Introduction
Positioning is the foundation of diagnostic radiography. Even with modern equipment and advanced post-processing, poor positioning leads to:
- Repeat exams
- Higher radiation dose
- Delayed diagnosis
- Radiologist frustration
- Patient dissatisfaction
This premium article covers the most common positioning errors, why they happen, and step-by-step fixes to master high-quality imaging.
1. Common Positioning Mistakes by Body Region
1.1 Chest X-ray Errors
Error 1 — Rotation
Signs: Asymmetric clavicles, uneven lung fields
Fix:
- Align MSP with bucky center
- Straighten shoulders
- Check clavicles before exposure
Error 2 — Inadequate Inspiration
Fix: Expose on second deep inspiration; coach clearly; watch for diaphragm drop.
Error 3 — Chin Over the Apex
Fix: Extend neck slightly; ensure chin clears apices.
1.2 Abdomen Errors
Error 1 — Cutoff Anatomy
Fix:
- Include diaphragm on upright
- Include pubic symphysis on supine
- Use correct centering points
Error 2 — Poor Exposure
Fix:
- Use AEC when possible
- Adjust kVp for large patients
- Limit scatter with tight collimation
1.3 Upper Extremity Errors
Common mistakes:
- Over-rotation of wrist
- Incorrect oblique of hand
- Poor centering on elbow
Fixes include:
- Visualizing joint spaces
- Using 45° oblique blocks
- Positioning from the proximal joint first
1.4 Lower Extremity Errors
Knee:
- Incorrect AP angle → leads to joint-space narrowing
Fix: Adjust CR 5–7° cephalad for AP knee (depending on habitus)
Foot:
- Over-rotation in oblique
Fix: True 30° rotation
Ankle:
- Mortise not visualized
Fix: 15–20° internal rotation
1.5 Spine Errors
Common issues:
- MCP not perpendicular to IR
- Shoulder superimposition on C-spine
- Cutoff anatomy on lumbar studies
Fix:
- Use compensatory filtration
- Apply traction for cervical
- Find proper centering (L3 for lumbar)
2. Technique Errors That Result in Repeats
- Wrong bucky selection
- AEC misuse
- Incorrect focal spot
- Improper distance (SID)
- Grid errors
- Motion from slow exposure
3. Communication Errors
Patients often:
- Don’t understand instructions
- Are anxious
- Move due to pain
- Struggle with breath holds
Fix with:
- Short, simple instructions
- Demonstrations
- Stabilization devices
- Proper immobilization for pediatrics
4. Tips From Expert Radiographers
- “Always check rotation — it’s the #1 cause of repeats.”
- “Position the patient, not the tube.”
- “Never rush through a trauma exam — slow is smooth, smooth is fast.”
- “Use your eyes, not assumptions — no two patients look the same.”
5. How CE Helps Improve Positioning Skills
Gage CE radiography courses include:
- Positioning refreshers
- Trauma and mobile imaging
- Pediatric radiography essentials
- Image critique & QA