Chest Radiography

Position
PA
Projection

CR
CR is perpendicular to IR and centered to
midsagital place at level of T7 (7 to 8
inches below vertebrae promines/
inferior angle of scapula)
IR centered to CR

Left Lateral
Position

CR is perpendicular, directed to
midthorax at level of T7 (3 to 4 inches
below level of jugular notch)

AP
Projection

CR to level of T7, 3 to 4 inches below

jugular notch

Left Lateral
Decubitis

AP Lordotic

CR is horizontal, directed to center of IR,

to level of T7, 3 to 4 inches inferior to
level of jugular notch. A horizontal beam
must be used to show air-fluid level or
pneumothorax
Have to move tube
CR perpendicular to IR, centered at
midsternum (3 to 4 inches below jugular
notch)
PT put hands on hips with palms out with
shoulders rolled forward
14x17 LW

RAO/LAO
(Anterior
Oblique)

CR is perpendicular, directed to level of

T7 (7 to 8 inches below vertebra
prominens)

RPO/LPO
(Posterior
Oblique)

CR is perpendicular to level of T7

Demonstrates
Included are both lungs from apices to
costophrenic angles and the air-filled
trachea from T1 down. Hilum region
markings, heart, great vessels, and bony
thorax are demonstrated
Included are the entire lungs from apices
to the costophrenic angles and from the
sternum anteriorly to the posterior ribs
and thorax posteriorly
Same as PA projection except: the heart
appears larger as a result of increased
magnification from a shorter SID and
increased OID of the heart. Possible
pleural effusion, and the lungs appear
more dense because they are not as fully
aerated
Entire lungs, including apices, both
costophrenic angles, and both lateral
borders of ribs should be included

Entire lung fields and clavicles should be

included
Both lungs from the apices to the
costophrenic angles should be included.
Air-filled trachea, great vessels, and
heart outlines are best visualized with 60
degree LAO position
Both lungs from the apices to the
costophrenic angles should be included.
Air-filled trachea, great vessels, and

*Extras*
Shield btw PT
and tube
Shield btw PT
and tube
Marker goes in
front
Never do
because lots of
radiation

If PT cant stand

Apices FSI
Angle pt or tube
20-30

RAO- PA with
right shoulder
against IR

heart outlines are best visualized with 60

degree LAO position
Lateral
Position
(Upper
Airway)

CR is perpendicular to center of IR at
level of C6 to C7, midway between the
laryngeal prominence of the thyroid
cartilage and jugular notch

The larynx and trachea should be filled

with air and well visualized

AP
Projection
(Upper
Airway)

CR is perpendicular to center of IR at
level of T1-2, about 1 inch above the
jugular notch

The larynx and trachea from C3 to T4

should be filled with air and visualized
through the spine. The area of the
proximal cervical vertebrae to the
midthoracic region should be included

PA
Projection
(on a
stretcher if
the patient
can't
stand)

CR is perpendicular to IR and centered to

midsagital place at level of T7 (7 to 8
inches below vertebrae promines/
inferior angle of scapula. Cassette
centered to level of CR)

Included are both lungs from apices to

costophrenic angles and the air-filled
trachea from T1 down. Hilum region
markings, heart, great vessels, and bony
thorax are demonstrated

Abdominal Radiography
Position
AP
Projection
(Supine)
KUB

CR
CR is perpendicular to and directed to
center of IR (to level of iliac crest) and
MSP
14x17 LW
Breathe in breathe out hold it out

Demonstrates

*Extras*

Outline of liver, spleen, kidneys, and airfilled stomach and bowel segments and
the arch of the symphysis pubis for the
urinary bladder region

Shield breast

PA
projection
(prone)

CR is perpendicular to and directed to

center of IR (to level of iliac crest)

Outline of liver, spleen, kidneys, and airfilled stomach and bowel segments and
the arch of the symphysis pubis for the
urinary bladder region

Lateral
Decubitus

CR horizontal, directed to center of IR

2 inches above level of iliac crest
Use horizontal beam to demonstrate airfilled levels and free intraperitoneal air
PT is on left side with both arms up
14x17 CW

Air-filled stomach and loops of bowel and

air-fluid levels where present it should
not include bilateral diaphragm
Usually do left b/c of gastric bubble

Alternate for
erect
Air levels
Fluid side=down
Air side=up

Erect
Abdomen

CR is horizontal to center of IR
2 inches above Iliac crest and MSP
include diaphragm

Air-filled stomach and loops of bowel and

air-fluid levels where present
It should include diaphragm and as much
of lower abdomen as possible

Shield btw
patient and tube
Do PA expect
KUB

Dorsal
Decubitus
(Left
lateral)

CR is horizontal to center of IR
2 inches above iliac crest and to MSP
PT is supine
Film on the side on pt on table
14x17 CW

Lateral
Position

CR is perpendicular to table, centered at

level of iliac crest to midcoronal plane
IR centered to CR
PT is standing

Diaphragm and as much of lower

abdomen as possible should be included.
Air-filled loops of bowel in abdomen with
soft tissue detail should be visible in
anterior abdomen and in prevertebral
regions
Diaphragm and as much as lower
abdomen as possible should be included.
Air-filled loops of bowel in abdomen with
soft tissue detail should be visible in
prevertebral regions

Alternate for
erect
Fluid side=down
Air side=up
Always do left
Shield on Pt side
in btw tube and
Pt

Ileus (non-mechanical small bowel

obstruction) or Mechanical ileus
(obstruction of bowel from hernia,
adhesions, ect.)
Acute
Abdominal
Series
(Acute
Abdomen)

CR to level of illiac crest on supine and

approximately 5cm (2inches) above level
of crest to include diaphragm on erect or
decubitus

Ascites (Abnormal fluid accumulation in

abdomen)
Perforated hollow viscus (such as bowel
or stomach, evident by free
intraperitoneal air)
Intra abdominal mass (neoplasms benign or malignant)
Post-op (abdominal surgery)

Pneumothorax- air in abdomen= that side up

Left hemothorax- left side down

Hand Radiography
Position

CR

Demonstrates

PA
Projection

CR is perpendicular to IR, directed to

third MCP joint
Elbow flexed

PA projection of entire hand and wrist

and about 1 inch of distal forearm are
visible. PA projection of hand
demonstrates oblique view of the thumb

PA Oblique
Projection

CR is perpendicular to IR, directed to

third MCP joint
Hand angled onto pinky side

Oblique projection of the entire hand and

wrist and about 1 inch of distal forearm
are visible

"Fan"
Lateral
Projection

CR is perpendicular to IR, directed to

second MCP joint
PT make an okay sign
Separate pinky and thumb
Thumb side up

Entire hand and wrist and about 1 inch of

the distal forearm are visible

CR is perpendicular to IR, directed to the

second to fifth MCP joints
Thumb rests next to rest of fingers

Entire hand and wrist and about 1 inch of

the distal forearm are visible. Thumb
should appear in slightly oblique position
and free of superimposition with joint
spaces open

Lateral in
Extension
and Flexion

*Extras*
IP and MCP joints
Base of 3-5
metacarpals FSI
1st digit seen in
PA oblique
position
1st and 2nd
metacarpal FSI
Use step wedge
so DIP joint isnt
closed
Anterior and
posterior
phalanges
IP and MCP joints
open
Soft tissue
foreign bodies

AP Oblique
Bilateral
Projection
(Norgaurd)

CR is perpendicular, directed to midpoint

between both hands at level of fifth MCP
joints
Lateral/pinky sides next to eachother
Palms up

Both hands from the carpal area to the

tips of digits in 45 degree oblique
position are visible
IP joints distorted

R/O early arthritic

changes and
base of proximal
phalanges

Full extension lateral- soft tissue FB

PA oblique- 1st and 2nd MC FSI
Thumb is always on the lateral side

Finger Radiography
Position

CR

Demonstrates

PA
Projection

CR is perpendicular to IR, directed to PIP

joint

Distal, middle, and proximal phalanges.

Distal metacarpal and associated joints

CR is perpendicular to IR, directed to PIP

joint
Hand rotated to pinky side
CR is perpendicular to IR, directed to PIP
joint
Digits 3-5 put thumb side up
Digits 1-2 put thumb down

45 degree view of distal, middle, and

proximal phalanges; distal metacarpal;
and associated joints

Interphalangeal
and MCP joints
open

Distal, middle, and proximal phalanges.

Distal metacarpal and associated joints
are visible

Anterior/posterior
displacement

PA Oblique
Projection
Lateral
projection

AP
Projection
(Thumb)

CR is perpendicular to IR, directed to first

MCP joint
Hand is hyperpronated
Have pt pull fingers back
Nail side of thumb is closer to the IR

Distal and proximal phalanges, first

metacarpal, trapezium, and associated
joints are visible. Interphalangeal and
metacarpophalageal joints should
appear open

*Extras*

Attempt to free
the base of the
carpometacarpal
region of soft
tissue
superimposition

PA Oblique
Projection
(Thumb)
Lateral
Position
(Thumb)
AP Axial
Projection
(Modifiied
Robert's
Method:
Thumb)
PA Stress
thumb
projection

CR is perpendicular to IR, directed to first

MCP joint
CR is perpendicular to IR, directed to first
MCP joint
Rotate hand toward pinky side until
thumb is straight
CR is directed 15 degrees proximally
(toward wrist) entering at the first CMC
joint/bottom of thumb
Extend fingers and hold back with other
hand
Nail side down
Palm up
CR is perpendicular to IR directed to
midway between MCP joints

Distal and proximal phalanges, first

metacarpal, trapezium, and associated
joints are visible in a 45 degree oblique
position
Distal and proximal phalanges, first
metacarpal, trapezium (superimposed),
and associated joints are visiized in the
lateral position
An AP projection of the thumb and first
CMC joint are visible without
superimposition. Base of first metacarpal
and trapezium should be well visualized

Place hand in PA
and collimate in
Interphalangeal
and MCP joints
open
Bennetts vs
Rolando FX
Better
demonstrate 1st
CMC joint
Make sure you
remesaure SID

Entire thumb from first metacarpals to

distal phalanges. Demonstrates
metacarpophalangeal angles and joint
spaces at MCP joints

Wrist Radiography
Position

CR

PA
projection

CR is perpendicular to IR, directed to

midcarpal area
8x10 LW
PT make a fist
Include up to knuckles on hand

PA Oblique
Projection

CR is perpendicular to IR, directed to

midcarpal area
8x10 LW
Rotate hand and wrist laterally (on pinky)
Include up to knuckles on hand
Fingers flexed to support hand

Demonstrates
Midmetacarpals and proximal
metacarpals, distal radius, ulna, and
associated joints and pertinent soft
tissues of the wrist joint such as fat pads
and fat stripes are visible. All the
intercarpal spaces do not appear open
because of irregular shapes that result in
overlapping
Distal radius, ulna, carpals, and at least
to midmetacarpal area are visible.
Trapezium and scaphoid should be well
visualized, with only slight
superimposition of other carpals on their
medial aspects

*Extras*
Hamate,
capatate,
scaphoid (prox)
-Make fist
Trapezium and
trapezoid

Lateral
Projection

PA Ulnar
Deviation/
Modified
Stetchers

CR is perpendicular to IR, directed to

midcarpal area
8x10 LW
Shoulder, forearm, and wrist on same
plane
Hand on pinky side
Thumb rests on ride on fingers
Angle CR 10 to 15 degrees towards
elbow
Center CR to scaphoid/thumb side
8x10 LW
Angle hand toward pinky side

PA Hand
elevated
and ulnar
deviation/
True
Stetcher

Center CR perpendicular to IR, and

directed to scaphoid/thumb side
8x10 LW
Angle hand toward pinky side

PA
Projection/
Radial
Deviation

CR is perpendicular to IR, directed to

midcarpal area
8x10 LW
Angle hand toward thumb side

Carpal
Canal
(Tunnel)/
Gaynor
Heart
Projection

Angle CR 25-30 degrees to 3rd

metacarpal (center of palm of the hand)
8x10 LW
Hyperextended
Have pt pull fingers back
Collimate into carpal region

Carpal
Bridge/
Tangential
Projection

Angle CR 45 degrees to the long axis of

the forearm. Direct CR to a midpoint of
the distal forearm about 4 cm proximal
to wrist joint

Distal radius, ulna, carpals, and at least

to midmetacarpal area are visible

Rotated back a
little bit
See anterior vs
posterior
displacement

Distal radius, ulna, carpals, and proximal

metacarpals are visible. Scaphoid should
be demonstrated clearly without
foreshortening with adjacent carpal
interspaces open
Distal radius, ulna, carpals, and proximal
metacarpals are visible. Carpals are
visible with adjacent interspaces more
open on the lateral (radial) side of the
wrist. Scaphoid is shown without
foreshortening or superimposition of
adjoining carpals
Distal radius, ulna, carpals, and proximal
metacarpals are visible. Carpals are
visible with adjacent interspaces more
open on the medial (ulnar) side of the
wrist.

Use sponge to
elevate hand 200
Center at snuff
box
Scaphoid

The carpals are demonstrated in a

tunnel-like arched arrangement
R/o carpal tunnel syndrome
Visualize pisiform and hamulus FSI

Pressure on
median nerve
Make sure no
calcifications or
osificiation

Tangential view of the dorsal aspect of

the scaphoid, lunate, and triquetrum is
visible. Outline of the capitate and
trapezium superimposed is visible

Center at snuff
box
Elongates
scaphoid
Angle tube

Ulnar side of
carpals

AP
Clenched

Wrist semisupinated and adjusted at 45

degrees obliquity to receptor place
CR directed perp to midcarpus
Can either supinate or pronante

Best demonstrates the pisiform and

triquetral free of superimposition
R/o ligamentous disruption or carpal
instability

Intercarpal faces
Stresses tendons

AP ob- pisiform and triquitrum

PA ob- trapezium and trapezoid
AP clenched- intercarpal faces
Coyles- scaphoid view
Pinky is always the medial side

Forearm Radiography
Position

CR

AP
Projection
(Forearm)

CR is perpendicular to IR, directed to

mid-forearm
14x17 LW
Hand supinated
SID 40

Lateral
Projection
(Forearm)

CR is perpendicular to IR, directed to

mid-forearm
14x17 LW
Elbow flexed at 900
Hand and wrist in true lateral position

Demonstrates
AP projection of the entire radius and
ulna is shown, with a minimum of
proximal row carpals and distal humerus
and pertinent soft tissues such as fat
pads and stripes of the wrist and elbow
joints
Lateral projection of entire radius and
ulna, proximal row of carpal bones,
elbow, and distal end of the humerus are
visible as well as pertinent soft tissue,
such as fat pads and stripes of the wrist

*Extras*
Medial/lateral
displacement
Include both
joints
Humeral
epicondyles are
superimposed
Head of radius
and ulna

SID 40

and elbow joints

superimposed

*Extras*
Medial
epicondyle FSI
See olecronon
fossa
1/3
to of the
proximal radius
will still be SI by
the ulna

Elbow Radiography
Position

CR

Demonstrates

AP
Projection
(Elbow
fully
extended)

CR is perpendicular to IR
Directed to mid-elbow joint
Hand supinated/palm up
Fist clenched
10x12 LW

Distal humerus, elbow joint space, and

proximal radius and ulna are visible
Medial epicondyle

AP
Projection
(Elbow
cannot be
fully
extended)
AP Oblique
Projection/
Lateral
(external
rotation)

CR is perpendicular to IR, directed to

mid-elbow joint, which is approximately
2 cm distal to midpoint of a line between
epicondyles
10x12 LW
CR is perpendicular to IR
Directed to mid-elbow joint
Start at the side of the plate and roll
them
Hand supinated/palm up
Pinky side up/thumb pointing to the
ground
10x12 LW

AP Oblique
Projection/
Medial
(internal
rotation)

CR is perpendicular to IR
Directed to mid-elbow joint
Hand pronated/palm down
Make sure epicondyles are rotated
medially
10x12 LW

Lateral
Projection

CR is perpendicular to IR
Directed to mid-elbow joint
Elbow at a 900 angle
Humerus and elbow on the same plane
Hand and wrist in lateral position
10x12 LW

Acute
Flexion
Projection

Distal humerus: CR perpendicular to IR

and humerus, directed to a point midway
between epicondyles.
Proximal forearm: CR perpendicular to
forearm (angling CR as needed), directed
to a point approx 2 inches proximal or
superior to olecranon process

Distal humerus is best visualized on

humerus parallel projection and
proximal radius and ulna are best
visualized on forearm parallel
projection

Oblique projection of distal humerus and

proximal radius and ulna is visible

Oblique projection of distal humerus and

proximal radius and ulna is visible
Radial head and neck is superimposed
over ulna

Lateral projection of distal humerus and

proximal forearm, olecranon process,
and soft tissues and fat pads of the
elbow joint are visible
Proximal humerus: Forearm and humerus
should be directly superimposed. Medial
and lateral epicondyles and parts of
trochlea, capitulum, and olecranon
process all should be seen in profile.
Optimal exposure should visualize distal
humerus and olecranon process through
superimposed structures. Soft tissue
detail is not readily visible on either
projection

Head, neck,
tubercle of radius
Lateral
epicondyle
Capitulum

Coronoid process
trochlea
medial
epicondyle
Joint space FSI
Olecranon
process
Trochelar notch
Fat pads
See Hershey
kiss
Cut of the
olecranon
Flex arm as much
as possible

Trauma
Axial
Lateral
(Coyle
Method)

Radial Head: CR angled 45 degrees

toward shoulder, centered to radial head
1 inch below elbow joint
Elbow flexed 90 degrees
Shoot through elbow

Axial
lateral
projections
(Coyle
Method)
Radial
Head
Laterals/
Lateromedi
al
projection

Coronoid Process: CR angled 45 degrees

away shoulder into midelbow joint
1 inch below elbow joint
Elbow flexed 80 degrees
CR near crease in elbow

CR is perpendicular to IR, directed to

radial head (approx 2 to 3 cm distal to
lateral epicondyle)

Distal forearm: proximal ulna and radius,

including outline of radial head and neck,
should be visible through superimposed
distal humerus. Optimal exposure
visualizes outlines of proximal ulna and
radius superimposed over humerus
Radial Head: joint space between radial
head and capitulum should be open and
clear.
Radial head, neck, and tuberosity should
be in profile and free of superimposition
except for a small part of the coronoid
process.
Coronoid Process: Distal portion of the
coronoid appears elongated but in
profile. Joint space between coronoid
process and trochlea should be open and
clear

Radial head,
neck, and
capitulum

Coronoid process
and trochlea

Radial head and neck should be partially

superimposed by ulna but completely
visualized in profile in various
projections. Radial tuberosity should be
visualized.

Medial- coronoid process, trochela, medial epipcondyle

Lateral oblique- lateral condyle, capitulum
Lateral- trochlear notch

Humerus Radiography
Position

CR

Demonstrates

*Extras*

AP Projection

CR is perpendicular to IR, directed to

midpoint of humerus
14x17 LW

AP projection shows the entire

humerus, including the shoulder and
elbow joints

Rotational
lateral
projection

CR is perpendicular to IR, directed to

midpoint of humerus
Wrist and arm rotated/palm back
14x17 LW

Lateral projection of the entire

humerus, including the elbow and
shoulder joints is visible
Epicondyles superimposed

Trauma
horizontal beam
lateral/laterome
dial projection

CR is perpendicular to midpoint of
distal two-thirds of humerus

Transthoracic
lateral
projection
(trauma)

CR is perpendicular to IR, directed

through thorax to mid-diaphysis

Transthoracic
lateral
projection
(proximal
humerus)

CR is perpendicular to IR, directed

through thorax to level of affected
surgical neck

Lateral projection of the midhumerus

and distal humerus, including the
elbow joint is visible. The distal twothirds of the humerus should be well
visualized
Lateral view of entire humerus and
glenohumeral joint should be
visualized through the thorax without
superimposition of the opposite
humerus
Lateral view of proximal half of the
humerus and scapulohumeral joint
should be visualized through the
thorax without superimposition of the
opposite shoulder

shield in front
Include both
elbow and
shoulder joint
Arm abducted
Hand supinated
shield in front
Include both
elbow and
shoulder joint
Include
glenohumeral
joints

Shoulder Radiography
Position

CR

AP
Projection/extern
al rotation (nontrauma)

CR is perpendicular to IR, directed

to 1 inch inferior to coracoid
process
Turn hand in
10x12 CW

AP
Projection/intern
al rotation (nontrauma)

CR is perpendicular to IR, directed

to 1 inch inferior to coracoid
process
Thumb goes posterior
10x12 CW

Inferosuperior
Axial Projection
(non-trauma) or
Lawrence

Direct CR medially 25 to 30
degrees centered horizontally to
axilla and humeral head
You have to move the whole tube
10x12 CW

PA transaxillary
projection/
Nobbs
modification
(non-trauma)
Inferosuperior
axial
projection/Cleme
nts modification
(non-trauma)

CR is directed perpendicularly to
the axilla and the humeral head to
pass through the glenohumeral
joint
8x10 CW
Direct horizontal CR perpendicular
to IR. If patient cannot abduct the
arm 90 degrees, angle the tube 5
to 15 degrees toward the axilla
8x10 CW

Demonstrates
AP projection of prox humerus and
lateral 2/3 clavicle and upper
scapula
Relationship of the humeral head to
the glenoid cavity
FX/dislocation of proximal humerus/
osteophytes/ bursal
Lateral view of proximal humerus
and lateral 2/3 clavicle and upper
scapula
Relationship of the humeral head to
the glenoid cavity
FX/dislocation of proximal humerus/
osteophytes/ bursal

*Extras*
Greater tubercle in
profile
Bank heart lesion

Lesser tubercle
inferior medial in
profile
Hill sacks

Lateral view of proximal humerus in

relationship to scapulohumeral
cavity
Coracoid process of scapula and
lesser tubercle of humerus

Orothopedics choice
of a lateral
Coracoid process
and lesser tubercle
Film against neck
Have to build
shoulder up

Lateral view of proximal humerus in

relationship to glenohumeral
articulation is visualized. Coracoid
process of scapula is not seen

PT erect PA
Head turned away
Affected arm
straight up

Lateral view of proximal humerus in

relationship to scapulohumeral
cavity is shown

PT laying down IR
next to neck
Affected arm up
straight

Posterior oblique
position/gelnoid
cavity (nontrauma)
Grashey

CR is perpendicular to IR, centered

to scapulohumeral joint which is
approx 2 inches inferior and medial
from the superolateral border of
shoulder
10x12 LW

Glenoid cavity should be seen in

profile without superimposition of
humeral head

Glenoid space and

greater tubercle
PT rotated 450
toward affected side

Tangential
projection/interc
ular (bicipital)
groove (nontrauma) Fisk

CR is perpendicular to IR, directed

to groove area at midanterior
margin of humeral head
8x10 CW

Anterior margin of the humeral head

is seen in profile. Humeral tubercles
and the intertubercular groove are
seen in profile

Humeral tubercles
and intertubercular
groove
No SI of acromin
process

AP
projection/neutra
l rotation
(trauma)

CR is perpendicular to IR, directed

to midscapulohumeral joint which
is approx 2 cm inferior and slightly
lateral to coracoid process

The proximal one-third of the

humerus and upper scapula and the
lateral two-thirds of the clavicle
Relationship of the humeral head to
the glenoid cavity

AP Scapulary Y
lateral (trauma)

PA Scapulary Y
lateral (trauma)

Neer Y Scapulary
lateral (trauma)
Tangential
projection/
supraspinatus
outlet (trauma)

CR is perpendicular to IR, directed

to scapulohumeral joint 2 to 21/2
inches below the top of the
shoulder
10x12 LW
CR is perpendicular to IR, directed
to scapulohumeral joint 2 to 21/2
inches below the top of the
shoulder
10x12 LW
CR is perpendicular to IR, directed
to scapulohumeral joint 2 to 21/2
inches below the top of the
shoulder
10-15 degree caudad
10x12 LW
Requires 10 to 15 degrees CR
caudal angle, centered posteriorly
to pass through superior margin of
humeral head

True lateral view of the scapula,

proximal humerus, and
scapulohumeral joint

Humeral head
posterior/acromial
450 Affected side
away

True lateral view of the scapula,

anterior humerus, and
scapulohumeral joint

Humeral head
anterior/coracoid
process
450 toward affected
side

Supraspinatus outlet region is open

Subacromial space
Supraspinatus outlet
450 toward affected
side

Proximal humerus is superimposed

over thin body of the scapula, which
should be seen on end without rib
superimposition

AP apical oblique
axial projection/
Garth (trauma)

CR 45 degrees cephalic, centered

to scapulohumeral joint
10x12 LW

Humeral head, glenoid cavity, and

neck and head of the scapula are
well demonstrated free of
superimposition

AP projection
(clavicle)

CR perpendicular to midclavical
10x12 LW

Entire clavicle visualized including

both AC and sternoclavicular joints
and acromion

AP axial
projection
(clavicle)

CR 15-30 degrees cephalad to

midclavicle
10x12 LW

Entire clavicle visualized including

both AC and sternoclavicular joints
and acromion

AP projection (AC
joints)

CR is perpendicular to midpoint
between AC joints, 1 inch above
jugular notch
14x17 CW or 2 8x10
1st exposure without weights
2nd exposure with weights

Both AC joints, entire clavicles and

SC joints are demonstrated

Anytime there is an angle of 15 degrees or more then you see the subacromial space
Finger looking bone- coracoid
Garth 45-45- glenoid and subacromial space
Grayshey- glenoid space
PA Y- anterior and coracoid
AP Y- posterior and acromion
Neer Y- subacromial space and supraspinatus outlet
AP external- proximal humerus/ greater tubercle
PA external- proximal humerus/ lesser tubercle
Inferosuperior axial- orthopedics choice of a lateral
AP axial- clavical above ribs

45-450
Glenoid, humeral
head, subacromial
space
Long bone so you
need to include both
joints
Collimate long and
skinny
Entire clavicle above
the scapula and ribs
Clavicle looks
horizontal
Rule out FX before
with weight
projection
Weights need to be
tied to wrists

Foot Radiography
Position

CR

Demonstrates

AP Projection
(dorsoplantar
projection)

Angle CR 10 degrees posteriorly

(toward heel) with CR perpendicular
to metatarsals
Direct CR to base of third metatarsal

Entire foot should be demonstrated,

including all phalanges and
metatarsals and navicular,
cuneiforms, and cuboids

AP Oblique
projection
(medial rotation)
Lateral/mediolat
eral or
lateromedial
projection

CR is perpendicular to IR, directed to

base of third metatarsal
CR is perpendicular to IR, directed
to medial cuneiform (at level of base
of third metatarsal)

Entire foot should be demonstrated

from distal phalanges to posterior
calcaneus and proximal talus
Entire foot should be demonstrated,
with a minimum of 1 inch of distal
tibia-fibula. Metatarsals are nearly
superimposed

*Extras*
A high arch
requires a
greater angle
and a low arch
needs 5 degrees
to be
perpendicular to
the metatarsals.
For foreign body,
CR should be
perpendicular to
IR with no CR
angle

AP weightbearing
projection

Angle CR 15 degrees posteriorly to

midpoint between feet at level of
base of metatarsals

Lateral weightbearing
projection

Direct CR horizontally to level of base

of third metatarsal

For AP, projection shows bilateral feet

from soft tissue surrounding
phalanges to distal portion of talus.
Distal fibula should be seen
superimposed over posterior half of
the tibia and plantar surfaces of heads
of metatarsals should appear directly
superimposed if no rotation is present
For lateral, entire foot should be
demonstrated, along with a minimum
of 1 inch of distal tibia-fibula.

Toe Radiography
Position

AP
Projection

AP oblique
(medial or
lateral
rotation)
Lateralmediolater
al

CR
Angle CR 10-15 degrees toward
calcaneus
CR is perpendicular to phalanges
If a 15 degree wedge is placed under the
foot for the parallel part-film alignment
the CR is perpendicular to the IR
Center CR to MTP joint in question
CR is perpendicular to IR, directed to
MTP joint in question
CR is perpendicular to IR
CR directed to interphalangeal joint for
first digit and to proximal
interphalangeal joint for second to fifth
digits

Demonstrates

*Extras*

Digits of interest and a minimum of the

distal half of metatarsals should be
included

Fractures or
dislocation of
toes

Digits in question and distal half of

metatarsals should be included without
overlap (superimposition)

Osteoarthritis

Phalanges of digit in question should be

seen in lateral position free of
superimposition by other digits, if
possible. When total separation of toes is
impossible esp. third and fourth digits,
the distal phalanx at least should be

Tangential
projection
(sesamoids
)

CR is perpendicular to IR, directed

tangentially to posterior aspect of first
MTP joint (depending on amount of
dorsiflexion of foot, may need to angle
CR slightly for a true tangential
projection)

separated and the proximal phalanx

should be visualized through
superimposed structures
Seasmoids should be seen in profile free
of superimposition. A minimum of the
first three distal metatarsals should be
included in collimation field for possible
seasmoids, with the center of the foursided collimation field (CR) at the
posterior portion of the first MTP joint.

Calcaneus
Position

Plantodors
al (axial
projection)

Lateralmediolater
al
projection

CR
Direct CR to base of third metatarsal to
emerge at a level just distal to lateral
malleolous
Angle CR 40 degrees cephalad from long
axis of foot (which also would be 40
degrees from vertical if long axis of foot
is perpendicular to IR
CR angulation must be increased if long
axis of plantar surface of foot is not
perpendicular to IR
CR perpendicular to IR, directed to a
point 1 inch inferior to medial malleolus

Demonstrates

Entire calcaneus should be visualized

from tuberosity posteriorly to
talocalcaneal joint anteriorly

Calcaneous is demonstrated in profile

with talus and distal tibia-fibula
demonstrated superiorly and navicular
and open joint space of the calcaneous
and cuboid demonstrated distally

*Extras*

Ankle Radiography
Position

CR

AP
Projection

CR is perpendicular to IR, directed to a

point midway between malleoli

AP mortise
projection
(15-20
degrees
medial
rotation)
AP oblique
projection
(45 degree
medial
rotation)

Demonstrates
Distal one-third of tibia-fibula, lateral and
medial malleoli, and talus and proximal
half of metatarsals should be
demonstrated

CR is perpendicular to IR, directed to a

point midway between malleoli

Distal one-third of tibia-fibula, tibial

plafont involving the epiphysis if present,
lateral and medial malleoli, talus, and
proximal half of the metatarsals should
be demonstrated. Entire

CR is perpendicular to IR, directed to

medial malleoli

Distal one-third of tibia-fibula with the

distal fibula superimposed by the distal
tibia, talus, and calcaneus appear lateral
profile. Tuberosity of fifth metatarsal,
navicular, and cuboid also are visualized

*Extras*

Lateralmediolater
al (or
lateromedi
al)
projection
AP stress
projections
(Inversion
and
eversion
position)

CR is perpendicular to IR, directed to a

point midway between malleoli

Distal one-third of lower leg, malleoli,

talus, and proximal half of metatarsals
should be seen

CR is perpendicular to IR, directed to a

point midway between malleoli

Ankle joint for evaluation of joint

separation and ligament tear or rupture
is shown. Appearance of joint space may
vary greatly depending on the severity of
ligament damage. Collimation to area of
interest

Tibia- Fibula Radiography

Position

CR

AP
Projection
(leg)

CR is perpendicular to IR, directed to

midpoint of leg

Lateralmediolater
al
projection

CR is perpendicular to IR, directed to

midpoint of leg

Demonstrates
Entire tibia and fibula must include ankle
and knee joints on this projection (or two
if needed)
The exception is alternative routine on
follow-up examinations
Entire tibia and fibula must include ankle
and knee joints on this projection (or two
if needed)
The exception is alternative routine on
follow-up examinations

*Extras*

Knee Radiography General Projections

Position
AP
projection

CR
Align CR parallel to articular facets (tibial
plateau) for average sized patient, CR is
perpendicular to IR
Direct CR to a point inch distal to apex
of patella
To see if CR is parallel to articular facets
for open joint space is to measure
distance from anterior superior iliac
spines to tabletop to determine the CR
angle as follows:
<19 cm: 3 to 5 caudad (thin thighs and
buttocks)
19 to 24 cm: 0 degree angle (average)

Demonstrates
Distal femur and proximal tibia and
fibula are shown
Femorotibial joint space should be open
with the articular facets of the tibia seen
on end with only minimal surface area
visualized

*Extras*

>24 cm: 3 to 5 cephalad (thick thighs)

AP Oblique

Angle CR 0 degrees on average patient

Direct CR to midpoint of knee at a level
inch distal to apex of patella

Distal femur and proximal tibia and

fibula with the patella superimposing the
medial femoral condyle are shown.
Lateral condyles of the femur and tibia
are well demonstrated, and the medial
and lateral knee joint spaces appear
unequal

AP Oblique
projection
(lateral,
external
rotation)

Angle CR 0 degrees on average patient

Direct CR to midpoint of knee at a level
inch distal to apex of patella

Distal femur and proximal tibia and

fibula with the patella superimposing the
lateral femoral condyle are shown.
Medial condyles of the femur and tibia
are demonstrated in profile

Lateralmediolater
al
projection

Angle CR 5 to 7 degrees cephalad for

lateral recumbent projection
Direct CR to point 1 inch distal to medial
epicondyle
Angle CR 7 to 10 degrees on a short
patient with a wide pelvis and about 5
degrees on a tall, male patient with a
narrow pelvis for lateral recumbent
projection

Distal femur and proximal tibia and

fibula and patella are shown in lateral
profile
Femoropatella and knee joints should be
open

AP weight
bearing
bilateral
knee
projection

CR is perpendicular to IR or 5 to 10
degrees caudad on thin patient directed
midpoint between knee joints at a level
below apex of patellae

Distal femur and proximal tibia and

fibula and femorotibial joint spaces are
demonstrated bilaterally

PA Axial
weightbearing
bilateral
knee
projection

CR angled 10 degrees caudad and

centered directly to midpoint between
knee joints at level inch below apex of
patellae when a bilateral study is
performed; alternatively, CR centered
directly to midpoint of knee joint at level
inch below apex of patella when a
unilateral study is performed

Distal femur and proximal tibia and

fibula and femorotibial joint spaces, and
intercondylar fossa are demonstrated
bilaterally or unilaterally

PA Axial
projection
(tunnel
view)
intercondyl
ar fossa

Prone: direct CR perpendicular to lower

leg (40-50 degrees caudad to match
degree of flexion)
Kneeling: : direct CR perpendicular to IR
and lower leg. Direct CR to midpopliteal
crease

AP axial
projection
(intercondy
lar fossa )

Direct CR perpendicular to lower leg (4045 cephalad)

Direct CR to a point inch distal to apex
of patella

PA
projection
(patella)

CR is perpendicular to IR
Direct CR to midpatella area which is
usually at approximately the midpoint
crease

Lateralmediolater
al
projection
(patella)

CR is perpendicular to IR
Direct CR to midpatella joint

Intercondylar fossa, articular facets

(tibial plateaus) and knee joint space are
demonstrated clearly
Center of four-sided collimation field
should be to midknee joint area.
Intercondylar fossa should appear in
profile, open without superimpositon by
patella. Intercondylar eminence and
tibial plateau and distal condyles of
femur should be clearly visualzed.
Knee joint and patella are shown, with
optimal recorded detail of patella
because of decreased OID if taken as PA
projection
Profile images of patella, femoropatellar
joint, and femorotibal joint are
demonstrated

Knee Radiography Tangential and Axial projections

Position
Tangential
(axial or
sunrise/skyli
ne) patella

CR
Angle CR caudad, 30 degrees from
horixontal (CR 30 degrees to femora)
adjust CR angle if needed for true
tangential projection of femoropatellar

Demonstrates
Intercondylar sulcus (trochlear groove)
and patella of each distal femur should
be visualized in profile with
femoropatellar joint space open

*Extras*

Merchant
bilateral
method
Tangential
patella
Inferosuperio
r projection

Hughston
method

joint spaces
Direct CR to a point midway between
patellae
Direct CR inferosuperiorly, at 10-15
degrees angle from lower legs to be
tangential to femoropatellar joint.
Palpate borders of patella to determine
specific CR angle required to pass
through infrapatellar joint space
Align CR approximately 15-20 degrees
from long axis of lower leg (tangential
to femoropatellar joint)
Direct CR to midfemoropatellar joint

Intercondylar sulcus (trochlear groove)

and patella of each distal femur should
be visualized in profile with
femoropatellar joint space open
Intercondylar sulcus (trochlear groove)
and patella of each distal femur should
be visualized in profile with
femoropatellar joint space open

Settegast
method

Direct CR tangential to femoropatellar

joint space (15 to 20 degrees from lower
leg)
Minimum SID is 40 inches

Intercondylar sulcus (trochlear groove)

and patella of each distal femur should
be visualized in profile with
femoropatellar joint space open

Hobbs
modification
superoinferio
r sitting
tangential
method

Align CR to be perpendicular to IR
(tangential to femoropatellar joint)
Direct CR to midermoropatellar joint
Minimum SID is 48 to 50 inches to
reduce maginification because of
increased OID

Intercondylar sulcus (trochlear groove)

and patella of each distal femur should
be visualized in profile with
femoropatellar joint space open

Patient supine,
45 degree knee
flexion

Patient prone, 55
degree knee
flexion

Patient prone, 90
degree knee
flexion
Rule out fracture
before acute
flexion of knee is
done

Patient sitting,
>90 degree knee
flexion

Femur Radiography
Position

CR

Demonstrates

*Extras*

AP
Projection
(femur-mid
and distal)
Lateralmediolater
al or
lateromedi
al
projection
(femurmid-and
distal)
Lateralmediolater
al
projection
(femurmid-and
proximal)

CR is perpendicular to femur and IR

Direct CR to midpoint of IR

Distal two-thirds of distal femur,

including knee joint is shown. Knee joint
space will not appear fully open because
of divergent x-ray beam

CR is perpendicular to femur and IR

directed to midpoint of IR

Distal two-thirds of distal femur,

including knee joint is shown. Knee joint
space will not appear open and distal
margins of the femoral condyles will not
be superimposed because of divergent xray beam

CR is perpendicular to femur and CR

directed to midpoint of IR

Proximal one-half to two-thirds of the

proximal femur, including the hip joint is
shown. Proximal femur and hip joint
should not be superimposed by opposite
limb

Hip Radiography

Position
AP Pelvis
projection
(bilateral
hips)
PA axial
oblique
projection
(acetabulu
m) teufel
method
AP
unilateral
hip
projection
(hip and
proximal
femur)
Axiolateral
inferosuper
ior
projection
(hip and
proximal
femur
trauma)
DaneliusMiller
method
Unilateral
frog-leg
projectionmediolater
al (hip and
proximal
femur)
Modified

CR
CR is perpendicular to IR, directed
midway between level of ASIS and the
symphysis pubis. This is approximately 2
inches inferior level of ASIS
Center IR to CR
When anatomy of interest is downside,
direct CR perpendicular and centered to
1 inch superior to the level of the greater
trochanter, apporox 2 inches lateral to
the midsagittal plane
Angle CR 12 degrees cephalad

Demonstrates
Pelvic girdile, L5, sacrum, and coccyx,
femoral heads and neck, and greater
trochanters are visible

Centered to the downside acetabulum,

the superoposterior wall of the
acteabulum is demonstrated

CR is perpendicular to IR, directed to 1

to 2 inches distal to midfemoral neck (to
include all of orthopedic appliance of hip,
if present). Femoral neck can be located
about 1 to 2 inches medial and 3 to 4
inches distal to ASIS

The proximal one-third of the femur

should be visualized, along with the
acetabulum and adjacent parts of the
pubis, ishium, and illium. Any existing
orthopedic appliance should be visible in
its entry

CR is perpendicular to femoral neck and

to IR

Entire femoral head and neck,

trochanter, and acetabulum should be
visualized

CR is perpendicular to IR, directed to

midermoral neck (center of IR)
Rotating onto affected side until the
femur is in contact with the tabletop and
parallel to the IR

Lateral views of acetabulum and femoral

head and neck, trochanteric area, and
proximal one-third of femur are visible

*Extras*

cleaves
method
Modified
axiolateralpossible
trauma
projection
(hip and
proximal
femur)

Angle CR mediolaterally as needed so

that it is perpendicular to and centered
to femoral neck. It should be angled
posteriorly 15-2o degrees from
horizontal

Lateral oblique views of acetabulum,

femoral head and neck, and trochanteric
area are visible

Pelvis Radiography Judeat and Inlet/Outlet projections

Position
AP bilateral
frog-leg
projection
(modified
cleaves
method)
AP axial outlet
projection (for
anteriorinferior pelvic
bones)
AP axial inlet
projection
Posterior
oblique
pelvis/acetabul
um (Judet
method)

CR

Demonstrates

CR is perpendicular to IR, directed to a

point 3 inches below level of ASIS (1
inch above the symphysis pubis)

Femoral heads and necks acetabulum

and trochanteric areas are visible on
one radiograph

Angle CR cephalad 20-35 degrees for

males and 30-45 degrees for females
Direct CR to midline point 1 to 2 inches
distal to the superior border of the
symphysis pubis or greater trochanters

Superior and inferior rami of pubis and

body of ramus of ishchium are
demonstrated well, with minimal
foreshortening or superimposition

Angle CR caudad 40 degrees (near

perpendicular to plane of inlet)
Direct CR to a midline point at level of
ASIS
When anatomy of interest is downside,
direct CR perpendicular and centered
to 2 inches distal and 2 inches medial
to downside ASIS
When anatomy of interest is upside,
direct perpendicular and centered 2
inches directly distal to upside ASIS

This is an axial projection that

demonstrates pelvic ring or inlet
(superior aperture) in its entirety
When centered to the downside
acetabulum, the anterior rim of the
acetabulum and the posterior
(ilioischial) column are demonstrated
The iliac wing also well visualized
When centered to the upside
acetabulum, the posterior rim of the
acetabulum and the anterior (iliopubic)

*Extras*

Different angles
caused by
difference in the
shape of male
and female
pelvis

column are demonstrated

The obturator foramen also is
visualized

Sacro-Illiac Joints Radiography

Position
AP axial
projection

Posterior
oblique
positions
(LPO and
RPO)

CR
Angle CR 30-35 degrees cephalad (males
about 30 and females 35, with an
increase in the lumbosacral curve)
Direct CR to midline about 2 inches
below level of ASIS
Center IR to CR

CR is perpendicular to IR
Direct CR 1 inch medial to upside of ASIS
Center IR to CR

Demonstrates

*Extras*

Sacroiliac joints and L5-S1 intervertebral

joint space

Sacroiliac joints farthest from IR

To demonstrate
the interior or
distal part of the
joint more
clearly, the CR
may be angled
15-20 degrees
cephalad

Bony Thorax Ribs

Position
AP
projection
(posterior
ribs) above
diaphragm
AP
projection
(posterior
ribs) below
diaphragm
PA
projection
(anterior
ribs) above
diaphragm

CR
CR perpendicular to IR, centered to 3 to
4 inches below jugular notch
IR centered to level of CR (top of IR
should be about 1 inches above
shoulders)
65-70 kVp

Demonstrates
Above diaphragm: ribs 1 through 10
should be visualized

CR perpendicular, centered to level of

xiphoid process
IR centered to CR (lower margin of IR at
iliac crest)

Below diaphragm: ribs 9-12 should be

visualized

CR perpendicular to IR, centered to T7 (7

to 8 inches below vertebra prominens as
for PA chest)
IR centered to level of CR (top of IR 1
inches above shoulders)

Ribs 1 through 10 should be visualized

above diaphragm

*Extras*

Unilateral
rib study
(AP-PA
position)

Posterior
or anterior
oblique
(Axillary
ribs)

Above diaphragm: CR perpendicular to

IR, centered midway between midsagitial
plane and outer margin of thorax
IR centered to level of CR (top of IR
should be about 1 inches above
shoulders)
Below diaphragm: align left or right
side of thorax to CR and to midline of
grid or table/upright bucky
IR centered to CR (bottom of IR at iliac
crest)
CR perpendicular to IR, centered midway
between lateral margin of ribs and spine
Above diaphragm: CR to level of 3 to 4
inches below jugular notch (T7) top of IR
approx 1 inches above shoulders
Below diaphragm: CR to level midway
between xiphoid process and lower rib
cage (bottom of cassette at about level
of iliac crest)

Above diaphragm: ribs 1 through 10

should be visualized
Below diaphragm: ribs 9-12 should be
visualized

Above diaphragm: ribs 1 through 10

should be included and seen above the
diaphragm
Below diaphragm: ribs 9-12 should be
included and seen below the diaphragm;
the axillary portion of the ribs under
examination is projected without selfsuperimposition

Bony Thorax Sternum

Position
RAO
position

CR
CR perpendicular to IR
CR directed to center of sternum (1 inch
to left of midline and midway between
the jugular notch and xiphoid process)

Demonstrates
Sternum is visualized, superimposed on
heart shadow

*Extras*

Lateral
position/ R
or L lateral

CR perpendicular to IR
CR directed to center of
sternum (midway between the jugular
notch and xiphoid process)
SID of 60-72 inches is recommended to
reduce magnification of sternum caused
by increased object image receptor
distance
Center IR to CR

Entire Sternum is visualized with minimal

overlap of soft tissues

Bony Thorax Sternoclavicular Joints

Position

CR

PA
projection

CR perpendicular, centered to level of

T2-T3, or 3 inches distal to vertebra
prominens (spinous process of C7)

Demonstrates
Lateral aspect of manubrium and medial
portion of the clavicals visualized lateral
to vertebral column through
superimposing ribs and lungs

*Extras*

Anterior
oblique
position
(RAO/LAO)

CR perpendicular, centered to level of

T2-T3, or 3 inches distal to vertebra
prominens and 1 to 2 inches lateral to
midsagitial plane

The manubrium, medial portion of

clavicals and sternoclavicular joint are
best demonstrated on the downside
The SC joint on the upside will be
foreshortened

Sacrum and Coccyx Radiography

Position

CR

Demonstrates

*Extras*

AP axial
sacrum
projection

AP axial
coccyx
projection

Lateral
Sacrum
and Coccyx
position
Lateral
coccyx
position

Angle CR 15 degrees cephalad

Direct CR 2 inches superior to pubic
symphysis
Center IR to CR

Angle CR 10 degrees caudad

Direct CR 2 inches superior to pubic
symphysis
Center IR to CR

CR perpendicular to IR
Direct CR 3-4 inches posterior to ASIS
(centering for sacrum)
Center IR to CR
CR perpendicular to IR
Direct CR 3-4 inches posterior and 2
inches distal to ASIS (centering for
coccyx)
Center IR to CR

Sacrum, SI joints and L5-S1

intervertebral joint space

Coccyx

Projection may
also be
preformed prone
(angle 10
degrees
cephalad) with
CR centered at
the coccyx which
can be located
using the greater
trochanter

Sacrum, Coccyx and L5-S1

High scatter so
close collimation

Coccyx with open segment interspaces,

if not fused

Cervical Spine Radiography

Position
AP open
mouth
projection
(C1 and C2)

AP axial
projection
Anterior
oblique
position
Posterior
oblique
position

Lateral
position

Lateral
position,
horizontal
beam
(trauma

CR
CR perpendicular to IR
Direct CR through center of open mouth
Center IR to CR
Angle CR 15-20 degrees cephalad
Direct CR to enter at the level of the
lower margin of thyroid cartilage to
pass through C4
Center IR to CR
Direct CR 15 degrees caudad to C4
(level of upper margin of thyroid
cartilage)
Direct CR 15 degrees caudad to C4
Center IR to CR

CR perpendicular to IR
Direct CR horizontally to C4 (level of
upper margin of thyroid cartilage)
Center IR to CR

CR perpendicular to IR
Direct CR horizontally to C4 (level of
upper margin of thyroid cartilage)
Center IR to CR

Demonstrates
Dens (odontoid process) and vertebral
body of C2, lateral masses and
transverse processes of C1 and
atlantoaxial joints demonstrated
through open mouth
C3 to T2 vertebral bodies; space
between pedicles and intervertebral
disk spaces clearly seen

*Extras*

Angle 15 when
supine
Angle 20 when
erect

Intervertebral foramina and pedicles on

the side of patient closest to the IR
Intervertebral foramina and pedicles on
the side of patient farthest from the IR

Cervical vertebral bodies, intervertebral

disk spaces, articular pillars, spinous
processes, and zygapophyseal joints

Cervical vertebral bodies, intervertebral

disk spaces, articular pillars, spinous
processes, and zygapophyseal joints

72 SID
compensates for
increased OID
and provides for
greater spatial
resolution
Longer SID
results in less
magnification
with increased
image sharpness

patient)

Swimmers
lateral
position (C5T3 region)
Lateral
position
(hyperflexion
and
hyperextensi
on)

AP projection
for C1/C2
(dens)
Fuchs
method

PA projection
for C1/C2
(dens)

CR perpendicular to IR
Direct CR to T1 which is approx 1 inch
above level of jugular notch anteriorly
and at level of vertebra prominens
posteriorly
Center IR to CR

Vertebral bodies and intervertebral disk

spaces of C5 to T3 are shown
The humeral head and arm farthest
from the IR are magnified and appear
distal to T4/T5 (if visible)

CR perpendicular to IR
Direct CR horizontally to C4 (level of
upper margin of thyroid cartilage)
Center IR to CR

C1 through C7 should be included on IR,

although C7 may not be completely
visualized on some patients

Elevate chin as needed to bring MML

(mentometal line) near perpendicular to
tabletop (adjust CR angle as needed to
be parallel to MML)
Ensure that no rotation of head exists
(angle of mandible equidistant to
tabletop)
CR is parallel to MML, directed to
inferior tip of mandible
Center IR to CR
Reverse position to the supine position.
Chin is resting on tabletop and is
extended to bring MMI near
perpendicular to table top (adjust CR
angle as needed to be parallel to MML)
Ensure that no rotation of head exists
CR is parallel to MML, through
midoccipital bone, about 1 inch
inferoposterior to mastoid tips and

Dens (odontoid process) and other

structures of C1 to C2

Dens (odontoid process) and other

structures of C1 to C2

angles of mandible
Center IR to CR
AP Wagging
jaw
projection

AP axial
projection
(vertebral
arch/pillars)

CR perpendicular to IR
Direct CR horizontally to C4 (level of
upper margin of thyroid cartilage)
Center IR to CR

Angle CR 20-30 degrees caudal

Direct CR to the lower margin of the
thyroid cartilage and pass through C5
Center IR to CR

C1 through C7 vertebral bodies with

overlying blurred mandible
Posterior elements of mid and distal
cervical and proximal thoracic vertebrae
In particular the articulations
(zygapopheal joints) between the lateral
masses are open and well
demonstrated, along with the laminae
and spinous process

Thoracic Spine Radiography

Position

AP Projection

Lateral position

CR
CR perpendicular to IR
Direct CR to T7 (3 to 4 inches below
jugular notch or 1-2 inches below
sternal angle)
Center IR to CR
CR perpendicular to long axis of
thoracic spine
Direct CR to T7 (3 to 4 inches below
jugular notch or 7-8 inches below
vertebra prominens)
Center IR to CR

Demonstrates
Thoracic vertebrae bodies,
intervertebral joint spaces, spinous
and transverse processes, posterior
ribs, and costovertebral articulations
Thoracic vertebral bodies,
intervertebral joint spaces, and
intervertebral foramina. T1 to T3 will
not be well visualized
Obtain a lateral image using a
swimmers lateral if the upper thoracic
vertebrae are of special interest

*Extras*

Oblique
position
(anterior/poster
ior oblique)

CR perpendicular to IR
Direct CR to T7 (3 to 4 inches below
jugular notch or 1-2 inches below
sternal angle)
Center IR to CR

Zygapophyseal joints: anterior oblique

positions (RAO and LAO) demonstrate
the downside Zygapophyseal joints,
and posterior oblique positions
(RPO/LPO) demonstrate the upside
joints

Lumbar Spine Radiography

Position

AP or PA
projection

CR
CR perpendicular to IR
Larger IR (35x43): direct CR to level of
iliac crest (L4-L5 interspace) this larger
IR will include lumbar vertebrae, sacrum,
and possibly coccyx
Smaller IR (30x35): direct CR to level of
L3, which may be localized by palpation
of the lower costal margin (1.5 inches
above iliac crest) this smaller IR will
include primarily the 4 lumbar vertebrae
Center IR to CR

Demonstrates

Lumbar vertebrae bodies, intervertebral

joints, spinous and transverse processes,
SI joints and sacrum are shown
35x43 approx T11 to the distal sacrum
included
30x35 T12 to S1 included

*Extras*

Obliques
posterior
or anterior
oblique
position

Lateral
position

Lateral L5S1 position

AP Axial
L5-S1
projection

CR perpendicular to long axis of thoracic

spine
Direct CR to L3 at the level of the lower
costal margin (1 to 2 inches above iliac
crest and 2 inches medial to upside ASIS)
Center IR to CR
CR perpendicular to IR
Larger IR (35x43): center to level of iliac
crest (L4-L5) this projection includes
lumbar vertebrae, sacrum, and possibly
coccyx
Smaller IR (30x35): center to level of L2L3, at lower costal margin (1.5 inches
above iliac crest) this smaller IR will
include the 5 lumbar vertebrae
Center IR to CR
CR perpendicular to IR with sufficient
waist support, or angle 5-8 degrees
caudad with less support
Direct CR to 1.5 inches inferior to iliac
crest and 2 inches posterior to ASIS
Center IR to CR
Angle CR cephalad, 30 males/35 females
Direct CR to level of the ASIS at the
midline of the body
Center IR to CR

Visualization of zygapophyseal joints

(RPO/LPO shown downside) (RAO and
LAO show upside)

Intervertebral foramina L1-L4, vertebral

bodies, intervertebral joints, spinous
processes, and L5-S1 junction.
Depending on the IR size used, the entire
sacrum also may be included

L5 vertebral body, first and second

sacral segments and L5-S1 joint space

and L5-S1 joint space and sacroiliac

joints

Cholangiogram Radiography
Position

CR

Demonstrates

*Extras*

Intravenous Urography Radiography

Position

CR

Demonstrates

*Extras*

Esophagus Radiography
Position

CR

Demonstrates

*Extras*

Upper Gastrointestinal System Radiography

Position

CR

Demonstrates

*Extras*

Small Bowel Series Radiography

Position

CR

Demonstrates

*Extras*

Lower Gastrointestinal Radiography

Position

CR

Demonstrates

*Extras*

Sinus Radiography
Position

CR

Demonstrates

*Extras*

Facial Bones Radiography

Position

CR

Demonstrates

*Extras*

Orbits Radiography
Position

CR

Demonstrates

*Extras*

Nasal Bone Radiography

Position

CR

Demonstrates

*Extras*

Zygomatic Arch Radiography

Position

CR

Demonstrates

*Extras*

Mandible Radiography
Position

CR

Demonstrates

*Extras*

Tempro-mandibular Joint Radiography

Position

CR

Demonstrates

*Extras*

Mastoid Air Cell Radiography

Position

CR

Demonstrates

*Extras*

Mastoid Tip Radiography

Position

CR

Demonstrates

*Extras*

Skull Radiography
Position

CR

Demonstrates

*Extras*