How to take X-rays

Upper Limb

Antero-Posterior Shoulder

Keep patient in anatomical position (Neutral with hand facing X-ray tube, or arm is in a sling then hand facing the ceiling) with back against the X-ray board

Centering point: 2.5cm inferior to coracoid process

Collimation:

Superiorly: Outer Skin Margins

Inferiorly: Angle of Scapula

Medially: End of clavicle

Laterally: Outer Skin Margins

• Broad Focus
• 100cm Distance
• No Grid/Bucky

For Osteoarthritis you should turn the patient 20 degrees laterally to better visualise the glenoid joint

70kV 6mAs

Axial Shoulder

Sit the patient on a chair next to the X-ray bed with the affected arm closest to the bed. Put a cassette on the bed underneath the patient's armpit and extend the patient's arm as far away from their body as they can manage. 

Centering point: Glenoid Cavity

Collimation:

Superiorly: Boarder of ribs

Inferiorly: Distal 3rd of Humerous

Medially: Outer Skin Margins

Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

70kV/6mAs

AP Elbow

The Humerous needs to be flat against the film.

Centering point: In Crease of Elbow - Condyles of humerous
Collimation:
Superiorly: Distant 1/3 humerous
Inferiorly: Proximal 1/3 radius and ulna
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

62kV 4mAs

Lateral elbow

Humerous needs to be at the same level as shoulder, 90 degrees to ulna and need to point the thumb to the sky.

Centering point: Funny bone (Olecranon) 4cm medial to this

Collimation:

Superiorly: Distant 1/3 humerous

Inferiorly: Proximal 1/3 radius and ulna

Medially: Soft Skin Margins

Laterally: Soft Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 6mAs

AP (PA) Wrist

Centering point: Midway between radial and ulna styloid process
Collimation:
Superiorly: Metacarples
Inferiorly: Distal 1/3 radius and ulna
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

62kV 4mAs

Lateral Wrist

Radius and Ulna need to overlap and the thumb needs to point upwards

Centering point: Radus and ulna styloid process
Collimation:
Superiorly: Metacarples
Inferiorly: Distal 1/3 radius and ulna
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

64kV 4mAs

Dorso Parma Hand

Hand down needs to be flat down
Centering point: Head of 3rd Metacarple
Collimation:
Superiorly: Outer Skin Margins
Inferiorly: Wrist Joint
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 2.5mAs

Oblique Hand

Angle to beam, Get patient to make the O shape with finger and thumb and curve fingers round

Centering point: Head of 3rd Metacarple

Collimation:

Superiorly: Outer Skin Margins

Inferiorly: Wrist Joint

Medially: Outer Skin Margins

Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 3mAs

Lateral Hand

The Lower Limb

AP Hip

Centering point: Anterior Superiour Illiac Spine (ASIS) midway between synthesis pubis, 4cm inferior.

Collimation:

Superiorly: ASIS

Inferiorly: Some Femur

Medially: 1/2 synthesis

Laterally: Outer Skin Margins

• Broad Focus
• 100cm Distance
• Grid and Bucky

75kV 12mAs

AP Knee

Centering point: 2.5 inferior to patella
Collimation:
Superiorly: Distal 1/3 femur
Inferiorly: Proximal 1/3 Tibia and Fibula
Medially:Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 5mAs

Lateral Knee

Centering point: 2.5cm distal to femural condile (will be superimposed)
Collimation:
Superiorly: Distal 1/3 femur
Inferiorly: Proximal 1/3 Tibia and Fibula
Medially:Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

65kV 8mAs

AP Ankle

Put your pen to the heel 1/2 section when internally rotating the foot, the heel base should be 2/3rds down the film in line with pen
Centering point: Midway of malioli
Collimation:
Superiorly: Distal 1/3 Tibia and Fibula
Inferiorly: Outer Skin Margins
Medially: Base of 5th metatarsal
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

65kV 4mAs

Lateral Ankle

Maliolli needs to be superimposed


Centering point: Medial maliolus
Collimation:
Superiorly: Distal 1/3 Tibia and Fibula
Inferiorly: Half metatarsals
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

65kV 4mAs

DP Foot

Centering point: Base of 3rd metatarsal
Collimation:
Superiorly: Toes Outer Skin Margins
Inferiorly: Outer Skin Margins
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 3mAs

Oblique Foot

Turned medially


Centering point: Base of 3rd metatarsal
Collimation:
Superiorly: Toes Outer Skin Margins
Inferiorly: Outer Skin Margins
Medially: Outer Skin Margins
Laterally: Outer Skin Margins

• Fine Focus
• 100cm Distance
• No Grid/Bucky

60kV 3mAs




Appendicular Skeleton

PA Chest

Cassette needs to be landscape, distance is higher to reduce magnification of the heart. Angle towards the feet (cordally) to avoid scatter to the eyes and thyroid but not too much (5-10 degrees) as this can result in an elongated chest. To push scapula out of the lung view roll the patient's shoulders forward
On Inspiration

Centering point: T7 - same level as inferior angle of scapula
Collimation:
Superiorly: Just above the shoulders - include the apices of lungs
Inferiorly: Costophrenic angles
Medially: None
Laterally: Outter margins of chest wall

Broad Focus
180cm
No Grid or Bucky

90kV 2-3mAs

AP abdomen

MUST check for pregnancy! 28 day rule and 10 day rule.
On expiration

Centering point: Illiac crest, top of pelvis to the midline (belly button usually)

Collimation:
Superiorly: Diaphram for kidneys
Inferiorly: Synthesis pubis
Medially: None
Laterally: Walls of abdomen

Broad focus
100cm
Grid and Bucky

80kV 25mAs
75kV 15mAs

AP pelvis

To be done landscape. Toes should point inwards in order to see the greater trocanters clearly. Must have gonad shield.

Centering point: Anterior Superior Illiac Spine (ASIS) 5cm distal to this and to the midline.

Collimation:
Superiorly: illiac Crest
Inferiorly: Proximal femur
Medially: None
Laterally: Outter Skin Margins

Broad focus
100cm
Grid and Bucky

80kV 12mAs

AP Cervical Spine

Chin should be parallel to the floor so that the Mandible and Occiput are superimposed angle cranially 15 degrees


Centering point: C4 level of thyroid cartilage

Collimation:
Superiorly: External Auditory Meatus
Inferiorly: T1
Medially: None
Laterally: Outter Skin Margins

Broad focus
100cm
Grid and Bucky

75kV 15mAs

Lateral Cervical Spine

Centering point: 2.5cm inferior and posterior to the angle of the manible

Collimation:

Superiorly: External Auditory Meatus

Inferiorly: T1

Medially: None

Laterally: Outer Skin Margins

Broad Focus

180cm

No Grid/Bucky

75kVp 28mAs

AP Thoracic Spine

Centering point: 18-21cm below jugular notch/inferior angle of the scapula

Collimation:

Superiorly: C7

Inferiorly: L7

Medially: Anterior boarder of Vertebral bodies

Laterally: Spinous processes

Broad Focus

100cm 

Bucky

80kV 48mAs

Lateral Thoracic Spine

Centering point: 18-21cm below jugular notch/inferior angle of the scapula

Collimation:

Superiorly: C7

Inferiorly: L7

Medially: Anterior boarder of Vertebral bodies

Laterally: Spinous processes

Broad Focus

100cm 

Bucky

80kV 48mAs

AP Lumbar Spine

On Expiration

Centering point: In between Iliac Crest and Lower Costal margins

Collimation:

Superiorly: T12

Inferiorly: Sacrum

Medially: Sacroilliac joints

Laterally: Sacroilliac joints

Broad focus

100cm

Bucky

80kV 15mAs

Lateral Lumbar Spine

Centering Point: Level of iliac crest

Collimation:

Superiorly: T12

Inferiorly: Sacrum

Medially: Anterior boarder of the vertebral bodies

Laterally: Spinous processes

Broad focus

100cm

Bucky

80kV 15mAs