Moderator:

Mr. S.C. BANSAL

Deptt. of Radio-Diagnosis
& Imaging
PGIMER, Chandigarh

Presented By:
RITIKA MANGLA
B.Sc.MT (X-Ray) – Second Year
Student
Deptt. Of Radio-Diagnosis & imaging
PGIMER, Chandigarh
1
Ward or Portable radiography is that
radiography which is restricted to patient
whose medical condition is such that it is
impossible for them to be moved to the x-ray
dept. without seriously affecting their medical
treatment and nursing care

2
 Patient can't be safely transported to radiology
department because of severe illness, Trauma or
surgery.
 Patient can't be carried to radiology department
because of Quarantine or isolation conditions
recommended for him or her . For example- in
ICU, NICU, CCU Patient etc.

3
 CTU  Orthopedic Ward
 NICU  Emergency
 ICU Recovery
 Surgical Ward
 CCU
 OT-Recovery
 PICU  OT – Radiography

4
 The patient’s medical condition.
 The degree of consciousness & co-operation.
 Restriction due to life support system, drips &
chest or abdominal drains.
 Location of ECG leads.
 Traction apparatus.
 Physical restriction due to room size.
 An adequate power supply.
 The shape, size & ability to move mobile or
portable x-ray equipment in confined spaces.

5
 Firstly, the x-ray requisition forms should be
checked to ensure that the examination in the
ward is necessary.
 Correct equipment & Correct cassettes must
be carried to avoid the repeat examinations
 Proper lead apron must be carried.

6
Through knowledge of ward is necessary along
with complete patient information i.e.-
 Name of the patient
 Age
 Sex
 Central Registration no.
 Examinations & the Views required
 Bed number and proper knowledge of x-
ray units.

7
 There may have a lots of leads connected to the
patient e.g. – ECG-Leads. So, any disturbance
regarding these should be undertaking with
permission of medical staff.
 Minimum disturbance should be applied to the
patient while positioning.
 Lifting of seriously ill patients should also be
undertaken with supervision of nursing staff.

8
X-ray equipment fall broadly into two groups:
 Portable.
 Mobile.
In the Radiography of chest & abdomen
the use of shortest exposure times is essential
to reduce the risk of movement blur. For these
examination the choice of equipment is
therefore, restricted to high output Mobile sets.

9
Portable equipment:-
FEATURES:
The word “portable” means that x-ray unit is
capable of being carried with implication that it
does not need more than one able bodied person to
do carrying at any given time.
 It is very simple to use and can be packed into
carrying cases and so transported .
 Portable relatively sets have low MA setting can
be dismantled for transfer.

10
Compact Vet APR X-ray System

A modern floor-mounted tube

support X-ray system. This system
is available in 10 different versions
with high frequency X-ray
generators, fixed or floating top
tables, anatomical programming
(APR) and lots more, including: 40
to 125kV, 10 - 320mA, 0.1 to
500mAs, 1ms to 5 seconds and
rotating anode X-ray tubes.
Automatic Exposure Control (AEC)
is available as an option.

11
 Various parts of equipment
SP Vet Mobile Stand
A mobile stand for the portable X-ray unit, facilitating a variety of
examinations down to floor level. Ideal for equine radiography.

Ceiling X-ray Support

A ceiling support system for the portable X-ray unit providing horizontal
and lateral movements over a table. Ideal for small compact X-ray rooms
where space is limited. Made to measure and subject to site survey.

X-ray Tables
A range of mobile radiolucent tables suitable for radiography with
options for a moveable cassette tray with a stationary or a moving bucky
grid.

12
Mobile equipment:-
FEATURES:
 The word “mobile “means that x-ray
equipment is capable of being moved. It is
mounted on the wheels and can be pushed by
human power.
 It is larger and heavier than portable sets and
need to be motorized or pushed b/w locations.
Mobile sets have high MA value and heavier.

13
TMX+
Mobile Radiographic Unit

The TMX+ is a mobile powerful

radiography system designed to
fulfill a wide range of clinical
applications in any location of
your department.
It has been especially designed
for totally adapted use in
intensive care, emergencies,
pediatrics, neonatology and
orthopedics rooms.

14
 ST 3-GENIUS 60 CARTLEX MARS-15R/SBM

TECHNIX S.P.A.-TMS150 MOBILE ART UNIT

CAPACITOR DISCHARGE
15
 CR PLATE
It consists of a polyester base over which a layer
of photostimulable phosphor [europium doped
barium fluoro bromide crystals- BaFBr:Eu 2] is
coated.
A protective layer composed of fluorinated
polymer material is applied over it. A supporting
layer which prevents the reflection if light is also
applied.
Next is the backing layer. This prevents the
scratching on the imaging plates during storage
and transfer. Therefore it has a protective action.
16
 CONTD…..

The next is the bar-code table which contains

the number assigned to the imaging plate.
This bar-code provides a mechanism for
associating each imaging plate with patient
identification, related examination and
positioning information.
The imaging plate is flexible and less than
1mm thick.

17
18
Common diagnosis which requires portable chest
radiography include:

 Congestive heart failure.  Plural effusion.

 Coronary heart disease.  Pneumonia.
 Lt. ventricular failure.  Dyspnoea.
 Pulmonary edema.  Severe chest pain.
 Pulmonary embolus.  Post operative chest
 Pneumothorax. radiography.

Generally AP view in supine position is done because it

is difficult for the patient to stand or lie in prone
positions. 19
AP-View:
 If possible, the patient should be x-rayed in sitting
erect & facing towards x-ray tube. The cassette is
supported against the back, using pillow or a large
wedge shaped foam pads, with its upper edge above
the lungs field.
 If this not possible, the patient may be positioned in
supine.
 The median saggital plane is adjusted at Rt. Angles to,
& in the midline of the cassette.
 The rotation of the patient is prevented by the use of
foam pads, rotation produces a range of artifacts &
must be avoided or minimized. If possible the arms
are rotated medially, with the shoulders brought
forward to bring the scapulae away from the lungs
field.
20
AP - Erect

21
AP - Supine

22
CR: - It is directed at Rt. Angle to
the cassette at the level of the
sternal angle.
For Fluid levels:
Views preferred are:
 Lateral Decubitus.
 Dorsal Decubitus.
With the use of Horizontal
central ray.
23
.

This projection is used to confirm the presence

of fluid. Moving the patient into a different
position causes movement of free fluid, so that
loculation is also detected . It may also be used
to demonstrate the lateral chest wall of the
affected side clear of fluid, and to unmask any
underlying lung pathology.

24
Positioning:
 Patient is turn on to the affected side & if
possible, raised on to a supporting foam pad.
 A cassette is supported vertically against the
anterior chest wall, & the median sagital plane
is adjusted at Rt. Angles to the cassette.
 The patient’s arm is raised & folded over the
head to clear the chest wall.
CR: It is directed horizontally at the level of 6 th

thoracic vertebrae.

25
 L

Lateral Decubitus
26
 This projection will show as much as possible of
lung fields, clear of a fluid level, when the
patient is unable to turned on their side .

Positioning:
 The patient lying supine is raised of the bed on to a
supporting foam pad.
 Arm extended & supported above the head.

 Cassette is supported vertically against the lateral

aspect of chest of affected side.
CR: It is directed horizontally & Rt. Angle to the cassette
through the axilla.

27
Dorsal Decubitus

28
 A series of radiographs are taken during post-
operative care in order to see the prognosis.
 Radiographs are taken with the patients supine
at first until the patient is fit to sit.
 Consistent radiographs are taken in order to
enable accurate comparison of radiographs
over period of time.
 Care should be taken to expose in full
inspiration.

29
Introduction:
Neonates suffering from respiratory
distress syndrome are examined soon
after the birth to show the lungs tissue
which are immature & unable to
perform normal respiration.
 The baby will be nursed in an
incubator.
 The primary beam is directed through
the incubator top.

30
Indications:-
 Respiratory  Esophageal atresia.
difficulties.  Previous anti-natal
 Infections. ultrasound
 Chronic lungs abnormality
disease. suspected.
 Thoracic cage
 Pleural effusion.
anomaly.
 Position of  Post-operative.
catheter/tubes.
31
 The baby is positioned supine on the cassette, with
the median sagital plane perpendicular to the
midline of the cassette, ensuring that the head &
chest are straight, shoulders & hips are at the same
level.
 The head may need a covered sand bag support on
either side.
 A 10° foam pad should be placed under the
shoulders to avoid a lordtic view & top lift the chin
& prevent it obscuring the lungs apices.

32
 Arms should be on either side, separated
slightly from the trunk to avoid being included
in the radiation field.
 Arms can be immobilized with Velcro bands or
sand bags.
CR: It is directed at Rt. Angles to the centre of
the cassette.

33
34
RADIOGRAPHY OF ABDOMEN
Portable or mobile radiography is often required in cases
of acute abdominal pain or following surgery, when the
patient is unable, to determine any of the following are
present.
 Gaseous distension in any part of the gastro-intestinal
tract.
 Free gas or fluid in the peritoneal cavity.
 Fluid level in the intestine.
 Location of radio-opaque foreign body.
 Evidence of aortic aneurysm.
35
 For Gaseous Distension:
- AP-Abdomen in supine position.

 For Free Gas in the Peritoneal Cavity:

- AP-Chest in erect position.
- AP-Abdomen in supine.
- AP/PA Lt. lateral Decubitous.

 For Fluid level:

- AP-Abdomen in erect position.

 For Radio-Opaque foreign body:

- AP-Abdomen in supine position.

 For Aortic Aneurysm:

- Lateral (Dorsal Decubitous)
36
AP-Supine:
 With the patient in supine position and cassette with
grid is carefully positioned under the abdomen.
 Care should be taken to avoid hurting the patient while
positioning the patient.
 Cassette should be positioned to include symphysis
pubis on the lower edge of the film.
 The cassette should also be in horizontal position on
the bed and not lying at an angle. If the cassette is not
flat, there may be grid cut off of the radiation beam.

CR:
 It is directed at Rt. Angles to the cassette & in the
midline at level of the iliac crests.
 Exposure is made on arrested expiration.
37
AP - Supine

38
 Depending on the patient’s medical conditions, the
patient’s bed is adjusted to enable the patient to
adopt an erect or semi-erect position. If necessary,
a no. of pillows or alternating supporting device
are positioned behind the patient to aid stability.
 The patient’s thigh are moved out of the beam to
ensure that they are not superimposed on the
image.
 A cassette is placed against the posterior aspect of
the patient, with the upper border of the cassette
positioned 2 or 3 cm above the xiphi-sternum joint
to ensure that the diaphragm is included on the
image to enable demonstrate a free air ion the
peritoneal cavity.

CR: It is directed at Rt. Angles to the centre of the cassette.

39
AP - Erect

40
 This Projection, is selected as an
alternative to the antero-posterior
erect projection when the patient is
unable to sit. It is also useful in
demonstrating free air in the
peritoneal cavity.

41
 Patient is turn on to the left side, ideally for20
minutes, allowing any free air in the abdominal
cavity to rise towards the Rt. Flank to avoid the
problem of the differential diagnosis when the air is
present on the Lt. side of the abdomen within the
region of the stomach.

 The cassette is supported vertically at Rt. Angle to

the horizontal central ray & is positioned against the
posterior aspect of the patient to include the Rt. Side
of diaphragm.
 \
CR: The horizontal central ray is directed to the
centre of the patient. 42
Lt. Lateral Decubitus

43
Definition: A physical injury caused by
external force or violence.
Or
A injury whether physical or psychic is
known as Trauma.
Trauma is divided a/c to body parts:
1) Appendicular Trauma.
2) Abdominal Trauma.
3) Thoracic Trauma.
4) Head Trauma.
5) Spinal Trauma.
44
INDICATIONS:
In order to diagnose: -
 Fracture.
 Soft tissue injury.
 Ligament tear.
 Tendon tear.

45
The basic of radiographic positioning must
be examined in order to understand while
the established radiographic position are
the way, they are, to be able to adapt them
to new situations and to enable the
radiological technologist to create his or
her own positions.

46
1) Whenever possible these views should be an
antero-posterior or postero-anterior view and a
lateral view.
2) Angle the part, CR or the film to avoid any
interfering objects.
3) Obtain two views, 90˚ apart.
4) The only thing that matters is the relationship
b/w the part, the CR & the film.
5) Include the entire structure or the area in the
examination.
47
 The First Principle is necessary because people
are three dimensional. A PA Projection
. radiograph shows height & width but no
depth. If a lateral Projection is taken with the
CR 90* From the PA, the height is repeated, but
the depth is also included.

48
 The second Principle concerns angulation of
the x-ray beam, the patient, or the film. In
general, angulation should be avoided. The
optimum situation would have the x-ray beam
perpendicular to the film, with no rotation of
the patient. Ofcourse, this is not always
possible. Principle 2 is used when super
imposition of structure is a problem. For ex. In
radiography of the skull, the petrous portion
of the temporal bone is often a problem

49
The third Principle calls for an AP or PA
projection & lateral projection. These projections
are best because the physicians are most familiar
with viewing the body from these aspects. If it is
not possible to obtain these projections, then the
radiographer should attempt two other
projections, 90* apart- possibly two obliques.

50
The fourth Principle is the key 2 adapting
position to non routine condition. As long as the
CR, the part, and the film maintain their
relationships, the position will produce the
desired results. In routine radiography, the CR is
usually vertical & the film is horizontal(either in
the bucky tray or on top of the radiographic
table.

51
The fifth Principle is designed to
ensure that no injuries are missed.
For structures, it means that both
joints must be included with a bone;
for example, the knee & ankle must
be included in an examination of
lower leg.
52
It is divided into:

 Upper Limb.
 Lower Limb.

The Appendicular skeleton, comprises of 126

bones, includes 2-limbs girdles & their attached
limb bones.

53
 CHONDRAL FRACTURE: - Cartilage
involved.

 OSTEOCHONDRAL FRACTURE- Both bone &

cartilage involved.

 CLOSED FRACTURE: - Skin intact.

 OPEN FRACTURE: - Disruption of skin

54
GREENSTICK FRACTURE:
Perforates one cortex ramifying within the
medullary bone (proximal metaphysis /diaphysis of
the tibia, middle third of the radius and ulna).

55
 COLLES specifically described fracture of the distal radius with
dorsal impaction, displacement, or angulation. This term is used
to refer both extra-articular & intra articular fractures.

56
Dislocation of the shoulder joint: -
The following clinical types should be recognized:

1. Acute dislocation:
              a) Anterior dislocation -- Commonest type.
             b) Posterior dislocation -- This is rare.
             c) Inferior dislocation– Lux erecta 
2. Old unreduced.
3. Recurrent dislocation.

57
 ANTERIOR DISLOCATION

NORMAL

58
59
Recommended Projection are:
 AP
 Trans-thoracic Lateral

Positioning of Trans-Thoracic Lateral:

 Ask the patient to seat or stand in lateral
position in front of a vertical grid device.
 Raise the uninjured arm.
 Elevation of uninjured shoulder, give the
desired depression of the injured side.
 Centre the cassette to the region of surgical
neck of a affected humerus.
 Instruct the patient to hold the breath at full
inspiration.

60
Views:
1) AP
2) Axial: - i) Supero-inferior. &
ii) Infero-superior.
1) AP-View:
Positioning:
 the patient stands or lies supine facing the X-ray
tube.
 The patient is rotated towards the affected side to
bring the posterior aspect of the injured shoulder
into contact with the midline of the cassette.
 The cassette is positioned to include the achromial
process & proximal half of the humerus.
CR: It is directed at Rt. Angles to the humerus &
centered to the head of the humerus.
61
AP - Erect AP - Supine

62
2) Axial View:
i. Supero-inferior: This projection can be taken
even when only a small degree of abduction is
possible.
Positioning:
 The patient is seated at one end of the table, with
trunk leaning towards the table, the arm of the
side being examined in its maximum abduction,
& the elbow resting on the table.
 The height of the table is adjusted to enable the
patient to adopt a comfortable position.
 The cassette rest on the table b/w the elbow and
the trunk.
CR: - It is directed at the tip of the acromion process
of the scapula

63
64
ii. Infero-superior: This projection is usually
undertaken with the patient supine on a trolley or the
X-ray table.
Positioning:
 The patient lies supine on the trolley, with the arm of
the affected side abducted as much as possible, the
palm of the hand facing upwards, & the medial &
lateral epicondyles of the humerus equidistance from
the table top.
 The shoulder & the arm raised slightly on a non-
opaque pads, & the cassette supported vertically
against the shoulder is pressed against the neck to
include as much of the scapula as possible in image.
CR: - It is directed to the patient’s axilla with minimum
angulations towards the trunk.

65
66
 When movement of the patient’s arm is restricted, a
modified technique is required.
1)AP – Erect View: -
Positioning:
 The cassette is placed in an erect cassette holder.
 The patient sits or stands with their back in contact with
the cassette.
 The patient is rotated towards the affected side to bring
the posterior aspect of the shoulder, upper arm & elbow
into contact with the cassette.
 The position of the patient is adjusted to ensure that the
medial & lateral epicondyles of the humerus are
equidistant from the cassette.
CR : - It is directed at Rt. Angle to the shaft of the
humerus & centered midway b/w the shoulder &
elbow joints.
67
68
2) Lateral View:
Positioning:
 The cassette is placed in a erect cassette holder.
 From the anterior position, the patient is rotated
through 90˚ until the lateral aspect of the injured
arm is in contact with the cassette.
 The patient is now rotated further until the arm is
just clear of the rib cage.

CR: - The horizontal central ray is directed at Rt.

Angles to the shaft of the humerus & centered
b/w the shoulder & the elbow joint.

69
70
 Lateral View:
Positioning: -It can be done in two way
they are:
A 1) The patient sits or stands facing the X-ray tube.
 A cassette is supported b/w the patient’s trunk &
elbow, with the medial aspect of the elbow in
contact with the cassette.
 A lead rubber sheet or other radiation protection
device is positioned to prevent the patient’s trunk
from the primary beam.

CR : - It is directed perpendicular to the shaft of the

humerus & centered to lateral epicondyle.

71
72
2. A cassette is supported vertically in a cassette
holder.
 The patient stands side ways, with the elbow flexed
& the lateral aspect of the injured elbow in contact
with the cassette. The arm is gently extended back
wards from the shoulder. The patient is rotated
forwards until the elbow is clear of the rib cage.

CR: - It is directed to the medial epicondyle &

the beam is collimated to the elbow.

73
74
AP – View:
Positioning:
 From the lateral position, the patient’s upper body is
rotated towards the affected side.
 The cassette is placed in an erect cassette holder, & the
patient’s position is adjusted so that the posterior
aspect of the upper arm is in contact with the cassette.
CR: -
i. If the elbow joint is fully flexed, the CR is directed
at Rt. Angle to the humerus to pass through the
forearm to a point midway b/w the epicondyles of
the humerus.
ii. If the elbow joint is only partial flexed, the CR is
directed at Rt. Angle to the humerus to a point
midway b/w the epicondyles of the humerus
75
76
→

77
Lateral Horizontal Beam:

This projection is used in the suspected fracture of the neck

of the femur.
Positioning:
 The patient lies in supine on the stretcher or a x-ray table.
 The legs are extended & the pelvis adjusted to make the
median sagital plane perpendicular to the table top. This may
not always be possible if the patient is great pain.
 If the patient is slender, it may be necessary to place a non-
radiopaque pad under the buttocks so that the whole of the
affected hip can be included in the image.
 The grid cassette is positioned vertically, with the sorter edge
pressed firmed against waist, just above the iliac crest.
78
 The longitudinal axis of the cassette should be parallel to
neck of the femur. This can be approximated by placing
a 45˚ foam pad b/w the front of the cassette & the lateral
aspect of the pelvis.
 The cassette is supported in this position by sand bags
or specific cassette holder affected to the table.
 The unaffected limb is raised until the thigh is vertical,
with the knee flexed this position is maintained by
supporting the lower leg on a stool or specialized
instrument.

CR : - It is directed midway b/w the femoral pulse &

palpable prominence of the greater tronchanter with
the central ray directed horizontally & at Rt. Angle to
the cassettes.

79
Neck of femur

80
For Shaft Fracture:
 The patient remains on the trolley or bed. If possible,
the leg may be slightly to centralize the patella b/w
the femoral condyles.
 The cassette is supported vertically against the
lateral aspect of the thigh, with the lower border of
the cassette level with the upper border of the tibial
condyle.
 The unaffected limb is raised above the injured limb,
with the knee flexed & the lower leg supported on a
stool or specialized support.

CR: - It is directed to the mid-shaft of the femur.

81
Shaft of femur

82
Lateral Horizontal View:
This projection is used in the suspected transverse
fracture of the patella.
Positioning:
 the patient is remains on the trolley, with the limb
gently raised & supported on pads.
 If possible, the leg may be rotated slightly to
centralized the patella b/w the femur condyles.
 The film is supported vertically against the medial
aspect of the knee.
 The centre of the cassette is level with upper
border of the tibial condyle.
CR: - It is directed to the upper border of the lateral
tibial condyle at 90˚ to the long axis of the tibia.
83
84
 Trauma to the abdomen contributes to 10% of
trauma mortality and higher % of the
morbidity.
Abdominal trauma is classified in
two parts:
1) Blunt trauma.
2) Penetrating trauma.

85
It occurs approximately 2/3rd of the abdominal
injury patients. Motor vehicle accidents accounts
for up to 80 % of the blunt trauma with the
remainder being caused by falls, assault and
industrial accidents.

Organ injuries in the blunt trauma can

be :
Kidney.
Intestine.
Liver.
Pancreases.
Spleen.
86
It can be caused by gun shoot injury, stab
wounds.
Organ injured in penetrating trauma
can be:
Liver.
Stomach.
Colon.
Kidney.
Billiary System.

87
The majority of the patients who suffer blunt
abdominal trauma are stable and required
diagnostic studies. For e.g.:
Plain abdominal radiography.
Ultrasonography.
Nuclear medicine study.
MRI.
Angiography
Computed tomography

88
 Plain Radiography:

Recommended projection are:

1) AP: - Same as Portable Radiography
2) Dorsal Decubitous: - Same as portable
Radiography.

89
It is divided into two parts:

1) Blunt Trauma: - Chest wall remains intact.

2) Penetrating Trauma: - Chest wall integrity is

breached, producing even if only transiently,
communication b/w the external environment
and internal contents of the thorax.

Recommended projection is:

 AP-Supine: - Same as Portable Radiography

90
For an examples: -
 Pneumothorax.
 With or without haemothorax.
 Pneumomediastinum or Haemomediastinum.
 Lungs parenchymal contusion.
 Pneumopericardium.
 Chest wall.
 Heavy diaphragm injuries.
 The position of various internal catheters,
lines and tubes can be assessed.

91
 Trauma to the head & spine causes most of the
death no.
 Up to 10 % cases are fatal & 10 % to 40 % are
moderate head injuries.
 Head injuries may be classified as: -
1. Mild.
2. Moderate.
3. Severe.

92
 HEAD INJURY
Moderate/Severe Mild

Neurological Neurological Headache No Headache

Stable Unstable

MRI CT-Scan CT-Scan

93
 In order to have accurate detection of
haemorrhage CT is the choice of the study.
 In order to have precision in the diagnosis of
fracture, plane radiography is preferred.

Views recommended:
1. Lateral Supine (Cross Table Lateral Position).
2. Fronto – Occipital 30˚ caudal angulations.

94
 With patient supine on a trolley or a bucky
table, the head is raised on non-opaque pad.
 The head is immobilized in this position.
 Cassette with grid is supported vertically
against the lateral aspect of the head including
the vertex & cervical vertebral upto three.
CR: It is directed horizontally centered
midway b/w glabella & external occipital
protuberance.

95
Lateral Horizontal Bean

96
Positioning:
Patient supine on trolley, adjust the head to
bring orbito-meatal line at right angle to the
cassette placed under head with grid.

CR: It is directed at an angle 30˚ towards the

feet midway b/w two EAM.

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Mainly the Cervical and Lumber vertebral got
affected by trauma.

INTRODUCTION:
 Cervical spine injuries can be critical.
 The occurrence is very common.
 In west ,Roadside accidents accounts for 32- 57% of
c-spine injuries.
 In rural region ,mostly c-spine injuries due to fall,
sporting accidents and slip from mountain tops.
 Technologists play a critical role in evaluation of c-
spine trauma by directing the entire extent and
type of c-spine injury.
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1. Cervical Spine fractures:
 Most of the cervical spine fractures occur at two
levels.
 1/3rd of the fractures occur at the level of C2.
 1/2 of the fractures occur at the level of C6 –C7.
 Atlas is the least common fracture site.

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 BASIC PROJECTION:
AP VIEW CROSS TABLE LATERAL

100
Positioning:
 With the patient supine the cassette is supported
vertically against the shoulder and centered at the
level of thyroid cartilage prominence.
 The patient's shoulders are depressed.

CR: - Directed at Rt. Angles to the cassette at a

point vertically below the prominence of thyroid
cartilage at the level of mastoid process.

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Cross Table Lateral Projection

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 OPEN MOUTH VIEW: -

OBLIQUE VIEWS: - To view laminae &

foraminae.

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Lateral (Horizontal Beam) view:
Positioning:
 The trolley is placed adjacent to the vertical bucky.
 Adjust the position of the trolley so that the lower
costal margin of patient coincide with the vertical
line of bucky.

CR: It is directed to the centre of the cassette.

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105
 Control of infection play an important
role in management of all patients,
especially following surgery & nursing
of premature babies.
 To prevent the spread of infection ,
local established protocols should be
adhered to by staff coming into contact
with patient for example:-hand
washing b/w patients & the cleanliness
of equipment used for radiographic
examination.

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 The radiological technologist should wear
 Sterilized gown.
 Face mask.
 Sterile gloves when touching the patient.
 Over shoes before entering these areas.

 Cassette should be cleaned & covered with sterile

sheet.

 X-ray equipment used in ICU, Cardiac surgery

&special care baby unit should ideally be dedicated
units and they should be cleaned with antiseptic
solution before being moved into infection. 107
1. Accurate collimation of the x-ray beam using light
beam diaphragm with additional lead masking within
the primary field balanced on top of the incubator.
2. It is our responsibility to ensure that the holders hands
are not in the primary beam.

3. The abdomen should be included in a chest radiograph

only if a assessment of catheters or relevant pathology
is present. In this case, male gonad should be protected.

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4. An accurate exposure chart a/c to infant weight
should be available.
5. All mobile equipment should have a dose area
product meter.
6. From safety point of view, Incubator of child to
be examined should always be away from the
Incubators of other babies.

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 This is of paramount importance.
 The radiological technologist is responsible for
ensuring that nobody enters the controlled area
during the exposure of the patient.
 The radiological technologist give appropriate
advice to ward staff in a clear & distinct
manner to avoid accidental exposure to
radiation.
 Any one assisting in an examination must be
protected from scatter radiation by use of lead
apron.

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 Use of inverse square law, with staff standing
as far away as possible from the unit and
outside the radiation field, should be made
when making an exposure.
 Lead protective shields may be used as
backstops when using a horizontal beam to
limit the radiation field.
 Exposure factors used for the examination
should be recorded, enabling optimum results
to be repeated. Patients tend to be X-rayed
frequently when under intensive care.

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1. Don’t move the patient when are on stretcher or backboard
until ordered to do so by the physician incharge of patient.

2. Ensure that correct patient & correct region are being

examined.

3. Ensure that equipment used should be in good working

order and be capable of giving good results when used
correctly.

4. Using pads, sandbags and other immobilizing device, the

patient or part should be immobilized in as comfortable a
position as possible and the shortest possible exposure
time used to avoid having to repeat the examination due to
patient movement.
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5. Radiographer must take care that a carefully planned
routine is carried out so that the examination does not have
to be repeated owing to faulty technique.

6. The field of radiation should be limited to minimum

necessary by use of cones & diaphragms.

7. Fastest possible screens and film consistent with the required

image quality should be used .

8. Take special care to make sure that the more radiation

sensitive regions are excluded from the beam of radiation
whenever possible . For example the use of gonad shields &
the modification of projections to reduce irradiation of lens
of eye or the thyroid gland.

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Trauma patient’s present a wide variety of challenges
for you as a radiographer. The nature of injury to the
patients and the patient’s condition require you to be
a knowledgeable radiographer. Technical knowledge
combine with creativity is require to provide to
physician with the necessary diagnostic information
to treat the patient,
So the trauma patient must be handle carefully
at the time of taking radiograph under the trauma
rules which include the special case in case of trauma
patients. General radiation safety measure must be
combine with Speed & Accuracy.

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