When I was a student, the most difficult x-rays for me to get right was the lateral knee. No matter what I did or who helped me, the radiograph would always turn out being either over rotated or just funky looking. Eventually, I figured out that by shooting the lateral knee cross-table, that I could get the condyles to perfectly superimpose almost everytime, thus producing a good lateral knee image!

Is there one single view or a series that has been your Achilles heel (pun intended)?

Through my time working in radiography departments, emergency rooms, ortho offices, and, as a mobile radiography tech I have picked up a few tips on what has helped me to get a good radiograph, most of the time.

TIP #1: Learn the Equipment

This sounds like a no-brainer, but not all equipment or imaging rooms for that matter are the same. I have worked at places where each room seemed to have a mind of their own. What I mean by this, is that what worked perfectly in on room would not always work in the other.

Often this was due to having different manufacturers equipment from room to room. For example, one room would have a state of the art Siemens DR equipment where another would have a CR based Philips system dating back to the civil war!

In order to best prepare yourself for success, you need to know the nuts and bolts of these rooms and how each manufacturers equipment works. Here are some examples.

• Is there auto-collimation or do you have to do all collimation manually?
• Are the techniques saved within the imaging system accurate?
• Are there any weird bugs in the room that might cause the tube and IR to not line up correctly or drift?
• Do you fully understand how to navigate within the imaging system’s computer interface?
• Is one room better for table work where another has a better upright bucky?

Knowing these points, will not only dramatically increase your chances of success but will also save you from looking confused once you are in the room with the patient.

TIP #2: Learn from your co-workers

I know there can be a tendency within some radiography departments to want to be known as a “RADTECH SUPERSTAR!”

I would be lying if I said that I have not struggled with this in the past, but at the end of the day our job is to help people get better not get a big head because we can get the odontoid 90% of the time!

The way I learned how to get rockstar lateral knee x-rays was that I ate a little crow and asked a senior tech to show me his technique. By doing this, I was able to learn a few simple tips that would have otherwise taken me ten years and over 100 retakes to figure out. This tip was to always shoot the lateral knee cross-table and to have the IR parallel to the femur no the tube. WARNING this technique might not work for you since there are some nuances, but for me, it tends to get the job done.

Tip #3 Learn from bad images

Next time you over rotate an oblige lumber spine or clip the pubic symphysis on a KUB, instead of just repeating the image, take a second to either take a mental note or actually write down what you think caused the image to need repeating.

I am not saying that everytime you have to repeat an image it is your fault, all I am saying is that you can learn a lot from your mistakes.

For example, say your lateral wrist x-rays never seem to be 100% superimposed, and you just can’t seem to figure out if you are rotating too much internally or externally.

Instead of continually making the same mistake, you can purchase an imaging critique book or find some information onlinewhich will help show you what an over or under rotated lateral wrist x-ray looks like. From there, you can try to look at your old images and see if your lateral wrist x-rays look like they are typically over-rotated or under-rotated. Doing this is extremely useful for extremities and spines.

Tip #4: Do the same thing every time

There is a saying in the hospital world, “first time every time.” At my old job, we use to say this about the endoscopy department. It seemed like every case was their first. They would call us 5 seconds before the physics was ready for images (GERRRR!!) and they never knew any of our names (we had all been there for years), and the list goes on and on.

Don’t be the endo department of x-ray! What I mean by this is that you should try to do the same thing every time, IE having a system.

For example, when I am performing an exam, I will always do the same thing in the same order (if possible). This includes (before I get the patient), getting the room ready, pulling the patient’s information up on the computer, having the correct exposures set on the imaging system, having the cassette in the buck (if the room is not DR) having the tube set to correct SID, and so on. When the patient is in the room. I will always say the same thing and do the images in the same order (AP, OBL, LAT). Doing this helps me not only be efficient but also very consistent. After I started doing this, it was like my brain already knew what the next step was, so I could focus on if the anatomy was positioned correctly collimation, and imaging factors.

This was particularly helpful when doing mobile radiography since with this kind of work; you never know what situation you are going into.

Tip #5 Be patient

No one likes to hear this, but it takes a while before you get good at this.

I get it when you are a new tech you want to take over the world and have statues made of you to commemorate you as being the god amongst all other technologists!

Sorry, but it does not work that way. Taking great x-rays is an art, and you are going to have to take a lot of them before you get good at this.

With that said, I am 100% confident that if you follow the steps I have outlined, you will become a better technologist much faster then if you just did nothing.

I would love to continue this conversation.

What can you add to this blog post that may help others take better x-rays?

Written by Ari B – Founder of Radtechbootcamp.com