Radiography Technique

1. Radiographic Technique 1
September, 2011
Prepared by:
Behzad Ommani
Bachelor of Radiology
Master of Medical Engineering

2. Radiography
Pelvis

3. Pelvis
AP PROJECTION
Image receptor : 35 x 43 cm crosswIse
Position of patient : Place the patient on the table In the
supine position.
Position of part :
• Center the midsagittal plane of the body to the midline
of the grid, and adjust it in a true supine position.
• Unless contraindicated because of trauma or pathologic
factors, medially rotate the feet and lower limbs about
15 to 20 degrees to place the femoral necks parallel with
the plane of the image receptor (IR). Medial rotation is
easier for the patient to maintain if the knees are
supported.

4. The heels should be placed about 8 to 10 inches (20 to 24
cm) apart.
• Immobilize the legs with a sandbag across the ankles, if
needed.
• Check the distance from the ASIS to the tabletop on each
side to be sure that the pelvis is not rotated.
• Center the IR midway between the ASIS and the pubic
symphysis. The center of the IR will be about 2 inches (5
cm) inferior to the ASIS and 2 inches (5 cm) superior to
the pubic symphysis in average-sized patients.
Pelvis

5. • If the pelvis is deep, palpate for the iliac crest and adjust
the position of the IR so that its upper border will
project 1 to 1/2 inches (2.5 to 3.8 cm) above the Crest.
Respiration: Suspend.
Central ray : Perpendicular to the midpoint of the IR
Pelvis

6. Pelvis

7. Congenital dislocation of the hip
Martz and Taylor' recommended two AP projections of the
pelvis for demonstration of the relationship of the
femoral head to the acetabulum in patients with
congenital dislocation of the hip.
• The first projection is obtained with the central ray
directed perpendicular to the pubic symphysis to detect
any lateral or superior displacement of the femoral
head.
• The second projection is obtained with the central ray
directed to the pubic symphysis at a cephalic angulation
of 45 degrees.
Pelvis

8. This angulation casts the shadow of an anteriorly displaced
femoral head above that of the acetabulum and the
shadow of a posteriorly displaced head below that of the
acetabulum.
Pelvis

9. Pelvis
LATERAL PROJECTION
Right or left position
Image receptor : 35 x 43 cm crosswise
Position of patient : Place the patient in the lateral
recumbent, dorsal decubitus, or upright position.
Position of part :
• When the patient can be placed in the lateral position,
center the midcoronal plane of the body to the midline of
the grid.
• Extend the thighs enough to prevent the femora from
obscuring the pubic arch.

10. • Place a support under the lumbar spine, and adjust it to
place the vertebral column parallel with the tabletop.
• If the vertebral column is allowed to sag, it will tilt the
pelvis in the longitudinal plane.
• Adjust the pelvis in a true lateral position, with the ASIS
lying in the same vertical plane.
• Place one knee directly over the other knee. A pillow or
other support between the knees promotes stabilization
and patient comfort.
Pelvis

11. • Berkebile, Fischer, and Albrecht' recommended a dorsal
decubitus lateral projection of the pelvis for
demonstration of the "gull-wing sign" in cases of
fracture dislocation of the acetabular rim and posterior
dislocation of the femoral head.
Central ray: Perpendicular to a point centered at the level
of the soft tissue depression just above the greater
trochanter (approximately 2 inches (5 cm)) and to the
mid.
• point of the image receptor Center the lR to the central
ray
Pelvis

12. Pelvis

13. AP OBLIQUE PROJECTION
MODIFIED CLEAVES METHOD
This projection is often called the bilateral "frog leg" position.
Image receptor : 35 x 43 cm crosswise
Position of patient : Place the patient in the supine
position.
Position of part :
• Center the mid sagittal plane of the body to the midline
of the grid.
• Flex the patient's elbows, and rest the hands on the
upper chest.
• Adjust the patient so that the pelvis is not rotated. This
can be achieved by placing the two ASISs equidistant
from the radiographic table.
Femoral Necks

14. • Place a compression band across the patient well above
the hip joints for stability, if needed.
Bilateral projection
Step 1
• Have the patient flex the hips and knees and draw the
feet up as much as possible.
Step 2
• Center the IR I inch (2.5 cm) superior to the pubic
symphysis
Step 3
• Abduct the thighs as much as possible, and have the
patient turn the feet inward to brace the soles against
each other for support.
Femoral Necks

15.  According to Cleaves. the angle may vary between 25
and 45 degrees, depending on how vertical the femora
can be placed.
Unilateral projection
• Adjust the body position to center the ASIS of the
affected side to the midline of the grid.
• Have the patient flex the hip and knee of the affected
side and draw the foot up to the opposite knee as much
as possible.
• After adjusting the perpendicular central ray and
positioning the IR tray, have the patient brace the sole of
the foot against the opposite knee and abduct the thigh
laterally approximately 45 degrees.
Femoral Necks

16. Femoral Necks

17. • The pelvis may rotate slightly.
Respiration : Suspend.
Central ray :
• Perpendicular to enter the patient's mid sagittal plane at
the level 1 inch (2.5 cm) superior to the pubic symphysis.
• For the unilateral position, direct the central ray to the
femoral neck.
Femoral Necks

18. AXIOLATERAL PROJECTION
ORIGINAL CLEAVES METHOD
NOTE: This examination is contraindicated for patients with
suspected fracture or pathologic.
Image receptor : 35 x 43 cm crosswise
Position of patient : Place the patient in the supine
position.
Position of part :
NOTE: This is the same part position as the modified
Cleaves method previously described. The projection
can be performed unilaterally or bilaterally.
Femoral Necks

19. Central ray : Parallel with the femoral shafts. According to
Cleaves, the angle may vary between 25 and 45 degrees,
depending on how vertical the femora can be placed.
Femoral Necks

20. Femoral Necks
• Congenital dislocation of the hip

21. Radiography
Hip

22. AP PROJECTION
ORIGINAL CLEAVES METHOD
NOTE: This examination is contraindicated for patients with
suspected fracture or pathologic.
Image receptor : 24 x 30 cm lengthwise
Position of patient : Place the patient in the supine
position.
Position of part :
• Adjust the patient's pelvis so it is not rotated. This is
accomplished by placing the ASISs equidistant from the
table.
Hip

23. • Medially rotate the lower limb and foot approximately
15 to 20 degrees to place the femoral neck parallel with
the plane of the IR, unless this maneuver is
contraindicated or other instructions are given.
Respiration: Suspend.
Central ray :
Perpendicular to the femoral neck.
• Place the central ray approximately 2 ½ inches (6.4 cm)
distal on a line drawn perpendicular to the midpoint of a
line between the ASIS an the pubic symphysis.
Hip

24. Hip

25. LATERAL PROJECTION
Mediolateral
LAUENSTEIN AND HICKEY METHODS
NOTE: This examination is contraindicated for patients with
suspected fracture or pathologic.
Image receptor : 24 x 30 cm crosswise
Position of patient : From the supine position, rotate the
patient slightly toward the affected side to an oblique
position. The degree of obliquity will depend on how
much the patient can abduct the leg.
Position of part :
• Adjust the patient's body, and center the affected hip to
the midline of the grid.
Hip

26. • Ask the patient to flex the affected knee and draw the
thigh up to a position at nearly a right angle to the hip
bone.
• Extend the opposite limb and support it at hip level and
under the knee.
Central ray :
• Perpendicular through the hip joint, which is located
midway between the ASIS and the pubic symphysis for
the Lauenstein method and at a cephalic angle of 20 to
25 degrees for the Hickey method.
• Center the IR to the central ray.
Hip

27. Hip

28. AXIOLATERAL PROJECTION
DANELIUS-MILLER METHOD
Surgical Lateral
Image receptor : 24 x 30 cm lengthwise
Position of patient : Place the patient in the supine
position.
Position of part
• Flex the knee and hip of the unaffected side to elevate
the thigh in a vertical position.
• Rest the unaffected leg on a suitable Support
• Unless contraindicated, grasp the heel and medially
rotate the foot and lower limb of the affected side about
15 or 20 degrees.
Hip

29. Hip
• Place the IR in the vertical position with its upper
border in the crease above the iliac crest.
Central ray : Perpendicular to the long axis of the femoral
neck.

30. Hip

31. AXIOLATERAL PROJECTION
CLEMENTS-NAKAYAMA MODIFICATIONl
 When the patient has bilateral hip fractures, bilateral
hip arthroplasty (plastic surgery of the hip joints), or
limitation of movement of the unaffected leg the
Danelius-Miller method cannot be used.
Image receptor : 24 x 30 cm lengthwise
Position of patient : Place the patient in the supine
position.
Hip

32. Position of part :
• For this position, do not rotate the lower limb internally.
Instead, the limb remains in a neutral or slightly
externally rotated position.
• Support a grid IR on the Bucky tray so that its lower
margin is below the patient.
• Adjust the grid parallel to the axis of the femoral neck
and tilt its top back 15 degrees.
Respiration : Suspend.
Central ray : Directed 15 degrees posteriorly and aligned
perpendicular to the femoral neck and grid IR.
Hip

33. Hip

34. Radiography
Acetabulum

35. PA AXIAL OBLIQUE PROJECTION
TEUFEL METHOD
RAO or LAO position
Image receptor : 8 x 10 inch (18 x 24 cm) lengthwise
Position of patient : Have the patient lie in a semi prone
position on the affected side.
Position of part :
• Align the body, and center the hip being examined to the
midline of the grid.
• Elevate the unaffected side so that the anterior surface
of the body forms a 38-degree angle from the table.
Acetabulum

36. • Have the patient support the body on the forearm and
flexed knee of the elevated side.
• With the IR in the Bucky tray, adjust the position of the
IR so that its midpoint coincides with the central ray.
Respiration: Suspend.
Central ray :
• Directed through the acetabulum at an angle of 12
degrees cephalad. The central ray enters the body at the
inferior level of the coccyx and approximately 2 inches
(5 cm) lateral to the midsagittal plane toward the side
being examined.
Acetabulum

37. Acetabulum

38. AP OBLIQUE PROJECTION
JUDET METHOD
RPO or LPO position
Image receptor : 24 x 30cm lengthwise
Internal oblique:
• For a patient with a suspected fracture of the iliopubic
column (anterior) and the posterior rim of the
acetabulum.
Position of patient : Place the patient in a semisupine
position with the affected hip lip.
Acetabulum

39. Position of part :
Align the body, and center the hip being examined to the
middle of the IR.
Elevate the affected side so that the anterior surface of the
body forms a 45 degree angle from the table .
Respiration: Suspend.
Central ray : Perpendicular to the IR and entering 2 inches
inferior to the ASIS of the affected side.
Acetabulum

40. Acetabulum

41. Acetabulum

42. External oblique:
• For a patient with a suspected fracture of the ilioischial
column' (posterior) and the anterior rim of the
acetabulum.
Position of patient : Place the patient in a semisupine
position with the affected hip down.
Position of part :
Align the body, and center the hip being examined to the
middle of the IR.
Elevate the affected side so that the anterior surface of the
body fonns a 45 degree angle from the table.
Respiration: Suspend.
Acetabulum

43. Central ray : Perpendicular to the IR and entering at the
pubic symphysis.
Acetabulum

44. Radiography
Other Part

45. PA PROJECTION
Image receptor : 8 x 10 inch (18 X 24 cm) crosswise
Position of patient : Place the patient in the prone position,
and center the midsagittal plane of the body to the
midline of the grid.
Position of part :
With the IR in the Bucky tray, center the IR at the level of
the greater trochanters.This positioning also centers the
IR to the pubic symphysis.
Respiration: Suspend.
Anterior Pelvic Bones

46. Central ray : Perpendicular to the midpoint of the IR. The
central ray enters the distal coccyx and exits the pubic
symphysis.
Anterior Pelvic Bones

47. AP AXIAL "OUTLET" PROJECTION
TAYLOR METHOD
Image receptor : 24 x 30 cm crosswise
Position of patient : Place the patient in the supine
position.
Position of part :
• Center the midsagittal plane of the patient's body to the
midline of the grid, and adjust the pelvis so that it is not
rotated. The ASISs should be equidistant from the table
• With the IR in the Bucky tray, adjust the tray's position
so the midpoint of the IR will coincide with the central
ray.
Respiration: Suspend
Anterior Pelvic Bones

48. Central ray :
Males
Directed 20 to 35 degrees cephalad and centered to a point
2 inches (5 cm) distal to the superior border of the pubic
symphysis.
Females
Directed 30 to 45 degrees cephalad and centered to a point
2 inches (5 cm) distal to the upper border of the pubic
symphysis.
Anterior Pelvic Bones

49. Anterior Pelvic Bones

50. SUPEROINFERIOR AXIAL "INLET“ PROJECTION
LlLIENFELD METHOD
Image receptor : 24 x 30 cm crosswise
Position of patient : Place the patient on the radiographic
table in a seated-upright position
Position of part :
• Center the midsagittal plane of the patient's body to the
midline of the grid.
• Flex the knees slightly and support them to relieve
strain.
Anterior Pelvic Bones

51. • Have the patient extend the arms for support, lean
backward 45 or 50 degrees, and then arch the back, if
possible, to place the pubic arch in a vertical position.
• With the IR in the Bucky tray, center it at the level of the
greater trochanters.
Central ray : Perpendicular to the midpoint of the image
receptor and entering ½ inches (3.8 cm) superior to the
pubic symphysis.
Anterior Pelvic Bones

52. Anterior Pelvic Bones

53. AP AND PA OBLIQUE PROJECTIONS
RPO and LPO positions
Image receptor : 24 x 30 cm lengthwise
Position of patient : Place the patient in the supine
position.
Position of part :
Center the sagittal plane passing through the hip joint of the
affected side to the midline of the grid.
Ilium

54. • Elevate the unaffected side approximately 40 degrees to
place the broad surface of the wing of the affected ilium
parallel with the plane of the IR.
• Support the elevated shoulder, hip, and knee on
sandbags.
• Adjust the position of the uppermost limb to place the
ASISs in the same transverse plane.
• Center the IR at the level of the ASIS.
Respiration: Suspend.
Central ray : Perpendicular to the midpoint of the IR
Ilium

55. Ilium