X-Ray - Positioning Lab Manual - Lab-Radiographic Procedures I | RDT 113, Lab Reports of Health sciences

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X-RAY

POSITIONING LAB MANUAL

FOR RDT 113, 114, 210

Roane State Community College

ORBC

Student Name_________________

Phone _________________________

POSITIONING LAB REQUIREMENTS AND RULES FOR MARKING IR

1. READ lab instructions BEFORE lab demonstration. 2. Refer to attach lab competency objectives for IR sizes & placement. 3. Minimum acceptable lab score is 75. Any student scoring below 75 must repeat the lab exam in presence of two instructors. Failure of the 2nd^ lab results in a D or F in the Procedures course. Students cannot advance to the next semester of the program if they receive less than a C in any RDT course. 4. Failed repeat exams must not exceed 3 failed lab attempts. 5. Place lead markers to correspond to the correct side of the patient! 6. For laterals, mark the side closest to the IR. 7. For obliques, mark according to your clinical protocol; however, R markers must be at patient’s R side and L markers at patient’s L side. 8. For extremities, decubitus projections, mark according to clinical protocol, but lead markers must ALWAYS correspond to correct side of patient. 9. Be certain the lead marker is NOT in the area of interest. If placed incorrectly, ten points are deducted from lab exam grade. 10. Be certain the lead marker is IN the coned field. If it’s not in coned field, the exam is considered NOT MARKED, and ten points are deducted from the lab exam grade. 11. Lab exams are timed. Each student has 20 minutes to complete the exam from start to finish. If not finished in 20 minutes, instructor will stop the exam; unfinished items will be deducted from the lab exam score. 12. Communication skills score includes the following areas: - calling patient by name, checking ID band, asking DOB - introducing yourself and explaining the exam as needed - asking females LMP and pregnancy question IN PRIVATE - instructing patient clearly and concisely during exam - focusing your attention on the patient and the exam - professional manner during the exam - talking only as necessary to complete task and maintain **cooperative patient relationship

13. Patient Care skills** score includes the following areas:
    • clean pillow case
    • clean table
    • patient safety considerations: tube out of way so patient doesn’t bump head; not leaving patient standing while getting the tube ready; locking table so patient cannot accidentally step on release lever when getting patient on and off table; etc.

RDT 113—RADIOGRAPHIC POSITIONING LABS

FALL SEMESTER

Laboratory Competencies

Chest Radiography

Instructor Demonstration: P-A Lateral Wheelchair or Stretcher Chest Chest, Decubitus Obliques (R or L) Portable Chest (using Stretcher as “bed”) AP Axial Lordotic

Student Practice and Test

The student will demonstrate positioning of:

**1. PA Projection – 14x17 LW (or CW)

2. Lateral - 14 x 17 LW
3. AP and Lateral WC or Stretcher Chest – 14x17 CW and 14x17 LW
4. Portable AP Chest (using stretcher as “bed”)**

Note: Use 72” FFD Expose on Full inspiration Use L & R markers Shield gonads

POSITIONING LAB MANUAL

CHAPTER 3—THE CHEST RADIOGRAPH Name IR SID Centering Positioning Instructions PA Chest 14x17 LW or CW depending on patient width

72 inches Perpendicular to T- and MSP (To ascertain location of T7: rule of thumb is 7-8 inches below vertebral prominence. Measure your span from thumb to 5th digit.) Another rule of thumb: IR will be about 1 ½--2 in. above shoulder level

Shield gonads. Marker on R or L side of patient. Rotate shoulders forward and depress downwards. Back of hands on hips. Weight evenly distributed on both feet. Chin raised. Check for thorax rotation. Collimate as needed! Expose on 2nd^ deep inspiration.

Left Lateral Chest

14x17 LW 72 inches Perpendicular to mid-thorax at level of T (3-4 inches below jugular notch) Often need to lower bucky about 1 inch from PA position.

Shield gonads. Use a left marker. Left side of patient against IR in a true lateral position., Center thorax to IR and CR. Coronal plane is perpendicular & sagittal plane parallel to IR. Patient’s arms are raised above head, chin is up. Center patient to IR and to CR. Collimate as needed. Expose on 2nd^ deep inspiration. Wheelchair or Stretcher AP/ Portable AP CXR

PA/Stretcher

14x17 CW 72” if possible

CR angled caudad to be perpendicular to sternum at 3- inches below jugular notch. Same as PA Erect

Shield gonads. Use marker on R or L side. Roll patient’s shoulders forward by rotating arms medially. Chin raised, no rotation, Collimate, expose on deep inspiration. Same as PA Erect. Wheelchair or Stretcher Lat CXR

14x17 LW 72” CR perpendicular to level of T-

Shield gonads. Use left marker. Chin up. Arms up. Remove armrests, if possible, from WC; place support sponges behind patient’s back. Expose on 2nd^ deep inspiration. Lateral Decubitus Chest Xray

14x17 Grid CW to patient

72” CR horizontal to center of IR, 3- inches below level of jugular notch.

place cardiac board or radiolucent pad under patient lying on right or left side. Chin raised, arms raised; patient’s back against IR with locked stretcher; no rotation. Adjust patient and cart so MSP is centered to IR. (top of IR about 1 inch above V. Prominens. RPO/LPO oblique chest

14x17 LW 72 inches Perpendicular to T level.

Shield gonads. Use right marker adjacent to R side. (textbook drawing is wrong!) Pt. rotated 45 degrees, right posterior shoulder against IR. Right arm raised with hand on back of head. Left arm flexed and hand on hip, palm out.. (textbook photo is wrong) Center thorax to CR and IR.

Laboratory Competencies

Abdominal Radiography

Instructor Demonstration A-P (KUB) Upright (to include diaphragm) Left lateral decube Dorsal decube Portable Abdomen (using stretcher as “bed”) Student Practice and Test The student will demonstrate positioning of:

**1. AP – 14 x 17 LW

2. Upright – 14 x 17 LW
3. Lateral decube – 14 x 17 LW to** **patient – CW to bucky
4. Portable Abdomen**

Note: Use 40” FFD Full expiration Grid technique Use L & R markers Shield gonads

POSITIONING LAB MANUAL CHAPTER 4—ABDOMINAL RADIOGRAPHY Name IR SID Centering Positioning Instructions AP (KUB) (^) 14x LW

40” Perpendicular

Collimate to IR size, then side to side if possible.

Patient supine. Central Ray directed to MSP at level of iliac crests. No rotation of pelvis or shoulders. (Check to be sure ASISs are equidistant to table.) Shield gonads of males only. Some patients require 2 projections with IR CW to demonstrate entire abdomen. AP upright (to include diaphragm)

14x LW

40” Perpendicular Collimate as above.

Patient erect. Central Ray is horizontal, directed to MSP—2 inches above level of crests (to include diaphragm). Top of IR at level of axilla usually. No rotation. Shield gonads of males only. Left Lateral Decubitus

14x Grid or Bucky LW to patient

40” Perpendicular to patient.

Collimate on 4 sides if possible.

Patient recumbent on left side. Can be placed on radiolucent pad to center abdomen to the grid or bucky. No rotation. Central Ray is horizontal, directed to MSP 2 inches above level of crests. If patient is not centered to the grid or bucky, be sure the upside of abdomen is included on the film. Shield gonads of males only. Dorsal Decubitus Position, R or L lateral

14x Grid or Bucky , LW to patient

40” Perpendicular to midcoronal plane of patient. Collimate to upper and lower abdomen soft tissue borders.

Patient supine with side of interest closest to grid or bucky. Central Ray is horizontal, directed to midcoronal plane 2 inches above level of crests. Side closest to the film determines which marker is used. Ensure no rotation Shield gonads of males only.

Portable Abdomen

14x grid, LW

40” Perpendicular to MSP at level of Iliac crest for general abdomen study; if exam is for feeding tube placement, center to include diaphragm.

Patient supine on stretcher or in bed. Place film under patient in the bed. Use lead marker on correct side. Ensure no patient rotation; ensure 40 inch SID. Shield gonads of males only. Determine if patient will require one projection LW or 2 projections CW.

POSITIONING LAB MANUAL

CHAPTER 5, PART 1 (Part 2 in Spring Term)

Name IR SID Centering Positioning Instructions Finger— PA

10x12—CW or LW Detail Screen, TT on all positions in this chapter.

40 inches from TT on all positions in this chapter

CR perpendicular to PIP

Shield gonads on all projections in this chapter. Patient is seated at end of table. Rest hand and forearm on table, pronate hand, spread fingers apart. L or R marker. 4-sided collimation on all positions in this chapter. Finger— PA Oblique

Same as above Same as above PIP Same as above, except place hand with fingers extended against 45 degree foam block with thumb side up. Be sure finger is parallel to IR. Finger— Lateral

Same as above Same as above PIP Same as above, except: Hand in lateral position (thumb side up), finger fully extended… lateromedial for 3-5th^ fingers; for 2 nd^ finger mediolateral is best. Remember “anatomic position determines lat vs. medial.

Thumb— AP

Same as above. Same as above. 1 st^ MP Joint Same as above, except: Hand is rotated internally to supinate thumb for AP (posterior surface of thumb is in contact with IR) Hold other fingers back with other hand. Collimate 4-sides to include entire 1 st^ metacarpal. Thumb— Oblique

Same as above Same as above 1 st^ MPJ Same as above except: abduct thumb slightly with palmar surface of hand against cassette. Thumb will be in 45 degree position. Thumb— Lateral

Same as above Same as above 1 st^ MPJ Same as above, except: fingers and hand slightly arched, rotate hand medially until thumb in true lateral. Hand— PA

10x12 CW or LW depending on size of hand.

Same as above Perpendicular to 3 rd^ MPJ

Rest hand and forearm on table. Hand is pronated with palmar surface on IR. Collimate 4 sides to outer margins of hand and wrist. Hand— Oblique

Same as above Same as above 3 rd^ MPJ Rest hand and forearm on table, elbow flexed about 90 degrees. Rotate entire hand and wrist laterally so digits are separated and parallel to IR; support with 45 degree foam block; collimate 4-sides. Alternate method: when metacarpals are area of interest, thumb and fingertips touch IR.

Hand— Lateral

Same as above. Same as above 2 nd^ MPJ “Fan” lateral: hand and wrist in lateral position, each digit supported on foam step block. All digits separated and parallel to IR, metacarpals in true lateral.

Lateral in extension or flexion: Extend fingers and thumb, superimposed, and support them against foam block.

Lateral in flexion: flex fingers in natural flexed position, thumb lightly touching first finger. Wrist— PA

10x12 CW or LW Detail Screen, TT

Same as above Perpendicular to midcarpal area.

Patient seated, forearm on table, elbow flexed 90 degrees. Hand is pronated and slightly arched to place carpals in contact with IR. Collimate 4 sides to include mid metacarpals and distal radius and ulna.. Wrist— Obli

Same as above Same as above Perpendicular to midcarpals

Same as above except: From pronated position, rotate hand and wrist laterally 45 degrees. Rest against 45 degree foam block.

Wrist— Lateral

Same as above. Same as above Perpendicular to midcarpal area.

Same as above except: wrist and hand in true lateral position, thumb up, fingers flexed or extended. If extended, use support to stabilize. Wrist, elbow and shoulder on same plane! Wrist— Scaphoid with CR angle and Ulnar Deviation

Same as above. Same as above Angle CR 10- degrees toward elbow, center to scaphoid (3/4 “ distal and medial to radial styloid process.)

Position as for PA wrist except, without moving forearm, evert hand (move toward ulnar side) as much as patient can tolerate without lifting or obliquing distal forearm.

POSITIONING LAB MANUAL CHAPTER 14—THE UPPER GI SYSTEM

Name IR SID Centering Positioning Instructions

PA (^) 10x12 or 14x LW

inches

Perpendicular to IR @ level of L (1-2 inches above lower lateral rib margin LLRM) and 1 inch left of MSP Center 2 inches higher- hypersthenics and 2” lower for asthenics.

Shield gonads on ALL. Left marker on left side. Ensure patient is not rotated. Make sure CR is lined up with Bucky on all five positions. If using 14x17 LW, collimate to ~12x14 LW

RAO 40- degrees : more for hyperstheni c and less for asthenic types

10x or 14x17 LW

inches

Perpendicular to IR @ level of L1 (sthenic types) (1-2” above LLRM) and midway between MSP and upside lateral border of abdomen: Adjust side to side centering to correct for body types (if collimation is too far to the left of the patient. Also as for PA: Adjust CR for body types as needed.

Instruct patient to RAO position: R. arm down, L arm up, L knee flexed.

R marker on patient’s right side is best.

RAO 35-

degrees for esophagram (barium swallow)

14x17 LW 40- inches

Perpendicular to IR. After placing patient in RAO position, place IR about 2 inches above shoulder level, center tube to bucky and center @ about 1 inch from MSP on upside.

Instruct patient to RAO position as above.

Right marker on patient’s right side is best.

Collimate to ~ 6-7” wide; be sure marker is in coned field.

Right Lat 10x or 14x LW

inches

Perpendicular to IR @ (at level of LLRM) and 1-1 and ½ inches anterior to MCP. (MCP is about half-way between vertebrae and anterior abdomen)

Adjust centering: higher or lower for body types.

Ensure patient is lying in true lateral position, check shoulders and hips; arms up and together.

Cone 14x17 to ~12x14.

LPO

degrees : more for hypersth and less for asthenic types

10x12 or 14x17 LW

inches

Perpendicular to IR (about ½ way between xiphoid tip and LLRM and ~ ½ way between MSP and left lateral margin of abdomen. Adjust for body type: if there is too much collimation on left side of patient, move patient so that centering is more on the right side. Also, adjust centering for hypersthenic and asthenic patients: 2 inches higher or lower.

Instruct patient to LPO position: both arms up, flex right knee, roll up some on L side. Use sponge if desired.

Left marker on L. side of patient. Right arm across chest

POSITIONING LAB MANUAL

CHAPTER FIFTEEN—LOWER GI SYSTEM Name IR SID Central Ray Positioning

PA

14x LW or 2 14x17s CW

40- inches

Perpendicular to MSP and Iliac Crest (for SBS 1 st^ image: 2 inches above crest to include stomach)

Shield males only. Check for rotation: ASIS distance to tabletop equal? Arms at sides or up on pillow. Lead marker correctly placed. Collimate side to side if asthenic body type. LPO or RPO— degrees

14x LW

40- inches

Perpendicular to level of iliac crest and 1 inch lateral to MSP on upside: adjust for asthenic and hypersthenic body types!! you don’t want inches of light on the table only.

Shield males only. Make sure patient is straight on the table, in LPO or RPO position. Make sure tube and bucky are lined up. L or R marker on appropriate L or R side. Collimate for asthenic body types as needed side to side.

AP Axial (aka “butterfly” position)

14x LW

40- inches adjusted for CR angle

30 degrees cephalad to MSP and 2 inches inferior to level of ASISs

No shielding possible usually. Check for rotation. Arms at sides or high on chest. 4-sided collimation to at least 10x14. Markers correctly placed! Textbook is wrong! PA Axial (aka “butterfly”)

14x LW

40- inches adjusted for CR angle

30 degrees caudad to MSP and to exit at level of ASISs

No shielding possible. Check for rotation Arms at sides or on pillow. Markers correctly placed. 4-sided collimation to at least 10x14. Lateral Rectum (usually left)

10x LW

or 14x coned to 10x

40- inches

Perpendicular to level of ASISs and midcoronal plane (MCP is ½ way between ASIS and posterior sacrum)

No shielding possible. Make certain patient is in true lateral position. Superimpose knees, arms up in front of head.

R and L Lat Decubitus

14x grid LW to the patient

40- inches

Perpendicular to MSP @ level of iliac crests.

Patient on R or L Side with grid positioned in grid holder behind patient. Ensure grid is perpendicular to table & CR centered to grid; patient not rotated. Markers placed correctly Males shielded.

Laboratory Competencies

Urinary System

Instructor Demonstration IVP - Nephrogram Posterior obl Cystogram AP (10-15 ° caudad tube angle) 45-60 ° AP Obl Cystourethrogram male – 30 ° AP obl female – AP (no angle)

Student Practice and Test The student will demonstrate positioning of:

**1. IVP - Nephrogram 10x12 CW or 14x17 CW

2. Post obl – 14 x 17 LW
3. AP cystogram – 10 x 12 CW or 14x17 CW
4. Obl cystogram 10 x 12 CW or14x17 CW
5. Male cystourethrogram –** **10 x 12 CW
6. Female cystourethrogram –** 10 x 12 CW Note: Use 40-42 inches SID Use markers adjacent to correct side of patient Suspend respiration on exhalation Shield gonads if possible

SPRING SEMESTER LABORATORY COMPS

• Review rules for marking radiographs from Fall Semester.
• Review all lab rules from Fall Semester.
• Hips and Pelvis, Ribs and Sternum combined in one lab.
• C-Spine and T-Spine combined in one lab.
• L-Spine and Sacrum/Coccyx combined in one lab.

Laboratory Competencies Forearm, Elbow and Humerus Chapter 5, part two

Instructor’s Demonstration Forearm AP lateral Elbow AP lateral internal oblique (medial oblique) and external oblique (lateral oblique) Two AP projections when elbow cannot be extended

Humerus AP Rotational lateral

Student Practice and Test: Forearm AP and lateral—14 x 17 LW Elbow AP and lateral—10 x 12 LW or CW internal or external oblique on 10 x 12 LW or CW

Humerus AP and lateral--14 x 17 LW

Note 40” SID Detail screen for parts 10 cm or less (most forearms and elbows) Grid technique for parts greater than 10 cm Immobilize part as necessary Shield gonads

POSITIONING LAB MANUAL CHAPTER 5, PART 2—FOREARM, ELBOW AND HUMERUS

Shield gonads on all projections! Closely collimate all projections!!

NAME IR SID CENTERING POSITIONING

Forearm—AP 14x17 LW Child: 10x12 LW Detail (extremity) Cassette)

40 inches to IR

Perpendicular to mid- forearm

Entire limb on same horizontal plane. Hand and arm fully extended, hand supinated. Instruct patient to lean laterally to place entire wrist, forearm and elbow in true AP position. Both wrist and elbow joints included! Forearm—Lat Same as above Same Same as above Limb on same plane. Seat patient at table so elbow can be flexed 90 degrees. Hand and wrist in true lateral position. Both wrist and elbow joints included! Elbow—AP 10x12 LW or CW Detail cassette

Same Perpendicular to mid-elbow joint.

Positioning same as for AP forearm. Elbow—Lateral 10x12 LW or CW Detail cassette

Same Same as above Positioning same as for Lateral forearm. Elbow—medial (internal) obli 45 degrees

10x12 LW or CW Detail cassette

Same Same as above Entire limb on same plane, hand and arm fully extended, hand pronated. Palpate epicondyles to ensure 45 degree rotation. Elbow—lateral (external) obli 45 degrees

10x12 LW or CW Detail cassette

Same Same as above Same as above, except: hand is supinated and entire arm rotated laterally 45 degrees. Patient must lean laterally. Palpate epicondyles. Elbow—special projections if patient unable to extend arm: AP with forearm parallel Demo Only

10x12 LW or CW Detail cassette.

Same Perpendicular to mid-elbow joint. (If elbow is flexed near 90 degrees, it may be necessary to angle CR 10- 15 degrees into the elbow joint)

Place forearm on IR with elbow region in center of it..

AP with humerus parallel Demo Only

Same as above Same Same as above. Place humerus on IR with elbow region in center of it. Humerus—AP Erect or supine.

14x17 LW or 10x12 LW for child. Detail cassette or grid for patient with humerus more than 10 cm

Sane Perpendicular to midpoint of humerus.

Extend limb. Abduct slightly and supinate hand so epicondyles are equidistant from IR. Patient may need to rotate body toward IR to place humerus in direct contact with it. Both shoulder and elbow joints must be included. Humerus— Lateral Erect or supine.

Same as above Same Same as above Extend limb; internally rotate limb to place epicondyles perpendicular to IR.