In computed tomography (CT), time, image quality, and patient safety are critical. Yet one key factor is often overlooked: proper patient positioning. Especially in routine or technically challenging scans, the right positioning can make all the difference — ensuring high-quality images without the need for repeat scans or unnecessary radiation exposure.
The tips and recommendations in this article are provided by CT expert Alex Riemer, author and educator and founder of the Alex Riemer Online Academy (AROA). Drawing on his extensive practical experience, he outlines how thoughtful use of positioning aids can improve clinical workflow, reduce stress for both staff and patients, and help achieve consistently reliable results — from head to toe.
Contents
From head to toe, clickable
Head
Paranasal Sinuses
Maxilla, Mandible, and Teeth
Neck and Cervical Spine
PRT / Infiltration
Shoulder
Thorax / Abdomen
ELBOW
Wrist
Pelvic-Leg Angiography
Foot and Upper Ankle
Hygiene in CT
Fazit
Head
Accurate head positioning is essential to protect the eye lenses from direct X-ray exposure. If a tiltable head holder is not available, positioning wedges can be used to achieve the required head tilt.
The line between the orbital roof and the external auditory canal should be parallel to the scan plane, passing through both corners of the eyes. The patient’s eyes should remain closed during alignment to avoid laser exposure.
For further tips, consult our blog on cranial CT.
Products:
- ProFoam Wedge Inclination: With different angles of 15, 30 or 40 degrees (1273, 1274 oder 1275)
- Optional: 1105 CT HeadFix and ProBelt 50 (5008, 5009, or 5012 for different manufacturers)
- Not in the image: 1113 PearlFit Roll 50 to set below the legs
Head - Emergencies
In urgent cases or when patients struggle to stay still, the inflatable CT HeadFix offers a fast and reliable positioning solution. A demonstration video is available on the website.
Product:
- 1105 CT HeadFix
- ProBelt 50 (5008, 5009, 5012 according to manufacturer)
Head – without Head Holder
In exceptional cases where a head holder is not available, positioning aids are needed to achieve proper head tilt.
The ProFoam Head Foam Mold, the blue ProFoam Wedge, or the white PearlFit Cushion can be used to support the head and maintain inclination.
Note: Positioning directly on the CT table should only be done in rare cases, as it may cause slight artifacts and increase dose.
Products:
- 1160 ProFoam Wedge 26x25x7 DS
- 1246: ProFoam Head/Neck
- Optional: 1116 PearlFit Cushion 50x30x10
- Not in the image: 1113 PearlFit Roll 50 to set below the legs
Paranasal Sinuses
The skull should be positioned so the hard palate is parallel to the scan plane. To achieve this, the head must be reclined until the line between the forehead and incisors is parallel to the table. For stabilization, use a strap (ProBelt 50) and cushion (Multipad) during the examination. To protect the eyes, lens protection or organ dose modulation should be used.
Products:
- 5008 ProBelt 50 VL for Canon, Siemens, and Philips CTs
- 5009 ProBelt 50 VH for GE CTs
- 1012 MULTIPAD Standard or 1071 MULTIPAD Slim or 1022 MULTIPAD Plus
- Not in the image: 1113 PearlFit Roll 50 to set below the legs
Maxilla, Mandible, and Teeth
The patient should bite on the indentation of a new, unused 5 ml syringe plunger with their incisors to distinguish between the upper and lower jaws. The head should be aligned so the occlusal plane is perpendicular to the table. If a tiltable head holder is not available, positioning wedges can help achieve the necessary inclination.
To protect the eyes, use lens protection or organ dose modulation.
Note: For implant planning, use the lens protector only if it does not interfere with the software.
Products:
- ProFoam Wedge Inklination: Je nach Winkel 15, 30 oder 40 Grad (1273, 1274 oder 1275)
- Optional: 1105 CT HeadFix and ProBelt 50 (5008, 5009, or 5012 for different manufacturers)
- Not in the image: 1113 PearlFit Roll 50 to set below the legs
Neck and Cervical Spine
The head should be positioned so the cervical spine is as parallel as possible to the CT table. If possible, recline the head so the lower orbital edge aligns with the external auditory canal.
A pillow provides comfortable positioning and helps prevent movement. For additional stabilization, a Multipad can be used in the head holder. The arms should be gently secured with straps so the patient can relax.
Products:
- 1114 PearlFit Cushion 30x20x4
- 1172 ProBelt 200 T5 for Canon
- Optional: 1105 CT HeadFix 1071 MULTIPAD Slim and ProBelt 50 (5008, 5009, 5012 je nach Hersteller)
- Not in the image: 1113 PearlFit Roll 50 to set below the legs
Swimmer’s View
In muscular or obese patients, image artifacts can occur at the cervico-thoracic transition. The swimmer’s position is an effective alternative to standard neck or cervical spine CT positioning. It improves image quality and reduces CTDI values by moving the humeral heads out of the scan plane. A drawback is that right-to-left comparisons can become more difficult.
Products:
- 1114 PearlFit Cushion 30x20x4
- 1115 PearlFit Cushion 50x30x7
- Not in the image: 1113 PearlFit Roll 50 to set below the legs
PRT / Infiltration
In PRT/spinal infiltration, the person is placed head-first in a prone position on the examination table.
In cervical procedures, a straight head position with face down is usually preferred for optimal treatment.
The PearlFit Forehead with recess and breathing slits allows the patient to lie quietly in the correct position for the entire duration.
To compensate for the curvature of the table and the relatively hard mat, a PearlFit Flex is placed in the upper body and hip area.
The feet are lifted slightly to avoid unpleasant pressure on the kneecap.
Products:
- 5005 PearlFit Forehead
- 1119 PearlFit Flex 3
- 1115 PearlFit Cushion 50x30x7 oder optional 1113 PearlFit Roll 50
Shoulder
Both Shoulders
For bilateral shoulder CT, the patient should be positioned supine, centered on the CT table. Ensure the arms are placed comfortably at the patient’s sides or slightly abducted if the scanner bore size allows. Most CT scanners have a 50 cm field of view, which may limit full visualization of very broad shoulders. Secure the arms with straps to minimize movement and ensure consistent positioning. A PearlFit Cushion provides additional stability and reduces the risk of motion artifacts.
Products:
Single Shoulder
Position the patient so the target shoulder (region of interest) aligns with the CT table seam.
This centers the area of interest within the scanner's field of view.
If possible:
- Shift the patient slightly toward the non-target (healthy) side.
- Extend the arm of the side being examined.
- Rotate the palm upward (supination).
Alternatively, the forearm can rest on the stomach if needed.
For stable positioning, use a ProBelt and sandbag.
- 1132 PearlFit Wedge 56x50x25
- 1163 ProFoam Wedge 60x25x12 DS
- 1172 ProBelt 200 T5
- 1262 Sandbag 30x20, 2 kg
- CT Table Cover
Thorax / Abdomen
The patient can be positioned head-first or feet-first on the CT table. The head should rest on a pillow, with the arms positioned above the head. This arm position is standard for optimal image quality at the lowest possible dose. If the patient has difficulty raising their arms, secure them with a belt or adjust to a higher angle for better support. Use a PearlFit Roll to support the legs for comfortable positioning.
Products:
Alternative Arm Positioning
If the patient cannot place their arms above the head during torso imaging, an alternative position is needed to avoid artifacts. The arms should be positioned in front of the body (see top image). The ProBelt Thorax is ideal for this: It holds the arms securely in front of the body with built-in straps to prevent slipping. This setup reduces artifacts and helps maintain optimal image quality. It also minimizes automatic kV increases, preserving iodine contrast effectiveness.
Products:
Elbow
Superman extended
Position the patient so the examined arm is fully extended forward. Place a PearlFit Cushion or Roll under the shoulder to increase comfort, maintain proper arm alignment, and reduce movement artifacts. Ask the patient to tuck their chin toward the chest to ensure the head and eyes are outside the scan area. Stabilize the distal forearm with a sandbag to minimize involuntary movement.
Products:
Superman Bent
If full arm extension is not possible, the elbow can be bent and positioned at an angle. Ensure the forearm is not parallel to the scan plane to avoid imaging artifacts.
Products:
Arm Next to Body
If the patient is unable to extend their arm due to injury or limited mobility, the elbow can be positioned next to the body. Shift the patient toward the healthy (non-target) side until the soft tissues of the examined elbow align with the table seam.
This positioning keeps the elbow within the scanner’s field of view. Ensure the forearm is not parallel to the scan plane. Adjust the table height so the entire elbow is fully captured.
If no specific protocol exists, use the CT shoulder protocol.
Breathing instruction: expiration.
Product:
- 1132 PearlFit Wedge 56x50x25
Arm on Stomach
For patients who cannot extend their arm due to injury or limited mobility, the elbow can be positioned on the stomach. Ensure the forearm is not parallel to the scan plane. Adjust the table height so the entire elbow is fully captured in the field of view.
Breathing instruction: Breath-hold at expiration.
Products:
Wrist
Position the patient so the examined arm is fully extended forward. Place a PearlFit Flex 3 under the shoulder for comfort and to reduce motion artifacts. The wrist should rest in a PearlFit Cushion to ensure stable positioning. Align the palm perpendicular to the table for optimal visualization of the carpal bones. Alternatively, the hand can be positioned parallel to the tabletop if needed. Use a ProBelt for additional stabilization.
Products:
Alternative
For lateral positioning of the wrist and hand, the Multipad combined with a PearlFit Cushion provides effective support. This setup helps maintain full extension of the hand and fingers throughout the examination.
Products:
Pelvic-Leg Angiography
For pelvic-leg vessel imaging, the legs should be fully extended. A flat PearlFit cushion placed under the knees increases comfort and reduces involuntary movement. Secure the forefeet together to maintain steady leg positioning during acquisition. The arms can rest comfortably on a PearlFit Wedge.
Products:
- 1115 PearlFit Cushion 50x30x7
- 1132 PearlFit Wedge 56x50x25
- Optional: 1220 ProBelt Wrap 70 to stabilize the feet
Foot and Upper Ankle
Bend the non-examined leg for comfort. Use a cushion to position the examined foot as centrally and stably as possible, either in the head holder or directly on the tabletop. If possible, rotate the leg slightly inward. Ensure the sole is perpendicular to the tabletop to minimize the scan area length.
Products:
- 1115 PearlFit Cushion 50x30x7 within the head holder and below the knee
- 1116 PearlFit Cushion 50x30x10 on the table
- 1132 PearlFit Wedge 56x50x25
Hygiene in CT
Thorough cleaning and disinfection are essential to protect staff and patients from cross-contamination. Contrast media, blood, and other body fluids require additional cleaning and can cause workflow delays. Pearl Technology products are designed with robust, easy-to-clean PU foil. They are Velcro-free and withstand disinfection with up to 90% alcohol. These features support efficient hygiene practices.
Products:
- CT Table Cover for all common manufacturers
- CT Gantry Cover for all common manufacturers
- ProBelt for all common manufacturers
Conclusion
Whether it’s a routine scan or a challenging positioning case, using the right positioning aids in CT can make a noticeable difference: faster workflows, fewer artifacts, and greater comfort and safety for the patient. The examples in this article show how thoughtful positioning – often with simple tools – can significantly improve image quality and efficiency.
If you’d like more tips or have questions about specific applications, feel free to get in touch or explore more insights with the Pearl Technology team or with Alex Riemer.
The ALEX RIEMER ONLINE ACADEMY is a learning and knowledge platform dedicated to radiological diagnostics. It gives you access to the knowledge you need—anytime, anywhere—to achieve the best possible results in your daily work.
At launch, the focus is on computed tomography (CT). In the near future, the Academy will gradually expand to cover additional topics such as MRI, conventional X-ray, and more.
My goal with this Online Academy is to offer you a reliable companion, advisor, and trainer—always available when you need it.
Warm regards,
Alex Riemer