What Is Radiographic Positioning?

Standard anatomical positioning ensures a universally understood description when imaging the body. Imagine a person standing up straight with their arms outstretched and palms facing forward. 

Posterior refers to the back half of the body. Anterior means that a structure is closer to the front half of the body. For example, the tip of your nose is anterior to the back of your head. Structures that are farther from the bottom of your toes are said to be superior anatomically. Inferior is defined as being lower in position. Lateral and distal structures stray from the midline. Medial and proximal ones stay central.

Radiographic Projection

The final image depends on the direction and angle that the x-ray passes through the body.

Anteroposterior (AP) projections enter the body through the front of the chest and leave through the back. Posteroanterior (PA) projections, logically, do the opposite. Projections going from side-to-side or diagonally are lateromedial and oblique, respectively. 

Things to Consider Before Taking That X-ray

There are several factors to consider when deciding which is the best radiographic position and projection to use.

Before proceeding with the X-ray consider:

  • Who is the patient?
  • What is their presentation?
  • What is the diagnostic differential?
  • What is the patient’s history
  • Are there any special factors? (disability, pregnancy, etc)
  • What resources are available?

Chest X-rays

Chest x-rays are among the most common procedures in medicine. They can show evidence of pneumonia, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disorder (COPD), lung cancer, cardiomyopathy, heart failure, and many other disorders.

PA and lateral chest x-rays are often prescribed when lung or heart disease is suspected.

PA projection on film appears as if the patient is facing you. Their right side will correspond to your left. A lateral view is useful because two structures that are ‘behind’ one another may superimpose on a PA view and become indistinguishable.

Abdominal X-rays

PA and AP can be used to investigate intestinal obstruction independently or may be used in conjunction particularly with obese patients.

Shoulder X-ray Views

The shoulder joints consist of various bones, tendons, muscles, blood vessels, nerves, and other structures in a confined area. Shoulder x-rays are often ordered in conjunction with CT or MRI scans. This is useful in patients with suspected trauma, shoulder pain, arthritis, or restriction of movement.

The AP view has proven to be useful for visualizing the glenohumeral joint, clavicle, superior ribs, and proximal humerus. The lateral view best demonstrates any suspected shoulder dislocation. Other shoulder x-ray views are indicated for certain trauma patients. A common one in these patients is called the modified trauma axial projection.

The Garth projection is a modification of this view specifically when glenohumeral dislocations are suspected. Others include the Grashey (AKA the true AP view) view, the Neers view, the axillary view, and the Stryker view.

Radiation Protection

Whatever case you are working on and whatever positioning view you use, always keep radiation protection in mind.  When you position properly, when you use the correct view, you are more likely to get the best image and not have to subject the patient to another x-ray and more radiation.  Also, “child size” your x-rays for children.  Image gently.  They are not small adults.  Their cells are reproducing at a rapid pace and they have their whole life ahead, so the least amount of radiation is important for their medical imaging.

Continuing Education in Radiology

The field of radiology, like the vast majority of medical specialties, is highly competitive and continuously evolving. Things that were taught 10 years may now be outdated.

The best way to stay competitive professionally and improve the care you provide for your patients is to seek to improve your knowledge and ability through continuing education. You can earn CE and CME credits through these courses and even take online courses and tests for X-ray, CT, MRI, and other imaging modalities.

Radiographic Positioning, Radiation Safety, Radiography Continuing Education

A common dilemma in radiographic positioning is dealing with a patient who is unable to physically get into the correct position to safely and effectively use an x-ray machine. From previous experience to reviewing case studies in radiology CE courses, your expertise will be invaluable. Not only will your patients receive better care, but your performance as a professional will also flourish.

There are always certain things to consider when choosing the most appropriate radiographic positioning for each patient. This will depend on the particular characteristics of your patient, such as age and body type, the current condition, the part of the body to be evaluated, and the availability of imaging modalities in your health center.

Radiographic positions will always be important to know. They could make the difference between making and/or missing a crucial diagnosis, or having to subject your patient to another x-ray and more radiation. 

We invite you to contact us if you are interested in advancing in the radiology field or just wanting to comply with ARRT®’s continuing education requirements.  We have many options and special deals for all levels.