Abdomen – Antero-posterior 40 Supine Abdomen – Prone 42 Abdomen – Left Lateral 44 Decubitus Acromioclavicular Joint 46 Ankle – Antero-posterior/ 48 Mortice Joint Ankle – Lateral 50 Calcaneum – Axial 52 Cervical Spine – Antero54 posterior C3–C7 Cervical Spine – Lateral Erect 56 Cervical Spine – Antero58 posterior C1–C2 ‘Open Mouth’ Cervical Spine – Lateral 60 ‘Swimmer’s’ Cervical Spine – Lateral Supine 62 Cervical Spine – Posterior 64 Oblique Cervical Spine – Flexion and 66 Extension Chest – Postero-anterior 68 Chest – Antero-posterior 70 (Erect) Chest – Lateral 72 Chest – Supine 74 (Antero-posterior) The patella should be projected clear of the femur. The femoral condyles should be superimposed. The proximal tibio-fibular joint is not clearly visible. Essential Image Characteristics The hip and knee joints should both be included on the image where possible.

Direct the horizontal central ray at right-angles to the middle of the image receptor at the mid-axillary line. Iliac crests and proximal femora, including the lesser trochanters, should be visible on the image. No rotation. The iliac bones and obturator foramina should be the same size and shape.ABDOMEN – PRONE This projection is used to demonstrate the bowel in barium followthrough examinations. It may also be used in excretion urography and barium enema examinations. External occipital Orbito-meatal protuberance baseline (OMBL) (INION) or Radiographic baseline (RBL) Centre in the midline at the level of the femoral pulse, with the central ray perpendicular to the image receptor. Collimate to the area under examination. Centre to the middle of the image receptor, with the central ray at right-angles to both the long axis of the tibia and an imaginary line joining the malleoli. A typical ‘pregnancy rule’ for women of child-bearing age. *Some women have menstrual cycles of more or less than 28 days or have irregular cycles. CT, computed tomography; LMP, last menstrual period.

The image receptor and beam are often centred too low, thereby excluding the upper thoracic vertebrae from the image. The lower vertebrae are also often not included. L1 can be identified easily by the fact that it usually will not have a rib attached to it. THEATRE RADIOGRAPHY Introduction Theatre radiography plays a significant role in the delivery of surgical services. The radiographer may be required for emergency procedures or planned surgery in both trauma and non-trauma procedures. CLAVICLE – POSTERO-ANTERIOR Although the clavicle is demonstrated on the antero-posterior ‘survey’ image, it is desirable to have the clavicle as close to the image receptor as possible to give optimum bony detail. The image should include the distal end of the radius and ulna and the proximal end of the metacarpals. The scaphoid should be seen clearly, with its long axis parallel to the image receptor. The projection is useful to confirm position and size of a lesion suspected on the initial projection or the position of leads post pacemaker insertion. However, it is not a routine examination because of the additional patient dose and the increasing use of computed tomography to examine the thorax.Where there is a possibility of injury to the base of the first metacarpal, the carpo-metacarpal joint must be included on the image. The knee and ankle joints should be included on the image. This is especially important in trauma, as a break in the bony ring may be accompanied by another fracture within the ring (such as the distal tibia and proximal fibula). The patient sits or lies supine on the X-ray table with both limbs extended. The affected leg is rotated medially until both malleoli are equidistant from the image receptor. The ankle is dorsiflexed. The position is maintained by using a bandage strapped around the forefoot and held in position by the patient. The image receptor is positioned with its lower edge just distal to the plantar aspect of the heel. If using an automatic exposure control, centring too far posteriorly will result in an underexposed image. It is common practice to obtain two projections, a lateral and an antero-posterior. In the case of a suspected foreign body in the thenar eminence, a postero-anterior projection is used to maintain the relationship with adjacent structures.

From the postero-anterior position, the hand is externally rotated 90 degrees. The palm of the hand is perpendicular to the image receptor, with the fingers extended and the thumb abducted and supported parallel to the image receptor on a non-opaque pad. The radial and ulnar styloid processes are superimposed. The antero-posterior light should be centred distally to the upper lateral incisor. This allows optimal positioning of the ‘focal trough’, the zone of focus outside of which the anatomical detail becomes blurred. Sacro-iliac joints – Posteroanterior Sacrum – Lateral Scaphoid – Postero-anterior with Ulnar Deviation Scaphoid – Anterior Oblique with Ulnar Deviation Scaphoid – Posterior Oblique Scaphoid Postero-anterior – Ulnar Deviation and 30-Degree Cranial Angle Shoulder Girdle – Anteroposterior Shoulder Joint – Antero-posterior (Glenohumeral Joint) Shoulder – Supero-inferior (Axial) Shoulder Joint Lateral Oblique ‘Y’ Projection Sinuses – Occipito-mental Sinuses – Occipito-frontal 15 Degrees Sinuses – Lateral Skull – Occipito-frontal 20 Degrees↓ Centre 2.5 cm below the apex of the patella through the joint space, with the central ray at 90 degrees to the long axis of the tibia. When the patient is unable to extend the elbow to 90 degrees, a modified technique is used for the antero-posterior projection. If the limb cannot be moved, two projections at right-angles to each other can be taken by keeping the limb in the same position and rotating the X-ray tube through 90 degrees.

The heart is moved further from the image receptor, thus increasing magnification and reducing accuracy of assessment of heart size (cardiothoracic ratio (CRT)). The image must include the upper third of the femur. When taken to show the positioning and integrity of an arthroplasty, the whole length of the prosthesis, including the cement, must be visualized. The area of interest must include from the diaphragm to symphysis pubis and the lateral properitoneal fat stripes. The bowel pattern should be demonstrated with minimal unsharpness.