January 27, 2015

Certified X-ray Tech and Radiologist

X-ray Tech and Radiologic Technogist Overview:

X-ray Tech is responsible for performing a examination in radiology departments in accordance to the standard protocol of department when patient conditions allows for producing a readable radiograph. X ray technicians also know as xray technologist, radiologic technologist or radiographer. The responsility necessary for the tech to know is that normal anatomy and normal anatomy variations is essential knowledge so that patient can be accurately position, and radiographic characteristics of various number of common abnormalities, although is not responsible for reading radiograph, explaining the cause, diagnosis and treatment of disease, but technicians professional responsibility is to produce an image that makes the abnormality evident on radiograph. The technician also take the medical history of patient, explains what to expect and answers the patient's questions when radiographic imaging is needed to patients.

Difference between Associate X-ray tech and BS Radilogic Technogist:
Xray tech can only be work with convetional X-ray machine and Fluoroscopy only while bachelors degree on radiologic technology can work with a variety of imaging systems including:
  • Conventional X-ray Machines
  • Ct scan machines
  • Magnetic Resonance Imaging (MRI) Machines
  • Fluoroscopy
  • Digital Mammography Machines

What are Radiologist?

The radiologist is a physician who is board certified to read, or interpret x-ray examinations. As the demand for the radiologist time increases, the available time is lessen to devote to the technnical aspects of radiology. This situation make the radiologist more dependent on the radiologic technician or x-ray tech to perform the technical aspects of patient care.

Radiology Trainings for Clinical Specialties Summary

Medical School - 4 years
Radiology Residency - 4 years (1 year clinical)

Nuclear Medicine - 4 years
Radiation Therapy (Oncology) - 4 years

After Residency:
Subspecialty Fellowship  - 1 year 
Research - 1 year
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Temporomandibular Joint (TMJ)

What is Temporomadibular Joint?

The TMJ is forms by two joints in the jaw and aticulates to each other, the madibular fossa recieves the condyles of mandible and this articulation is called the Temporomandibular joint (TMJ).
TMJ is a synovial type joint (a joint that is movable type and it is common in mammals) because both hinge type and gliding joint type is present.

Temporomadibular Disorders and Diagnosis:

The common disorder of TMJ is the temporomandibular syndrome is a dysfunction of the TM joint. Some others are Arthritis, Erosions, Painful joint due to habitual clenching of the teeth and inborn abnormalities at birth.
Radiographic examinations and other machines in radiology is the common diagnostic medium for its diagnosis.

TMJ X-Ray (Temporomandibular Joint)

A radiographic examination with the use of ionizing radiation produced by the x ray machines and stores the image in a radiographic film. These are some projection and Methods use when taking TMJ.

Panoramic Tomography, Pan Tomography and Rotational Tomography

Panoramic Tomogram Temporomandibular Joint is Demonstrated
It provides an image of entire mandible including lateral view free of superimposition and termed use to designate the technique employed to produce a tomogram of curve body parts. It is also the most comfortable way for patient who also suffer in severe mandibular or TMJ trauma before and after splint wiring of the teeth application, but must be first taken with conventionsal radiographs in AP, PA or a verticosubmental views to constitute fragment position. This technique is very useful for general survey study of various dental abnormalities and become a add-on to on conventional periapical radiographs rather than replacing it.


Symptoms of TMJ is depending on disorder happen to patient, Usually pain in the jaw and muscle pain located beneath the jaws are the most common symptoms. Some symptoms are pain in neck, painful movement of jaw, clicking sounds when opening and closing mouth and for severe cases locking of jaws are possible.

Common Treatments:

Avoiding highly movements of joints, eating soft foods and applying cold compress to affected area are home remedies treatment that is effective to relief its pain. When pain becomes worsen seek for a specialist/doctor (orthodontist) advice and ask for other options in treatment. Pain releiver, Surgery, TMJ exercise, Splints, and possible TMJ implants are the usual recommendation of physician.

Nightguards / Mouthguards

Is a stabilization splints that a doctor will recommend for oral appliance, stabilization splints or bite guard is the common name, it is widely used for treating TMJ disorder. And It is made of plastic that guards and fits into the upper or lower teeth. If symptoms continues or worsen tell your doctor immediately  may other treatment is needed in addition to splint.
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January 19, 2015

Online Guides to Radiology Schools and Accredited Programs

Radiologic Technologist are the one who manipulate radiation that exit in x ray tube by adjusting, the technique factor for a specified projection, depending on anatomy to be examine. Radiologic Technicians and X ray tech
have slightly diffirences but these two work in diagnostic imaging with the help of penetrating x-ray coming from x-ray machines tubes. Radiologic technician are 4 year degree graduate and passed the licensure exam taken on their country, while x-ray technician two to three year graduate and associated in radiologic tech, but they have also a licensure examination as a requirements after school.

Furthermore, programs like ct scan, mammography for female, ultrasound, MRI and others in nuclear medicine, can be specialized so that they can work on these special area in radiology. There many schools and universities that offer this specialization and some are online programs.

These are some Radiology Degree and Accreditations:

Certificate in Radiography - It can complied within two years of learning, which may includes basic diagnostic on x ray films or interpreting it, radiation patient safety is also taught and a certificate is given to you after completion the required learning as proof of qualification.

Associate Degree in Radiology - These includes patient safety, digital imaging, and actual trainings to qualify Associate in radiology. 3 years in schools for theory and a 1 year internship in hospital x-ray departments and radilogy clinics. Licensure examination are also given.

Bachelor's Degree in Radiology - A 3 years studying in school and 1 year of intership on hospital are required to finish a bachelors degree. BS in Radiologic Technology can manipulate other imaging machine such as MRI, Computed Tomography (CT) scan and Ultrasound. But need to enroll to a training programs.

Masters Degree in Radiology - After finishing Bachelors degree, other technicians prefer to enroll an masteral degree in radiology for continues learning and others are required in teaching. It needs 3 years to finish, case study must be complied to qualify.

Doctorate Degree in Radiology - it is the highest level of education, finishing doctorate can teach on his/her specified field (Radiology) and became the chairperson on its related field. It is also highest to Masters degree and has a tittle of PhD.

Basic Salary of Radiologic Technologist:

The average salary is depending on country where will you preferring to work. in 2013 according to google, it reaches $56,760 for a median salary. Technician earn more than the clinical laboratory technician (medical technicians) earns only $40,240. The highest pay where in the metropolitan countries like Vallejo, California has a basic salary of $91,400, Oakland, California is $89,530 and   San Jose, California is $85,550. These country has other licensure examination required to work in their areas.



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January 13, 2015

Ultrasound (Sonography) of the Brain (Cranial) - Neonatal

Ultasound of the brain of the newborn or neonatal is an integral part of their treatment in the Neonatal Intesive Care Unit (NICU), it can done through the fontanels of the skull in newborn, because this fontanel are still open and can be use as a window to view the neonatal's brain through ultrasound. The procedure allows rapid evaluation and screening of premature infants for intracranial hemorrhage. It is adanvantage rather than the MRI and CT because it is highly portable, cheap, requires no sedation to patient and has no ionizing radiation.
Ultrasound can also be important in the studies and follow up of hydrocephalus. Cranial sutures also may be evaluated and studied, and assisting in diagnosis of craniosynosotosis (premature suture closure).
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TMJ X-Ray - Axiolateral Oblique - Modified Law Method

Axiolateral Oblique Projection - Modified Law Method

Pathology Demonst
rated are Abnormal relationship or rang of motion between condyle and TM fossa is shown. Usually these projection taken in open and closed mouth positions.

Technical Factors and Patient Position:

Image receptor size is 18 x 24 or 8 x 10 inches, Lengthwise
Moving or Stationary Grids
70 to 80 kV range, mAs is 14 and use small focal spot.
Axiolateral Oblique Projection TMJ (Supine Closed Mouth)
Patient is in erect or semiprone position but erect is preferred in this projection/method if patient condition allows. The lateral portion of the head is rested against IR, table or bucky, with the area of interest closest to image receptor.

Part Position, Central Ray, Collimation and Respiration:

IPL is perpendicular to cassette to prevent tilting.
Midsagittal plane is parallel to cassette.
IOML is perpendicular to front edge of cassette.
Rotate head from lateral position (face down towards bucky or cassette by 15°)
midsagittal plane of the head is rotated 15° from flat surface or plane of cassette.
Angle central ray 15° caudad centered to 4 cm superior to upside EAM. (to pass through downside TMJ).
Image receptor and collimation must be align and centered.
SID is 40 inches.
Collimate on all side of IR to yield a field size of apprx. 4 inches square.
Suspended respiration during exposure to minimize patient motion.

Radiographic Criteria on Modified Law Method:

Open Mouth Axiolateral Oblique Projection

Structure Shown:

The Temporomadibular joint nearest to cassette is visible. Closed mouth position demonstrate condyle within mandibular fossa.
In open mouth the condyle moves to the anterior margins of the madibular fossa.
Correct Patient Positioning:
The TMJ or the area of interest is clearly demonstrated with superimposition of opposite TMJ. (15° rotation of head from lateral prevent this superimposition.)
Cervical spine is not superimposed to the Temporomandibular Joint interest.

Correct Collomation and Central Ray:

TMJ of interest is in the middle of image.

Correct Exposure or Technic Factor use:

Contrast and density are enough to visualize TMJ.
Sharp bony margins indicates no motion.
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Temporomandibular Joint (TMJ) XRAY - AP AXIAL (Modified Towne Method)

AP Axial Projection - Modified Towne Method - TMJ

Taking TMJ Temporomandibular joints axial projection if patient has possible fracture do not attempt to open mouth.
AP AXIAL TMJ (Closed Mouth Position)

Pathology Demonstrated and Technical Factors TMJ joint.

Fractures and abnormal relationship/ range of motion between condyle and temporomadibular fossa.
Image receptor used 18 x 24 cm or 8 x 10 inches, put in crosswise.
Moving or stationary grid.
70 to 80 kV range, mAs 16, and Small focal spot.
if AEC is used, density is reduced to 20% - 30%.

Patient Position and Part Position:

Remove all objects from head and neck like metallic and plastics,
Patient position when taking TMJ joint is ERECT or SUPINE.
Posterior part of of the skull is rested on table or bucky.
Orbitomeatal Line (OML) is perpendicular to image receptor or bucky,
To make IOML perpendicular to CR angle central ray by 7°.
MSP of patient is in midline to avoid head rotation and tilt.

Central Ray and Collimation:

Central ray is 35° caudad from OML or 42° from IOML.
Central Ray is directed to 1 inch anterior level of temporomandibular joint or 2inches to EAM.
Image receptor is in the center of Central Ray.
SID 40 inches.
Collimate on region of interest.

Patient Respiration:

Suspended during exposure.

When patient conditions allows, these projections are taken open and close mouth for comparison on somes departments protocol and to best demonstrate temporomadibular fossae and joints increase cnetral ray angulation by 7°.

Radiographic Criteria:

Structure must be shown on these projection are Condyloid processes of mandible a
AP Axial Projection (Closed Mouth)
nd temporomandibular joint and fossae.
Correct Positioning:

Patient with no rotation indicates the ff:

Condyloid process is shown symmetrical, lateral to the cervical spine, clear visualization of condyle
and TM fossae relationship.

Collimation and Central Ray:

Condyloid process of the mandible and the TMJ and fossa are in collimated field. and TMJ must be in center.

Correct Technic Factor used:

Contrast and density are sufficient to visualize condyloid process and temporomadibular fossa.
Sharp bony margins indicate no motion.
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January 8, 2015

Radiation Oncology (Therapy) - Radiologic Technology Facts

Radiation oncology is a field of medicine that radiation is the main source of treating cancer, including computers and healthcare professional. The second leading to death in U.S is cancer according to American Cancer Society. It was projected last 2007 that 1.4 million in the U.S were given a diagnosis of cancer. Approximately half of these patients will going to have a radiation therapy for cure, for preventing recurrence or for relieving symptoms also known as palliation.
A low to high energy ionizing radation is use to destroy the cancer cells while the normal tissue are preserve. There are three types of radiation use for therapy, the Photon, gamma rays, and electron, these are delivered in many type of treatment or ways depending on the location of cancer cells. Teletherapy or long-distance therapy and brachytherapy for short distance therapy are the primary mechanism for delivering the therapeutic and palliative radiation.

Radiation Theraphy Equipment and Machine:

Cobalt-60 was developed in 1950's and were commonly used for external-beam therapy. Cobalt-60 emits an average energy of 1.25 MeV gamma rays use for treatment. Cobalt-60 units were slowly replaced by linear accelerators in the beginning of 1970's. The linear accelerators produce photon and electron treatment beams with varying energy ranges from 6 to 20 MeV. The ability to treat with photons or electrons at different energies has led to the development of treatment protocols that are based on type, size, and location of the cancer cells.

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January 7, 2015

Intravenous Pyelogram (IVP) - Radiologic Technologist

In radiology Intravenous Pyelogram is the radiographic examination of renal pelvis using contrast media. Because pyelo mean renal pelvis. The common x-ray examination of the urinary system is the intravenous urogram.
The intravenous urogram visualizes the minor and major calyces, renal pelves, ureters and urinary bladder with the help of radiographic dye (contrast media). This examination is a true functional test because contrast media molecules are quickly removed from the bloodstream and excreted totally by our normal kidney.
The common term for this examination in radiology department is intravenous pyelogram (IVP) but this term is not accurate because this procedure because intravenous urogram (IVU) visualizes more than just the renal pelvis.

What is the Purpose of Intravenous Pyelogram / Intravenous Urogram?

  • To opacify the urinary system's collecting portion.
  • To access the functional ability of the two kidneys.
  • Evaluate a pathology or anatomic anomalies in the urinary system.

Contraindication of Intravenous Pyelogram:

15 Minutes Interval
  • Hyper sensitivity to iodinated contrast media.
  • Anurea
  • Multiple Myeloma
  • Diabetes
  • Severe hepatic or renal disease
  • Congestive heart failure.
  • Pheochromocytoma
  • sickle cell anemia
  • Renal Failure acute ot chronic
  • Taking the following medicines: metformin, Glucophage, Avandament, Glucovance Diofen, Fortament, Riomet, Actosplus Met, Diabex or Metagrip. This medication must not take for 48 hours after the completion of the iodinated contrast media study.
  • Take Clinical History of Patient
  • Sensitivity Test of Contrast Media
  • Take Scout Film Radiograph
  • Inject The Contrast Media
  • Start the time of injection, time and amount of contrat media

  • 1 Minute - Nephrogram or Nephrotomogram
  • 5 Minutes - AP Supine
  • 10 to 15 Minutes - AP SUPINE
  • 20 Minutes - Posterior Obliques (RPO and LPO)
  • Postvoid - It can be taken prone or erect.
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Digital Mammography Advantages and Film-Screen Mammogram Machine

Computed Radiography Mammography  (Digital Mammography, Mammogram)
Computed Radiography or digital radiology can be used for mammography mostly like same way as it is general radiography with its IP and image processor. The cassette used in Computed Radiology has image plates that also can be use in existing mammographic old systems.

Advantage of Computed Radiology Mammography:

Operating Cost:

Computed Radiography plates can be exposed many times before they have to be replaced.  In other words it is more economical because the cost of film used in old mammogram machine and associated wet processing are now eliminated.

Teleradiology Options:

The images in Computed mammogram can be retrieved and transferred to remote locations for reading and consultation. Teleradiology is the term used or Telemammography is sometimes used because images can be transmitted electronically.

Archiving and PACS options:

The image can be stored electronically after interpreting at any desired location through PACS. The hard copy films of mammography that where it stores are now eliminated because images are incorporated in existing PACS. Outside referring physicians may have now access to these digital images from mammography, but depending on the extend of PACS. Duplication, Transport, Space in radiology storage, and permanent loss and damage are now not required. Images are readily available and it is more convenient for both Patients and Physicians.

Image Manipulation:

Image in Computed and Digital Mammography can be manipulated in post-processing. The number of repeats images are reduced, provided that the correct positioning and exposure factors were used. Fewer retakes lead to low radation to patient and less patient discomfort.


Film screen mammography is the standard in breast imaging. There are some and great benefit of  fim-screen mammography, exellent image quality with low radiation dose to patients, Women can undergo mammogram regularly. Good screen film mammography has the ability to to see fine detail, edge sharpness and soft tissue. However digital mammography is rapidly developing and as in all digital imaging has a certain unique advantages over the standard film screen mammography.
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January 6, 2015

Endoscopy - ERCP Procedure - Radiologic Tech Guide

Endoscopic Retrograde Cholangiopacreatography (ERCP) - this endoscopic procedure is used to diagnose a pathology in the biliary and pancreas. It is useful in diagnostic method when the biliary ducts at the ampulla are not obstructed and dilated.
Flouroscopy is used to perform the ERCP by passing a fiberoptic endoscope through the mouth into the duodenum. Local anesthesia is sprayed in the throat of the patient that causes temporary paresis of pharyngeal to ease the passage of the endoscope, food and drinks are prohibited for at least 1 hour after the procedure. After the procedure, the patient food may be withheld for up to 10 hrs. to minimize irritation to the stomach and small intestine.

The endoscopy technician locates the hepatopancreatic ampulla (ampulla of vater), a small cannula is inserted through the endoscpe and directed into the ampulla.
Left Lateral Position: Cannulation Procedure

Once the cannula is place properly, the contrast medium is injected into the common bile duct. Perform fluoroscopy and take spot radiograph as patient is positioned.

Oblique Spot Film Radiograph:
To prevent overlap or superimposition of the common bile duct and the pancreatic duct.
Note: The injected contrast media will drain from normal ducts within approximately 5 minutes, spot film must be taken immediately.
Spot Film PA Projection
The contrast medium that is used will depend on the preference of the radiologist or gastroenterologist. Dense contrast agents opacify small duct, but may obscure some small stones. A more diluted contrast is recommended. A sensitivity test history of a patient is not necessary it's use for ERCP. However patient must be watched carefully for a reaction to the contrast media used during ERCP.
The ERCP procedure is usually indicated when both clinical and radiographic findings indicated abnormalities in the biliary system and pancreas.
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AP Axial Sacroiliac joints Patient's position, Respiration, Pathology demonstrate shielding and shielding.

Taking sacroiliac joints in ap axial the patient is in supine position, provide pillow for head and knee support under knee for patient comfort. For patient position the legs is fully extended. Demonstrated pathology are dislocation or subluxation of the Sacroiliac joints (SI joints) and fracture. During exposure respiration is suspended to minimize patient motion. Use of gonadal shielding for males. For females it not possible to use lead shield (ovarian shielding) because it will directly obscure the area being radiograph.
sacroiliac position ap

What are the Technical and Central Ray Factors?

Image receptor size - 24 x 30 cm or 10 x 12 inches.
Moving or stationary grid are applicable.
85 kV decrease or increase by  5 kV depending on body habitus.
mAs 9.
Central Ray is 30° to 35° cephalad (towards the head).
Males requires 30° CR angulation.
Females requires 35° CR angulation, with an increase in the lumbosacral curve.
Central Ray is Directed to a middle point about 2 inches below the ASIS.
SID is 40 inches or 100 cm.

Collimation and Part Position:

Collimation is to area of interest but be sure that side of margins do not cut off sacroiliac joints.
Align the midsagittal plane to CR and to middle of x-ray table/ bucky / grided cassette.
Ensure that pelvis is not rotated.
ASIS table distance equal on both sides.
Angulated CR is directed or projected to middle of the IR.

sacroiliac radiograph with labelRADIOGRAPHIC CRITERIA:

Stucture Shown on Radiograph: Sacroiliac joints, L5 to S1 junction and the entire sacrum is evident.
Proper Patient Position: No rotation when spinous process of L5 is in middle of vertebral body and symmetric appearance of bilateral wings (ala) of sacrum.
Sacroiliac joints are equally distant from midline of vetebrae.

Collimation, CR, and Exposure Criteria: 

Correct Central Ray angulation when sacroiliac joints spaces and the L5 to S1 junction and sacral foramina should appear open.
Proper Collimation: Sacroiliac (SI) joints and the first two segments of sacrum must be in center of radiograph or in the collimated field.
Exposure Criteria: Optimal density should visualize all of the sacrum and the margins of the SI joints spaces.
Bony margins and trabecular markings should be visible and sharp, indication no motion.


If patient cannot assume the AP position (supine), patient can be taken in prone (PA Projection) with a reverse central ray agulation 30° to 35° caudad angle. The Central Ray (CR) will be centered to the level of L4 or slightly above the iliac crest.

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Pathology demonstrated when taking lateral position is a lateral view of coccyx and sacrum. The L5-S1 joints are also seen. These two are commonly together. A separate AP projection is necessary because of variance in tube angulation. but in this lateral projection can be taken with one exposure centering to include both the sacrum and coccyx. This projection is recommended to decrease in genital dose. High amounts of secondary and scatter radiation are generated in this projection. Close collimation is primary needed to reduce patient dose and achieve a high quality image.

Technical Factors:

Image receptor size is: 24 x 30 cm or 10 x 12 inches. Cassette in lengthwise.
Moving or stationary grid.
90 or add more or less 5 kV.
Lead mats on table behind patient to reduce scatter radiation to image receptor.
If coccyx is to be included, a boomerang-type filter is useful to ensure optimal density.
mAs 55
lateral view coccyx and sacrum

Shielding and Patient Position:

Shield gonads without obscuring area of interest for male patients.
Complete ovarian shielding on females may obscure a portion of sacrum in not correctly placed.
Position patient lateral recumbent, with a pillow for head.

Part Position:

Patients knee is flexed.
Place a support under waist and between knees and ankkles to maintain patient position and ensure comfort.
Align long axis of sacrum and coccyx to central ray and to midline of table or gird.
Ensure no rotation of body and pelvis for true lateral position.

Central Ray, Correct Collimation and Respiration:

Cental ray is perpendicular to image receptor.
Center CR 3 to 4 inches (8 to 10 cm) posterior to ASIS ( centering for sacrum).
IR is centered to CR.
SID is 40 inches or 100cm.
Collimation is in four-sided to area of interest.
Suspend breathing on expiration.
radiograph with lable

Radiographic Criteria | Lateral view Sacrum and Coccyx

Proper Patient position:  greater sciatic notches and femoral head are superimposed.
Correct Collimation and Central Ray: Sacrum and coccyx appear in center of Image receptor, with closely collimated field.
Exposure Criteria: Optimal contrast and density should clearly demonstrated the sacrum.
The coccyx may appear slightly overexposed, depending on patient size and filter use.
Sharp bony margins indicate no motion.

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December 20, 2014


When performing x-ray examination of the coccyx in ap axial projection, pathology and fractures of coccyx is demonstrated.

Note: The urinary bladder should be emptied before the procedure begins. Also patient may require to take a cleaning enema as ordered by the doctor to remove fecal material and gas in the colon.

Technical Factors:

  • Image receptor size - 24 x 30 cm or 10 x 12 inches film used. Lengthwise
  • Moving or stationary grid
  • 75 to 80 kV range or 85 to 90 kV but mAs is reduced.
  • mAs for 80 kV is 15 and 90 kV is 8.

Use of Shielding:

x ray coccyx
AP Coccyx 10° Caudad
  • For male patient use of gonadal shielding.
  • Ovarian shielding for females
  • Use of shielding in females is not possible without obscuring the area being examined.

Patient and Part Positioning:

  • Patient is in supine position, provide pillow for head support and legs are extended, with support under knees for patient comfort.
  • Midsagital plane is align to table or grid.
  • Ensure that the pelvis is not rotated.

Central Ray, Collimation and Respiration:

  • Angulate centeral rat 10° caudad towards the feet, to enter 2 inches in the upper symphysis pubis.
  • Image receptor is align to center ray.
  • SID of 40 inches used.
  • The four side of area of interest is well collimated.
  • Suspend breathing on expiration.

Notes: Increase central angle to 15° caudad if the curvature of the anterior coccyx is greater. palpation or as evidence on the lateral.
This may also be done in prone position if necessary to patient condition, in 10° cephalad angle.
Center central ray to coccyx by localizing the greater trochanter.

Radiographic Criteria | X-ray of Coccyx:

coccyx radiograph with labelAnatomy and Structure Shwown:

  • Coccyx free of self-superimposition and superimposition of symphysis pubis.

Patient Positioning:

  • Correct coccyx and central ray alignment demonstrate coccyx free of superimposition and projected superior to pubis.
  • Coccygeal segments should appear open on radiograph, if not they may be fused, or an increase on central ray angulation. (the greater the curvature of the coccyx, the greater is the angulation needed).
  • Coccyx should appear equal distant from lateral walls of the pelvic opening, this is an indication of correct positioning and no patient rotation.

Collimation, Central Ray and Exposure Factors:

  • The coccyx should be in the middle of collimated field or in the radiograph.
  • Optimal density and contrast demonstrate the coccyx.
  • Sharp bony margins indication of no motion.
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X-ray examination of the sacrum taken in AP axial projection, the Pathology and disease of sacrum is demonstrated.

Note: The urinary bladder should be emptied before this procedure begins. Also desirable is to have the lower colon free of gas and fecal material which may require a cleaning enema, as ordered by a doctor.

Technical Factors:

  • Cassette size - 24 x 30 cm or 10 x 12 inches, lengthwise
  • Moving or stationary grid
  • 75 to 80 kV range, mAs 15 (85 to 90 kV and reduction to mAs 8)


  • Use gonadal shielding for males. Ovarian shielding o females is not possible without obscuring area of interest.

Positioning of Patient:

sacrum xray
Sacrum Ap Axial
  • Align mid-sagittal plane to CR and midline of table or gird.
  • Ensure no rotation of pelvis exist.

Central Ray:

  • CR angled 15° cephalad, to enter 2 inches or 5 cm superior to pubic symphysis.
  • IR centered to projected CR
  • SID is 40 inches (100 cm)


  • Close four-sided collimation to area of interest.


  • Suspend respiration on expiration.

sacrum radiograph ap axialNote:Radiologic Technologist may require to increase centeal ray angle to 20° cephalad for patients with an apparent greater posterior curvature or hit of the sacrum and pelvis.

The sacrum of the female patients is usually shorter and wider than the males sacrum ( a consideration in close four- sided collimation.)

This sacral x-ray can also be performed in patient prone position with an angulation of 15° caudad necessary to patient condition.

Sacral X-ray Radiographic Criteria:

In Sacral x-ray structure shown should be a nonforeshorted AP projection of sacrum,the Sacroilliac joint and Lumbar 5 to Sacral 1 junction.
If proper patient position indicating no rotation of pelvis, the lower part of the sacrum should be centered in the pelvic opening.
Foreshortening and the pubis and sacral foramina should not be superimposed for correct alignment of sacrum and the central ray.
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December 19, 2014


Pathology Demonstrated on Perguson Method

  • This method demonstrates different deforming primarily curve from compensatory curve.
  • Two images must be done in performing this method. The standard is in patient in erect AP or PA and the one is with foot or hip on the convex side of the elevated curve.

Technical Factors:

  • Cassette size 35 x 43cm or 14 x 17 inches, put in lengthwise,
  • 35 x 92 cm or 14 x 36 inches may also be used if available.
  • Moving or stationary grid
  • Erect marker
  • Compensating filters for uniformity of image and density along vertebral area.
  • SID 60 inches or 152 cm
  • kV 90
  • mAs 25
Perguson method
PA Projection without elevation

Use of Shielding:

  • Place lead shielding over gonads without obscuring the area being expose, breast shield for young female patients.

Patient Position:

  • Position patient, either seated or erect, and arms on side.
  • For 2nd image, put block under the patients foot or in hips if the patient is seated on the curve side so that the patient can barely maintain position without assistance.
  • If 3 to 4 inches block is available place it under the patients buttocks if patient is seated and under its foot if standing.

Part Position:

  • Mid-sagittal plane and cassette must be aligned with patient arms on side.
  • No rotation of torso or pelvis as possible.
  • A minimum of 1-2 inches of cassette below the iliac crest.

Central Ray:

  • Centeral ray is directed to and perpendicular to center of cassette.
  • SID is 40 to 60 inches, if IR is longer, longer SID is required to obtain adequate collimation if a 14 x 36 inches film is used.


  • Collimate on four sided area of interest.


  • Suspend respiration on expiration.

Note: compression band is not required on this method. For 2nd image, place block support under the patient foot on curve side unassisted.
PA projection should be done for radiographs, to reduce patient exposure to rediation sensitive area like thyroid and breast.

Radiographic Criteria | Ferguson Method

Structure Shown:

Ferguson method radiograph
  • All thoracic and lumbar vertebrae should be demonstrated.
  • A minimum of 1 inch of iliac crest should be included on the image.

Proper Positioning:

  • Thoracic and lumbar vertebrae should be demonstrated in as true a AP or PA projection as possible.

Collimation and CR:

  • Vertebral column should be in the center of the image or in collimation field.

Exposure Criteria:

  • Optimal density and contrast will clearly demonstrate the lumbar and thoracic vertebrae.
  • A compensating filter may be useful for obtaining uniform density along the vertebral column.
  • Sharp bony margins indicate no motion.
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December 3, 2014



Pathology Demonstrated:

  • Occipital bone, petrous pyramids, and foramen magnum, with dorsum sallae and posterior clinoids in its shadow, are shown.
  • This is an alternative projection for patients who cannot flex their neck sufficiently for AP axial (Towne). It results in magnification of the occipital area but results in lower doses to facial structures and the thyroid gland.

This is not recommended when the occipital bone is the area of interest because of excessive magnification.

Tecnical Factors:

  • IR size - 24 x 30 cm (10 x 12 inches), lengthwise
  • Moving or stationary grid
  • 70 to 80 kV range
  • Small focal spot
  • mAs 20

PA Axial - CR 25° Cephalad to OML

Patient Position:

  • Remove all metallic or plastic objects from the patient's head and neck. Take radiograph with patient in the erect or prone position.

Part Position:

  • Rest patient's nose and forehead against the table/Bucky surface.
  • Flex neck, bringing OML perpendicular to IR.
  • Align midsagittal plane to CR and to the midline of the grid or table/Bucky surface.
  • Ensure that no rotation or tilt exist (midsagittal plane perpendicular to IR).

Central Ray:

  • Angle CR 25° cephalad to OML.
  • Center CR to midsagittal plane to pass through level of EAMs and exit 1 1/2 inches (4 cm) superior to the nasion.
  • Center image recptor to projected CR.
  • Minimum SID is 40 inches (100 cm)


  • Collimate to the outer margins of the skull on all sides.


  • Suspend respiration.

Radiographic Criteria in PA Axial Projection | Haas Method:

Structure Shown:

PA Axial
  • Occipital bone, petrous pyramids, and foramen magnum are shown, with the dorsum sallae and posterior clinoids visualized in the shadow of the foramen magnum.


  • No rotation is evident, as indicated by bilateral symmetric petrous ridges.
  • Dorsum sallae and posterior clinoids are visualized in the foramen magnum, which indicates correct CR angle and proper neck flexion and extension.
  • No tilt as evidenced by correct placement of anterior clinoids within the middle of the foramen magnum.

Collimation and CR:

  • In Haas Method the entire skull is visualized in the image with the vertex near the top and the foramen magnum and mastoid portions near the bottom.
  • Collimation borders are visible to outer margins of skull.

Exposure Criteria:

  • Density and contrast are sufficient to visualize occipital bone and sellar structures within foramen magnum.
  • Sharp bony margins indicate no motion.
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December 1, 2014



  • Do NOT attemp to rotate arm or force abduction if fracture or dislocation is suspected.

Pathology Demonstrated:
  • Osteoporosis, Osteoarthritis, and the HillSachs defect may be demonstrated.

Technical Factor:
  • IR size - 18 x 24 cm (8 x 10 inches), lengthwise
  • 70 +- 5 kV range
  • mAs 10

  • Place lead shield over pelvis and radiosensitive regions.
Arm abducted 90 degrees

Patient Position:
  • Position patient in the lateral recumbent position with the affected arm up.

Part Position:
  • Abduct arm 90degrees from body if possible.

Central Ray:
  • Direct horizontal CR perpendicular to the IR.
  • If the patient cannot abduct the arm 90 degrees, then angle the tube 5 - 15 degrees toward the axilla.
  • Minimum SID is 40 inches (100cm).
Arm partially abducted.

  • Collimate closely on four sides.

  • Suspend respiration during exposure.

Radiographic Criteria:

Stucture Shown:
  • Lateral view of proximal humerus in relationship to the scapulohumeral cavity is shown.

  • Arm is seen to be abducted about 90degrees from the body.
  • The relationship of the humeral head and glenoid cavity should be evident.

Collimation and CR:
Inferosuperior axial shoulder joint: Clements modification.
  • Collimation should be visible on four sides to the affected shoulder.
  • CR and center of collimation field should be at the axilla and humeral head.

Exposure Criteria:
  • Optimal density and contrast with no motion will demonstrate clear, sharp bony trabecular markings.
  • The bony margins of the acromion and distal clavicle will be visible through the humeral head.
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About Me

X-Ray and Radiologic Tech - Guide Radiographic Positioning | Radiology Dept. - Radtechonduty