PCL radiography is a program of 3 years ,

which prepares the manpower by providing

a combination of Academic and
technical skills, to enter and peruse
successfully, a career in Radiographic
imaging.
During this 3 years program , In 1st year
we need to study about the basic science,
and in 2nd year we study about radiology
and in the final year we visit different
hospital for our clinical practice.
 The clinical posting was conducted from
(2071/09/01) to (2072/03/30)
In Orthopedic Hospital (2071/09/01) to (2071/10/31)
Green City Hospital (2071/11/01 to (2071 /12/29)
And Kanti Children Hospital (2072/01/1) to (2072/03 /31)
In a group of 8 students. This clinical posting was also
Divided into two shift i.e., Morning and Evening.
 Nepal orthopedic hospital
(of the Nepal NOH ) was
established in the premises
disabled association new
life centre Jorpati in
Kathmandu in August 999.
Its sole intention has been
to provide quality of
orthopedic care, at an
affordable price of which
most Nepalese has bean
deprived.
 1. Outpatient Services
➢ 2 .In patient services
➢ 3. Emergency Services
➢ 4. Surgeries
➢ 5. Physiotherapy
➢ 6. Orthotic and
Prosthetic service
➢ 7.Operation Theater]
➢ 8. ICU
➢ 9.General ward
➢ 10. Outreach camp & Social
service
➢ 11. Laboratory
➢ 12. Pharmacy
➢ 13. Radiology
S.N. Examination Requested Projection Total case Remarks

1 SKULL AP/LAT 8

2 PNS OM VIEW 15

3 C-SPINE AP/LAT 54
L/S SPINE AP/LAT 72
D/L SPINE AP/LAT 64

4 KUB AP 28

5 PELVIS AP 72

6 CXR (chest x-ray) PA VIEW 25

AP VIEW 33
7 ABDOMEN SUPINE/ERECT 27

8 S I joint AP/LAT 9
S.N. Examination Requested Projection Total case Remarks

9 SHOULDER AP /AXIAL 51

10 SCAPULA AP 52

11 CLAVICLE AP 16

12 HUMERUS (ARM) AP/LAT 84

13 ELBOW AP/LAT 95

14 FOREARM AP/LAT 96

15 WEIST AP/LAT 99

16 HAND AP/OBLIQUE 106

17 HIP JOINT AP/LAT 34

➢ Established in the year 2012 AD
➢ Green City Hospital (GCH) is a
well equipped multi-speciality
hospital located in Basundhara,
Kathmandu.
➢ It is led by a team of
compassionate multi-disciplinary,
highly trained doctors, nurses and
technicians who can provide the
best care to every patient through
integrated clinical service and
education.
➢ It is spread across 28,475 sq.ft.
of land.
➢ The hospital has 100 beds
including 15 intensive care units
(ICU), modular operation theatre
and fully automated laboratory.
 ➢Orthopedic & Trauma Care
➢ICU/CCU
➢Nephrology Service
➢Psychological Care Unit
➢Urology Service
➢Laparoscopic Surgery
➢Maternity and Gynecology Services
➢Pediatric Services
➢Physiotherapy Services
➢Dermatology , Venerology & leprology
➢Cardiology
➢ENT(Ear , Nose , Throat)
➢Radiology
➢ Radiology Department
Consist of Computed
Radiography(CR) of
Agfa
➢ 200 mA machine of
Allenger
➢ Rotating anode X-ray
tube of Toshiba
➢ Focal spot :2.0/1.0
➢ Permanent filtration:
0.9Al/75
➢ It has floating type of
table
S.N. Examination Requested Projection Total case Remarks

1 SKULL AP/LAT 25

2 PNS OM VIEW 20

3 C-SPINE AP/LAT 54
L/S SPINE AP/LAT 65
D/L SPINE AP/LAT 34

4 KUB AP 52

5 PELVIS AP 33

6 CXR (chest x-ray) PA VIEW 95

AP VIEW 68
7 ABDOMEN SUPINE/ERECT 26

8 S I joint AP/LAT 5
S.N. Examination Requested Projection Total case Remarks

9 SHOULDER AP /AXIAL 53

10 SCAPULA AP 15

11 CLAVICLE AP 13

12 HUMERUS (ARM) AP/LAT 54

13 ELBOW AP/LAT 36

14 FOREARM AP/LAT 25

15 WEIST AP/LAT 28

16 HAND AP/OBLIQUE 37

17 HIP JOINT AP/LAT 24

18 FEMUR AP/LAT 18

19 KNEE AP/LAT/SKYLINE 36

20 LEG AP/LAT 26

21 ANKLE AP/LAT 33
S.N. Examination Requested Projection Total case Remarks

22 FOOT AP/OBLIQUE 38

23 CALCANIUM AXIAL/LAT 25

24 IVU Control 12
Immediate
5min
15min
Full bladder
Post mict.
25 Lopogram Control 2
Injected after 100ml CM
Injected after again 200ml
CM
Injected after again 200ml
CM
Total 952

Prepared By:- Submitted to:-

Gyanendra Maharjan Program co-ordinator
CRD Program
➢ Kanti Children’s Hal
(KCH) was established
in the year 1963 AD as
a general hospital.
➢ It was converted into
Kanti Children’s
Hospital in the year
1970.
➢ This hospital was
founded under former
Soviet aid.
➢ It is 500 bed hospital
➢ During 1970-1998
KCH received aids
from German-Nepal
Assistance
Association.Associatio
n.
➢24hour’s Emergency
Services.
➢Out-patient service.
➢In-patient services.
➢Pharmacy.

➢Critical
care(ICU
,NICU,PICU
and SICU)
➢Orthopedics and Trauma
care.
➢Radiology(CT scan ,USG
and Digital x-ray (CR
and DR) etc.
➢ This brand is
from Philips

➢ It is 16 slice CT

➢ Multi detector

➢ Supporting pads
➢ Philips computer
was conducted
S.N. Examination Requested Projection Total case Remarks

1 SKULL AP/LAT 12

2 PNS OM VIEW 8

3 C-SPINE AP/LAT 26
L/S SPINE AP/LAT 18
D/L SPINE AP/LAT 14
4 KUB AP 26

5 PELVIS AP 34

6 CXR (chest x-ray) PA VIEW 50

AP VIEW 715
7 ABDOMEN SUPINE/ERECT 54

8 S I joint AP/LAT 2
S.N. Examination Requested Projection Total case Remarks

9 SHOULDER AP /AXIAL 15

10 SCAPULA AP 5

11 CLAVICLE AP 6

12 HUMERUS (ARM) AP/LAT 11

13 ELBOW AP/LAT 13

14 FOREARM AP/LAT 15

15 WEIST AP/LAT 12

16 HAND AP/OBLIQUE 10

17 HIP JOINT AP/LAT 16

S.N. Examination Requested Projection Total case Remarks
18 FEMUR AP/LAT 16
19 KNEE AP/LAT/SKYLINE 12

20 LEG AP/LAT 16

21 ANKLE AP/LAT 13

22 FOOT AP/OBLIQUE 19

23 CALCANIUM AXIAL/LAT 14

24 IVU Control 9
Immediate
5min
15min
Full bladder
Post mict.
BA- ENEMA Control 8
Injected 50ml CM
Injected after 50ml CM
Injected after again
50ml CM
S.N. Examination Requested Projection Total case Remarks

BA-MEAL Control 5
Immediate
Supine Ap
RAO
LAO
Lateral
Tilted AP

MCUG/ RUG Control 6

Injected 40ml CM
Injected after 20ml CM
Injected after again
30ml CM

Total 1180
 NIRJALA GIRI
CERTIFICATE IN DIAGNOSTIC RADIOGRPHY
3rd YEAR
YHSA

22
 The largest cavity of the body,
 Bounded;
 Anteriorly - by abdominal wall muscles
 Posteriorly - by the vertebral column and posterior wall
muscles
 Laterally - by lower ribs and parts of muscles of abdominal
wall
 Superiorly - by the diaphragm
 Inferiorly - by pelvic cavity

23
24
 Occupied by the organs and glands of the digestive
which are listed below:;
 The stomach , small intestine and most of the large
intestine.
 The liver ,gall bladder , bile ducts and pancreases.
Other structures include:
 The spleen
 2 kidneys and the upper part of the ureters
 2 adrenal(suprarenal) glands
 Numerous blood vessels , lymph vessels, nerves
 Lymph nodes

25
Fig: organs of anterior part of abdominal cavity

26
Fig: organs of posterior part of abdominal cavity

27
 Divided into nine regions :

28
 Careful preliminary patient preparation of the intestinal
and gastric contents is important for a clear view of all
the abdominal structures.
 For non-acute conditions, patient preparation is as
follows:
(1) Patient placed on a low-residue diet for (2 days)
prior to x-ray examination to prevent formation of gas
due to excessive fermentation of the intestinal contents
(2) Patient should be instructed to take some laxative
the night before the examination.

29
One of the prime requisite in abdominal examinations
is the prevention of movement, both voluntary and
involuntary.
 To prevent muscle contraction, the patient must be
adjusted in a comfortable position so that he can
relax.
 A compression band may be applied across the
abdomen for immobilization but not compression.
 The exposure should be made 1-2 sec after
suspension of respiration to allow involuntary
movement of viscera to subside.

30
 In examinations of the abdomen without a contrast
medium, it is necessary to obtain maximum soft tissue
differentiation throughout its different regions.
 Because of the wide range in thickness of the
abdomen and the delicate differences in physical
density between the contained viscera, it is necessary
to use a more critical exposure technique than is
required to demonstrate the difference in density
between an opacified organ and the structures adjacent
to it.
 The exposure factors should thus be adjusted to
produce a radiograph with moderate gray tones and
less black and white contrast.

31
 A sharply demonstrated outline of the psoas muscles,
lower border of liver, kidneys ribs and spinous
processes of the lumbar vertebra are the best criteria
for judging the quality of an abdominal radiograph.

High mA and shorter exposure times must be used to

freeze voluntary and involuntary organ movements
(breathing and bowel peristalsis).
Exposure is taken on second full arrested expiration
(to displace diaphragm upward ) to give a better view
of the abdominal structures.

32
 Gonadal shields should often be used on males (upper
edge of the shield at the symphysis pubis). For
females, shields are used only where they could not
obscure essential anatomical structures (the lower
border of the shield should be at the symphysis pubis).
 For potential early pregnancy, the ‘10-day Rule’ (the
LMP) must always be observed, unless permission has
been given by the medical specialist as to ‘ignore’ it,
e.g., in the case of an emergency (e.g., trauma), or in
case of a female with a removed uterus.

33
 Basic : Antero-posterior – supine (KUB) (so named
because it includes the kidneys, ureters and bladder).
 Alternative: Postero-anterior – prone
 Supplementary: Antero-posterior –erect
Anteroposterior – left lateral
decubitus
Lateral
Lateral- dorsal decubitus
Anterior and posterior obliques ( for

contrast studies)

34
 Bowel obstruction
 Perforation
 Renal pathology
 Acute abdomen
 Foreign body localization
 Toxic megacolon
 Aortic aneurysm
 Control or preliminary films for contrast studies
 Detection of calcification or abnormal gas collection

35
36
Patient position:
 Patient supine, with the median sagittal plane at right angles
 Pelvis adjusted so that the ASIS are equidistant from the table
 Cassette placed longitudinally and positioned so that the symphysis pubis is
included
 Arms placed alongside the trunk or above the head.

37
Centering of beam:
 Vertical central ray directed approx. at the level of a point 1 cm
below the line joining the iliac crests.
Equipment setting: ( for screen film combination)

Kv mA S mAs FFD Film Grid focus

size

65 300 0.12 36 100 cm 35 X 43 Yes large

cm

38
Picture criteria:
 Whole of abdomen from upper abdomen to symphysis pubis.
 Lateral abdominal wall and the properitoneal fat layer.
 Psoas muscle, lower border of liver and the kidneys.
 Ribs and spinous processes of the lumbar vertebra.
 Whole of the urinary tract should be visualized.
 Bowel gas pattern with minimal unsharpness.

39
40
 When kidneys are not of primary interest, PA projection should be
used.
 It reduces patient gonad dose compared to the AP projection
Patient position:
 Patient prone, with median sagittal plane at right angles to the
table
 Arms up beside the head and both legs extended

41
 CR, equipment setting, picture criteria same as supine projection.

42
Position of patient:
 Patient turned onto the side of examination,
with hands resting near the head. The hips and
knees are flexed for stability.

 With the MSP parallel to the table, the vertebral

column( abt 8 cm anterior to the posterior skin
surface) positioned over the midline of the
table

 Immobilization band applied across the pelvis.

 Cassette centered at the level of iliac crests.

43
 Centring of the beam:
 Vertical central ray directed to the centre of the cassette

Equipment setting:

Kv mA S mAs FFD Film Grid focus

size
75 300 0.12 64 100 cm 35 X 43 Yes large
cm

44
Picture criteria:
 The prevertebral space along with abdominal aorta
 Any other intra abdominal calcifications or tumour masses should
be clearly visible.

45
Patient position:
 Patient stands with the back against the
vertical bucky.
 Patient’s legs separated well apart to
maintain a comfortable position.
 The median sagittal plane is adjusted at
right angles and coincident with the midline
of the table.
 The pelvis is adjusted so that the anterior
superior iliac spines are equidistant.

46
 Centring of beam:
 The horizontal central ray is directed perpendicular to midpoint at
the level of iliac crests.
Equipment setting:

Kv mA S mAs FFD Film Grid focus

size
65 300 0.12 36 100 cm 35 X 43 Yes large
cm

47
Picture criteria:
 Both domes of diaphragm to ensure that any free air in the peritoneal
cavity is demonstrated.
 Lateral abdominal wall and properitoneal fat
 Psoas muscle, lower border of liver and kidney shadows
 Vertebra in center of film.
 Side identification marker placed properly.

48
Lateral decubitus is done instead of abdomen erect if
patient is unable to stand or sit.
Patient position:
 Patient in lateral recumbent position
 Elbows and arms flexed and hand resting near head
 Cassette positioned in vertical bucky against the posterior aspect of the
trunk

49
 Centring of beam:
 The central ray is directed perpendicular to midpoint at the level
of iliac crest with x-ray tube horizontally.
Equipment setting:

Kv mA S mAs FFD Film Grid focus

size
65 300 0.12 36 100 cm 35 X 43 Yes large
cm

 Note: Patient should be placed in lateral decubitus position for 5-

10 mins to allow the free air to rise

50
Picture criteria:
 Air fluid levels when an erect abdomen cannot be obtained.
 Lung area above dome of diaphragm
 Lateral abdominal wall and properitoneal fat
 Psoas muscle, lower border of liver and kidney shadows
 No rotation

51
52
Occasionally, the patient cannot sit or even be rolled on to the
side, in which case the patient remains supine and a lateral
projection is taken using a horizontal central ray.
Patient position:
 Patient supine
 Arms raised away from the abdomen and thorax.
 Cassette positioned vertically against patient’s side

53
 Centring of the beam:
 The horizontal central ray is directed to the lateral aspect of the
trunk so that it is at right-angles to the cassette and centred to it.
Equipment setting:

Kv mA S mAs FFD Film Grid focus

size
75 300 0.12 36 100 cm 35 X 43 Yes large
cm

54
Picture criteria:
 Thorax to the level of mid-sternum and as much of the abdomen
as possible.
 Pre-vertebral space for determining the air fluid levels in
abdomen.
 Lung area above dome of diaphragm, without motion.
 Patient elevated to demonstrate entire abdomen

55
 Clark’s positioning in radiography, 12th
edition
 Merrill’s atlas of radiographic positions and
radiologic procedures, 12th edition
 Different other books and websites

56
THANK YOU
57
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