Orientation of the X-ray image

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X-rays carry information about the side in addition to identifying the patient and the day of the examination. Accordingly, classic skiagraphic images must be placed correctly on the negatoscope, with digital images we must find out if they are correctly oriented on the screen.

Reverse versus Obverse[edit | edit source]

The X-ray images are marked with the name, surname and birth number of the patient with the date of the examination. You can read this information if you are looking at the correct side of the slide.

Right versus left side[edit | edit source]

The images are labeled laterally, usually with letters, with R or P indicating the right side, L the left side.

If we are viewing an image of the central structures (abdomen, chest, skull, spine) in AP (anterior-posterior) or PA (posterior-anterior) projection, we orient the image as if we were looking at the patient from the front (left side to the right and right to the left).

_fetch_thumbnail.php?img=HydroPNO.CR.1.001_0001.jpg Chest X-ray: the letter L in the upper left corner indicates the left side of the patient

If we view the image of the central structures in the lateral projection, the letter indicates the side that was closer to the x-ray (eg left lateral projection of the chest).

_fetch_thumbnail.php?img=Drobny%20epiduralni%20hematom,%20fissura.CR.1.001_0001.jpg X-ray of the skull in lateral projection: the letter L means, it is a left lateral projection

For images of the peripheral skeleton, the letter indicates the side of the patient on which the structure is imaged (R = right arm, elbow, hip..., L = left...).

_fetch_thumbnail.php?img=Hydrops%20loketniho%20kloub%20po%20fr%20pod%20hlavickou%20radia.CR.1.001_0001.jpg X-ray of the elbow joint: the letter R indicates that it is right elbow

Bad image label[edit | edit source]

'We can recognize the incorrect marking of the side of the image:

  • in a chest X-ray so that usually the shadow of the aortic knob and the heart is to the left. However, there are exceptions.
  • for a native abdominal image such that the stomach shadow is usually below the left diaphragm, the liver shadow below the right, the heart shadow to the left. However, there are exceptions.
  • Compared to the older image,
  • in the event of a lateral discrepancy between the data on the request form and the image,
  • by asking the patient.

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