A B

ADAMS (MODIFICATION OF HERMODSSON'S VIEW) BALL CATCHERS VIEW

The same as Hermodsson's view but with internal rotation increased from 70 degrees to 100 See Norgaads view.
degrees. See Hermodsson’s view.
Ref:Rockwood and Green's Fractures in Adults, Lippincott.
BALL’S METHOD (AP)
Pelvimetry view.
AHLBACK METHOD Patient erect, centre the horizontal beam to the midline at the level of the superior
Weight-bearing AP view of the knee in full extension. border of the symphysis pubis.

ALBERS-SCHONBERG BALL’S METHOD (LATERAL)

Demonstrates the TMJs. Pelvimetry view.
Head in the lateral position, then rotate the head 20 degrees towards the film. Centre to Patient erect in the lateral position. Centre horizontal central ray to the level of the
the TMJ in contact with the film, with the tube angled 20 degrees upwards. superior border of the acetabulum.

ALEXANDER METHOD BECLERE METHOD

View of the optic canal in cross section. View of the intercondyloid fossa in profile.
Both sides for comparison. Patient supine. Knee flexed so that the long axis of the femur is at 120 degrees to the
Patient sat with the back of head against the skull table. Upper border of the skull table long axis of the tibia. Direct the central ray at right angles to the long axis of the
angled backward 15 degrees . Position the patients head so that the midsagittal plane tibia and centre to the knee joint.
makes an angle of 40 degrees to the plane of the bucky. Head extended so that the
acanthomeatal line is at right angles to the plane of the bucky. Centre to the lower outer
BERQUIST VIEW
margin of the orbit away from the film.
See Capitellum view

ALEXANDER METHOD (ACJ)

BERTEL
Routine lateral oblique view of the acromio-clavicular joint.
Demonstrates the orbital floors and the infra-orbital fissure.
Ref: K.Clarke. Positioning in Radiography, 11th Ed
Head in the PA position with radiographic baseline at right angles to the film. Centre to
the nasion with the tube angled 20 degrees towards the head
ALEXANDER STRESS VIEW Ref: Goldman and Cope. A Radiographic Index. Wright Publishing, Bristol.
View of the acromio-clavicular joint.
Position as for lateral scapula. Patient then asked to thrust the affected shoulder
BETT'S VIEW
forward.
View to demonstrate the trapezium. Shows the trapezium without the overlapping of other
Ref: Alexander, O.M.Radiography of ACJ articulation, Med. Radiogra. 30:34-39, 1954.
carpal bones.

ALTSCHUL
Gedda / Betts or Clements view. It’s basically an offsetview where you externally rotate
Position as for Townes (half-axial skull view) view but angle 35 degrees rather than 30
the wrist and hand obliquly it to the image plate at about 45 degrees, and angle cranially
degrees.
about 5 degrees It not only gives you a full view of the trapezium, but it gives you a
good CMC view and then isolates the STT and TT joints. It helps to stage arthritic disease
ANTHONSON'S VIEW and in the selection of surgical technique
Subtalar joint view.
Foot in the lateral position. Dorsi-flex the foot. Angle the vertical central ray 25
BIGLIANI'S VIEW (Y VIEW)
degrees towards the foot and, 30 degrees towards the toes. Centre immediately below the
Hip projection.
medial malleolus.
Pelvis in the AP position. Flex, abduct and externally rotate the hip. Centre to the hip
joint.
ARCELIN
Demonstrates the petrous temporal region.
BLACKETT-HEALY METHODS
Head in the AP position and rotate 45 degrees away from the side being examined with the
Shoulder views
radiographic baseline at right angles to the film. Centre to the baseline at a point 2.5cm
1. A tangential projection of the insertion of the teres minor.
in front of the EAM, with the tube angled 10 degrees to the feet.
Patient prone. Internally rotate the arm, flex the elbow and place the hand on the back.
Ref: Goldman and Cope. A Radiographic Index. Wright
Centre to the head of the humerus.
2. A tangential projection of the insertion of the subscapularis. C
Patient supine. Abduct the arm, flex the elbow, and pronate the hand. Centre to the
shoulder joint.
CAHOON
View to demonstrate the styloid processes of the skull.
BLONDEAU Position as for Bertel's view and angle the tube 25 degrees cranially.
OM facial bones overtilted by 5 degree Ref: Goldman and Cope. A Radiographic Index. Wright Publishing, Bristol..

BLOOM AND OBATA CALDWELL

See Velpeau. Routine OF 20 view of the skull.
Ref: K.Clarke. Positioning in Radiography. 11th Ed.
BRATTSTROM METHOD
Skyline patella.
CAMP COVENTRY METHOD
View of the intercondylar notch.
BREWERTON'S VIEW
Patient prone. The tibia is elevated by 40-50 degrees. The central ray is directed to the
To show erosions of the metacarpal heads and the bases of the phalanges.
knee joint so that it makes a right angle with the long axis of the tibia.
Hand in the AP position i.e. palm facing upwards. The metacarpal-phalangeal joints are
flexed to 45 degrees with the phalanges in contact with the film. Tube angled 20 degrees
(from ulnar side) to the head of the third metacarpal. CAPITELLUM VIEW (BERQUIST VIEW)
View to demonstrate fractures of the radial head.
Patient positioned as for lateral elbow. The tube is angled 45 degrees to the forearm
BRIDGEMAN VIEW
along the humeral axis. Centre to the radial headwards.
See Stecher Method, point 1.
Ref: Berquist, T. (1993). Diagnostic Radiographic Techniques in the Elbow. The Elbow and
its Disorders, 2nd ed. WB Saunders, Philadelphia 98-119.
BRODEN I
Subtalar joint view.
CARPEL BOSS
Foot positioned as for AP ankle, then rotate the foot 45 degrees medially. Angled the tube
Demonstrates bony protuberance on the dorsum of the wrist at the level of the second and
cranially between 10 degrees and 40 degrees .
third carpo-metacarpal joints.Wrist slightly ulnar deviated with the ulnar side to the
cassette. 30 degree supination of the wrist to place the dorsal prominence at the
BRODEN II dorsoradial aspect of the second to third carpo-metacarpal joints and at a tangent to the
Subtalar joint view. vertical central ray. Centre to pass through the dorsal prominence.
Foot positioned as for AP ankle, then rotate the foot 45 degrees externally. Angle the Ref: Gilula and Yin. Imaging of the Wrist and Hand, Saunders.
tube cranially 15 degrees.
Ref: Hansen and Swiontkowski, ORTHOPAEDIC TRAUMA PROTOCOLS, Raven Press.
CARPAL BRIDGE VIEW
A tangential projection of the carpus. Demonstrates fractures of the scaphoid, lunate
BUTTERFLY VIEWS dislocations, and foreign bodies in the dorsum of the wrist.
Elongated views of the rectosigmoid segments of large intestine. The back of the hand rests on the cassette with the forearm at right angles to the hand.
AP BUTTERFLY Direct the central ray 4cm proximal to the wrist joint with a 45 degree angle towards the
Centre 5cm inferior to the anterior-superior iliac spine (ASIS) and angle the vertical fingers.
central ray 40 degrees towards the head. Ref: Lentino, W. et al (1957). The carpal bridge view, J. Bone Joint Surg. 39-A:88-90.

LPO BUTTERFLY CARPAL CANAL

Centre 5cm inferior to and 5cm medial to the right ASIS. Angle the vertical central ray 40 Routine carpal tunnel view.
degrees towards the head. Ref: K.Clarke. Positioning in Radiography. 11th Ed.

PA BUTTERFLY CAUSTON METHOD

Centre to the ASIS and angle the vertical central ray 40 degrees towards the feet.
RAO BUTTERFLY
Centre to the level of the ASIS and 5cm to the left of the lumbar spinous processes. Angle
the vertical central ray 40 degrees towards the feet.
Oblique foot projection to demonstrate the sesamoids.
Foot lateral with the medial side against the cassette. Angle the central ray 40 degrees
towards the ankle and centre to the first metatarsophalangeal sesamoids.
Ref: Causton, J. (1943):Projection of the sesamoid bones in the region of the first
metatarsophalangeal joint, Radiology 9:39.
CHASSARD'S VIEW
View to show the sigmoid colon.
Patient sits with both legs over the side of the table and leans forward slightly. Centre
fairly high up the patients back.
CHAUSSE II
Oblique transoral view of the foramen jugulare.
The patient is positioned as for an AP skull with the mouth wide open. Rotate the head 10
degrees away from the side in question. Direct the central ray up through the open mouth
so that it makes an angle of 35 degrees to a line joining the superior border of the EAM
and the anterior nasal spine.
Ref: Chausse, C. (1950).Trois incidences pour l'exam du rocher, Acta Radiol. 34:274-287.
CHAUSSE III
Head in the PA position then rotate the head 5-10 degrees towards the unaffected side.
Centre along the radiographic baseline midway between the outer canthus and the EAM.
CHAUSSE IV
See Stenvers view (C-Ear).
CINCINATTI VIEW
Supine chest x-ray coned to the mediastinum, a high kV filter is used.
The filter consists of 0.5mm copper and 0.4mm tin inserted so that the copper layer is
nearest the tube. A CT scoutview (topogram) is an alternative.
CLEAVES METHOD (HIP)
Axial projection of the femoral heads, necks, and trochanteric areas projected onto one
film. Position as a frog-leg lateral and centre to the symphysis pubis with the central
ray angled to be parallel with the long axes of the femoral shafts.
CLEAVES METHOD (SHOULDER)
An axial projection of the shoulder.
This technique requires non-cassette film.
Ref: Cleaves, E.N.(1941).A new film holder for roentgen examination of the shoulder,
A.J.R. 45:288-290.
CLEMENTS view. It’s basically an offsetview where you externally rotate the wrist and hand
obliquly it to the image plate at about 45 degrees, and angle cranially about 5 degrees It
not only gives you a full view of the trapezium, but it gives you a good CMC view and then
isolates the STT and TT joints. It helps to stage arthritic disease and in the selection
of surgical technique
CLEMENTS NAKAYAMA METHOD
Lateral view of acetabulum and femoral head.
This method can be used where the opposite hip cannot be raised for a horizontal beam
lateral hip.
COALITION VIEW
Demonstrates a calcaneotalar coalition.
Patient standing with the cassette under the long axis the calcaneum. Angle the central
ray 45 degrees and direct it through the posterior surface of the flexed ankle to the
level of the base of the fifth metatarsal.
COBEYS VIEW is a weight bearing AP ankle projection used to demonstrate the angulation
between the long axix of the calcaneum and the tibia (some call it a Buckview)
It is a PA projection done on a special radiolucent platform. The patient stands on the
platform equal weight on both feet with the toes on the side of interest against a 7 X 17
IR. (no grid, 40 SID) The platform holds the IR at a 20 degree tilt from vertical (away
from the patient)
The CR is angled caudal at 20 degree centered at the level of the ankle joint. (The tube
and IR will be parallel to eachother.) Collimate to include as much of the tib/fib
possible. A radiopaque marker is placed just behind the heel for measuring purposes when
analizing alignment.e tibia, radiographically imaging the coronal plane alignment of the
hindfoot.
COLCHER-SUSSMAN PROJECTION (AP)
Pelvimetry view.
Metal ruler engraved at cm intervals (Colcher-Sussman pelvimeter) is required.
Patient supine with the knees flexed and the thighs abducted so that the ruler can be
placed horizontally, centred to the gluteal fold at the level of the ischial tuberosities.
Centre the vertical central beam 2.5cm above the symphysis pubis.
COLCHER-SUSSMAN PROJECTION (LATERAL)
Pelvimetry view.
Metal ruler engraved at cm intervals (Colcher-Sussman pelvimeter) is required.
Patient lies in the lateral position thighs extended so that they do not obscure the
symphysis pubis.The ruler is horizontal at the height of and against the mid sacrum.
Centre horizontal beam to the greater trochanter.
COYLE TRAUMA METHODS
Projections of the radial head and/or the coronoid process of the ulna
Radial head view Elbow flexed 90 degrees and hand pronated. Vertical central ray angled 45
degrees towards the shoulder. Centre to the radial head.
Coronoid process view
Elbow flexed 80 degrees from extended position with the hand pronated. Vertical central
ray angled 45 degrees away from the shoulder and directed to the elbow joint.
Ref: Coyle, George F.(1980).Radiographing Immobile Trauma Patients, Unit 7, Special
Angled Views of Joints - Elbow, Knee, Ankle. Multi-Media Publishing, Inc., Denver.
CRANIODORSAL HEADVIEW
Hip view.Supine hip with the knees extended and legs internally rotated. Central ray
angled 30 degrees caudally, centre over the hip.
Ref: Schneider (1964).
CRANIOVENTRAL HEADVIEW
Hip view.
Supine hip centred on the femoral head with the leg raised 45 degrees.
Ref:Schneider (1964).
 D FEIST-MANKIN METHOD
See Isherwood method.
DANELIUS-MILLER METHOD
Routine horizontal beam view of the hip. FERGUSON'S VIEW
View of the sacro-iliac joints.
The patient is supine and the tube is angled 25-30 degrees cranially. With this
DANELIUS-MILLER MODIFICATION OF LORENZ METHOD
projection, the symphysis pubis overlaps the sacrum.
See Danelius-Miller Method.
Ferguson view, the patient is in the same position as for the AP Pelvis. The tube in
angled 30-35 degrees cephalic and is centered to the midportion of the pelvis. It shows
DENEER METHOD the SI joints more clearly and helps in evaluating injury to the sacral bone, the pubis,
See Dunlop Method. and the ischial rami
Ref: Positioning in Radiography, K.Clarke, 11th Ed. p139.
DIDIEE VIEW
Shoulder view. FISK METHOD
Patient prone with cassette under the shoulder. Arm parallel to the table top with a 7.5cm A projection of the bicipital groove.
pad under the elbow. Dorsum of hand on the hip with the thumb directed upward. Beam angled Patient erect. Flex the elbow, rest the forearm on the cassette and supinate the hand.
45 degrees. Centre to the bicipital groove.
Ref: Fisk, C. (1965).Adaption of the technique for radiography of the bicipital groove,
Radiol. Technol. 37:47-50.
DUNCAN-HOEW METHOD
Flexion and extension views of the lumbar spine (PA and lateral).
FLAMINGO VIEWS
Stress views of the symphysis pubis.
DUNLAP, SWANSON, AND PENNER METHOD Two views. Patient stands on each leg in turn. Centre to the symphysis pubis.
Projection to show the acetabula in profile.
The patient is sat upright on the bucky table with their legs over the side. The vertical
central ray is directed 30 degrees towards the lateral aspect of the pelvis towards the FLYING ANGEL
acetabulum. Routine lateral thoracic inlet view.
Ref: Dunlap et al (1956).Studies of the hip joint by means of lateral acetabular Ref: K.Clarke. Positioning in Radiography. 11th Ed.
roentgenograms, J.Bone Joint Surg. 38-A:1218-1230
FRIEDMAN METHOD
DUTT'S VIEW (JOHNSON AND DUTT) An axiolateral projection of the femoral head, femoral neck and upper femur.
PA oblique of the cribiform plate. Position as for turned lateral hip but angle the vertical central ray 35 degrees cephalad.
Head in the PA position. The head is then rotated towards the affected side until the Kisch recommends the central ray be angled 20 degrees cephalad.
median-sagittal plane is 40 degrees to the perpendicular. Raise the chin until the
radiographic baseline is 30 degrees to the perpendicular. Centre through the orbit in
FROG-LEG POSITION (MODIFIED LAUENSTEIN AND HICKEY METHOD)
contact with the film, with the tube angled 10 degrees towards the feet.
Lateral projection of both hips.
Patient supine with the knees flexed and legs abducted so the soles of the feet are in
E contact.
Ref: K. Clarke, Positioning in Radiography, 11th Ed.
ERASO METHOD
Projection of the jugular foramina. FUCHS METHOD
The patient is positioned as for an AP skull. The chin is then raised and the central ray Projection of the temporal styloid process.
is angled upwards to make an angle of 65 degrees to the OM line. Centre to the midline at Position the patient as for a lateral skull view. Angle the central ray cranially 10
the level of the EAM. degrees and anteriorly 10 degrees and centre to the styloid process against the film. Both
Ref: Eraso, S.T. (1961). Roentgen and clinical diagnosis of glomus jugulare tumors, sides for comparison.
Radiology 77:252-256.
FURMAIER METHOD
F Skyline patella.
Ref: The Journal of Bone and Joint Surgery (1974). 56-A, NO.7, OCTOBER
FALSE PROFILE VIEW
See Le Quesne method. G
GARTH'S VIEW medially 30 degrees.
Apical axial oblique view of the shoulder - useful for trauma dislocation cases 2. To demonstrate the spaces between the second and third, the third and fourth, and the
Centre to the head of the humorous. fourth and fifth metatarsals, adjust the foot so that the heel is rotated laterally 20
Patient erect or Supine rotated 45 degrees to the affected side, central ray angled 45 degrees.
degrees caudaly.
Ref: Merrill Volune 1 page 145
H

Discussion:
HAAS
- used in the instability patient to visulaize the anterior/inferior glenoid
Demonstrates the petrous temporal region, foraman magnum, and dorsum sellae.
rim for fractures or calcification following dislocation;
Head in the PA position with the radiographic baseline at right-angles to the film. Centre
in the midline to the external occipital protuberance with the central ray angled 25
- Technique:
degrees cranially.
- patient is seated with the arm at the side;
Ref: Haas, L.(1927).Verfahren zur sagittalen Aufnahme der Sellage gend, Fortscr.
- cassette is placed posterior, parallel to the spine of the scapula
Roentgenstr. 36:1198-1203.
- beam is directed thru the glenohumeral joint toward the cassette
at angle of 45 deg degrees to the plane of the thorax, and
directed 45 deg caudally; HARRIS
Axial projection of the heel. Useful for demonstrating talo-calcaneal bars.
Roentgenographic demonstration of instability of the shoulder: the apical Patient stands with both feet on the film. The patient leans forward slightly. The tube is
oblique projection. A technical note. positioned behind the patient and the central ray is angled 45 degrees towards the heels
JBJS. 66-A: 1450-1453, Dec. 1984. and is centred between the medial malleolus.

GAYNOR-HART METHOD HARRIS AND BEAM (SKI JUMP)

Inferosuperior carpal tunnel projection. Three axial projections of the calcaneum (both sides).
Ref: K.Clarke. Positioning in Radiography. 11th Ed. Patient standing, central ray central ray centred between the feet and the angled 35
See also Templeton and Zim method. degrees, 40 degrees and 45 degrees.

GEDDA / Betts or Clements view. It’s basically an offsetview where you externally rotate
the wrist and hand obliquly it to the image plate at about 45 degrees, and angle cranially
about 5 degrees It not only gives you a full view of the trapezium, but it gives you a
good CMC view and then isolates the STT and TT joints. It helps to stage arthritic disease
and in the selection of surgical technique
GRANDY METHOD
Routine lateral cervical spine.
GRASHEY METHOD (SHOULDER)
Routine view of the shoulder to demonstrate the glenohumeral joint space (shoulder turned
through 45 degrees).
Ref: K.Clarke. Positioning in Radiography. 11th Ed.
GRASHEY METHOD (SKULL)
Demonstrates ?
Patient positioned as for AP skull with the OM baseline horizontal. Angle the horizontal
central ray down 30 degrees and centre between the upper borders of the EAMs.
GRASHEY METHODS (FOOT)
Oblique plantodorsal projections of the foot.
Patient prone, dorsal surface of foot in contact with cassette. Centre to the base of the
third metatarsal.
1. To demonstrate the space between the first and second metatarsals, rotate the heel
HAYES VIEW
To demonstrate the superior-inferior sacro-iliac joints.
Patient sat upright on the bucky table with their legs over the side. The vertical central
ray is directed along the plane of the sacro-iliac joint in question.
HENKELTOPF
Routine infero-superior view of the zygomatic arches (jug handles).
HENSCHEN
Demonstrates the petrous temporal region.
Head in the lateral position. Centre 5cm above the EAM away from the film, with the tube
angled 15 degrees towards the feet.
HERMODSSON'S VIEW (INTERNAL ROTATION VIEW)
Shoulder view. Patient supine with the humerus horizontal to the top of the table. Arm
adducted to the side of the patient, the humerus is internally rotated 45 degrees, and the
forearm lies across the anterior trunk. Vertical central ray is angled 15 degrees towards
the feet and centred over the humeral head.
Ref: Rockwood and Green's Fractures in Adults, Lippincott.
HERMODSSON'S VIEW (TANGENTIAL)
Shoulder view
Patient prone. The elbow is flexed 90 degrees and the dorsum of the hand is placed behind
the trunk, over the upper lumbar spine. The thumb points upward. The film is placed
superior to the adducted arm. The x-ray tube is placed posterior, lateral and inferior to ISHERWOOD METHODS (subtalar region)
the elbow joint, making a 30 degree angle with the humeral axis. 1. Projection to demonstrate the anterior subtalar articulation.
Medial border of the foot at a 45 degree angle to the cassette. Centre 2.5cm distal and
HICKEY (skull) 2.5cm anterior to the lateral malleolus.
The profile view of the mastoid region. 2. Projection to demonstrate the middle articulation of the subtalar joint and give an
end-on view of the sinus tarsi.
Foot in the AP ankle position. Rotate the ankle 30 degrees medially. Centre to a point
HICKEY (HIP)
2.5cm distal and 2.5cm anterior to the lateral malleolus with a 10 degree cephalad
See Lauenstein and Hickey Methods.
angulation.
3. Projection to demonstrate the posterior articulation of the subtalar joint in profile.
HILL-SACHS VIEW Foot in the AP ankle position. Rotate the ankle 30 degrees laterally. Centre to a point
AP shoulder with arm in marked internal rotation. 2.5cm distal to the medial malleolus with a 10 degree cephalad angulation.

HIRTZ
J
The routine SMV projection.
Some cases overtilt by 15 degrees
JAROSCHY METHOD
See Hugheston.
HOBB'S VIEW
View of the sterno-clavicular joints.
Centre to the midline at the level of the sterno-clavicular joints. JOHNER VIEW
Tangential shoulder view.
Patient supine with the elbow flexed and the forearm resting on the abdomen. Film placed
HOLMBLAD METHOD
vertically against the superior aspect of the shoulder. Angle the central ray 20 degrees
View of the knee.
medially and 20 degrees below the horizontal. Centre to the head of the humerus.

HOUGH METHOD
JOHNSON METHOD
Projection of the sphenoid strut.
An axiolateral projection of the femoral head and neck.
Patient positioned as for a PA skull with the radiographic baseline horizontal. Turn the
Patient in the AP pelvis position. Place the cassette vertically against the lateral
head 20 degrees towards the side being examined. The horizontal central ray is angled
aspect of the hip of interest. Tilt the cassette backward 25 degrees. Direct the
downwards by 7 degrees so that is emerges through the orbit on the side being examined.
horizontal central ray 25 degrees cephalad and 25 degrees downwards and centre to the
Ref: Hough, J.E.(1968).Sphenoid strut: parieto-orbital projection, Radiol. Technol.
femoral neck.
39:197-209.
Ref: Johnson,C.R (1932).A new method for roentgenographic examination of the upper end of
the femur, J. Bone Joint Surg. 30:859-866,
HSIEH METHOD
PA oblique projections of the hip. Demonstrates posterior dislocations of the femoral
JOHNSON AND DUTT
head.
See Dutt's view.
Patient prone with the unaffected side raised by 45 degrees. Direct the vertical central
ray between the posterior surface of the iliac blade and the femoral head.
JONES POSITION
View of the elbow in flexion. Demonstrates the olecranon process in profile and the distal
Hsieh, C.K.(1936). Posterior dislocation of the hip, Radiology 27:450-455.
humerus. Place the humerus on the cassette and flex the arm.

HUGHSTON
Two projections taken, one with the central ray angled at right angles to the forearm (for
Patella view.
olecranon) and another with the central ray angled at right angles to the humerous (for
Ref:: Hughston (1968). Subluxation of the Patella, J. Bone and Joint Surg., 50-A:1003-
distal humerus).
26.

JUDET VIEWS
I
Oblique views of the acetabulum.
1. Raise the affected side by 45 degrees and centre to the affected hip.
INLET AND OUTLET VIEWS (PELVIS) 2. Raise the unaffected side by 45 degrees and centre to the affected hip.
See Pennal's views. Ref: K.Clarke. Positioning in Radiography. 11th Ed.
JUG HANDLE VIEW Patient prone, elevate the hip on the affected side and slightly flex the knee. Centre to
SMV projection of the zygomatic arches. the joint space between the patella and the femoral condyles at an angle of 30 degrees
caudal.
K
KURZBAUER METHOD
Unobstructed lateral projection of the sterno-clavicular articulation.
KANDEL METHOD
Patient lies on the affected side with the arm of that side next to the head. Vertical
Suroplantar projection to demonstrate clubfoot.
central ray directed 15 degrees caudal and centred to the lowermost sterno-clavicular
The patient stands on the cassette. The vertical central ray is angled 40 degrees and
articulation.
directed to the heel so that it emerges from the midfoot.
Ref: Kandel, B. (1952). The suroplantar projection in the congenital clubfoot of the
infant, Acta Orthop. Scand. 22:161-173. L

KASABACH METHOD LAQUERRIERE AND PIERQUIN METHOD

Oblique projection of the odontoid process. Ulnar groove projection.
Patient supine. Rotate the head 45 degrees away from the side being examined. Angle the Ref: K.Clarke. Positioning in Radiography. 11th Ed.
vertical central ray 10 degrees caudal and centre to a point midway between the outer
canthus and the EAM.
LAUENSTEIN AND HICKEY METHODS
Ref: Kasabach, H.H. (1939). A roentgenographic method for the study of the second
Lateral hip projection demonstrating the acetabulum and upper end of femur.
cervical vertebrae, A.J.R 42:782-785.

LAUENSTEIN
KEMP-HARPER METHOD
Routine turned lateral hip projection.
SMV projection of the jugular foramina.
Patient with back to the vertical bucky.
Chin elevated until the OM line is vertical. Angle the horizontal central ray 20 degrees LAUENSTEIN AND HICKEY METHOD
downwards. Centre below the chin so that the central ray passes between and through the As for turned lateral hip but angle the vertical central, ray 20 degrees cephalad.
EAM on the side in question.
Ref: Kemp Harper, R.A.(1957). Glomus jugulare tumors of the temporal bone, J.Fac.
Radiologists 8:325-334. LAURINS VIEW
View of the patella.

KISCH METHOD
See Friedman method. LAW
Demonstrate the petrous temporal region.
Head in the lateral position, then rotate the head 15 degrees towards the film. Centre 5cm
KITE METHODS above and 5cm behind the EAM away from the film with the tube angled 15 degrees towards
Projections to demonstrate clubfoot. the feet.
True lateral and dorsoplantar projections of the foot.
LAW METHOD (FACIAL BONES)
KNUTSSON METHOD Projection to demonstrate the floor and posterior wall of the antrum.
Skyline patella. Patient sitting PA with the head fully extended so that the chin and zygoma of the side of
Ref: The Journal of Bone and Joint Surger (1974). 56-A, NO.7, October interest, and the nose, are in contact with the cassette. Angle the central ray upward 30
degrees from the horizontal and centre to the lower antrum.
Ref: Law, F.M.(1933). Nasal accessory sinuses, Ann. Roentgenol. 15:32-51, 53-76.
KOVACS METHOD
Profile image of the lowermost lumbar intervertebral foramen.
Patient lies on the affected side and then rotate the pelvis 30 degrees anteriorly. Centre LAWRENCE METHOD
along a straight line extending from the superior edge of the uppermost iliac crest Lateral view of the proximal humerus.
through the fifth lumbar segment to the inguinal region of the dependent side. Supine, horizontal beam axial shoulder.
Ref: Kovacs, A. (1950) .X-ray examination of the exit of the lowermost lumbar root,
Radiol. Clin. 19:6-13.
LAWRENCE METHOD
Transthoracic lateral humerus.
KUCHENDORF METHOD
Oblique PA projection of the patella.
LENTINO METHOD LOW-BEER METHOD
See carpal bridge view. Parietotemporal projection.
Position the head in the lateral position. Angle the horizontal central ray upward 10
degrees and anteriorly 33 degrees. Centre to the back of the head so that the beam enters
LEONARD-GEORGE METHOD
at the level of the lower orbital margin and passes through the foraman magnum.
Demonstrates the femoral head and neck.
Similar appearances to Stenvers view.
Patient supine. A curved cassette is placed on the medial aspect of the leg of interest
(between the thighs). Direct the central ray perpendicular to the femoral neck.
LOWENSTEIN'S VIEW
Routine frog lateral hips.
LEQUESNE METHOD (FALSE PROFILE VIEW)
View of the acetabulum in profile.
Patient standing with their back against the vertical bucky. Move the unaffected hip LYSHOLM METHOD
forward so that the pelvis makes an angle of 60 degrees with the bucky. Central the Profile view of the petrosa, IAM, and the mastoid cells. Head in the lateral position then
horizontal central ray the affected hip. See also Urist's view. rotate 15 degrees towards the affected side. Angle the central ray 30 degrees from the
vertical and centre through the foraman magnum.
LETOURNEL VIEW
Iliac wing view. M

LEWIS METHOD MAY View

The routine view of the sesamoid bones of the first metatarsal. View to demonstrate the zygomatic arch.
Ref: K.Clarke. Positioning in Radiography. 11th Ed. Head in the PA position with the chin raised as far as possible. The head is then rotated
15 degrees away from the side being examined. Centre through the zygomatic arch, with the
tube angled towards the feet so that the central ray is at right-angles to the
LILIENFELD (CALCANEUM)
radiographic baseline.
See coalition view.

MACNAB'S VIEW
LILIENFELD (HIP)
View of the patella.
A posterolateral projection of the ileum and acetabulum.
Patient prone then raise the unaffected side by 75 degrees. Centre at the level of the
greater trochanter of the hip in contact with the film. MACQUEEN-DELL
Transpharyngeal view of the head of the mandibular condyle.
The film is parallel to the median sagittal plane and centred to the EAM of the affected
LILIENFELD (SYMPHYSIS PUBIS)
side. The central ray is angled 5 degrees cranially and 5 degrees posteriorly towards the
An superoinferior projection of the pubic and ischial bones and symphysis pubis.
condyle to be examined.
Position as for AP pelvis then raise the body by 45 degrees. Centre in the midline at the
level of the greater trochanter. See also Staunig Method.
MARTZ AND TAYLOR
Two AP projections of the pelvis to demonstrate the relationship of the femoral head to
LINDBOLM
the acetabulum in patients with CDH.
AP lordotic chest.
First projection with the central ray at right angles to the symphysis pubis.
Patient leans back 30+ dgerees, centre to mid sternum.
Second projection with the central ray directed 45 degrees towards the head and centred to
the symphysis pubis. This casts an anteroirly displaced femoral head above the acetabulum.
LODGE-MOOR PROJECTIONS A posteriorly displaced head is cast below the acetabulum.
Lateral oblique projections to demonstrate the cervical articular facets (four views in Ref: Martz and Taylor (1954). The 45 degree angle roentgenographic study of the pelvis in
total). Patient supine with the X-ray tube on the right hand side. First projection with congenital dislocation of the hip, J.Bone Joint Surg. 36-A:528-532.
the patients right side elevated by 20 degrees. Second projection with patients left side
elevated by 20 degrees. For both views, centre the horizontal central ray to C5. When the
MAYER
raised side is nearest to the tube then angle 5 degrees cephalad. When the raised side is
To demonstrate the petrous temporal region.
away from the tube then angle 5 degrees caudal. Repeat the two projections from the left
Patient in the AP position with the radiographic baseline at right-angles to the film.
side.
Rotate the head 45 degrees towards the side being examined, and centre through the EAM
nearest the film, with the tube angled 45 degrees towards the feet.
LORENTZ METHOD (MODIFICATION)
See Danellus-Miller method.
MERCEDES VIEW O
Routine superior-inferior axial shoulder view, or lateral scapula view
OPPENHEIM'S VIEW
MERCHANT'S VIEW Cephaloscapular projection.
View of the patella. Patient supine. Knees flexed 45 degrees over the end of the table. X-ray beam passed from superior to inferior across the glenoid face to a cassette behind
Position femora so that they are parallel to the table top. Place knees and feet together. the patient who is leaning forward.
Angle the central ray 30 degrees from the horizontal ( 30 degrees to femora). Centre
midway between patellae.
OUTLET VIEW
Ref: Merchant, A, et al (1975). Reontgenographic Analysis of Patellofemoral Congruance,
See supraspinatus outlet view.
J. Bone and Joint Surg., 56-A: 1391-96, Oct.

P
MILLER METHOD
Projection of the hypoglossal canal.
Patient positioned as for an AP skull with the radiographic baseline horizontal. Rotate PAWLOW METHOD
the head 45 degrees towards the side in question. The horizontal central ray is angled Swimmer's view with the patient on their side.
downwards an unknown number of degrees so that it passes through the foraman magnum.
PEARSON METHOD
MILLER'S VIEW A bilateral AP projection of the acromoclavicular joints. Both joints taken in one expose
To demonstrate anterior or posterior dislocation of the shoulder. on a wide film.
The patient is positioned as for the routine trauma shoulder view. The tube is then angled
45 degrees towards the feet and centred to the glenoid.
If the head of the humerus is projected below the glenoid then the dislocation is PENNAL'S VIEWS (TILE'S VIEW)
anterior. Trauma views to show the pelvic inlet and outlet.
If the head of the humerus is projected above the glenoid then the dislocation is VIEW 1
posterior. Patient positioned as for an AP pelvis. Angle the central ray 40 degrees caudally and
centre midway between the ASIS.
VIEW 2
MODIFIED CLEAVES Patient positioned as for an AP pelvis. Angle the central ray 40 degrees cranially and
Hip view. Frog view with the thighs abducted to approx. 40 degrees. Centre 2.5cm above the centre in the midline 4cm below the upper border of the symphysis pubis.
symphysis pubis. Ref: Tile M. and Pennal G. Fractures of the Pelvis. Chapter 15.

MODIFIED FUCHS METHOD PILLAR VIEWS

Projection of the temporal styloid process. Details not known. Cervical spine views to demonstrate the posterior intervertebral joints.
Position as for AP cervical spine. Take two exposures, one with the head rotated at right-
angles to the left and one with the head rotated at right-angles to the to the right.
MORTISE VIEW
Angle the vertical central ray 30 degrees towards the feet. Centre just behind the angle
True AP ankle.
of the mandible with the top of the cassette at the level of the EAM.
Ref: K.Clarke. Positioning in Radiography, 11th Ed, p157.
N
PIRIE
NOLKE METHOD This is the routine OM 30 sinus view with the mouth open.
Projection of the upper sacral canal. Ref: Goldman and Cope. A Radiographic Index. Wright Publishing, Bristol..
Patient sits upright on the bucky table with the feet over the side of the table and leans
forward. Centre to the sacrum.
PORCHER-POROT
Oblique transmaxillary view of the foramen jugulare.
NORGAADS VIEW (BALL CATCHERS VIEW) The radiographic baseline is vertical. The tube is angled 55 degrees cranially. The head
Projection of both hands. Supination of each hand to an angle of 35 degrees . Centre is then rotated 40 degrees away from the affected side. Centre midway between the EAM and
midway between the heads of the fifth metacarpals. the angle of the mouth on the affected side.

PRAYER POSITION
Lateral calcanei.
Legs abducted and the planar surfaces of the feet placed together. Centre between the S
heels.
SANSREGRET MODIFICATION OF CHAUSSE III METHOD
Q Slight oblique projection of the petrosa and attic wall.
Patient supine. Rotate the head 10 degrees away from the side of interest. Adjust the
infraorbitomeatal line so that it is 30 degrees from the vertical. Centre to a point 2.5
QUESADA METHOD
cm medial to the EAM at the level of the upper orbital margin on the affected side.
Projections of the clavicle. Patient prone.
Ref: Sansgret, A.(1963), Technique for the study of the middle ear, A.J.R. 90:1156-1166.
1. Centre to the midpoint of the clavicle at an angle of 45 degrees caudal.
2. Centre to the midpoint of the clavicle at an angle of 45 degrees cephalad.
Ref: Quesada, F (1926). Technique for the roentgen diagnosis of fractures of the SCHNEIDER METHOD
clavicle, Surg. Gynecol. Obstet. 42:424-428. Demonstrates the upper contour of the femoral head.
1. Patient supine with the femour flexed 60 degrees.
2. Patient supine with the femour flexed 30 degrees.
R
Vertical central ray centred to the hip joint.

REVERSE TOWNES
SCHULLER
Demonstrates the condyles, condylar heads and condylar hypo/hyperplasia.
Lateral view of the petrous temporal region.
PA Townes ( half-axial skull) with 30 degree angulation.

SERENDIPITY VIEW
REVERSE WATERS
View of the sterno-clavicular joints.
Method (AP) facial bones.
Patient supine. Angle the horizontal central ray 40 degrees towards the head. Centre
midway between the sterno-clavicular joints.
RHESE METHOD
The routine PA oblique of the optic foramen
SETTEGAST METHOD
Ref: K. Clarke. Positioning in Radiography, 10th ed.
Tangential projection of the patella.
Patient prone. Knee flexed to at least 90 degrees . Centre to the patellofemoral joint
RIPPSTEIN METHOD space. The degree of angle is dependent on the amount of knee flexion but should be 15-20
Foreshortened view of the femurs and femoral neck. degrees towards the joint space.
Requires a Rippstein leg support.
Patient supine with the hips flexed 90 degrees and abducted 20 degrees. The legs are
SIMMONS VIEWS
parallel in a Rippstein leg support. Vertical central ray centred to the symphysis pubis.
To demonstrate congenital talipes equinovarus.
Ref: Rippstein, J. (1955). On Assesment of the Neck of the Femur by Means of Two X-rays.
1.AP of both feet with the x-ray tube angled 30 degrees to the hindfoot.
Z. Orthop. 86; 345-360.
2.AP of each foot with the foot held in the position of fullest correction. The x-ray tube
is angled 30 degrees to the hindfoot.
RISSER METHOD 3.Lateral of each foot. The film is placed against the medial aspect of the foot and a
Demonstrates both iliac crests and epiphysis. horizontal beam is used.
Patient supine. Centre to the iliac crests. Ref: Simmons G.W (1977), Analytical radiographs of club foot. Journal of bone and joint
Ref: Risser, J.C.(1958). The Iliac Apophysis: An invaluable sign in the management of surgery. 59B(4): 485-9.
scoliosis, Clin. Orthop. 11: 111-119.
STAUNIG METHOD
ROCHER An inferosuperior projection of the pubic and ischial bones and symphysis pubis.
AP Skull centred through orbits Patient prone. Centre to the symphysis pubis with the central ray angled 35 degrees
cephalad.
See also Lilienfeld Method.
ROBERT'S VIEW
True AP thumb.
ROSENBERG METHOD STECHER METHODS
45 degree posteroanterior flexion weight-bearing view of the knee. Projections of the scaphoid.
Ref: Rosenburg T. et al. The Journal of Bone and Joint Surgery 1. PA wrist position with the cassette inclined by 20 degrees so that the hand is higher
than the wrist. Centre to the scaphoid.

Bridgeman view has the wrist in ulnar flexion.

2. PA wrist position with the forearm horizontal and the central ray angled 20 degrees
towards the elbow. Similar projection to 1.
3. PA wrist position with the fist clenched. This position tends to widen the fracture
line.
Ref: Stecher, W.R. (1937). Roentgenography of the carpal navicular bone, A.J.R. 37:704-
705.
STENVER
Oblique view of the petrous temporal region.
Ref: K. Clark, Positioning in Radiography, 11th Ed.
STOCKHOLM C
Similar to Stenver's view but designed for use with a skull unit.
Head in the lateral position, with the centre of the bucky 2.5cm in front of the EAM and
1cm above the orbitimeatal line. The tube is angled 10 degrees towards the head, and 30
degrees towards the face. The grid must be rotated accordingly.
Ref: Goldman and Cope. A Radiographic Index. Wright Publishing, Bristol..
STORK METHOD
See Flamingo view.
STRYKER'S VIEW
Technique:
- the patient is supine;
- a cassette is placed under the involved shoulder
- the palm of the hand of the affected extremity is placed on top
of the head with the fingers toward the back of the head;
- the beam is centered over the occur;
- coracoid process and tilted 10 deg cephalad;
Demonstrates defects in the posterolateral aspect of the humeral head
Ref: K.Clarke. Positioning in Radiography. 11th Ed.
TARRANT METHOD
A method to demonstrate the clavicle projected above the thoracic cage.
Patient sitting with the cassette on the lap. Central ray directed from behind the patient
to the clavicle. The central ray is at right angles to the coronal plane of the clavicle.
Ref: Tarrant, R.M. 91950). The axial view of the clavicle, X-ray Techn. 21:358-359.
TAYLOR METHOD (MASTOID)
SMV projection to demonstrate the mastoid processes,IAM ,EAM and inferior petrosal
sinuses.
Patient sitting, OM line vertical. Centre to the midline 2.5cm anterior to the level of
the EAM at an upward angle of 20 degrees.
Ref: Taylor, H.K. (1931). The roentgen findings in suppuration of the petrous apex, Ann
Otol. Rhinol. Laryngol 40:367-395.
TAYLOR METHOD (PELVIS)
An inferosuperior projection of the pubic and ischial rami.
Position as for AP pelvis. Centre 5cm distal to the upper border of the symphysis pubis
with a 25 degree cephalad angulation (male) or a 40 degree cephalad angulation (female).
TEMPLETON AND ZIM METHOD
Superoinferior carpal tunnel projection.
The forearm is placed at right angles to the cassette with the hand in contact with the
cassette. Direct the vertical central ray through the carpal tunnel at an angle of 40
degrees towards the fingers.
Ref: Templeton, A.W., and Zim, I.D.(1964). The carpal tunnel view, Mo. Med. 61:443-444.
See also Gaynor-Hart method.
TEUFEL METHOD
Acetabulum and femoral head margin including the fovea capitis.
Patient in 35-40 degrees anterior oblique position. Centre 2.5cm superior to the level of
the greater trochanter. Central ray angled 12 degrees cephalic.

SUPRASPINATUS OUTLET VIEW THOMS’ METHOD (AP, PELVIC INLET)

Modification of the scapular Y (transscapular) view. Demonstrates the anterior third of Pelvimetry view.
the acromion. Requires the use of the Thoms’ positioning device (patient positioning platform with
Patient standing and position 30-40 degrees posterior obliquely or 40-60 degrees anterior- backrest).
obliquely, and the horizontal central ray is angled 10-15 degrees caudally. The patient is seated on the positioning device at an angle of 50 degrees. The backrest is
Demonstrates Shoulder Impingment. then adjusted to bring the plane of the pelvic inlet parallel to the plane of the film.
Abduct legs and place posterior indicator arm of device against the area of L4/L5.
Anterior indicator arm is positioned between the legs against the pelvis, 1 cm below the
SWANSON METHOD
symphysis pubis.
See Dunlop method.
Centre vertical central ray 6cm posterior to the symphysis pubis.

T
THOMS’ METHOD (LATERAL)
Pelvimetry view.
TALAR NECK VIEW Patient standing in the lateral position. Metal centimetre marked ruler is placed between
Foot view. the buttocks against the sacrum. Horizontal central ray directed to a point between the
Patient lies supine. The knee is flexed so that the sole of the foot is in contact with symphysis pubis and the depressed area located inferior to L5.
the cassette then internally rotate the foot by 15 degrees. The vertical central ray is
angled 15 degrees towards and centred to the midfoot.
TIEGE'S VIEW
Trauma axillary view.
Patient supine with the cassette above the shoulder. The forearm is brought across the W
chest and the horizontal central ray is centred to the shoulder joint.
WALLACE-HELLIER VIEW
TILE View of the shoulder.
See Pennal’s view. The patient sits with their back to the table and the affected shoulder is turned towards
the table so that the blade of the scapula is parallel to the table side. The vertical
central ray is angled 30 degrees towards the anterior aspect of the shoulder. Centre to
TITTERINGTON
the shoulder joint.
The routine OM 30 view.
Ref: Wallace H A and Hellier M, Improving radiographs of the injured shoulder,
Radiography, 1983, 49, 229-233.
TOWNES
The routine half-axial view of the skull.
WATERS
Ref: K.Clarke. Positioning in Radiography. 11th Ed.
The routine OM view of the sinuses.
Ref: K.Clarke. Positioning in Radiography. 11th Ed.
TUBEROSITY VIEW
View of the elbow.
WEST POINT SHOULDER (WEST POINT AXILLARY LATERAL)
Elbow AP, angle 20 degrees towards the olecranon. Various degrees of rotation are used.
Patient prone. Shoulder raised on a pad. Head turned away from affected side. Cassette
against superior aspect of shoulder. Centre to the axilla. Angle 25 degrees downward from
TWINNING METHOD the horizontal and 25 degrees medially. This gives a tangential view of the anteroinferior
Swimmer's view for C7/T1 rim of the glenoid.

U WIGBY-TAYLOR METHOD
Open mouth oblique projection of the styloid process of the skull.
Position the patient as for an AP skull then rotate the head 78 degrees to the affected
URIST'S VIEW side. Angle the central ray cranially 8 degrees and centre to the styloid process nearest
View of the acetabular rim in profile. Patient supine, injured side elevated 60 degrees. the film.
See also Lequesne method. Both sides for comparison.

V WILLIAMS METHOD
Projection to demonstrate the costovertebral and costotransverse joints.
VEIHWEGER METHOD Patient supine. Angle the central ray 20 degrees cephalad and centre to the sixth thoracic
Ulnar groove projection. vertebrae.
Ref: Positioning in Radiography , K.Clarke, 11th ed.
WINDOW VIEW
VALDINI Demonstrates the kidneys during an IVP in an infant.
Demonstrates the squamous portion of the occipital bone and the foramen magnum. Child positioned as for an AP abdomen. Angle the vertical central ray 35 degrees towards
Head in the PA position with the chin tucked in as far as possible and the frontal region the feet. This projects the kidneys through the liver on the right and the stomach on the
resting on the film, with the radiographic base-line tilted 45-50 degrees downwards. left.
Centre in the midline at the level of the EAM. Ref: RADIOGRAPHY; XLV:538.
Ref: Goldman and Cope. A Radiographic Index. Wright Publishing, Bristol..
WORMS
VELPEAU VIEW AP skull
Axillary lateral view of the shoulder. 25 degree angle between OM baseline and central ray
Patient stands with their back against the table and leads backwards. Centre the vertical
central ray to the shoulder joint. Y
Ref: Rockwood and Green's Fractures in Adults, Lippincott.

Y VIEW
VOGT BONE-FREE PROJECTIONS Axial shoulder or lateral scapula.
AP and lateral views of the eye using dental film.
 Z II. UNDERDEVELOPMENT
A. Improper development
ZANCA'S VIEW 1. Time too short
As for the routine view of the ACJ but with a 10-15 degree cephalic tilt of the x-ray 2. Temperature too low (Hydroquinone inactive below 55°F. or 13°C.)
beam. 3. Combination of both
4. Inaccurate thermometer.
ZANELLI METHOD B. Exhausted developer
Projection to demonstrate the TMJs in the open and closed positions.Patient lateral with 1. Chemical activity used up
the head 30 degrees away from the vertical i.e. top of head against the cassette. Centre 2. Activity destroyed by contamination
2.5cm anterior to the EAM. C. Diluted developer
1. Water added to raise level instead of fresh developer
ZIMMERS VIEW 2. Melted ice from cooling attempt
Transorbital TMJ view. 3. Water overflowed from wash tank
Patient holds cassette behind TMJ. Mouth open wide. Position the tube at the outer canthus 4. Insufficient chemical mixed originally due to tank actually larger
of the opposite eye and aim downwards and backwards across the orbit to the condyle under than rating
investigation. 5. Improper additions.
Ref: Eric Whaites , Essentials of Dental Radiography and Radiology Churchill Livingston.
D. Incorrectly mixed developer
1. Exact capacity of tank unknown.
ZITER'S VIEW 2. Mixing ingredients in wrong sequence
Scaphoid view. 3. Omission of ingredients
Wrist PA with ulnar deviation. Angle the tube 25 degrees up towards the elbow. Centre 4. Unbalanced formula composition
between the styloid processes.
Ref: Radiography (1983), 49, 229-233. 5. Overdose of sodium bicarbonate as retarded in concentrated developer
during hot weather
6. Too low a Ph causing of inactivity the hydroquinone.
"COMMON CAUSES OF UNSATISFACTORY RADIOGRAPHS"
II HIGH DENSITY
I. LOW DENSITY
I. OVER EXPOSURE
I. UNDER EXPOSURE A. Wrong exposure factors
A. Wrong Exposure Factors 1. Too high kilovoltage
1. Too low kilovoltage 2. Too low milliampereage
2. Too low milliampereage 3. Too short exposure
3. Too short exposure 4. Too great focal-film distance
4. Too great focal-film distance B. Meters out of calibration
B. Meters out of calibration C. Timer out of calibration
C. Timer out of calibration D. Inaccurate setting of meters or timer
D. Inaccurate setting of meters or timer E. Drop in coming line voltage
E. Drop in coming line voltage 1. Elevators, welders, furnaces, blowers, etc., on same circuit
1. Elevators, welders, furnaces, blowers, etc., on same circuit 2. Insufficient size of power line or transformers
2. Insufficient size of power line or transformers F. Photocell timer out of adjustment
F. Photocell timer out of adjustment G. Incorrect centering of patient to photocell.
G. Incorrect centering of patient to photocell
H. Central ray of x-ray tube not directed on film. II IMPROPER DEVELOPMENT
1. X-ray tube rotated in casing A. Time too long
I. Distance out of grid radius B. Temperature too high
J. Bucky timer inaccurate C. Combination of both
K. One or more valve tube burned out. (full wave rectifying machines). D. Inaccurate thermometer
E. Insufficient dilution of concentrated developer
F. Omission of bromide when mixing III. IMPROPER DEVELOPMENT

III. FOG- SEE SECTION ON "FOG" V. FOG

A. Light struck
B. Radiation I. UNSAFE LIGHT
C. Chemical A. Light leaks into processing room
D. Film deterioration 1. Leaks through doors, windows etc.,
2. Poorly designed labyrinth entrance
III LOW CONTRAST a. Bright light at outer entrance
b. Reflect from white uniforms of persons passing through
I. OVER PENETRATION FROM TOO HIGH KILOVOLTAGE 3. Sparking of motors
A. Over measurement of part to be examined a. Ventilating fans
B. Incorrect estimate of material or tissue density b. Dryer fans
C. Meters out of calibration c. Mixers-barium
D. Meters inaccurately set 4. Light leaks in film-carrying box
E. Surge in incoming line voltage B. Safelights
F. Under measurement of focal-film distance 1. Bulb too bright
2. Improper filter
II. SCATTERED RADIATION a. Not dense enough
A. Failure to use bucky diaphragm b. Cracked
B. Failure to use stationary grid c. Bleached
C. Failure to use cut-out diaphragm d. Shrunken
D. Failure to use suitable cones C. Turning on light before fixation is complete
E. Failure to lead backing cassette D. Luminous clock and watch faces
E. Lighting matches in darkroom
III. TOO SHORT EXPOSURE F. Where film is carried from machines to darkroom in containers, containers may
A. Timer out of calibration leak light
B. Timer inaccurately set
C. Overload relay kicked out II. RADIATION
A. Insufficient protection
IV. IMPROPER DEVELOPMENT 1. During delivery or transportation in laboratory or shop
2. Film storage bin
3. Loaded cassette racks-steel back should face toward source of
IV. HIGH CONTRAST radiation
4. Not enough protection for loading darkroom
I. UNDER PENETRATION FROM TOO LOW KILOVOLTAGE B. Improper storage
A. Under measurement of part to be examined 1. Radium
B. In parts of varying thickness, setting of kilovoltage for thinner sections 2. Isotopes
C. Meters out of calibration 3. X-ray machines
D. Meters inaccurately set
E. Drop in incoming line voltage III. CHEMICAL
1. Elevators, welders, furnaces, etc., on same line A. Prolonged development
2. Insufficient size of power line or transformer B. Developer contaminated
F. Over measurement of focal-film distance 1. Foreign matter of any kind (metal, etc.)

II. TOO LONG EXPOSURE IV. DETERIORATION OF FILM

A. Timer out of calibration A. Age (Use oldest film first)
B. Timer inaccurately set B. Storage condition
1. Too high temperatures
 a. Hot room II. WHITE OR CRYSTALLINE
b. Cool room but near radiator or hot pipe A. Milky fixer
2. Too high humidity 1. Acid portion added too fast while mixing
a. Damp room 2. Acid portion added when too hot
b. Moist air 3. Excessive acidity
3. Ammonia or other fumes present in darkroom or other working area 4. Glacial acetic acid mistaken for 28%
C. Delivery conditions 5. Developer splashed into fixer
1. Moisture precipitation when cold box of film is opened in hot humid 6. Insufficient rinsing
room. B. Prolonged washing
2. Fresh boxes should be stored overnight at room temperature before
opening III. GRIT
A. Dirty water
V. EXCESSIVE PRESSURE ON EMULSSION OF UNPROCESSED FILM B. Dirt in dryer
A. During storage
B. During manipulation in darkroom VII. MARKS ON EMULSION SURFACES

VI. LOADED CASSTTES STORED NEAR HEAT SUNLIGHT OR RADIATION I. RUNS

A. Insufficient fixing
STAINS ON RADIOGRAPHS 1. Weakened fixer
I. YELLOW 2. Unbalanced formula
A. Exhausted, oxidized developer 3. Exhausted ingredients
1. Old 4. Low acid content
2. Covers left off a. Deficient when fresh
3. Scum on developer surface b. Diluted from rinse water.
a. Oil from pipelines c. Neutralized by developer because of insufficient or no rinsing
b. Impure water used when mixing B. Drying temperature too high
c. Dust C. Contact with hot viewing box
B. Prolonged development
C. Insufficient rinsing II. BLISTER.
D. Exhausted fixing bath A. Formation of gas bubbles in gelatin
1. Carbonate of developer reacting with acid of fixer
II. DICHROIC 2. Unbalanced processing temperature
A. Old, exhausted developer a. Combination of hot fixer and cool developer
1. Colloidal metallic b. Combination of cool fixer and hot developer
B. Nearly exhausted fixer 3. Excessive acidity of fixer or stop bath
C. Developer containing small amount of fixer or scum 4. No agitation of film when first placed in fixer
D. Film partially fixed in weak fixer exposed to light and refixed
E. Prolonged intermediate rinse in contaminated rinse water. III. RETICULATION
A. Non-uniform processing temperatures
III. GREEN TINTED 1. Developer (hot)
A. Prolonged immersion in chrome alum fixing bath 2. Rinse
B. Insufficient washing 3. Fixer (cool)
VI. DEPOSIT IN RADIOGRAPHS 4. Wash
I. METALLIC B. Weakened fixer with little hardening action
A. Oxidized products from developer
B. Silver salts reacting with hydrogen sulfide in air to from silver sulfide IV. FRILLING
C. Improper solder used in repair of hangers. A. Weakened fixer with little hardening action
D. Silver loaded fixer B. Hot processing solutions
1. Developer
 2. Rinse
3. Fixer IX. BRITTLENESS OF FINISHEDRADIOGRAPHS
4. Wash
C. Prolonged washing I. EXCESSIVE DRYING TEMPERATURE

V. AIR BELLS II. EXCESSIVE DRYING TIME

A. Air bubbles trapped on film surfaces preventing development
B. Dropping film into developer without agitation as soon as immersed III. OUTLET AIR TOO DRY

VI. DRYING MARKS UNEVEN DRYING OF GELATIN IV. EXCESSIVE HARDENING IN FIXER
A. Excessive drying temperatures A. Excessive fixation
B. Extremely low humidity B. Excessive acidity
C. Failure to use wetting agent
D. Puddles (buckshot marks) X. STREAKS ON RADIOGRAPHS
1. Drops of water striking semi dried emulsion surface
E. Streaks I. INSUFFICIENT AGITATION WHILE PROCESSING
1. Drops of water running down semi-dried emulsion surface
a. Water trapped on hanger frames II. FOG
b. Water splashes
c. Dirty hangers III. CHEMICALLY ACTIVE DEPOSITS ( DRIED CHEMICALS ON HANGERS )
d. Drying air flow too rapid
IV. PRESSURE FOG
VII. WHITE SPOTS
A. Screens Pitted V. SCRATCHES
B. Grit or dust present in film or screen A. Careless handling
C. Chemical dust settling on film or screens (particles of certain chemical B. Grit present in air, cassettes, or on illuminator
dusts will also cause black spots)
VI. EXPOSURE TO WHITE LIGHT BEFORE COMPLETE FIXING
VIII ARTIFACTS
A. Crescents-rough handling VII. UNEVEN DRYING DUE TO HIGH TEMPERATURE AND LOW HUMIDITY
B. Smudge marks- fingerprints of finger abraisions
C. Bands in marginal areas usually due to screen mounting medium. XI. LACK OF DETAIL OR FUZZINESS

VIII SLOW DRYING I. MOTION (TUBE, FILM, SUBJECT)

A. Inadequate immobilization
I. WATER GLOSSED FILMS B. Too long exposure
A. Insufficient hardening in fixer C. Vibration of floor
1. Too short fixing period D. Slipping of subject on mount
2. Weakened fixer from splashing E. Stepping on and off operator's platform during exposure where control and
3. Exhausted fixer tube are mounted on common mobile base
4. Insufficient acidity F. Failure to arrest tube vibration after positioning before making exposure
B. Prolonged washing
C. Wash water too warm II. POOR CONTACT OF INTENSIFYING SCREENS

II. INCOMING AIR TOO HUMID III. IMPROPER DISTANCE RELATIONSHIP

A. Objective-film distance too great
III. INCOMING AIR TOO COLD B. Target-film distance too short

IV. AIR VELOCITY TOO LOW XII. STATIC

 B. Dryer air tubes not seated properly
I.LOW HUMIDITY

II. INSULATION V. PROCESSING STREAKS

A. Rollers and crossovers encrusted with chemical deposits
III. IMPROPER HANDLING IN: B. Dirty wash water
A. Removal from box C. Film not Hardened properly by chemicals
B. Removal from interleaving paper VI DRYING STREAKS
C. Loading cassette
D. Unloading cassette A. Dirty air tubes
E. Loading hanger B. Film not hardened properly by chemicals
F. Films stacked before processing
VII. "PI-LINES"
"COMMON CAUSES OF UNSATISFACTORY RADIOGRAPHS WITH AUTOMATIC PROCESSOR"
A. A thin black line running across the film opposite to the direction of
I. DECREASED DENSITY travel. Caused by deposit on rollers in the developer tank. "Pi-Lines" are most
A. Under-replenishment often seen in new machines, and will usually disappear after 500 films have been
B. Developer temperature low processed.
C. Exhausted developer. Drain and clean tanks every six months or 50,000 films
whichever occurs first VIII. INSUFFICIENT DRYING
D. Developer improperly mixed
E. Too low p.H. humidity A. Temperature too low
B. Dryer thermostatic control or heater inoperative
II. INCREASED DENSITY C. High humidity in dryer section indicating one of the following
A. Over-replenishment 1. Insufficient air venting resulting in back pressure
B. Developer temperature high 2. Damper in exhaust line not open far enough
C. Contamination of developer with fixer 3. Exhausting into an existing line carrying a higher pressure than that
D. Developer improperly mixed coming from the processor.
E. Light leaks in processor cover or in light seal where processor enters 4. Lack of insufficient air conditioning
darkroom D. Film not hardened properly by chemicals
E. Solutions too hot
III. FAILURE OF FILM TO TRANSPORT
A. Chemicals improperly mixed RADIOLOGIC SCIENCES
B. Chemical contaminated or diluted
C. Chemical temperature too high 1. A filled lung seen on x-ray as
D. Incorrect replenishment rates A. Soft tissue density
E. Dirty racks, turnarounds, or crossovers
F. Racks, or crossover not seated properly or warped
B. Radiolucent
G. Dirty wash water. C. Variable
H. Overlapped films D. Radiopaque
I. Tacky films in dryer section
J. Incorrect dryer temperature Explanation: In x-ray lucent – dark, opaque – dense/white. Air does not
K. Dryer tubes incorrectly located or seated attenuate x-ray photons, therefore air is radiolucent;
L. Hesitation in drive assembly which causes film to pause in transit fluid/metal/calcifications/solid - radiopaque
M. Film not tracking through the processor on a straight course
2. This is not a cardiac border forming structure on PA chest
IV. SCRATCHES
A. Inferior vena canal
A. Guide shoe out of line or dirty B. Right ventricle
 C. Left ventricle A. Cavitation
D. Right atrium B. Mediastinal mass
C. Atelectasis
Explanation: On PA chest, the cardiac forming borders are right atrium, D. Hilar enlargement
left ventricle, and left atrium
Explanation: Atelectasis – loss of lung volume. Bronchogenic cancer can
3. The most commonly used puncture site for angiography obstruct the bronchus causing loss of lung volume (loss of air)
A. Carotid artery
B. Axillary artery 8. the circle of Willis is seen in the
C. Femoral artery A. Abdomen
D. Brachial artery B. Chest
C. Brain
Explanation: The most commonly used puncture site in angiography is D. Muscles
usually the right groin (femoral artery)
Explanation: The circle of Willis is the principal blood supply to the
4. the following are proximal carpal bones except brain. Cerebral arteries are anterior, middle, and posterior cerebral
A. Capitate artery
B. Scaphoid
C. Lunate 9. Hepatorenal fossa is also called
D. Pisiform A. Cul de sac (recto-uterine pouch)
B. Morrisons pouch
Explanation: Proximal carpal bones are scaphoid, lunate, triquetrum, C. Epiploic foramen
pisiform. Distal carpal bones are trapezium, trapezoid, capitate, hamate D. None of the above

5. The first X-ray film in intravenous urography (IVU) is called Explanation: In doing ultrasound, we scan the hepatorenal fossa to look
A. Nephrogram for fluid collection.
B. Pyelogram Cul de sac – is also called pouch of Douglas
C. Cystogram Epiploic foramen – connects the Morrisons pouch to the superior recess
D. KUB film
10. Damasceaus curve is seen in
Explanation: KUB film is the first x-ray film in IVU, it is non-contrast A. Atelectasis
film. B. Pneumothorax
What do we look at KUB film? – Irregular calcifications, renal and psoas C. Pulmonary mass
shadows, lumbar spine D. Pleural effusion
6. Fluid containing structure seen on Ultrasound as
A. Hypoechoic Explanation: Pleural effusion is defined as presence of fluid in pleural
B. Hyperechoic cavity. On chest X-ray, the radiographic hallmark of pleural effusion is
C. Hyperdense blunting of the costophrenic sulcus
D. Hypodense
11. Most commonly involved paranasal sinus in acute chronic sinusitis
Explanation: In ultrasound, we used the term echoic. Water is hypoechoic A. Ethmoid
In CT scan, we use the term hyperdense or hypodense B. Maxillary
C. Frontal
7. The most common radiographic sign for bronchogenic cancer is D. Sphenoid
 A. Malignancy
Explanation: Maxillary sinus is best seen on water’s view. But today, CT B. Gallstone passage
scan of paranasal sinus has been the hallmark imaging of the paranasal C. Ascariasis
sinuses D. Alcohol abuse

12. This is a measure of current referring to the number of electrons Explanation: The hallmark of chronic pancreatitis is calcification
flowing per second
A. Kilovoltage 17. The first film in an intravenous urography (IVU) is also called
B. Heat unit A. Nephrogram
C. Milliamperage B. Pyelogram
D. None of the above C. Cystogram
D. KUB film
Explanation: The number of electrons depends directly on the tube
current (mA). The greater the mA, the more electrons are produced Explanation: KUB film is the first film or the scout film taken during
IVU
13. Retrosternal fullness on lateral chest film means enlargement of Nephrogram is taken 1 minute after injection of CM
the what chamber Pyelogram is taken 5 minutes after
A. Left atrium Cystogram is taken during full bladder
B. Right atrium
C. Right ventricle 18. The total number of cranial nerves
D. Left ventricle A. 10
B. 11
Explanation: In chest film – retrocardiac is the left ventricle; C. 12
retrosternal is the right ventricle D. 13

14. The knee joint is formed by the Explanation: There are 12 total cranial nerves in the skull
A. Tibia and Fibula
B. Femur and Tibia 19. The following has depressed diaphragm
C. Patella A. Diaphragmatic hernia
D. Femur and Fibula B. Pulmonary emphysema
C. Abdominal mass
Explanation: The femur articulates with tibia through the femorotibial D. Phrenic nerve paralysis
joint. The fibula – lateral, tibia – medial
Explanation: Diaphragmatic hernia, abdominal mass, and phrenic nerve
15. Scattered radiation is usually seen in paralysis may elevate diaphragm
A. Photoelectric effect
B. Compton effect 20. Spontaneous pneumothorax occurs usually in
C. Coherent scattering A. Infants
D. Photodisintegration B. Elderly
C. Young patients
Explanation: Compton Effect is the most common interaction between x-ray D. History of pneumonia
and body tissues and is responsible for almost all scatter radiation
Explanation: Pneumothorax – air in the pleural space
16. Most common cause of chronic pancreatitis Radiographic hallmark – visceral pleural line
21. The number of thoracic vertebrae is Explanation: On Upper GI series, the fundus is the most dependent
A. 11 portion of the stomach during supine position
B. 12
C. 13 26. A ____ is a volume element
D. 12 A. Pixel
B. Voxel
Explanation: Cervical – 7; Thoracic – 12; Lumbar – 5; Sacral – 5 (fused) C. Any of the above
D. None of the above
22. The first cervical vertebra is called
A. Atlas Explanation: Voxel is the term for volume element; Pixel is the picture
B. Axis element
C. Odontoid
D. Occiput 27. Ability of the CT scanner to display separate images of two
objects close together
Explanation: Atlas is the other name for 1st cervical vertebra; axis is A. Contrast resolution
the other name for 2nd cervical vertebra; odontoid process is the part B. Spatial resolution
of 2nd cervical vertebra C. Scanner design
D. Field size
23. Wilhelm Conrad Roentgen discovered x-rays on
A. November 8, 1895 Explanation: Contrast resolution is the ability to display an image of
B. November 9. 1895 two objects with different density
C. December 8, 1895
D. December 9, 1895 28. Fluid seen on T2W image on MRI as
A. Dark
Explanation: X-rays was accidentally discovered by Wilhelm Conrad B. Bright
Roentgen on November 8, 1895 C. Isointense
D. Hypodense
24. Posterior accousting shadowing on ultrasound is indicative of
A. Cyst Explanation: The characteristics of fluid (water) on MRI are as follows:
B. Abscess T1 – Dark
C. Calcification T2 – Bright
D. None of the above
29. What structure is seen at the superior aspect of both kidneys?
Explanation: Cyst is water containing and is hypoechoic on ultrasound A. Parathyroid
without acoustic shadowing B. Pancreas
Abscess – seen as a complex mass lesion (hyper and hypoechoic mixture) C. Adrenals
D. Colon
25. On supine position, barium will be found on what part of the
stomach Explanation: Adrenal glands are paired structures seen at the superior
A. Fundus portion of both kidneys. It is divided into a cortex and medulla
B. Cardia
C. Pylorus 30. _____ of a tissue is the product of its density and the velocity
D. Body of sound in that tissue
 A. Acoustic Impedance Explanation: Molybdenum is the filter used in mammography. To reduced
B. Wavelength the amount of higher energy radiation in the molybdenum tube spectrum, a
C. Attenuation molybdenum filter of 0.030 mm thickness is commonly used
D. Frequency
35. On CT scan, hemorrhage is usually seen as
Explanation: RAYL – unit for acoustic impedance in cgs system defined as A. Hypodense
g/cm2 x 10-5. The velocity of sound in tissue is fairly constant over a B. Hyperdense
wide range of frequencies C. Hypointense
D. Hyperintense
31. The tube film distance on Chest PA should be
A. 6 inches Explanation: Hypodense in CT scan – fluid, infarct, edema
B. 6 feet Hypo and Hyperintense are used in MRI
C. 8 inches
D. 8 feet 36. On CT scan, a normal thyroid gland appears
A. Hyperdense
Explanation: Chest radiography (PA) is taken on inspiration, 6 Feet B. Isodense
tube-film distance, and upright C. Hypodense
D. Variable
32. Cholelithiasis is found in the
A. Liver Explanation: Normal thyroid gland is hyperdense because thyroid gland
B. Kidney contains iodine which can attencuate the photons. Iodine is also the
C. Gallbladder primary component of the contrast media
D. Pancreas
37. Apple core deformity of colon cancer is seen in what modality
Explanation: Cholelithiasis is the stone in gallbladder. Lithiasis means A. UGIS
stone B. Ultrasound
Nephrolithiasis – kidney stones C. Barium enema
D. CT scan
33. A septum at the fundus of the gallbladder seen in a GB series is
called Explanation: Barium enema – colon
A. Fibrosis Upper GI series – stomach, duodenum
B. Phrygian cap Small Intestine Series (SIS) – small intestines
C. Contracture Esophagogram – esophagus
D. Infundibulum
38. Which of the following involves emission of a signal from a
Explanation: Phrygian cap – is infolding of the body and fundus of patient
gallbladder. Best seen in ultrasound A. Magnetic Resonance Imaging (MRI)
B. CT
34. The filter used for mammography C. Diagnostic Ultrasound
A. Molybdenum D. Spiral CT
B. Aluminum
C. Titanium Explanation: Magnetic Resonance Imaging involves emission of a signal
D. Zinc from a patient
39. Most of the energy of the electrons in x-ray is converted into
A. X-ray Explanation: Gray is the unit of absorbed dose. Defined to the radiation
B. Heat necessary to deposit energy of one Joule in one Kilogram (J/Kg)
C. Scatter radiation Unit of absorbed dose equivalent is Sievert
D. Any of the above
44. _____ refers to the outside dimensions of the CT slice
Explanation: energy of the electrons in x-ray is converted into heat as A. Pixel
99% and 1% into x-ray B. Voxel
C. Field Size
40. Open mouth view is used to image what structures D. Pitch
A. C1 and C2
B. C2 and C3 Explanation: Filed size dictates the maximum size of anatomic part that
C. T1 and T2 can be examined
D. T2 and T3
45. The point of bifurcation of the trachea into the right and left
Explanation: C1 and C2 are visualized in an open mouth view. main bronchi is called
Open mouth view is used to assess the relationship of the odontoid A. Bronchioles
process of C2 and lateral masses of C1 B. Carina
C. Acinus
41. Stones in the kidney are also called D. Lobule
A. Renal cyst
B. Renal carbuncle Explanation: Carina – point of bifurcation of the right and left main
C. Nephrolithiasis bronchi. Level of T4
D. Cholelithiasis Bronchioles – smaller bronchi at the periphery
Acinus – Bronchiole and alveolus
Explanation: Nephrolithiasis – stone in the kidney
Renal cyst – fluid containing foci in the kidney 46. The Hounsfield unit of water is
Renal carbuncle – secondary to infection A. 0 to +20 HU
Ureterolithiasis – stone in the ureter B. -20 to -80 HU
C. +100 to +200 HU
42. The distal abdominal aorta divides into _____ arteries D. +30 to +50 HU
A. Internal iliac
B. Common iliac Explanation: -20 to -80 – Fat
C. External iliac +30 to +50 – Solid/Hemorrhage
D. Femoral +100 to +200 – Calcification

Explanation: Common iliac arteries divide into external and internal 47. There are ____ cervical vertebra bodies
iliac arteries. Usually at the level of L4 and L5 A. 6
B. 7
43. The _____ is the unit of absorbed dose C. 8
A. Rad D. 9
B. Rem
C. Sievert Explanation: Cervical vertebra – 7
D. Roentgen
48. Comet tail artifact on Ultrasound is seen in what pathology? D. Intensity
A. Gallstones
B. Renal cyst Explanation: Piezoelectric crystal is made of innumerable dipoles
C. Cholesterolosis arranged in a geometric pattern
D. Liver abscess Electric dipole – distorted molecule that appears to have a positive
charge on one end and negative charge on the other
Explanation: Comet tail artifact is acoustic shadowing – Gallstone
53. The colonic segment seen at the right side of the abdomen is
49. The oblique and horizontal fissures of the lungs are found in the _____
A. Right lobe A. Ascending colon
B. Right and Left lobe B. Descending colon
C. Left lower lobe C. Transverse colon
D. Left upper lobe D. Sigmoid colon

Explanation: The oblique and horizontal fissures are found on the right Explanation: ascending colon – right
lung. Descending colon – left
Oblique fissure – divides middle lobe and lower lobe Transverse colon – mid abdomen
Horizontal fissure – divides upper lobe and middle lobe Sigmoid – usually at the left lower quadrant

50. The hila as seen on Chest PA is mainly composed of 54. Visceral pleura line on chest x-ray is indicative of
A. Arteries A. Pneumoperitoneum
B. Veins B. Pleural effusion
C. Lymphatics C. Pneumothorax
D. None of the above D. Pulmonary mass

Explanation: Hilum is the singular of hila. Right hilum is lower than Explanation: Pneumothorax is air in pleural space. Defined as a line
the left, composed of arteries, veins and lymphatics with no identifiable vascular markings laterally

51. The most effective way of removing scatter radiation from large 55. Ability of crystals of certain inorganic salts to emit light when
radiographic field excited by x-rays
A. Grid A. Luminescence
B. Restrictor B. Intensifying screen
C. Aperture C. Fluorescence
D. Bucky factor D. Reflecting coat

Explanation: Grid is consists of lead foil strips separated by x-ray Explanation: Fluorescence is a form of luminescence produced when light
transparent spacers. is emitted instantaneously (within 8 to 10 sec)
Grid ratio – height of the lead strips to the distance between them Luminescence – emission of light by a substance
(h/d)
56. The third and lateral ventricles are seen in
52. The most important component of an ultrasonic transducer is A. Brain
A. Wavelength B. Abdomen
B. Piezoelectric crystal C. Chest
C. Density D. Neck
 Explanation: Femur is the largest bone of the lower extremity. It
Explanation: 3rd lateral ventricle is seen in the brain. (Ventricular communicates with the acetabulum of the hip bone. Also known as Thigh
system) bone
Third lateral – divided into frontal horn, body, trigone, and occipital
horn 61. On external rotation of the shoulder, the intertubercular line is
displaced
57. The thymus gland is seen in what compartment of the chest A. Laterally
A. Anterior mediastinum B. Medially
B. Middle mediastinum C. Center
C. Posterior mediastinum D. Superiorly
D. Any of the above
Explanation: Intertubercular line is seen between the greater and lesser
Explanation: Thymus gland is located in the anterior mediastinum. More tuberosity. On internal rotation, the intertubercular line is displaced
prominent in children, consider a lymphoid organ medially

58. Uterine mass containing high density echoes due to calcification 62. Fracture of the distal radius with dorsal dislocation of the
A. Endometriosis fracture fragment
B. Endometrial cancer A. Smith fracture
C. Uterine fibroids B. Colles fracture
D. Sarcoma C. Bhartons fracture
D. Malgaigne fracture
Explanation: Uterine fibroids – mass containing high density echoes due
to calcification Explanation: Smith fracture – fracture of the radius with ventral
Endometriosis – endometrial implants outside the uterus dislocation
Sarcoma – tumor involving the muscle Malgaigne fracture – fracture of the iliac bone

59. What element is used as the target anode on x-ray production? 63. The number of protons is equivalent to
A. Tungsten A. Atomic number
B. Zinc B. Atomic mass
C. Platinum C. None of the above
D. Copper
Explanation: Atomic number is the number of protons and/or electrons.
Explanation: Tungsten is the element used as the target anode on x-ray Represented by the symbol Z
because of some several reasons: high atomic number, high melting point, Atomic mass – total number of protons and neutrons in the nucleus of an
reasonably good material for absorbing heat atom

60. The largest bone in the lower extremity 64. The paranasal sinus inferior to the sella turcica
A. Tibia A. Maxillary
B. Femur B. Frontal
C. Fibula C. Sphenoid
D. Patella D. Ethmoid

Explanation: Pituitary gland is located within the sella turcica

Sella turcica should be visible on lateral x-ray of the skull
 D. Parathyroid
65. A chemical process that amplifies the lateral image by a factor
of millions to form a visible silver pattern Explanation: Isthmus – is the structure connecting the two lobes of the
A. Development thyroid gland
B. Replenishment Pyramidal lobe – accessory lobe of the thyroid gland
C. Fixing Thyromegaly – medical term for enlargement of the thyroid
D. Washing
70. Fluid in the scrotal sac as seen on ultrasound is also called
Explanation: Development – basic reaction is reduction (addition of an A. Varicocele
electron) of the silver ion, which changes it into black metallic silver B. Hydrocele
C. Orchitis
66. Sunrise view is used to visualize D. Torsion
A. Radio-ulnar joint
B. Ankle joint Explanation: Hydrocele – fluid seen in the scrotal sac
C. Patellofemoral joint Varicocele – prominent pampiniform plexus
D. Atlantoaxial joint Orchitis – inflammation of the testis
Torsion – twist of the twist around its pedicle
Explanation: Patellofemoral joint (sunrise view) – is used to visualized
patellar dislocation. Relationship of the patella with the femur 71. The entire appearance of either right or left eye orbit are seen
in
67. Metastasis to the liver is best seen on what phase of the CT scan A. Coronal scan
A. Plain non contrast B. Sagittal scan
B. Arterial phase C. Transverse scan
C. Portal venous phase D. None of the above
D. None of the above
Explanation: Transverse scan – is used to scan optic nerve; extra-ocular
Explanation: 80% of the blood supply of the liver comes from the portal muscles; superior oblique; inferior oblique; superior, inferior, medial,
vein and lateral rectus
Primary liver tumors are best assessed at the arterial phase
72. The presence of a mass located in the posterior mediastinum is
68. Column of Bertin is seen in what organ most likely
A. Thyroid A. Hiatal hernia
B. Adrenals B. Thymoma
C. Kidneys C. Neurogenic
D. Stomach D. Aneurysm

Explanation: Column of Bertin – cortex seen protruding into the renal Explanation: Neurogenic – posterior mediastinum
medulla. May be mistaken for a mass during ultrasound Anterior mediastinum – thymus, lymphoma, intrathoracic thyroid
Middle mediastinum – heart
69. What structure is seen connecting the two lobes of the thyroid
gland 73. A saccular outpouching at the wall of an artery is called
A. Papilla A. Aneurysm
B. Diverticulum B. Dissection
C. Isthmus C. Cyst
 D. Perforation 78. Blunting of costophrenic sulci on Chest x-ray is indicative of
A. Pneumothorax
Explanation: Aneurysm – outpouching of the wall of an artery B. Pleural effusion
Dissection – blood collection within the tunica media of the vessel wall C. Pneumoperitoneum
D. Hemoperitoneum
74. The coiled spring appearance of intussusception is seen in what
modality Explanation: It needs about 200 to 300 ml to blunt a lateral
A. MRI costophrenic sulcus
B. Ultrasound Only needs 10 ml to blunt a posterior gutter (Lateral chest x-ray)
C. CT scan
D. Barium Enema 79. The right hemidiaphragm is _____ compare to the left
A. Higher
Explanation: Barium enema visualizes coiled spring appearance of B. Lower
intussusception C. At equal level
Intussusception – defined as invagination of a segment of bowel into D. Depends on inspiration
more distal bowels
Explanation: The right hemidiaphragm is lower than the left
75. Fat is seen on Ultrasound as hemidiaphragm
A. Hyperehoic The left pulmonary artery is higher in location than the right pulmonary
B. Hypoechoic artery
C. Hypodense Hila is composed mainly of arteries
D. Hyperdense
80. Calcifications are seen on CT as
Explanation: Hyperechoic is the appearance of fat in ultrasound A. Hypodense
Fat is seen as Hypodense in CT and in MRI T1 - bright and T2 - bright B. Hyperdense
C. Isodense
76. Mediastinal structures do not include the following D. Isointense
A. Axillary vessels
B. Thymus gland Explanation: Hypodense on CT includes: water, infarct, edema, and fat
C. Lymph nodes
D. Heart 81. The superior mesenteric artery is a branch of ____
A. Abdominal aorta
Explanation: Mediastinum includes: heart, thymus gland, major arteries B. Iliac artery
and veins, lymph nodes, trachea/carina, esophagus C. Femoral artery
D. Subclavian artery
77. The most common location of sinusitis is _____
A. Frontal Explanation: Major branches of the abdominal aorta are: celiac artery,
B. Sphenoid renal arteries, inferior and superior mesenteric artery
C. Ethmoid
D. Maxillary 82. The brachiocephalic artery divides into right common carotid
artery and right ____ artery
Explanation: Maxillary sinus is the most common location of sinusitis A. Arch of the aorta
The most common location of paranasal malignancy is frontal sinus B. Subclavian artery
C. External carotid artery
 D. Internal carotid artery Explanation: Hydronephrosis – dilatation of the pelvocalyceal structure
of the kidney
Explanation: Aortic arch has 3 branches: brachiocephalic artery, left Hydroureter – dilated ureter, usually secondary to stone
common carotid artery, and left subclavian artery
87. Salter Harris classification is used in what system
83. What is the most common location of gastrointestinal tuberculosis A. Fracture involving epiphysis
A. Descending colon B. Fracture involving diapysis
B. Ascending colon C. Fracture involving shoulder joint
C. Ileocecal D. Fracture involving femur
D. Rectum
Explanation: Salter Harris – fracture involving epiphysis
Explanation: Ileocecal is the most common location of GI tuberculosis Grade 2 is the most common – fracture involving epiphysis, metaphysis,
Radiographic signs of tuberculosis are fleischner sign, and stierlin diaphysis
sign
88. The diploe of the cranium is seen as _____ on T1WI
84. This pulse sequence is the best for imaging of the anatomy of the A. Dark
structures B. Bright
A. T1WI C. Isointense
B. T2WI D. Hypodense
C. DWI
D. GRE Explanation: Diploe is seen between the inner and outer tables of the
cranial vault made of fat
Explanation: T1WI – best for imaging anatomy of the structures
T2WI – best for pathology 89. The structure above the prostate gland and posterior to the
DWI – best for infarct urinary bladder
GRE – best for blood A. Urethra
B. Ureter
85. Saccular outpouching of barium enema is called C. Seminal vesicle
A. Ulcer D. Ejaculatory duct
B. Diverticulum
C. Cancer Explanation: Seminal vesicle is located above the prostate gland and
D. Stone posterior to the urinary bladder. It communicates with the prostate
gland through the ejaculatory duct
Explanation: Diverticulum – saccular outpouching of barium enema
Diverticulosis – multiple diverticulum 90. Rotation along the long axis of the stomach
Diverticulitis – infected diverticulum with spastic colon A. Ulcer
B. Volvolus
86. Radiographic term for dilatation of the pelvocalyceal structures C. Tumor
of the kidney D. Intussusception
A. Hydronephrosis
B. Renal cyst Explanation: Volvolus – is the rotation of the stomach
C. Renal stone Two types of gastric volvolus: organoaxial – long axis; and
D. Cholelithiasis mesenteroaxial – short axis. Also seen in sigmoid and ileum
91. It divides the right and left hepatic lobe by ultrasound C. 3rd part
A. Right hepatic vein
B. Left hepatic vein
D. 4th part
C. Middle hepatic vein
Explanation: The C-loop corresponds to 2nd part of the duodenum. Comes
D. Portal vein
in contact with the head of the pancreas
Widening of the C-loop on UGIS – is indicative of pancreatic head
Explanation: Right hepatic vein – divides the anterior and posterior
malignancy
segment of the right lobe
Left hepatic vein – divides the medial and lateral segment of the left
96. The left main coronary artery divides into left anterior
lobe
descending and ____
A. Left posterior descending
92. Radiographic term for infected collecting system
B. Left circumflex
A. Hydronephrosis
C. Left marginal
B. Pyonephrosis
D. Left obtuse marginal
C. Renal cyst
D. Renal abscess
Explanation: Left main coronary artery divides into left anterior
descending and left circumflex
Explanation: Pyonephrosis – infected collecting system. Pyo – means pus
Coronary artery originates from the ascending aorta – from left
Patients with staghorn calculi are predispose
ventricle
Staghorn calculi – renal stone that confine within the calyceal system
97. Intimal flap on CT is indicative of
93. Fracture of the clavicle most commonly seen in what segment
A. Aortic aneurysm
A. Lateral third
B. Aortic dissection
B. Middle third
C. Aortic diverticulum
C. Medial third
D. Aortic leak
D. All of the above
Explanation: Aortic dissection – is the intimal flap on CT. Considered a
Explanation: Fracture of clavicle is most commonly seen in the middle
surgical emergency if it occurs at the ascending aorta
third segment. It involves almost 80% of the fracture
98. Air fluid level seen on paranasal sinuses is most likely due to
94. Air collection within the biliary system is called
A. Acute sinusitis
A. Hemobilia
B. Chronic sinusitis
B. Pneumobilia
C. Polyp
C. Pneumoperitoneum
D. Hematoma
D. Pneumothorax
Explanation: Acute sinusitis is the fluid level seen on paranasal
Explanation: Pneumobilia – air collection in the biliary system
sinuses. Fluid goes to dependent level while the air is above
Pneumo – means air
Pneumothorax – air in the lungs
99. Retrocardiac fullness on lateral chest x-ray is indicative of
what chamber enlargement
95. The C loop seen on UGIS corresponds to what part of the duodenum
A. Right atrium
A. 1st part B. Right ventricle
B. 2nd part C. Left atrium
 D. Left ventricle Explanation: Other characteristics of ileum: communicates with cecum;
comprise about 3/5 of the small intestines
Explanation: Retrosternal (on lateral chest x-ray) – right ventricle
Retrocardiac – left ventricle 104. The ureterovesical junction is seen in what segment of the ureter
A. Proximal 3rd
100. The midline radiolucent structure at the region of the neck seen
on PA chest is most likely
B. Mid 3rd
A. Esophagus C. Distal 3rd
B. Thymus D. None of the above
C. Trachea
D. Rib Explanation: Uterovesical junction is seen on the distal 3rd segment of
the ureter
Explanation: Trachea – midline radiolucent structure of the neck in Vesical – urinary bladder
chest PA. Trachea is the passageway between the upper airway and the 3 constriction of the ureter: ureteropelvic junction as it enters the
lung parenchyma consist of c shape cartilages pelvic brim and ureterovesical junction
Air (in chest x-ray) – radiolucent
105. The position used main for angiography to give good picture of the
101. Hallmark of chronic pancreatitis on imaging chambers of the heart
A. Necrosis A. LAO
B. Calcification B. LPO
C. Pancreatic enlargement C. Frontal view
D. Calculi D. RAO

Explanation: Acute pancreatitis – diffuse enlargement of the pancreas Explanation: LAO – position used main for angiography
indicate by calcification; pancreatic duct dilatation
Pancreatic ducts: duct of wirsung (major); duct of santorini (minor) 106. Most common indication for a thyroid scan
A. Diffuse goiter
102. Duodenal bulb indicates what part of the duodenum B. Thyroid goiter
C. Ectopic goiter
A. 1st part D. Thyroid nodule
B. 2nd part
C. 3rd part Explanation: Thyroid nodule – common indication for a thyroid scan
D. 4th part Appearance of normal thyroid scan – homogeneous uptake; each lobe
measures 2 to 5 cm; asymmetry is common
Explanation: Duodenal bulb is found in the first part of the duodenum.
Seen as mushroom-like on UGIS 107. At birth, the epiphysis of the long bones consists of masses of
Most common location of duodenal ulcers cartilage. On conventional radiography this is shown as
A. Radiopaque as the diaphysis
103. The following are characteristics of the jejunum except B. Radiolucent
A. Prominent valvulae conniventes C. Same density as soft tissue
B. Presence of lymphoid follicles D. Ossified
C. Communicates with the 4th part of the duodenum
Explanation: Radiolucent is the appearance of the epiphysis of the long Explanation: Dysphagia (difficulty upon swallowing) – is the most common
bones at birth since it consist masses of cartilage. Cartilage is seen indication of esophagogram
as radiolucent on x-ray Odynophagia – pain upon swallowing
Hematemesis – vomit blood
108. The linguia is segment of what pulmonary lobe? Hemoptysis – cough blood
A. Right upper lobe
B. Left upper lobe 112. In lateral view of the chest, the anterior border of the heart is
C. Right lower lobe formed by
D. Left lower lobe A. Right atrium
B. Right ventricle
Explanation: Left upper lobe segments are: linguia, apicoposterior, C. Left atrium
anterior D. Left ventricle
Lingular division is divided into superior and inferior segment
Explanation: In lateral view of the chest:
109. The 1 minute film on intravenous urography (IVU) is also called Right ventricle – is the anterior border of the heart
A. KUB film Left ventricle – is the posterior border of the heart
B. Nephrogram
C. Pyelogram 113. The proximal esophagus starts at what level
D. Cystogram A. C3
B. C4
Explanation: Nephrogram is the 1 minute film of the IVU – it assesses C. C5
the renal cortical outline; best assess the size of the kidneys D. C6
IVU produce about 17% increase in magnification of the renal size
5 minute film – Pyelogram Explanation: 3 constriction of the esophagus: at the level of C6;
Full bladder – Cystogram crossed by the left main bronchus; esophagogastric junction

110. The pulmonary veins arise from what chamber of the heart 114. In the adult population, the diaphragm is located on this level on
A. Right atrium chest x-ray
B. Right ventricle A. 10th posterior rib
C. Left atrium
D. Left ventricle
B. 9th posterior rib
C. 10th posterior intercostal space
Explanation: Left atrium – pulmonary vein D. 9th posterior intercostal space
Right ventricle – pulmonary artery
Right atrium – superior and inferior vena cava Explanation: Diaphragm is located on the level of 10th posterior rib on
Left ventricle – ascending aorta chest x-ray
Posterior rib on chest x-ray is more horizontal
111. The most common indication of an esophagogram Anterior rib is slanting on chest x-ray
A. Dysphagia
B. Hematemesis 115. Disk herniation is composed mainly of _____
C. Hemoptysis A. Nucleus pulposus
D. Epigastric pain B. Annulus fibrosus
C. Anterior longitudinal ligament
D. Posterior longitudinal ligament
 120. The first paranasal sinus to appear
Explanation: Intervertebral disk has two components – nucleus pulposus A. Maxillary
(inner) and annulus fibrosus (outer) B. Sphenoid
C. Ethmoid
116. The splenic and superior mesenteric veins join to form _____ D. Frontal
A. Hepatic vein
B. Portal vein Explanation: Maxillary sinus is the first paranasal sinus to appear
C. Pancreatic vein Ethmoid is the second sinus to appear
D. Gastric
121. The main purpose of doing upright film in scout film of the
Explanation: Splenic and superior mesenteric vein joins to form the abdomen
portal vein A. Detect mass lesion
Inferior mesenteric vein joins the splenic vein B. Detect calcification
C. Detect pneumoperitoneum
117. Most commonly used puncture site for angiography D. Detect hydronephrosis
A. Carotid
B. Groin Explanation: Doing upright film is SFA (scout film of abdomen), its main
C. Brachial purpose is to detect pneumoperitoneum
D. Axilla SFA – is taken upright and/or supine
If patient cannot due upright, left lateral decubitus can be used
Explanation: Most commonly puncture site in angiography is the femoral
artery 122. Lateral decubitus view of the chest is used to detect
Femoral artery is located in the groin A. Pulmonary mass
B. Pleural effusion
118. The view is utilized to delineated the upper lung lesion not C. Pulmonary calcification
clearly visualized due to overlying rib cage and clavicle D. Pulmonary granuloma
A. Oblique view
B. Lateral decubitus view Explanation: Lateral decubitus will show layering of fluid along
C. Apicolordotic view dependent portion of the hemithorax
D. Lateral view
123. Cleansing enema is usually a prerequisite in doing barium enema.
Explanation: Apicolordotic view is utilized to delineate the upper lung What disease does not require cleansing enema
lesion. Use especially for tuberculosis because of the predilection of A. Colonic mass
the tubercle bacilli at the upper lobes B. Colonic polyp
C. Hirschprung disease
119. The frequent location of colon diverticula is at the D. None of the above
A. Cecum
B. Ascending colon Explanation: Hirschprung disease – usually seen in children. It is the
C. Rectum presence of aganglion segment at the region of the rectum
D. Sigmoid
124. Rounded structures simulating the eyes as seen on the frontal
Explanation: Location of diverticula is decreasing order: Sigmoid – radiograph of the spine
descending colon – transverse – ascending colon A. Spinous process
B. Pedicles
 C. Disk space C. Choledocholithiasis
D. Vertebral body D. Nephrolithiasis

Explanation: Pedicles – is the rounded structures simulating the eyes as Explanation: Choledocholithiasis – stone in the common bile duct
seen on the frontal radiograph of the spine Cholecystolithiasis – stone in the gall bladder
Scottie dog – is seen on the oblique x-ray of the spine Cholelithiasis – general term for stone in the biliary tract
Pars interarticularis detect – spondylolysis
129. To check for urinary retention by ultrasound, one can request the
125. Bulla is seen on chest x-ray as following
A. Radiopaque A. Pre and post void film
B. Radiolucent B. Pre void film only
C. Hypodense C. Post void film only
D. Hypoechoic D. Renal sonogram

Explanation: Radiolucent – appearance of bulla in chest x-ray Explanation: Pre and post void film is requested to check urinary
Bulla – an air containing structure whose wall measures about 1 mm retention, especially in children because retained urine in the bladder
Other structures that appear as radiolucent on chest x-ray: cavity, may cause urinary tract infection (UTI)
emphysema, bleb
130. The occipital condyle of the occipital bone articulates with the
126. The following are seen in KUB film except A. Atlas
A. Renal shadow B. Axis
B. Psoas shadow C. C2
C. Lumbar vertebra D. Both A and C
D. Pancreas
Explanation: Occipital condyle – are paired structures of the occipital
Explanation: Normally seen in a KUB film are: renal shadow, psoas bone at the region of foramen magnum, it articulates with the atlas (C1)
shadow, flank stripe, liver and spleen (if enlarged), lumbar spine and of the vertebrae
hip bones, urinary bladder C2 – axis

127. Diffuse increased parenchymal echogenicity of the liver parenchyma

on ultrasound most likely denotes
A. Mass lesion
B. Fatty liver
C. Hepatic cyst
D. Hepatic abscess

Explanation: Fatty liver is a diffuse increased parenchymal echogenicity FILM CASSETTE OR FILM HOLDER
of the liver parenchyma A device used to protect films upon carrying in one place to
Secondary to increase triglycerides of the liver cells another. It is a light proof device used to protect films upon exposure
Non-specific to white light. It allows radiation to pass through and exposed the film
to record the image part being examined.
128. Stone within the common bile duct is also called
A. Cholecystolithiasis Types of Cassette
B. Cholangitis
A. Cardboard Cassette
A light proof device made of cardboard used for handling
certain type of x-ray film. Cardboard cassette comprises of two had
cardboard the cover for an easy handling bonded with a black cloth, and
affixed inside is the black cover envelope that folds around the film to
prevent exposure to white light. The back cover has a lead foil to
absorb back scattered radiation. It is only used for examination of thin
body parts.
This type of cassette requires high MaS that produce more
image resolution.
B. Screen Cassette
A cassette is made up of aluminum with metal frame, hard
plastic and other radiolucent substance. This type composed of
intensifying screen either one or two sheet which is placed inside of
the part of cassette. The intensifying screen emits visible light as
exposed to radiation which helps in recording image.
Kinds of Cassette
A. Extremity Cassette
This type of cassette that gives a better detail visualization and
it is used for examination of body parts with 11 cm and below. It
consists of intensifying screen with finer grain of phosphor crystal.
B. Regular Cassette
A cassette that consists of either medium or high speed
intensifying screen. It can be use in examination of different body
parts with low technical factors.
C. Gridded Cassette
This cassette consists of a grid attached on the front side
or tube side. This is used for examination of body parts from 12 cm and
above. It is used for examination on table top if the patient cannot be
positioned on the x-ray table for Bucky technique.
D. Curve Cassette
It is a cassette used for examination of unextended body
part. This allows the part examined to position in close contact with
the film. This is mostly being used in the examination of shoulder to
take an axiliary view.
E. Utrasonographic film Cassette
These types of cassette are being used in ultrasonography.
These cassettes are not exposed to radiation but they are inserted to
the machine analyzer to transfer the image on film for permanent record.
The cassette does not consist of intensifying screen. Actually, it
handles two films to record more views on particular examination.
Loading and Unloading of Film in the Cassette
A. Before loading or unloading film in the cassette, be sure that the
white light is OFF and the door is closed.
B. When loading the film in the cassette, be sure to remove the
interleaving paper so that it will be properly exposed with the light
emitted by the phosphor crystals.
C. Properly hold the film on the edge corner and never handle the mid
part to prevent formation of finger print most especially if you had wet
fingers or hand.
D. Place the lock properly to prevent an opening which causes the light
leak and will lead to the exposure of the film.
INTENSIFYING SCREEN
An intensifying screen is a device that converts the energy
of the x-ray beam into visible light. This visible light interacts with
the radiographic film forming the latent image. The intensifying screen
acts as amplifier of the remnant radiation reaching the film. The use of
intensifying screen result is considerably lower radiation dose being
absorbed by the patient but it has the disadvantage of casing a
reduction of an image resolution. On the other hand, it produces
temporary image that being watched in TV monitor.
Screen Construction
Intensifying screens are made up of flexible sheets of
plastic or cardboard. They are cut in sizes corresponding to film sizes.
The intensifying screen mounted inside the cassette are usually one on
tube side and one on the back side in which the radiographic film is
sandwiched between the two screens in relation to this film that will be
used is double-emulsion film.
Parts of Intensifying Film
A. Base
The base has 100 micrometer or 1 millimeter thick that
serves as a mechanical support for the phosphor layer. It is made of
high grade cardboard polyester or metal. Polyester is the best choice as
a base material in screen construction just as it is a base material for
radiographic film.
Requirements for a Base Material
1. It must be rugged and moisture resistant.
 2. It must not suffer radiation damage nor discolor with age (shiny
white).
3. It must be chemically inert and do not interact with the phosphor
layer.
4. It must be flexible.
5. It must not contain impurities that would imaged by x-rays.
B. Reflective Layer
A thin layer of substance attached between the base and
phosphor layer with approximately 25 micrometer or 0.25 mm thick which
is made up of magnesium oxide or titanium dioxide. When x-rays interact
with the phosphor, light is emitted with equal intensity in all
directions. Therefore, less than a half of the light is emitted in the
direction of the film. The reflective layer block the light emitted
headed in the opposite directions and redirects it to the film. The
reflective layer doubles the number of light photons reaching the film.
In some screens use special dyes in the phosphor layer to
selectively absorb those light emitted at a large angle of the film.
C. Phosphor Layer
The sensitive part of the intensifying screen is the
phosphor. The phosphor emits light during interaction by x-rays; it
converts the energy of the x-ray beam into visible light. Phosphor
layers vary in thickness from 15- 300 micrometer, depending on the type
of screen. The active substance of most phosphors before 1980 was
crystalline calcium tungstate embedded in a polymer matrix. Rare earth
metals are the phosphor material in newer, faster screens. The screen
will glow brightly when stimulated by x-rays.
Characteristics of Phosphor
1. The phosphor should have a high atomic number so that the
probability of x-ray interaction is high. This is called quantum
detection efficiency.
2. The phosphor should emit a large amount of light per x-ray
interaction. This is called the x-ray conversion efficiency.
3. The light emitted must be of proper wavelength to match the
sensitivity of the x-ray film. This is called spectral matching.
4. Phosphor after glow, the continuing emission of light after
stimulation of the phosphor by x-rays should be minimum.
Materials used as Phosphor
1. Barium Platinocyanide
A phosphor that was never applied to diagnostic radiology
with success.
2. Zinc sulfide
It was once used for low KVp techniques but never gained
wide acceptance.
3. Barium Lead Sulfate
A screen used particularly with high KVp techniques.
4. Calcium Tungstate
A type of phosphor that has good quality control procedure.
It can be able to use with a low or high KVp techniques.
5. Rare Earth Metals
Gadolinium Lanthanum and Yttrium- this screen are faster
than those made of calcium tungstate.
D. Protective Layer
This is 15 to 25 micrometer thick and it is applied over the
emulsion to make the screen resistant to abrasion and damage caused by
handling. It prevents build up of static electricity and provides a
surface for cleaning without damage to the phosphor. The protective
layer must be transparent to light.
Two Types of Screen
A. Radiographic Screen
It is a screen attached in the cassette which is used for
radiography. The phosphor of screen are made up of calcium tungstate,
Gadolinium oxysulfite, Lanthanum oxybromide and Ytrium oxysulfite
crystals which emit visible light upon exposure in radiation in a blue
violet, green, and blue green respectively. It helps in exposure of film
to provide a permanent record.
B. Fluoroscopic screen
It is a screen that is used in fluoroscopy. This phosphor of
this screen is made up of Zinc cadmium sulfite which emits light in
yellow green range. This is used for direct viewing examination on a
T.V. monitor. The exposure does not require film therefore the image
produced is only temporary.
PROCESSING SOLUTION
Mixing Processing Solution
Processing chemicals are available in powder or liquid form.
A powder is usually used in manual and liquid is for automatic
processor. It is repacked in a required volume of water as stated on the
printed procedure. Mostly, a package of solution is diluted with 4 to 5
gallons of water. The technician need only to follow the instruction and
proper preparation of the developer and fixer on the printed level.
In mixing solution, pure or distilled water should be poured
into the tank or pail, and the chemicals added slowly while the mixture
is stirred vigorously permitting to dissolve the solution while quickly
and without lumping.
When the chemicals are entirely dissolved, sufficient cold
water should be added to bring the solution to the correct volume and
temperature, stirred thoroughly to mix the cold water with the distilled
solution. Never use the solution unless all the chemicals are thoroughly
dissolved.
Major Factors that Affect Mixing of Solution
A. Water Temperature
Temperature of the water in which the chemicals are to be
dissolved should not exceed as shown on the level of package.
Temperature should be maintained generally at 68o F.
B. Mixing Containers
The containers for mixing the chemicals should be made
corrosive-resistant materials, such as good enamel or glazed
earthenware, hard-rubber or type 3l b stainless steel.
Vessels made of tin, copper, zinc aluminum or galvanized
iron should be avoided.
C. Mixing Paddles
Separate paddles for the developer and for the fixer should be
employed for mixing purposes. Afterwards they should be washed with
clear water and hang up to dry. Stainless steel paddle or hard-rubber
paddles are preferred.
D. Water Impurities
1. A dead animal, vegetables, mud rust in water weaken the
activity of the chemicals.
2. A chemical found freely in nature that have been dissolved in
the water such as calcium and magnesium salt in form of bicarbonate
chloride and sulfate. The results are not injurious to the image but may
produce a scum on the surface of the film that reduces its transparency.
E. Cleanliness
Cleanliness of the processing equipment is the success of
the reaction as base upon the purity of solution.
1. Spilled Solution
Should be wipe at once otherwise it may evaporate and the
chemical may react in the film or it may damage the intensifying screen
surfaces which may result in artifacts.
2. Wet hand
A wet hand with water or solutions should never be used for
handling film to prevent damage on emulsion.
F. Processing Tank Cover
The tank should have a cover fitted on it to close when not
in used. If the tank is covered it reduces the amount of air contact
with the solutions. Thereby it lessens the effect of aerial oxidation
when not in use. Also it prevents too much evaporation that can increase
the room humidity that result to fog in the film.
9.3 Processing Chemistry
We have two solutions in different forms that can be able to
use in the two system of processing these solutions consist of several
chemicals which perform various functions in the developer and fixer. In
general, the function of developer reduces the exposed silver to black
metallic silver. The fixer solution removes the unexposed silver halide
crystal from the film.
A. Developer Solution for Manual Processor
The developer solution prepared for this system of
processing is mostly powder form; consist of four agents as follows (1)
Activator (2) Reducer (3) Restrainer and (4 Preservative.
1. Activator (Accelerator or Alkalinizer)
The chemical compositions are sodium carbonate or sodium
hydroxide.
Functions
A. It causes the film emulsion to swell and soften permitting the
action of other chemical on the exposed crystal.
B. It provides necessary alkaline medium needed to activate the
other chemicals.
2. Reducer or Developing Agent
Usually metal and hydroquinone are combined for manual
processing. As synergism means the ability of two agents working
together is better than the result of each agent working independently.
Metal react quickly on the crystals and build the gray tones of
the image.
Hydroquinone is slower acting than metal. It builds up the black
tones of the image and therefore brings out the film contrast.
Functions
A. It provides electron to neutralize a positive ion.
B. It acts on the exposed silver halide crystal converting the
atomic silver to black metallic silver.
3. Restrainer
A chemical used are potassium bromide and potassium iodide. As
bromine is a by product of development process it also acts as reducing
agent.
If a film is left in the developer too long the reducer will
override the restrainer and develop the unexposed crystal.
It prevents the reducing agent to attack those unexposed Ag Br
crystal.
Functions
It controls the activity of reducing agent to keep on unexposed
silver halide crystal from being chemically attacked and tends to
prevent fog.
4. Preservative
A chemical that is used to preserve the solution is sodium
sulfite. As the tank is usually open air is introduced into the
chemistry so oxidation occurs. Hydroquinone is particularly sensitive to
aerial oxidation.
It is easy to tell if the developer has been oxidized
because it turns to brownish in color.
Maintain chemical balance among the solution.
Functions
a. It maintains balance among developer content over a reasonable
period of time.
b. It prevents aerial oxidation of the reducing agent by
capturing oxygen from air.
c. It react with quinine, a by product of hyroquinone which is a
dye, capable of staining the film and form a colorless compound called
hydroquinone monosulfate.
5. Solvent
The solution will be diluted I water to obtain the proper
activity. The chemicals must be properly dissolve especially the powder
form to avoid being retained on the film surface.
Wetting agent is first treated on the film to allow
chemicals to penetrate through the emulsion swelling the gelatin and
causing it to expand.
Note
Manual developer should be maintained at 68o F to obtain the
correct sensitivity of the chemicals.
9.4 Developer Solution for Automatic Processor
The advisable form of solution to be used for this
system is liquid. A powder form is not required because undissolve
chemicals will intact on the rollers, this will destruct the movement of
rollers and it can damage the film. Automatic developer solution
consists of five agents such as activator, reducer, restrainer,
preservative and hardener.
1. Activator
Sodium carbonate acts the same purpose as in manual
developer.
2. Reducer
A chemical used in this system is phenidone and
hydroquinone. Phenidone performs the same function as metal in manual
and also the hydroquinone act on the same capability.
Hydroquinone and phenidone are combined for rapid
processing. Both are having more electrons that can be easily released
to neutralize the silver ions.
Metal should not be able to use in automatic developer
because its capability is below 75o F, automatic processor usually
perform within 80o to 100oF.
3. Restrainer
Potassium bromide also serves the same function as in
manual. Potassium bromide is also called as starter solution in which
potassium bromide is not included in automatic developer replenisher.
4. Preservative
Sodium sulfite serves as the same function in manual
developer.
5. Hardener
A chemical used is gluteraldehyde which is only
present on automatic developer. This chemical is used to control the
swelling of the emulsion and thereby it helps to prevent damage of the
emulsion as it passed through the transport rollers.
6. Solvent
The same purpose as in manual developer.
9.5 Fixer Solution
Fixer solution is also prepared the same in developer.
Powder is usually for manual and liquid for automatic processor. Fixer
in both systems contains four basic agents (1) Acidifier (2) Clearing
Agent (3) Hardener (4) Preservative.
1. Acidifier
A chemical used is acetic acid this stops development
by neutralizing the alkaline developer that may be carried from the
developing solution. It also provides acidity which is required for the
other chemicals to function.
2. Clearing Agent
 The chemical being used is either ammonium thiosulfate
or sodium thiosulfate. It acts on the film emulsion by removing the
unexposed crystals and dissolve them into solution as silver salts.
3. Hardener
The chemical content of hardener is aluminum chloride,
chrome alum or potassium alum. It decreases the possibility of physical
injury to the gelatin emulsion. It shrinks and hardens the emulsion so
that it can be handled without damage and withstands the normal effect
of processing.
4. Preservative
Sodium sulfite serves as the same function in developer
solution.
5. Solvent
Water is also use for diluting fixer like in developer
solution.
Classification of Developer as to addivity
The phenidone-hydroquinonehas 15 times more super addivity
than the elon or metol-hydroquinone combination. Thereby, it can be used
for fast or short time of development.
The action of hydroquinone is more selective in the sense
that it acts more on the exposed crystal that receives more energy than
those received less energy.
Metol or Elon and Phenidone acts uniformly on all exposed
silver halide crystals, regardless of whatever these crystals have
absorb a little or a lot of energy. And this is responsible in the
formation of detail.
Sodium bromide and potassium bromide are both restrainers.
The potassium bromide is usually used in which the by product is the
potassium salt which is more soluble than the sodium salt.
PRINCIPLES INVOLVED IN RADIGRAPHIC TECHNIQUE
A. Basic Imaging Principle
B. Qualitative Principle of X-ray
C. Quantitative Principle of X-ray
D. Principles of Magnification
E. Principle of Distortion
F. Principle Involve in Visible Detail
A. Basic Imaging Principle
Exposure – As the term is used here, is equal to the
intensity of the radiation reaching a given area in the film
multiplied by the time during which it acts. It is thus the amount
of energy reaching a particular area of the film and causing a
particular density on the processed film. The film absorbed
different intensities of radiation that had been passed through
the different dense of body tissue.
The different intensities of radiation will reach the film
and cause different form of exposure. The higher radiation intensity
provide greater exposure and it will be darker than the lower radiation
intensity that will reach the film become lighter on image density
formed. By means of this exposure the latent image will form.
B. Qualitative Principle of X-ray
When we speak of the quality of the primary beam, we
actually mean the ability of the beam to penetrate matter or , more
specifically human tissue.
A high quality beam is one with relatively high penetrating
power and a low quality beam is one with low penetrating power.
The amount of x-ray photons must penetrate the part and reach the
film to provide sufficient density and the desired degree of contrast.
Wavelength is another term associated with beam quality.
“ The shorter the wavelength of the x-ray photons, the greater the
penetrating power”.
How do you alter the quality of the primary beam ?
 It is by changing the KVp setting on our control panel.
How does the KVp affect beam quality?
 If you increase the KVp on your control panel you increase the
energies of the electrons across the x-ray tube. The electron energy
range and the photon energy range increase proportionately.
C. Quantitative Principle of X-ray
The quantity or the intensity of a beam of x-radiation of a given
FFD/SID can be defined as “the characteristic that affects the density
on a radiograph.”
 SID – source of radiation to image -receptor distance.
How do you control the intensity of the primary beam?
 By controlling the amount of MA.
“The higher MA the more X-ray is produced.”
An increase in MA results in a higher filament temperature
and more electron available to transverse the tube for interaction. The
more electrons interacting with the target, the more photons produced.
The increase in the number of its proportionate to the increase in the
number of photons, and consequently the intensity is doubled.
The exposure time is another way to regulate the number of
electrons interacting with the target. If the exposure time is
increased, electrons are emitted from the filament at the same rate.
This change in the exposure time double the number of
electrons interacting with the target and consequently doubles the
number of photons produced.
Another way to affect the intensity is with the KVp while MA
and exposure time control intensity by regulating the number of photons
produced, KVp controls intensity by affecting the number of photons
produced and by regulating the mean energy of the photons.
If the KVp is increase the energy of the electron is also
increase.
D. Principle of Magnification
Magnification – means abnormal enlargement on size of the part being
recorded on film.
Magnification should normally kept to minimum so that the
part is projected as near as possible to its actual size.
To obtain this, the affected part should be positioned as
the close as possible to the film and the FFD/SID must be kept to
minimal so that the part is projected as near as possible to its actual
size. This aspect is important to the radiologist interpretation because
increased magnification increase the penumbra on a radiograph, causing
less clarity of the image.
Penumbra means unsharpness on the margin of the image.
In addition enlargement of some body parts is assign of
disease. If the part is magnified because of the projections, the
radiologist may have difficulty making a diagnosis.
Two (2) Factors affecting magnification :
a. FFD/SID
b. Part-Film distance.
If you make two radiographs of a particular body part using
the same part-film distance and different FFD’s, the radiographs with
the longer FFD/SID will show less magnification.
Part-film distance also has a pronounced effect on
magnification if the FFD/SD remains constant.
E. Principle of Distortion
Distortion – means the untrue shape of the image recorded in the
film, a part is said to be distorted when it is not projected on the
film in its true shape.
As a general rule, you should try to keep distortion to a
minimum on your radiographs so that the part will appear in its normal
shape.
Central Ray – CR-Part-Film relationship:
- the plane of the part and the plane of the film must be
parallel and the CR should be perpendicular to this plane to minimize
distortion.
Acceptable Distortion:
 There is time when distortion is permissible, even necessary Contrast – difference between the blackness and whiteness of the
in order to demonstrate the part being to free from superimposition. radiograph.

F. Principle Involved in Visible Detail Density – total blackness of the radiograph.

Darkroom – is a room where is the exposed film must develop in Definition/Resolution – the ability to separate the 2 objects.
order to covert the invisible image to manifest image.
Radiograph – is a permanent record of human structures after passing
The exposed film composed of the invisible image must thru an X-ray beam.
undergo the stages of processing cycle.
PURPOSE OF RADIOGRAPHY
Radiographic technique
“ to attain a record of maximum information.”
– refers to the different technical factors that is appropriate to
examine part of human body so as to produce a desirable radiographic How:
image.

- is a systematic procedure used by the radiographer to  The equipment must be adequate.

accomplish task for producing high quality radiograph
Subject/Object – any affected part of human body that is taken through
the exposure of radiation . It is described as the part to be examined
Penetration – ability of radiation to pass the part to be examined to
reach the film.
 The quality of film and processing chemical must be adequate.
 The radiologic technologist, is completely competent.
“The higher the atomic no. being examined the more x-ray will
absorb.”
Atomic number of some elements

Processing Cycle – process of developing on method of transforming a. Hydrogen (H) - 1

latent to manifest image.
b. Carbon(C) - 6
c. Nitrogen (N) - 7
Image – compose of various detail of an anatomical structure on the
film. d. Oxygen(O) - 8
e. Aluminium (Al) - 13
2 Types f. Calcium (Ca) - 20
g. Rhenium (Re) - 75

 Latent – invisible image

Effective Atomic Numbers of Various Materials Important to Diagnostic
 Manifest – visible image Radiology

RADIOGRAPHIC IMAGE QUALITY FACTORS Type of Substance Effective Atomic No.

Detail – minute area of black metallic silver. Human Tissue

  Fat 6.3 The upper radiograph has a high level of contrast and the lower
radiograph has a lower level of contrast.
 Muscle 7.4
 Lung 7.4 In each of the two radiographs, there is a small circle, which is
 Bone 13.8 of equal density in both radiographs.

Contrast Agent Effective Atomic No. Step wedge – is a device use to evaluate the effect of KV on contrast.

 Air 7.6
 Iodine 53
 Barium 56

Other

 Concrete 17
 Molybdenum 42
 Tungsten 74
 Lead 82

The usual objective in radiography is to produce an image showing the

highest amount of detail possible. This requires careful control of a
number of different variables that can affect image quality.

Radiographic sensitivity is dependent on the combined

effects of two independent sets of variables. One set of variables
affects the contrast and the other set of variables affects the
definition of the image.

Radiographic contrast

- is the degree of density difference between two areas on a radiograph.

- difference between the blackness and whiteness of the

radiograph.
Radiographic definition is the abruptness of change in going from one
Contrast makes it easier to distinguish features of
area of a given radiographic density to another.
interest, such as defects, from the surrounding area.
Like contrast, definition also makes it easier to see features of
interest, such as defects, but in a totally different way.
 In the image to the right, the upper radiograph has a high level of Exposure
definition and the lower radiograph has a lower level of definition. In FFD – Focal Film Distance (SID)
the high definition radiograph it can be seen that a change in the (Distance between the x-ray tube to the film)
thickness of the step wedge translates to an abrupt change in
radiographic density. It can be seen that the details, particularly the The Patient Factors
small circle, are much easier to see in the high definition radiograph.
In the lower image, the radiographic setup did not produce a  Thickness
faithful visual reproduction. The edge line between the steps is  Part composition
blurred. “ the thicker the patient the more radiation required to penetrate.”

Image Quality Factor

Optical density (The degree of opacity of a translucent medium.)
3 Groups of Factors Radiographic Techniques Contrast
Detail - minute area of black metallic silver.
1. Exposure Technique factors Distortion - means the untrue shape of the image recorded in the
2. The Patient Factors film, a part is said to be distorted when it is not projected on the
3. Image Quality Factor film in its true shape.

Exposure Technique factors RADIOGRAPHIC QUALITY

 KV
 Refers to the fidelity of the image of the anatomic Film density define as the blackness on the film. Tissue density
structure on the radiograph. describes the nature of tissues, such as bone(more
Radiograph – is a permanent record of human structures after passing dense),muscles, and lungs (much less dense).
thru an X-ray beam. Densitometer – device use to measure the density.
Penetrometer – device use to measure penetrating power.
2 QUALITIES OF RADIOGRAPH
1. High quality radiograph The Relationship Between Attenuation and Density
2. Poor quality radiograph Attenuation is a term best describes the reduction in strength force
also called absorption.
2 Important Characteristics of a Radiograph Standard factoring: mAs & KVp
1. Resolution – the ability to image to separate object and visually Are use to increase/ decrease the effect to radiation in human tissue.
detect one from the other. This is sometimes called “The more attenuation is produce, the lesser the density.
Sharpness. The lesser attenuation, the more density is produced”.
Types of contrast resolution: The relation between mAs and density is directly proportion.
a. High Contrast – spatial resolution If the mAs is double the density is also double.
Ex. Bone – soft tissue interface The relation between FFD and density is inversely proportional.
b. Low Contrast – sometimes called contrast detectability involves
object to similar subject contrast. The relationship between KVp and Density
Ex. Liver, pancreas, spleen, intestine An increase in KVp will result in increase in density.
Though it is not proportionate because this KVp is
The Radiographer must able to assess the following: proportionate to the penetrating power to the beam.
15% Rule
1. Density A 15% increase in KVp will approximately double the density
2. Contrast to the film.
3. Definition Secondary Factors Affecting Density
4. Distortion 1. KVp
2. FFD/SID
QUALITY CONTROL INFLUENCE 3. Anode Heel Effect
FACTOR The physics of x-ray production demonstrate that the
variation in intensity is present when one measures the
Density mAs -KVp intensity to the anode and cathode side of the x-ray
beam. The intensity of radiation is greater on cathode side.
-FFD The intensity of radiation is lesser on anode side.
4. Equipment Calibration and Operation
Contrast KVp Density can severely affected by poorly calibrated
equipment. Properly selections of factor are also essential.
Definition FFD -KVp, mAs 5. Processing the Latent Image
The time temperature relationship is important in processing
Distortion FFD/SID radiograph to show optimum density. Solutions that are too
hot will increase density and solution that too low
temperature will produce radiograph that are insufficient in
Difference between Film Density and Tissue Density density.
6. Film Type
 If the film contains increase amount of silver halide
crystal will increase density. Slower film type build less
density and require an adjustment in the exposure factor.
Film Speed – the ability of the film to react on radiation.
7. Screen Type / I.S. Type
Increases the density on the film by intensifying the action
of x-ray beam.
As the screen speed increase the density will increase. The
thicker the phosphor, lighter is produced.
Screen speed – the ability of the screen to react on radiation.
8. Characteristic of Tissue
The structure and composition of the body tissue may affect
density by changing attenuation. More dense / compact
structure will absorb more of the x-ray photons as they pass
through the tissue, less radiation will exit.
9. The Grid
Use to absorb some of the scattered and secondary radiation
produce by body part. The grid is placed between the patient
and the film.
The Grids improve the quality of the film by absorbing
scattered radiation.
Attenuation and Contrast Relationship
Due to absorption and interaction without beam attenuation
,contrast would not be present because uniform density would
be present.
Controlling Factor for Contrast is KVp
KVp – for penetration
Kv = T x 2 + C
2 Types of Contrast
1. Subject/Tissue Contrast
2. Film Contrast
SUBJECT / TISSUE CONTRAST
Difference in the density of adjacent structures.
FILM CONTRAST
Refers to those quality of x-ray film that result in the
recording of high contrast/low contrast.
FACTORS THAT AFFECTS RADIOGRAPHIC CONTRAST
1. Film Screen Systems
The use of film will increase contrast. The faster the
screen the greater the contrast is.
2. Processing
The proper time temperature relationship in chemical mixture
are necessary to build contrast. During the processing
cycle. Chemical Fog will tend to prevent good contrast fog
may result if temperature are too high.
3. Beam Restriction – other term collimator / cone.
Lead – good radiation absorber
The use of beam restriction is very important in radiography
good contrast. As the beam becomes more restricted to the
actual size of the part, less scatter radiation is produce
which in turn reduces fog, resulting in greater contrast on
the film. It was first demonstrated by Dr. William Rollins.
4. Grid
It absorb scattered x-ray that travels in many direction to
prevent hitting the film so that the fog is prevented. It
absorbs secondary and scattered radiation that causes film
fog. Grid produces an increase in contrast.
5. Pathology and Composition of the Part
In here, water content in the body will result in radiograph
exhibiting low contrast and the same is true for the fat
content. Contrast on the radiograph can be enhancing by
the use of compression.
DEFINITION – describe the clarity and sharpness of the image. It means
to make definite, clear and refers to the sharpness of
outline and the detail of sharpness of minute markings.
MAXIMUM DEFINITION – describe an image that outline object extremely
well. The lines and markings of the actual anatomical part
is the best example:
It implies that the radiograph shows minimum magnification
and distortion. It also has clarity that enhances the
visibility of the anatomic markings.
UMBRA – the true object /shape on the film.It shows minimal
magnification.
PENUMBRA – a small area/ thin area blurring around the umbra.
CHARACTERISTICS AND DEFINITION
1. Recorded Detail
Is the actual visible image and the part/ interested
recorded on the film.
Recording the Image Detail is Dependent on the following:
1. FSS – Focal Spot Size
“The smaller the FSS the greater the image sharpness.”
 The use of large focal spot will result in increase blurring around
the object.
2. FFD –Focal Film Distance/ SID –source to image-receptor distance
“the longer the FFD/SID the greater the sharpness of the
image. As the FFD/SID decrease the unsharpness will
increased.
3. OFD – Object Film Distance/ OID
“the shorter the OFD the greater the image sharpness.
4. MOTION - The biggest enemy in the production of a good
radiograph. The result is blurred image. The movement and either
the patient the x-ray tube during exposure will result blurring of
the image.
2 Types of Motion
a. Voluntary – can be controlled by patient Ex: body movement, extra,
breathing.
b. Involuntary –can’t control by human will. Ex: the unconscious
patient
Motion can be reduced by the following:
 Use the shortest time of exposure.
 Restrict the patient motion by instructing/restraining device.
2. DISTORTION
The misinterpretation of size and shape of the object.
TYPES OF DISTORTION
a. Size distortion(magnification)
b. Shape distortion(true distortion)
MAGNIFICATION
- unnecessary enlargement of image in the finished
radiograph. It occurs because the part is not in direct
contact with the film.
*SHAPE DISTORTION OR TRUE DISTORTION
–is present when the image represents the untrue shape of
the actual object.
When the shape and the object is distorted it is describe as
ELONGATED or FORESHORTENED.
*ELONGATION– refers to the image that is stretched and appears longer
than the actual size.
The stretching of the image is produced when the x-ray
tube/film holder is improperly aligned.
* FORESHORTENING–occurs when the object appears shorter that the actual
size. Resulted from poor alignment of the part and the film
ACTIONS TO REDUCE DISTORTION
 Use the longest acceptable FFD/SID
 Place the part as near as the film as possible.
 Place the object and interest the near possible to the film as
possible.
 Use perpendicular CR
3. VISIBILITY DETAIL
It is the ability to see detail recorded on the film
from scattered radiation.
In order for visibility of the image to be the best,
proper density is critical. Too much density or little density is
a result of overexposure or underexposure.
Density in the proper amounts must be present on the
radiograph, in order to have contrast. Contrast is important to
make detail visible.
All factors related to contrast density and scatter
radiation are important and must be properly controlled for the
best possible visibility and the detail on the radiograph.
KINDS OF X-RAY BEAM
1. Primary Radiation
Is the portion of the beam emitted from the focal, spot of
x-ray tube
2. Leakage Radiation
Is the portion of the beam emitted by the x-ray tube due to
improper design and protective housing.
3. Scattered Radiation
A radiation that undergone the change of direction emitted
by matter after the interaction of the x-ray photon.
4. Remnant Radiation
Is the portion of primary radiation that emerges from the
body tissues to expose the x-ray film and eventually record
the images.
“As a number of scattered radiation increase image clarity decrease”.
Factors Affecting Scattered Radiation
1. KVp
 2. Field Size
3. Patient Thickness
As the KV increase, the scattered radiation will also
increase. However the amount of radiation absorb by the
patient will decrease
Different Devices that Use to Reduce the Scattered Radiation
1. Collimator/Bean restriction
2. Grid
Field Size
- Refer to the size of the area on the patient that is exposed
by the primary beam.
Control of the field size is probably the most important
factor for controlling scattered radiation.
“the larger the filed size the greater the amount of scattered
radiation.”
Patient Thickness
As the part thickness of tissue density increase the
secondary radiation will also increase. Increasing patient
thickness more x-ray undergoes multiple scattering.
Compression Device – use to reduce SR.
Collimator – the most effective method of reducing the scattered
radiation. Proper collimator has the primary effect or
reducing patient dose by restricting the volume of tissue
irradiated.
3 Types of Restricting Device
1. Aperture Diagram
2. Cones and Cylinder
3. Variable Aperture Collimator
4. Aperture Diaphragm – the simplest of all beam restrictor. It is
basically lead/lead line metal diaphragm. Attached to the x-ray
tube. It has the hole in the middle. The holes may vary in size/
shape according to prescribe use. The size of the hole in the
diaphragm determines the field size.
Disadvantage: the opening is not adjustable.
In Summary: Aperture diaphragm would be rated as poor beam
restrictor. However, they are very effective when compare with
exposure mode with no model beam restriction.
Cone & Cylinder
– are heavy metal device that are attached to the housing of
the x-ray tube for the purpose of restricting beam. They may
vary from 8-12 inches in length with shapes that are flared
circular, rectangular, cylindrical with added extension.
Variable Aperture Collimator –
is a box like structure attached to the part of x-ray tube
for the purpose of restricting the beam. This is the most
common restricting device in diagnostic radiology. It
compose of 3mm thick lead. Inside the collimator are a
matching pairs of lead shutter. The lower shutter is movable
to allow varying field size.
The upper pair of shutter is located nearest the focal spot
and is known as the part/entrance shutter.
The entrance shutter are fixed to serve must like an
aperture diagram.
Another characteristics of collimator is the beam centering
device. Collimator have a light house inside the structure
that is used for centering the beam. When the light is
deflected by a mirror that is mounted in a middle of the
collimator.
The light rays hit the mirror and reflected through the
open shutter to represent the border of the beam. The
collimator also adds total inherit filtration of the x-ray
beam. The collimator is equivalent of approximately 1.0 mm
Aluminum which is a primary result of the mirror that is
place in the path of the beam.
Automatic Collimator – is also known as Positive Beam Limiting Device
(PBLD)
It works very the same as the regular collimator. The
difference with an automatic collimator is the movement of
the shutter which is accomplished with electronic motors
instead of manual selection. Electronic sensing device are
attached to the cassette rays and latched as the cassette is
placed in the tray and latched the sensor is activated to
automatically adjust the shutter to the size of the film.
Beam Alignment Test For Collimators
The alignment of the primary beam with the light from the
collimator is formed to insure that the light beam
duplicates the borders of the primary beam.
The test is performed using a 14 x 17 cassette. The light
beam is adjusted to leave a 2 inches unexposed border around
the edge of the cassette. The corner of the light beam are
marked with paper clips/other metal marker placed on the
cassette. The center of the beam is also marked along with a
reference point using a R/L marker. Make the exposure using
approximately 2.5 mAs and tKVp.
 The test radiograph is examined to determine if the beam as Penetrability – refers to the range of x-ray beams in
marked by the metal object is identical to the primary beam. matter.
“ Higher energy x-ray beams are able to penetrate matter farther than
AIRGAP TECHNIQUE low-energy Beam.”
Is a technique that seems to be growing in application as an High Quality of Hard – x-ray beam with high
alternative to the use of the radiographic grid. The use of penetrability.
air gap technique is another method to reduce scattered Soft Beams – low penetrability are of low quality.
radiation. Thereby enhancing radiographic contrast.
In a typical air gap technique the film would be move 10- Half Value Layer – thickness of absorbing material necessary to reduce
15cm from the patient the portion of scattered radiation the x-ray intensity to half of its original value.
generated in the patient would be scattered away from the - Range of 3 to 5mins. Al, or 4 to 8 cm of
film and not be detected by the radiographic film. soft tissue
Generally, when employing an air gap technique the technique - Best method for specifying x-ray quantity
factor are about the same as 7:1 Grid. The AGT sometimes 3 Principal Parts of Set Up
called “air-filtration” but it should be obvious that air 1. X-ray Tube
filtration is an improper name for this procedure. Because 2. Radiation Detector
the air does not act as a filter of low energy scattered 3. Graded Thickness of filter
radiation. Factors Affecting X-ray Quality
Use of an air gap between patient and film decreases scatter 1. Kilovoltage – as KVp is increased, so is beam
radiation that reaches the film without the need to use quality and therefore HVL
higher kVp or mAs settings. An increase in KVp results in a shift of the x-ray emission
The term "air filtration" has been used to describe this spectrum toward the high energy side, causing an increase in
technique, but this is a misnomer because there is little the effective energy of the beam, thus making it more
attenuation of scatter and no hardening of the x-ray beam. penetrating.
2. Filtration – primary purpose of adding filtration to an x-ray beam
Factors Affecting X-ray Quantity is to selectively remove low-energy x-rays that have no
1. Milliampere – seconds – X-ray quantity is directly proportional to chance of getting to the film.
the mAs. As filtration is increased, so is beam quality, but quantity is
decreased.
2. Kilovoltage – X-ray quantity varies rapidly with changes in KVp. The Aluminum is Chosen Because it is:
change in x-ray quantity is proportional to the square of 1. Efficient in removing low-energy x-rays through photoelectric
the ratio of the KVp. effect.
2. It is easily available
3. Distance – radiation intensity from an x-ray tube varies inversely 3. Inexpensive
with the square of the distance from the target. The 4. Easily shaped into filters.
relationship is inversely square law.
Types of Filtration
4. Filtration – x-ray machine have metal filters, usually 1 to 3 mm 1. Inherent Filtration – glass envelope of an x-ray tube filters the
aluminum (Al), positioned in the useful beam. emerging x-ray beam.
Primary purpose of these filters is to reduce the number of - Usually about 0.5 mm Al = x-ray
low-energy x-ray that reach the patient. tube.
-Usually window sometimes made
of beryllium
X-ray Quality – penetrability or penetrating power, of an x-ray beam. - 0.1 mm Al
2. Added Filtration – produce by thin sheets of Al
attached between the protective
tube housing and collimator.
- Two sources of total 2-3 mm of
aluminum.
3. Compensating Filters – one of the most difficult tasks racing the
radiologic technologist is producing an image with a uniform
average density when examining a body part that varies
greatly in thickness or tissue composition.
- It compensates for difference in
subject radio capacity
Some Commonly Employed Compensating Filters
1. Wedge Filter – is principally used when having a radiograph on a
body part, such as the foot that varies considerably in
thickness.
2. Bilateral Wedge Filter – or through filter, employ in chest
radiography.
Thin central region of the wedge is positioned over the mediastinum,
while the lateral thick portions shadow the lung fields.
3. Bow Tie shaped Filter – used with some CT scanners to compensate for
the shape of the head or body.
4. Conic Filters – either concave or convex, find application in
digital fluoroscopy where the image receptor, the image
intensifier tube, is round.
5. Step-Wedge Filter – (diagramed) is an adaption of the wedge filter.
Employed usually where long sections of the anatomy are
radiographed and imaged with two or three separate films.
Used in rapid changer for translumbar and femoral arteriography and
venography.