Radiographic Procedures III

Course Description

RTE1523C – Radiographic Procedures III is the third and final positioning course in a Florida radiography program. Daytona State College titles it Radiographic Procedures III and Lab. The C suffix reflects an integrated laboratory; Broward College carries the same content as RTE1523 (3 credits, 48 lecture hours) plus RTE1523L (1 credit, 32 laboratory hours).

Procedures III covers the material a student has not yet met and generally the hardest of it. Where Procedures I established the chest, abdomen, and extremities, and Procedures II the spine, bony thorax, and pelvis, this course typically covers the skull and facial bones, the paranasal sinuses, contrast studies of the gastrointestinal and urinary systems, and specialized and trauma procedures. Institutions distribute content differently, so verify locally.

Cranial positioning is the reason this course has a reputation. Skull and facial projections depend on precise relationships between positioning lines — the orbitomeatal line, the infraorbitomeatal line, the acanthiomeatal line — and the central ray, and small angular errors produce images that are clearly non-diagnostic rather than merely imperfect. Students who coast through Procedures I and II tend to encounter difficulty here.

Contrast procedures introduce a different dimension: the radiographer is no longer working alone with a cooperative patient, but assisting with a fluoroscopic examination in sequence with a radiologist, managing contrast administration and timing, and imaging anatomy that changes minute to minute.

Offered at approximately 12 Florida institutions with JRCERT-accredited radiography programs.

Learning Outcomes

Required Outcomes

• Identify cranial and facial anatomy and the positioning lines used to align it.
• Position accurately for routine skull projections including AP axial, lateral, and PA axial.
• Position accurately for facial bone, orbit, nasal bone, zygomatic arch, and mandible projections.
• Position for paranasal sinus projections upright and demonstrate air-fluid levels.
• Position for temporomandibular joint and mastoid projections where included.
• Describe patient preparation for gastrointestinal and urinary contrast studies.
• Describe contrast media selection for each study and identify contraindications.
• Assist with fluoroscopic procedures including esophagram, upper GI, and barium enema.
• Perform positioning and imaging for intravenous urography and cystography.
• Describe radiation protection considerations specific to fluoroscopy.
• Adapt standard positioning for trauma patients without moving the patient.
• Perform cross-table and modified projections for the immobilized patient.
• Select technical factors appropriate to cranial, contrast, and trauma imaging.
• Evaluate images against diagnostic criteria and identify specific positioning corrections.
• Identify artifacts and their causes in contrast and cranial imaging.
• Demonstrate assigned competencies to program standards.

Optional Outcomes

• Describe pediatric imaging modifications and dose reduction.
• Describe bone densitometry and its positioning requirements.
• Describe surgical and mobile imaging procedures.
• Describe cross-sectional anatomy relevant to CT correlation.
• Describe biliary, arthrographic, and myelographic procedures.
• Relate laboratory competencies to ARRT clinical competency requirements.

Major Topics

Required Topics

• Cranial anatomy — bones of the skull, sutures, and cranial base.
• Positioning lines — OML, IOML, AML, GML, and the interpupillary line.
• Skull projections — lateral, PA axial (Caldwell), AP axial (Towne), and submentovertical.
• Facial bones — lateral, parietoacanthial (Waters), and modified Waters.
• Orbits, nasal bones, zygomatic arches, and mandible.
• Paranasal sinuses — upright positioning and air-fluid level demonstration.
• Temporomandibular joints and mastoids where included.
• Contrast media for GI and GU studies — barium, water-soluble agents, and selection.
• Patient preparation — bowel prep, NPO status, and scheduling sequence.
• Esophagram and upper GI — positioning sequence and fluoroscopic assistance.
• Small bowel series and barium enema — single and double contrast.
• Urinary studies — IVU, cystography, and voiding cystourethrography.
• Fluoroscopy — equipment, operation, and radiation protection.
• Trauma radiography — modifying position rather than moving the patient.
• Mobile and surgical imaging — C-arm orientation and technique adjustment.
• Image critique — diagnostic criteria for cranial and contrast images.
• Competency evaluation — checkoffs against program standards.

Optional Topics

• Pediatric imaging and dose optimization.
• Bone densitometry.
• Arthrography, myelography, and biliary studies.
• Cross-sectional anatomy and CT correlation.
• Equipment quality control.
• ARRT competency mapping.

Resources & Tools

• Merrill's Atlas of Radiographic Positioning and Procedures, Volumes 1–2 (Elsevier) — the standard reference; Volume 2 covers the skull and contrast studies.
• Bontrager's Textbook of Radiographic Positioning and Related Anatomy (Elsevier).
• Positioning pocket guide — carried into clinical by nearly every technologist.
• Energized laboratory and skull phantom — cranial positioning cannot be learned without one.
• Fluoroscopy suite access — observation and assisted practice where the program provides it.
• ACR Manual on Contrast Media — free; contrast selection, preparation, and reaction management.
• ARRT — Radiography clinical competency requirements.
• Florida Department of Health, Bureau of Radiation Control — state licensure and fluoroscopy rules.

Career Pathways

• Radiologic Technologist (SOC 29-2034) — via ARRT certification and Florida licensure.
• Fluoroscopy and GI/GU technologist — where this course's content is the daily work.
• Surgical and trauma radiographer — emergency departments and operating rooms.
• Interventional and cardiovascular radiographer.
• Advanced modality technologist — CT, MRI, mammography, via ARRT post-primary certification.
• Clinical instructor — with experience and often a bachelor's degree.

Special Information

Skull positioning is the hardest content in the radiography curriculum

Nearly every program reports it, and the reason is geometric. Cranial projections require the correct positioning line perpendicular or parallel to the receptor, the correct central ray angle, and the correct rotation — and an error of a few degrees in any of them puts structures on top of one another. There is no way around repetition with a skull phantom. Students who start practicing in week one rather than checkoff week do markedly better, and programs provide open lab time for exactly this.

Contrast studies require a different kind of competence

Positioning an extremity is a solo, unhurried task. Assisting with a barium enema is not: the radiologist is fluoroscoping, the contrast is moving, the patient is uncomfortable, and images must be obtained at the right moment in the right position. The skill being built is working in sequence with other people under time pressure, which is closer to what clinical practice actually feels like. Students should expect the pace to be the difficult part rather than the positioning itself.

Trauma imaging means moving the tube, not the patient

The governing principle in trauma radiography is that the patient's position is fixed — by injury, by immobilization, or by clinical instruction — and the radiographer adapts by moving the tube and receptor to achieve an equivalent projection. Cross-table laterals and modified angles substitute for standard positioning. Getting this wrong can cause real harm, which is why it is taught explicitly rather than improvised.

Fluoroscopy carries the highest occupational dose in general radiography

Scatter radiation during fluoroscopic procedures is the largest source of occupational exposure for most technologists. Distance, shielding, lead apron and thyroid shield discipline, and minimizing beam-on time are not formalities. Florida's Bureau of Radiation Control regulates fluoroscopic equipment and operator requirements, and the ALARA principle has direct personal consequences here.

Count contact hours, not credits

Broward's configuration gives the arithmetic: RTE1523 is 3 credits at 48 lecture hours and RTE1523L is 1 credit at 32 laboratory hours — so the combined RTE1523C represents roughly 80 contact hours. The clinical courses running alongside it are heavier still: RTE1804, RTE1814, and RTE1824 each carry 2 credits for 256 contact hours. A radiography term is far larger than its credit total suggests, and this is why students are advised against full-time work during the program.

Numbering and sequence

The Procedures sequence runs RTE1503 → RTE1513 → RTE1523, each with a corresponding L laboratory at 1 credit and 32 hours, or combined as C courses. Institutions distribute body regions across the three differently, so content in RTE1523C at one college may appear in RTE1513C at another. SCNS equivalency applies to the same number at the same level, never across numbers. Programs are cohort-based, sequential, and limited-access, so mid-program transfer is rarely practical.