Clark's Pocket Handbook for Radiographers (Clark's Companion Essential Guides)

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The horizontal central beam is directed at right-angles to the image receptor at the level of the eighth thoracic vertebrae (i.e. spinous process of T7 – found by using the inferior angle of the scapula). Exposure is made in full normal arrested inspiration. An FRD of 180 cm should be used to minimize magnification. The petrous ridges must appear below the floors of the maxillary sinuses. There should be no rotation. The image should include the apices and costophrenic angles and lung margins anteriorly and posteriorly. Image processing should be optimized to visualize the heart and lung tissue, with particular regard to any lesions if appropriate. The central ray is directed perpendicular to the image receptor and centred in the midline at the levels of the angles of the mandible.

The patella must be centralized over the femur. The distal third of femur and proximal third of tibia are included. 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 0 and 90 degrees to the receptor with the central ray at right-angles to the receptor. If the patient is positioned with the median sagittal plane at right-angles to or parallel to the receptor the projection is obtained by directing the central ray at some angle to the median sagittal plane. for written consent if an examination incurs a higher risk, e.g. angiography. To be able to give consent (adult or child) the patient should meet the following criteria: ■ they should understand the risk versus benefit; ■ they should understand the nature of the examination and why it is being performed; ■ they should understand the consequences of not having the examination; ■ they should be able to make and communicate an informed decision. If these conditions are not fulfilled then other individuals may be able to give consent, e.g. parents, or in an emergency situation the examination may proceed if it is considered in the best interest of the patient (see hospital policy).This projection may also be undertaken with the patient supine and the cassette supported vertically against the side of the face. Again, a horizontal beam is used to demonstrate fluid levels. Over- and under-rotation lead to non-superimposition of the talar trochlear surfaces. Over-rotation ⫽ fibula projected posterior to the tibia. Under-rotation ⫽ shaft of the fibula superimposed on the tibia. The vertical central ray is centred over the head of the fifth metacarpal. The tube is then angled so that the central ray passes through the head of the third metacarpal, enabling a reduction in the size of the field.

The image should demonstrate the head of the humerus, the acromion process, the coracoid process and the glenoid cavity of the scapula. Section 1 Key Aspects of Radiographic practice Anatomical Terminology Positioning Terminology Projection Terminology General Considerations for the Conduct of Radiographic Examinations Patient Identity and Consent Justification of Examination Radiation Protection Pregnancy Evaluating Images: ‘The 10-Point Plan’ Examination Timeline Guidelines for the Assessment of Trauma Theatre Radiography The whole of the mandible from the lower portions of the temporo-mandibular joints to the symphysis menti should be included in the image. There should be no rotation evident. Skull – Occipito-frontal 188 30 Degrees↑ (Reverse Towne’s) Skull – Lateral Erect 190 Skull – Fronto-occipital 192 20 Degrees↑ (Supine/Trolley) Skull – Modified Half Axial 194 (Supine/Trolley) Skull – Lateral (Supine/Trolley) 196 Sternum – Lateral 198 Thoracic Spine – 200 Antero-posterior Thoracic Spine – Lateral 202 Thumb – Antero-posterior 204 Thumb – Lateral 206 Tibia and Fibula – 208 Antero-posterior Tibia and Fibula – Lateral 210 Toe – Hallux – Lateral 212The image should include the distal end of the radius and ulna and the proximal end of the metacarpals. The pisiform should be seen clearly in profile situated anterior to the triquetral. The long axis of the scaphoid should be seen perpendicular to the image receptor. GENERAL CONSIDERATIONS FOR THE CONDUCT OF RADIOGRAPHIC EXAMINATIONS Patient Considerations ■ ■ ■ ■ ■ ■