Understanding proper positioning during an X-ray procedure is critical for producing diagnostic-quality results, which aid in diagnosing injuries, diseases, and abnormalities.
Proper positioning entails a thorough understanding of human anatomy and what positions produce the best images of different structures and their symptoms and diseases. Additionally, multiple images from various angles are often needed for accurate diagnostics.
This article delves into the basics of X-ray positioning, the most common positions used, and how to properly prepare the patient. We will also explore some specific applications of these principles.
Preparing Patients for an X-Ray
It’s essential to prepare patients for an X-ray procedure, explaining what will be done, why, and what will be expected of them during the procedure. Also, informing them of potential side effects from things like contrast media and any sensations they may experience, such as a warm flush or a metallic taste in the mouth, will help prepare the patient and minimize their movement during the procedure.
The patient should be allowed to ask questions and get clear answers. Clear communication helps alleviate anxiety or apprehension and allows them to relax, which, in turn, helps ensure good imaging results. Additionally, the patient may need to be informed about what they should or should not wear or if they must do other preparations, such as fasting before gastrointestinal procedures.
Typically, a gown is worn to prevent any problems with clothing interfering with image quality. Metal or other objects, such as necklaces, rings, and other jewelry, are also commonly removed.
Finally, female patients should always be asked if they are pregnant or trying to become pregnant. In the case of pregnancy, the imaging should be delayed if possible. In the case of a patient planning to get pregnant, it should be scheduled during the first ten days after the onset of menstruation since they will be least likely to be pregnant during that time.
Basic Positioning in Radiography
Following basic positioning best practices helps ensure that the many advantages of X-rays are realized. They help provide high-quality images that can be used for rapid and accurate diagnostics.
First and foremost, it’s essential to understand human anatomy, the reason for the imaging, and the nuances of the different types of X-ray equipment being used. Every imaging technique has specific positioning methods that will help provide the best images of that body structure and for that purpose.
For example, a chest X-ray often must be done while the patient stands up and holds their arms slightly away from the body. A spinal X-ray, on the other hand, usually requires the patient to lie flat on the table. Often, multiple images from different positions are needed to ensure accurate diagnostics.
One important factor in effective positioning is ensuring that the body part is either parallel or perpendicular to the X-ray beam. This helps reduce distortion and produces accurate images of the structure being examined.
Another critical factor is ensuring patient comfort. Support cushions or straps may be necessary to help a patient hold the correct position. If the patient is uncomfortable, especially if they are experiencing pain, this can cause unwanted movement during the image and may necessitate repeating the procedure.
Last but not least, safety measures are critical to minimize radiation exposure. Shielding non-targeted parts can sometimes be necessary to protect sensitive areas like the reproductive organs.
Furthermore, radiologists and doctors always consider the ALARA (as low as reasonably achievable) principle when deciding which imaging modality is used, which positions, and how many images are required to obtain diagnostic-quality images while minimizing total radiation dose.
Upper and Lower Extremity Radiography
Imaging the upper and lower extremities requires precision positioning to obtain diagnostic-quality images for conditions from fractures to degenerative diseases like arthritis. Proper positioning is also critical in helping provide the most comfortable experience possible, especially when patients are in pain or have mobility issues due to their condition. Pain and resulting unwanted movements can also negatively impact image quality.
The upper extremities include the hands, wrists, elbows, and shoulders, and the techniques used can vary widely. For example, hand and wrist X-rays are performed with the patient lying their arm flat on the table and spreading their fingers to ensure accurate views of the joint spaces and bone alignment.
Conversely, elbow and shoulder X-rays typically require different arm angles and rotations to capture the joint structures and diagnose abnormalities.
The lower extremities include the feet, knees, ankles, and hips. They also require specific, precise positioning. For example, a standard foot X-ray is done with the foot placed flat and may be done in both standing and sitting positions.
It helps assess weight-bearing aspects of the bones and joints. Knee and hip X-rays, on the other hand, often involve lateral or side positioning and special angles so the doctor can visualize joint spacing, soft tissues, and bone integrity.
Gastrointestinal Radiography
Gastrointestinal radiography is a specialized imaging technique that focuses on the digestive tract. It usually involves using contrast agents such as barium swallows and barium enemas to enhance the visibility of the gastrointestinal tract and provide diagnostic-quality images of the stomach, intestines, and other digestive structures.
It’s critical for diagnosing inflammatory bowel disease, gastrointestinal bleeding, and structural abnormalities. A barium swallow test involves the patient ingesting a barium solution, which coats the esophagus lining, stomach, and small intestine. X-rays are then taken at different time intervals to track the movement of the barium throughout the digestive system. This is invaluable in diagnosing ulcers, tumors, and blockages.
Barium enemas are very similar, except the contrast agent is introduced to the colon through the rectum. Barium enemas are essential for producing high-quality images of the large intestine and are routinely used for patients experiencing symptoms of Ulcerative Colitis.
Patient preparation is critical for ensuring clear images. It generally involves dietary restrictions or fasting so that the GI tract is free of anything that could obstruct the view. Proper positioning is also essential and may include lying or standing in various positions, depending on the part of the GI tract being examined.
What Is the Proper Positioning for an X-Ray?
Proper positioning depends entirely on the part of the body being examined and why. Even with the same body structure, positioning will vary for different diagnostic purposes. The doctor will determine which X-rays they need for diagnostics based on the body part in question and the symptoms the patient is exhibiting.
Here are the most common positioning techniques.
Antero-Posterior (AP)
The Antero-Posterior (AP) positioning is often used for examining the abdomen, chest, and limbs. Here, the patient is positioned so the X-ray beam passes from the front (anterior) to the back (posterior) of the body.
Postero-Anterior (PA)
The Postero-Anterior (PA) position is the opposite of the AP, where the patient is placed so that the X-ray travels from back to front instead. It is often used in chest X-rays to provide clear images of the lungs.
Lateral View
The lateral view is frequently used when imaging the spine, chest, and skull. The patient is aligned on their left or right side to provide a different view of the internal structures.
Oblique View
In the oblique view, the patient is positioned not on their side, back, or front but at an oblique angle. This view is helpful when examining the spine, pelvis, or other complex bones since it provides additional information that is often missed in the AP and PA views.
Axial Projection
An axial projection is used in cranial imaging and for examining certain joints, such as the knees and shoulders. It involves directing the X-ray beam along the axis of the body or body part.
Cross-Table Lateral View
Cross-table lateral views are often used in emergency situations or when the patient cannot be moved easily. Here, the X-ray beam is directed across the table from one side of the patient to the other.
Final Thoughts
Proper positioning during X-ray procedures is essential for obtaining high-quality diagnostic images. Understanding the nuances of human anatomy, the specific requirements for certain anatomical structures, and the context of the examination ensures that radiologists can simultaneously optimize image quality and patient comfort.
Effective communication with patients before and during the procedure is critical in alleviating anxiety and enhancing image quality. For medical imaging facilities looking to enhance their imaging capabilities, consider exploring advanced digital X-ray systems available at PatientImage.
