--- title: Tricky Patient Positioning in CT – Tipps by an Expert description: Optimize CT scans with expert tips on patient positioning from Alex Riemer. Enhance image quality, reduce repeat scans, and ensure patient comfort and safety with practical guidance. --- [Pearl Technology Blog ](https://www.pearl-technology.ch/en/blog) # [Tricky Patient Positioning in CT – Tipps by an Expert](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert) Written by [Alex Riemer](https://www.pearl-technology.ch/en/blog/author/alex-riemer) | Jun 26, 2025 2:02:10 PM 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](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#HEAD) ### [Paranasal Sinuses](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#PARANASALSINUSES) ### [Maxilla, Mandible, and Teeth](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#MAXILLA) ### [Neck and Cervical Spine](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#NECK) ### [PRT / Infiltration](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#PRT) ### [Shoulder](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#SHOULDER) ### [Thorax / Abdomen](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#Thorax) ### [ELBOW](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#ELBOW) ### [Wrist](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#WRIST) ### [Pelvic-Leg Angiography](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#PELVIC) ### [Foot and Upper Ankle](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#FOOT) ### [Hygiene in CT ](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#HYGIENE) ### [**Fazit**](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert?hs_amp=true#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.](https://www.pearl-technology.ch/en/blog/computertomografie-des-sch%C3%A4dels-was-mtr-beachten-sollten?hsLang=en) Products: - [ProFoam](https://www.pearl-technology.ch/en/profoam?hsLang=en) Wedge Inclination: With different angles of 15, 30 or 40 degrees (1273, 1274 oder 1275) - Optional: 1105 [CT HeadFix ](https://www.pearl-technology.ch/en/ctheadfix?hsLang=en)and [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 50 (5008, 5009, or 5012 for different manufacturers) - Not in the image: 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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](https://www.pearl-technology.ch/en/ctheadfix?hsLang=en). Product:  - 1105 [CT HeadFix ](https://www.pearl-technology.ch/en/ctheadfix?hsLang=en) - [ProBelt](https://www.pearl-technology.ch/probelt?hsLang=en) 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](https://www.pearl-technology.ch/en/profoam?hsLang=en) Wedge 26x25x7 DS - 1246: [ProFoam](https://www.pearl-technology.ch/en/profoam?hsLang=en) Head/Neck - Optional: 1116 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x10 - Not in the image: 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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](https://www.pearl-technology.ch/en/probelt?hsLang=en) 50 VL for Canon, Siemens, and Philips CTs - 5009 [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 50 VH for GE CTs - 1012 [MULTIPAD](https://www.pearl-technology.ch/en/multipad?hsLang=en) Standard or 1071 MULTIPAD Slim or 1022 MULTIPAD Plus - Not in the image: 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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](https://www.pearl-technology.ch/profoam?hsLang=en) Wedge Inklination: Je nach Winkel 15, 30 oder 40 Grad (1273, 1274 oder 1275) - Optional: 1105 [CT HeadFix ](https://www.pearl-technology.ch/ctheadfix?hsLang=en)and [ProBelt](https://www.pearl-technology.ch/probelt?hsLang=en) 50 (5008, 5009, or 5012 for different manufacturers) - Not in the image: 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 30x20x4 - 1172 [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 200 T5 for Canon - Optional: 1105 [CT HeadFix ](https://www.pearl-technology.ch/en/ctheadfix?hsLang=en)1071 [MULTIPAD](https://www.pearl-technology.ch/en/multipad?hsLang=en) Slim and [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 50 (5008, 5009, 5012 je nach Hersteller) - Not in the image: 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 30x20x4 - 1115 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x7 - Not in the image: 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Forehead - 1119 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Flex 3 - 1115 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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: - 1116 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x10 - 1172 [ProBelt](https://www.pearl-technology.ch/probelt?hsLang=en) 200 T5 for Canon   ### 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.   Products: - 1132 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Wedge 56x50x25 - 1163 [ProFoam](https://www.pearl-technology.ch/en/profoam?hsLang=en) Wedge 60x25x12 DS - 1172 [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 200 T5 - 1262 [Sandbag](https://www.pearl-technology.ch/en/sandbag?hsLang=en) 30x20, 2 kg - [CT Table Cover](https://www.pearl-technology.ch/en/cttablecover?hsLang=en)   # 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: - 1132 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Wedge 56x50x25 - 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Roll 50 – Knee Roll - 1172 [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 200 T5   ### 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: - 1132 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Wedge 56x50x25 - 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Roll 50 - 1173 [ProBelt](https://www.pearl-technology.ch/probelt?hsLang=en) 200 Thorax PFC   # 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: - 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Roll 50 - 1115 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x7 - 1262 [Sandbag](https://www.pearl-technology.ch/en/sandbag?hsLang=en) 30x20, 2 kg ### 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: - 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Roll 50 - 1115 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x7 ### 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](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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: - 1132 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Wedge 56x50x25 - Not in the image: 1113 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Roll 50 to set below the legs   # 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: - 1116 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x10 - 1119 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Flex 3 - 1172 [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 200 T5 for Canon   ### 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: - 1116 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x10 - 1119 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Flex 3 - 1022 [MULTIPAD](https://www.pearl-technology.ch/en/multipad?hsLang=en) Plus   # 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](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x7 - 1132 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Wedge 56x50x25 - Optional: 1220 [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 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](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x7 within the head holder and below the knee - 1116 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) Cushion 50x30x10 on the table - 1132 [PearlFit](https://www.pearl-technology.ch/en/pearlfit?hsLang=en) 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](https://www.pearl-technology.ch/en/cttablecover?hsLang=en) for all common manufacturers - [CT Gantry Cover ](https://www.pearl-technology.ch/en/ct-gantry-cover?hsLang=en)for all common manufacturers - [ProBelt](https://www.pearl-technology.ch/en/probelt?hsLang=en) 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](https://www.pearl-technology.ch/en/?hsLang=en) team or with [Alex Riemer.](https://www.alex-riemer.de/) 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**     [View full post](https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert) ```json { "@context" : "http://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Alex Riemer" }, "dateModified" : "2025-06-30T16:12:43.712Z", "datePublished" : "2025-06-26T14:02:10Z", "headline" : "Tricky Patient Positioning in CT – Tipps by an Expert", "image" : { "@type" : "ImageObject", "height" : 660, "url" : "https://1582016.fs1.hubspotusercontent-na1.net/hubfs/1582016/image-png-Jun-20-2025-03-41-57-4963-PM.png", "width" : 495 }, "mainEntityOfPage" : "https://www.pearl-technology.ch/en/blog/tricky-patient-positioning-in-ct-tipps-by-an-expert", "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "height" : 60, "url" : "/hs/hsstatic/content_shared_assets/static-1.4092/img/default-amp-logo.png", "width" : 60 }, "name" : "Pearl Technology Blog" } } ```