When I was a student, the most difficult x-rays for me to get right were the lateral knee x-rays. No matter what I did, or who helped me, the radiograph would always turn out to be either over-rotated or just funky-looking. Eventually, I figured out that by shooting the lateral knee cross-table, I could get the condyles to perfectly superimpose almost every time, thus producing a good lateral knee image!
Whether you're a radiography student or a newly certified X-ray tech, mastering radiographic positioning takes time, patience, and smart strategies. But the good news? You can fast-track your growth with these proven insights. Below are my five tips to help you take better x-rays, improve image accuracy, and boost your confidence as a technologist.
Tip 1: Learn the Equipment Inside and Out
Not all imaging rooms are created equal. Some facilities use modern digital radiography (DR) systems, while others rely on outdated CR systems, and that can change everything about your workflow.
Key things to know about your equipment:
- Is auto-collimation available, or do you need to adjust manually?
- Are the exposure techniques pre-set, and do they reflect real-world accuracy?
- Do the tube and image receptor stay aligned or drift unexpectedly?
- Is the software interface intuitive or clunky?
- Is one room better for tabletop work and another for upright imaging?
Mastering the quirks of each system before bringing in a patient will help you avoid unnecessary retakes, delays, and frustration. It will also boost your confidence and efficiency, especially during high-stress cases.
Tip 2: Learn from Your Co-Workers’ Experience
There’s a subtle pressure in many radiography departments to be a “rad tech superstar.” I would be lying if I said that I haven’t 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.
Some of the most valuable techniques I’ve learned came from simply asking my co-workers how they approach difficult views. As I mentioned earlier, I constantly struggled with lateral knees. Then I asked a senior tech to show me his technique: shoot cross-table and ensure the IR is parallel to the femur and perpendicular to 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.)
Moral of the story? Don’t let ego hold you back. Learn from the pros around you and you’ll progress faster — and with fewer mistakes.
Tip 3: Study Bad Images to Get Better
Mistakes are inevitable in radiography. But instead of just repeating a poor image, pause and analyze what went wrong.
Ask yourself:
- Was my patient positioning off?
- Did I over- or under-rotate the body?
- Did I miss collimation or misjudge source-to-image distance (SID)?
Next, compare your image to reference materials online, or you can purchase an imaging critique book. If your lateral wrist views are consistently flawed, you can look at examples of rotated vs. ideal positioning. Over time, you’ll start seeing patterns and correcting them naturally.
Tip 4: Follow the Same Routine Every Time
There’s a saying in radiology: “First time, every time.” And it works.
The most consistent technologists I’ve worked with all had a defined system. They did things in the same order — every single time — so that they didn’t have to think through each step during patient care. This freed their focus to concentrate on positioning, exposure, and image quality.
Here’s my go-to routine:
- Prepare the room before bringing the patient in.
- Pull up the patient’s record and verify the exam.
- Set the correct exposure techniques.
- Position the cassette or DR panel properly.
- Set SID, lock the bucky, and check alignment.
Once the patient enters, I say the same instructions and follow the same image order: AP, oblique, lateral. This process works especially well in mobile radiography, where every situation is unpredictable.
Consistency equals confidence. When you build a dependable workflow, you’ll make fewer mistakes and radiate professionalism.
Tip 5: Be Patient
No one likes to hear this, but you’re not going to become a master tech overnight. No matter how talented or motivated you are, becoming excellent at taking x-rays takes repetition, experience, and humility.
Early on, you’ll miss views, struggle with positioning, and make technical errors. That’s normal.
But here’s the good news: if you consistently:
- Learn your equipment
- Ask for help
- Analyze your mistakes
- Stick to a routine
…you will get better and faster than you think.
Radiography is both a science and an art. With dedication and practice, you’ll develop an instinct for perfect positioning, proper technique, and image excellence.
Conclusion:
Improving your x-ray technique is about being intentional, consistent, and open to learning. These five tips will not only help you reduce retakes but also make you more efficient, confident, and accurate in your work. Remember: every great technologist was once a beginner.
Start small, stay curious, and never stop improving.
Are you ready to take better X-rays?
With courses like Radiography Positioning, Radiography Image Evaluation and Quality Control, and Radiography Image Production, Clover Learning’s all-in-one video-based radiography training and ARRT® exam prep resource is built to help you succeed. Join us today and become one step closer to taking better X-rays.
Interested in what other radiography courses we offer? Browse our course catalog here.
FAQs
1. How long does it take to become good at X-ray positioning?
It depends on your learning style and how often you practice. Most technologists see big improvements within 6–12 months of active clinical experience.
2. What are the hardest X-rays to get right?
Commonly difficult views include the lateral knee, odontoid, oblique lumbar spine, and cross-table hip due to complex positioning requirements.
3. Is mobile radiography harder than in-hospital imaging?
Mobile x-ray can be more challenging due to uncontrolled environments, patient limitations, and limited equipment — but it’s also a great way to sharpen your adaptability.
4. How do I know if my X-ray is under- or over-rotated?
Compare your image to positioning references or peer-reviewed image critiques. Learning visual cues, like symmetry in vertebrae or joint spaces, will guide you.
