Patient identification and pregnancy status must be confirmed with either the anaesthetist or an appropriate member of the theatre team before any radiation exposure. Records should be kept of patient details, exposure time and radiation dose when screening is employed. The radiographer must give clear instructions to staff before exposures are made regarding their role in reducing the risk of accidental exposure. Direct the central ray at right-angles to the long axis of the sacrum and towards the palpable coccyx. Sacro-iliac joints – Posteroanterior Sacrum – Lateral Scaphoid – Postero-anterior with Ulnar Deviation Scaphoid – Anterior Oblique with Ulnar Deviation Scaphoid – Posterior Oblique Scaphoid Postero-anterior – Ulnar Deviation and 30-Degree Cranial Angle Shoulder Girdle – Anteroposterior Shoulder Joint – Antero-posterior (Glenohumeral Joint) Shoulder – Supero-inferior (Axial) Shoulder Joint Lateral Oblique ‘Y’ Projection Sinuses – Occipito-mental Sinuses – Occipito-frontal 15 Degrees Sinuses – Lateral Skull – Occipito-frontal 20 Degrees↓

The postero-anterior projection of the forearm with the wrist pronated is not satisfactory because, in this projection, the radius is superimposed over the ulna for part of its length. The authors have included a range of additional information new to this text. This includes a protocol for evaluating images (the "10-point plan") and a range of general advice for undertaking procedures in a professional and efficient manner. The book also includes basic information in relation to some non-imaging diagnostic tests, common medical terminology, and abbreviations. This is designed to help readers gain a better understanding of the diagnostic requirements and role of particular imaging procedures from the information presented in X-ray requests. In addition, the book discusses image evaluation, medical abbreviations, relevant normal blood values, and radiation protection.

Oblique Using Beam Angulation When the median sagittal plane is at right-angles to the receptor, right and left anterior or posterior oblique projections may be obtained by angling the central ray to the median sagittal plane. NB This cannot be done if using a grid unless the grid lines are parallel to the central ray. Problems can occur with producing an optimal image with this technique, due to a number of factors, including patient movement and positioning errors. It is essential that the patient is able to co-operate and stay still for up to 20 seconds for a successful examination to take place. The vertical central ray is directed 2.5 cm distally along the perpendicular bisector of a line joining the anterior superior iliac spine and the symphysis pubis over the femoral pulse. The primary beam should be collimated to the area under examination and gonad protection applied where appropriate. Exposure) Regulations (IR(ME)R) 2000. This legislation is designed to protect patients by keeping doses as low as reasonably practicable. (ALARP). The regulations set out responsibilities for those who refer patients for an examination (referrers); those who justify the exposure to take place (practitioners); and those who undertake the exposure (operators). Radiographers frequently act as practitioners and as such must be aware of the legislation along with the risks and benefits of the examination to be able to justify it. Is there an alternative imaging modality? The use of an alternative imaging modality that may provide more relevant information or the information required at a lower dose should be considered. The use of non-ionizing imaging modalities, such as ultrasound and magnetic resonance (MRI), should also be considered where appropriate. The area on the image should include the upper third of both femora and the iliac crests. There should be evidence of properly positioned gonad protection, unless its presence would obscure essential anatomy.

The entire length of the clavicle should be included on the image. The lateral end of the clavicle will be demonstrated clear of the thoracic cage. There should be no foreshortening of the clavicle. The exposure should demonstrate both the medial and the lateral ends of the clavicle.The image should include the distal phalanges and calcaneum. The ankle joint and soft tissue margins of the plantar aspect of the foot should be included. The longitudinal arches of the feet should be clearly demonstrated. Section 2 Radiographic Projections Abdomen – Antero-posterior Supine Abdomen – Prone Abdomen – Left Lateral Decubitus Acromioclavicular Joint Ankle – Antero-posterior/ Mortice Joint Direct the vertical central ray towards the midclavicular line on the raised side at the level of the lower costal margin. The horizontal central ray is centred to the palpable coracoid process of the scapula. The primary beam is collimated to include the head, the greater and lesser tuberosities of the humerus, together with the lateral aspect of the scapula and the distal end of the clavicle.

The central ray must pass through the joint space at 90 degrees to the humerus, i.e. the epicondyles should be superimposed. The image should demonstrate the distal third of humerus and the proximal third of the radius and ulna. Lateral radiograph of the hand with foreign body marker. There is an old fracture of the fifth metacarpal. Full lung fields with the scapulae projected laterally away from the lung fields and clavicles symmetrical and equidistant from the spinous processes. Sufficient inspiration – visualizing either six ribs anteriorly or 10 ribs posteriorly. The costophrenic angles, diaphragm, mediastinum, lung markings and heart should be defined sharply. The knee and ankle joints should be included on the image. This is especially important in trauma, as a break in the bony ring may be accompanied by another fracture within the ring (such as the distal tibia and proximal fibula). Centre in the midline at the level of the posterior superior iliac spines. The central ray is angled 5–15 degrees caudally from the vertical, depending on the sex of the patient. The female requires greater caudal angulation of the beam. The primary beam is collimated to the area of interest.SCAPHOID – POSTERO-ANTERIOR WITH ULNAR DEVIATION For suspected scaphoid fractures, three or more projections may be taken: these normally include the postero-anterior and lateral (wrist projections, pp 218–221), plus one or more of the three projections described in this book.

From the postero-anterior position, the hand and wrist are rotated 45 degrees externally and placed central over an image receptor. The hand should remain adducted in ulnar deviation. The hand is supported in position, with a non-opaque pad placed under the thumb. The forearm is immobilized using a sandbag. The image should include the apices and costophrenic angles and lung margins anteriorly and posteriorly. Image processing should be optimized to visualize the heart and lung tissue, with particular regard to any lesions if appropriate.The image should contain all of the cranial bones and the first cervical vertebra. Both the inner and outer skull tables should be included. A true lateral will result in perfect superimposition of the lateral portions of the floors of the anterior cranial fossa and those of the posterior cranial fossa. The image receptor and beam are often centred too low, thereby excluding the upper thoracic vertebrae from the image. The lower vertebrae are also often not included. L1 can be identified easily by the fact that it usually will not have a rib attached to it. Where there is a possibility of injury to the base of the first metacarpal, the carpo-metacarpal joint must be included on the image. The image should include the fingertip and the distal third of the metacarpal bone.