Background: Accurate patient positioning is fundamental to achieving diagnostic-quality radiographic images. Positioning errors can compromise image interpretation, increase repeat examinations, and lead to unnecessary radiation exposure. Despite established positioning guidelines, errors continue to occur in routine radiographic practice, highlighting the need for systematic evaluation.

Aim: To assess the prevalence and pattern of positioning errors in routine radiographic examinations and to analyze their distribution across different types of X-ray studies.

Materials and Methods: A prospective observational study was conducted in the Department of Radiology of a tertiary care hospital over a nine-month period from January to September 2025. A total of 250 routine radiographic examinations were evaluated. Images were assessed for positioning accuracy based on standard radiographic criteria, including anatomical coverage, centering, rotation, angulation, and patient posture. Data were analyzed using descriptive statistical methods, and results were expressed as frequencies and percentages.

Results: Out of 250 radiographs, 162 images (64.8%) demonstrated at least one positioning error. Chest radiographs showed the highest frequency of errors (72%), followed by spine (62%), extremity (61.4%), and pelvic examinations (53.3%). Inadequate anatomical coverage (26.4%) was the most common error, followed by patient rotation (22.8%) and incorrect centering (20.4%). A statistically significant association was observed between examination type and the occurrence of positioning errors (p < 0.05).

Conclusion: Positioning errors were found to be highly prevalent in routine radiographic examinations, particularly in chest imaging. These errors have important implications for image quality, diagnostic accuracy, and patient radiation dose. The findings emphasize the need for continuous quality assurance measures, regular image audits, and targeted radiographer training to reduce positioning-related errors and improve overall radiographic practice.

Keywords: Radiographic Positioning, Positioning Errors, Diagnostic Radiography, Image Quality, Quality Assurance