Clark\'s Companion Essential Guides - Clark\'s Pocket Handbook for Radiographers
Radiographic positioning is a crucial aspect of diagnostic imaging, involving proper patient placement to obtain accurate and high-quality radiographic images. It requires knowledge of anatomical landmarks, standardized techniques, and the use of positioning aids to ensure consistent and reproducib...
Lecture notes Introduction to Radiographic Imaging Clark's Companion Essential Guides - Clark's Pocket Handbook for Radiographers
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PACEMAN
P - Positioning….Patient correctly positioned?
A - Area…….Area of interest covered?
C - Collimation & Centering…..Image properly collimated?
E - Exposure….. Exposure Index (EI)? Correct contrast, density and penetration?
M - Marker…..Radiographic marker? Correct one?
A - Artefact…. Artefacts aka jewellery. metal
N - Need for repeat….Need anything repeated?
Positioning - DP Hand
● Patient seated at the end of the table with elbow flexed at 90 degrees
● Patient’s legs must not be placed under the table for radiation purposes
● A sheet of lead-rubber can be positioned over the lower abdomen and thighs to cover the gonads (depends
on protocol)
● Forearm should be rested on table so the palmar hand can come into direct contact with the imaging
receiver
● The fingers should be extended and slightly separated
● Remove artefacts before the examination
● If using Direct Radiography (DR) the hand should be placed close to the centre of the cassette
● If using Computed Radiography (CR) then a 24x30 cassette is chosen, Two projections on one cassette
○ Used in landscape position with one half used for each of 2 exposures
● Palmar surface in contact with image receiver (IR)
● Central Ray → Vertical to IR, centred on 3rd metacarpophalangeal joint
● Distance → 100cm FFD/SID
● Collimate → All four sides of hand and carpal bones
Positioning - Oblique Hand
● From the DP position rotate the entire hand and wrist laterally 45 degrees
○ Flex the fingers slightly so thumb and finger tips touch IR (Make OK sign and then slightly
separate)
● Central Ray → Centred to 2nd/ 3rd metacarpophalangeal joint
● Distance → 100cm FFD/SID
● Collimate → All 4 sides to outer margins of hand and wrist
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,Positioning - Lateral Hand
● From the DP position rotate the entire hand and wrist laterally 90 degrees
● Fingers should be extended as much as possible
● Thumb should be abducted so as not to overly the fingers
● Central Ray → Head of 2nd metacarpophalangeal joint
● Distance → 100cm
● Collimate → All 4 sides to outer margins of hand and wrist
Positioning - DP Finger
● Same as DP Hand
● The affected finger should be extended
● Central Ray → Relevant metacarpophalangeal joint or interphalangeal joint
● Distance → 100cm FFD/SID
● Collimation → Include adjacent finger to help identify finger and identify abnormality
Positioning - Lateral Finger
● 3rd-5th → Fingers extended, positioned with its medial aspect in contact/ close to the IR
● Use a foam pad to separate fingers if patient unable
● 2nd → Patient forearm internally rotated, extended elbow
● Central Ray → Relevant metacarpophalangeal or proximal interphalangeal joint
● Distance → 100cm FFD/ SID
Positioning - DP or PD Thumb
● Patient is seated parallel to the x-ray table or patient facing away from the table
● A sheet of lead-rubber MUST be positioned over the lower abdomen and thighs to cover the gonads
● The arm should be extended across the table and internally rotated until the posterior aspect of the thumb
comes into contact with IR
● Centre Ray → First metacarpophalangeal joint
● Distance → 100cm FFD/ SID
● Collimate → Trapezium and all 4 sides of thumb
Positioning - Lateral Thumb
● Start with the hand pronated (palm against the IR) and thumb abducted
● With the fingers slightly arched the hand should be rotated internally until the thumb is in true lateral position
● Centre Ray → First metacarpophalangeal joint
● Distance → 100cm FFD/ SID
● Collimate → Trapezium and all 4 sides of thumb
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, Positioning - DP Wrist
● Legs must not be placed under the table
● Affected arm abducted and extended across the Image Receiver (IR)
● The elbow is flexed 90 degrees and anterior aspect of forearm placed in contact with IR and wrist direct
contact
● Radial and ulnar styloid processes are equidistant from the IR
● Fingers should be relaxed
● Centre ray
○ Centre midway between the radial and ulnar styloid processes
● Distance → 100cm FFD/SID
● Collimate
○ Include metacarpal-phalangeal joints, carpals, metacarpals and the distal third of the radius and
ulna
○ Soft tissues outline of the wrist
Positioning - Lateral Wrist
● Affected arm abducted and extended across the IR with elbow flexed at 90 degrees
● The forearm should be externally rotated through 90 degrees until the medial aspect of the wrist comes into
contact with the IR
● Further external rotation (5 degrees) may be necessary to superimpose the radial and ulnar styloid
processes
● Central Ray
○ Centre to the radial styloid process
● Distance → 100cm FFD/SID
● Collimate
○ Include metacarpal-phalangeal joint, metacarpals, carpometacarpal joints, carpals,
radio/ulnar-carpal joint, distal radio-ulnar joint, distal third of radius and ulna
○ Soft tissues dorsal and palmar
Positioning - DP Ulnar Deviation (Scaphoid)
● The elbow is flexed to about 90 degrees and anterior aspect of forearm placed in contact with IR with the
wrist in direct contact
● Radial and ulnar styloid processes are equidistant from the IR
● From the DP wrist position the hand should be abducted - flexed towards the ulna (opens up the joint
spaces around the scaphoid)
● Central Ray
○ Centre midway between the radial and ulnar styloid processes
● Distance → 100cm FFD/SID
● Collimate
○ All 4 sides to include the carpal region and wrist
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