Final Requirement - SABORNIDO

MARY KATHERINE V.
SABORNIDO
DAVAO DOCTORS COLLEGE, INC
-AESTIMAMUS VITAM-
Gen. Malvar St., Davao City 8000
Tel. Nos.: 222-0850 to 53 Fax: 221-1074
E-mail: www.davaodoctors.edu.ph
RADIOLOGIC TECHNOLOGY PROGRAM

APPROVAL SHEET
In partial fulfilment of the requirements for the Degree of
Bachelors of Science in Radiologic Technology, this Undergraduate
Internship Requirement entitled “GENERAL RADIOLOGIC
PROCEDURES, AND SPECIAL RADIOLOGIC PROCEDURES” has been
prepared and submitted by MARY KATHERNE V. SABORNDO, an
RT Intern of Davao Doctors College, Inc. who is hereby
recommended and approved.
Accepted as a partial fulfillment of the requirements of the
Radiologic Technology Program of Davao Doctors College, Inc. A.Y.
2020- 2021.
Signed By:
EDWARD JAMES E. IGNACIOI, RRT, MBA
RT Clinical Coordinator
LEONILA P. FELIZARTE, RRT, MAED, PHD
RT Program Chair
DR. ERLYN JESSIE DY, MSChem
Dean, College of Allied Health Sciences
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TABLE OF CONTENTS
CLINICAL EDUCATION I Page No.

Approval Sheet……………………………………………………………….. 2
Table of Contents…………………………………………………………….. 3
CE1 Reflective Journal Compilation……………………………………… 4
CE1 Procedural Logbook Compilation ………………………………….. 31
General Radiography Procedures
Upper Extremities - (Hand, Wrist, Forearm, Elbow, Humerus)
Shoulder Girdle - (Shoulder Joint, Scapula, Clavicle)
Pelvic Girdle - (Hip Joint, Pelvis)
Lower Extremities - (Foot, Ankle, Leg, Knee, Femur)
Vertebral Column - (Cervical, Thoracic, Lumbar Spine)
Thoracic Cage - (Thoracic Bony Cave, Ribs)
Thoracic Contents - (Chest Radiography)
Skull - (Skull Series)
Abdomen - (Abdomen Radiography)
SPECIAL RADIOGRAPHIC PROCEDURE

BARIUM CONTRAST CASES- (Esophagram, UGIS, Barium Enema) …. 145
IODINATED CONTRAST CASES- (IVP) …………………………………… 182
SECOND SEMESTER
PROCEDURAL MANUAL ……………………………………………………. 190

REFLECTIVE JOURNAL …………………………………………………….. 195
LEARNING JOURNAL ……………………………………………………….. 225
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: June 7-11, 2021
TOPIC: FIRST WEEK OF PRE-INTERNSHIP
I. WEEKLY LEARNING EXPERIENCE:
I learn to be more prepared and be self-disciplined. Having a structure and

practicing self-discipline can help me set boundaries and begin to maintain a new
routine as an intern student. Also, I need to be prepared to read my assignment
and quizzes before class and be ready to respond to my instructors during virtual
discussions. Now, more than ever, I need to stay engaged in their classes because
now I am responsible for my own knowledge and I can always be in control of my
learning.
II. REFLECTION:
For this 1st week of pre-internship, we review and discuss the major subjects
we encounter during our second year. Our clinical instructor makes use of the
resources available to them and makes an effort to discuss the topic of Medical
Terminology, Human Anatomy and Physiology, Professional Ethics and
Jurisprudence, Patient Care and Management, Radiation Biology, and Radiation
Protection.
Since this is the first week of our pre-internship we have done many reviews
about our major subjects during our second year that refresh our minds from the
information we forgot. As we still face some uncertainty surrounding this pandemic
and the future of our education system. One of the most important things to
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remember during this time is that I can always be in control of my learning. I need
to be always patient with myself and remain positive and hopeful. We need to be
patient because what we are experiencing is valid and my other batch mates may
be experiencing it differently. Social distancing can feel very isolating, missing the
traditional learning because of so many struggles to adjust to our new norm during
virtual discussion. We are all doing the best we can during these hard times.
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REFLECTIVE JOURNAL
NAME: Sabornido, Mary Katherine V. DATE: June 14-19, 2021
TOPIC: SECOND WEEK OF PRE-INTERNSHIP
For this week, we had discussed all Ultrasound, Interventional

Radiography, and Special Procedures. I've come to learn the fundamentals and
essentials of ultrasound as the method of imaging of choice for determining the
health of the baby developing within the womb of the mother. In addition to that,
the advantages of ultrasound, are it is non-ionizing, the portability of the equipment
is easy to perform, non-invasive examination. Other examples of typical ultrasound
sites include several internal organs, including the liver, pancreas, as well as
gallbladder to the heart, and other soft tissues. As such, ultrasound is especially
effective for imaging soft tissues and structures as well as motion.
In addition to that, the two things I learned and understand are first from the
special procedure. I got to review from Upper GI series to the Small Bowel Series
since this is a very essential procedure to be able to detect abnormal anatomical
and functional conditions by the use of contrast media. To be able to identify
pathologies in the radiograph and about the patient preparation. Also, for
Interventional Radiology, I find this topic a hard one which makes me interested in
it even more. This taught me to explore more about different information and not
just only read one piece of data.
II. REFLECTION:
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Honestly, I found this week’s exhausting due to multiple quizzes and

assignments, even though we were provided a recorded video but the fact that we
should still have a long time absorbing all the information, therefore we’ve been
struggling to adjust ourselves. More importantly, this week taught me to study hard,
not to rely solely on the material provided to me, and to learn to navigate myself,
push myself, and take a good break to refresh my mind.
We, as future radiologic technologists hold a great responsibility to take

good care of our patients at their peak of quality healthcare services. Our institution
exerts their very effort just to extend their knowledge to teach us in the most
possible way in these trying times.
Our instructor-led a conversation about how to deal with stress. We are all
aware that the epidemic has a significant impact on our mental health, and it is
critical that someone educates you on how to deal with stress. I've learned that
stress may be managed in a variety of ways, including talking to family and friends.
Since I got to talk to my groupmates about the stressful activity that we had this
week, which I appreciated especially in today’s time where we feel misunderstood.
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: June 21-26, 2021
TOPIC: THIRD WEEK OF PRE-INTERNSHIP

In this week, we had reviewed the subjects Computed Tomography Scan,
Quality Assurance and Quality Control, Radiation Therapy, Nuclear Medicine,
Radiographic Positioning, and Magnetic Resonance Imaging. I have come to learn
the basic and important details of radiographic positioning about certain methods,
different routinary projections associated with the anatomic structure that has been
demonstrated of every desired body part, and some history taking.
Moreover, is about the Quality Assurance and Quality Control that I always
keep in mind the ALARA principle which means “As Low as Reasonably
Achievable” ensuring the cardinal rules, the distance, time, and shielding. For the
safety of the patient, for you as a Radiologic Technologist, and for the people
around you. I understood a lot from this week’s discussions since most of the topics
are quite familiar to me so I kind of recall things especially the ones I learned from
our third-year days.
II. REFLECTION:
As future radiologic technologists, we must ensure that we are fully ready
in dealing with our chosen field. Every day is a learning experience. Considering
the familiarity with the concepts, there were times when I faced various things that
were foreign to me, which is why I really have to put in more work, particularly this
week's conversation concerning posture.
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This week has been difficult for us since we have to split our time between
studying for our daily quiz and taking our Saturday exam. And I still look on the
bright side and think about how this will prepare us for the actual battle in the board
exam and hospital setting. To still be able to embrace and adjust to changes with
ease. To be able to express our fears but still keep going and trying. Occasionally
we need to take some time away and chat with our families rather than spending
all of our time staring at our phones.
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: June 28-July 3, 2021

TOPIC: FOURTH WEEK OF PRE-INTERNSHIP
This week's experience seemed to have been put upside-down as if I were

on a roller coaster that drove me insane. I was both excited and disappointed in
myself after passing the practical exam, but then there were the part three written
exams, which I had to retake over and over again in order to pass. Nothing
worthwhile comes easily, so let us take it one step at a time until we achieve it.
II. REFLECTION:
Day by day, I learn something new, most notably from my errors, which
have taught me to be a better person as I attempt to move on in my life. This week
made me want to give up, but there seemed to be no need to do so. Taking the
exam several times since you fail it several times. It's as if you're dragging yourself
down while you strive to climb back up. But whether you win or lose is entirely up
to you.
So I fought, and the second time I received a greater score than the first.
However, it was insufficient to qualify for and pass the exam. I was very
disappointed that I had failed again, so I prepared myself and tried harder. So I
tried again to pass the exam, and luckily, I got a little grip on it and eventually
passed. A lot of what-ifs run through my head, such as what if I don't pass the
board exam? What I'd think. I know I'll need a lot of bravery and fortitude if that
happens (hopefully not) to try again and again.
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: July 5-11, 2021
TOPIC: FIFTH WEEK OF PRE-INTERNSHIP

For this week of pre-internship, we have done a lot of activities, which
improved our creative ideas. I learned how to make a customized image receptor
in various sizes, as well as a lead marker and shielding such as thyroid shielding,
gonadal shielding, and flat contact shielding from simple materials. Creating a
chart of exposure elements in every routine projection is really valuable to me
because it serves as a preparation reference for our upcoming exams.
At the same time, I've learned the fundamentals of taking a medical history
and maintaining patient rapport. These things are critical since this is the first step
before conducting the required examination, and it aids in the development of a
relationship with the patient in terms of improving communications and achieving
more precise outcomes.
II. REFLECTION
Establishing rapport is an important point in physician-patient

communication, and it has a beneficial impact on patient satisfaction and overall
therapeutic outcomes. The major purpose of acquiring a medical history from the
patient is to further comprehend the patient's state of health and establish whether
or not the history is related to any acute complaints in order to steer you toward a
diagnosis.
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This week's asynchronous activity gives me a lot of learning when it comes

to our future job. Communication with our patients is very important, especially in
my chosen field where we need to know the patient history of the patient and their
conditions. In a way, we can guide and access them because we all know some
of them don’t have any idea what to do during their situation. I was satisfied with
the outcome of my return demonstration, and my teacher gave me good feedback
about my output. Which makes me do better presentations every return
demonstration.
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REFLECTIVE JOURNAL

TOPIC: SIXTH WEEK OF PRE-INTERNSHIP
In our sixth week of pre-internship we have done a lot of return

demonstrations about the upper extremity such as the hand, wrist, elbow, and
forearm.
I have come to realize in this weak activity, the importance of proper and
correct positioning of the hand of the patient every time you do the positioning. It
is important because the part of the anatomy that needs to be seen in the
radiograph is the main thing. We demonstrate how to conduct various radiographic
procedures with confidence using standard protocols. The proper positioning of
the patient. \ To produce good quality images of body organs. Moreover, we did
our weekly examination on the upper extremity. That always helps us to familiarize
ourselves with sufficient information about the said topic.
II. REFLECTION:
Clinical competency is very essential and is done through positioning

demonstration and return demonstrations as part of our laboratory exercises. At
the end of the course, we as interns should demonstrate skills in patient
preparation and proper positioning techniques for routine and specialized
radiographic examinations.
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REFLECTIVE JOURNAL
TOPIC: SEVENTH WEEK OF PRE-INTERNSHIP
This week taught me a lot about the lower extremities, which include the
foot, ankle, leg, and knee, as well as return demonstrations, daily quizzes, and
inspections of those parts. All of this helped me remember what I learned in
anatomy back in my second year. But apart from that, I've learned not to
procrastinate and to spend time planning ahead of time and completing projects
because putting things off always ends up backfiring.
On the other side, we also completed our weekly exam on the topic we
discussed this week. It serves as a review of our learnings from both the recorded
lecture and the return demonstration.
II. REFLECTION:
This week, we've become acclimated to the routine and realized how
important it is to have it in our system. I always make it a point to complete the
chores on my to-do list before continuing with my day, and I never delay.
Considering the knowledge of the topics, I still encountered several things that
were unfamiliar to me, and this is why I need to put in more effort, particularly in
this week's conversation regarding posture. We've been studying for our daily quiz
and reading for our Saturday exam every week, so we've been preparing every
week.
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REFLECTIVE JOURNAL

TOPIC: EIGHT WEEK OF PRE-INTERNSHIP
This week, I studied the humerus, shoulder, clavicle, and scapula. This
week will be the same as the previous ones, with daily quizzes, return
demonstrations, examinations, and the never-ending login and out. This schedule
has already been set into our system, and we have reached the point when we
must accomplish activities before proceeding with our home duties.
My return demonstration, in which I erroneously put a thyroid shield in the

clavicle and shoulder inspection, comes to me this week. A thyroid shield is not
required in these procedures since it may cause the final result to be overlaid.
II. REFLECTION:
We had our return demonstrations, during which I always take note of our
Clinical Instructors' remarks so that I may improve in the areas where I need to
improve. Because it might be tough to tell if you're doing things right. I like our
clinical teacher's comments and extra information since reading and evaluating
what's stated in the book from the perspective of a clinical instructor is still different.
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: August 2-7, 2021
TOPIC: FIRST WEEK OF INTERNSHIP
On our first week of the internship program, we discussed all the femur, hip,
and pelvis radiography. We also did our return demonstration of the routine
projection on every part. Just like last week, I have come to recall the anatomy of
every part, and also, I learned how to locate it in a radiograph.
On the other hand, we also did our weekly examination about the topic we
discussed for this week. It serves as an assessment of our learnings in both
recorded lessons and returns demonstrations.
II. REFLECTION:
Always set your priorities. This week really tested me on how I prioritize
things. During the weekly examination, I got a low score because I rushed in
answering each item. I was never hesitant in submitting my examination because
I have other things to do, never minding that I might fail the exam. This made me
realize that I should always set my priorities which is my academics. I really need
to put first my schooling over everything.
In conclusion, always be aware of the consequences of every decision you

make because it may affect your overall plans. Set your priorities accordingly and
fulfill them one by one, by striving hard and doing your best.
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REFLECTIVE JOU RNAL
TOPIC: SECOND WEEK OF INTERNSHIP
We discussed the vertebral column radiography, including the cervical spine,

thoracic spine, and lumbar spine, during our second week of internship. In every
section, we also did a practical return demonstration of the routine projection. I was
able to memorize the anatomy of each portion, as well as how to locate it in a
radiograph, just like last week. On the other side, we also completed our weekly
exam on the topic we discussed this week. In both recorded lessons and return
demonstrations, it functions as an assessment of our learnings.
II. REFLECTION:
During this week’s practical return demonstration, it made me realize that

there are a lot of possibilities that may happen such as when your clinical instructor
asks you a question that you have never encountered before but by doing your
best and giving your own opinion you can answer the question efficiently.
Simply do your best in everything you do, and it will have a positive impact on
your life. As a result, I always appreciate my clinical instructor's comments and
ideas during the feedback portion of our return demonstration. It motivates me to
do my best in my next performance and teaches me how to accomplish my best in
my future endeavor.
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REFLECTIVE JOURNAL
TOPIC: THIRD WEEK OF INTERNSHIP
During our third week of the internship program, we discussed the skull,
temporomandibular joint, and paranasal sinuses radiography. As usual, we did a
live discussion with our clinical instructor which made me understand more about
the topic. I was able to recall the basic anatomy of each part and also how to locate
each part in a radiograph.
On the other hand, we also did our procedure manual which serve as our
personal summary of the said topic. We are not able to do our return demonstration
and weekly examination due to the holiday.
II. REFLECTION:
If you are tired learn to rest, not quit. This week was less difficult for us and
made us have time to rest because we only had four days of class, three days of
live lecture, and one day for the case study presentation. I really appreciate the
time that I can be free from the stress of having an examination and return
demonstration in a week.
Thus, I have more time with myself and had more time to sleep because
sometimes I compromised my sleep to study.
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REFLECTIVE JOURNAL
TOPIC: FOURTH WEEK OF INTERNSHIP
In this week, we discussed abdomen and chest radiography. We also had our
weekly examination for the skull, paranasal sinuses, and temporomandibular joint
topic because last Friday was a holiday.
Additionally, we had our return demonstration for the abdomen and chest topic
as well as the weekly examination. Thus, this week has a hectic schedule
compared to the normal week.
II. REFLECTION:
Strive for progress. This is my quote of the week. I admit that I had a hard time
striving for this week, I had a lot of things to do and finish. I always put in my mind
that if I keep on striving there is progress happening, it may be positive or negative.
I tried to finish everything on time, and I keep on pushing myself to do better in
every examination but there’s always been a failure in every success.
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: August 31- SEP 4, 2021
TOPIC: FIFTH WEEK OF INTERNSHIP
For this week, we discussed the bony thorax radiography which includes
the sternum, and ribs. We did also our weekly examination for that topic and
monthly examination for all the topics discussed. Additionally, we also did our
practical exam for the skull series and ribs, prelim examination of the RTEP subject
was also done for this week.
II. REFLECTION:
Make an effort to improve. This is this week's quote. I admit that I struggled
to achieve my goals this week because I had so many things to do and finish. I've
always believed that if I keep pushing, I'll make progress, whether it's positive or
negative. I am proud that I survived this week’s examinations and practical exams.
Moreover, I am more motivated and had the will to improve every day for all
the achievements I received for this prelim term. I know that it is still a long run but
I always believe that small steps create big steps ahead.
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: September 6-11, 2021
TOPIC: SIXTH WEEK OF INTERNSHIP
For this week, we discussed the Esophagogram procedure including its

routinary projections. The Esophagogram procedure has four routinary projections
which are the RAO, Lateral, AP, and LAO projections.
In addition, we also did our practical return demonstration of the said

procedure. Just like the usual week, we did our weekly examination of the topic
discussed.
II. REFLECTION:
Invest wisely your extra time. For this week’s reflection, I have come to
realize the importance of time and how to manage it properly. I had a hard time
managing my extra time for my study time I failed to attend the synchronous class
for this week which made me worry. Thus, I should be more practical. I should
always set my priorities which is my studies because this is the way I can achieve
my dream to become a radiologic technologist in the near future.
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REFLECTIVE JOURNAL
TOPIC: SEVENTH WEEK OF INTERNSHIP
For this week, our clinical instructor discussed the Upper Gastrointestinal
Series procedure. It has five routinary projections which are the RAO, PA, Right
Lateral, LAO, and PA positions. I have also come to learn the patient preparation
before the procedure, the patient should be NPO for eight hours before the
examination and should not be chewing gum and even smoking before the
examination because it can cause gastric secretions and salivations that could
affect the proper coating of the barium in the gastric mucosa.
On the other hand, I also learned the barium preparation for the UGIS
examination. It depends on what type of barium is being used, if thin barium is
used it should be one part of barium sulfate and one part of water. If thick barium
is used, it should be three to four parts of barium sulfate and one part of water.
II. REFLECTION:
Be attentive in everything you do. During this week’s return demonstration, I

got a good comment from my clinical instructor. He has also given me a comment
and advice about the UGIS procedure, especially during the scout film procedure
that the gonadal shielding should be placed correctly to avoid obstructing the
anatomy of interest.
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REFLECTIVE JOURNAL
TOPIC: EIGHT WEEK OF INTERNSHIP
For this week's discussion, I learned about the Lower Gastrointestinal

System which is a very long topic and that includes the anatomy that serves as our
refreshers, the contrast is being used, and also the different positions. I also
learned the positions to take for post-evacuation which helps if there's still contrast
media left on the colon of the patient. I certainly recall other issues, such as the
significance of the body habitus of the patient in the positioning and how the
radiologic technologist should be good about the anatomy of the body in order to
properly center and position the patient.
I got learned about the procedures' preparations the day before and the day
of the procedure. Which includes light meals, NPO after, also taking laxatives
before sleeping, and also it is important to do the patient history taking, patients
who have undergone certain procedures should avoid taking laxatives.
II.REFLECTION:
Just like last week, we had return demos, examinations, manual creation,
logbook, and logging in and out this week. Moreover, I am pleased with the return
demonstration results as well as the case study presentation. Also, I appreciate
how considerate and sympathetic our Clinical Instructors have been this week. I
really hope things improve since we miss the old school environment.
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: October 4-9, 2021
TOPIC: NINTH WEEK OF INTERNSHIP
For this week's discussion we learn a lot about part 2 for the Image Critique.
The importance of controlling the density and contrast of the image and aligning
the part, IR, and tube properly to avoid cut-offs of the part to be imaged. Proper
patient positioning and always properly collimating the four sides of the anatomy
of interest
For this week, we tackle the recorded detail as the result of the geometry of
the beam; it could be the Focal Spot Size, the Object-to-Image Receptor Distance,
and the Source-to-Image Receptor Distance. There are two types of distortion:
Size Distortion, which is the result of the SID, and OID, Shaper Distortion, which is
the result of the tube, patient, and film alignment.
II. REFLECTION:
We learned and are still learning more about the proceedings discussion about
film critique. Still, we are looking forward to the MedSpace application so we could
showcase our learnings from the online return demonstrations.
I also just barely passed the weekly examination, to which I really breathed a
sigh of relief..
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REFLECTIVE JOURNAL
TOPIC: TENTH WEEK OF INTERNSHIP
Indicate at least two major learning you have earned for the week. The
importance of controlling the density and contrast of the image and aligning the
part, IR, and tube properly to avoid cut-offs of the part to be imaged. Proper patient
positioning and always properly collimate the four sides of the anatomy of interest.
II. REFLECTION:
Still, we are looking forward to the MedSpace application so we could

showcase our learnings from the online return demonstrations. But regardless, we
were still glad for this change of pace because for me film critique is one of the
most important qualities a radiographer should have to ensure the quality of
performance within the workplace.
It led me to the conclusion that I really need to find balance within my time
and try to make way for my studying time. Even with the struggles and the stresses
this week, I am still really thankful to God for giving me the strength to push through
all these troubles of mine.
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REFLECTIVE JOURNAL
TOPIC: ELEVENTH WEEK OF INTERNSHIP
In this week's discussion, we learn a lot about Image Critique. The importance
of controlling the density and contrast of the image and aligning the part, IR, and
tube properly to avoid cut-offs of the part to be imaged. Proper patient positioning
and always properly collimating the four sides of the anatomy of interest
We tackle the recorded detail as the result of the geometry of the beam; it
could be the Focal Spot Size, the Object-to-Image Receptor Distance, and the
Source-to-Image Receptor Distance. There are two types of distortion: Size
Distortion, which is the result of the SID, and OID, Shaper Distortion, which is the
result of the tube, patient, and film alignment.
II. REFLECTION:
We were grateful for the change of pace because, in my opinion, film critique
is one of the most important abilities a radiographer should possess in order to
assure the quality of performance in the job.
I narrowly passed the weekly exam, so I heaved a sigh of relief. Despite the
difficulties and strains of this week, I am grateful to God for providing me with the
strength to persevere in the face of adversity.
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REFLECTIVE JOURNAL
TOPIC: TWELVETH WEEK OF INTERNSHIP
Indicate at least two major learning you have earned for the week. This week
has been very helpful for me health-wise and mental-wise because we all really
needed a good long rest after all the busy weeks past.
II. REFLECTION:
We were extremely relieved that we would be having a long weekend this

week because of the holidays on November 1 and November 2, it gave us time to
spend with our friends and family and also to prepare for our upcoming thesis
defence next week.
I did a good job in our monthly examinations for CE1 and RTEP this week all
thanks to proper time management and group studies with my friends.
This week has been very helpful for me health-wise and mental-wise because
we all really needed a good long rest after all the busy weeks past. A breather was
well deserved for all of us students and teachers alike. But now as the holiday end,
it’s time to get ready once again for the upcoming week especially since it’s the
thesis defense week. I am very nervous and anxious but I know me and my
groupmates can do this because we have prepared fully for this moment.
Godspeed to all of us and I hope we all keep safe!
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REFLECTIVE JOURNAL
NAME: SABORNIDO, MARY KATHERINE V. DATE: November 3-6, 2021
TOPIC: THIRTEENTH WEEK OF INTERNSHIP
For this week’s discussion, our topic is all about special procedures: barium
swallow, barium meal, barium enema, and intravenous urography. Special
procedures are those procedures that require the use of contrast media. It is used
to highlight organs in the abdomen since the abdomen is filled with low-density
organs that are hard to identify with just an x-ray procedure.
II. REFLECTION:
At the end of the week, we had our weekly film critique. For me, this week’s
film critique is more challenging than the past weeks because special procedures
are one of the hardest topics. However, with enough study time, we manage to
survive the week. Also, we had our usual case study on Thursday that mainly
talked about the said topics. Our group collaborated on our report, and we received
a passing mark due to our efforts.
Furthermore, we've been under a lot of stress this week because of our
upcoming research defense. We were all focused on getting ready, which made it
tough to concentrate on other assignments, but we managed to get by.
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REFLECTIVE JOURNAL
TOPIC: FOURTEENTH WEEK OF INTERNSHIP
For this week, we discussed the Thyroid Ultrasound. It is divided into three
anatomic areas which are the right and left lobes that are located on either side of
the trachea and it is usually joined at the inferior poles by the thin film located on
either side of the trachea. On the other hand, we also did our case study
presentation about the topic. We also did our final thesis defense.
II. REFLECTION:
Belief in yourself. We finally finished our thesis final defense this week and
were accepted. We were incredibly fortunate that our efforts were successful, as
we had worked tirelessly for several weeks trying to gather responses, obtain
numerical data, collect statistics, and so on. We all put in many hours, and it feels
great to have overcome such a significant challenge. Thus, believing in yourself is
the best thing you can do in every complicated situation.
Words are inadequate to express how delighted I feel right now. I've always
regarded thesis defense as a significant challenge that cannot be easily overcome.
But I praise God Almighty for providing us with the wisdom and strength to
overcome present and future challenges.
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REFLECTIVE JOURNAL
TOPIC: FIFTEENTH WEEK OF INTERNSHIP
For this week, we discussed the whole abdomen and we had our monthly
examination and our topic was all about ultrasonography scanning protocol -
thyroid scanning and KUB scanning and barium enema and IVU.
II. REFLECTION:
This week was the last week of our typical program, which included
ultrasound talks, case study discussions on Thursday, and monthly assessments
on Friday. We were relieved on Saturday since it was a vacation day, allowing us
to prepare for our impending Revalida. Moreover, all of us still feel the exhaustion
from last week ’s thesis defense. We were still sluggish in our tasks and felt too
tired to even check-in and checkout of our attendances.
We're nearing the end of our online class, and we're going to attack the final
task with everything we've got. We will get through this final stretch of
examinations. May God grant us the strength and determination we need during
this closing period.
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GENERAL RADIOGRAPHY PROCEDURES

UPPER EXTRIMITY (HAND)
INTERN NAME: SABORNIDO, MARY KATHERINE
DATE PERFORMED: SEPTEMBER 27, 2021
PROCEDURE: HAND ROUTINE
ROUTINE POSITIONS: PA PROJECTION, PA OBLIQUE PROJECTION
I. Clinical Indication: • Fractures, dislocations, or foreign bodies of the

phalanges, metacarpals, and all joints of the hand •
Pathologic processes such as osteoporosis and
osteoarthritis
II. Technical Factors: • Minimum SID—40 inches (102 cm) • IR size—24 ×
30 cm (10 × 12 inches), lengthwise • Nongrid • Detail
screens for analog imaging • Analog—50 to 55 kV
range • Digital systems—55 to 60 kV range
III. Shielding Shield all radiosensitive tissues outside region of
interest.
IV. Patient Position 1. PA - Hand
Seat patient at end of table with elbow flexed about
90° and hand and forearm resting on table.
2. PA Oblique - Hand
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90° and hand and forearm resting on table.
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V. Part Position 1. PA - Hand

• Pronate hand with palmar surface in contact with IR;
spread fingers slightly.
• Align long axis of hand and forearm with long axis of
IR.
• Center hand and wrist to IR.
2. PA Oblique – Hand
• Pronate hand on IR; center and align long axis of
hand with long axis of IR.
• Rotate entire hand and wrist laterally 45° and
support with radiolucent wedge or step block, as
shown, so that all digits are separated and parallel to
IR.
R
VI. Central Ray & 1. PA Central Ray - Hand

Collimation • Center CR to level of iliac 3RD MCP.
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2. PA Oblique Central Ray - Hand

• Direct CR perpendicular to IR to a point about 1
inch (2.5 cm) to the left of the MSP.
• Center CR to level of iliac 3RD MCP.
VII. Anatomy 1. PA - Hand

Demonstrated PA projection of entire hand and
wrist and about 2.5 cm (1 inch) of distal forearm are
visible. PA projection of hand demonstrates oblique
view of the thumb.
2. PA Oblique- Hand
• Oblique projection of the entire hand and wrist and
about 2.4 cm (1 inch) of distal forearm are visible.
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VIII. Evaluation 1. PA - Hand

Criteria - Exposure • Long axis of hand and wrist aligned with long axis
of IR.
• No rotation of hand, as evidenced by symmetric
appearance of both sides or concavities of shafts of
metacarpals and phalanges of digits 2 through 5 and
the appearance of equal amounts of soft tissue on
each side of phalanges 2 through 5.
• Digits should be separated slightly with soft tissues
not overlapping.
• MCP and IP joints should appear open, indicating
correct CR location and that hand was fully
pronated.
• CR and center of collimation field should be to third
MCP joint
2. PA Oblique- Hand
• Long axis of hand &wrist should be aligned with IR.
• 45° oblique is evidenced by the following: midshafts
of metacarpals should not overlap; some overlap of
distal heads of third, fourth, and fifth metacarpals but
no overlap of distal second and third metacarpals
should occur; excessive overlap of metacarpals
indicates over-rotation, and too much separation
indicates under-rotation.
• MCP and IP joints are open without foreshortening
of midphalanges or distal phalanges, indicating that
fingers are parallel to IR.
• CR and center of collimation field should be at third
MCP joint
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UPPER EXTREMITY (WRIST)

PROCEDURE: WRIST ROUTINE
ROUTINE POSITIONS: WRIST PA PROJECTION WRIST
LATERAL(LATEROMEDIAL) PROJECTION
I. Clinical Indication: • Fractures of distal radius or ulna, isolated
fractures of radial or ulnar styloid processes, and
fractures of individual carpal bones • Pathologic
processes, such as osteomyelitis and arthritis
II. Technical Factors: • Minimum SID—40 inches (102 cm) • IR size—18
× 24 cm (8 × 10 inches), lengthwise • Nongrid •
Detail screens for analog imaging • Analog—60 to
65 kV range • Digital systems—65 to 70 kV range
interest.
IV. Patient Position 1. PA - Wrist
90° and hand and wrist resting on IR, palm down.
Drop shoulder so that shoulder, elbow, and wrist
are on same horizontal plane.
2. Lateral (Lateromedial) - Wrist
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Seat patient at end of table, with arm and forearm

resting on the table and elbow flexed about 90°.
Place wrist and hand on IR in thumb-up lateral
position. Shoulder, elbow, and wrist should be on
same horizontal plane.
V. Part Position 1. PA – Wrist
• Align and center long axis of hand and wrist to IR,
with carpal area centered to CR. • With hand
pronated, arch hand slightly to place wrist and carpal
area in close contact with IR.

• Align and center hand and wrist to long axis of IR.
• Adjust hand and wrist into a true lateral position,
with fingers comfortably flexed; if support is needed
to prevent motion, use a radiolucent support block
and sandbag, and place block against extended
hand and fingers as shown.
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VI. Central Ray & 1. PA Central Ray- Wrist

Collimation • CR perpendicular to IR, directed to midcarpal
area
2. Lateral (Lateromedial) - Wrist Central Ray-

Wrist
• CR perpendicular to IR, directed to midcarpal
area.
VII. Anatomy R
Demonstrated
1. PA - Wrist
• Midmetacarpals and proximal metacarpals;
carpals; distal radius, ulna, and associated joints;
and pertinent soft tissues of the wrist joint, such as
fat pads and fat stripes, are visible.
• All the intercarpal spaces do Nt appear open
because irregular shapes that result in overlapping

• Distal radius and ulna, carpals, and at least the
midmetacarpal area are visible.
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1. PA - Wrist
VIII. Evaluation Criteria • Long axis of the hand, wrist, and forearm is
- Exposure aligned with IR.
• True PA is evidenced by the following: equal
concavity shapes are on each side of the shafts of
the proximal metacarpals; near-equal distances
exist among the proximal metacarpals; separation
of the distal radius and ulna is present except for
possible minimal superimposition at the distal
radioulnar joint.
• CR and center of collimation field should be to the
midcarpal area
• Long axis of the hand, wrist, and forearm should
be aligned with long axis of IR.
• True lateral position is evidenced by the following:
ulnar head should be superimposed over distal
radius; proximal second through fifth metacarpals
all should appear aligned and superimposed.
• CR and center of collimation field should be to
midcarpal region.
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UPPER EXTREMITY (FOREARM)
PROCEDURE: FOREARM ROUTINE
ROUTINE POSITIONS: FOREARM AP PROJECTION, FOREARM LATERAL
(LATEROMEDIAL) PROJECTION
I. Clinical Indication: • Fractures and dislocations of the radius or ulna •

Pathologic processes such as osteomyelitis or
arthritis
× 35 cm (11 × 14 inches), for smaller patients; 35 ×
43 cm (14 × 17 inches), for long forearms,
lengthwise • Nongrid • Detail screens for analog
imaging • Analog—60 to 70 kV range • Digital
systems—70 to 75 kV range
interest.
IV. Patient Position 1. AP - Forearm
Seat patient at end of table, with hand and arm fully
extended and palm up (supinated).
2. Lateral (Lateromedial) - Forearm

Seat patient at end of table, with elbow flexed 90°.
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1. AP - Forearm
V. Part Position • Drop shoulder to place entire upper limb on same
horizontal plane.
• Align and center forearm to long axis of IR,
ensuring that both wrist and elbow joints are
included. (Use as large an IR as necessary.)
• Instruct patient to lean laterally as necessary to
place entire wrist, forearm, and elbow in as near a
true frontal position as possible. (Medial and lateral
epicondyles should be the same distance from IR.)

• Drop shoulder to place entire upper limb on same
horizontal plane.
• Align and center forearm to long axis of IR; ensure
that both wrist and elbow joints are included on IR.
• Rotate hand and wrist into true lateral position, and
support hand to prevent motion, if needed. (Ensure
that distal radius and ulna are superimposed
directly.)
• For heavy muscular forearms, place support under
hand and wrist as needed to place radius and ulna
parallel to IR.
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1. AP Central Ray- Forearm
VI. Central Ray & • CR perpendicular to IR, directed to mid-forearm.

Collimation
VI. Central Ray & 2. Lateral (Lateromedial) - Wrist Central Ray-

Collimation Forearm
• CR perpendicular to IR, directed to mid-forearm
VII. Anatomy 1. AP - Forearm

Demonstrated • AP projection of the entire radius
and ulna is shown, with a minimum
of proximal row carpals and distal
humerus and pertinent soft tissues,
such as fat pads and stripes of the
wrist and elbow joints.
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• Lateral projection of entire radius
and ulna, proximal row of carpal
bones, elbow, and distal end of the
humerus are visible as well as
pertinent soft tissue, such as fat pads
and stripes of the wrist and elbow joints.
1. AP - Forearm
VIII. Evaluation Criteria • Long axis of forearm should be aligned with long
- Exposure axis of IR.
• No rotation is evidenced by humeral epicondyles
visualized in profile, with radial head, neck, and
tuberosity slightly superimposed by the ulna.
• Wrist and elbow joint spaces are only partially
open because of beam divergence.
approximate midpoint of the radius and ulna
• Long axis of forearm should be aligned with long
axis of IR.
• Elbow should be flexed 90°.
• No rotation as evidenced by head of ulna being
superimposed over the radius, and humeral
epicondyles should be superimposed. • Radial
head should superimpose coronoid process, with
radial tuberosity demonstrated.
• CR and center of collimation field should be to
midpoint of the radius and ulna.
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UPPER EXTREMITY (ELBOW)
PROCEDURE: ELBOW ROUTINE
ROUTINE POSITIONS: ELBOW AP PROJECTION, ELBOW LATERAL
I. Clinical Indication: • Fractures and dislocations of the elbow •

Pathologic processes, such as osteomyelitis and
arthritis.
× 30 cm (10 × 12 inches), crosswise (two
exposures) or lengthwise (single exposure) •
Nongrid • Detail screens for analog imaging •
Analog—60 to 70 kV range • Digital systems—70 to
75 kV range
interest.
IV. Patient Position 1. AP - Elbow
Seat patient at end of table, with elbow fully
extended, if possible
2. Lateral (Lateromedial) - Elbow
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Seat patient at end of table, with elbow flexed 90°.
V. Part Position 1. AP - Elbow

• Extend elbow, supinate hand, and align arm and
forearm with long axis of IR.
• Center elbow joint to center of IR.
• Ask patient to lean laterally as necessary for true
AP projection. (Palpate humeral epicondyles to
ensure that they are parallel to IR.) • Support hand
as needed to prevent motion.

• Align long axis of forearm with long axis of IR.
• Center elbow joint to CR and to center of IR.
• Drop shoulder so that humerus and forearm are on
same horizontal plane.
• Rotate hand and wrist into true lateral position,
thumb side up.
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• Place support under hand and wrist to elevate hand

and distal forearm as needed for heavy muscular
forearm so that forearm is parallel to IR for true
lateral elbow.
VI. Central Ray & 1. AP Central Ray- Elbow

Collimation • CR perpendicular to IR, directed to mid-elbow
joint, which is approximately 2 cm (3 4 inch) distal
to midpoint of a line between epicondyles.
2. Lateral (Lateromedial) - Elbow Central Ray-

Elbow
• Align long axis of forearm with long axis of IR.
• Center elbow joint to CR and to center of IR.
• Drop shoulder so that humerus and forearm are
on same horizontal plane.
• Rotate hand and wrist into true lateral position,
thumb side up.
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• Place support under hand and wrist to elevate

hand and distal forearm as needed for heavy
muscular forearm so that forearm is parallel to IR
for true lateral elbow.
VII. Anatomy 1. AP - Elbow

Demonstrated • Distal humerus, elbow
joint space, and proximal
radius and ulna are visible.
3. Lateral (Lateromedial) – Elbow

• Lateral projection of distal
humerus and proximal forearm,
olecranon process, and soft
tissues and fat pads of the elbow
joint are visible.
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VIII. Evaluation Criteria 1. AP - Elbow

- Exposure • Long axis of arm should be aligned with long axis
of IR.
• No rotation is evidenced by the appearance of
bilateral epicondyles seen in profile and radial
head, neck, and tubercles separated or only slightly
superimposed by ulna.
• Olecranon process should be seated in the
olecranon fossa with fully extended arm
• Elbow joint space appears open with fully
extended arm and proper CR centering.
midelbow joint.

• Long axis of the forearm should be aligned with
long axis of IR, with the elbow joint flexed 90°.
• About one-half of radial head should be
superimposed by the coronoid process, and
olecranon process should be visualized in profile.
• True lateral view is indicated by three concentric
arcs of the trochlear sulcus, double ridges of the
capitulum and trochlea, and the trochlear notch of
the ulna. In addition, superimposition of the
humeral epicondyles occurs.
• CR and center of collimation field should be
midpoint of the elbow joint.
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UPPER EXTREMITY (HUMERUS)
DATE PERFORMED: OCTOBER 1, 2021
PROCEDURE: HUMERUS ROUTINE
ROUTINE POSITIONS: HUMERUS AP PROJECTION, HUMERUS LATERAL
I. Clinical Indication: • Fracture and dislocation of the humerus •

Pathologic processes including osteoporosis
II. Technical Factors: • Minimum SID—40 inches (102 cm) • IR size—
lengthwise (large enough to include entire
humerus) • For larger patient, 35 × 43 cm (14 × 17
inches) may be needed to place cassette
diagonally to include both joints • For smaller
patient, 30 × 35 cm (11 × 14 inches) • Grid
(nongrid, detail screen for smaller patient) •
Analog—70 ± 6 kV range • Digital systems—75 to
85 kV range
interest.
IV. Patient Position 1. AP - Humerus

Position patient erect or supine. Adjust the height of
the cassette so that shoulder and elbow joints are
equidistant from ends of IR.
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2. Lateral (Lateromedial) - Humerus

Position patient erect with back to IR and elbow
partially flexed, with body rotated toward affected
side as needed to bring humerus and shoulder in
contact with cassette. Internally rotate arm as
needed for lateral position; epicondyles are
perpendicular to IR.
V. Part Position 1. AP - Humerus
Rotate body toward affected side as needed to bring

shoulder and proximal humerus in contact with
cassette.
• Align humerus with long axis of IR, unless diagonal

placement is needed to include both shoulder and
elbow joints.
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• Extend hand and forearm as far as patient can

tolerate.
• Abduct arm slightly and gently supinate hand so

that epicondyles of elbow are parallel and
equidistant from IR.
Position patient erect with back to IR and elbow

partially flexed, with body rotated toward affected
side as needed to bring humerus and shoulder in
contact with cassette. Internally rotate arm as
needed for lateral position; epicondyles are
perpendicular to IR.
VI. Central Ray & 1. AP Central Ray- Humerus

Collimation
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• CR perpendicular to IR, directed to midpoint of

humerus.
2. Lateral (Lateromedial) -
Humerus Central Ray-
Humerus
• CR perpendicular to IR,
directed to midpoint of
humerus
VII. Anatomy 1. AP - Humerus

Demonstrated • AP projection shows the entire humerus, including
the shoulder and elbow joints.
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• Lateral projection of the entire humerus, including

elbow and shoulder joints, is visible.
VIII. Evaluation Criteria 1. AP - Humerus

- Exposure
• Long axis of humerus should be aligned with long
axis of IR.
• True AP projection is evidenced at proximal

humerus by the following: greater tubercle is seen
in profile laterally; humeral head is partially seen in
profile medially, with minimal superimposition of the
glenoid cavity.
• Distal humerus: lateral and medial epicondyles

both are visualized in profile.
• Collimation to area of interest.
• True lateral projection is evidenced by the

following: epicondyles are directly superimposed;
lesser tubercle is shown in profile medially, partially
superimposed by lower portion of glenoid cavity.
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SHOULDER GIRDLE (SHOULDER JOINT)
PROCEDURE: SHOULDER ROUTINE ROUTINE
POSITIONS: AP PROJECTION: EXTERNAL ROTATION, INTERNAL
ROTATION, NEUTRAL ROTATION, POSTERIOR OBLIQUE: GRASHEY
METHOD
I. Clinical • Fractures or dislocations of proximal humerus and

Indication: shoulder girdle • Calcium deposits in muscles, tendons,
or bursal structures • Degenerative conditions including
osteoporosis and osteoarthritis
II. Technical • Minimum SID—40 inches (102 cm) • IR size—24 × 30
Factors: cm (10 × 12 inches), crosswise (or lengthwise to show
more of humerus if injury includes proximal half of
humerus) • Grid • Analog—70 to 75 kV range • Digital
systems—75 to 85 kV range
interest.
IV. Patient 1. AP PROJECTION: EXTERNAL ROTATION
Position Perform radiograph with the patient in an erect or
supine position. (The erect position is usually less
painful for patient, if condition allows.) Rotate body
slightly toward affected side if necessary to place
shoulder in contact with IR or tabletop.
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2. AP PROJECTION: INTERNAL ROTATION

Perform radiograph with the patient in an erect or
supine position. (The erect position is usually less
painful for patient, if condition allows.) Rotate body
slightly toward affected side if necessary to place
shoulder in contact with IR or tabletop.
3.. AP PROJECTION: NEUTRAL ROTATION

•Perform radiograph with patient in erect or supine
position. (The erect position is usually less painful for
patient if
condition allows.) Rotate body slightly toward affected
side if neces sary to place shoulder in contact with IR or
tabletop
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V. Part 1. AP PROJECTION: EXTERNAL ROTATION

Position • • Position patient to center scapulohumeral joint
to IR.
• • Place patient’s arm at side in “as is” neutral
rotation. (Epicondyles generally are
approximately 45° to plane of IR.)

• Position patient to center scapulohumeral joint to
center of IR.
• Abduct extended arm slightly; internally rotate arm
(pronate hand) until epicondyles of distal humerus are
perpendicular
to IR.
3.. AP PROJECTION: NEUTRAL ROTATION

• Position patient to center scapulohumeral joint to IR.
• Place patient’s arm at side in “as is” neutral rotation.
(Epicon dyles generally are approximately 45° to plane
of IR.)
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VI. Central 1. AP PROJECTION: EXTERNAL ROTATION

Ray & • CR perpendicular to IR, directed to 1 inch (2.5
Collimation cm) inferior to coracoid process

• CR perpendicular to IR, directed to 1 inch (2.5
cm) inferior to coracoid process
3. AP PROJECTION: NEUTRAL ROTATION

• CR perpendicular to IR, directed to
midscapulohumeral joint, which is approximately
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3/4 inch (2 cm) inferior and slightly lateral to

coracoid process
VII. Anatomy 1. AP PROJECTION: EXTERNAL ROTATION

Demonstrated • AP projection of proximal humerus and lateral two-
thirds of clavicle and upper scapula, including
relationship of the humeral head to the glenoid
cavity.

• Lateral view of proximal half of the humerus and
scapulohumeral joint should be visualized through the
thorax without superimposition of the opposite shoulder
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3. AP
PROJECTION: NEUTRAL ROTATION
• The proximal one-third of the
humerus and upper scapula and the lateral two-thirds
of the clavicle are shown, including the relationship of
the humeral head to the glenoid cavity
VIII. 1. AP PROJECTION: EXTERNAL ROTATION

Evaluation • Full external rotation is evidenced by greater tubercle
Criteria - visualized in full profile on the lateral aspect of the
Exposure proximal humerus. • Lesser tubercle is superimposed
over humeral head. • Collimation to area of interest.
• Full internal rotation position is evidenced by lesser
tubercle visualized in full profile on the medial aspect of
the humeral head. • An outline of the greater tubercle
should be visualized superimposed over the humeral
head. • Collimation to area of interest. Exposure: •
Optimal density (brightness)
3. AP PROJECTION: NEUTRAL ROTATION
• With neutral rotation, both the greater and the lesser
tubercles most often are superimposed by the humeral
head. • Collimation to area of interest.
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SHOULDER GIRDLE (SCAPULA)
PROCEDURE: SCAPULA ROUTINE ROUTINE
POSITIONS: AP PROJECTION, LATERAL PROJECTION
I. Clinical Indication: • Fractures and other pathology of scapula •

Horizontal fractures of the scapula; arm placement
should be determined by scapular area of interest
30 cm (10 × 12 inches), lengthwise • Grid • Analog—
75 ± 5 kV range • Digital systems—75 to 85 kV range
• Minimum of 3 seconds exposure time with optional
breathing technique (3 to 4 seconds is desirable) •
Manual exposure factors (AEC is not recommended)
interest.
IV. Patient Position 1. AP - Scapula
•Perform radiograph with patient in erect or supine
position. (The erect position may be more
comfortable for the
patient.) Posterior surface of shoulder is in direct
contact with
tabletop or IR without rotation of thorax. (Rotation
toward affected side would place the scapula into a
truer posterior position, but this also would result in
greater superimposition of the rib cage.)
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2. Lateral - Scapula
•Perform radiograph with patient in erect or
recumbent position. (The erect position is preferred if
patient’s condition allows.) Face patient toward IR in
anterior oblique position.
V. Part Position 1. AP - Scapula

• Position patient so that midscapula area is centered
to CR. • Adjust cassette to center to CR. Top of IR
should be about 2 inches (5 cm) above shoulder, and
lateral border of IR should be about 2 inches (5 cm)
from lateral margin of rib cage. • Gently abduct arm
90°, and supinate hand. (Abduction moves scapula
laterally to clear more of the thoracic structures.)
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• Have patient reach across front of chest and grasp

opposite shoulder. This best demonstrates body of
scapula (Figs. 5-90 and 5-91). or
• Have patient drop affected arm, flex elbow, and
place arm behind lower back with arm partially
abducted, or just let arm hang down at patient’s side.
• Palpate superior angle of the scapula and AC joint
articulation. Rotate the patient until an imaginary line
between the two points is perpendicular to IR; this
results in a lateral position of the body of the scapula.
VI. Central Ray & 1. AP - Scapula

Collimation •CR perpendicular to midscapula, 2 inches (5 cm)
inferior to coracoid process, or to level of axilla, and
approximately 2 inches (5 cm) medial from lateral
border of patient.
• CR to midvertebral border of scapula
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VII. Anatomy 1. AP - Scapula

Demonstrated • Entire scapula should be visualized in
a lateral position, as evidenced by
direct superimposition of vertebral and
lateral borders
• Entire scapula should be
visualized in a lateral position.
VIII. Evaluation Criteria 1. AP - Scapula
- Exposure • True lateral is shown by direct superimposition of
vertebral and lateral borders. • Body of scapula
should be in profile, free of superimposition by ribs. •
As much as possible, the humerus should not
superimpose area of interest of the scapula. •
Collimation to area of interest.
• True lateral is shown by direct superimposition of
vertebral and lateral borders. • Body of scapula
should be seen in profile, free of superimposition by
ribs. • As much as possible, the humerus should not
superimpose area of interest of the scapula. •
Collimation to area of interest.
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SHOULDER GIRDLE (CLAVICLE)
PROCEDURE: CLAVICLE ROUTINE ROUTINE
POSITIONS: AP PROJECTION, AP AXIAL PROJECTION
I. Clinical Indication: • Fractures or dislocations of clavicle • Departmental

routines commonly include both AP and AP axial
projections
30 cm (10 × 12 inches), crosswise • Grid • Analog—
70 ± 5 kV range • Digital systems—75 to 85 kV range
• AEC not recommended
interest.
IV. Patient Position 1. AP - Clavicle

Perform radiograph with patient in erect or supine
position with arms at sides, chin raised, and looking
straight ahead. Posterior shoulder should be in
contact with IR or tabletop, without rotation of body
2. AP Axial - Clavicle
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Perform radiograph with patient in erect or supine

position with arms at sides, chin raised, and looking
straight ahead. Posterior shoulder should be in
contact with IR or tabletop, without rotation of body
V. Part Position 1. AP - Clavicle

• Center clavicle and IR to CR. (Clavicle can be
readily palpated with medial aspect at jugular notch
and lateral portion at AC joint above shoulder.)
2. AP Axial – ClaviclE
• Center clavicle and IR to CR. (Clavicle can be
readily palpated with medial aspect at jugular notch
and lateral portion at AC joint above shoulder.)
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VI. Central Ray & 1. AP - Clavicle

Collimation • CR perpendicular to midclavicle
• CR 15° to 30° cephalad to midclavicle
VII. Anatomy 1. AP - Clavicle• Entire clavicle visualized, including

Demonstrated both AC and sternoclavicular joints and acromion
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• Entire clavicle visualized, including both AC and
sternoclavicular joints and acromion
VIII. Evaluation Criteria 1. AP - Clavicle

- Exposure • Clavicle is demonstrated withoutany foreshortening.
• The midclavicle is superimposed on the superior
scapular angle.
• Collimation borders should be visible
2. AP Axial- Clavicle
• Correct angulation of CR projects most of the
clavicle above the scapula and second and third ribs.
• Only the medial portion of the clavicle is
superimposed by the first and second ribs
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PELVIC GIRDLE (HIP JOINT)
PROCEDURE: HIP ROUTINE
ROUTINE POSITIONS: AP UNILATERAL
I. Clinical Indication: Postoperative or follow-up examination to

demonstrate the acetabulum, femoral head, neck,
and greater trochanter; Evaluate condition and
placement of any existing orthopedic appliance
II. Technical Factors: AP - Minimum SID—40 inches (102 cm)
AP - IR size—10 × 12 inches, lengthwise
AP - Grid
AP - 80 to 85 kV range
III. Shielding AP - Shield radiosensitive tissues outside region of

interest.
IV. Patient Position 1. AP Unilateral Patient Position – HIP

With patient supine, place arms at sides or across
superior chest
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V. Part Position 1. AP Unilateral Part Position – HIP

• Locate femoral neck and align to CR and to midline
of table and/or IR.
• Ensure no rotation of pelvis (equal distance from
ASISs to table).
• Rotate affected leg internally 15° to 20°
VI. Central Ray & 1. AP Unilateral Central Ray –HIP

Collimation • CR is perpendicular to IR, directed to 1 to 2 inches
(2.5 to 5 cm) distal to midfemoral neck (to include all
of orthopedic appliance of hip, if present). Femoral
neck can be located about 1 to 2 inches (3 to 5 cm)
medial and 3 to 4 inches (8 to 10 cm) distal to ASIS
1. AP Unilateral Anatomy Demonstrated – HIP

• The proximal one-third of the femur should be
VII. Anatomy
visualized, along with the acetabulum and adjacent
Demonstrated
parts of the pubis, ischium, and ilium.
• Any existing orthopedic appliance should be visible
in its entirety
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VIII. Evaluation Criteria 1. AP Unilateral Evaluation Criteria – HIP

- Exposure • Optimal exposure visualizes the margins of the
femoral head and the acetabulum through overlying
pelvic structures without overexposing other parts of
the proximal femur or pelvic structures.
• Trabecular markings of the greater trochanter and
neck area appear sharp, indicating no motion
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PELVIC GIRDLE (PELVIS)
DATE PERFORMED: NOVEMBER 29, 2021
PROCEDURE: PELVIS
ROUTINE POSITIONS: AP (Bilateral Hips)
I. Clinical Indication: Fractures, joint dislocations, degenerative disease,

and bone lesions
II. Technical Factors: AP– 40 inches SID; 14 X 17 inches IR, Crosswise,
Grid is use
III. Shielding AP – Shield gonads on all male patients. Ovarian
shielding on
females, however, generally is not possible without
obscuring
essential pelvis anatomy (unless interest is in area
of hips only).
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IV. Patient Position 1. AP Projection: Pelvis

• With patient supine, place arms at sides or
across superior chest; provide pillow for head
and support for under knees; may be
performed erec position and no fracture is
suspected.
V. Part Position 1. AP Projection: Pelvis

• Align midsagittal plane of patient to centerline
of table and to CR.
• Ensure that pelvis is not rotated; distance
from tabletop to each ASIS should be equal.
• Separate legs and feet, then internally rotate
long axes of feet and lower limbs 15° to 20°
(see warning earlier). Technologist may have
to place sandbag between heels and tape
top of feet together or use additional
sandbags against feet to retain this position
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VI. Central Ray & 1. AP Projection: Pelvis

Collimation • CR is perpendicular to IR, directed midway
between level of ASIS and the symphysis
pubis. This is approximately 2 inches (5 cm)
inferior to level of ASIS
• Collimate on four sides to anatomy of interest
VII. Anatomy 1. AP Projection: Pelvis

Demonstrated • Pelvic girdle, L5,
sacrum and coccyx,
femoral heads and
neck, and greater
trochanters are visible.
•
VIII. Evaluation Criteria 1. AP Projection: Pelvis
- Exposure • Optimal exposure visualizes L5 and sacrum
area and margins of the femoral heads and
acetabula, as seen through overlying pelvic
structures, without overexposing the ischium
and pubic bones.
• Trabecular markings of proximal femora and
pelvic structures appear sharp, indicating no
motion
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LOWER EXTREMITY (FOOT)

PROCEDURE: FOOT ROUTINE
ROUTINE POSITIONS: AP PROJECTION, AP OBLIQUE PROJECTION: MEDIAL
ROTATION, LATERAL: MEDIOLATERAL ROTATION
I. Clinical Indication: Location and extent of fractures and fragment

alignments, joint space abnormalities, soft tissue
effusions; Location of opaque foreign bodies
II. Technical Factors: AP, AP Oblique, LATERAL - Minimum SID—40 inches
AP, AP Oblique - IR size—10 × 12 inches, lengthwise
LATERAL - IR size—8 × 10 inches, for smaller foot, or
10 × 12 inches, for larger foot, lengthwise
AP, AP Oblique, LATERAL - Nongrid
AP, AP Oblique, LATERAL - 60 to 70 kV range
III. Shielding AP, AP Oblique, LATERAL - Shield all radiosensitive
tissues outside region of interest.
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IV. Patient Position 1. AP Patient Position – FOOT

Place patient supine; provide a pillow for patient’s
head; flex knee and place plantar surface (sole) of
affected foot flat on IR
2. AP Oblique Patient Position – FOOT

Place patient supine or sitting; flex knee, with plantar
surface of foot on table; turn body slightly away from
side in question.
3. Lateral Patient Position – FOOT

Place patient in lateral recumbent position; provide
pillow for patient’s head.
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V. Part Position 1. AP Part Position – FOOT

• Extend (plantar flex) foot but maintain plantar surface
resting flat and firmly on IR.
• Align and center long axis of foot to CR and to long
axis of portion of IR being exposed. (Use sandbags if
necessary to prevent IR from slipping on tabletop.)
• If immobilization is needed, flex opposite knee also
and rest against affected knee for support.
2. AP Oblique Part Position – FOOT

• Align and center long axis of foot to CR and to long
axis of portion of IR being exposed.
• Rotate foot medially to place plantar surface 30° to
40° to plane of IR. The general plane of the dorsum of
the foot should be parallel to IR and perpendicular to
CR.
• Use 45° radiolucent support block to prevent motion.
Use sandbags if necessary to prevent IR from slipping
on tabletop.
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3. Lateral Part Position – FOOT

• Flex knee of affected limb about 45°; place opposite
leg behind the injured limb to prevent over-rotation of
affected leg.
• Carefully dorsiflex foot if possible to assist in
positioning for a true lateral foot and ankle.
• Place support under leg and knee as needed so that
plantar surface is perpendicular to IR. Do not over-
rotate foot.
• Align long axis of foot to long axis of IR (unless
diagonal placement is needed to include entire foot).
• Center mid area of base of metatarsals to CR
VI. Central Ray & 1. AP Central Ray – FOOT

Collimation • Angle CR 10° posteriorly (toward heel) with CR
perpendicular to metatarsals.
• Direct CR to base of third metatarsal.
2. AP Oblique Central Ray – FOOT

• CR perpendicular to IR, directed to base of third
metatarsal
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3. Lateral Central Ray – FOOT

• CR perpendicular to IR, directed to medial cuneiform
(at level of base of third metatarsal)
1. AP Anatomy Demonstrated – FOOT

VII. Anatomy
• Entire foot should be demonstrated, including all
Demonstrated
phalanges and metatarsals and navicular, cuneiforms,
and cuboids.
2. AP Oblique Anatomy Demonstrated – FOOT

• Entire foot should be demonstrated from distal
phalanges to posterior calcaneus and proximal talus.
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3. Lateral Anatomy Demonstrated – FOOT

• Entire foot should be demonstrated, with a minimum
of 1 inch (2.5 cm) of distal tibia-fibula.
• Metatarsals are nearly superimposed with only the
tubesity of the fifth metatarsal seen in profile.
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LOWER EXTREMITY (ANKLE)
PROCEDURE: ANKLE ROUTINE
ROUTINE POSITIONS: AP PROJECTION, LATERAL: MEDIOLATERAL
PROJECTION
I. Clinical Indication: Bony lesions or diseases involving the ankle joint,

distal tibia and fibula, proximal talus, and proximal
fifth metatarsal; Projection is useful in the evaluation
of fractures, dislocations, and joint effusions
associated with other joint pathologies
II. Technical Factors: AP, LATERAL - Minimum SID—40 inches
AP, LATERAL - IR size—10 × 12 inches, lengthwise
AP, LATERAL - Nongrid
AP, LATERAL - 60 to 70 kV range
III. Shielding AP, LATERAL - Shield all radiosensitive tissues
outside region of interest.
IV. Patient Position 1. AP Patient Position – ANKLE

Place patient in the supine position; place pillow
under patient’s head; legs should be fully extended
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2. Lateral Patient Position – ANKLE

Place patient in the lateral recumbent position,
affected side down; provide a pillow for patient’s
head; flex knee of affected limb about 45°; place
opposite leg behind injured limb to prevent over-
rotation.
V. Part Position 1. AP Part Position – ANKLE

• Center and align ankle joint to CR and to long axis
of portion of IR being exposed.
• Do not force dorsiflexion of the foot; allow it to
remain in its natural position
• Adjust the foot and ankle for a true AP projection.
Ensure that the entire lower leg is not rotated. The
intermalleolar line should not be parallel to IR
2. Lateral Part Position – ANKLE

• Center and align ankle joint to CR and to long axis
of portion of IR being exposed.
• Place support under knee as needed to place leg
and foot in true lateral position.
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• Dorsiflex foot so that plantar surface is at a right

angle to leg or as far as patient can tolerate; do not
force. (This helps maintain a true lateral position.)
VI. Central Ray & 1. AP Central Ray – ANKLE

Collimation • CR perpendicular to IR, directed to a point midway
between malleoli
2. Lateral Central Ray – ANKLE

• CR perpendicular to IR, directed to medial
malleolus
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VII. Anatomy 1. AP Anatomy Demonstrated – ANKLE

Demonstrated • Distal one-third of tibia-fibula, lateral and medial
malleoli, and talus and proximal half of metatarsals
should be demonstrated.
2. Lateral Anatomy Demonstrated – ANKLE

• Distal one-third of tibia and fibula with the distal
fibula superimposed by the distal tibia, talus, and
calcaneus appear in lateral profile.
• Tuberosity of fifth metatarsal, navicular, and cuboid
also are visualized.
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VIII. Evaluation Criteria 1. AP Evaluation Criteria – ANKLE

- Exposure • Optimal exposure with no motion demonstrates
clear bony margins and trabecular markings.
• Talus must be penetrated enough to demonstrate
the cortical margins and trabeculae of the bone.
• Soft tissue structures also must be visible.
2. Lateral Evaluation Criteria – ANKLE
• No motion, as evidenced by sharp bony margins
and trabecular patterns.
• Lateral malleolus should be seen through the distal
tibia and talus, and soft tissue must be demonstrated
for evaluation of joint effusion
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LOWER EXTREMITY (LEG)
PROCEDURE: LEG ROUTINE
PROJECTION
I. Clinical Indication: Pathologies involving fractures, foreign bodies, or

lesions of the bone; Localization of lesions and
foreign bodies and determination of extent;
Alignment of fractures demonstrated
II. Technical Factors: AP, LATERAL - Minimum SID—40 inches (102 cm);
may increase to 44 to 48 inches (112 to 123 cm) to
reduce divergence of x-ray beam and to include
more of body part
(or diagonal, which requires 44 inches [112 cm]
minimum SID)
AP, LATERAL - Nongrid (unless lower leg measures
>10 cm)
III. Shielding AP, LATERAL - Shield all radiosensitive tissues
IV. Patient Position 1. AP Patient Position – LEG

Place patient in the supine position; provide a pillow
for patient’s head; leg should be fully extended.
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2. Lateral Patient Position – LEG

Place patient in the lateral recumbent position,
injured side down; the opposite leg may be placed
behind the affected leg and supported with a pillow
or sandbags.
V. Part Position 1. AP Part Position – LEG

• Adjust pelvis, knee, and leg into true AP with no
rotation.
• Place sandbag against foot if needed for
stabilization and dorsiflex foot to 90° to leg if
possible.
• Ensure that both ankle and knee joints are 1 to 2
inches (3 to 5 cm) from ends of IR (so that divergent
rays do not project either joint off IR).
• If limb is too long, place the leg diagonally (corner
to corner) on one 35 × 43 cm (14 × 17 inches) IR to
ensure that both joints are included. (Also, if needed,
a second smaller IR may be taken of the joint nearest
the injury site.)
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2. Lateral Part Position – LEG

• Ensure that leg is in true lateral position. (Plane of
patella should be perpendicular to IR.)
• Ensure that both ankle and knee joints are 1 to 2
inches (3 to 5 cm) from ends of IR so that divergent
rays do not project either joint off IR.
• If limb is too long, place the leg diagonally (corner
to corner) on one 35 × 43 cm (14 × 17 inches) IR to
ensure that both joints are included. (Also, if needed,
a second, smaller IR may be taken of the joint
nearest the injury site.)
VI. Central Ray & 1. AP Central Ray – LEG

Collimation • CR perpendicular to IR, directed to midpoint of leg
2. Lateral Central Ray – LEG

• CR perpendicular to IR, directed to midpoint of leg
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VII. Anatomy 1. AP Anatomy Demonstrated – LEG

Demonstrated • Entire tibia and fibula must include ankle and knee
joints on this projection (or two if needed).
• The exception is alternative routine on follow-up
examinations
2. Lateral Anatomy Demonstrated – LEG

• Entire tibia and fibula must include ankle and knee
joints on this projection (or two if needed).
• Exception is alternative routine on follow-up
examinations
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VIII. Evaluation Criteria 1. AP Evaluation Criteria – LEG

- Exposure • Correct use of anode heel effect results in an image
with nearer equal density at both ends of IR.
• No motion is present, as evidenced by sharp
cortical margins and trabecular patterns.
• Contrast and density (brightness) should be
optimum to visualize soft tissue and bony trabecular
markings at both ends of tibia.
2. Lateral Evaluation Criteria – LEG

• No motion is present, as evidenced by sharp
cortical margins and trabecular patterns.
• Correct use of the anode heel effect results in near-
equal density at both ends of the image.
• Contrast and density (brightness) should be
optimum to visualize soft tissue and bony trabecular
markings.
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LOWER EXTREMITY (KNEE)

PROCEDURE: KNEE ROUTINE
PROJECTION
I. Clinical Indication: Fractures, lesions, or bony changes related to

degenerative joint disease involving the distal femur,
proximal tibia and fibula, patella, and knee joint
II. Technical Factors: AP, LATERAL - Minimum SID—40 inches (102 cm)
AP - IR size—10 × 12 inches, lengthwise
LATERAL - IR size—8 × 10 inches or 10 × 12
inches, lengthwise
AP, LATERAL - Grid or Bucky, >10 cm (70 ± 5 kV);
Nongrid, tabletop, <10 cm (65 ± 5 kV)
III. Shielding AP, LATERAL - Shield all radiosensitive tissues o
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IV. Patient Position 1. AP Patient Position – KNEE

Place patient in supine position with no rotation of
pelvis; provide pillow for patient’s head; leg should
be fully extended.
utside region of interest.
2. Lateral Patient Position – KNEE

This position may be taken as a horizontal beam
lateral or in the lateral recumbent position.
Lateral recumbent projection This projection is

designed for patients who are able to flex the knee
20° to 30°. Take radiograph with patient in lateral
recumbent position, affected side down; provide
pillow for patient’s head; provide support for knee of
opposite limb placed behind knee being examined
to prevent over-rotation
Horizontal beam projection This lateromedial
beam projection is ideal for a patient who is unable
to flex the knee because of pain or trauma. Use a
horizontal beam with IR placed beside knee. Place
support under knee to avoid obscuring posterior soft
tissue structures
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1. AP Part Position – KNEE

• Align and center leg and knee to CR and to midline
of table or IR. • Rotate leg internally 3° to 5° for true
AP knee (or until interepicondylar line is parallel to
plane of IR).
• Place sandbags by foot and ankle to stabilize if
needed.
2. Lateral Part Position –KNEE

• Adjust rotation of body and leg until knee is in true
lateral position (femoral epicondyles directly
superimposed and plane of patella perpendicular to
plane of IR).
• Flex knee 20° to 30° for lateral recumbent
projection
• Align and center leg and knee to CR and to midline
of table or IR
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VI. Central Ray & 1. AP Central Ray –KNEE

Collimation • Align CR parallel to articular facets (tibial plateau);
for average-size patient, CR is perpendicular to IR
• Direct CR to a point 1 2 inch (1.25 cm) distal to
apex of patella
2. Lateral Central Ray – KNEE

• Angle CR 5° to 7° cephalad for lateral recumbent
projection
• Direct CR to a point 1 inch (2.5 cm) distal to medial
epicondyle.
VII. Anatomy 1. AP Anatomy Demonstrated – KNEE

Demonstrated • Distal femur and proximal tibia and fibula are
shown.
• Femorotibial joint space should be open, with the
articular facets of the tibia seen on end with only
minimal surface area visualized
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2. Lateral Anatomy Demonstrated – KNEE

• Distal femur, proximal tibia and fibula, and patella
are shown in lateral profile.
• Femoropatellar and knee joints should be open
VIII. Evaluation Criteria - 1. AP Evaluation Criteria – KNEE

Exposure • Optimal exposure visualizes the outline of the
patella through the distal femur, and the fibular head
and neck do not appear overexposed.
• No motion should occur; trabecular markings of all
bones should be visible and appear sharp.
• Soft tissue detail should be visible
2. Lateral Evaluation Criteria – KNEE

• Optimal exposure with no motion visualizes
important soft tissue detail, including fat pad region
anterior to knee joint and sharp trabecular markings
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LOWER EXTREMITY (FEMUR)

PROCEDURE: FEMUR ROUTINE
PROJECTION
I. Clinical Indication: Mid- and distal femur, including knee joint for
detection and evaluation of fractures and/or bone
lesions.
II. Technical Factors: AP, LATERAL - Minimum SID—40 inches (102 cm)
AP, LATERAL - Grid
III. Shielding AP, LATERAL - Shield radiosensitive tissues outside
the region of interest. Ensure that shielding does not
obscure any aspect of the femur.
1. AP Patient Position – FEMUR

IV. Patient Position
Place patient in the supine position, with femur
centered to midline of table; give pillow for head.
(This projection also may be done on a stretcher with
a portable grid placed under the femur.)
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2. Lateral Patient Position – FEMUR

Place patient in the lateral recumbent position, or
supine for trauma patient.
V. Part Position 1. AP Part Position – FEMUR

• Align femur to CR and to midline of table or IR.
• Rotate leg internally about 5° for a true AP, as for
an AP knee. (For proximal femur, 15° to 20° internal
leg rotation is required, as for an AP hip.)
• Ensure that knee joint is included on IR, considering
the divergence of the x-ray beam. (Lower IR margin
should be approximately 2 inches [5 cm] below knee
joint
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2. Lateral Part Position –FEMUR

Lateral Recumbent
WARNING: Do not attempt this position if patient has
severe trauma.
• Flex knee approximately 45° with patient on
affected side, and align femur to midline of table or
IR.
• Place unaffected leg behind affected leg to prevent
over-rotation.
• Adjust IR to include knee joint (lower IR margin
should be approximately 2 inches [5 cm] below knee
joint). A second IR to include the proximal femur and
hip generally will be required on an adult
Trauma Lateromedial Projection

• Place support under affected leg and knee and
support foot and ankle in true AP position.
• Place IR on edge against medial aspect of thigh to
include knee, with horizontal x-ray beam directed
from lateral side
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VI. Central Ray & 1. AP Central Ray –FEMUR

Collimation • CR is perpendicular to femur and IR.
• Direct CR to midpoint of IR
2. Lateral Central Ray – FEMUR

• CR perpendicular to femur and IR directed to
midpoint of IR
1. AP Anatomy Demonstrated – FEMUR

VII. Anatomy • Distal two-thirds of distal femur, including knee
Demonstrated joint, is shown.
• Knee joint space will not appear fully open because
of divergent x-ray beam.
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2. Lateral Anatomy Demonstrated – FEMUR

• Distal two-thirds of distal femur, including the knee
joint, is shown.
• Knee joint will not appear open, and distal margins
of the femoral condyles will not be superimposed
because of divergent x-ray beam
VIII. Evaluation Criteria

1. AP Evaluation Criteria – FEMUR
- Exposure
• Optimal exposure with correct use of anode heel
effect or use of compensating filter will result in near
uniform density (brightness) of entire femur.
• No motion should occur; fine trabecular markings
should be clear and sharp throughout length of
femur.
2. Lateral Evaluation Criteria – FEMUR

• Optimal exposure with correct use of anode heel
effect or use of compensating filter will result in near-
uniform density (brightness) of entire femur.
• No motion is present; fine trabecular markings
should be clear and sharp throughout length of femur
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VERTEBRAL COLUMN (CERVICAL)

DATE PERFORMED:
PROCEDURE: CERVICAL SPINE
ROUTINE POSITIONS: AP OPEN MOUTH, AP AXIAL, OBLIQUE, LATERAL
I. Clinical Indication: AP Open Mouth

• Pathology (particularly fractures) involving C1
and C2 and adjacent soft tissue structures
• Demonstrates odontoid and Jefferson fractures
AP Axial Projection
• Pathology involving the mid and lower cervical
spine (C3 to C7).
• Demonstrates clay shoveler’s fracture,
compression fractures, and herniated nucleus
pulposus (HNP).
Anterior and Posterior Oblique Positions
• Pathology involving the cervical spine and
adjacent soft tissue structures, including stenosis
involving the intervertebral foramen.
Lateral
• Pathology involving the cervical spine and
adjacent soft tissue structures, including
spondylosis and osteoarthritis
II. Technical Factors: AP Open Mouth and AP Axial
• SID – 40 inches
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• IR size—18 × 24 cm (8 × 10 inches), lengthwise

• Grid
Anterior and Posterior Oblique Positions
• SID – 40 -72 inches
• IR size—18 × 24 cm (8 × 10 inches) or 24 × 30
cm (10 × 12 inches), lengthwise
• Grid (optional because of air gap) but required
when using higher kV ranges
Lateral
• SID – 60 -72 inches
• IR size—18 × 24 cm (8 × 10 inches) or 24 × 30
cm (10 × 12 inches), lengthwise
• Grid (optional because of air gap) but required
when using higher kV ranges
III. Shielding AP Open Mouth, AP Axial, Oblique, Lateral - Shield
radiosensitive tissues outside region of interest.
IV. Patient Position 1. AP Open Mouth Projection
Position patient in the supine or erect position with
arms by
sides. Place head on table surface, providing
immobilization if
needed.
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2. AP Axial Projection
Position patient in the supine or erect position, with
arms by sides.
3. Anterior and Posterior Oblique Positions

The erect position preferred (sitting or standing), but
recumbent
is possible if the patient’s condition requires.
4. Lateral Position
Position patient in the erect lateral position, either
sitting or standing, with shoulder against vertical IR.
V. Part Position 1. AP Open Mouth Projection
• Align midsagittal plane to central ray (CR) and
midline of table and/or IR.
• Adjust head so that, with mouth open, a line from
lower margin of upper incisors to the base of the
skull (mastoid tips) is perpendicular to table
and/or IR, or angle the CR accordingly.
• Ensure that no rotation of the head or thorax
exists.
• Ensure that mouth is wide open during exposure.
Do this as the last step and work quickly.
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• Align midsagittal plane to CR and midline of table
and/or IR.
• Adjust head so that a line from lower margin of
upper incisors to the base of the skull (mastoid
tips) is perpendicular to table and/or IR. Line
from tip of mandible to base of skull should be
parallel to angled CR.
• Ensure no rotation of the head or thorax exists.

• Align midsagittal plane to CR and midline of table
and/or IR.
• Place patient’s arms at side; if patient is
recumbent, place arms as needed to help
maintain position.
• Rotate body and head into 45° oblique position.
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• Protract chin to prevent mandible from

superimposing vertebrae.
4. Lateral Position
• Align midcoronal plane to CR and midline of
table and/or IR.
• Center IR to CR, which should place top of IR
about 1 to 2 inches the external auditory meatus
(EAM).
• Depress shoulders
• Ask patient to relax and drop shoulders down
and forward as far as possible.
• Protract chin (to prevent superimposition of the
mandible on upper vertebrae).
•
VI. Central Ray & 1. AP Open Mouth Projection
Collimation CR perpendicular to IR direct through center of open
mouth. Collimate on four sides to anatomy of
interest.
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Angle CR 15°to 20° cephalad direct to enter at the
level of the lower margin of thyroid cartilage to pass
through C4. Collimate on four sides to anatomy of
interest.

Anterior Oblique (RAO, LAO)
• Direct CR 15° caudad to C4 (level of upper margin
of thyroid cartilage).
Posterior Oblique (RPO, LPO)
• Direct CR 15° cephalad to C4.
• Center IR to CR.
Collimate on four sides to anatomy of interest.
4. Lateral Position
CR perpendicular to IR directing CR horizontally to
C4 (level of upper margin of thyroid cartilage).
Collimate on four sides to anatomy of interest.
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VII. Anatomy 1. AP Open Mouth Projection

Demonstrated
Dens (odontoid process) and vertebral body of C2,

lateral masses and transverse processes of C1, and
atlantoaxial joints demonstrated through the open
mouth.
C3 to T2 vertebral bodies; space between pedicles
and intervertebral disk spaces clearly seen.

Anterior: Oblique: intervertebral foramina and
pedicles on the side of the patient closest to the IR
Posterior: Oblique: intervertebral foramina and
pedicles on the side of the patient farthest from the
IR
4. Lateral
Position
Cervical vertebral bodies
intervertebral joint spaces,
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articular pillars, spinous processes, and

zygapophyseal joints.
VIII. Evaluation Criteria - 1. AP Open Mouth Projection

Exposure • Clear demonstration of soft tissue margins and
of bony margins and trabecular markings of
cervical vertebrae.
• No motion
• Clear demonstration of soft tissue margins and
cervical vertebrae.
• No motion
• Clear demonstration of soft tissue margins and
cervical vertebrae. No motion
4. Lateral Positions
• Clear demonstration of soft tissue margins,
including margins of the trachea, and of bony
margins and trabecular markings of cervical
vertebrae. No motion
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VERTEBRAL COLUMN (THORACIC SPINE)

PROCEDURE: THORACIC SPINE
ROUTINE POSITIONS: AP, LATERAL
I. Clinical Indication: Pathology involving thoracic spine, such as

compression fractures, subluxation, or kyphosis.
II. Technical Factors: AP and Lateral – 40 inches SID; 14 X 17 inches IR,
Lengthwise
III. Shielding AP and Lateral – Shield all radiosensitive tissues
outside region of interest
IV. Patient Position 2. AP Projection: Thoracic Spine
• Position patient supine (preferred) with arms at
side and head on table or on a thin pillow. If
patient is erect, arms at side and weight evenly
distributed on both feet.
3. Lateral Position: Thoracic Spine

• Position patient in the lateral recumbent
position (preferred), with head on pillow and
knees flexed. For the erect position, place
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arms outstretched, with weight evenly

distributed on both feet.
2. AP Projection: Thoracic Spine

V. Part Position • Align midsagittal plane to CR and midline of
table and/or IR. Flex knees and hips to reduce
thoracic curvature. Ensure that no rotation of
thorax or pelvis exists.

• Align posterior half of thorax to CR and midline
of table and/or IR. Raise patient’s arms to right
angles to body with elbows flexed. Support
waist so entire spine is near parallel to table.
Palpate spinous processes to determine
alignment. Flex knees and hips, ensure no
rotation on pelvis.
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VI. Central Ray & 2. AP Projection: Thoracic Spine

Collimation • CR perpendicular to IR. Direct CR to T7 (3 to
4 inches [8 to 10 cm] below jugular notch or 1
to 2 inches [3 to 5 cm] below sternal angle).
Centering is similar to that used with AP chest.
Center IR to CR.
• Collimate on two sides of anatomy (four sides
if possible).

• CR perpendicular to long axis of thoracic
spine. Direct CR to T7 (3 to 4 inches [8 to 10
cm] below jugular notch or 7 to 8 inches [18 to
21 cm] below the vertebra prominens). Center
IR to CR.
• Collimate on two sides of anatomy (four sides
if possible).
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VII. Anatomy 2. AP Projection: Thoracic

Demonstrated • Thoracic vertebral bodies, intervertebral joint
spaces, spinous and transverse processes,
posterior ribs, and costovertebral articulations.

• Thoracic vertebral bodies, intervertebral joint
spaces, and intervertebral foramina. T1 to T3
will not be well visualized. Obtain a lateral
image using a cervicothoracic (swimmer’s)
lateral if the upper thoracic vertebrae are of
special interest.
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VIII. Evaluation Criteria 2. AP Projection: Thoracic Spine

- Exposure • Clear demonstration of bony margins and
trabecular markings of thoracic vertebrae.
• No motion

• Clear demonstration of bony margins and
trabecular markings of thoracic vertebrae.
• No motion.
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VERTEBRAL COLUMN (LUMBAR SPINE)

PROCEDURE: LUMBAR SPINE
ROUTINE POSITIONS: AP (or PA), Oblique – anterior or posterior,
Lateral, Lateral L5 – S1
I. Clinical Indication: • Pathology of the lumbar vertebrae, including

fractures, scoliosis, and neoplastic processes
• Defects of the pars interarticularis (e.g.,
spondylolysis) Both right and left oblique
projections obtained.
• Spondylolisthesis involving L4-L5 or L5-S1
and other L5-S1 pathologies
II. Technical Factors: AP (or PA), Lateral,
• Minimum SID— 40 inches (102 cm)
• IR size— 14 X 17 inches portrait
• Grid
III. Shielding AP (or PA), Lateral, - Shield radiosensitive tissues
IV. Patient Position 1. AP (or PA)
• Position patient supine with arms at side and
head on pillow (also may be done in prone or
erect position
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2. Lateral
• Place patient in the lateral recumbent position,
with head on pillow, knees flexed, with support
between knees and ankles to better maintain
a true lateral position and ensure patient
comfort.
V. Part Position 1. AP (or PA)

• Align midsagittal plane to CR and midline of
table and/or grid
• Flex knees and hips to reduce lordotic
curvature.
• Ensure that no rotation of thorax or pelvis
exists.
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2. Lateral
• Align midcoronal plane to CR and midline of
table and/or IR
• Place radiolucent support under waist as
needed to place the long axis of the spine near
parallel to the table
• Ensure that no rotation of thorax or pelvis
exists.
VI. Central Ray & 1. AP (or PA)

Collimation • CR perpendicular to IR.
• Larger IR (35 × 43): Direct CR to level of iliac
crest (L4-5). This larger IR will include lumbar
vertebrae, sacrum, and possibly coccyx.
• Smaller IR (30 × 35): Direct CR to level of L3,
which may be localized by palpation of the
lower costal margin (1.5 inches [4 cm] above
iliac crest). This smaller IR will include
primarily the five lumbar vertebrae.
• Center IR to CR.14 X 17 inches, field of view
or collimate on four sides to anatomy of
interest.
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1. Lateral
• CR perpendicular to IR (see Notes).
• Larger IR (35 × 43): Center to level of iliac
crest (L4-5). This projection includes lumbar
vertebrae, sacrum, and possibly coccyx.
• Smaller IR (30 × 35): Center to L3 at the level
of the lower costal margin (1.5 inches [4 cm]
above iliac crest). This includes the five lumbar
vertebrae. Center IR to CR.
VII. Anatomy 1. AP (or PA)

Demonstrated • Outline of liver, spleen, kidneys, and air-filled
stomach and bowel segments and the arch of
the symphysis pubis for the urinary bladder
region.
2. Lateral
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• Intervertebral foramina L1-L4, vertebral

bodies, intervertebral joints, spinous
processes, and L5-S1 junction.
• Depending on the IR size
used, the entire sacrum
also may be included
VIII. Evaluation Criteria 1. AP (or PA)

- Exposure • No patient rotation indicated by SI joints
equidistant from spinous processes, spinous
processes in midline of vertebral column, and
transverse processes of equal length.
Exposure:
trabecular markings of lumbar vertebrae.
• No motion.
2. Lateral
• Spinal column aligned parallel to the IR, as
indicated by open intervertebral foramina and
open intervertebral joint spaces.
• No rotation is indicated by superimposed
greater sciatic notches and posterior vertebral
bodies.
trabecular markings of lumbar vertebrae. No
motion.
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THORACIC CAGE (THORACIC BONY CAGE)
DATE PERFORMED:
PROCEDURE: STERNUM
ROUTINE POSITIONS: RAO & LATERAL
I. Clinical RAO
Indication:
• When performed erect, RAO demonstrates
pathology of the sternum, including fractures and
inflammatory processes
LATERAL
• When performed erect, AP demonstrates

pathology of the sternum, including fractures and
inflammatory processes
• Depressed sternal fractures
II. Technical RAO & LATERAL

Factors: • Minimum SID— 40 inches (102 cm)
• IR size—24 × 30 cm (10 × 12 inches), or 30 × 35 cm
(11 × 14 inches), lengthwise
III. Shielding RAO & LATERAL
• Shield radiosensitive tissues outside region of
interest.
IV. Patient RAO PROJECTION Patient Position
Position
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• Erect (preferred) or semiprone position with slight

rotation, right arm down by side, and left arm up
LATERAL Patient Position

• Erect (preferred) or lateral recumbent
V. Part Position RAO Projection Part Position

• Position patient oblique, 15° to 20° toward the
right side, RAO
• Align long axis of sternum to CR and to midline
of table/upright Bucky.
• Place top of IR about 11 2 inches (4 cm) above
the jugular notch
LATERAL Part Position

Erect
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• Position patient standing or seated with

shoulders and arms drawn back.
Lateral Recumbent
• Position patient lying on side with arms up

above head and keeping shoulders back.
• Place top of IR 11 2 inches (4 cm) above the
jugular notch.
• Align long axis of sternum to CR and midline of
grid or table/upright Bucky.
• Ensure a true lateral, with no rotation.
VI. Central Ray & RAO Projection Central Ray

Collimation
• Central ray (CR) perpendicular to IR
• CR directed to center of sternum (1 inch [2.5 cm]
to left of midline and midway between the jugular
notch and xiphoid process)
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LATERAL Central Ray
CR is perpendicular to IR.
• CR is directed to center of sternum (midway between

the jugular notch and xiphoid process).
• SID of 60 to 72 inches (152 to 183 cm) is

recommended to reduce magnification of sternum
caused by increased object image receptor distance
(OID).
(If unable to obtain this SID and if a minimum of 40

inches [102 cm] is used, a larger IR of 30 × 35 cm [11 ×
14 inches] is recommended to compensate for the
magnification.)
Center IR to CR.
VII. Anatomy RAO Projection Anatomy Demonstrated

Demonstrated
• Sternum is visualized, superimposed on heart
shadow
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LATERAL Anatomy Demonstrated
Entire sternum with minimal overlap of soft tissues.
VIII. Evaluation RAO Projection

Criteria -
• Optimal contrast and density (brightness) demonstrate
Exposure
outline of sternum through overlying ribs, lung, and
heart.
• Bony margins appear sharp, but lung markings are

blurred if breathing technique was used.
• No motion (with suspended respiration)
LATERAL POSITION
• No superimposition of humeri, shoulders, or soft

tissue on sternum.
• Entire sternum with no superimposition of the ribs.
• Lower aspect of sternum not obscured by breasts of
female patient.
• Optimal contrast and density (brightness) to
visualize the entire sternum. • No motion, indicated
by sharp bony margin
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THORACIC CAGE (RIBS)
INTERN NAME: SABORNIDO, MARY KATHERINE V.
DATE PERFORMED:
PROCEDURE: RIBS
ROUTINE POSITIONS: PA & AP
I. Clinical AP
Indication:
pathology of the ribs, including fracture and
neoplastic processes
PA

pathology of the ribs, including fracture and
neoplastic processes. Injuries to ribs below the
diaphragm are generally to posterior ribs;
therefore, AP projections are indicated.
II. Technical AP & PA

Factors: • Minimum SID— 40 inches (102 cm)
• IR size—35 × 43 cm (14 × 17 inches), lengthwise
III. Shielding
AP & PA
• Shield radiosensitive tissues outside region of
interest.
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IV. Patient AP PROJECTION Patient Position

Position • Erect preferred or prone if necessary, with arms down
to the side
• Feet spread slightly, weight equally distributed on both
feet
• Chin raised
• Hands on lower hips, palms out, elbows partially
flexed
• Shoulders rotated forward against IR to allow scapulae
to move laterally clear of lung fields; shoulders
depressed downward to move clavicles below the
apices
PA Patient Position
• Patient erect, feet spread slightly, weight equally
distributed on both feet
• Chin raised, resting against IR
• Hands on lower hips, palms out, elbows partially
flexed
• Shoulders rotated forward
against IR to allow scapulae to
move laterally clear of lung fields;
shoulders depressed downward
to move clavicles below the
apices
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V. Part Position AP Projection Part Position

• Align midsagittal plane to CR and to midline of
• Rotate shoulders anteriorly to remove scapulae
from lung fields.
• Raise chin to prevent it from superimposing upper
ribs; look straight ahead.
• Allow no rotation of thorax or pelvis.
PA Part Position
• Align midsagittal plane to CR and to midline of
• Rotate shoulders anteriorly to remove scapulae
from lung fields.
• Allow no rotation of thorax or pelvis.
VI. Central Ray & AP Projection Central Ray

Collimation
CR perpendicular to IR, centered to 3 or 4 inches (8 to
10 cm) below jugular notch (level of T7)
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IR centered to level of CR (top of IR should be about 11

2 inches [4 cm] above shoulders)
PA Central Ray
CR perpendicular to IR, centered to T7 (7 to 8 inches [18

to 20 cm] below vertebra prominens as for PA chest. IR
centered to level of CR (top of IR 11 2 inches [4 cm]
above shoulders
VII. Anatomy AP Projection Anatomy Demonstrated

Demonstrated
Above diaphragm: Ribs 1 through 10 should be
visualized.
Below diaphragm: Ribs 9 through 12 should be visualized.
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PA Anatomy Demonstrate
Ribs 1 through 10 visualized above the diaphragm.
AP Projection
VIII. Evaluation
Criteria - • Rotation of the thorax should not be evident.
Exposure • Optimal contrast and density (brightness) to
visualize ribs through the lungs and heart shadow
or through the dense abdominal organs if below
the diaphragm.
• No motion, as demonstrated by sharp bony
markings
PA POSITION
• No rotation of the thorax.

• Optimal contrast and density (brightness) to visualize
ribs through the lungs and heart.
• No motion, as demonstrated by sharp bony markings
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THORACIC CONTENTS (CHEST RADIOGRAPHY)
PROCEDURE: CHEST
ROUTINE POSITIONS: PA & LATERAL
I. Clinical Indication: PA
➢ When performed erect, PA demonstrates pleural

effusions, pneumothorax, atelectasis, and signs of
infection.
LATERAL
➢ A 90° perspective from PA projection may

demonstrate pathology situated posterior to the
heart, great vessels, and sternum.
II. Technical Factors: PA & LATERAL

➢ Minimum SID—72 inches (183 cm)
➢ IR size—35 × 43 cm (14 × 17 inches), lengthwise
III. Shielding PA & LATERAL
➢ Shield radiosensitive tissues outside region of
interest.
IV. Patient Position PA PROJECTION Patient Position
➢ Patient erect, feet spread slightly, weight equally
distributed on both feet
➢ Chin raised, resting against IR
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➢ Hands on lower hips, palms out, elbows partially

flexed
➢ Shoulders rotated forward against IR to allow
scapulae to move laterally clear of lung fields;
shoulders depressed downward to move clavicles
below the apices
LATERAL Patient Position

➢ Patient erect, left side against IR unless patient
complaint involves right side (in that case, do a
right lateral if departmental protocol includes this
option)
➢ Weight evenly distributed on both feet
➢ Arms raised above head, chin up
PA Projection Part Position

V. Part Position
➢ Align midsagittal plane with CR and with midline of
IR with equal margins between lateral thorax and
sides of IR.
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V. Part Position ➢ Ensure no rotation of thorax by placing the

midcoronal plane parallel to the IR.
➢ Raise or lower CR and IR as needed to the level of
T7 for an average patient. (Top of IR is
approximately 11 2 to 2 inches [4 to 5 cm] above
shoulders on average patients.)
Lateral Part Position

➢ Center patient to CR and to IR anteriorly and
posteriorly. • Position in a true lateral position
(coronal plane is perpendicular and sagittal plane
is parallel to IR;
➢ Lower CR and IR slightly from PA if needed.
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VI. Central Ray & PA Projection Central Ray

Collimation
➢ CR perpendicular to IR and centered to midsagittal
plane at level of T7 (7 to 8 inches [18 to 20 cm]
below vertebra prominens, or to the inferior angle
of scapula)
➢ IR centered to CR
Lateral Central Ray
CR perpendicular, directed to midthorax at level of T7

(3 to 4 inches [7.5 to 10 cm] below level of jugular
notch.
VII. Anatomy PA Projection Anatomy Demonstrated

Demonstrated
➢ Included are both lungs from apices to
costophrenic angles and the air-filled trachea from
T1 down.
➢ Hilum region markings, heart, great vessels, and

bony thorax are demonstrated.
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Lateral Anatomy Demonstrated
➢ Included are the entire lungs from apices to the

costophrenic angles and from the sternum
anteriorly to the posterior ribs and thorax
posteriorly.
VIII. Evaluation PA Projection

Criteria - Exposure
➢ No motion evident by sharp outlines of rib margins,
diaphragm, and heart borders as well as sharp
lung markings in hilar region and throughout lungs.
➢ Sufficient long-scale contrast for visualization of

fine vascular markings within lungs
➢ Faint outlines of at least midthoracic and upper

thoracic vertebrae and posterior ribs visible
through heart and mediastinal structures
Lateral
➢ No motion evident by sharp outlines of the

diaphragm and lung markings • Should have
sufficient exposure and long-scale contrast for
visualization of rib outlines and lung markings
through the heart shadow and upper lung areas
without overexposing other regions of the lungs
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SKULL (SKULL SERIES)
INTERN NAME: SABORNIDO, MARY KATHERINE V

PROCEDURE: SKULL SERIES
ROUTINE POSITIONS: AP Axial ( Towne Method), LATERAL, PA 15 DEG
(CALDWELL METHOD) or PA AXIAL PROJECYTION 25 DEG to 30 DEG,
PA PROJECTION (0DEG)
I. Clinical Indication:
AP Axial ( Towne Method), PA 0 degree
➢ Skull fractures (medial and lateral displacement),
neoplastic processes, and Paget’s disease
Lateral, PA Axial Projection 15 degrees (Caldwell
Method) or PA 25 degrees to 30 degrees
➢ Skull fractures, neoplastic processes, and Paget’s
disease
II. Technical Factors: AP Axial ( Towne Method), Lateral, PA Axial

Projection 15 degrees (Caldwell Method) or PA 25
degrees to 30 degrees and PA 0 degree
➢ Minimum SID—40 inches (102 cm)

➢ IR size—24 × 30 cm (10 × 12 inches), lengthwise
➢ Grid
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III. Shielding
AP Axial ( Towne Method), Lateral, PA Axial
Projection 15 degrees (Caldwell Method) or PA 25
degrees to 30 degrees and PA Projection 0 degree
interest.
IV. Patient Position AP Axial ( Towne Method) Patient Position
➢ Remove all metal, plastic, or other removable
objects from the patient’s head. Take
radiograph with the patient in the erect or supine
position
Lateral Patient Position

➢ Remove all metal, plastic, or other removable
objects from patient’s head. Take radiograph with
patient in the erect or recumbent semiprone
position.
PA Axial Projection 15 degrees (Caldwell Method)

or PA 25 degrees to 30 degrees Patient Position
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➢ Remove all metallic or plastic objects from the

patient’s head and neck. Take radiograph with
patient in the erect or prone position.
PA Projection 0 degree Patient Position

➢ Remove all metallic or plastic objects from patient’s
head and neck. Exposure is taken with patient in
the erect or prone position.
V. Part Position AP Axial ( Towne Method) Part Position

➢ Depress chin, bringing OML perpendicular to IR.
For patients unable to flex the neck to this extent,
align IOML perpendicular to IR. Add radiolucent
support under the head if needed (see Note).
➢ Align MSP to CR and to midline of the grid or the
table/imaging device surface.
➢ Ensure that no head rotation or tilt exists.
➢ Ensure that the vertex of the skull is within
collimation field.
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Lateral Part Position

➢ Place the head in a true lateral position, with the
side of interest closest to IR and the patient’s body
in a semiprone position as needed for comfort.
Align MSP parallel to IR, ensuring no rotation or tilt.
➢ Align IPL perpendicular to IR, ensuring no tilt of
head (see Note).
➢ Adjust neck flexion to align IOML perpendicular to
front edge of IR. (GAL is parallel to front edge of
IR.)

or PA 25 degrees to 30 degrees
Part Position
➢ Rest patient’s nose and forehead against
table/imaging device surface.
➢ Flex neck as needed to align OML perpendicular to
IR.
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➢ Align MSP perpendicular to midline of the grid or

table/imaging surface to prevent head rotation or
tilt.
➢ Center IR to CR
PA Projection 0 degree Part Position

➢ Rest patient’s nose and forehead against
table/imaging surface.
➢ Flex neck, aligning OML perpendicular to IR.
➢ Align MSP perpendicular to midline of
table/imaging device to prevent head rotation or tilt
(EAM same distance from table/ imaging device
surface).
➢ Center IR to CR.
VI. Central Ray & AP Axial ( Towne Method) Central Ray

Collimation ➢ Angle CR 30° caudad to OML, or 37° caudad to
IOML (see Note).
➢ Center at MSP 21 2 inches (6.5 cm) above the
glabella to pass through the foramen magnum at
the level of the base of the occiput.
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➢ Center IR to projected CR.
Lateral Central Ray

➢ Align CR perpendicular to IR.
➢ Center to a point 2 inches (5 cm) superior to EAM
or halfway between the glabella and the inion for
other types of skull morphologies.
➢ Center IR to CR

or PA 25 degrees to 30 degrees Central Ray
➢ Angle CR 15° caudad, and center to exit at nasion.
➢ Alternative with CR 25° to 30° caudad, and center
to exit at nasion
PA Projection 0 degree Central Ray

➢ CR is perpendicular to IR (parallel to OML) and is
centered to exit at glabella.
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VII. Anatomy AP Axial ( Towne Method) Anatomy Demonstrated

Demonstrated ➢ Occipital bone, petrous pyramids, and foramen
magnum are demonstrated with the dorsum sellae
and posterior clinoids visualized in the shadow of
the foramen magnum.
Lateral Anatomy Demonstrated

➢ Entire cranium visualized and superimposed
parietal bones of cranium.
➢ The entire sella turcica, including anterior and
posterior clinoid processes and dorsum sellae, is
also demonstrated.
➢ The sella turcica and clivus are demonstrated in
profile
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or PA 25 degrees to 30 degrees Anatomy
Demonstrated
➢ Greater and lesser sphenoid wings, frontal bone,
superior orbital fissures, frontal and anterior
ethmoid sinuses, supraorbital margins, and crista
galli are demonstrated.
PA with 15° Caudad Angle:
➢ Petrous pyramids are projected into the lower one-
third of the orbits.
➢ Supraorbital margin is visualized without
superimposition.
PA with 25° to 30° Caudad Angle:
➢ Petrous pyramids are projected at or just below the
IOM to allow visualization of the entire orbital
margin.
➢ Collimation to area of interest.
PA Projection 0 degree Anatomy Demonstrated

➢ Frontal bone, crista galli, internal auditory canals,
frontal and anterior ethmoid sinuses, petrous
ridges, greater and lesser wings of sphenoid, and
dorsum sellae are shown.
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VIII. Evaluation AP Axial ( Towne Method)

Criteria - Exposure ➢ Density (brightness) and contrast are sufficient to
visualize occipital bone and sellar structures within
foramen magnum.
➢ Sharp bony margins indicate no motion.
Lateral
➢ Density (brightness) and contrast are sufficient to
visualize bony detail of bony structures and
surrounding skull.

or PA 25 degrees to 30 degrees
visualize the frontal bone and sellar structures
without overexposure to perimeter regions of skull.
PA Projection 0 degree
visualize frontal bone and surrounding bony
structures.
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ABDOMEN (ABDOMEN RADIOGRAPHY)
INTERN NAME: SABORNIDO, MARY KATHERINE V

PROCEDURE: ABDOMEN
ROUTINE POSITIONS: AP Projection
I. Clinical AP Projection
Indication:
➢ Pathology of the abdomen, including bowel
obstruction, neoplasms, calcifications, ascites, and
scout image for contrast medium studies of abdomen
II. Technical AP Projection

Factors:
➢ Minimum SID—40 inches (102 cm) • IR size—35 × 43
cm (14 × 17 inches), lengthwise • Grid
III. Shielding AP Projection

interest.
AP Projection
IV. Patient
➢ Supine with midsagittal plane centered to midline of
Position
table or IR
➢ Arms placed at patient’s sides, away from body
➢ Legs extended with support under knees if this is more

comfortable
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V. Part Position AP Projection
➢ Center of IR to level of iliac crests, with bottom margin

at symphysis pubis
➢ No rotation of pelvis or shoulders (check that both
ASIS are the same distance from the tabletop)
VI. Central Ray & AP Projection

Collimation
➢ CR perpendicular to and directed to center of IR
(to level of iliac crest)
VII. Anatomy AP Projection

Demonstrated
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➢ Outline of liver, spleen, kidneys, and air-filled stomach

and bowel segments and the arch of the symphysis
pubis for the urinary bladder region.
VIII. Evaluation AP Projection

Criteria -
➢ No motion; ribs and all gas bubble margins appear
Exposure
sharp.
➢ Sufficient exposure (mAs) and long-scale contrast
(kV) visualize psoas muscle outlines, lumbar
transverse processes, and ribs.
➢ Margins of liver and kidneys should be visible on
smaller to average-sized patients
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BARIUM CONTRAST CASES (ESOPHAGRARM)

PROCEDURE: ESOPHAGOGRAM
ROUTINE POSITIONS: RAO, LATERAL, AP, LAO
I. Clinical Indication: Strictures, foreign bodies, anatomic anomalies, and neoplasms

of the esophagus
II. Technical Factors: RAO, LATERAL, AP, LAO - Minimum SID—40 inches
RAO, LATERAL, AP, LAO - IR size (14 × 17 inches), lengthwise
RAO, LATERAL, AP, LAO – Grid
RAO, LATERAL, AP, LAO - 100 to 125 kV range
III. Shielding RAO, LATERAL, AP, LAO - Shield all radiosensitive tissues
IV. Patient Position 1. Lateral Patient Position – Esophagogram

Position patient recumbent or erect (recumbent preferred)
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2. RAO Patient Position – Esophagogram

- Position patient recumbent or erect. Recumbent is preferred
because of more complete filling of the esophagus (caused by
the gravity factor with the erect position).
3.. AP Patient Position – Esophagogram

- Position patient recumbent or erect (recumbent preferred).
4. LAO Patient Position – Esophagogram

- Position patient recumbent or erect (recumbent preferred).
V. Part Position 1. Lateral Part Position – Esophagogram
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• Place patient’s arms over the head, with the elbows

flexed and superimposed.
• Align midcoronal plane to midline of IR or table.
• Place shoulders and hips in a true lateral position.
• Place top of IR about 2 inches (5 cm) above level of
shoulders, to place center of IR at CR.
2. RAO Part Position – Esophagogram

• Rotate 35° to 40° from a prone position, with the right
anterior
body against the IR or table.
• Place right arm down with left arm flexed at elbow and up by
the patient’s head, holding cup of barium, with a straw in
patient’s mouth.
• Flex left knee for support.
• Align midline of thorax in the oblique position to midline of IR
or table.
• Place top of IR about 2 inches (5 cm) above level of shoulders
to place center of IR at CR.
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3. AP Part Position – Esophagogram

• Align MSP to midline of IR or table.
• Ensure that shoulders and hips are not rotated.
• Place right arm up to hold cup of barium.
• Place top of IR about 2 inches (5 cm) above top of shoulder,
to place CR at center of IR.
4. LAO Part Position – Esophagogram

• Rotate 35° to 40° from a PA, with the left anterior body
against
IR or table.
• Place left arm down by patient’s side, with right arm flexed at
elbow and up by patient’s head.
• Flex right knee for support.
• Place top of IR about 2 inches (5 cm) above level of shoulders,
to place CR at center of IR.
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VI. Central Ray & Collimation 1. Lateral Central Ray – Esophagogram

• CR perpendicular to IR
• CR to center of IR at level of T5 or T6 (2 to 3 inches [5
to 7.5 cm] inferior to jugular notch)
2. RAO Central Ray – Esophagogram

3.. AP Central Ray – Esophagogram

• CR to MSP, 1 inch (2.5 cm) inferior to sternal angle (T5-
T6) or approximately 3 inches (7.5 cm) inferior to
jugular notch
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4. LAO Central Ray – Esophagogram

VII. Anatomy Demonstrated 1. Lateral Anatomy Demonstrated – Esophagogram

• Entire esophagus is seen between thoracic spine and
heart.
2. RAO Anatomy Demonstrated – Esophagogram

• Esophagus should be visible between the vertebral column
and heart.
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• RAO provides better visibility of pertinent anatomy between

vertebrae and
heart than LAO.
3. AP Anatomy Demonstrated – Esophagogram

• Entire esophagus is filled with barium.
4. LAO Anatomy Demonstrated – Esophagogram

• Esophagus is seen between hilar region of lungs and thoracic
spine.
• Entire esophagus is filled with contrast medium.
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VIII. Evaluation Criteria - 1. Lateral Esophagogram –

Exposure • Appropriate technique is used to visualize clearly borders of
the contrast media–filled esophagus.
• Sharp structural margins indicate no motion
2. RAO Esophagogram -
• Appropriate technique is used to visualize clearly borders of
the contrast media–filled esophagus.
3. AP Esophagogram -
• Appropriate technique is used to visualize the
esophagus through the superimposed thoracic vertebrae.
• Sharp structural margins indicate no motion.
4. LAO Esophagogram -
• Appropriate technique is used to visualize clearly borders of
contrast media–filled esophagus through the heart shadow. •
Sharp structural margins indicate no motion.
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BARIUM CONTRAST CASES (UGIS)

PROCEDURE: UGIS
ROUTINE POSITIONS: RAO, PA, RIGHT LATERAL, LPO, AP
I. Clinical Indication: RAO – Ideal position for demonstrating polyps and

ulcers of the pylorus, duodenal bulb, and C-loop of
the duodenum
PA – Polyps, diverticula, bezoars, and signs of
gastritis in the body and pylorus of the stomach
RIGHT LATERAL – Pathologic processes of the
retrogastric space (space behind the stomach);
Diverticula, tumors, gastric ulcers, and trauma to the
stomach may be demonstrated along posterior
margin of stomach
LPO – When a double-contrast technique is used,
the air-filled pylorus and duodenal bulb may better
demonstrate signs of gastritis and ulcers
AP – Possible hiatal hernia may be demonstrated in
Trendelenburg position
II. Technical Factors: RAO, PA, RIGHT LATERAL, LPO, AP - Minimum
SID—40 inches
RAO RIGHT LATERAL, LPO - IR size—24 × 30 cm
(10 × 12 inches), or 30 × 35 cm (11 × 14 inches),
lengthwise
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PA - IR size—24 × 30 cm (10 × 12 inches), or 30 ×

35 cm (11 × 14 inches), or 35 × 43 cm (14 × 17
inches) lengthwise if small bowel is to be included
AP - IR size—30 × 35 cm (11 × 14 inches), or 35 ×
43 cm (14 × 17 inches) lengthwise
RAO, PA, RIGHT LATERAL, LPO, AP – Grid
RAO, PA, RIGHT LATERAL, LPO, AP - Analog or
digital systems—100 to 125 kV range; 90 to 100 kV
for double-contrast study
III. Shielding RAO, PA, RIGHT LATERAL, LPO, AP - Shield all
radiosensitive tissues outside region of interest.
RAO- UGIS
PA- UGIS
RIGHT LATERAL-UGIS
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LPO- UGIS
AP- UGIS
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IV. Patient Position 1. RAO Patient Position – UGIS

Position patient recumbent, with body partially
rotated into an RAO position; provide a pillow for
patient’s head.
2. PA Patient Position – UGIS

Position patient prone, with arms up beside head;
provide a pillow for patient’s head.
3. RIGHT LATERAL Patient Position – UGIS

Position patient recumbent in a right lateral position.
Provide a pillow for patient’s head. Place arms up by
patient’s
head and flex knees
4. LPO Patient Position – UGIS
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Position patient recumbent, with the body partially

rotated into an LPO position; provide pillow for
patient’s head
5. AP Patient Position – UGIS

Position patient supine, arms at sides; provide a
pillow for patient’s head.
V. Part Position 1. RAO Part Position – UGIS

• From a prone position, rotate 40° to 70°, with right
anterior body against IR or table (more rotation
sometimes is required for heavy hypersthenic
patients, and less is required for thin asthenic
patients). Place right arm down and left arm flexed at
elbow and up by the patient’s head
• Flex left knee for support.
2. PA Part Position – UGIS
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• Align MSP to CR and to table.

• Ensure that the body is not rotated.
3. RIGHT LATERAL Part Position – UGIS

• Ensure that shoulders and hips are in a true lateral
position.
• Center IR at CR (bottom of IR about at level of iliac
crest).
4. LPO Part Position – UGIS

• Rotate 30° to 60° from supine position; with left
posterior against IR or table (more rotation may be
required for heavy hypersthenic patients and less
may be required for thin asthenic patients).
• Flex right knee for support.
• Extend left arm from body and raise right arm high
across chest to grasp end of table for support. (Do
not pinch fingers when moving Bucky.)
• Center IR at CR (bottom of IR at level of iliac crest).
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5. AP Part Position – UGIS

• Align MSP to midline of table.
• Ensure that body is not rotated.
• Center IR to CR.
• Bottom of 11 × 14-inch (30 × 35-cm) IR should be
about at
level of iliac crest
VI. Central Ray & 1. RAO Central Ray – UGIS

Collimation • Direct CR perpendicular to IR.
• Sthenic type: Center CR and IR to duodenal
bulb at level of
• L1 (1 to 2 inches [2.5 to 5 cm] above lower
lateral rib margin), midway between spine and
upside lateral border of abdomen, 45° to 55°
oblique.
• Asthenic: Center about 2 inches (5 cm) below
level of L1, 40° oblique.
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• Hypersthenic: Center about 2 inches (5 cm)

above level of L1 and nearer midline, 70°
oblique.
• Center IR to CR
2. PA Central Ray – UGIS

• Direct CR perpendicular to IR.
• Sthenic type: Center CR and IR to level of
pylorus and duodenal bulb at level of L1 (1 to
2 inches [2.5 to 5 cm] above lower lateral rib
margin) and about 1 inch (2.5 cm) left of the
vertebral column.
• Asthenic: Center about 5 cm (2 inches) below
level of L1.
• Hypersthenic: Center about 5 cm (2 inches)
above level of L1 and nearer midline.
• Center IR to CR
3. RIGHT LATERAL Central Ray – UGIS

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• Sthenic type: Center CR and IR to duodenal

bulb at level of L1(level of lower lateral margin
of the ribs) and 1 to 1 1/2 inches
• (2.5 to 4 cm) anterior to midcoronal plane
(near midway between anterior border of
vertebrae and anterior abdomen).
above L1
• Asthenic: Center about 2 inches (5 cm) below
L1.
4. LPO Central Ray – UGIS

• Sthenic type: Center CR and IR to level of L1
(about midway between xiphoid tip and lower
lateral margin of ribs) and midway between
midline of body and left lateral margin of
abdomen, 45° oblique.
above L1, 60° oblique.
• Asthenic: Center
about 2 inches (5
cm) below L1 and
nearer to midline,
30° oblique
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5. AP Central Ray – UGIS

• Center CR perpendicular to IR.
• Sthenic type: Center CR and IR to level of L1
(about midway between xiphoid tip and lower
margin of ribs), midway between midline and
left lateral margin of abdomen.
above L1.
• Asthenic: Position CR about 2 inches (5 cm)
below and nearer to midline
VII. Anatomy 1. RAO Anatomy Demonstrated – UGIS

Demonstrated • Entire stomach and C-loop of duodenum are
visible.
2. PA Anatomy Demonstrated – UGIS

• Entire stomach and duodenum are visible
3. RIGHT LATERAL Anatomy Demonstrated –
UGIS
• Entire stomach and duodenum are visible.
• Retrogastric space is demonstrated.
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• Pylorus of stomach and C-loop of duodenum

should be visualized well on
hypersthenic patients.
4. LPO Anatomy Demonstrated – UGIS

• Unobstructed view of duodenal bulb should
be provided, without superimposition by the
pylorus of the stomach

• Diaphragm and lower lung fields are included
for demonstration of possible hiatal hernia.
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VIII. Evaluation Criteria 1. RAO Evaluation Criteria – UGIS

- Exposure • Appropriate technique is used to visualize clearly
the gastric folds without overexposing other pertinent
anatomy.
2. PA Evaluation Criteria – UGIS

gastric folds without overexposing other pertinent
anatomy.
3. RIGHT LATERAL Evaluation Criteria – UGIS

anatomy.
4. LPO Evaluation Criteria – UGIS

• Appropriate technique is used to visualize gastric
folds without overexposing other pertinent anatomy.

anatomy.
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SPECIAL RADIOGRAPHIC PROCEDURES
BARIUM CONTRAST CASES (BARIUM ENEMA)
PROCEDURE: Barium Enema
ROUTINE POSITIONS: AP/PA, RAO, LAO, LPO AND RPO, LATERAL RECTUM,
R LATERAL DECUBITUS, L LATERAL DECUBITUS, PA Postevacuation, AP OR
LPO axial (butterfly), PA OR RAO axial (butterfly)
I. Clinical Indication: Obstructions, including ileus, volvulus, and

intussusception Double-contrast media barium
enema is ideal for demonstrating diverticulosis,
polyps, and mucosal changes
II. Technical Factors: AP/PA, RAO, LAO, LPO AND RPO, LATERAL
RECTUM, R LATERAL DECUBITUS, L LATERAL
DECUBITUS, PA Postevacuation, AP OR LPO axial
(butterfly), PA OR RAO axial (butterfly)- Minimum
SID—40 inches, IR size—14 x 17, lengthwise, Grid
III. Shielding AP/PA, RAO, LAO, LPO AND RPO, LATERAL
RECTUM, R LATERAL DECUBITUS, L LATERAL
DECUBITUS, PA Postevacuation, AP OR LPO axial
(butterfly), PA OR RAO axial (butterfly)- Shield all
radiosensitive tissues outside region of interest
1. AP/PA- Barium Enema
IV. Patient Position Patient is prone or supine, with a pillow for the head.
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2. RAO- Barium Enema

Patient is semiprone, rotated into a 35° to 45° RAO,
with a pillow for the head.
3. LAO- Barium Enema

Patient is semiprone, rotated into a 35° to 45° LAO,
with a pillow for the head.
4. LPO AND RPO- Barium Enema

Patient is semisupine, rotated 35° to 45° into right
and left posterior obliques, with a pillow for the head.
LPO
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RPO
5. LATERAL RECTUM- Barium Enema

Patient position is lateral recumbent, with a pillow for
the head.
6. RIGHT LATERAL DECUBITUS- Barium Enema

Patient is in lateral recumbent position, with a pillow
for the head and lying on the right side on a
radiolucent pad, with a portable grid placed behind
the patient’s back for an AP projection. The patient
also can be facing the portable grid or the vertical
table for a PA projection. (If patient is on a cart, lock
wheels or secure cart to prevent patient from falling.)
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7. LEFT LATERAL DECUBITUS- Barium Enema

Position patient lateral recumbent, with a pillow for
the head,and lying on the left side on a radiolucent
pad. (If on a cart, lock wheels or secure cart to
prevent patient from falling.)
8. AP Postevacuation- Barium Enema

Patient is prone or supine, with a pillow for the head.
9. PA OR RAO axial (butterfly)- Barium Enema

Position patient prone or partially rotated into an
RAO position, with a pillow for the head.
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V. Part Position 1. AP/PA- Barium Enema

• Align MSP to midline of table.
• Ensure that no body rotation occurs.
2. RAO- Barium Enema

• Align MSP along long axis of table, with right and
left abdominal margins equidistant from centerline of
table or CR.
• Place left arm up on pillow, with right arm down
behind the patient and left knee partially flexed.
• Check posterior pelvis and trunk for 35° to 45°
rotation.
3. LAO- Barium Enema
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• Align MSP along long axis of table, with right and

left abdominal margins equidistant from centerline of
table or CR.
• Place right arm up on pillow, with left arm down
behind patient and right knee partially flexed.
• Check posterior pelvis and trunk for 35° to 45°
rotation.
4. LPO AND RPO- Barium Enema

• Flex elevated-side elbow and place in front of head;
place opposite arm down by patient’s side. Partially
flex elevated-side knee to maintain this position.
Align MSP along long axis of table, with right and left
abdominal margins equidistant from centerline of
table.
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5. LATERAL RECTUM- Barium Enema

• Align midaxillary plane to midline of table or IR.
• Flex and superimpose knees; place arms up in
front of the head.
• Ensure that no rotation occurs; superimpose
shoulders and hips.
6. RIGHT LATERAL DECUBITUS- Barium Enema

• Position patient or IR so that iliac crest is placed to
center of IR and CR.
• Place arms up, with knees flexed.
7. LEFT LATERAL DECUBITUS- Barium Enema

• Position patient or IR so that iliac crest is placed to
center of IR and CR.
• Place arms up, with knees flexed.
• Ensure that no rotation occurs; superimpose
shoulders and hips from above.
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8. AP Postevacuation- Barium Enema

• Align MSP to midline of table or CR.
• Ensure that no body rotation occurs.
9. PA OR RAO axial (butterfly)- Barium Enema

• Position patient prone and align MSP to midline of
table.
• Place arms up beside head or down by sides away
from body.
• Ensure no rotation of pelvis or trunk.
VI. Central Ray & 1. AP/PA Central Ray- Barium Enema

Collimation • Center CR to level of iliac crest.
2. RAO Central Ray- Barium Enema
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• Direct CR perpendicular to IR to a point about 1

inch (2.5 cm) to the left of the MSP.
• Center CR and IR to level of iliac crest
.
3. LAO Central Ray- Barium Enema
• CR is perpendicular to IR, directed to a point about
1 inch (2.5 cm) to the right of MSP.
• Center CR and IR to 1 to 2 inches (2.5 to 5 cm)
above iliac crest.
4. LPO AND RPO Central Ray- Barium Enema

• Angle CR and center of IR to level of iliac crests
and about 1 inch (2.5 cm) lateral to elevated side of
MSP.
LPO
RPO
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5. LATERAL RECTUM Central Ray- Barium

Enema
• CR is perpendicular to IR (CR is horizontal for
ventral decubitus).
• Center CR to level of anterior superior iliac spine
(ASIS) and midcoronal plane (midway between
ASIS and posterior sacrum).
6. RIGHT LATERAL DECUBITUS Central Ray-

Barium Enema
• Direct CR horizontal, perpendicular to IR.
• Center CR to level of iliac crest and MSP.
7. LEFT LATERAL DECUBITUS Central Ray-

Barium Enema
• Direct CR horizontal, perpendicular to IR.
• Center CR to level of iliac crest and MSP.
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8. AP Postevacuation Central Ray- Barium

Enema
• Center CR and center of IR to iliac crest.
9. PA OR RAO axial (butterfly) Central Ray-

Barium Enema
• Angle CR 30° to 40° caudad.
PA - Align CR to exit at level of ASIS and MSP.
RAO - Align CR to exit at level of ASIS and 2 inches
(5 cm) to left of lumbar spinous processes.
• Center film holder to CR.
VII. Anatomy AP/PA Anatomy Demonstrated – Barium Enema

Demonstrated The transverse colon should be primarily barium-
filled on the PA and air-filled on the AP with a double-
contrast study.
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• Entire large intestine, including the left colic flexure,

should be visible
2. RAO Anatomy Demonstrated – Barium Enema
• The right colic flexure and the ascending and
sigmoid colon are seen “open” without significant
superimposition.
• The entire large intestine is included, with the
possible exception of the left colic flexure, which is
best demonstrated in LAO position (or may require
a second image centered higher).
• The rectal ampulla should be included on the lower
margin of the radiograph.
3. LAO Anatomy Demonstrated – Barium Enema

• The left colic flexure should be seen as “open”
without significant superimposition.
• The descending colon should be well
demonstrated.
• The entire large intestine should be included
4. LPO AND RPO Anatomy Demonstrated –

Barium Enema
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• LPO: The right colic (hepatic) flexure and the

ascending and rectosigmoid portions should appear
“open” without significant superimposition.
• RPO: The left colic (splenic) flexure and the
descending portions should appear “open” without
significant superimposition. (A second IR centered
lower to include the rectal area is required on most
adult patients if this area is to be included on these
postfluoroscopy “overheads.”) The rectal ampulla
should be included on the lower margins of the
radiograph. Entire contrast-filled large intestine,
including the rectal ampulla, should be included.
5. LATERAL RECTUM Anatomy Demonstrated –

Barium Enema- Contrast-filled rectosigmoid region
is demonstrated.
6. R LATERAL DECUBITUS Anatomy
Demonstrated – Barium Enema
• Entire large intestine is
demonstrated to include air-filled
left colic flexure and descending
colon.
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7. L LATERAL DECUBITUS Anatomy

• Entire large intestine is
demonstrated, with air-filled right
colic flexure, ascending colon, and
cecum.
8. PA Postevacuation Anatomy
• Entire large intestine should be
visualized with only a residual
amount of contrast media.
9. AP OR LPO axial (butterfly) Anatomy
• Elongated views of the
rectosigmoid segments should
be visible with less overlapping
of sigmoid loops than with a 90°
AP projection.
10. PA OR RAO axial (butterfly) Anatomy
• Elongated views of rectosigmoid segments of the
large intestine are shown without excessive
superimposition.
• The double-contrast study best visualizes this
region of overlapping loops of bowel.
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VIII. Evaluation Criteria 3. AP/PA Barium Enema-

- Exposure • Appropriate technique should visualize the
entire air-filled and barium-filled large
intestine without overexposing the mucosal
outlines of the sections of primarily air-filled
bowel on a double-contrast study.
4. RAO Barium Enema-
• Appropriate technique should visualize the
entire air-filled and barium-filled large
intestine without overexposing the mucosal
outlines of the sections of primarily air-filled
bowel on a double-contrast study.
5. LAO Barium Enema-
contrast-filled large intestine without
significant overexposure of any portion.
6. LPO AND RPO Barium Enema-
contrast-filled large intestine without
significant overexposure of any portion.
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7. LATERAL RECTUM Barium Enema-
• Appropriate technique is used to visualize
both the contrast-filled rectum and the
sigmoid regions, with adequate penetration to
demonstrate these areas through the
superimposed pelvis and hips.
8. R LATERAL DECUBITUS Barium Enema-
borders of the entire large intestine, including
barium-filled portions, but to avoid
overpenetration of the air-filled portion of the
large intestine.
• Mucosal patterns of air-filled colon should be
clearly visible.
• If the air-filled portion of the large intestine is
overpenetrated consistently, a compensating
filter should be considered.
9. L LATERAL DECUBITUS Barium Enema-
borders of the entire large intestine, including
barium-filled portions, but to avoid
overpenetration of the air-filled portion of the
large intestine.
• Mucosal patterns of air-filled colon should be
clearly visible.
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• If the air-filled portion of the large intestine is

overpenetrated, a compensating filter should
be considered.
10. PA Postevacuation Barium Enema-
outline of entire mucosal pattern of the large
intestine without overexposure of any parts.
• Postevacuation and R or L markers should be
visible.
11. AP OR LPO axial (butterfly) Barium
Enema-
outlines of all rectosigmoid segments of large
intestine.
12. PA OR RAO axial (butterfly) Barium
Enema-
outlines of all rectosigmoid segments of the
large intestine without overpenetrating the
air-filled outlines of these segments of large
intestine with air-contrast study.
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SPECIAL RADIOGRAPHIC PROCEDURES
IODINATED CONTRAST CASES (IVP)
PROCEDURE: INTRAVENOUS UROGRAPHY
ROUTINE POSITIONS: AP PROJECTION, RPO AND LPO POSITION
I. Clinical Pathologies involving fractures, foreign bodies, or lesions of

Indication: the bone; Localization of lesions and foreign bodies and
determination of extent; Alignment of fractures
demonstrated
II. Technical AP (scout), AP (nephrogram), RPO & LPO, AP (postvoid) -
Factors: Minimum SID is 40 inches (102 cm)
AP (scout), AP (postvoid) - IR size—14 × 17 inches,
lengthwise
AP (nephrogram) - IR size—11 × 14 inches, crosswise
RPO & LPO - IR size—14 × 17 inches, lengthwise, or 11 ×
14 inches, crosswise
AP (scout), AP (nephrogram), RPO & LPO, AP (postvoid) -
Grid
AP (scout), AP (nephrogram), RPO & LPO, AP (postvoid) -
75 to 80 kV range
III. Shielding AP (scout), AP (nephrogram), RPO & LPO, AP (postvoid)-
Shield all radiosensitive tissues outside region of interest
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1. AP (scout) Patient Position – IVP

IV. Patient
Situate the patient supine, with a pillow for the head, arms
Position
at the sides, away from the body, and support under the
knees to relieve back strain.
2. AP (nephrogram) Patient Position – IVP

Position the patient supine, with a pillow for the head, arms
at the sides, away from the body, and support under the
knees to relieve back strain.
3. RPO & LPO Patient Position – IVP

The patient is supine and is partially rotated toward the right
or left side.
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4. AP (postvoid) Patient Position – IVP

Patient is erect, with back against the table, or in prone
position
1. AP (scout) Part Position – IVP

• Align midsagittal plane to centerline of table and to CR.
• Ensure no rotation of trunk or pelvis.
• Include symphysis pubis on bottom of IR without cutting
off upper kidneys. (A second smaller IR for bladder area
may be necessary on hypersthenic patients.)
2. AP (nephrogram) Part Position – IVP

• Align midsagittal plane to centerline of table or grid.
• Ensure no rotation of trunk or pelvis
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3. RPO & LPO Part Position – IVP

• Rotate body 30° for both R and L posterior oblique
positions.
• Flex elevated-side knee for support of lower body.
• Raise arm on elevated side and place across upper chest.
• Center vertebral column to midline of table or grid and to
CR.
V. Part Position
4. AP (postvoid) Part Position – IVP

• Align midsagittal plane to center of table, grid, or IR, with
no rotation.
• Position arms away from the body.
• Ensure that the symphysis pubis is included on bottom of
the IR.
• Center low enough to include the prostate area, especially
on older men.
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VI. Central Ray & 1. AP (scout) Central Ray – IVP

Collimation • CR is perpendicular to IR.
• Center CR and IR to level of iliac crest and to midsagittal
plane.
2. AP (nephrogram) Central Ray – IVP

• Center CR midway between xiphoid process and iliac
crest.
3. RPO & LPO Central Ray – IVP

• CR is perpendicular to IR.
• Center CR and IR to level of iliac crest and vertebral
column
4. AP (postvoid) Central Ray – IVP

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• Center to level of iliac crest and midsagittal plane or, for

larger patients, 1 inch (2.5 cm) lower to ensure that the
bladder area is included.
1. AP (scout) Anatomy Demonstrated – IVP

• Entire urinary system is visualized from upper renal
shadows to distal urinary bladder. The symphysis
pubis should be included on lower margin of the IR.
• After injection, only a portion of the urinary system
may be opacified on a specific radiograph in the series
VII. Anatomy
Demonstrated
2. AP (nephrogram) Anatomy Demonstrated – IVP

• Entire renal parenchyma is visualized, with some filling of
collecting system with contrast media
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3. RPO & LPO Anatomy Demonstrated – IVP

• The kidney on elevated side is placed in profile or parallel
to the IR and is best demonstrated with each oblique.
• The downside ureter is projected away from the spine,
providing an unobstructed view of this ureter.
4. AP (postvoid) Anatomy Demonstrated – IVP

• Entire urinary system is included, with only residual
contrast media visible.
• All of symphysis pubis (to include prostate area on males)
is included on radiograph.
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VIII. Evaluation 1. AP (scout) Evaluation Criteria – IVP

Criteria - • No motion due to respiration or movement
Exposure • Appropriate technique with short-scale contrast
demonstrating the urinary system
2. AP (nephrogram) Evaluation Criteria – IVP

• Appropriate technique is used to demonstrate renal
parenchyma
3. RPO & LPO Evaluation Criteria – IVP

• No motion due to respiration or movement is evident.
• Appropriate technique with short-scale contrast is used to
visualize the urinary system
4. AP (postvoid) Evaluation Criteria – IVP

• No motion due to respiration or motion is evident.
• Appropriate technique is used to demonstrate residual
contrast media in the urinary system.
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PROCEDURAL MANUAL
WHOLE BRAIN RADIATION THERAPY (WBRT)
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PROCEDURAL MANUAL
ABDOMENT WITH CONTRAST AGENT

BRAIN TREATMENT
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PROCEDURAL MANUAL
MRI BRAIN SCAN
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PROCEDURAL MANUAL
ULTRASOUND
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PROCEDURAL MANUAL
NUCLEAR MEDICINE
BONE SCAN
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REFLECTION
NAME: SABORNIDO, MARY KATHERINE V. DATE: January 26, 2021
TOPIC: Nuclear Medicine 2
For our discussion last week, the History and development of Nuclear
Medicine modality, Radioactivity, Radionuclides, and Radiopharmaceuticals.
Nuclear medicine is a multidisciplinary field that develops and applies instruments
and radiopharmaceuticals to investigate physiological processes and diagnose
and cure diseases noninvasively. Examples of diseases treated with nuclear
medicine procedures are hyperthyroidism, thyroid cancer, lymphomas, and bone
pain from some types of cancer.
Moreover, based on the video discussion of the nuclear medicine virtual tour.
Nuclear medicine has two areas. The first area is the supervised area. A
Supervised Area is one where either person might receive more than one-tenth of
the relevant annual dose limit, or the conditions of the area need to be kept under
review to determine whether it could become a Controlled Area. biological
pathways or reactions, and in liquid form. The second area is the Hot lab a specially
designed room in a nuclear medicine hospital where the radiopharmaceuticals are
delivered, stored, and prepared for dispensing. Materials and Methods: The
radiation doses in the hot lab were measured by GM and NaI Detectors for about
12 months.
II. Weekly Reflection
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In addition, we have discussed Bone scan images in our case study. It is the
skeleton's metabolic activity. Traditionally, this has been performed by imaging a
radionuclide whose physiology closely resembles a metabolic process occurring
within the bone. The radionuclides technetium-99m (Tc-99m) or fluoride-18 are
often used in bone nuclear scintigraphy (F-18). Tc-99m is commonly connected to
medronic acid (Tc- 99m MDP), while F-18 is commonly integrated into sodium
fluoride (F-18 NaF). These molecules are injected intravenously, and the decay of
photons from the radioisotope is captured by a nuclear camera containing a salt
crystal.
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REFLECTION
NAME: SABORNIDO, MARY KATHERINE DATE: February 4, 2022
TOPIC: BONE SCAN
I. Weekly Learning Experience
For this week, we are assigned to watch two videos about Bone Scan.
When you schedule your bone scan, the hospital or imaging center staff will tell
you how to prepare. Usually, you do not need much special preparation before a
bone scan, but it's important to confirm this with the place giving you the test. If
anything is unclear in the instructions, talk with your health care team. What to eat.
You can typically eat and drink normally before your appointment. Your usual
medications. Tell your health care team about all medications you take, including
over-the-counter (OTC) drugs and supplements. Medicines that contain barium or
bismuth can affect the test results. Your doctor may ask you not to take them
before your scan. Personal medical history, tell the staff if you have any drug
allergies or medical conditions. Women should tell their health care team if they
are breastfeeding or may be pregnant.
This week really taught us more about bone scans, and it is so interesting
and exciting to know about the process of the procedure. And also, to know about
the two parts of the procedure which are the injection of the radioactive material
into the vein and the bone scan.
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REFLECTION
TOPIC: Nuclear Imaging Procedure
For this week, we were given a video about the various Nuclear Imaging
Procedures that were usually done within Nuclear Medicine facilities. The Bone
Scan was the first procedure that was discussed. Its indications include bone
metastasis, osteomyelitis, and other conditions. It is used with the pharmaceutical
MDP with a 25 mCi dose and a waiting time of 2-3 hours. The second video that
was given to us today was about the Radiation Therapeutic Unit. Following that,
we were shown a room with a red light indicating an ongoing procedure, as well as
adjustable lead shields, monitoring gadgets, lead robes, and a thyroid shield. The
therapy room was also shown to us.
Moreover, tomotherapy is a very advanced technology for delivering radiation

therapy. TomoTherapy is a novel method of delivering radiation therapy in the fight
against cancer. It is used to treat any cancer, it treated common cancers such as
breast cancer, prostate, and lung cancer. The method integrates treatment
planning, CT image-guided patient positioning, and therapy delivery into a single
system. The TomoTherapy equipment resembles a computed tomography (CT)
system. TomoTherapy combines intensity-modulate radiation therapy using a
specialized CT scanner that pinpoints the tumor and delivers 360-degree radiation
to it.
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This week really taught us more about nuclear imaging procedures, and it is
so interesting and exciting to know about the process and the procedure. Nuclear
medical imaging creates images of the inside of your body using small amounts of
radioactive material, a specialized camera, and a computer. Our clinical instructor
had just expounded and explained more on what happened on the video, as well
as asked us about what happened in what we watched so that we could truly study
it. We are also preparing our case presentation about radthera brain cancer.
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REFLECTION
TOPIC: Radiation Therapy Virtual Tour
For this week, there was a lot of information that was given to us about the
radiology department that we will be working in the future. I think it was good to
have a virtual tour inside each room in the radiology department inside the hospital.
With this, we can have a good foundation to know what is inside in each room and
the equipment and machines that we will be working on, if ever we got to work in
the specific department. And having this will give us an idea on how things work
inside the hospital and at least, we will not be ignorant to such when we start to
work there. These are the notable information that I gathered along the week:
1. The simulator was introduced as an additional device to assist with

preparation of external radiation therapy which came from the necessity to check
prior to treatment both that the plan can be delivered in practice and that the
relationship of the beam set-up to the patient’s anatomical features is correct. For
the CT simulation, the patients are now imaged on a CT scanner specially
configured to acquire threedimensional images used for treatment planning. It
allows the radiation oncologist to localize the tumor and surrounding areas that will
require radiation treatments. Markings were drawn by a radiation oncologist for the
future photon and electron planning. The radiation isocenter is an important point
- usually the room lasers are adjusted to intersect at radiation isocenter.
2. Immobilization devices are used to make sure the patients stay in the
treatment position during the course of the treatment. Mostly used devices are
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thermoplastic mask because it is easier to mold. Techniques used in radiation

therapy; single beam, two parallel opposed fields, isocentric setup, four field box,
coplanar noncoplanar beams. Single beam uses a high energy single beam photon
and also known as photon beam radiation. It uses photon beams to get to the
tumor but also can damage healthy tissue around the tumor. Two parallel opposed
fields is the simplest combination of two fields directing the same axis from
opposite sides.
3. An isocentric technique is where all beams used in a radiation treatment
have a common focus point, a.k.a. the isocenter. Isocentric techniques require less
patient repositioning as multiple field arrangements can be delivered with gantry
and collimator movements, reducing treatment times.
4. Four-field box or 3D-CRT is a treatment that shapes the radiation beams
to match the shape of the tumor and it uses the targeting information to focus
precisely on the tumor, while avoiding the healthy surrounding tissue.
5. IMRT or Intensity Modulated Radiotherapy is 3D conformal radiotherapy
techniques which optimize the dose distribution by varying the radiation fluence
across the beam and it uses linear accelerators to safely deliver precise radiation
to a tumor while minimizing the dose to surrounding normal tissue.
6. IGRT or Image Guided Radiotherapy is a technique of imaging the patient
anatomy on the treatment machine just prior to each daily dose. It is used in
conjunction with IMRT and RapidArc for precise patient positioning and provides
high resolution, 3D images to visualize tumor sites throughout the course of the
treatment.
7. ART or Adaptive Radiotherapy uses image information to change
subsequent treatment including change target and organ margins and evaluate
dose calculations. The TBI or total body irradiation is a form of radiotherapy used
primarily as part of the preparative regimen for hematopoietic stem cell (or bone
marrow) transplantation. Stereotactic radiosurgery doses are delivered in one
fraction during surgery, while stereotactic radiotherapy doses delivered in multiple
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fractions and both these procedures uses high energy beam. The process starts
with simulation or localization of tumor or cancer using x-ray simulator or CT
simulator, then the treatment planning, and then the treatment itself.
8. IGRT is used to treat tumors in areas of the body that move, such as the
lungs. Radiation therapy machines are equipped with imaging technology to allow
your doctor to image the tumor before and during treatment. By comparing these
images to the reference images taken during simulation, the patient's position
and/or the radiation beams may be adjusted to more precisely target the radiation
dose to the tumor. CT scanning is done to conduct a treatment simulation session
and to create reference images. IMRT or Intensity Modulated Radiotherapy is an
advanced mode of high-precision radiotherapy that uses computer-controlled
linear accelerators to deliver precise radiation doses to a malignant tumor or
specific areas within the tumor. IMRT allows for the radiation dose to conform more
precisely to the threedimensional (3-D) shape of the tumor by modulating—or
controlling the intensity of the radiation beam in multiple small volumes. IMRT also
allows higher radiation doses to be focused on the tumor while minimizing the dose
to surrounding normal critical structures.
9. The CT planning procedure is comprised of three parts: patient
assessment, in which doctors consulted with the patient for basic information and
a history of known disease, checking for the accessories needed to be used in the
diagnostic procedures, which will vary greatly depending on the intended organ of
choice, and patient instruction before and after the procedure, such as when
performing this procedure for example. Positioning is important because it helps
to keep everything in alignment and symmetrical, such as keeping shoulders level
while spine is straight and not curved. It is also important to position the patient in
the most comfortable position because this will be her/his position throughout the
treatment. CT markers would be applied to the patient's body as landmarks. Start
with the thermoplastic mask, which should be preheated so that it may be formed
to fit the patient's head. This mask will act as an immobilization device for any head
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diagnostic procedure; however, it should not be too hot to avoid burning the
patient. Radtech would, then, take a topogram or scout film to ensure that
everything was in proper alignment, and if everything was okay, he would begin
scanning and taking radiographic images to that everything was in proper
alignment. After scanning, the images that were obtained would be sent to a
physicist for contouring, which is a process in which a physicist or a doctor reviews
the images and marks those areas that appear to contain suspected tumors or
lesions so that these areas can be checked again for further evaluation. After the
contour plans for the digital reconstructed radiograph (DRR) have been completed,
the radiograph will be sent to the computer where it will be used as the foundation
for reproducing the placement. The following are the steps in the radiotherapy
workflow: It would be evaluated by the doctor, patient set up and immobilization
would refer to the processes and equipment used, and patient evaluation would
refer to the doctor's examination of the patient. At – the – target and organs – As
previously discussed, risky delineation occurs during patient contouring.
Radiotherapy planning, dosimetry, and validation are all included. The treatment
simulation would come next, and the treatment delivery would come last. Some of
the most well-known cancers that are treated in a radiation therapy center include
breast, head and neck, cervical, prostate, lung, rectal, and brain cancers. Each
organ has a specific dose that should not be exceeded above the prescribed limit.
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REFLECTION
NAME: SABORNIDO, MARY KATHERINE DATE: March 9, 2022
TOPIC: Radiation Therapy Virtual Tour
This week, we watched a new video regarding the issue and then went to
our regular FGD to have a more in-depth discussion. The first step is to understand
about cervical cancer, which is caused mostly by different strains of the sexually
transmitted infection human papillomavirus (HPV). Brachytherapy is a short-
distance therapy that is frequently used in conjunction with EBRT as part of a
cervical cancer treatment plan. Before each CT scan session, we must have the
request form filled out with the patient's position and any necessary accessories
such as the pelvic board and thermoplastic mask.
They also demonstrated patient preparation in cervical CA cases, in which

the patient is told to drink one liter of water and then wait 20-25 minutes. The length
of time a patient will wear a thermoplastic mask depends on the plan; in certain
circumstances, it will be 25 days. The CT scan control room is where you can
observe the patient's current position and whether or not the patient's spine is
aligned, as well as the superior and inferior border of the spine. Before applying a
thermoplastic mask to a patient, get a topogram image to check that the patient's
spine is aligned. After the topogram and some correction on the patient position,
the thermoplastic mask is heated then cools it off then placed on the pelvic area of
the patient. CT markers are placed on the pelvic mask for reference.
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After the CT scanning, the image is sent to the physics room, where the
treatment planning is done and this is also where the image is edited, what
technique to be used on the patient, and where the contouring happens and
treatment planning. After the physics room, will then proceed to treatment and
setting up the patient. The patient is positioned inside the room and then scanning
and setting up the FOV or field of view for the treatment. After selecting the FOV,
the machine begins scanning with a 150-second scanning time. One image was
from tomotherapy, while the other was from a CT scan. They must now be
matched. We can accept the image once it has been replicated with the exact
patient location, and then proceed to treatment. Proceed to the status console to
begin after some program finalization.
II. REFLECTION
I also know about the radiotherapy workflow for a brain CA case includes;
patient evaluations, CT scan simulation, target and OAR’s delineation and
planning, treatment simulation, and treatment delivery. For the CT simulation, we
need the accessories to be used, the positioning for the patient, and the
immobilization, which is the thermoplastic mask. The accessories are overlay,
headmask, and pillow. There is no tilting in the patient's position, which is supine
with arms at the side. The headmask is then applied to immobilize the patient, and
the scan is limited to the vertex of the skull to the base, with a 2cm margin on all
sides.
Furthermore, the image is submitted to the physics room for contouring and
planning after the simulation. The patient's location in the treatment simulation is
similar to that in the CT simulation. There are parameters in the control console
that you can store after you've correctly positioned the patient for therapy delivery.
To avoid headaches, make sure the patient received dexamethasone or steroids.
I also learned the type of radiation in radiobiology and fractionation are photon and
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megavoltage. Total dose for it can be varied in special circumstances, such as

histology of the tumor (melanoma 5000 cgy, lymphomas 3000 cgy). Usually, 4000
cgy in 20 fractions over 5 weeks is the total dose. The radiotherapy technique is
that the whole brain irradiation with the shape blocked at the base of the skull to
shield the eyes and encompass the cranial contents with 2 cm margin all around
and opposed lateral.
We also had our return demonstration which makes me retain all the
important things to learn with these topics and having to demonstrate it makes it
easier for us analyze and visualize what the procedure is in a hospital setting. I
also find this unit a very interesting one.
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REFLECTION
NAME: SABORNIDO, MARY KATHERINE V. DATE: March 18, 2022
TOPIC: CT SCAN
For this week we discussed a lot about the CT scan images, it is used
in treatment planning for patients with cancer, tumors, and other serious illnesses.
Because it's a step-by-step process, it can help radiation and medical oncologists
decide which treatment plan is best for their patients. However, it's a special
scanner that can compensate for high doses from other modalities. This computer
generates a series of photos from various viewpoints. This two-dimensional (2D)
scan reveals a slice of the inside of the body. A computer uses this information to
create a cross-sectional image, like one piece in a bread loaf and to generate a
number of slices in which the process is repeated.
Moreover, There are three major components of CT Imaging System: The

Operating Console, Computer and Gantry. The gantry is the largest part of the
system. It is made up of related equipment related to the patient including the
patient support, positioning couch, mechanical supports and the scanner housing.
It also placed the heart of the CT scan, the X-ray tube and detectors that generate
and detect rays. Its subsystems receive electronic commands from the operating
console and transmit data to the computer for image acquisition and post-
processing tasks. The Operating Console contains meters and controls for proper
selection of imaging technique, proper mechanical movement of gantry, and for
the use of computer commands. This console allows physicians to manipulate and
retrieve previous images for optimization. The computer is used for reconstruction
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of the images where it has a microprocessor and a primary memory in which

images are stored. The CT scan machine uses a high voltage generator, but the
size of this generator is small so it will be fit inside the gantry which is composed
of cathode and anode tanks and able to provide 53.2 kilowatts of power. Due to
the drawback of other Generation Clinical CT Scanner, a slip ring technology was
developed, specifically, in the 6th Generation of Clinical CT Scanner which is a
volumetric scanner and allows a continuous procedure to acquire images.
Furthermore, prior to scanning the patient, there are particular instructions

on how to run the scanner. First and foremost, the equipment will automatically
request a warm up for the tube heating. Following that, for Instrumentation and
Quality Control, the machine is turned on, the patient request is checked, the
patient is searched in the computer, all the parameters and information that are
required are applied, and because the machine has different accessories, for
example, if the requested examination is for the cranium, the CT foot extender
must be changed to a CT Head holder. So, if the patient is properly positioned,
according to one of the techs who led the virtual tour, the table's position must be
set to 0 by hitting the appropriate button. It is for scanning safety and efficacy. Even
the CT Scan Machine emits radiation, yet it is useful for patients with serious
conditions, which is why the ALARA concept is vital in the Imaging Department to
provide a quality image without compromising the technologist's and patient's
health due to radiation exposure.
A virtual tour of the Davao Regional Medical Center facilities. They begin by
demonstrating the LINAC machine. Then there's a look at the Nuclear Medicine
department. Third, they have shown the MRI room, which is a 1.5T PHILIPS MRI
MACHINE. For each procedure, we must identify the patient parameters, double-
check the procedure, check the patient's creatinine result (and current swab result
as per covid-19 protocols), secure the contrast media waiver, which must be
signed, and then proceed with the procedure. Toshiba 16- slice CT scan machine
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was introduced and used to show the practice of DRMC. In the complete abdomen
case, the scan is from the head to the femoral. To avoid extravasation, the DRMC
employs a Bolus contrast injection. In a supine position, with arms at the side and
feet first. Then, align both hips and arms up for a relaxed position or relax pose,
and check the isocentric /collimator line. Explain the breathing instructions to the
patient and then execute the scan. When the line is dislodged or the line is fine,
use a saline solution of 10cc, then apply the bolus as the artery is very fragile and
easily extravasated). For the portal venous phase, add 30cc and patient instruction
before injecting contrast media with constant communication to the patient.
Computed tomography uses a computer to process information collected

from the passage of x-ray beams through an area of anatomy. The images created
are cross-sectional. The individual CT slice shows only the parts of the anatomy
imaged at a particular level. Each CT slice represents a specific plane in the
patient’s body. The structures in a CT image are represented by varying shades
of gray. The creation of these shades of gray is based on basic radiation principles.
A third option is that the photons may be absorbed by a given structure in varying
amounts, depending on the strength (average photon energy) of the x-ray beam
and the characteristics of the structure in its path. The degree to which a beam is
reduced is a phenomenon referred to as attenuation.
In addition, all x-ray beam sources for CT and conventional radiography

produce x-ray energy that is polychromatic. That is, the x-ray beam comprises
photons with varying energies. The spectrum ranges from x-ray photons that are
weak to others that are relatively strong. It is important to understand how this
basic property affects the image. This phenomenon can produce artifacts. All CT
examinations are performed by obtaining data for a series of slices through a
designated area of interest. The nature of the anatomy and the pathology
suspected determines how the examination is performed. Scanners allow the
technologist to select slice thickness, and these scanners vary in the thickness
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choices available. Thicker CT slices increase the likelihood of missing very small
objects. The first step in creating a CT image is to acquire data that result from the
attenuation of the x-ray beam as it passes through the patient to strike the detector.
The mechanisms housed within the gantry and the patient table is the components
necessary for data acquisition.
II. REFLECTION:
For this week, there is a lot of information that was given to us about the
radiology department that we will be working in the future. I think it was good to
have a virtual tour inside each room in the radiology department inside the hospital.
With this, we can have a good foundation to know what is inside each room and
the equipment and machines that we will be working on, if ever we got to work in
the specific department. And having this will give us an idea on how things work
inside the hospital and at least, we will not be ignorant to such when we start to
work there.
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REFLECTION
NAME: Sabornido, Mary Katherine V. DATE: March 24, 2022
TOPIC: CT SCAN
The core of this week's classes focused on CT scans and the fundamental
ideas of how to use them, as well as how to understand the machines that go along
with them. Even though we did not get hands-on experience with the equipment,
we were given an insight into how it is used in regular situations.
In the virtual tour of the Davao Regional Medical Center facilities, I learned
that for each procedure, we must first identify the patient parameters, double-check
the procedure, check the patient's creatinine result (and current swab result as per
covid-19 protocols), secure the contrast media waiver, which must be signed, and
then start the procedure. The scan is from the head to the femoral in the full
abdomen case. The DRMC uses a Bolus contrast injection to prevent
extravasation. Suspended in a supine position, arms at sides and feet first. Then,
for relax position or relax pose, align both hips and arms up and verify the isocentric
/collimator line. Explain to the patient the breathing instructions before beginning
the scan. Use a 10cc saline solution when the line is detached or fine, then apply
the bolus (the artery is very fragile and quickly extravasated). For the portal venous
phase, add 30cc and patient instruction before injecting contrast media with
constant communication to the patient. Before we start, we should always double
check the patient, patient’s request, patient’s details, requested procedure, and
patient’s clinical history. If the requested procedure uses contrast media, we
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should check if the patient signed the contrast media waiver or consent form to
avoid accident to the patient. We should always practice to prepare the equipment
needed before the exam.
For cranium and neck procedure, the patient is in supine position and with
the head of the patient secured with foam wedge and lock/tighten the Velcro to
prevent patient movement. The patient is in the examination table and turn on the
lasers to accurately position the patient. The landmark for the cranium is 2-3
fingers above the head and center the patient’s MCP to the laser. Before going to
console room, set the table position to 0. For thoracic and abdomen procedure,
the patient is in supine position, feet first, and hands above the head, and then
position the patient inside the gantry. Make sure the laser is centered in the
patient’s MCP. There are two landmarks; one in the mammary line for abdomen
and one in the lip area for chest. Once the patient is positioned, set the table
position to 0 then continue to scan. For the contrast media examination of the
cranium, 30cc or 50cc syringe is used because it is more convenient and faster,
while for the contrast media examination of the thoracic, abdomen, and lower
extremities, the high-pressure injector or power injector is used.
Before every exam protocol, we must get topogram to ensure proper

scanning of every procedure. The difference between biphasic and triphasic,
biphasic has no delayed scan (delayed scan is when we scan the patient 5mins
after administering the contrast media) and triphasic has delayed scan. Before
performing the whole abdomen scan, let the patient drink at least 800ml of water
mixed with 25ml of contrast media. We go to the delayed phase images to check
how much contrast media is still inside the body and how far it travelled. Surview
and plain will automatically reconstruct the plain scan to thinner cuts.
The display functions are the final step in creating the CT image. Analog
monitors display the CT image. Therefore, the digital signal from the computer’s
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memory must be converted back to an analog format. Changing the window width
broadens or narrows the range of visible CT numbers. Window width and window
level determine which aspects of an image are displayed as shades of gray. The
shade of gray that is assigned to a specific anatomic structure is related to the
structure’s beam attenuation. Higher Hounsfield values are represented by lighter
shades of gray. The window width selects the range of Hounsfield units for a
particular image, and the window level determines the center Hounsfield unit in
this range. In general, the window level is set at roughly the same level as the
Hounsfield value of the tissue of interest. Optimal window settings are highly
subjective, and they vary dramatically within the field. Published window widths
and centers are intended to serve as guidelines only. Patient conditions as well as
personal preference make considerable adjustment necessary. CT systems offer
a variety of functions that allow images to be manipulated to facilitate diagnosis.
Defining an ROI is the first step in many measurement and display functions.
Hounsfield measurement, standard deviation, and distance measurement may
offer valuable diagnostic information. It is important to annotate images with any
information that may not be immediately apparent. Examples of such annotation
include “Images in this study have been flipped, top to bottom” and “Delayed
image: 15-minute post contrast injection.” The technologist must understand the
difference between image magnification and decreasing the display field of view
size and use each function appropriately.
In a neurologic imaging procedure, the patient’s head is positioned in the

head holder for most protocols of the head. The patient should be made as
comfortable as possible and immobilized as effectively as possible to prevent
motion artifact on the images. It is not necessary to ask the patient to suspend
breathing for CT studies of the head or neck. The slice angle is determined by the
position of the patient’s head (i.e., moving the chin up or down) and the angle of
the gantry. Recent practice favors programming slices of the brain parallel to the
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supraorbital meatal line (rather than the orbital meatal line) to reduce radiation
exposure to the lens of the eye. The image obtained in either the prone or the
supine coronal position is essentially the same. Obviously, the images are flipped
inferior-superior. The preferred position involves several factors; including patient
comfort, radiologist preference, and the effect of gravity on anatomic structures.
Imaging the posterior fossa of the brain is a challenge because of the great
difference in beam attenuation ability between the dense bone of the skull and the
much less dense tissue of the brain that causes beam-hardening artifact, which is
common in the posterior fossa. This inherent limitation may be managed by
decreasing slice thickness when scanning the posterior fossa and increasing the
kVp setting.
In examinations of the head, the helical CT mode is used mainly for the
purpose of generating three- dimensional reformations or to minimize motion-
related artifacts. In general, routine head studies are done using an axial mode,
and CT angiography (CTA) studies of the head and neck are done using a helical
mode. However, it is important that technologists recognize certain potentially
critical pathologic changes so that when present, they can be brought to the
attention of a radiologist. The technologist can play a vital role by bringing the scan
to the radiologist’s attention so that these patients receive prompt medical
attention. CT is the primary imaging modality for emergent indications such as
trauma and acute changes in neurologic status. For most applications concerning
structural imaging of the brain and skull base, nonenhanced CT is usually
adequate. IV contrast administration is indicated for infection and neoplasm, but in
practice this is not frequently performed because those indications most often
prompt an MRI, obviating the need for enhanced CT. However, in some situations
MRI is contraindicated or unavailable, leaving enhanced CT the best diagnostic
option. Routine scanning of the neck is typically performed with the patient supine
and the neck slightly extended. It is most often performed in the helical mode.
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II. WEEKLY REFLECTION
The patient should be instructed to lower the shoulders as far as possible

to reduce artifacts that damage images in the lower neck. When scanning the neck,
IV contrast medium is utilized unless it is contraindicated. The purpose of CT
scanning of the neck is to provide enough time for the mucosa, lymph nodes, and
pathologic tissue to enhance after contrast administration while keeping the
vasculature opacified. The benefits of CT angiography include the fact that it is
noninvasive and widely available. The advantage of CTA over standard
angiography in terms of saving time is especially crucial in cases where treatment
decisions must be made rapidly. The parameters of a CT venography (CTV) scan
are very similar to those of a CTA scan, with the exception that images are
obtained while the contrast is in the venous enhancement phase. CT scans are
indeed very effective in detecting and locating foreign bodies in the orbit and within
the eye (IOFBs). When compared to other imaging modalities, it has also been
demonstrated to be more effective at detecting vitreous hemorrhage and lens
displacement. Other undiscovered intracranial and facial injuries can also be
detected with a CT scan. The CT findings of ocular damage match the clinical
findings quite well. CT scanning, as opposed to ordinary x-rays, provides more
detailed information about head injuries, stroke, brain tumors, and other brain
illnesses.
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REFLECTION
TOPIC: CT scan of the chest and abdomen
I. WEEKLY LEARNING EXPERIENCE
An authentic DRMC hospital inspection was presented in the film.

We also have two patients from the movie who were questioned about their past,
specifically if they had allergies and if they were allergic to certain foods like
seafood, eggs, or eggplants. Some of the patient's residual metallic items were
also checked by the technician. Ensure that all metals, such as bra wire, belts, and
even buttons, as well as belly bands, are removed from the body. The patient, on
the other hand, is now positioned in bed, feet first and reclined in the user interface,
following the brief interview. The patient's procedure, on the other hand, is a CT
scan of the chest and abdomen. By straightening the spine and eliminating
scoliosis, the technician strives for proper planning.
The next step is to administer a saline flush and ask the patient if they feel
any discomfort to check for extravasation. After the flush, contrast media for the
chest and arterial phases is administered before continuing the scanning. As a
result, before allowing the patient to depart, go through the images. They also
demonstrated the tibe/heat load, which is the quantity of energy that is deposited
throughout the exposure. The procedure also includes post-procedural care, which
is why the patient was questioned in the first place if this was their first time
undergoing such a surgery or if they had previously experienced it in order to
connect the post-procedural care. In such instances, if the patient is a first-timer,
a delayed onset of allergic reaction to contrast is possible. Thus, the patient must
wait for at least one hour before the heplock is removed; however, if this is not the
patient's first time, the patient must stay for at least 30-45 minutes, depending on
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the institution. The second patient, on the other hand, had the identical procedure
performed on both the chest and the entire abdomen. The patient, however, stated
that she is allergic to seafood. As a result, double-check the patient's information
to avoid a negative reaction to contrast media, and the tech will be responsible if
any reactions take place.
The preparation of the patient for CT examination of the belly and pelvis is
more significant than preparation for CT examination of any other portion of the
body. In general, the more oral contrast material used in an abdominopelvic CT
scan, the greater the bowel opacification. Although a volume of at least 600 mL is
advised, patient compliance may be a barrier to meeting this volume goal. The
bladder may be seen in the best light on CT when it is filled with urine or contrast
agent. Multiphasic imaging is commonly used for particular pancreas, liver, and
kidney tests, as well as numerous abdominal CTA procedures. There is
substantially more information in each given slice than can be displayed by a single
window with its width and level settings set to their maximum. As a result, images
are routinely examined in several window configurations. Patients are asked to
hold their breath during abdominopelvic scanning to reduce movement and motion
artifacts, which are undesired. Anatomic structures will be shifted, distorted, or
concealed while the patient moves during the scanning process. The most
accurate approach to assess this is through non-contrast CT scans. Many
operators include a liver ROI as well as a spleen ROI in their operations. Fatty
infiltration of the liver is suspected and should be addressed when the liver value
is at least 10 HU lower than the spleen level. The majority of hepatic hemangiomas
have a distinct appearance on CT scans.
On unenhanced computed tomography, hemangiomas appear as a well-

defined hypodense tumor (CT). The lesion demonstrates progressive "filling-in"
enhancement from the periphery in the hours following IV contrast administration.
After a while, the lesion's appearance becomes more evenly enhanced. On CT
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scans, the majority of hepatic hemangiomas have a characteristic appearance. On

unenhanced computed tomography, hemangiomas appear as a well-defined
hypodense tumor (CT). Following the administration of IV contrast, the lesion
shows gradual "filling-in" enhancement from the periphery over time. After a while,
the lesion's appearance becomes more uniformly enhanced. CT scans of the
kidneys and ureters without contrast agents are often used to detect calcifications
and calculi that may be concealed by the contrast agent. Two ways for identifying
whether an adrenal mass is benign or malignant are assessing the attenuation
values of the mass and analyzing the quantity of iodinated contrast washed out of
the bulk on delayed imaging. By finding an incidentaloma and personalizing the
study to provide the radiologist with the data needed to evaluate whether the mass
is benign or malignant, an astute technologist can spare a patient the time, money,
and radiation exposure involved with a repeat examination. Detecting an
incidentaloma and personalizing the investigation to give the radiologist the
information he or she needs to evaluate whether the mass is benign or malignant.
Doctors might try to diagnose the nature of lesions in the adrenal gland using
specific adrenal imaging methods. The purpose of imaging is to reduce
unnecessary biopsies, the number of follow-up investigations required for an
accurate diagnosis, and the overall expense of health-care services and
procedures. Any homogeneous adrenal mass measuring less than 10 HU on
unenhanced CT is considered benign, and the scan protocol does not need to be
changed in this circumstance. This is significant because it contributes to the
diverse clinical presentation of acute appendicitis as a result of the appendix's
varying position. Furthermore, because of the variation in location, finding the
appendix on cross-sectional scans is more difficult. There is a large degree of
variation in appendicitis treatment protocols; different combinations of oral, rectal,
IV, and no contrast material may be employed in different conditions. Protocols
also differ in terms of the anatomical area that will be scanned. According to the
literature, the reported accuracy of all process modifications for detecting
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appendicitis is high. When the appendix is found to be normal, the rate at which
these procedures yield a different diagnosis may be the most variable.
Musculoskeletal imaging procedures are the focus of the discussion. CT of

the musculoskeletal system has several advantages, including the ability to display
cross-sectional anatomy and spatial relationships, the ability to image both sides
of the body for comparison (particularly useful in evaluating joint asymmetry), the
ability to display bone and soft tissue components simultaneously, the ability to
perform multiplanar and three-dimensional reformation retrospectively, and the
ability to perform multiplanar and three-dimensional reformation prospectively.
Scanner protocols for the musculoskeletal system are customized for each patient.
Intravenous contrast medium is not typically used for musculoskeletal damage, but
it is useful for other causes such as infection or soft-tissue tumor evaluation.
Multiplanar reformations are included in the majority of musculoskeletal
treatments. Musculoskeletal protocols follow the main scanning rules acquired in
previous chapters. However, a few specialized examinations, such as the wrist,
shoulder, knee, foot, and ankle, are worth highlighting due to their distinct
placement issues. CT wrist tests are recommended for complex fractures of the
distal radius and ulna, scaphoid fractures, and other carpal fractures that are not
clear on conventional x-ray imaging.
CT may also be useful in detecting small fractures. It is frequently difficult

to place the patient comfortably and securely for a CT examination of the wrist.
Various approaches are employed. The patient is sometimes positioned with his
arm above his head. Another option is for the patient to sit or stand on the far side
of the scanner and extend his arm into it. A third, less desirable method is to scan
the patient's wrist while it is resting on his abdomen. In some cases, such as tibial
plateau fractures, CT remains the modality of choice. The major purpose of a knee
CT is to determine the degree and alignment of fracture fragments, particularly at
the articular surfaces. Knee CT is also used to evaluate the bone integrity around
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the prosthesis. CT data from the foot and ankle can be shown in a variety of
imaging planes. Some of these planes can be retrieved directly by putting the
patient in a precise posture, whilst others can be displayed best by reformatting
the data. Which plane(s) to display is determined by which joint is of main concern.
In some cases, CT is the modality of choice.
II. WEEKLY REFLECTION
We must also be aware of the various uses of the modalities in order to have the
knowledge that will help us in our future work as radiologic technologists. We can
better protect ourselves and future patients if we are aware of and educate
ourselves on scanning procedures. Even though we are learning online, our clinical
instructors provide us with a high-quality education. They also shared their
knowledge of hospital settings with us interns, which was extremely helpful in our
professional development.
Case studies can teach us more about the patient's disease, what symptoms to
look for, and how to make an accurate diagnosis using various procedures and
modalities. We also learned about some new diseases and medical terms that we
may come across in future exams and jobs. By doing this as a group, we can also
practice how to communicate with one another online and how to work as a team
in order to be successful in our group presentation.
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REFLECTION
NAME: SABORNIDO, MARY KATHERINE V. DATE: April 22, 2022
This week, we focused on musculoskeletal imaging procedures. CT of the

musculoskeletal system has several advantages, including the ability to display
cross-sectional anatomy and spatial relationships, the ability to image both sides
of the body for comparison, the ability to display bone and soft tissue components
simultaneously, excellent contrast sensitivity, and the ability to perforate the joints.
Multiplanar reformations are included in the majority of musculoskeletal
treatments.
At the same time, we also discussed Magnetic Resonance Imaging (MRI).

Multi-planar imaging is the ability of an MRI to obtain direct transverse, sagittal,
coronal, and oblique plane images. Ionizing radiation is not used in MRI; instead,
RF electromagnetic radiation and magnetic fields are used, which do not induce
ionization and so do not have the potentially detrimental consequences associated
with ionizing radiation. The essential concept behind MR is that if a specific atomic
nucleus is stimulated by a magnetic field, it can change shape (absorb energy
from) and then release the excess absorbed energy by emitting radio waves.
II. WEEKLY REFLECTION:
This is the first week of MRI discussion and we just cover two topics this week,
it's been a relatively easy week for me. It also provides me with new information
that I can apply in my future endeavors.
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REFLECTION
NAME: SABORNIDO, MARY KATHERINE V. DATE: April 28, 2022
In this week’s discussion, the topic of Magnetic Resonance Imaging

Hardware was discussed. This refers to both inside and outside the modality the
system's pieces and components. The system's magnets are explained in further
detail, and an MRI system block diagram helps me grasp the system and how it
works. Coils for the neck, head, and extremities were added, as well as coils for
the neck, head, and extremities.
The three essential components are the Gantry, Operating Console, and
Computer System. The main magnet and associated electromagnetic devices are
housed in the gantry; however, unlike a CT scanner, the MRI gantry has no moving
parts and only the patient couch. The gantry can be intimidating to the patient after
being seated on the couch and slid to the aperture. The image acquisition and
image processing controls are managed by the computer, although the bulk are
controlled by the unique function keys on the operating console. The third
component is the computer system; the most popular type of computer is the
minicomputer, which is available in three sizes. The computer should be big, quick,
and able to store and manipulate data.
Prior to the treatment, the daily test should be performed to ensure that the
coils are in good working order. Then there are RF coils, which include abdominal
coils, whole-body coils, head coils, knee coils, and breast coils. The allocated
Technologist will insert the phantom and head coil into the machine for the weekly
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QAQC test in MRI. Head coils and whole-body coils can be used to calibrate and
check the scanner and magnet. Then open the SPT (system performance tool)
and run the PIQT (periodic image quality test), which may take 15 to 20 minutes
for calibration. The planning can be done manually, and there should be three
views for Phantom and three views for real.
The primary magnet is the MRI system's beating heart. The primary
magnet's job is to keep the B0 constant and consistent throughout the MRI scan.
Because B0 homogeneity influences picture resolution, uniformity, and distortion,
it is necessary to maintain a homogenous B0. The kind of primary magnet
influences at least two variables in the selection of an MRI system: the desired
field strength and site constraints. Because increasing field strength increases the
extent of the accompanying peripheral magnetic field for any given magnet design,
field strength and siting limits are linked.
Conducting electric current through coiled wire produces electromagnets.

High B0 magnetic field strength is a key feature of MRI systems based on
superconducting electromagnet technology. The majority of superconducting
clinical imaging devices work at 0.5, 1.0, or 1.5 Tesla. Many sites have
superconducting imaging systems operating at 3 T and 4 T; however, these are
specialized systems. The tensile strength of superconducting electromagnets used
in analytical spectroscopy and high-energy physics has already surpassed 14 T.
Because of their high electric current and tiny bore size, these systems may reach
such high fields. Higher B0 necessitates stronger gradient magnetic fields, which
results in a wider RF bandwidth.
Superconducting MRI magnets have various advantages. If spectroscopy

is to be performed, a high magnetic field intensity is required. Higher B0 intensity
is desirable because such imaging systems' increased magnetic resonance (MR)
signal creates a higher signal-to-noise ratio (SNR), allowing for shorter
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examination periods. Furthermore, because of the enhanced SNR, these systems

can provide images with higher spatial and contrast resolution. The field of a
superconducting electromagnet can also be homogenized or shimmed in ways that
ordinary magnet systems cannot. Superconducting magnets are essentially
homogenous due to their solenoidal construction. Shimming is necessary for
imaging with a tiny field of view (FOV), fat suppression, rapid imaging, and
spectroscopy. TThe 0.5 mT (5 gauss) fringe magnetic field associated with
pacemaker exclusion spans around 10 m in all directions at a magnetic field
strength of 1 T. This passive shielding, however, is both heavy (up to 250 tons for
a 7 Tesla magnet) and expensive. Passive shielding is therefore rarely employed
in clinical MRI systems. The need for cryogenic gases is a disadvantage of the
superconducting magnet. The NbTi superconducting wire must be kept at
temperatures below its critical temperature of 9 K to remain superconducting.
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SUMMARY
NAME: Sabornido, Mary Katherine V. DATE: January 14, 2022
TOPIC: NUCLEAR MEDICICNE
For yesterday's discussion, we have discussed Nuclear medicine which is a

radiopharmaceutical for the diagnosis, therapy & medical research. Determines
the cause of medical problems based on organ or tissue function, or physiology.
The hotspot of this topic is radiopharmaceutical accumulation, which appears black
and highly metabolic in the area. For the principles, nuc med test the radioactive
material, or tracer is generally introduced into the body by injection, swallowing, or
inhalation.
Moreover, in historical developments, John Dalton (1803) was the father of

atoms & molecules. Wilhelm Conrad Roentgen is the one who discovered the x-
rays. Antoine Henri Becquerel is the father of radioactivity. The radium & polonium
is discovered by Marja Sklrdowska Curie. The father of nuclear medicine,
radioindicator is George de Hevesy. Ernest Lawrence (1931) invented the
cyclotron and made it possible for de Hevesy to expand his studies to a broader
spectrum of biologic processes by using phosphorus-32, sodium-22, and other
cyclotron-produced radioactive tracers. Enrico Fermi (1946) developed the nuclear
reactor, which is greatly extended the ability of the cyclotron to produce radioactive
tracers. Benedict Cassen (1950) developed the first Rectilinear scanner. Hal Anger
(1958) introduced the gamma camera. Roy Edwards and David Kuhl (1960s) made
the next advance in nuclear medicine imaging with the development of a crude
single-photon emission computed tomography (SPECT) camera known as the
MARK IV.
Furthermore, in basic nuclear physics, the nuclei of atoms are composed of

protons, which have a positive electrical charge, and neutrons, which are
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electrically neutral. Electrons are electrically negative and have a charge equal in
magnitude to that of a proton. The number of electrons in an atom is normally equal
to the number of protons in the nucleus. In radioactive detectors, the gas-filled
detectors detect radioactivity, it must first interact with matter and release energy.
the Geiger- Mueller survey meter, usually called the Geiger counter. The other is
the dose calibrator, which is an ionization chamber used to measure the amount
of radioactivity in a sample, such as a syringe, vial, or test tube. The scintillation
detectors which mean emit light photons, sensitive elements used to detect
ionizing radiation by observing the emission of light photons induced in a material.
In addition, SPECT produces images similar to those obtained by CT or MRI

in that a computer creates thin slices through a particular organ. PET imaging uses
positron emissions from particular radionuclides to produce detailed functional
images within the body. The radionuclides used in nuclear medicine are produced
in reactors or particle accelerators. Radiopharmaceuticals can be used as
diagnostic and therapeutic agents. Radiopharmacology is the branch of
pharmacology that specializes in these agents.
For the imaging method in nucmed, static imaging is the acquisition of a single
image of a particular structure. This image can be thought of as a "snapshot “of
the radiopharmaceutical distribution within a part of the body. Whole-body imaging
uses a specially designed moving detector system to produce an image of the
entire body or a large body section. It is used primarily for; whole-body bone scans,
whole-body tumor or abscess imaging, and other clinical and research
applications. Dynamic imaging displays the distribution of a particular
radiopharmaceutical over a specific period.
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SUMMARY
TOPIC: NUCLEAR MEDICINE
Radiation safety is the main health issue of concern to a nuclear medicine

technologist (NMT). Ionizing radiation is a known carcinogen at high doses, and
clinical symptoms are known to be associated with chronic low-dose exposure. A
SPECT-CT scan is a type of nuclear medicine scan where the images or pictures
from two different types of scans are combined together. The combined scan can
provide precise information about how different parts of the body are working and
more clearly identify problems. Radioactive iodine for hyperthyroidism, while
radiation can cause thyroid cancer, treatment of hyperthyroidism with radioactive
iodine does not increase your chances of getting thyroid cancer. In dual-energy x-
ray absorption, there are two processes the bone density test and body
composition.
Moreover, as sir Rommel Glenn Lorenzo said, there has two areas in nuclear
medicine, first area is the supervised area which this place has no radiation. For
example, the offices, consultation area, and pantry. The second area is the
controlled area, this place where we wear the thermoluminescent detectors (TLD)
and the PPE. For example, the RIA room, SPECT CT room, treadmill area, bone
densitometer room, waiting area for patients, thyroid uptake room, hot lab, and
storage room.
Furthermore, sir Kenth Justine Tingcay, explain to us more the nucmed

facility. First is the reception area, where the patient is interviewed by the clerk
before starting a procedure, second is the reception area, where they interview the
patient before starting the procedure and where the result will be released after the
procedure, next is the consultation area, where the doctor consults the patient after
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the procedure and the result has been given to give advice or any medication to
help toward the patient. Lastly, the pantry area where the employees eat.
Controlled area, this is the place where has radiation exposure before entering the
room you should have PPE and the TLD. Hot lab, where they keep the radioactive
materials, in the fume hood where they put the radioactive materials for quality
control of dose calibrator. Dose calibrator is where they measure the radioactive
materials, the preparation area where they mix or dilute the medicine they inject in
the patient.
In addition, thyroid uptake area, in the thyroid uptake machine they measure
the thyroid of the patient if it is hyperthyroid or hypothyroid and to measure also to
monitor the bioassay to know if the iodine- 131 is already digest. In the reading
room, after they scan the images, it will be send via PACS and the doctor will
interpret the diagnosis and give it to the reception to release to the patient. The
siemens symbia intevo bold, is has a detector for gamma camera and ct scan,
basically, it’s 2 in 1 machine where they perform the bone scan, renal scan, thyroid
scan, RBC tagging, and other procedure. RIA room, where they perform the blood
test, the TSH and NT4. The patient will be given a radioactive agent and will be
put in the gamma well counter to read the samples as it will give values on what
the patient situation.
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SUMMARY
For today’s FGD, I was assigned the topic of how a kidney transplant may
be assessed via nuc med scan. The many forms of renal scans are used to
investigate various functioning features of the kidneys; nevertheless, all of these
procedures involve the injection of a radiopharmaceutical or radiotracer into the
patient, which emits a trace quantity of radioactivity. Because the radiotracer
interacts differently with different types of tissue, it can assist physicians in
determining whether something is amiss with the kidneys or if they are working
appropriately. Renal scintigraphy can also be used to assess the success of a
kidney transplant. The radiotracer is injected and travels throughout the body to
the kidneys, where it emits energy in the form of gamma rays. A gadget known as
a gamma camera detects this energy. The camera collaborates with a computer
to generate images that provide information on the structure and function of organs
and tissues.
Moreover, Renal scintigraphy has been used to evaluate kidney transplant

anatomy, blood flow, and function. The radiolabelled isotopes used in nuclear
imaging allow for the tracking of blood flow through the kidney. This allows the
imaging of blood flow, obstructions, or leaks in the newly transplanted kidney.
A nuclear medicine scan uses small amounts of radiation to create pictures

of tissues, bones, and organs inside the body. The radioactive material collects in
certain areas of your body, and special cameras find the radiation and make
images that help your medical team diagnose and treat cancer and other illnesses.
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SUMMARY
For this day, we are assign to watch a video about Radioactive Iodine
Therapy which is discussed by sir Lorenzo and sir Tingcay. RAI Therapy is
a treatment for overactive thyroid (hyperthyroidism) and certain types of thyroid
cancer. The radioactive iodine has a half-life of 8 days. For the radioactive iodine
is treatment for thyroid cancer and certain kinds of hyperthyroidism
(hyperthyroidism) and it can be given with low dose or high dose.
Moreover, low dose treatment has 5 to 15 mCi and is used to treat Grave’s
disease which can cause overactive thyroid or hyperthyroidism. High dose
treatment has 15 to 200 mCi and is used to treat thyroid cancer, which has 2 types,
papillary or follicular. After a day of RAI therapy low dosage treatment, the patient
may be discharged the next day after receiving radiation safety instructions. For
the screening procedures are, SPECT/CT with t99m is thyroid scan, to determine
the severity of hyperthyroidism, for radioimmunoassay (RIA) is thyrotropin (TSH),
free thyroxine (FT4) but some doctors order anti-TPO. In RAI therapy high dose
treatment, 15 mCi to 200 mCi is used to treat thyroid cancer and metastatic thyroid
cancer.
In addition, the patient is admitted for 3 days, for visiting relatives, the time
is limited for visiting hours and minors are not allowed. Pregnant are not allowed
inside the isolation room. The patient can be discharged when radiation levels are
25 uSv per hr at 1 meter, which will be monitored by a radtech, and the patient will
have a post RAI imaging after discharge and after seven days. Radiation safety
instructions will be given prior to discharge and to be observed for one month.
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The radiation safety instructions include, this must be given to patient after
discharge and is strictly observed for one month, the patient must stay in a
separate room with separate bathroom, the patient must not be cuddled, kissed
and the relatives should keep a one meter distance to the patient, when using toilet
flush twice and if possible use disposable utensils, the patient must not share
utensils and must not cook or prepare food, the patient can visit the Nuclear
Medicine Department for radiation monitoring and ask for advice when to resume
normal activities, and avoid being pregnant for one year after a RAI therapy. For
the precautionary, the pregnant women should be deferred, and breastfeeding
should be discontinued for 8 days after oral intake of radioactive I-131. The
radioisotope used is Iodine-131 or I-131, mode of administration is orally, the dose
is 5 mCi or 185 MBq, the collimator used is high energy, and for the scanning is
whole body after 48 hrs. and 72 hrs.
Furthermore, in imaging procedures for RAI after thyroidectomy for

diagnostic purposes before therapy with I-131, and several studies indicate that I-
123 is comparable to high-dose I- 131 post-treatment imaging in the detection of
thyroid remnants after thyroidectomy. After the radioactive iodine treatment, a
whole body scan (post-RAI WBS) is done to identify any thyroid cancer that has
spread outside the thyroid bed, like become metastatic.
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SUMMARY
NAME: SABORNIDO, MARY KATHERINE DATE: January 24, 2022
TOPIC: Nucmed 2- Elution and Reconstitution of Radiopharmaceuticals
For this summary, we are assigned to watch a video about Elution and
Reconstitution of Radiopharmaceuticals. This process is known as ‘eluting the
generator’ and the resultant eluate is used to compound the radiopharmaceuticals.
In making technetium using a generator, first, we need to wear proper PPE, TLD
(Thermoluminescent detector), thyroid shield, and lead gown- to protect from
radiation exposure. Elute, is we need to evacuate the vial and saline.
The first step is, Attach Saline Vial, the next step is, Insert the elution vial in
lead shielding. Then, after that attach the Elution vial and wait until elution is
completed for 5-10 minutes. After that, remove the elution vial attach protecting
vial/Cap and measure the dose calibrator. Then, get the technetium, using tong for
distance. Use time, distance, and shielding. Noted, that 20 mCi in Bone Scan. The
time of maximum yield of 99mTechnetium is 23 hours, after which the 99mTc
appears to decay with the half-life of 99Mo (66hrs).
Moreover, the reconstitution of radiopharmaceuticals, nuclear medicine

work, personnel usually receive the highest hand radiation dose during the
reconstitution of 99Tcm-labelled radiopharmaceuticals. Diethylenetriamine
Pentaacetate Pharmaceutical is for the renal scan. The purpose is to see and to
know if the kidney of the patient is functioning. The Methylene Diphosphonate is
for a bone scan. MDP is to diagnose Bone Mets or any inflammation or fracture of
a patient. TECHIDA is diagnosing congenital, liver, gall bladder, or bile ducts that
cause the patient pain, this is mostly for pediatric patients.
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In addition, for bone scan procedure, use Tc99m + MDP. We need Syringe
and MDP pharmaceutical + TC99m (Tc99m is radioactive). First, extract the
Tc99m, in 20mCi and after extract the Tc99m.
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SUMMARY
TOPIC: Nucmed 2- Radioactivity, Radionuclides, and Radiopharmaceuticals
For today’s summary, ma’am Tricia discussed to us the basic isotope

notation, radionuclide production, radioactive decay, and the radioactive half-life.
In the basic isotope notation, the atom may be thought of as a collection of protons,
neutrons, and electrons. The protons and neutrons are found in the nucleus, and
shells of electrons orbit the nucleus with discrete energy levels. By definition, all
isotopes of a given element have the same number of protons and differ only in
the number of neutrons.
Moreover, in radionuclide production, the radionuclides used to make

radiopharmaceuticals are produced artificially, mainly in a nuclear reactor or in a
cyclotron. The type of radionuclides produced in a cyclotron or in a reactor
depends on the type of energy of the bombarding particles and the target material.
A half-life usually refers to the physical half-life, which is the amount of time
necessary for a radionuclide to be reduced to half of its existing activity. the
physical half-life has characteristic values for each radioactive nuclide. Biologic
half-life refers to the time it takes an organism to eliminate half of an administered
compound or chemical on a strictly biologic basis. While the effective half-life
incorporates both the physical and biological half-lives. Therefore, when speaking
of the effective half-life of a particular radiopharmaceutical in humans, one needs
to know the physical half-life of the radioisotope used as a tag or label as well as
the biologic half-life of the tagged compound.
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Furthermore, in imaging radiopharmaceuticals the Gallium-67 is for the

bone, krypton-81m is for pulmonary ventilation, the rubidium-82 is for myocardial
perfusion, indium-111 DTPA uses for CSF flow, gastric liquid emptying, Iodine-123
in sodium uses for thyroid, iodine-131 in sodium uses for thyroid cancer, xenon-
127 or 133 in sodium uses for lung ventilation, thallium-201 in chloride uses for
myocardial perfusion, and technetium-99m for diphosphonate uses for bone, etc.
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SUMMARY
TOPIC: Bone Scan
For today we are assigned to watch a video about how to person a bone scan
and this video helped us a lot. A bone scan is a type of nuclear radiology
procedure. This means that throughout the process, a small amount of a
radioactive substance is used to aid in the evaluation of the bones. The radioactive
substance, referred to as a radionuclide or tracer, will concentrate within the bone
tissue at areas where physical and chemical changes are aberrant.
A bone scan is an imaging technology that creates three-dimensional images

of the bones by using radioactive chemicals. A gamma camera detects the
radiation released by then radio tracers, and a computer generates three-
dimensional images. A bone skin uses a technique called single photon emission
computed tomography, or SPECT, which uses a radioactive substance and a
special camera to produce 3d images of the organs and other internal structures.
Unlike an x-ray, which shows what internal structures look like, spec shows how
these structures work, for example.
The nuclear medicine bone scans consist of two parts: the injection and the
scan. In the first part, a small amount of radioactive material will be injected into a
vein, and you will be asked to return to the imaging area in about two hours.
Because the radioactive materials in the second part of your scan require time to
be absorbed by the bones, you may eat whatever your doctor permits during the
two-hour wait. Because the radioactive material is eliminated from your body
through urine, it is critical that you stay hydrated. In the video, the Radiologic
Technologists gets a Topogram or a Scout film, this is a 2-dimensional X-ray image
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acquired using a CT scanner. The topogram is routinely used in clinical CT

scanning only to define the scan range of the subsequent CT scan.
Words and Terminologies
• Bone Scan - a bone skin is a type of nuclear medicine tool that uses trace
amounts of radioactive substances called radiotracers to evaluate physical and
chemical bone changes.
• Topogram - is routinely used in clinical CT scanning only to define the scan range
of the subsequent CT scan.
Process of Bone Scan
This test requires no special preparation; you may eat and take your
medications as usual. If you are pregnant or think you might be pregnant, please
inform your healthcare team during your appointment. The nuclear medicine bone
scans have two parts: the injection and the scan. For the first part, you will be given
an injection of a small amount of radioactive material into a vein and asked to
return to the imaging area in about two hours. For the second part of your scan,
the radioactive materials need time to be absorbed by the bones, so you may eat
whatever your doctor permits during the two-hour wait.
Because the radioactive material is eliminated from your body through urine,
it is critical that you stay hydrated. Before the scan, remove any metals you may
be wearing, such as jewelry, belt coins, or coins in your pocket. You will be asked
to empty your bladder before the scan so that any radioactive urine does not block
the pelvic bone. The scan takes about thirty minutes, and there are no restrictions.
After your bone scan, your - will receive the bone scan images and test results,
and these findings will be discussed with you.
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SUMMARY
TOPIC: Nudmed- Bone Scan
For today’s task, we are assigned to watch two videos about Bone Scan.
How does a nuclear medicine bone scan work? A bone scan is a nuclear medicine
test. This means that the procedure uses a very small amount of a radioactive
substance, called a tracer. The tracer is injected into a vein. The tracer is absorbed
in different amounts and those areas are highlighted on the scan. When cells and
tissues are changing, they absorb more of the tracer. This may indicate the
presence of cancer.
Moreover, when you schedule your bone scan, the hospital or imaging
center staff will tell you how to prepare. Usually, you do not need much special
preparation before a bone scan, but it's important to confirm this with the place
giving you the test. If anything is unclear in the instructions, talk with your health
care team. What to eat. You can typically eat and drink normally before your
appointment. Your usual medications. Tell your health care team about all
medications you take. Different methods including over the counter (OTC) drugs
and supplements. Medicines that contain barium or bismuth can affect the test
results. Your doctor may ask you not to take them before your scan. Personal
medical history, tell the staff if you have any drug allergies or medical conditions.
Women should tell their health care team if they are breastfeeding or may be
pregnant. What to wear, before the test, you will need to remove metal objects,
such as jewelry. You may also need to change into a hospital gown. For the
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insurance, costs, and consent. If you are concerned about the costs of your bone
scan, contact your insurance provider before your scan. Ask if the test is covered
and how much, if any, you will have to pay. The hospital or center staff will ask you
to sign a consent form when you arrive for your scan. This form states that you
understand the test’s risks and benefits. The form also states that you agree to
have the test. If you have concerns, talk with your doctor before you sign.
Furthermore, during the bone scan. First, the technologist injects the tracer
into your body through a vein in your arm. But you will not feel the tracer move
through your body. It takes 1 to 4 hours for your bones to absorb the tracer. While
you wait, you will drink several glasses of water. By urinating frequently, you will
remove radioactive material that has not been collected in your bones. Next, you
will lie on your back on an exam table. The technologist will place a large scanning
camera above your body. You will need to remain still to prevent blurry pictures.
During the scan, the camera moves slowly around your body. It takes pictures of
the tracer in your bones. This helps to get pictures from different angles. A whole-
body bone scan takes about 1 hour to finish. You may feel discomfort from staying
in the same position for a long time.
After a bone scan, you can do normal activities after the scan. You should
not feel any side effects from the tracer or the test itself. Your doctor may ask you
to drink lots of water for the next 1- 2 days. These flushes out any tracer left in your
body. Typically, all of the radioactive material washes away after 2 days. Call your
doctor right away if you have pain, redness, or swelling around the injection site
on your arm.
The bone scan is a very sensitive study but it is not specific (since it is 2D
only). Although findings on the bone scan are non-specific, their monostotic or
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polyostotic status and anatomical distribution can provide important clues to the
differential diagnosis.
SUMMARY

TOPIC: NUCLEAR MEDICINE IMAGING PROCEDURES
Different methods, different medications, is described in the video

presentation. Methylene Diphosphonate (MDP) will be used as the
radiopharmaceutical, with a dosage of 25mCi and a 3 hour wait time. The entire
body acquisition and static capture of bone scan images are also available. Renal
Scan GFR (Glomerular Filtration Rate) also suggests a variety of renal illnesses
and the radiopharmaceuticals Diethylenetriaminepentaacetic acid (DTPA), with a
dosage of 15mCi and dynamic image collection. The physician uses a renal scan
to determine whether the patient's GFR is normal or not. The detector takes
numerous pictures during dynamic acquisition. Renal Scan Tubular Function is
another kidney scan that distinguishes renal masses and quantifies renal regional
function. Dimercaptosuccinic Acid (DMSA) will be used as the
radiopharmaceutical, with a dosage of 5mCi and a waiting time of 3 hours (the
same as a bone scan) and a Static Image capture.
Parathyroid imaging can also detect adenomas or benign tumors in the

parathyroid gland. It uses Sestamibi as its radiopharmaceutical, with a dosage of
25mCi (the same as a bone scan) and a three-part static Image Acquisition: after
15 minutes, after 30 minutes, and after 3 hours. Thyroid scans are used to assess
palpable nodules as well as other thyroid illnesses like Grave's disease and
hypothyroidism. Evaluation of ectopic thyroid tissue, undeveloped thyroid, and
lingual thyroid in children. Tc99m is the radiopharmaceutical. It includes static
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Image Acquisition with a dose of 1-3mCi for pediatric patients and 3-10mCi for
adults.
RBC tagging in the Gastrointestinal Bleeding Study indicates the location of

gastrointestinal bleeding sites as well as non-gastrointestinal bleeding sites. PYP
(Sodium Pyrophosphate) at a dose of 25mCi is the radiopharmaceutical used in
the gastrointestinal bleeding research. Meckel's Scan is a radiopharmaceutical
that identifies Meckel's Diverticulum localisation and uses Tc-99m at a dosage of
15mCi. It features Dynamic Image Acquisition (5 minutes, 10 minutes, 30 minutes,
45 minutes, and 1 hour). Pediatric patients frequently undergo this treatment.
Acute cholecystitis, biliary tract obstruction and post-surgical biliary tract

evaluation, bile leak detection, liver transplant evaluation, and other hepatobiliary
illnesses are all indicated by hepatobiliary imaging. Techida is the
radiopharmaceutical, and the dose is 6mCi. Static Image Acquisition is used in the
hepatobiliary system (5 min, 10 min, 15 min, 30 min and up to 1 hour). Pediatric
patients are frequently seen on this scan.
Lung perfusion indicates a pulmonary embolism diagnosis. MAA

(Macroaggregated Albumin) will be used as the radiopharmaceutical, with a dose
of 6mCi. The radiopharmaceutical is DTPA in the form of aerosol, and it uses the
same static picture acquisition as lung perfusion. Inhalation is used to administer
radiopharmaceuticals during this scan. Lung Perfusion is done on the 1st day and
Lung Ventilation is done on the 2nd day Bone Densitometry measures the density
of the bones, helps diagnose osteoporosis. Most common patients are mostly
women in their post-menopausal stage.
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SUMMARY

TOPIC: TomoTherapy
Today we’re tasked to watch a video about TomoTherapy. As the radiation

oncologist stated, tomotherapy is a very advanced technology for delivering
radiation therapy. TomoTherapy is a novel method of delivering radiation therapy
in the fight against cancer. It is used to treat virtually any cancer we have treated
common cancers such as breast cancer, prostate, and lung cancer. The method
integrates treatment planning, CT image-guided patient positioning, and therapy
delivery into a single system. The TomoTherapy equipment resembles a computed
tomography (CT) system.
Tomotherapy has many advantages in terms of really controlling the radiation

dose within the body keeping it directed towards our target, the cancer cells, and
keeping it away from all the normal tissue that we want to spare. TomoTherapy
combines intensity-modulate radiation therapy using a specialized CT scanner that
pinpoints the tumor and delivers 360-degree radiation to it. It obtains a CT scan
prior to treatment on a daily basis, this allows us to see whether our target that we
had planned to initially has shifted out of position in any way. So, if you come in for
tomotherapy treatment you will be ensured that we are targeting the exact
millimeters of where you were initially planned to be targeted. You will not be off-
center by 2-4 millimeters, may not sound like much but sometimes it makes all the
difference in the world.
The doctor then specifies the amount of radiation that should be given to the
tumor, as well as the allowed amounts for healthy tissue nearby. The Hi-Art
treatment system determines the best pattern, position, and strength of the
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radiation beams to be given. In big cancer, center setting like at Hoag, it has seen
virtually everything or it seems like it is planned everything possible and so there
comes the expertise you're coming to a center that's had close to 10 years of
experience and one of the earliest adopters of tomotherapy. Cancer is now a re-
treatable disease, thanks to this breakthrough technology, which opens up new
therapeutic choices.
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SUMMARY

TOPIC: CT scan simulation and immobilization.
For today’s learning discussion we are assigned to watch three videos

discussed by sir Rosendo about CT scan simulation and immobilization. Simulator
was introduced in the late 1960s, it is an additional device to assist with the
preparation of external radiation therapy (green et al 1964; karzmark and rust
1972). The original concept to check prior to treatment both that plan can deliver
in practice and relationship of the beam set-up to the patient’s anatomical features
is correct. The device used before in simulation is fluoroscopy for x-ray machines.
CT simulation is where patients are imaged on CT scanner, configured to

acquire three dimensional images used for treatment planning. CT scanner allows
the radiation oncologist to localize the tumor and surrounding areas that will require
radiation treatments. Examples of this are breast patient cases. Marking made by
radiation onco for future plans, photon plan and electron plan for superficial
treatment the deep marks is the photon. The CT scan in DDH is used for CT scan
and simulation, one simulation room requires a special laser for isocenter of the
patient. Immobilization devices are used to make sure the patients stay in the
treatment position during the course of the treatment. Radiation therapist will
manipulate the device. Thermoplastic mask is prepared for minutes to put on the
patient face, what will be the shape of the patient while doing the CT scan it will be
also the set-up of the patient in the treatment.
Wingstep and breast step is used for breast cases or upper extremities.
Breast step is for chest and breast cancer patients, the angle can be changed or
adjusted, the wing step is stationary. Bodyfix and Bellystep, bellystep for prone
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position, for rectal cancer cases. Bodyfix is for lower abdomen cases to immobilize
the entire body. Lower extremities and misc is for lower extremities, knee, index
and to fix. Techniques in rad therapy has single beam which uses high energy
single photons.
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SUMMARY

TOPIC: IMRT and IGRT
For this day we discussed the special techniques used in radiation therapy
which is the Intensity Modulated Radiation Therapy (IMRT) and Image Guided
Radiation Therapy (IGRT). IMRT is a 3D conformal radiotherapy technique that
optimizes the dose distribution by varying the radiation fluence across the beam.
IGRT is a technique of imaging the patient's anatomy on the treatment machine
just prior to each daily dose.
The IMRT, the delivery is fully dynamic using the sliding window technique
where each pair of leaves form a small moving window. This way the dose
modulating by size and the speed of these windows. IMRT typically is administered
five days a week for five to eight weeks. For each session, the patient is in the
treatment room for 15 to 30 minutes. Small amounts of radiation given on a daily
basis, rather than a few large doses, help to reduce damage to body tissues
surrounding the tumor. During the treatment, the patient must lie still. The intensity
of each beam's radiation dose is dynamically varied according to the treatment
plan. IGRT is used in conjunction with IMRT and repedar for precise patient
positioning, this enervated treatment technology provides high resolution of 3-
dimensional images to visualize size throughout the course of treatment. In doing
so, incremental adjustments to the patient's position can be made. Thereby
creating the accuracy of each dose of radiation. IGRT typically allows the patient
to breathe normally during their treatment and combines advanced imaging in
treatment capability into a single machine.
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Based on what I have observed the difference between the IGRT has more
to do with the patient's precise positioning on the treatment table to ensure the
accuracy of the radiation beam. IMRT has more to do with modulating the dosage
and shaping of the radiation beam to the precise dimensions of the prostate and
its affected areas.
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SUMMARY

TOPIC: Treatment Planning in Radiation Therapy
For this day, we are assigned to watch a topic video about Treatment
Planning in Radiation Therapy. The topic outline is all about the CT planning
procedure and treatment planning and set up procedure in replication of planned
CT treatment.
In CT Planning Procedure there is a patient assessment, check accessories

to be used, and patient instructions before and after the procedure. The patient
assessment is the doctor's order, the doctor checks the anatomy to be examined.
The check accessory to be used, in every case, has different accessories, so make
sure to prepare the accessory to be used depending on the anatomy of interest.
For patient instructions before and after the procedure, it varies in cases, and for
pelvic cases, it should be full bladder and the tapes. After the procedure instructs
the patient not to remove the tapes because it will serve as the reference during
the set-up.
In CT simulation, there are positioning, instructions, and CT markers. For

positioning, it should be aligned and symmetrical. Make sure the spine is straight,
the pelvis, and the shoulders are at the same level. A full bladder is required to
distend the intestines to avoid diarrhea. Patients must be instructed to avoid
unnecessary movements to avoid getting poor-quality images and image blur. CT
marker, for planning, put CT markers on the scars, as well as on the mask used
by the patient.
The equipment and procedures in simulation, accessories examples are a

thermoplastic mask, immobilization device, wingstep, breast step and body fix, and
bellystep. The thermoplastic mask must be heated first to allow it to be shaped on
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the patient’s head with enough heat. In a CT image, after positioning the patient,
the rad tech will scan. In Topo image, check the alignment of the patient's body,
straight the spine, pelvis for guinea cases, and for chest x-ray straight the shoulder
and the head should not be tilted. After scanning the plane and contrast the patient,
the image obtained will be sent to the physicist for contouring and planning.
Furthermore, a Digitally reconstructed radiograph (DRR) after contouring

and making a plan and it will be sent to the console computer and make it a basis
to produce positioning. A digitally reconstructed radiograph (DRR), which is utilized
for treatment verification in CT simulation, is one of the important images that can
be transmitted via telecommunication in radiotherapy.
In radiotherapy workflow, the patient evaluation is when the patient is being

evaluated by the doctor. Patient set-up and immobilization is CT simulation. Target
and organs at risk delineation it is for patient contouring. The radiotherapy
planning, dosimetry, and validation is the time when the doctor prescribes the total
amount of dose to be given to the patient. Treatment simulation is performed by
the rad tech and the position in the CT scan is should be reproduced by the rad
tech in the treatment room. Lastly, the treatment delivery.
In treatment planning, the CT scan that ben used has an electron density
and the basis of the computation. After making fields, example of 3D planning and
the basis is the contour from the doctor that takes 2-4 hours. Example of it, are
GTV, ITV, PTV, and CTV. The red is the CTV it is the tumor that is contoured by
the doctor and makes a planning target volume after covering the pelvic area with
the green highlight. They used the SAD technique, it should be center and the
basis is the isocenter of the machine. So, the source is 89.6 and it should be same
in the isocenter or the basis.
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SUMMARY

TOPIC: Brachytherapy, LDR, and HDR
Brachytherapy has been most widely applied in the treatment of cervical,

prostate, breast, and skin cancers. Brachytherapy can be characterized according
to three main factors, source placement, treatment duration, and dose rate.
The storage room is the area where we store our radioactive materials.
Before entering the room, we wear proper shielding, wear a lead gown, hydroid
shielding, and lead goggles. The brachytherapy storage room is where all the
radioactive materials are being stored. The radioactive sources are placed inside
a storage box and to handle these tongs are used. The radioactive source used in
DDH is Cs-137. When inserting radioactive source in a low dose brachytherapy
procedure, the equipment needed are straws that have the radioactive sources
and a Fletcher-suit applicator. The applicator is inserted in vagina of the patient
positioned in Lithotomy position and the applicator has three tubes, two of the
straws are inserted in the left and right tubes tubes which is called ovoids, the
remaining one is inserted into the middle tube which is called tandem, and then
after inserting the straws you close them. In inserting the radioactive source, just
follow the principle of Time, Distance, and Shielding.
The High Dose Rate (HDR) Brachytherapy, is a form of internal radiotherapy

where an oncologist; temporarily implants a catheter, a small plastic tube, or
balloon in the tumor area. It removes the catheter after you have completed the
entire course of treatment. It may need multiple sessions of HDR brachytherapy.
The HDR exceeds 12 Gy/hour, the clinical example are breast, cervix, prostate,
and skin. We use Cesium-137.
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Moreover, Low Dose Rate (LDR) Brachytherapy, emits radiation at a rate

of 0.4-2Gy/hour and the clinical example is prostate and oral. LDR entails
permanently or temporarily inserting radioactive seeds inside or around the tumor
to administer radiation over time, and we use Cobalt 60. In LDR we are the ones
to put in the source.
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SUMMARY

TOPIC: CERVICAL CANCER
Today we were shown a video discussing about cervical cancer. It is a type

of cancer that occurs in the cells of the cervix, the lower part of the uterus that
connects to the vagina. Various strains of the human papillomavirus (HPV), a
sexually transmitted infection, play a role in causing most cervical cancer.
Brachytherapy is mainly used in addition to EBRT as a part of the main treatment
for cervical cancer.
Shown in the video first were the accessories used for patients with cervical
CA cases are pelvic board and thermoplastic mask. Before any CT scan
procedure, we must have the request form with indicated patient position and
accessories to be used. In the CT scan room, when turning on the CT scanner, the
green laser lights will light which is used for patient centering and alignment.
Before starting the procedure, the patient couch should be prepared and for
the patient position, the patient is in supine with both arms up. They also showed
the patient preparation in cervical CA cases, in which the patient is instructed to
drink 1 liter of water and then wait for 20-25 minutes. The thermoplastic mask on
one patient depends on the plan on how long it will be used, in some cases it will
be 25 days. In the CT scan control room is where you can see the current position
of the patient and will be monitored if the spine of the patient is aligned and also
the superior and inferior border of the spine. Before placing a thermoplastic mask
to the patient, make sure to obtain a topogram image to ensure alignment of the
patient’s spine. Topogram (a CT scout view) is a 2D x-ray image acquired using a
CT scanner. In the video, it showed the lateral view of the patient.
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After the topogram and some correction on the patient position, the
thermoplastic mask is heated then cools it off then placed on the pelvic area of the
patient. CT markers are placed on the pelvic mask for reference. After the CT
scanning, the image is sent to the physics room, where the treatment planning is
done and this is also where the image is edited, what technique to be used on the
patient, and where the contouring happens and treatment planning. After the
physics room, will then proceed to treatment and setting up the patient. The patient
is positioned inside the room and the scanning and setting up the FOV or field of
view for the treatment. In the video, it showed a yellow and other color outline,
which is the OAR or organs at risk, and the red outline, which is the PTV or
planning target volume.
After choosing the FOV, the machine starts to scan with a scanning time of
150 seconds. Two images were shown, one from the tomotherapy, and the other
from CT scan. Now they need to be matched. Once the image is already
reproduced with exact patient position, we can already click accept then proceed
to treatment. After some finalization in the program, then proceed to status console
to start.
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SUMMARY

TOPIC: BRAIN CANCER
Today we were shown a video about brain cancer. It is a type of carcinoma

that involves an overgrowth of cells in the brain that forms tumors. Cancerous, or
malignant, brain tumors can grow very quickly, depending on the type of tumor.
They can disrupt the way the body works, and can be life-threatening. Brain cancer
however is quite uncommon.
Radiotherapy is a common treatment for secondary brain tumors. It aims to

shrink the cancer, relieve the pressure inside your skull, and reduce your
symptoms.
The radiotherapy workflow for a brain CA case includes; patient evaluations,

CT scan simulation, target and OAR’s delineation and planning, treatment
simulation, and treatment delivery. For the CT simulation, we need the accessories
to be used, the positioning for the patient, and the immobilization, which is the
thermoplastic mask. The accessories are an overlay, head mask, and pillow. The
patient positioning is supine with arms at the side and observe no tilting. Then
apply the head mask for the immobilization and the scan is only from the vertex of
the skull to the base and at least 2cm margin for both. After the simulation, the
image is sent to the physics room for contouring and planning. In the treatment
simulation patient position is the same as in the CT simulation. There are
parameters in the control console so that after you positioned the patient correctly,
you will save the parameters for treatment delivery. Make sure that the patient took
the dexamethasone or steroids to avoid headache.
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The type of radiation in radiobiology and fractionation are photons and

megavoltage. Total dose for it can be varied in special circumstances, such as
histology of the tumor (melanoma 5000 cgy, lymphomas 3000 cgy). Usually, 4000
cgy in 20 fractions over 5 weeks is the total dose. The radiotherapy technique is
that the whole brain irradiation with the shape blocked at the base of the skull to
shield the eyes and encompass the cranial contents with 2 cm margin all around
and opposed lateral.
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SUMMARY

TOPIC: CT SCAN
For this day we are assigned to watch video discussion in CT scan. CT scan
is also known as “CAT Scan” or computerized axial tomography, it is a painless
diagnostic test that uses x-rays and computers to create cross-sectional images of
bones and tissues inside your body. The doctor may recommend a CT scan to
examine your body for any of the following blood clots, broken bones, brain tumor
(cancerous tumor), infection (sinus infection), internal injuries and bleeding
(ruptured spleen), and signs of heart and vascular disease (heart disease).
A CT scanner is a large square or round x-ray machine with a tunnel through

the center. A CT scan helps your doctors, select a location for surgery, biopsy, or
radiation therapy, check the treatment of cancer or heart disease, and check
condition after the surgery. During a CT scan, you will lie on a table that slowly
passes through the tunnel. As you move through the tunnel, a giant ring called a
gantry will rotate around your body. Gantry contains a tube that will release x-ray
beams and detectors that will measure the amount of radiation absorbed by the
body. The x-ray beams will capture many views of your body from different angles.
As the gantry spins, the detectors will send data to a computer.
The scan allows the doctor to see the location of a condition inside the body
which will help them decide how to treat it or to see how well the treatment is
progressing in some cases patient may receive contrast dye. If you received a
drink with contrast dye, your esophagus or stomach will be highlighted. If you
received an injection your blood vessels, gallbladder, liver, or urinary tract will be
highlighted. If you received a barium enema your large intestine will be highlighted.
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After the procedure, the patient could resume normal activities, if you received
contrast dye. Drink plenty of fluids, to help the kidneys remove the dye from the
body.
In DRMC virtual tour, they use Neusoft 128 slice CT scan the Uninterrupted
Power Supply (UPS). Inside the control room, the operating console, computer for
PACS (picture archiving and communication system), and accessing the hospital
integrated system. Inside the T scan room, there has a gantry, table, lead gown,
patient’s gown, preparation area, and high-pressure syringe. In the operating
console, it consists of, a keyboard, monitor, mouse, buttons which can access the
gantry from the inside, and button and monitor for the high-pressure syringe.
The machine’s quality control, upon turning on the machine we must first
perform the warm-up so that the tube can be properly warmed up before any
procedures. Contrast media-iodine based can cause an allergic reaction, diabetes
or renal disease, require special care because kidneys involved with filtering iodine
from the bloodstream.
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SUMMARY

TOPIC: DRMC CT SCAN VIRTUAL TOUR
Today we had a virtual tour in which Sir Merchard James P. Alonzo, the
technologist in charge, took us for a walk throughout DRMC and their CT facilities.
First, off was the demonstration of the LINAC machine and peek at the Nuclear
Medicine department. Second, they showed the MRI room, which is a 1.5T
PHILIPS MRI machine. With that, they also explained the basics before condoning
any procedure. For each procedure, we must identify the patient parameters,
double-check the procedure, check the patient’s creatinine result (and current
swab result as per covid-19 protocols). Secure the contrast media waiver, which
must be signed, and then proceed with the procedure.
In the last parts of the virtual tour, the DRMC’s Toshiba 16-slice CT scan
machine was introduced and used to show the practice of an abdominal case in
which the scan is from the head to the femoral. To avoid extravasation, the DRMC
employs a Bolus contrast injection. In a supine position, with arms at the side and
feet first. Then, align both hips and arms up for a relaxed position or relaxed pose,
and check the isocentric or collimator line. Explain the breathing instructions to the
patient and then execute the scan. When the line is dislodged or the line is fine,
use a saline solution of 10cc, then apply the bolus as the artery is very fragile and
easily extravasated). For the portal venous phase, add 30cc and patient instruction
before injecting contrast media with contrast communication to the patient.
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SUMMARY
TOPIC: CT scan and data acquisition
Our topic for today is all about basic principles of CT scan and data acquisition.
Computed tomography uses a computer to process information collected from the
passage of x-ray beams through an area of anatomy. The images created are
cross-sectional. The elimination of superimposed structures, the capacity to
identify minor changes in density of anatomic structures and anomalies, and the
higher image quality are the key advantages of CT over conventional radiography.
Each CT slice shows a different plane in the body of the patient. The Z axis refers
to the thickness of the plane. The thickness of the slices is determined by the Z
axis. The CT slice data is further divided into elements: width is represented by X,
while height is represented by Y.
We also discussed the different parts of a CT scan machine and its functions:
(1) Gantry - ring-shaped part of the CT scanner. It houses many of the

components
necessary to produce and detect x-rays. The CT gantry can be tilted either forward
or backward as needed to accommodate a variety of patients and examination
protocols.
In addition, the gantry houses the following parts:
a. Slip rings b. Generator
c. Cooling systems d. X-ray source
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e. Filtration f. Collimation g. Detectors
(2) Console - master control center of the CAT scanner. It is used to input all of the
factors related to taking a scan.
(3) Patient table - The patient lies on the table (or couch, as it is referred to by
some manufacturers) and is moved within the gantry for scanning.
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SUMMARY

TOPIC: IMAGE RECONSTRUCTION and IMAGE DISPLAY
This day the assigned topic is Image Reconstruction and Image display.
Some of the terminology used to describe steps in the reconstruction process may
be unfamiliar to the reader. Therefore, the first step in describing image
reconstruction is to define common terms. An algorithm is a precise set of steps to
be performed in a specific order to solve a problem. Algorithms are the basis for
most computer programming. The reconstruction algorithms are used by the
computer to solve the many mathematical equations necessary for information
from the detector array to be converted to information suitable for image display.
Moreover, Fourier Transform was developed by the 17th-century

mathematician Baron Jean-Baptiste-Joseph Fourier, the Fourier transform is a
method to study waves of many different sorts and also to solve several kinds of
linear differential equations. Loosely speaking it separates a function into its
frequency components. A rough analogy is a musical chord being separated into
individual notes. More precisely, it is a technique for expressing a waveform as a
weighted sum of sines and cosines. Computers generally rely on a version known
as discrete Fourier transform (DFT). An efficient algorithm to compute DFT and its
inverse is called fast Fourier transform (FFT). FFTs are of great importance to a
wide variety of applications including acoustical and image analysis and have been
used in fields as varied as geologic surveying to actuarial analysis for the insurance
industry. Interpolation is a mathematical method of creating missing data.
Furthermore, the equipment components used for image construction are

hard drive, input, and output device, CPU, and memory. The hard disk (or hard
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drive) is an essential component of all CT systems. The number of images that the
hard disk can store varies according to the make and model of the scanner. It is
important to remember that an enormous amount of information is collected for
each image. When hard disk space capacity is reached, existing data must be
deleted before any new data can be acquired. Many facilities use a long-term
storage device to save these data. Saving studies on auxiliary devices for possible
future viewing is referred to as archiving. Input and output devices are ancillary
pieces of computer hardware designed to feed data into the computer or accept
processed data from the computer. Examples of input devices are keyboard,
mouse, touch-sensitive plasma screen, and CT detector mechanisms. Output
devices include monitors, laser cameras, printers, and archiving equipment such
as optical disks or magnetic tape.
The CPU is the component that interprets computer program instructions

and sequences tasks. It contains the microprocessor, the control unit, and the
primary memory. In the past, the CPU design frequently used for CT image
reconstruction was the array processor. Also called a vector processor, this design
was able to run mathematical operations on multiple data elements
simultaneously. The central processing unit, or CPU, interprets computer program
instructions and sequences tasks. It has been referred to as the “brain” of the CT
system. The three principal types of solid- state memory are read-only memory
(ROM), random access memory (RAM), and write- once-read-many times
(WORM) memory. Both ROM and RAM are part of the system’s primary memory.
Primary storage refers to the computer’s internal memory. It is accessible to

the CPU without the use of the computer’s input/output channels. Primary memory
is used to store data that are likely to be inactive use. Primary storage is typically
very fast. ROM is imprinted at the factory and is used to store frequently used
instructions such as those required for starting the system. The opposite of RAM
is serial access memory (SAM), which stores data that can only be accessed
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sequentially (like a cassette tape). WORM refers to computer storage devices that
can be written to once but read from many times. These can be subdivided into
two types: those that can be physically written to only once, such as CD-R
(compact disk-recordable) and DVD-R (digital video disk-recordable), and those
that have rewriting capabilities but use devices that prevent data already written
on a tape from being rewritten, reformatted, or erased. The rationale for disabling
rewrite functionality is to comply with regulatory standards, such as the Health
Insurance Portability and Accountability Act (HIPAA).
All the thousands of bits of data acquired by the system with each scan are
called raw data. The terms scan data and raw data are used interchangeably to
refer to the data sitting in the computer waiting to be made into an image. The
process of using raw data to create an image is called image reconstruction. This
process is referred to as retrospective reconstruction. Raw data includes all
measurements obtained from the detector array. Raw data storage requires much
more computer storage space than that image data. To form an image, the
computer assigns one value (Hounsfield unit) to each pixel. This value, or density
number, is the average of all attenuation measurements for that pixel. The two-
dimensional pixel represents a three-dimensional portion of patient tissue. The
pixel value represents the proportional amount of x-ray energy that passes through
anatomy and strikes the detector. Once the data are averaged so that each pixel
has one associated number, an image can be formed. The data included in this
image are appropriately called image data. Image data require approximately one-
fifth of the computer space needed for raw data. For this reason, image data allow
measurements such as Hounsfield units, standard deviation, and distance, but
anything not seen on the image is unavailable for analysis.
Image display includes all of the system components necessary to convert

the digital data created from the reconstruction process to electrical signals needed
by the CT display monitor. The display system also includes the ability to display
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patient information and scan protocol data, and provides many graphic aids
designed to assist in image interpretation.
The device used to display CT images is generally a black-and-white or color

monitor. The display device is usually either a cathode-ray tube (CRT) or some
form of flat panel such as a TFT LCD (thin-film transistor, liquid crystal display).
CRT monitors are heavier, bulkier, hotter, and less durable than the newer LCD
monitors. In addition, LCD monitors produce higher luminance and higher spatial
resolutions. Digital-to-analog converters (DAC) accomplish this task. DAC
changes the digital signal from the computer memory back to an analog format so
that the image can be displayed on the monitor.
CT systems offer a variety of functions that allow images to be manipulated

to facilitate diagnosis. Defining an ROI is the first step in many measurement and
display functions. Hounsfield measurement, standard deviation, and distance
measurement may offer valuable diagnostic information. It is important to annotate
images with any information that may not be immediately apparent. Examples of
such annotation include “Images in this study have been flipped, top to bottom”
and “Delayed image: 15-minute post-contrast injection.” The technologist must
understand the difference between image magnification and decreasing the
display field of view size and use each function appropriately.
In some instances, the images are transferred to film. The camera is an

output device that transfers the image from the monitor to the film. The camera
used maybe a multiformat camera, although most CT systems today include a
laser camera. Multiformat cameras transfer the image displayed on the monitor to
film. Laser cameras bypass the image on the display monitor and transfer data
directly from the computer, bypassing the video system entirely, thereby
significantly improving image quality.
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The display functions are the final step in creating the CT image. Analog
monitors display the CT image. Therefore, the digital signal from the computer’s
memory must be converted back to an analog format. In general, the window level
is set at roughly the same level as the Hounsfield value of the tissue of interest.
Optimal window settings are highly subjective, and they vary dramatically within
the field. Published window widths and centers are intended to serve as guidelines
only. Patient conditions, as well as personal preference, make the considerable
adjustment necessary.
Image reconstruction refers to the process whereby a computer manipulates

data collected from the detectors to create a CT image. A basic understanding of
the concepts common in computer science is a helpful building block. These
concepts include the use of algorithms, Fourier transform, and methods of
interpolation. Raw data include all attenuation measurements obtained from the
detector array. Some of these raw data are used in the creation of the image. After
the raw data are averaged and each pixel is assigned a Hounsfield number, an
image can be reconstructed. The data that form this image is then referred to as
image data. SFOV refers to a selected circle in the center of the gantry. Raw data
are acquired and calibrated for any object that lies within this circle. The entire
scan circle or any portion of the circle may be selected to display on the monitor.
The size of the circle that is displayed is called DFOV. Once the computer has
manipulated the raw data throughout the image reconstruction process, it is then
ready to be displayed.
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SUMMARY
TOPIC: DRMC CT SCAN
For this day, we are assigned to watch DRMC CT scan virtual tour. The
clinical application, head, and neck, second the upper extremities mainly thoracic
(thoracic, and abdomen, third is the lower extremities consist of pelvis, legs, and
knees. For the reminder, always double-check the patient, check the patient’s
request form, the patient’s details, check requested procedures, check the
patient’s clinical history. For contrast procedure, check if the patient signed the
waiver or consent form, to avoid damages with a patient.
The preparation of equipment needed for the exam, foam wedges for
cranium of infants and children, feet rest for thoracic and abdomen, head holder
for cranium and neck. The common items needed in contrast examination. First is
the contrast media, second is the syringes, 5cc syringe to check patency of
patient’s IV line, 30cc or 50cc for bolus administration of contrast media. The third
is the high-pressure syringe which is used along with a power injector.
For the positioning of the patient, place the patient in a supine position for
cranium and neck procedures. Secure patient’s head with foam wedge then locks
or tighten with Velcro to prevent patient movement. Make sure to turn on the lasers
to properly position the patient. The landmark for the cranium is 2-3 fingers above
the head. Make sure the centering of patient’s MCP to the lasers. Before going into
the console room, set the table position to 0. That is also applicable in thoracic and
abdomen examinations. The two landmarks for the chest and abdomen, for the
abdomen which should be in the nipple line, and for the chest, it should be in the
lip area.
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Contrast media examination for the cranium, 30cc or 50cc syringe is

normally used and more convenient and faster. The contrast examination of the
thoracic, abdomen and lower extremities normally used a high-pressure injector or
power injector. The examination protocols it usually used in axial plain for cranial
procedures, it is for the patients with a diagnosis of CVA or stroke. The brain helical
is the patient who has undergone trauma. The difference between cranium plain
and cranium with contrast, the contrast medium highlights the overall structure of
the organ, while the plain is plain. The cranium with contrast, appearance is bright
and structures are more visible compared to plain. Protocols commonly used are
chest plain and chest with contrast. The protocol for thoracic and abdomen
requests is thora ABD IV contrast timed.
The overview of scan list for a chest with contrast studies, first is
surview/topogram/plain scan, next is the chest plain and the other scan list is
automatic reconstruction, lastly the IV contrast. The biphasic has no delayed scan.
Delayed scan, the scanning patient is 5 minutes after administering contrast media
to the patient. Triphasic has delayed scan, scanning patient after 5 minutes of
contrast media administration. The plain whole abdomen is an ample amount of
contrast media visible inside the patient. Before performing a whole abdomen
scan, let the patient drink 800ml of water mixed with 25ml of contrast. The locator
is set in the aorta of the patient, once contrast media enters the aorta, it will
automatically scan the patient.
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SUMMARY
TOPIC: Neurologic Imaging Procedures
For this day, the topic is all about Neurologic Imaging Procedures. Ionizing
radiation is used to create images in a neurological CT (computed tomography)
scan. The components in your brain and spinal cord are examined with this
noninvasive imaging examination. A CT scan of the brain can be used to look for
tumors and other lesions, as well as traumas, cerebral hemorrhage, and structural
abnormalities. When another type of tests, such as x-rays or a physical exam, is
inconclusive, this method is used if the patient has hydrocephalus, infections, brain
function, or other disorders.
The patient's head is positioned in the head holder for most head imaging
protocols, according to the General Imaging Methods for the Head. The head
holder can sometimes be used for neck procedures, depending on the design.
When the head holder isn't needed, a molded sponge is placed directly on the scan
table and the patient's head is positioned within it. To avoid motion artifact on the
images, the patient should be made as comfortable as feasible and immobilized
as well as possible. Small wedge sponges on either side of the patient's head are
commonly used to achieve this. For CT scans of the head, it is usually unnecessary
to instruct the patient to hold their breath.
The slice angle is determined by the patient's head position and the gantry's
angle. Although it was originally typical to design the brain's cross-sectional slices
to be parallel to the orbitomeatal line, more current practice prefers using the
supraorbital meatal line to decrease radiation exposure to the eye's lens. Many
multidetector CT systems have the drawback of not allowing the gantry to be tilted
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when in helical mode. As a result, for routine brain imaging, axial or step-and-shoot
techniques are frequently used. The beam-hardening artifact is widespread in the
posterior fossa due to the dense bone of the skull.
It is not the technologist's job to interpret images. However, technologists

must be able to spot certain potentially essential pathologic alterations so that they
can be brought to the attention of a radiologist when they occur. When scanning
the neck, an IV contrast medium is utilized unless it is contraindicated. The
purpose of CT scanning of the neck is to provide enough time for the mucosa,
lymph nodes, and pathologic tissue to enhance after contrast administration while
keeping the vasculature opacified. A delay of 1 to 3 hours between the contrast
injection and CT scanning is recommended when CT is conducted following
intrathecal contrast delivery for fluoroscopic myelography. This time delay permits
the contrast substance to dilute enough.
A non-contrast CT scan of the brain is used to distinguish ischemic stroke

from hemorrhagic stroke, examine the state of cerebral circulation and tissue, and,
secondarily, assess the underlying disease. The transport of iodinated contrast
through the cerebral arteries is monitored in perfusion studies. CT perfusion is
most used to diagnose acute; however, it can also be used to diagnose vasospasm
or tumor grading. CT perfusion can also be utilized to measure cerebrovascular
reserve during temporary balloon occlusion techniques with few modifications.
In conclusion, CT perfusion is a useful tool for assessing patients who have

had an acute stroke, but it can also be used to diagnose other cerebrovascular
illnesses. The CT scan is useful for determining the cause of a neurologic problem
or assessing injuries to the head, sinuses, temporal bone, neck, and spine. The
benefits of a broader scanning range, shorter scanning time, and finer z-axis
resolution were realized with the advent of multi-slice CT, all of which are beneficial
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in the neuroradiologic diagnosis. CT is the predominant imaging modality for

trauma and acute changes in the neurologic state, such as ischemia and cerebral
bleeding. For quick examination of the cervical and cerebral arteries, CTA has
become a popular alternative to digital subtraction angiography. The anatomy and
pathology of the spine can also be seen clearly on a CT scan. The utility of CT with
intrathecal contrast medium injection is well established, and the use of CT as a
follow-up study to standard fluoroscopic myelography is common in spine
evaluation.
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SUMMARY
TOPIC: Neurologic Medicine
Today we were given a virtual presentation of an actual scan courtesy from

the DRMC hospital. Both of the patients involved with the procedure were allowed
to be filmed and gave their consent thoroughly to which we students are grateful
for so we could see an actual CT procedure to be done. First off, the patients were
interviewed and asked if they had allergies to certain foods like seafoods, eggs
and eggplants. The tech also inspected some remaining metallic materials from
the patient’s body. Making sure that the body is free from all metals like bra’s wire,
belt, or even buttons as well as the belly bands.
After the short interview of the patient, the patient is then now positioned in
bed, feet first and supine in the user interface. The patient’s procedure is a chest
and whole abdomen CT scan. The tech aims for correct planning by straightening
the spine, no rolling below pelvis or the hips part. Once the patient is settled down
on the bed, you have to pre-instruct the patient’s breathing exercise prior to the
procedure. Upon entering the control room, then the procedure can be started. The
tech now is communicating with the patient. Eventually the first procedure was a
plain scan. The tech then made additional reconstruction details for chest area, for
lung reconstruction with slice thickness of 5.0/5mm. The tech constantly
communicates to the patient. The next procedure is the administration of saline
flush, ask the patient for any discomfort sensation to check for extravasation, after
the flush is the administration of contrast media for chest and arterial phase then
continue the scanning. Consequently, review the images before letting the patient
leave. They also showed about the tibe/heat load, it is the amount of energy
deposited during the exposure.
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The procedure also has post-procedural care, the reason why the patient
was being asked in the first place if this is their first time undergoing such a
procedure or they had experienced already to interconnect the post-procedural
care. In such cases, if the patient is a first timer, there is a possibility of having
delayed onset of allergic reaction to contrast. Thus, the patient must stay for at
least 1 hour before removal of heplock, however if it's not their first time therefore
the patient must stay at least 30-45 minutes depending on the institution. On the
other hand, the same goes to the second patient, they both performed chest and
whole abdomen. However, the patient said she’s allergic to seafood, that’s why the
techs held the procedure and went to confirm if the patient had pre-med, so as the
patient said she’s somehow allergic to seafoods. Consequently, double check the
patient’s information to avoid adverse reaction to contrast media, thus the tech will
take the responsibility once there’s an occurrence of any reactions.
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SUMMARY
TOPIC: Abdominal and Pelvic CT examinations
Today we were given a reference about the abdominal and pelvic CT

examinations. The preparation of the patient for CT examination of the abdomen
and pelvis is more important than the preparation of the patient for CT evaluation
of any other part of the body. As a general rule, the bigger the volume of oral
contrast material used in an abdominopelvic CT scan, the better the bowel
opacification. Although a volume of at least 600 mL is recommended, patient
compliance may be a limiting issue in achieving this volume target. When the
bladder is filled with urine or contrast agent, the bladder may be seen in the best
light on CT.
For specific examinations of the pancreas, liver, and kidney, as well as in

many abdominal CTA procedures, multiphasic imaging is widely employed. In any
given slice, there is significantly more information than can be displayed by a single
window with its width and level settings set to their maximum. As a result, photos
are frequently evaluated in two or more window configurations. During
abdominopelvic scanning, patients are asked to hold their breath during data
gathering in order to reduce movement and motion artifacts, which are
undesirable. Movement of the patient throughout the scanning process will result
in anatomic structures being moved, deformed, or obscured.
When fatty infiltration of the liver occurs, the liver's attenuation is lower than
normal, and there is an abnormal attenuation differential between the liver and the
spleen, respectively. Non-contrast CT scans are the most accurate way to
determine this. Many operators incorporate a ROI of the liver as well as a ROI of
the spleen in their procedures. When the liver measurement is at least 10 HU lower
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than the spleen level, fatty infiltration of the liver is suspected and should be
treated.
On CT scans, the majority of hepatic hemangiomas exhibit a distinct look.

Hemangiomas present as a well-defined hypodense tumor on unenhanced
computed tomography (CT). In the hours following IV contrast injection, the lesion
exhibits progressive "filling-in" enhancement from the periphery. After a while, the
lesion gets evenly enhanced in appearance.On CT scans, the majority of hepatic
hemangiomas exhibit a distinct look.
Hemangiomas present as a well-defined hypodense tumor on unenhanced

computed tomography (CT). Following the introduction of IV contrast, the lesion
exhibits increasing "filling-in" enhancement from the periphery as time goes on.
After a while, the lesion gets evenly enhanced in appearance. CT scans of the
kidneys and ureters without the use of contrast agents are typically reserved for
the detection of calcifications and calculi that may be hidden by the contrast agent
Assessing the attenuation values of an adrenal mass and measuring the

amount of iodinated contrast that is washed out of the bulk on delayed imaging are
two methods for determining whether an adrenal mass is benign or cancerous. An
astute technologist can save a patient the time, money, and radiation exposure
associated with a repeat examination by identifying an incidentaloma and tailoring
the study to provide the radiologist with the data necessary to determine whether
the mass is benign or malignant. Identifying an incidentaloma and tailoring the
study to provide the radiologist with the data necessary to determine whether the
mass is benign or malignant
Using specialized adrenal imaging procedures, doctors can try to determine

the nature of lesions in the adrenal gland. With imaging, the goal is to reduce
unneeded biopsies, the number of follow-up investigations required for an
appropriate diagnosis, and the overall cost of health-care services and procedures.
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Any homogenous adrenal mass that measures less than 10 HU on unenhanced

CT is considered benign, and there is no need to change the scan protocol in this
case. In addition, because of the variance in location, it is more difficult to find the
appendix on cross-sectional scans. In appendicitis treatment procedures, there is
a great deal of variety; different combinations of oral, rectal, IV, and no contrast
material may be used in different situations. Protocols also differ in terms of the
anatomical area that will be scanned during the scan. The stated accuracy of all
procedure modifications for diagnosing appendicitis is high, according to the
literature. When the appendix is proven to be normal, the rate at which these
methods provide an alternate diagnosis may be the most variable among them.
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SUMMARY
TOPIC: Musculoskeletal Imaging Procedure
For today’s learning discussion focused on Musculoskeletal Imaging

Procedure. Scanning protocols for the musculoskeletal system are customized for
each patient. Although intravenous contrast medium is not usually used in the
treatment of musculoskeletal damage, it is useful in other situations, such as the
diagnosis of infection or a soft-tissue malignancy. Multiplanar reformations are
found in the majority of musculoskeletal prototypes.
It can be challenging to arrange a patient for a CT examination of the wrist

in a comfortable and stable manner. Various methods are employed. The patient
is sometimes positioned with his arm above his head. Another option is for the
patient to sit or stand on the scanner's far side and extend his arm into it. Scanning
the patient's wrist as it sits on his abdomen is a third, less desirable option.
CT arthrography is useful for evaluation of the joint capsule and

intracapsular structures and for finding loose bodies within the joint. The protocols
used to scan the musculoskeletal system are tailored to each patient and region
being examined. Radiologists typically review each request for a musculoskeletal
CT examination and adjust the protocol to be used to fit the circumstances. Oral
contrast media not indicated for musculoskeletal protocols. Unless specified by the
radiologist, examinations are performed without intravenous contrast media, as
well. Clinical indications that may necessitate IV contrast include infection or tumor.
When IV contrast is ordered, 150mL of LOCM is injected at 2mL/s and scanning
begins after 60 second.
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MRI is the primary imaging modalities for many musculoskeletal disorders.

MDCT is also useful in the detection of fine calcification, which is particularly
important in the diagnosis of cartilage or bone-forming tumors and other
abnormalities of bone formation. In other clinical situations CT and MRI
examinations are complementary and both are performed to provide a
comprehensive diagnosis.
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SUMMARY
NAME: Sabornido, Mary Katherine V. DATE: April 18, 2022
TOPIC: Magnetic Resonance Imaging
The virtual tour of MRI at Davao Doctors Hospital is the topic of today's
video presentation. Magnetic Resonance Imaging, or MRI, is a technique that
allows doctors to detect, monitor, and treat medical disorders. Strong magnets,
radio waves, gradients, and a computer are used in MRI to create images of the
inside of the body. MRI images are more detailed than those obtained through
other methods. Before having an MRI, the technician will ask you to remove all
metallic things from your body, such as belts and jewelry, as it is not safe to have
an MRI with some medical implants.
There were access zones in every portion of the MRI department in the
video that was shown to us. The first zone is an MRI access space, which also
serves as a patient and reception waiting area. Zone 2 is for patient screening and
procedure preparation. While zone 3 is prohibited from general public access by a
reliable restricting technique that distinguishes between MR and non-MR workers,
zone 4 is open to the general public. Before entering this area, you will pass
through a fingerprint-access door and a metal detector to see if there is any metal
inside the body or any metallic objects. In addition, the MRI department has items
or materials such as an MR-compatible fire extinguisher, an MR-compatible
stretcher, and a wheelchair.
There is a statement in the MRI room before you enter zone 3 that says
"please do not enter without the supervision of MRI personnel," and there are also
warning signs because this area has a strong magnetic field. There is a comfort
room, dressing room, and locker for patients' possessions inside the MR room, as
well as consent paperwork for each patient to fill out prior to the procedure and
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slippers. Zone 4 is where the MRI machine is located in an area that has a strong
magnet which can detect any metallic objects. MRI machine has magnetic field
strength with 1.5 T and there is coil mounted which is the head coil where it acts
as an antenna to receive the radio frequency signal coming out of the body and
transmit that data to a computer which then generates images and also there is a
coil cabinet where the different types of coils are placed, and also there is a MR
compatible mechanical injector. Inside the MRI room the allowed things are
marked as a MR-safe or MR-conditional. In MRI console area there is a mirror in
between in MRI room. There is a computer, different types of monitors and control
buttons to press like stop button, pause, start, moving/stop the table and
microphone button used to communicate with the patient inside the MRI room.
For preparation, you will lie on a table just outside the scanner. MRI
scanners are very noisy and the patient will probably wear earplugs or
headphones. For different equipment such as pillows and straps this will help to
maintain the correct position of the patient once the patient is ready the table will
slide into the scanner. Inside the scanner is very narrow. During the scan magnets
in the machine will create a strong magnetic field but it’s not harm as what people
think then the scanner will send radio waves through your body, when the radio
waves are turned off the scanner will pick up energy signals from the patient’s body
those signals are used to make the pictures during the scan the patient should stay
still to have a clear image and asked to hold breath for a short time. MRI’s takes
30-45 minutes or longer to have a complete procedure in some cases patients will
undergo with contrast dye with you with MRI, the dye with MRI helps to make clear
pictures. If the patient received contrast dye the tech may ask the patient to drink
plenty of water to drink to remove them from the body.
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SUMMARY
TOPIC: Overview of Magnetic Resonance Imaging
For this day we discussed the overview of Magnetic Resonance Imaging.

Magnetic resonance images are made with RF in the range from approximately 10
to 300 MHz. Use of the RF region of the electromagnetic spectrum to produce an
image is especially spectacular. It is based on an analytical procedure called
nuclear magnetic resonance (NMR) and was first called nuclear magnetic
resonance imaging (NMRI). Some of the leaders in radiology were concerned
about using the word nuclear around patients since NMRI really didn’t involve any
kind of ionizing radiation. As a result, that word was dropped early in the
development of this imaging process, and we are left with magnetic resonance
imaging (MRI).
MRI has multi-Planar Imaging ability which helps obtain direct transverse,
sagittal, coronal, and oblique plane images. NO Radiation, MRI does not use
Ionizing radiation, MRI uses RF electromagnetic radiation and magnetic fields,
which do not cause ionization and therefore do not have associated potentially
harmful effects of ionizing radiation. The basic principle of MR is that if a specific
atomic nucleus is placed in a magnetic field, it can change shape be triggered by
radio waves of the correct frequency (absorb energy from) Following The nuclei
release the extra absorbed energy by releasing radio waves as a result of this
stimulation. An antenna can receive (the MR) signal, which can then be examined.
The Benefits of MRI Contrast Resolution, Multi-Planar Imaging, and No Radiation
are preferred above other modalities. MRI (magnetic resonance imaging) is a
technique Low-density objects with identical soft tissue can be visualized thanks
to the high contrast resolution.
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There are 3 main components of the MRI Gantry, Computer, and Operating
Console. A gantry is a large, usually cylindrical device that accommodates the
patient during imaging, MRI gantry does not have moving parts everything is
electronically controlled, and the patient's aperture is usually 50- 60 cm in
diameter. RF coils which are called the RF probe surround the patient in this
aperture, RF coils produce RF waves. It serves as an RF transmitter and receiver
at the same time. Computer, similar to CT, only faster and bigger. During MRI
examination, more data are collected and the computations required are longer
and more difficult than the CT, lastly, MRI operating control. Hydrogen is abundant
in the human body, Abundant with a large magnetic moment, and exists in 2
molecules: Water & Fats. Hydrogen is considered magnetically active. In net
magnetization, more protons align in one direction than in the other “sum of the
contributions of all magnetic moments of the individual protons”. Need not be
aligned with the direction of the magnetic field.
Net magnetization Can be classified into two components: Longitudinal

magnetization and Transverse magnetization. The Cartesian coordinate axis, X,
Y, and Z, is always rendered with the Z-axis as the vertical axis as shown. Vector
diagrams that show this coordinate system will be used to develop the physics of
MRI.
Precession is a change in the orientation of the rotation axis of a rotating

body, due to the influence of B, the hydrogen nucleus “wobbles” or precesses (like
a spinning top as it comes to rest). The axis of the nucleus forms a path around B0
known as the “precessional path” the speed at which hydrogen precesses depends
on the strength of B0 and is termed the “precessional frequency” The precessional
paths of the individual hydrogen nucleus’ is random, or “out of phase” The Larmor
Equation, Sir Joseph Larmor is an Irish-born mathematical physicist, Professor of
mathematical physics at Cambridge, His famous 1897 equation was to explain
Zeeman splitting of optical spectra due to electron orbital motion, not NMR. Larmor
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frequency is the frequency at which the hydrogen precess. The frequency of

precession. When a Hydrogen atom is near an externally applied magnetic field
(Bo), an increase or decrease causes the precessional frequency or resonant
frequency also increase or decrease. Larmor Equation, Where: ω0 = frequency of
precession / resonant frequency (MHz) Y = gyromagnetic ratio (MHz/T) B0 =
strength of external magnetic field (T). A Fourier transform (FT) is a mathematical
transformation that decomposes functions that are spatially or temporally
dependent into functions that are spatially or temporally dependent. Decomposing
the waveform of a musical chord into the intensity of its constituent pitches is an
example application.
For the RF coil, placing a patient in a magnetic field (B0) polarizes the
patient and causes each proton dipole to process randomly. Net magnetization
changes along the Z direction and the protons precess in a phase when a proper
radiofrequency (RF) pulse is transmitted to the patient. Precessing net
magnetization induces a radiofrequency (RF) signal in a receiving coil. That RF
signal is called a free induction decay. The free induction decay is a decreasing
harmonic oscillation of the Larmor frequency. When a Fourier transformation (FT)
is performed on the free induction decay, a nuclear magnetic resonance spectrum
result. If the same tissue were in the two highlighted pixels, both pixels would be
represented by the same peak in the nuclear magnetic resonance spectrum. In the
presence of a gradient magnetic field, BX, the nuclear magnetic resonance
spectrum provides information on pixel location. Projections can be obtained by
rotating the gradient magnetic field around a patient. An image can be
reconstructed from these projections by back projection.
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SUMMARY
In today's discussion, the topic of Magnetic Resonance Imaging Hardware

was discussed. This refers to both inside and outside the modality the system's
pieces and components. The system's magnets are explained in further detail, and
an MRI system block diagram helps me grasp the system and how it works. Coils
for the neck, head, and extremities were added, as well as coils for the neck, head,
and extremities.
The three main components are the Gantry, Operating Console, and
Computer System. The main magnet and associated electromagnetic devices are
housed in the gantry; however, unlike a CT scanner, the MRI gantry has no moving
parts and only the patient couch. The gantry can be intimidating to the patient after
being seated on the couch and slid to the aperture. The image acquisition and
image processing controls are managed by the computer, although the bulk are
controlled by the unique function keys on the operating console. The third
component is the computer system; the most popular type of computer is the
minicomputer, which is available in three sizes.
As polarization specifies the geometrical orientation of the oscillations,

using the MR magnet would provide a strong, stable, and spatially uniform
polarizing magnetic field, which is a major need in establishing net nuclear spin
magnetization. The direction of the electric field is the polarization of
electromagnetic waves; by convention, the direction of the electric field is the
polarization of electromagnetic waves. Weight, stray field dimension, overall bore
length, start-up and operational costs all play a part in deciding which MRI magnet
to utilize.
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The ideal magnet design will be determined by the anticipated demands of

clinical applications as well as the MRI experiments to be done, as available
magnet technologies usually provide a balance between diverse requirements.
Permanent, resistive, and superconducting magnets are the three types of
magnets. Shimming was also discussed, which is used to improve the primary
magnetic field uniformity and so provide a high-quality image.
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SUMMARY
Today we discussed about the different phantoms, the daily QAQC and
weekly QAQC test in MRI. First discussed was the RF coil testing. Its function is
to test the coils if they are functioning well prior to the procedure. The RF coil is
the part of the MRI system that excites the aligned spins and receives an RF signal
back from the sample. The RF coil is the part of the MRI system that excites the
aligned spins and receives an RF signal back from the sample.
For the knee coil, we use a phantom bottle. The bottle is wrapped with the
knee coil. For the whole-body coil, the bottle is put below the coil to simulate a
human spine. For the breast coil, two bottles are put within the two holes of the coil
to simulate hanging breasts of prone positioned patients. For the head coil, a ridge
is used to aligned for the collimator light to simulate a head of a patient. The
collimator should be aligned with the triple underscore mark on the phantom.
Next up is the weekly QAQC with the technologist placing a phantom and
head coil into the machine. This QAQC is mostly focused with the calibration and
testing of the coils within the machine. The first step demonstrated was using the
Periodic Image Quality Test (PIQT) through the System Performance Tool (SPT).
The PIQT will then automatically go on with the phantom scanning and calibration
which should take for about 15-20 mins. The technologist will now set the
parameters for the RL (right to left) , FH (feet to head) and AP after that timeframe.
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SUMMARY
NAME: Sabornido, Mary Katherine V. DATE: May 4, 2022
For this day we had our FGD and we were shown a video about a brain
scan procedure. A special type of MRI is the functional MRI of the brain (fMRI). It
produces images of blood flow to certain areas of the brain. It can be used to
examine the brain's anatomy and determine which parts of the brain are handling
critical functions. This helps identify important language and movement control
areas in the brains of people being considered for brain surgery. Functional MRI
can also be used to assess damage from a head injury or from disorders such as
Alzheimer's disease.
First was scanning the patient with a metal detector with patients’ info
already encoded within the system. Patient is positioned supine with
immobilization devices placed to limit patient motion and given MRI compatible
headphones to suppress MRI noise. head coil is then put onto patient and is
centered towards patient’s IOML.
We were also shown the procedure planning which involved the various
pulse sequences for the procedure. next up is the patient scanning. the
technologist first configured the setup for the seizure MRI procedure. For the image
planning, the sagittal coronal and transverse images were shown and setup. one
thing to note is that the anterior and posterior horn of the corpus callosum should
be aligned and the odontoid process of c2 if neck is included.
The third part was about the MRI sequence and the different ways in
enhancing MRI image. The MRI sequence goes with T1 and then T2. T1 highlights
fat tissue while T2 highlights water content and suppresses fat. The prime
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difference with the two is that T1 visualizes normal anatomy while T2 evaluates
pathology. The PD of Proton density image is used to evaluate extremities.
For the image enhancing tools, STIR or short tau inversion recovery is a
sequence used to suppress fat. SPIR or spectral presaturation with inversion
recovery is the counterpart of STIR but used in images with contrast. DWI or
diffusion weighted imaging is used to evaluate lesions within part.
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SUMMARY
NAME: Sabornido, Mary Katherine V. DATE: May 5, 2022
Learnings about the video presentation.
DDH MRI Brain and Cervical Spine Procedure
BRAIN MRI SCAN
Patient position
• Materials: foams, wedge foams, ear plugs, head coil.

• Patient is screened first, then patient changes into a patient gown
• Patient t is positioned (supine, head first)
• Ensure patient’s comfort
• Instruct patient what is the procedure about and what to expect
during the procedure
• Patient is provided with earplugs to protect hearing from MRI noise
• Scan time: 30mins
• Insert the foams at the sides of both ears to avoid them from being
clipped into the head coil and to support head position.
• Place the head coil and lock properly
• Check laser alignment, it should be aligned at the level of patient’s
glabella
• Send the patient inside the gantry and proceed with the scan.
CERVICAL SPINE (neck) SCAN
Patient position
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• Materials: Cervical coil/neck coil

• Procedure is all the same with brain scan except for the type of coil
used and the laser alignment
• Laser alignment (isocenter) is at the level below the mandible
AT OPERATING CONSOLE
• Obtain a 3D plane localizer

• Brain scan planning (sagittal, axial/transverse, coronal)
• Start with the 3D plane localizer to have basis for initial planning
• Click the same rx and click scan, then plan sagittal planning
• FOR SAGITTAL PLANNING: load the 3-plane localizer, click slices
(23), FOV (25), thickness (5), and interval (1)
• Uncheck show slices to view middle slice in the sagittal view center
the line following the inter hemispheric fissure, straight to brain in
coronal
• Scan takes about 2mins 46 secs
• FOR AXIAL/TRANSVERSE PLANNING: same as sagittal
• Electromechanical injector monitor/automatic injector: turn on,

warning signs appear then press continue
• Reset button: change parameter/protocol

• Store button: save modifications made
• Recall button: see saved protocols
• Each study has different approach in injecting CM
• Each hospital has diff standards and protocols
• A (white) syringe is for CM, B (Blue) syringe is for saline flush starts
with saline then pauses, resumes with injection of cm then followed
by saline
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• Stop watch: for timer

• KVO: to keep vein open
• To arm: to get Para injector ready
• Notification for confirmation appears: check for air when light blinks,
cm can be injected
• Preparing CM with electromechanical injector for administration
connect the IV line to EM injector tube.
• Test inject if line is okay, whether pt complains or not.
• Press start button

• After test, inject contrast.
Image discussion with Ms. Ivy Krista Diel, RRT for BRAIN
• Plain: no enhancement
• Contrast: has white enhancement
• T1 sequence for brain
• for CERVICAL
• T1- fat saturation: sequence used for contrast
• CM used in MRI, to enhance and clarify internal body structures
• Commonly used are with the base gadolinium

• Gadoteric acid (brand name Dotarem): 10ml depends on procedure,
used in any MRI studies. Has computations for dose, recommended
dose is .1milli mole per kg. compute depending on pt’s weight
• Gadovist (gen name Gadobutrol): prefilled syringe, more
concentrated, only 5ml
290
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• Preferred for abd and liver studies is MULTIHANCE (gen name

gadobenate dimeglumine) in DDH, 10ml vial
• Primovist, the best cm for liver studies. Prefilled syringe, 10ml. good
for small lesion masses on liver
• CM mentioned above are around 4k-6k, primovist is 15k.
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Final Requirement - SABORNIDO

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MARY KATHERINE V.

RADIOLOGIC TECHNOLOGY PROGRAM

RADIOLOGIC TECHNOLOGY PROGRAM

RADIOLOGIC TECHNOLOGY PROGRAM

CLINICAL EDUCATION I Page No.

SPECIAL RADIOGRAPHIC PROCEDURE

PROCEDURAL MANUAL ……………………………………………………. 190

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: SABORNIDO, MARY KATHERINE V. DATE: June 7-11, 2021

TOPIC: FIRST WEEK OF PRE-INTERNSHIP

I. WEEKLY LEARNING EXPERIENCE:

I learn to be more prepared and be self-disciplined. Having a structure and

RADIOLOGIC TECHNOLOGY PROGRAM

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: Sabornido, Mary Katherine V. DATE: June 14-19, 2021

TOPIC: SECOND WEEK OF PRE-INTERNSHIP

I. WEEKLY LEARNING EXPERIENCE:

For this week, we had discussed all Ultrasound, Interventional

RADIOLOGIC TECHNOLOGY PROGRAM

Honestly, I found this week’s exhausting due to multiple quizzes and

We, as future radiologic technologists hold a great responsibility to take

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: SABORNIDO, MARY KATHERINE V. DATE: June 21-26, 2021

TOPIC: THIRD WEEK OF PRE-INTERNSHIP

I. WEEKLY LEARNING EXPERIENCE:

RADIOLOGIC TECHNOLOGY PROGRAM

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: SABORNIDO, MARY KATHERINE V. DATE: June 28-July 3, 2021

I. WEEKLY LEARNING EXPERIENCE:

This week's experience seemed to have been put upside-down as if I were

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: SABORNIDO, MARY KATHERINE V. DATE: July 5-11, 2021

TOPIC: FIFTH WEEK OF PRE-INTERNSHIP

I. WEEKLY LEARNING EXPERIENCE:

Establishing rapport is an important point in physician-patient

RADIOLOGIC TECHNOLOGY PROGRAM

This week's asynchronous activity gives me a lot of learning when it comes

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: SABORNIDO, MARY KATHERINE V. DATE: July 12-17, 2021

I. WEEKLY LEARNING EXPERIENCE:

In our sixth week of pre-internship we have done a lot of return

Clinical competency is very essential and is done through positioning

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: SABORNIDO, MARY KATHERINE V. DATE: July 19-24, 2021

TOPIC: SEVENTH WEEK OF PRE-INTERNSHIP

I. WEEKLY LEARNING EXPERIENCE:

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: SABORNIDO, MARY KATHERINE V. DATE: July 24-31, 2021

I. WEEKLY LEARNING EXPERIENCE:

My return demonstration, in which I erroneously put a thyroid shield in the

RADIOLOGIC TECHNOLOGY PROGRAM

NAME: SABORNIDO, MARY KATHERINE V. DATE: August 2-7, 2021

TOPIC: FIRST WEEK OF INTERNSHIP

I. WEEKLY LEARNING EXPERIENCE:

In conclusion, always be aware of the consequences of every decision you

RADIOLOGIC TECHNOLOGY PROGRAM

REFLECTIVE JOU RNAL

NAME: SABORNIDO, MARY KATHERINE V. DATE: August 9-14, 2021