Optimising Positioning in Radiography

AECC University College Lecturer and Superintendent Radiographer, Dr. Fiona Mellor, is part of a research group investigating the importance of positioning in Radiography. The group recently received confirmation of a research grant from the College of Radiographers Industry Partnership Scheme to progress this work.

Fiona tells us more about the research, how the project came together, and what the group hopes to achieve with their research:

Importance of positioning

“This research actually came about following a Twitter conversation about a year ago with some of my colleagues: Professor Beverley Snaith at Mid Yorkshire NHS Trust, Dr. Philip Cosson at Teeside University, and Dr. Andrew England at Keele University.

“We’ve all worked together on research projects in the past and we were talking about positioning in Radiography.

“When positioning a patient, you use certain bony landmarks to make sure that positioning is consistent and reliable between patients. This is really important because position changes how our anatomy looks. When somebody is standing up, for example, their anatomy appears slightly different to when they are lying down.

“We were discussing how Chiropractors routinely image patients when they are standing up and in the NHS, patients are usually lying down. This makes a significant difference to what we see on the images. We were thinking particularly about the pelvis, which is one of the most common examinations. When you stand, your pelvis might tilt differently to when you are lying down.

“Or if an Orthopaedic surgeon wants to undertake a hip replacement, for example, it’s really important that we are getting the correct measurement on the X-ray. If we’re taking X-rays in slightly different positions, we’re going to show slightly different measurements.

“There is a lot of variability even just within the lying down (supine) technique. Our research project is looking to validate a new centring technique for pelvic radiography that we hope will help keep positioning more consistent.”

New technique

“Our new technique is based on our experience as radiographers and lecturers. We feel that some of the existing techniques need adjusting. If we take the pelvis as an example again, a lot of books advise you to feel around for the symphysis pubis bone at the front of the pelvis and create an imaginary line to help position the X-ray.

“Feeling for this bone can be embarrassing for the patient, and for the practitioner, and in practice a lot of radiographers have found variations on this technique. Different techniques could potentially lead to inconsistencies.”


“We formed a group called the Indication Driven Radiography (IDR) Group and started to look at writing a textbook to help with positioning that would be evidence-based. We’re hoping that the textbook will eventually be available to download so it’s easy to access.

“We’ve called the project STOPPAGE: Standardisation Of Supine Pelvic Radiograph Technique. We applied for funding through the College of Radiographers Industry Partnerships Scheme and have secured just under £10,000.

“Two NHS Trusts, Warrington NHS Trust and Mid Yorkshire NHS Trust, are going to take part in our interventional study. One of the Trusts will carry on as normal and the other will receive training and undertake our new positioning technique.

“We’re going to look at the resultant radiographs and determine if there’s more variability in existing care versus this new positioning method.”

Fiona’s research background

“I fell off a horse when I was 10 years old and suffered a number of broken bones. I was in hospital and had many X-rays. That’s when I first learned what X-ray was.

“I developed an interest in Photography, which evolved into an interest in Radiography because I also really liked programmes like Red Dwarf and Quantum Leap which gave me an interest in Physics. I studied Diagnostic Radiography and when I graduated, my first job concentrated on trauma and neuro-imaging.

“I worked in a trauma centre in Bristol for a few years and then moved back to the University of Hertfordshire to pursue research because my passion has always been to have an evidence base for what we do and why, which is where research comes in.

“I started working at AECC University College in 2003, working with Alan Breen on developing the Quantitative Fluoroscopy (QF) technique. I worked with Alan on a number of smaller research projects to validate the technique I did my PhD part-time at Bournemouth University and used QF at AECC University College, between 2009 and 2014.

“This research was seen as important enough to attract full funding from the National Institute of Health Research Clinical Academic Training Scheme.

“My PhD compared people with chronic mechanical low back pain to people without, to see if their spinal movement was different. We found that people with back pain have more variability in how their vertebra move, compared to people without pain. The vertebra of people without back pain tend to move in a more ordered way.

“I was then awarded further funding from the Radiological Research Trust to compare disc degeneration using the upright MRI scanner at AECC University College, and compare this to spinal motion using QF.

“In 2014, left AECC to do some postdoctoral research in London and then returned to Dorset to work in Radiotherapy research. I ran a cancer research trials that involved Radiotherapy.

“I started lecturing at AECC University College in December 2019 and I maintain my clinical practice in wider radiographic techniques by undertaking CT and X-ray at Poole hospital in bank shifts.”

Fi Mellor

Above: Fi Mellor