UCSD Musculoskeletal Radiology

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Plain Film Protocols

MUSCULOSKELETAL RADIOGRAPHY

 


 

!For acute injuries, follow trauma protocol or other methods as directed by Radiologist.                      

 

!Use the smallest image receptor possible for each exposure. 

 

!If patient has internal fixators/prosthesis, always include the entire length of the fixator/prosthesis.

 

!ONLY ONE EXPOSURE PER RECEPTOR.

 

!ALWAYS USE GONADAL SHIELDING WHENEVER PRIMARY BEAM  IS WITHIN 5 CM OF GONADS.

 

 

UPPER EXTREMITIES

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

FINGERS – for second through fifth digits.  For thumb series, see next entry.

IDXRad exam code: 73140/2nd/3rd/4th/5th

 

1.         PA Hand

 

8x10 or 10x12 LW

 

Pronate hand onto receptor, include all digits on image. Flatten hand on receptor whenever possible.

 

CR perpendicular to base of third (3rd) metacarpal

 

2.         Oblique of digit

 

8x10 LW

 

Rotate hand laterally 45E, separate fingers

 

CR perpendicular to proximal PIP

 

3.         Lateral of digit

 

8x10 LW

 

Rotate hand into lateral position, separate affected finger and place closest to image receptor

 

CR perpendicular to proximal PIP

 


 

 

 

UPPER EXTREMITIES  (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

THUMB

IDXRad exam code: 73140/1st

 

1.         PA Hand

 

8x10 or 10x12 LW

 

Pronate hand onto receptor, include all digits on image. Flatten hand on receptor whenever possible.

 

CR perpendicular to base of third (3rd) metacarpal

 

2.         Lateral thumb

 

 

8x10 LW

 

Rotate hand laterally 45E, separate fingers

 

CR perpendicular to proximal PIP

 

3.         AP thumb

 

8x10LW

 

Rotate hand into supine position, separate affected finger and place posterior surface closest to image receptor

 

CR perpendicular to proximal PIP

 

HAND   (Include the wrist on all hand images.)

IDXRad exam code: 73130

 

1.         PA hand

 

8x10 or10x12 LW

 

Pronate hand onto receptor.  Flatten hand whenever possible and include wrist in collimation.

 

CR perpendicular to the base of third (3rd) metacarpal

 

2.         Oblique hand

 

8x10 or 10x12 LW

 

Rotate hand laterally 45E, separate fingers

 

CR perpendicular to third metacarpal

 

3.         Lateral hand

 

8x10 or 10x12 LW

 

Rotate hand 90E into true lateral position, thumb parallel to image receptor, fingers "fanned" to avoid superimposition.

 

CR perpendicular to second metacarpal

 

 

UPPER EXTREMITIES (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

HAND - Arthritis survey

IDXRad exam code: 73120

 

1.         PA of each hand

 

8x10 LW

 

Pronate hand, flex fingers to position wrist closer to image receptor.

 

CR perpendicular to base of third metacarpal

 

2.         AP Norgaard projection (Ball catcher's position)

 

10x12 CW

 

Place both hands on the image receptor.  Supinate hands into 45E oblique. 

 

CR perpendicular to level of third metacarpal

 

WRIST - Non-trauma, infection

IDXRad exam code: 73100

 

1.         PA

 

8x10 LW

 

Pronate hand, flex fingers to position wrist closer to image receptor.

 

CR perpendicular to midcarpals

 

2.         Lateral

 

8x10 LW

 

Rotate hand and wrist 90E, elbow flexed 90E

 

CR perpendicular to midcarpals

 

3.         Ulnar oblique

 

8x10 LW

 

Rotate hand and wrist laterally 45E, elbow flexed 90E

 

CR perpendicular to midcarpal


 

 

UPPER EXTREMITIES (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

WRIST - Trauma

IDXRad exam code: 73110

 

1.         PA

 

8x10 LW

 

Pronate hand, flex fingers to position wrist closer to image receptor.

 

CR perpendicular to midcarpals

 

2.         Lateral

 

8x10 LW

 

Rotate hand and wrist 90E, elbow flexed 90E, epicondylar line perpendicular to image receptor

 

CR perpendicular to midcarpals

 

 

3.         Ulnar oblique

 

8x10 LW

 

Rotate hand and wrist laterally 45E, elbow flexed 90E

 

CR perpendicular to midcarpal

 

4.         Radial oblique

 

8x10 LW

 

Rotate hand and wrist medially 45E, elbow flexed 90E

 

CR perpendicular to midcarpals

 

5.         Navicular view

 

8x10 LW

 

Pronate hand, have patient move hand laterally as much as possible without lifting or rotating forearm, epicondylar line perpendicular to image receptor

 

CR angled 20E toward elbow, centered to scaphoid

ELBOW  (Non-trauma, chronic injuries and infection)

IDXRad exam code: 73070

 

1.         AP

 

10x12 LW

 

Supinate forearm, fully extended

 

CR perpendicular to elbow joint

 

2.         Lateral

 

10x12 LW

Flex elbow 90E, have forearm and humerus in the same plane, wrist and elbow in true lateral, epicondylar line perpendicular to image receptor

 

CR perpendicular to elbow joint

UPPER EXTREMITIES  (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

Elbow - Trauma

IDXRad exam code: 73080

 

1.         AP

 

10x12 LW

 

Pronate hand, extend arm so that the forearm and humerus are in the same plane.

 

CR perpendicular to elbow joint

 

2.         Lateral

 

10x12 LW

 

Flex elbow 90E, have forearm and humerus in the same plane, wrist and elbow in true lateral, epicondylar line perpendicular to image receptor

 

CR perpendicular to elbow joint

 

 

3.         Lateral oblique (radial)

 

10x12 LW

 

Forearm fully extended, supinate hand and laterally rotate arm to form an angle of 45E off image receptor 

 

CR perpendicular to elbow joint

 

4.         Medial oblique (ulnar)

 

10x12 LW

 

Forearm fully extended, pronate hand

 

CR perpendicular to elbow joint

 

5.         Radial head view

 

8x10 LW

 

Elbow in true lateral, flexed 90E, humerus and wrist in same plane, epicondylar line perpendicular to image receptor

 

CR angled 45E towards humerus, enters at radial head

HUMERUS

IDXRad exam code: 73060

 

1.         AP - include BOTH  joints

 

14x17 LW

 

Patient supine or upright, supinate hand and arm, fully extended

 

CR perpendicular to mid-humerus

 

2.         Lateral - include    BOTH joints

 

14x17LW

 

Patient supine or upright, abduct arm and flex elbow 90E, rotate humerus 90E from AP

 

CR perpendicular to mid-humerus

 

UPPER EXTREMITIES  (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

SHOULDER  (Non trauma, chronic pain)

IDXRad exam code: 73030 - two or more views

 

1.         AP - internal rotation

 

10x12 CW

 

Patient supine or upright, rotate arm internally until epicondyles of humerus are perpendicular to image receptor

 

CR angled 20E caudad, passing through glenoid fossa

 

2.         AP - external rotation

 

10x12 CW

 

Patient supine or upright, rotate arm externally to place epicondyles parallel to image receptor

 

CR angled 20E caudad, passing through glenoid fossa

 

SHOULDER  (Trauma, acute injuries -  perform the following procedures)

IDXRad exam code: 73030 two or more views

 

 

 

1.         AP - neutral position

 

10x12 CW

 

Patient supine or upright, do not rotate arm for acute injuries.

 

CR perpendicular to glenoid fossa

 

2.         Lateral "Y" view

 

10x12 LW

 

Patient PA , rotate patient's non-affected side away from image receptor until scapula is perpendicular to image receptor, the affected shoulder usually forms angle of 60E with image receptor

 

CR perpendicular to mid vertebral border of scapula

 

3.         Axillary view, as tolerated by patient

 

8x10 CW

 

Abduct arm 90E away from body, supinate hand, rotate head away, place receptor firmly against shoulder and neck

 

CR perpendicular to glenoid fossa

 


 

UPPER EXTREMITIES  (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

SHOULDER - ADDITIONAL VIEWS   (As directed by radiologist.)

IDXRad exam code: 73020 one view only

 

Supraspinatus view (Bigliani method)

 

8x10 LW

 

Patient PA , rotate patient's non-affected side away from image receptor until scapula is perpendicular to image receptor, the affected shoulder usually forms angle of 60E with image receptor

 

 

CR angled 15E caudad, enters at coracoid process

CLAVICLES

IDXRad exam code: 73000

 

1.         AP - 0 tube angle

 

10x12 CW

 

Patient supine or upright with no rotation, MSP perpendicular to image receptor.

 

CR perpendicular to mid-clavicle

 

2.         AP - axial view

 

10x12 CW

 

Patient supine or upright with no rotation, MSP perpendicular to image receptor

 

CR angled 20E cephalic

ACROMIOCLAVICULAR JOINTS (AC)  Use 72" SID for this procedure.

IDXRad exam code: 73010

 

1.         AP - without weights

 

14x17 CW to include both joints or two 8x10 CW for each AC joint

 

Patient upright in AP position, equal weight on both feet, no rotation, arms relaxed at sides. patient to suspend respiration during exposure.  Always include both joints bilaterally.

 

CR perpendicular to AC joints

 

2.         AP- with weights

 

14x17 CW for both joints or two 8x10 CW for each joint

 

 

Follow non-weight bearing protocol, add 10 pound weights to each hand.   Always include both joints bilaterally.  Strap weights to wrist for optimum images.

 

CR perpendicular to AC joints

UPPER EXTREMITIES  (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

SCAPULA

IDXRad exam code: 73010

 

1.         AP

 

10x12 LW

 

Patient supine or upright, rotate patients body until scapula rests on table, abduct affected arm 90E away from trunk, flex elbow for patient comfort

 

CR perpendicular to mid-scapula

 

2.         Lateral

 

10x12 LW

 

Patient PA, recumbent or erect, rotate patient's non-affected side away from Bucky until the scapula is lateral, angle of affected shoulder and image receptor will be approximately 60E

 

CR perpendicular to mid-scapula

 

 

LOWER EXTREMITIES

 

TOES

IDXRad exam code: 73660

 

1.         AP foot

 

10x12 LW

 

Place sole of foot flat on receptor in dorsal plantar position

 

CR angled 5E-10E to base of third (3rd) metatarsal

 

2.         Medial oblique of affected toe(s)

 

10x12 LW

 

From AP position, internally rotate foot 45E

 

CR perpendicular to proximal PIP joint

 

3.         Lateral of toe(s)

 

10x12 LW

 

Rotate foot towards affected side, until foot is in lateral position

 

CR perpendicular to proximal PIP joint

 


 


 

 

LOWER EXTREMITIES (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

FOOT - perform all three views for trauma and non-trauma cases

IDXRad exam code:  73630

 

1.         AP (Dorsoplantar)

 

10x12 LW

 

Plantar surface of foot against image receptor, with no rotation

 

CR angled 5E-10E to base of third (3rd) metatarsal

 

2.         Medial Oblique

 

10x12 LW

 

Rotate foot medially 45E

 

CR perpendicular to base of third (3rd) metatarsal

 

3.         Lateral-Mediolateral projection

 

10x12 LW

 

Rotate foot laterally until foot is in lateral position

 

CR perpendicular to base of third (3rd) metatarsal

 

OS CALCIS

IDXRad exam code: 73650

 

1.         Lateral calcaneus

 

8x10 LW

 

Place foot in mediolateral position

 

CR perpendicular to mid-calcaneus

 

2.         Axial plantodorsal

 

8x10 LW

 

Patient’s leg fully extended, ankle flexed to place plantar surface horizontal and perpendicular to image receptor

 

CR angled 40E with long axis of the foot, to base of 3rd metatarsal

 


 

LOWER EXTREMITIES (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

ANKLE

IDXRad exam code: 73610

 

1.         AP

 

8x10 LW

 

Place foot so that plantar surface of foot is perpendicular to image receptor, in vertical position

 

CR perpendicular to ankle joint

 

2.         Mortise

 

8x10 LW

 

From AP position, rotate leg medially 10E -15E until intermalleolar line is parallel to image receptor

 

CR perpendicular to ankle joint

 

3.         Mediolateral lateral

 

8x10 LW

 

From AP position, rotate leg, foot and ankle towards affected side until foot is in lateral position

 

CR perpendicular to medial malleolus

 

TIBIA FIBULA

IDXRad exam code: 73590

 

1.         AP

 

14x17 on diagonal

 

Patient supine, leg fully extended, no rotation on pelvis or leg, femoral epicondylar line parallel to image receptor

 

CR perpendicular to mid-tibia

 

2.         Mediolateral lateral

 

14x17 on diagonal

 

Patient to lie on affected side, ensure affected leg is in lateral position with the unaffected side anterior., femoral epicondylar line perpendicular to image receptor

 

CR perpendicular to mid-tibia

 


 

 

LOWER EXTREMITIES (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

KNEE  - Non -trauma, chronic injury

IDXRad exam code: 73560

 

1.         AP

 

10x12 LW

 

Patient supine, leg extended, femoral epicondyles parallel to table.  Perform erect if standing images ordered.

 

CR perpendicular to 1 cm inferior to patellar apex

 

2.         Mediolateral lateral

 

10x12 LW

 

Patient to lie on affected side, unaffected leg anterior to part, knee flexed about 45E

 

CR angled 5E cephalic, to a point 1 cm distal to epicondyle

 

KNEE - Trauma, acute injury

IDXRad exam code: 73562

 

1.         AP

 

10x12 LW

 

Patient supine, leg extended, femoral epicondyles parallel to table.  Perform erect if standing images ordered.

 

CR perpendicular to 1 cm inferior to patellar apex

 

2.         Mediolateral lateral

 

10x12 LW

 

Patient to lie on affected side, unaffected leg anterior to part, knee flexed about 45E

 

CR angled 5E cephalic, to a point 1 cm distal to epicondyle

 

3.         Lateromedial Cross-table lateral

 

10x12 CW

 

Patient supine, part raised above tabletop, do not flex knee for cross-table lateral.

 

Horizontal CR perpendicular to knee joint

 


 

 

LOWER EXTREMITIES (continued)

 

ADDITIONAL VIEWS, KNEES, upon radiologist's approval

IDXRad exam code: 73560 for two views, 73562 for more than two views

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

4.         Medial oblique

 

10x12 LW

 

From AP position, rotate knee medially 45E

 

CR perpendicular to 1 cm inferior to patellar apex

 

5.         Lateral oblique

 

10x12 LW

 

From AP position, rotate knee laterally 45E

 

CR perpendicular to 1 cm inferior to patellar apex

 

PATELLA

IDXRad exam code: 73560 for two views, 73562 for more than two views

 

1.         PA

 

8x10 LW

 

Patient supine or upright, femoral epicondyles parallel to image receptor, leg fully extended

 

CR perpendicular to mid-patella

 

2.         Mediolateral Lateral

 

8x10 LW

 

Patient to lie on affected side, with unaffected leg anterior, knee flexed 5E

 

CR perpendicular to mid-patella

 

3.         Merchants View - bilateral patellar view

 

14x17 CW

 

Patient supine with legs flexed over Merchant board

30E-45E, knees close together, image receptor to lie on distal tibias

 

CR angled caudal parallel to patella, enters at joint space

 

4.         Axial projection (Sunrise method)

 

8x10 LW

 

Patient prone, knee flexed to maximum patient ability

 

CR angled cephalic so that there is a 45E with tibia

 


 

LOWER EXTREMITIES (continued)

 

FEMUR - Include both joints on images

IDXRad exam code: 73550

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

1.         AP - to include knee and distal femur

 

14x17 LW

 

Patient supine, leg fully extended, femoral epicondyles parallel to image receptor

 

CR perpendicular centered to include knee joint

 

2.         AP - to include hip and proximal femur

 

14x14 LW

 

Patient supine, leg fully extended, femur rotated medially 15 degrees for true AP projection of hip

 

CR perpendicular to include hip joint

 

3.         Mediolateral Lateral - to include knee

 

14x17 LW

 

Patient to lie on affected side, unaffected leg anterior to part, flex knee 45E

 

CR perpendicular to include knee joint

 

4.         Lateral frog-leg hip

 

14x14 LW

 

Patient supine, flex knee and abduct leg 40 degrees from vertical, so femur forms an angle of 50 degrees with image receptor.

 

CR perpendicular to femoral neck

 

HIPS - Non-trauma, chronic injury

IDXRad exam code: 73510

 

1.         AP Pelvis

 

14x17 CW

 

Patient supine, MSP perpendicular to image receptor, legs fully extended and internally rotated 15E

 

CR perpendicular to MSP 2" inferior to ASIS

 

2.         Frog-leg lateral of affected hip

 

10x12 LW or size needed to include prosthesis

 

Patient supine with knee flexed and knee abducted 40 degrees from vertical.  For older patients, you may oblique body slightly toward side of interest.

 

CR perpendicular to femoral neck

 

LOWER EXTREMITIES (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

HIPS - Trauma, acute injury

IDXRad exam code: 73510

 

1.         AP Pelvis

 

14x17 CW

 

Patient supine, MSP perpendicular to image receptor, legs fully extended and internally rotated 15E

 

 

CR perpendicular to MSP 2" inferior to ASIS

 

2.         Translateral lateral of affected hip

 

10x12 CW or size needed for prosthesis

 

Flex and elevate unaffected leg, place receptor vertically on table lateral to affected hip.  Place receptor high enough to include femoral head.

 

Horizontal CR perpendicular to femoral neck

 

SACROILIAC JOINTS

IDXRad exam code: 72200

 

1.         AP Pelvis

 

14x17 CW

 

Patient supine, legs fully extended and internally rotated 15E

 

CR perpendicular to MSP 2" inferior to ASIS

 

2.         AP axial

 

10x12 LW

 

Patient supine, legs fully extended and internally rotated 15E

 

CR angled 20E cephalic to mid sacrum

 


 

LOWER EXTREMITIES (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

ACETABULUM (JUDET VIEWS) - include iliac crest to ischial tuberosities, collimate to affected side only.  (If ordered as follow-up films in OPR, position as oblique pelvis views and schedule as IDXRad exam code 72190.

IDXRad exam code: 72190                          

 

2.         Right Posterior Oblique (RPO)

 

14x14 LW

 

Rotate body into 45E RPO, include iliac crest and ischial tuberosities on image

 

CR perpendicular to affected hip joint

 

3.         Left Posterior Oblique (LPO)

 

14x14 LW

 

Rotate body into 45E  LPO, include iliac crest and ischial tuberosities on image

 

CR perpendicular to affected hip joint

 

PELVIS - include Inlet/Outlet views only if requested

IDXRad exam code: 72190

 

1.         AP Pelvis

 

14X17 LW

 

Patient supine, MSP perpendicular to image receptor, legs fully extended and internally rotated 15E

 

 

CR perpendicular to MSP 2" inferior to ASIS

 

2.         AP axial outlet view

 

14x17 LW

 

Patient supine in AP pelvis position, include iliac crest and ischial tuberosities on image

 

Male: CR angled 20E-30E cephalic to 2 cm superior to symphysis pubis

Female: CR angled  30E to 45E  cephalic

 

3.         AP axial inlet view

 

14x17 LW

 

Patient supine in AP pelvis position, include iliac crest and ischial tuberosities on image

 

Male: CR angled 20E-30E caudal to ASIS

Female: CR angled  30E to 45E  caudal


 

 


 

VERTEBRAL COLUMN

 

CERVICAL SPINE - ALWAYS include ALL views on new patients or following new injury.  For follow-up exams, the area of interest needs to be visualized.  If the area of interest is NOT C1-C2, the odontoid can be omitted. 

 

IDXRad exam code:  72040 = C-spine 2 or 3 views,  72050 = minimum of four views, 72052 = complete, including obliques and/or flexion extension views

 

Exams/Views to be done

 

Image receptor size

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

1.         AP

 

10x12 LW

 

Patient supine or upright, neck slightly extended with no rotation.  Mastoid tip should be superimposed on the gonion.

 

CR angled 10E cephalic to

C-4

 

2.         Lateral  (Use 72" SID whenever possible)

 

10x12 LW

 

Patient supine or upright, exposure taken on expiration, shoulders relaxed to lower humeral heads.  Use sandbags to maximize visualization of entire C-spine.

 

CR perpendicular to C4, include C1- T1 on image.

 

3.         AP odontoid     (open mouth)

 

8x10 LW

 

Patient supine or upright, open mouth, flex neck to have line from upper teeth to skull base perpendicular to table.

 

CR parallel to the line from the teeth to base of the skull.

 

4.         Swimmer's view - to visualize C7-T1

 

10x12 LW

 

Patient supine or upright, place left side against image receptor, vertically raise left arm and relax right arm to side of the body.

 

CR perpendicular to C4 (A 5E  caudal angle may be needed to separate shoulders.)

 


 

VERTEBRAL COLUMN - (continued)

 

CERVICAL SPINE - Flex-ext series.  Requesting physician MUST be present to remove collar and supervise neck movement.  Need to include from C1-T1.  For follow-up flex-ext exams, a neutral lateral is not needed.

 

IDXRad exam code:  72040 = if C-spine flex-ext views only, 72052 = complete including flex-ext views

 

Exams/Views to be done

 

Image receptor size

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction


 

 

1.         Flexion Lateral

 

10x12 LW

 

Patient supine or upright, exposure taken on expiration, shoulders relaxed to lower humeral heads.  Patient to flex neck to maximum without assistance

 

CR perpendicular to C4, include C1- T1 on image.

 

2.         Extension Lateral

 

10x12 LW

 

Patient supine or upright, exposure taken on expiration, shoulders relaxed to lower humeral heads.  Patient to extend neck to maximum without assistance

 

CR perpendicular to C4, include C1- T1 on image.

 

CERVICAL SPINE - Additional views - to be done on approval of bone radiologist.  To reduce thyroid exposure, perform anterior obliques whenever possible.

 

IDXRad exam code: 72050 = complete C-spine

 

1.         Right anterior oblique

 

10x12 LW

 

Place patient into 45E  RAO

 

CR angled 10E -15E  caudal to C-4

 

2.         Left anterior oblique

 

10x12 LW

 

Place patient into 45E  LAO

 

CR angled 10E -15E  caudal to C-4

 


 

VERTEBRAL COLUMN - (continued)

THORACIC SPINE

 

IDXRad exam code: 72070 = T-spine, 2 views, 72072 = T-spine, 3 views, 72074 = minimum of four views

 

 

 

 

 

1.         AP

 

14x17 LW

 

Patient supine or upright, exposure taken on inspiration.  If performed with patient supine, flex knees to reduce thoracic kyphosis.

 

CR perpendicular to T7, 3"(7.5cm) below sternal angle

 

2.         Lateral

 

14x17 LW

 

Patient in left lateral, erect or recumbent, breathing technique preferred, otherwise on inspiration.

 

CR perpendicular to T7

 

THORACIC SPINE - additional views.  For follow-up flex-ext exams, a neutral lateral is not needed.

 

IDXRad exam code: 72072 = T-spine, 3 views, 72074 = minimum of four views

 

1.         Swimmer's

 

10x12 LW

 

Patient supine or upright, place left side against image receptor, vertically raise left arm and relax right arm to side of the body.

 

CR perpendicular to C4 (A 5E  caudal angle may be needed to separate shoulders.)

 

2.         Right Posterior Oblique

 

14x17 LW

 

From AP position, rotate right side up from image receptor 70E

 

CR perpendicular to T7

 

3.         Left Posterior Oblique

 

14x17 LW

 

From AP position, rotate left side up from image receptor 70E

 

CR perpendicular to T7


 

 

VERTEBRAL COLUMN - (continued)

 

Exams/Views to be done

 

Image receptor size

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

4.         Flexion lateral

 

14x17 LW

 

Patient in left lateral, erect or recumbent, in maximum flexion.  Breathing technique preferred, otherwise on inspiration.

 

CR perpendicular to T7

 

5.         Extension lateral

 

14x17 LW

 

Patient in left lateral, erect or recumbent, in maximum extension.  Breathing technique preferred, otherwise on inspiration.

 

CR perpendicular to T7

 

LUMBAR SPINE -    Include AP pelvis if patient has not had a pelvis within the last three months.  Do NOT schedule and bill patient for a separate single view pelvis unless it is specifically requested by clinician. 

 

IDXRad exam code: 72100 = L-spine, 2 or 3 views, 72110 = L-spine minimum of four views, 72114 = complete, including bending

 

1.         AP pelvis

 

14x17 CW

 

Patient supine, legs fully extended and internally rotated 15E

 

CR perpendicular to MSP 2" inferior to ASIS

 

2.         AP L-spine

 

14x14 LW

 

Patient supine  or standing.  If supine, knees flexed to reduce lordotic curvature.

 

CR perpendicular to L2, 3 cm superior to iliac crest.

 

3.         Lateral L-spine

 

14x14 LW

 

Patient in left lateral position, knees flexed, use supports to place spine parallel to table.

 

CR perpendicular to iliac crest.

 


 

VERTEBRAL COLUMN - (continued)

 

LUMBAR SPINE  - additional views.  For follow-up flex-ext exams, a neutral lateral is not needed.

 

IDXRad exam code: 72110 = L-spine minimum of four views, 72114 = complete, including bending

 

Exams/Views to be done

 

Image receptor size

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

1.         Right Posterior Oblique L-spine

 

14x14 LW

 

From AP position, rotate body to the right 45E

 

CR perpendicular to iliac crest, 2" (5cm) medial to ASIS

 

2.         Left Posterior Oblique L-spine

 

14x14 LW

 

From AP position, rotate body to the left 45E

 

CR perpendicular to iliac crest, 2" (5cm) medial to ASIS

 

3.         Flexion Lateral L-spine

 

14x14 LW

 

Patient in lateral position, maximum patient flexion

 

CR perpendicular to iliac crest

 

4.         Extension Lateral     L-spine

 

14x14 LW

 

Patient in lateral position, maximum patient extension

 

CR perpendicular to iliac crest

 

5.         L5-S1 Lateral

 

10x12 LW

 

Patient in lateral position

 

CR perpendicular to L5-S1 3cm inferior to iliac crest

 


 

VERTEBRAL COLUMN - (continued)

 

Exams/Views to be done

 

Image receptor size

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

SACRUM

 

IDXRad exam code: 72220 = sacrum and coccyx, minimum of two views

 

1.         AP

 

10x12 LW

 

Patient supine, hips and knees flexed

 

CR angled 20E cephalic to MSP midway between ASIS and symphysis pubis

 

2.         Lateral

 

10x12 LW

 

Patient in left lateral position, knees flexed

 

CR perpendicular to ASIS and mid-sacrum

 

COCCYX

 

IDXRad exam code:72220 = sacrum and coccyx, minimum of two views

 

1.         AP

 

8x10 LW

 

Patient supine with hips and knees flexed

 

CR angled 10E caudal to 2" (5cm) superior to symphysis pubis

 

2.         Lateral

 

8x10 LW

 

Patient in left lateral position

 

CR perpendicular to ½" (1cm) superior to coccyx tip

 


 

VERTEBRAL COLUMN - (continued)

 

SCOLIOSIS -           Use compensating filter and breast shields when possible, refer to patent's personal technique reference card.  If a reference card cannot be found, create one and place in the file.  ALWAY include C7-S1.

 

IDXRad exam code: 72069

 

Exams/Views to be done

 

Image receptor size

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

1.         PA (Use 72" SID)

 

14x36 LW

 

Patient erect or prone

 

CR perpendicular to include C7-S1 on image receptor

 

2.         Lateral (Use 72" SID)

 

14x36 LW

 

Patient in left lateral position, elevate both arms to right angles to trunk

 

CR perpendicular to include C7-S1 on image receptor

 

SCOLIOSIS - additional views

 

IDXRad exam code:72069

 

1.         AP best bend, right

 

14x36 LW

 

Patient supine or upright with maximum spine flexion laterally to the right

 

CR perpendicular to include C7-S1

 

2.         AP best bend, left

 

14x36 LW

 

Patient supine or upright with maximum spine flexion laterally to the left

 

CR perpendicular to include C7-S1

 


 

 

MISCELLANEOUS BONE STUDIES

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor

 

Central ray (CR) direction

 

SCAN-O-GRAM:      Place and tape scanogram ruler under patient before positioning.  Must include ruler markings from iliac crest to ankle!  Use two (2) 14x17 receptors.  DO NOT MOVE PATIENT ON THE RULER ONCE YOU HAVE BEGUN IMAGING!  Show both right and left joint spaces.  In some cases, the joint spaces may not be in the same transverse plane.  In these cases, center between the two joints.  ALWAYS use one receptor for each exposure.  DO NOT expose two views on one receptor.

 

IDXRad exam code: 76040

 

1.         AP - wing of pelvis

 

14x17 CW

 

Patient supine, legs fully extended in AP position

 

CR perpendicular to iliac crest

 

2.         AP - hip joint

 

14x17 CW

 

Patient supine, legs fully extended in AP position

 

CR perpendicular to hip joint

 

3.         AP - knee joints

 

14x17 CW

 

Patient supine, legs fully extended in AP position

 

CR perpendicular to knees

 

4.         AP - ankle joints

 

14x17 CW

 

Patient supine, legs fully extended in AP position

 

CR perpendicular to ankles

 

LEG ALIGNMENT - include joints from hip to ankle

IDXRad exam code: 76040

 

  AP only (72" SID)

 

14x56 LW

 

Patient supine or upright, equal weight in each foot

 

CR perpendicular to include hip to ankle joints

 


 

 

MISCELLANEOUS BONE STUDIES (continued)

 

Exams/Views to be done

 

Image receptor

 and orientation

 

Patient position relative to image receptor                       

 

Central ray (CR) direction

 

 

ARTHRITIS JOINT SURVEY - Review each request with Bone radiologist for imaging.  See previous sections for positioning criteria.

 

1.  AP/Lateral C-spine

 

2.  AP/Lateral

    T-spine

 

3.  AP/Lateral L-spine

 

4.  AP bilateral shoulders

 

5.  AP/Lateral bilateral

     knees

         


 

 

 

6.  AP pelvis

 

 

7.  AP, Oblique and  Lateral bilateral hands (to

     include wrists)         

 

 

8.  AP/Lateral bilateral

     ankles (include heel on

     lateral views)

 

9.  AP/Oblique bilateral feet

 

METASTATIC BONE SURVEY - Review each request with Bone radiologist for imaging.

 

1.  Left lateral skull

 

3.  AP/Lateral

     C-spine

 

5.  AP/Lateral L-spine

 

7.  AP/Lateral bilateral

      humerus (to include

     shoulders)

 

9.  AP/Lateral bilateral

     forearms

 

2.  AP ribs, bilaterally

 

4.  AP/Lateral

    T-spine

 

6.  AP pelvis

 

8.  AP/Lateral bilateral

     femurs

 

10. AP/Lateral bilateral

      tibia/fibulas

 

CHONDROCALCINOSIS - Recurrent arthritis survey (pseudogout).  Review each request with Bone radiologist for imaging.

 

1.  AP/Lateral bilateral

     hands to include wrists

 

2.  AP pelvis

 

3.  AP/Lateral bilateral

      knees

 

Knees are the most affected joints in pseudogout.

 

 Date this page was last updated: 06/28/2005 06:37:00 AM

 

 

 

 

MUSCULOSKELETAL

 

Write time of exam on all bone films.  Films taken in surgery, portables, trauma, E.D. often have multiple studies; times are needed to sort films.  For acute injuries, follow trauma protocol or other methods as directed by Radiologist.

 

If patient has internal fixators/prosthesis, always include the entire length of the fixator/prosthesis.

 

USE GONADAL SHIELDING WHENEVER PRIMARY BEAM IS WITHIN 5 CM OF GONADS.

 

 

UPPER EXTREMITIES

Exams/Views to be done

Cassette size, type

 and orientation

     Patient position relative to film

Central ray (CR) direction

FINGERS  (For acute injuries, film the PA hand and oblique/lateral of the affected digit.)  For thumb series, see next entry.

1.  PA Hand

½ of 10x12 LW, LFC, tabletop

Pronate hand onto extremity cassette, include all digits on radiograph. Flatten hand in cassette whenever possible.

CR perpendicular to base of third (3rd) metacarpal

2.  Oblique of digit

1/4 of 10x12 LW

Rotate hand laterally 45E, separate fingers

CR perpendicular to proximal PIP

3.  Lateral of digit

1/4 of 10x12 LW

Rotate hand into lateral position, separate affected finger and place closest to film

CR perpendicular to proximal PIP

THUMB

Follow protocol above.  PA hand position shows the thumb in oblique position.  Series will include:

1.  PA hand          2.  Lateral Thumb          3.  AP thumb


 

 

UPPER EXTREMITIES (continued)

Exams/Views to be done

Cassette size, type

 and orientation

     Patient position relative to film

Central ray (CR) direction

HAND   (Include the wrist on hand films.) 

1.  PA hand

½ of 10x12 CW

Pronate hand onto extremity cassette.  Flatten hand whenever possible and include wrist in collimation.

CR perpendicular to the base of third (3rd) metacarpal

2.  Oblique hand

½ of 10x12 CW

Rotate hand laterally 45E, separate fingers

CR perpendicular to third metacarpal

3.  Lateral hand

8x10 LW

Rotate hand 90E, thumb parallel to film, fingers "fanned" to avoid superimposition

CR perpendicular to second metacarpal

WRIST  (Non-trauma)

1.  PA

½ of 8x10 CW

Pronate hand, flex fingers to position wrist closer to film.

CR perpendicular to midcarpal

2.  Lateral

½ of 8x10 CW

Rotate hand and wrist 90E, elbow flexed 90E

CR perpendicular to midcarpal

WRIST - (Acute injuries)

1.  PA

½ of 8x10 CW

Same as described above for chronic conditions. 

Same as described above.

2.  Lateral

½ of 8x10 CW

Same as described above for chronic conditions. 

Same as described above.

3.  Ulnar oblique

½ of 8x10 CW

Rotate hand and wrist laterally 45E, elbow flexed 90E

CR perpendicular to midcarpal

WRIST - (Acute injuries)

4.  Radial oblique

½ of 8x10 CW

Pronate hand, have patient move hand laterally as much as possible without lifting or rotating forearm

CR angled 20E toward elbow, centered to scaphoid

5.  Navicular view

 

 

 

 

FOREARM

1.  AP  (Include BOTH

     joints on each film.)

½ of 11x14 LW

Supinate hand and forearm. 

CR perpendicular to mid-forearm

2.  Lateral - flex elbow 90E

½ of 11x14 LW

Flex elbow 90E,  rotate hand and wrist to lateral position; have hand, elbow and humerus in the same plane. 

CR perpendicular to mid-forearm

ELBOW  (Non-trauma, chronic injuries)

1.  AP

½ of 10x12 CW

Supinate forearm, fully extended

CR perpendicular to elbow joint

2.  Lateral

½ of 10x12 CW

Flex elbow 90E, have forearm and humerus in the same plane, wrist and elbow in true lateral 

CR perpendicular to elbow joint


 

 

ELBOW  (Trauma, acute injuries)

1.  AP

½ of 10x12 CW

Same as described above for chronic conditions. 

Same as described above.

2.  Lateral

½ of 10x12 CW

Same as described above for chronic conditions. 

Same as described above.

3.  Lateral oblique (radial)

½ of 10x12 CW

Forearm fully extended, supinate hand and laterally rotate arm to form an angle of 45E off film 

CR perpendicular to elbow joint

4.  Medial oblique (ulnar)

½ of 10x12 CW

Forearm fully extended, pronate hand

CR perpendicular to elbow joint

5.  Radial head view

8x10 LW

Elbow in true lateral, flexed 90E, humerus and wrist in same plane

CR angled 45E towards humerus, enters at radial head

 

HUMERUS

1.  AP - include BOTH  

     joints

14x17 LW

Patient supine or upright, supinate hand and arm, fully extended

CR perpendicular to mid-humerus

2.  Lateral - include

     BOTH joints

14x17LW

Patient supine or upright, abduct arm and flex elbow 90E, rotate humerus 90E from AP

CR perpendicular to mid-humerus


 

 

SHOULDER  (Non trauma, chronic pain)

1.  AP - internal rotation

10x12 CW

Patient supine or upright, rotate arm internally until epicondyles of humerus are perpendicular to film

CR perpendicular to glenoid fossa

2.  AP - external rotation

10x12 CW

Patient supine or upright, rotate arm externally to place epicondyles parallel to film

CR perpendicular to glenoid fossa

SHOULDER  (Trauma, acute injuries -  perform the following procedures)

 

1.  AP - neutral position

10x12 CW

Patient supine or upright, do not rotate arm.

CR perpendicular to glenoid fossa

2.  Lateral "Y" view -

    patient placed PA

10x12 LW

Patient PA , rotate patient's non-affected side away from film until scapula is perpendicular to film, the affected shoulder usually forms angle of 60E with film

CR perpendicular to mid vertebral border of scapula

SHOULDER - ADDITIONAL VIEWS   (As directed by radiologist.)

1.  Axillary view

8x10 CW

Abduct arm 90E away from body, supinate hand, rotate head away, place cassette firmly against shoulder and neck

CR perpendicular to glenoid fossa

3.  Supraspinatus view

     (Bigliani method)

8x10 LW

Follow positioning protocol for Lateral "Y" view

CR angled 15E caudad, enters at coracoid process

 


 

 

CLAVICLES

1.  AP - 0 tube angle

10x12 CW

Patient supine or upright with no rotation

CR perpendicular to mid-clavicle

2.  AP - axial view

10x12 CW

Patient supine or upright with no rotation

CR angled 20E cephalic

ACROMIOCLAVICULAR JOINTS (AC)

1.  AP - non-weight

             bearing

(Use 72" SID)

14x17 CW to include both joints or two 8x10 CW for each AC joint

Patient upright in AP position, equal weight on both feet, no rotation, arms relaxed at sides. patient to suspend respiration during exposure.  Always include both joints bilaterally.

CR perpendicular to AC joints

2.  AP - weight bearing

 

Follow non-weight bearing protocol, add 10 pound weights to each hand.   Always include both joints bilaterally.  Strap weights to wrist for optimum films.

CR perpendicular to AC joints

SCAPULA

1.  AP

10x12 LW

Patient supine or upright, rotate patients body until scapula rests on table, abduct affected arm 90E away from trunk, flex elbow for patient comfort

CR perpendicular to mid-scapula

2.  Lateral

10x12 LW

Patient PA, recumbent or erect, rotate patient's non-affected side away from Bucky until the scapula is lateral, angle of affected shoulder and film will be approximately 60E

CR perpendicular to mid-scapula


 

 

LOWER EXTREMITIES

TOES  (AP view of foot to be done with acute injuries, otherwise AP of affected toe only.)

1.  AP foot

½ of 10x12 LW

Place sole of foot flatly on cassette in dorsal plantar position

CR angled 5E-10E to base of third (3rd) metatarsal

2.  Medial oblique of

     affected toe(s)

1/4 of 10x12 LW

From AP position, internally rotate foot 45E

CR perpendicular to proximal PIP joint

3.  Lateral of toe(s)

1/4 of 10x12 LW

Rotate foot towards affected side, until foot is in lateral position

CR perpendicular to proximal PIP joint

FOOT

1.  AP (Dorsoplantar)

½ of 10x12 LW

Plantar surface of foot against film, with no rotation

CR angled 5E-10E to base of third (3rd) metatarsal

2.  Medial Oblique

½ of 10x12 LW

Rotate foot medially 45E

CR perpendicular to base of third (3rd) metatarsal

3.  Medial-Lateral Lateral

½ of 10x12 LW

Rotate foot laterally until foot is in lateral position

CR perpendicular to base of third (3rd) metatarsal


 

 

FOOT (WEIGHT- BEARING)

1.  AP

½ of 10x12 LW

Patient upright, follow positioning protocol above

CR angled 5E-10E to base of third (3rd) metatarsal

2.  Lateral

½ of 10x12 LW

Patient upright, follow positioning protocol above

Horizontal CR perpendicular to base of third (3rd) metatarsal

3.  Oblique

½ of 10x12 LW

Patient upright, foot in Dorsoplantar position

CR angled 45E medially to base of third (3rd) metatarsal

OS CALCIS

1.  Lateral calcaneus

½ of 8x10 CW

Place foot in mediolateral position

CR perpendicular to mid-calcaneus

2.  Axial plantodorsal

½ of 8x10 CW

Place plantar surface perpendicular to film

CR angled 40E with long axis of the foot, to base of 3rd metatarsal

ANKLE

1.  AP

½ of 10x12 CW

Place foot so that plantar surface of foot is perpendicular to film

CR perpendicular to ankle joint

2.  Mortise

½ of 10x12 CW

From AP position, rotate leg medially 10E -15E until intermalleolar line is parallel to film

CR perpendicular to ankle joint

3.  Mediolateral lateral

8x10 LW

From AP position, rotate leg, foot and ankle towards affected side until foot is in lateral position

CR perpendicular to medial malleolus

TIBULA FIBULA

1.  AP

14x17 on diagonal

Patient supine, leg fully extended, no rotation on pelvis or leg

CR perpendicular to mid-tibia

2.  Mediolateral lateral

14x17 on diagonal

Patient to lie on affected side, ensure affected leg is in lateral position with the unaffected side anterior to part

CR perpendicular to mid-tibia

 

KNEE  - Non -trauma, chronic injury

 

 

 

 

1.  AP

10x12 LW

Patient supine, leg extended, femoral epicondyles parallel to table.  Perform erect if standing films ordered.

CR perpendicular to 1cm inferior to patellar apex

2.  Mediolateral lateral

10x12 LW

Patient to lie on affected side, unaffected leg anterior to part, knee flexed about 45E

CR angled 5E cephalic, to a point 1cm distal to epicondyle

KNEE - Trauma, acute injury

1.  AP

10x12 LW

Same as described above.

Same as described above.

2.  Mediolateral lateral

10x12 LW

Same as described above.

Same as described above.

3.  Lateromedial Cross

     table lateral

10x12 CW

Patient supine, part raised above tabletop, do not flex knee for cross-table lateral.

Horizontal CR perpendicular to knee joint


 

 

KNEE ADDITIONAL VIEWS - upon radiologist's approval

4.  Medial oblique

10x12 LW

From AP position, rotate knee medially 45E

CR perpendicular to 1 cm inferior to patellar apex

5.  Lateral oblique

10x12 LW

From AP position, rotate knee laterally 45E

CR perpendicular to 1 cm inferior to patellar apex

 

PATELLA

1.  PA

8x10 LW

Patient supine or upright, femoral epicondyles parallel to film, leg fully extended

CR perpendicular to mid-patella

2.  Mediolateral Lateral

8x10 LW

Patient to lie on affected side, with unaffected leg anterior, knee flexed 5E

CR perpendicular to mid-patella

3.  Merchants View -

     bilateral patellar view

11x14 CW

Patient supine with legs flexed over Merchant board

30E-45E, knees close together, film to lie on distal tibias

CR angled caudal parallel to patella, enters at joint space

4.  Axial projection

     (Sunrise method)

8x10 LW

Patient prone, knee flexed to maximum patient ability

CR angled cephalic so that there is a 45E with tibia


 

 

FEMUR - Include both joints on films if possible

1.  AP - to include knee

     and distal femur

14x17 LW

Patient supine, leg fully extended, femoral epicondyles parallel to film

CR perpendicular centered to include knee joint

2.  AP - to include hip

      and proximal femur

11x14 LW

Position patient and part exactly as above if performing two exposures.

CR perpendicular to include hip joint

3.  Mediolateral Lateral -

     to include knee

14x17 LW

Patient to lie on affected side, unaffected leg anterior to part, flex knee 45E

CR perpendicular to include knee joint

4.  Lateral frog-leg hip

11x14 LW

Patient supine, flex knee and fully abduct leg

CR perpendicular to femoral neck

 

HIPS - Non-trauma, chronic injury

1.  AP Pelvis

14x17 CW

Patient supine, legs fully extended and internally rotated 15E

CR perpendicular to MSP 2" inferior to ASIS

2.  Frog-leg lateral of

     affected hip

10x12 LW or

11x14 LW to include prothesis

Patient supine with knee flexed and knee fully abducted.  For older patients, you may oblique body slightly toward side of interest.

CR perpendicular to femoral neck


 

 

HIPS - Trauma, acute injury

1.  AP Pelvis

14x17 CW

Follow positioning protocol above for AP pelvis.

Same as above AP pelvis

2.  Translateral lateral of

     affected hip

10x12 CW or

11x14 CW

Flex and elevate unaffected leg, place cassette vertically on table lateral to affected hip.  Place cassette high enough to include femoral head.

Horizontal CR perpendicular to femoral neck

SACROILIAC JOINTS

1.  AP Pelvis

14x17 CW

Follow positioning protocol above for AP pelvis.

Same as above AP pelvis

2.  AP axial

10x12 LW

Patient in AP position.

CR angled 20E cephalic to mid sacrum

 

ACETABULUM (JUDET VIEWS) - include iliac crest to ischial tuberosities, collimate to affected side only

1.  AP Pelvis - if not taken

     previously for current

     injury

14x17 CW

Follow filming protocol for AP pelvis above

2.  Right Posterior Oblique

11x14 LW

Rotate body into 45E RPO, include iliac crest and ishial tuberosities on film

CR perpendicular to affected hip joint

3.  Left Posterior Oblique

     (LPO)

11x14 LW

Rotate body into 45E  LPO, include iliac crest and ishial tuberosities on film

CR perpendicular to affected hip joint


 

 

PELVIS - include Inlet/Outlet views only if requested

1.  AP Pelvis

14X17 LW

Follow AP pelvis protocol above

2.  AP axial outlet view

14x17 LW

Patient supine in AP pelvis position, include iliac crest and ischial tuberosities on film

Male: CR angled 20E-30E cephalic to 2 cm superior to symphysis pubis

Female: CR angled  30E to 45E  cephalic

3.  AP axial inlet view

14x17 LW

Patient supine in AP pelvis position, include iliac crest and ischial tuberosities on film

Male: CR angled 20E-30E caudal to ASIS

Female: CR angled  30E to 45E  caudal

 

MISCELLANEOUS BONE STUDIES

SCAN-O-GRAM:  Place and tape scanogram ruler under patient before positioning.  Must include ruler markings from iliac crest to ankle!  Use two (2) 14x17 cassettes.  DO NOT MOVE PATIENT ON THE RULER ONCE YOU HAVE BEGUN FILMING!  Show both right and left joint spaces.  In some cases, the joint spaces may not be in the same transverse plane.  In these cases, center between the two joints.

1.  AP - wing of pelvis

½ of 14x17 CW

Patient supine, legs fully extended in AP position

CR perpendicular to iliac crest

2.  AP - hip joint

½ of 14x17 CW

Same as above

CR perpendicular to hip joint

3.  AP - knee joints

½ of 14x17 CW

Same as above

CR perpendicular to knees

4.  AP - ankle joints

½ of 14x17 CW

Same as above

CR perpendicular to ankles

       


 

 

LEG ALIGNMENT - include joints from hip to ankle

  AP only (72" SID)

14x56 LW

Patient supine or upright, equal weight in each foot

CR perpendicular to include hip to ankle joints

 

ARTHRITIS JOINT SURVEY - Review each request with Bone radiologist for filming.  See previous sections for positioning criteria.

1.  AP/Lateral C-spine

2.  AP/Lateral

    T-spine

3.  AP/Lateral L-spine

4.  AP bilateral shoulders

5.  AP/Lateral bilateral knees

5.  AP/Lateral

   bilateral knees

6.  AP pelvis

6.  AP/Lateral bilateral ankles (include heel on     lateral views)

7. AP/Oblique/Lateral bilateral hands (to  include wrists)

8.  AP/Oblique bilateral feet

 

MISCELLANEOUS BONE STUDIES (continued)

METASTATIC BONE SURVEY - Review each request with Bone radiologist for filming.

1.  Left lateral skull

3.  AP/Lateral

     C-spine

5.  AP/Lateral L-spine

7.  AP/Lateral bilateral

      humerus (to include

     shoulders)

9.  AP/Lateral bilateral

     forearms

2.  AP ribs, bilaterally

4.  AP/Lateral

    T-spine

6.  AP pelvis

8.  AP/Lateral bilateral

     femurs

10. AP/Lateral bilateral

      tibia/fibulas


 

 

CHONDROCALCINOSIS - Recurrent arthritis survey (pseudogout).  Review each request with Bone radiologist for filming.

1.  AP/Lateral bilateral

     hands to include wrists

2.  AP pelvis

3.  AP/Lateral bilateral

      knees

Knees are the most affected joints in pseudogout.