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RADIOGRAPHIC ANATOMY AND POSITIONING Radiographic Anatomy and Positioning Anatomic Planes A plane is a flat surface formed by making a cut (imaginary or real) through the body or a part of it. In radiography, various planes are used as points of reference that assist in localizing areas of the body to permit specific centering guidelines. The major anatomic planes used in radiographic positioning are: Longitudinal plane Running lengthwise; in the direction of the long axis of the body or any of its parts or sections. Transverse plane Placed across the body at right angles to the frontal and sagittal planes. Transverse planes are perpendicular to the long axis of the body or limbs, regardless of the position of the body or limb; in the anatomic position, transverse planes are horizontal; otherwise the two terms are not synonymous. Median (midsagittal) plane A plane vertical in the anatomic position, through the midline of the body, that divides the body into right and left halves. Sagittal plane Plane parallel to the median plane; sagittal planes are vertical planes in the anatomic position. Frontal (coronal) plane A vertical plane at right angles to the sagittal plane, dividing the body into anterior and posterior portions, or any plane parallel to the central frontal plane. Transpyloric plane A transverse plane midway between the superior margins of the manubrium of the sternum and the symphysis pubis; the pylorus may be located on this plane in the supine or prone positions, but in the erect (anatomic) position it descends to a lower level. Subcostal plane A transverse plane passing through the inferior limits of the costal margin (i.e., the 10th costal cartilages); it delimits the boundary between the hypochondriac and epigastric regions superiorly and the lateral and umbilical regions inferiorly. RADIOGRAPHIC ANATOMY AND POSITIONING transverse plane transpyloric plane (9th costal cartilage) subcostal plane (10th costal cartilage) transverse plane midsagittal or median plane sagittal planes transverse plane transpyloric plane (9th costal cartilage) subcostal plane (10th costal cartilage) transverse plane frontal planes Anatomic Planes RADIOGRAPHIC ANATOMY AND POSITIONING medial superior anterior posterior lateral proximal distal inferior Body Part Terminology Anterior The front surface of the body. Often used to denote the position of one structure relative to another (i.e., situated nearer the front of the body). Posterior The back surface of the body. Often used to denote the position of one structure relative to another (i.e., situated nearer the back of the body). Medial Relating to the middle or center; near to the median or midsagittal plane. Lateral Farther from the median or midsagittal plane. Proximal Nearest the trunk or the point of origin, said of part of a limb, of an artery, or nerve, so situated. Distal Situated away from the center of the body or from the point of origin; specifically describes to the extremity or distant part of a limb or organ. Superior Situated nearer the vertex of the head in relation to a specific point. Inferior Situated nearer the soles of the feet in relation to a specific reference point. RADIOGRAPHIC ANATOMY AND POSITIONING abduction flexion adduction extension Body Movement Abduction Movement of a limb or body part farther from or away from the midline of the body. Adduction Movement of a limb or body part closer to or toward the midline of the body. Extension Straightening of a joint or extremity so that the angle between contiguous (adjoining) bones is increased. Flexion Bending of a joint or extremity so that the angle between contiguous (adjoining) bones is decreased. RADIOGRAPHIC ANATOMY AND POSITIONING Eversion Movement of turning a body part outward (away from the midline). Inversion Movement of turning a body part inward (toward the midline). Pronation Movement of turning the body to face downward or turning the hand so that the palm is facing downward. Supination Movement of turning the body to face upward or turning the hand so that the palm faces upward. inversion eversion supinate pronate RADIOGRAPHIC ANATOMY AND POSITIONING anatomic supine Positioning Terminology Anatomic position Position of the body when the subject is facing the front in the erect position with the arms and legs fully extended. The palms of the hands are facing forward and the feet are together. In radiography, this term is used as the reference position of the body to describe various positions. Supine position Position in which the subject is lying on the back with the face up. Sometimes referred to as the dorsal recumbent (lying down) or dorsal decubitus position, because the back (dorsal surface) of the body is dependent (nearer the table). RADIOGRAPHIC ANATOMY AND POSITIONING prone lateral oblique Prone position Position in which the subject is lying face down on the front of the body. Sometimes referred to as the ventral recumbent or ventral decubitus position, because the front (ventral surface) of the body is dependent (nearer the table). Lateral position Position in which the side of the subject is next to the film. A lateral position is named by the side of the subject that is situated adjacent to the film. Sometimes referred to as an erect lateral if the subject is sitting or standing, and a lateral recumbent or lateral decubitus if the subject is lying down. Oblique position Position in which the subject is neither prone nor supine, but rotated somewhere between. In radiographic terminology, the subject is in a posterior oblique position if some part of the posterior surface of the body is closer to the film, and in an anterior oblique position if some part of the anterior surface of the body is closer to the film. RADIOGRAPHIC ANATOMY AND POSITIONING right anterior oblique (RAO) left anterior oblique (LAO) left posterior oblique (LPO) right posterior oblique (RPO) Right anterior oblique (RAO) Patient is lying semiprone (face down) on the radiographic table or standing facing a vertical grid device with the right side closer to the film. Left anterior oblique (LAO) Patient is lying semiprone (face down) on the radiographic table or standing facing a vertical grid device with the left side closer to the film. Left posterior oblique (LPO) Patient is lying semisupine (face up) on the radiographic table or standing with the back against a vertical grid device with the left side closest to the film. Right posterior oblique (RPO) Patient is lying semisupine (face up) on the radiographic table or standing facing away from a vertical grid device with the right side closest to the film. RADIOGRAPHIC ANATOMY AND POSITIONING dorsal decubitus ventral decubitus lateral decubitus Decubitus position Patient is lying down, and the central ray is horizontal (parallel to the floor). Dorsal decubitus Patient is lying supine (face up) on the radiographic table or on a stretcher placed next to a vertical grid device. The x-ray beam enters from one side of the patient and exits the other. Ventral decubitus Patient is lying prone (face down) on the radiographic table or on a stretcher placed next to a vertical grid device. The x-ray beam enters from one side of the patient and exits the other. Lateral decubitus Patient is lying on either side on the radiographic table or on a stretcher placed next to a vertical grid device. For a left lateral decubitus, the patient is lying on the left side with the right side up, whereas for a right lateral decubitus, the patient is lying on the right side with the left side up. The x-ray beam passes through the patient from front to back or back to front, depending on whether the patient is facing toward or away from the radiographic tube. RADIOGRAPHIC ANATOMY AND POSITIONING anteroposterior (AP) lateral posteroanterior (PA) Radiographic Projections In radiography, the term projection describes the path along which the x-rays travel from the radiographic tube through the subject to the image receptor. Anteroposterior (AP) projection Patient is either supine (face up) on the radiographic table (dorsal decubitus) or erect with the back against a vertical grid device. The x-ray beam enters the front (anterior) surface of the body and exits the back (posterior) surface. Posteroanterior (PA) projection Patient is either prone (face down) on the radiographic table (ventral decubitus) or erect facing a vertical grid device. The x-ray beam enters the back (posterior) surface of the body and exits the front (anterior) surface. Lateral projection Patient is lying on either side on the radiographic table (lateral decubitus) or standing with either side against a vertical grid device. The lateral projection is always named by the side of the patient that is placed next to the film. RADIOGRAPHIC ANATOMY AND POSITIONING axial tangential tangential Oblique projection Patient is rotated into a position that does not produce either a frontal (AP or PA) or lateral projection. Axial projection Any projection in which there is longitudinal angulation of the central ray with respect to the long axis of the body part. Tangential projection Any projection in which the central ray passes between or passes by (skims) body parts to project an anatomic structure in profile and free of superimposition. Adapted from Eisenberg RL, Dennis CA, May CR. Radiographic positioning, 2nd ed. Boston: Little, Brown & Co., 1995.