblique elbow does not need a repeat?
greater and lesser tubercle both superimposed over proximal humerus
How do we know a neutral AP humerus does not need a repeat?
SI joint open with minimal overlap of sacrum and ilium
How do we know a posterior oblique SI joints does not need a repeat?
A-C joint superimposed by humeral head, coracoid process demonstrated anteriorly
How do we know a superoinferior axial shoulder does not need a repeat?
femoral head and acetabulum penetrated, femoral neck seen without elongation or foreshortening, trochanters partially superimpose femoral neck
How do we know a surgical lateral hip does not need a repeat?
pisiform and hamate are not superimposed, carpals seen in arch arrangement
How do we know a tangential carpal canal does not need a repeat?
humerus centered between spine and sternum, unaffected humerus and shoulder should not overlap area of interest, humerus parallel to long axis of IR
How do we know a transthoracic lateral humerus does not need a repeat?
greater tubercle of humerus in profile, lesser tubercle superimposed over proximal humerus
How do we know an AP shoulder external rotation does not need a repeat?
S-C joint not rotated, sternal end between 1st and 2nd rib
How do we know an AP Axial Clavicle?
S-I joints symmetrical and equidistant from spine, spinous process of L5 and median sacral crest aligned vertically
How do we know an AP Axial L5-S1 does not need a repeat?
symmetry of obturator foramina, alignment of coccyx with symphysis pubis, obturator foramina stretched out
How do we know an AP Axial Outlet does not need a repeat?
symmetry of SI joints, coccyx/sacrum are aligned to symphysis pubis, alignment of spinous process of L-5 and median sacral crest
How do we know an AP Axial S-I joints does not need a repeat?
coccyx aligned vertically with symphysis pubis, obturator foramina symmetrical
How do we know an AP Axial coccyx does not need a repeat?
obturator foramina look squeezed, rami are superimposed, and symmetry of pubic and ischial rami bilaterally
How do we know an AP axial inlet does not need a repeat?
S-I joints symmetrical, sacrum aligned vertically with symphysis pubis and spinous processes
How do we know an AP axial sacrum does not need a repeat?
S-C joint is slightly open and not rotated, sternal end between 3rd and 4th rib
How do we know an AP clavicle does not need a repeat?
radial head, neck, and tuberosity slightly superimposed, elbow joint open, humeral epicondyles not rotated
How do we know an AP elbow does not need a repeat?
radius and ulna are parallel, radial, head, neck, and tuberosity are slightly superimposed, no distortion of carpals
How do we know an AP forearm does not need a repeat?
lesser trochanter equal with medial margin of femur, obturator foramen not distorted
How do we know an AP hip does not need a repeat?
greater tubercle is in profile, lesser tubercle superimposed over proximal humerus, elbow appears AP
How do we know an AP humerus does not need a repeat?
T11-sacrum are visible, S-I joints are visible, vertebral bodies aligned vertically, spinous processes in midline of bodies, transverse processes equal in length on both sides
How do we know an AP lumbar spine does not need a repeat?
humeral head articulates with glenoid cavity, glenoid cavity in profile
How do we know an AP oblique shoulder does not need a repeat?
femoral condyles superimposed, knee joint open, femoropatellar joint open
how do we know a lateral knee does not need a repeat?
femoral condyles are superimposed, distal and proximal superimposition of tibia and fibula, no superimposition of shafts
how do we know a lateral lower leg does not need a repeat?
proximal fibula completely superimposed under tibia, half-1/3 of patella projected lateral over distal femur
how do we know a lateral oblique knee does not need a repeat?
patella in profile, patellofemoral joint open
how do we know a lateral patella does not need a repeat?
toe of interest in profile, true lateral of phalange, increased concavity of anterior metatarsal
how do we know a lateral toe does not need a repeat?
distal tibiotalar joint well visualized
how do we know a medial oblique 45 degree ankle does not need a repeat?
bases of 1st and 2nd metatarsals are superimposed, bases of 3rd-5th metatarsals free from superimposition, unequal concavity of metatarsal shafts
how do we know a medial oblique foot does not need a repeat?
proximal tib fib joint open, half-1/3 of patella projected medial over distal femur
how do we know a medial oblique knee does not need a repeat?
visualization of mortise joint, slight superimposition of distal tibia and fibula
how do we know a mortise does not need a repeat?
patella centered over distal femur, between condyles and epicondyles, tibial spines centered under intercondylar fossa
how do we know a pa patella does not need a repeat?
greater trochanter superimposed over proximal femur, lesser trochanter not superimposed
how do we know a proximal lateral femur does not need a repeat?
joint spaces between sesamoids and distal metatarsals open and clearly demonstrated
how do we know a tangential sesamoids does not need a repeat?
palm pronated on IR, fingers slightly separated, center perpendicular to third mcp
PA Hand Position
affected shoulder against bucky, rotate patient 45-60 degrees, center at midvertebral border
PA Oblique Shoulder Y view position
hand rotated 45 degrees from prone towards lateral, center perpendicular to third mcp
PA Oblique hand position
finger flat against IR, center perpendicular to PIP
PA finger position
angle 15-30 degrees cephalic, steeper angle for thinner patients, center at midclavicle
AP Axial Clavicle position
legs extended, angle 40 degrees caudal, center at ASIS and midsagittal plane
AP Axial Inlet Position
supine, legs extended, angle 30 degrees cephalic for males, 35 for females, center 2 inches below ASIS and midsagittal plane
AP Axial L5-S1 position
legs extended, angle 20-35 degrees cephalic for male, angle 30-45 degrees for female, center at midsagittal plane and 1-2 inches below symphysis pubis
AP Axial Outlet position
supine, legs extended, angle 15 degrees cephalic and center 2 inches between ASIS and symphysis pubis
AP Axial Sacrum position
supine, legs extended, angle 10 degrees caudal between ASIS and symphysis pubis
AP Axial coccyx position
arms in neutral position, center perpendicular to midpoint of clavicle
AP Clavicle position
arm abducted 90 degrees, use quiet breathing technique, center perpendicular to 2 inches below coracoid process and 2 inches medial of lateral border
AP Scapula Position
legs extended, 30 degree cephalic angle for males, 35 for females, center midline 2 inches below ASIS
AP axial S-I joints position
arm extended, hand supinated, humerus on same plane as elbow, center perpendicular to midelbow joint
AP elbow position
foot flat on IR, angle 10 degrees cephalic and center at base of 3rd metatarsal
AP foot position
elbow extended, hand supinated, forearm on same plane as humerus, center perpendicular to mid forearm
AP forearm position
arm extended and slightly abducted, hand supinated, center perpendicular to midshaft of humerus
AP humerus position
arm extended in supinated position, hand and wrist rotated 45 degrees medially
AP oblique wrist position
legs extended, feet inverted 15-20 degrees, center perpendicular between ASIS and symphysis pubis
AP pelvis position
arm extended, palm supinated, center perpendicular to 1 inch inferior coracoid process
AP shoulder external rotation position
arm extended, palm pronated with thumb facing wall bucky, center perpendicular to 1 inch inferior to coracoid process
AP shoulder internal rotation position
hand and thumb in internal rotation with thumbnail against IR, center perpendicular to 1st MCP
AP thumb position
plantar surface flat on IR, CR angled 10-15 degrees toward calcaneus, centered at MTP of interest
AP toe position
finger rotated 45 degrees towards lateral, center perpendicular to PIP
PA oblique finger position
hand and wrist rotated 45 degrees laterally, center perpendicular to midcarpal region
PA oblique wrist position
hand pronated, fingers cupped, center perpendicular to midcarpal region
PA wrist position
start with hand and wrist in PA position, flex hand towards thumb side, center perpendicular to midcarpal region
PA wrist with radial deviation position
start with hand and wrist in PA position, flex hand towards pinky side, center perpendicular to midcarpal region
PA wrist with ulnar deviation position
72 inch SID, arms in neutral position, apply 8-10 pound weights for weight bearing, center perpendicular to midsagittal plane at level of A-C joints
A-C joints position
legs extended, feet inverted 15-20 degrees, center perpendicular to femoral neck
AP Hip
supine, standing if ordered, flex knees/hips, center perpendicular to iliac crests and midsagittal plane
AP Lumbar Spine position
patient rotated 35-45 degrees towards affected side, center perpendicular to shoulder joint
AP Oblique Shoulder Grashey position
pisiform in profile, bases of 1st, 2nd, and 3rd metacarpals superimposed, space between 4th and 5th metacarpals, slight superimposition of distal radius and ulna
How do we know an AP oblique wrist does not need a repeat?
ala, obturator foramina, and S-I joints are symmetrical, spinous processes, sacrum, and coccyx are aligned, lesser trochanters equal with medial margin of femurs
How do we know an AP pelvis does not need a repeat?
lesser tubercle of humerus in profile against glenoid cavity, greater tubercle superimposed over proximal humerus
How do we know an AP shoulder internal rotation does not need a repeat?
equal concavity on shafts of phalanges and metatarsals, digits not superimposed
How do we know an AP toe does not need a repeat?
radial head projected almost free from ulna, lateral condyle seen above medial condyle, radial head and capitulum elongated
How do we know an axial lateral elbow does not need a repeat?
z joints are open and aligned vertically, pedicle is in middle of body
How do we know an oblique L spine does not need a repeat?
unequal concavity of phalangeal and metatarsal shafts
How do we know an oblique toe does not need a repeat?
intervertebral joint space L5-S1 open, vertebral body L5 is boxlike
How do we know the L5-S1 spot does not need a repeat?
finger on side, fully extended, flex rest of fingers, center perpendicular to PIP
Lateral finger position
hand in lateral position, elbow flexed 90 degrees, center perpendicular to midcarpal region
Lateral wrist position
position LPO to look at right SI joints, RPO to look at left, rotate patient 25-30 degrees, center perpendicular to 1 inch medial to independent ASIS
Posterior oblique S-I joints
leg extended, foot dorsiflexed, center perpendicular to ankle joint midmalleoli
ap ankle position
rotate entire leg 5 degrees internally, center perpendicular with 2 inches of light beyond knee joint
ap distal femur position
rotate foot and leg inward 5 degrees, center half inch distal to apex of patella on fat pad, angle cr 5 degrees caudal for thin, perpendicular for average, 5 degrees cephalic for thick
ap knee position
leg extended, dorsiflex the foot, center perpendicular to midshaft of tibia
ap lower leg position
internally rotate entire leg 15-20 degrees, center perpendicular to 6 inches inferior to ASIS
ap proximal femur position
elbow flexed 90 degrees on same plane as humerus, hand and wrist pronated, angle 45 degrees downwards towards shoulder, center at bump on elbow
axial lateral elbow position
leg extended, foot dorsiflexed, plantar surface perpendicular to IR, center 40 degrees cephalic at base of 3rd metatarsal
axial plantodorsal calcaneus position
center perpendicular so there is 3 inches of light below medial epicondyle of femur
distal lateral femur position
shove imaging receptor between arm and patient's body if they are recumbent, take image cross table
distal lateral humerus position
knee flexed, foot at level of opposite knee, leg abducted 45 degrees, center perpendicular to femoral neck and align collimator to leg
frog lateral hip position
femoral condyles nearly superimposed, patella in profile
how do we know a distal lateral femur does not need a repeat?
distal fibula superimposed over posterior half of tibia, ankle joint open
how do we know a lateral ankle does not need a repeat?
calcaneus is in profile
how do we know a lateral calcaneus does not need a repeat?
superimposition of distal fibula on posterior half of tibia, metatarsals nearly superimposed
how do we know a lateral foot does not need a repeat?
bases of 1st and 2nd metatarsals separated, bases between 2nd and 5th metatarsals superimposed, equal concavity of metatarsals, equal distance between shafts of 2nd-5th metatarsals
how do we know an AP foot does not need a repeat?
femoral condyles are symmetrical, partial superimposition of proximal tibia and fibula, tibial spines centered under intercondylar fossa, patella superimposed over distal femur, knee joint space open
how do we know an AP knee does not need a repeat?
slight superimposition of distal tibia and fibula, open tibiotalar joint
how do we know an ap ankle does not need a repeat?
femoral condyles symmetrical, patella centered between femoral condyles
how do we know an ap distal femur does not need a repeat?
knee and ankle joint open, condyles symmetrical, shafts of tibia and fibula are parallel and slight overlap at proximal and distal tib fib joints
how do we know an ap lower leg does not need a repeat?
greater trochanter in profile, lesser trochanter along medial margin of shaft
how do we know an ap proximal femur does not need a repeat?
visualization of subtalar joint, metatarsals not demonstrated laterally to heel
how do we know an axial plantodorsal calcaneus does not need a repeat?
apex of patella not superimposed over fossa, femoral condyles appear symmetrical
how do we know an intercondylar fossa does not need a repeat?
patient prone, flex knee 40-50 degrees, center perpendicular to lower leg, angle CR to max flexion of knee
intercondylar fossa position
same as lateral, use c technique to find centering point, 1.5 inches below iliac crest and 2 inches posterior to ASIS, perpendicular if there is no sag in waist, 5-8 degrees caudal for large sag in waist, 5-8 cephalic for bulge in waist
lateral L5-S1 spot position
foot on lateral side, knee flexed, foot dorsiflexed, center perpendicular to medial malleolus
lateral ankle position
lateral surface of foot on IR, dorsiflex foot, center perpendicular to 1 inch inferior to medial malleolus
lateral calcaneus position
elbow flexed 90 degrees, hand and wrist in true lateral, elbow on same plane as humerus, center perpendicular to bump on elbow
lateral elbow position
foot on lateral side, dorsiflexed, center perpendicular to base of 3rd metatarsal
lateral foot position
elbow flexed 90 degrees, wrist and hand in lateral position, forearm on same horizontal plane as humerus
lateral forearm position
rotate thumb internally to place dorsal surface of hand on hip, point thumb towards wall behind patient, arm flexed at elbow, center perpendicular to midshaft
lateral humerus position
patient laying on affected side, flex knee 20-30 degrees, 5 degree cephalic angle, center 1 inch distal to medial epicondyle bump
lateral knee position
lay on affected side, knee slightly flexed, foot dorsiflexed, center perpendicular to midshaft of tibia
lateral lower leg position
recumbent on left side, standing if ordered, place lower body towards cathode, center perpendicular to iliac crest and midaxillary plane
lateral lumbar spine position
elbow extended and on same plane as humerus, entire arm rotated 45 degrees externally, center perpendicular to midelbow joint
lateral oblique elbow position
rotate lower leg laterally 45 degrees, use same angle as AP knee, center 1/2 distal to apex of patella
lateral oblique knee position
laying on affected side, flex knee 5-10 degrees, center perpendicular to patellofemoral joint
lateral patella position
recumbent in true lateral, center perpendicularly horizontally to level of ASIS, vertically 3-4 inches posterior to upside ASIS
lateral sacrum and coccyx position
rotate patient 45-60 degrees from PA, have affected arm grab other shoulder to free scapula from superimposition, center perpendicular to midvertebral border
lateral scapula position
abduct thumb, place on its side on IR, center perpendicular to 1st MCP
lateral thumb position
1st-3rd digit have medial side of foot against IR, 4th-5th have lateral side of foot against IR, center perpendicular to IP for 1st digit, PIP for rest
lateral toe position
leg extended, foot dorsiflexed, rotate foot and leg 45 degrees medially, center perpendicular to midmalleoli
medial oblique ankle 45 degree position
elbow extended, entire arm rotated 45 degrees internally, hand pronated flat on IR, elbow on same plane as humerus, center perpendicular to midelbow joint
medial oblique elbow position
foot and leg rotated 30-40 degrees internally, center perpendicular to base of 3rd metatarsal
medial oblique foot position
rotate lower leg medially 45 degrees, use same angle as AP knee, center 1/2 inch distal to apex of patella
medial oblique knee position
leg extended, foot dorsiflexed, rotate foot and leg 15-20 degrees medially, center perpendicular to midmalleoli
medial oblique mortise joint position
leave humerus where it is, center perpendicular to midshaft
neutral humerus AP position
recumbent unless ordered standing, rotate patient 45 degrees into RPO and LPO, center perpendicular to L3, 1-2 inches above iliac crest and 2 inches medial to independent ASIS
oblique l spine position
rotate foot to form 30-45 degree angle to IR, rotate internally for 1st-3rd digits, externally for 4th-5th digits, center perpendicular to MTP of interest
oblique toe position
hand in prone position, thumb aligned straight on IR, center perpendicular to 1st MCP
pa oblique thumb position
patient prone, rotate leg 5 degrees internally, no angle on tube, center perpendicular to patella (popliteal line)
pa patella position
patient lies on affected side, center perpendicular to 6 inches inferior to ASIS
proximal lateral femur position
sitting adjacent to table, lean and abduct shoulder across IR, angle 5-15 degrees away from axilla
superoinferior axial shoulder position
affected leg extended, opposite leg raised up, IR is parallel to femoral neck, CR is perpendicular to femoral neck
surgical lateral hip position
arm extended, hand pronated, hyperextend wrist as much as possible, fingers pulled back, 25-30 degree angle downwards center 1 inch distal to base of 3rd metacarpal
tangential carpal canal position
patient seated in chair or side of table, affected knee flexed, IR is on a stool under knees, center perpendicular to IR, parallel to patellofemoral joint
tangential patella (sunrise) chair position
patient seated or laying down affected knee flexed, they hold the IR, use cephalad angle to be parallel to patellofemoral joint
tangential patella (sunrise) recumbent position
dorsiflex foot, heel against IR toes pointed to the ceiling, center perpendicular to 1st MTP joint
tangential sesamoids position
lateral position with affected side adjacent to IR, affected arm in neutral position, opposite arm overhead, center perpendicular to midshaft, use breathing technique
transthoracic lateral humerus position
