Mastering Radiographic Positioning: A Guide to Accurate Imaging and Patient Positioning

Radiography is more than just taking X-rays; it's an art and science that demands precision, knowledge, and attention to detail. Correct radiographic positioning ensures that the images are diagnostically useful, minimizing patient discomfort and exposure while maximizing diagnostic accuracy. Let’s explore how to position patients for imaging of various body parts—crucial knowledge for radiologic technologists and healthcare professionals alike.

Why Radiographic Positioning Matters

Proper positioning is essential for:

Obtaining clear and undistorted images
Avoiding repeated exposures
Diagnosing fractures, abnormalities, and pathologies accurately
Ensuring patient comfort and safety

Each anatomical area has specific positioning requirements based on its structure, orientation, and clinical indication. Let’s break down positioning techniques by body region.

1. Skull and Facial Bones

a. PA Skull View

Patient Position: Upright or prone
Head: Forehead and nose touch the image receptor (IR), orbitomeatal line (OML) perpendicular to the IR
Central Ray (CR): Directed perpendicular to the IR at the glabella

b. Lateral Skull View

Patient Position: Seated or standing
Head: Side of interest closest to the IR, midsagittal plane (MSP) parallel to IR
CR: 2 inches above the external auditory meatus (EAM)

Clinical Tip: Immobilize the head with positioning aids to prevent motion blur.

2. Chest

a. PA Chest View

Patient Position: Standing, facing the IR
Shoulders: Rolled forward to move the scapulae out of the lung field
Chin: Raised
CR: Perpendicular to T7 (inferior angle of scapula)

b. Lateral Chest View

Patient Position: Side of interest against the IR, arms elevated
MSP: Parallel to IR
CR: Level of T7

Clinical Tip: Take the image during full inspiration to expand the lungs.

3. Abdomen

a. AP Supine (KUB)

Patient Position: Supine, arms at sides
Legs: Extended or slightly bent for comfort
CR: At the level of iliac crests

b. Erect Abdomen

Patient Position: Standing
CR: 2 inches above iliac crests to include diaphragm

Clinical Tip: Use a short exposure time to minimize motion artifacts from peristalsis.

4. Upper Limb

a. AP Shoulder

Patient Position: Upright or supine
Arm: Slightly abducted, palm facing forward
CR: 1 inch inferior to coracoid process

b. Elbow (AP View)

Patient Position: Seated with arm extended and supinated
CR: Perpendicular to the elbow joint

c. Wrist (PA View)

Patient Position: Seated, forearm resting on the table
Hand: Pronated
CR: Mid-carpal area

Clinical Tip: Ensure joints are straight and not rotated unless an oblique view is intended.

5. Lower Limb

a. AP Knee

Patient Position: Supine
Leg: Extended and straight
CR: Directed to the knee joint, angled 5° cephalad if needed (based on patient habitus)

b. Lateral Foot

Patient Position: Lying on the affected side
Foot: Lateral side down, dorsiflexed
CR: Perpendicular to the base of the 3rd metatarsal

c. Pelvis (AP View)

Patient Position: Supine
Legs: Internally rotated 15–20° unless contraindicated
CR: Midway between ASIS and symphysis pubis

Clinical Tip: Shield the patient’s gonads when appropriate, especially in pelvic exams.

6. Spine

a. AP Cervical Spine

Patient Position: Upright or supine
Chin: Slightly elevated
CR: C4 level (thyroid cartilage)

b. Lateral Lumbar Spine

Patient Position: Left lateral decubitus
Knees: Slightly flexed for stability
CR: Level of L4 (iliac crest)

Clinical Tip: Use sponges to ensure spine is parallel to IR, especially in lateral views.

Conclusion: Precision in Positioning

Mastering radiographic positioning requires both theoretical understanding and practical experience. Patient cooperation, clear communication, and attention to detail are keys to success. As radiologic professionals, our goal is to capture diagnostic-quality images the first time, every time—minimizing radiation exposure and maximizing clinical insight.