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