Positioning Reviewer

UPPER EXTREMITIES
1st CMC JOINT

METHOD PROJECTION CR SD
Robert ⊥ to the 1st
Long and
Rafert
Lewis
AP CMC Joint
15° entering
1st CMC
Joint
10-15°
First CMC Joint
free from
superimposition of
the soft tissues of
the hand
entering 1st
CMC Joint
Burman 45° entering Magnified (18” SID)
1st CMC concavo-convex
Joint outline of the 1st
CMC Joint
Angulation of the Central Ray:

1.) May help to project soft tissue of the hand away from the first CMC Joint
2.) It can help open the joint space when they are not shown on a ⊥ CR.
1st MCP JOINT

Folio PA ⊥ midway bet. For diagnosis
hands at the of UCL
level of MCP rupture/Skier’s
joints Thumb
METACARPAL FRACTURES
METHOD PROJECTION POSITION SD
Lane, Kennedy Reverse PALM DOWN; Severe MC
and Kuschner Oblique rotation of deformities or
Recommendation (ROLKK) hand 45° FX
medially
Kallen Tangential FLEX MCP MC Head FX
Recommendation Oblique Joints 75-80°;
(TOK) 40-45° rot to
ULNAR side;
40-45° forward
HAND: Lateral-Lewis LL
Lewis Recommendation: rotate the hand 5° posteriorly
- Removes superimposition of MCs
RHEUMATOID ARTHRITIS
NORGAARD APOB ⊥ midway bet. For early
BILAT./ hands at the detection of
BREWERTON level of MCP RHEUMATOID
UNILATERAL joints ARTHRITIS
Stapczynski recommendation: for demonstration of FX of the
base of the 5th MC
WRIST
PA – slightly oblique rotation of ulna
AP – BD ulna and C. interspaces (better)
SCAPHOID/CAPITATE
METHOD POSITION CR SD
Daffner, 30° towards Elongates
Emmerling and
Butterbaugh
PABED PA the elbow
30° towards
scaphoid and
capitate
Elongates
the fingertips capitate
WRIST: Lateral
Burman recommendation: lateral position of the SCAPHOID should be
obtained with the wrist in PALMAR FLEXION
SD: Carpal Boss
- Rotates the bone anteriorly into a dorsovolar position
Fiolle: Carpal Boss (Carpe Bossu)

- Small bony growth on the dorsal surface of the 3rd CMC joint
WRIST: PAOB and APOB

Lateral Rot PAOB: Carpals on the lateral side of the wrist (Trapezium
and Scaphoid)
Medial Rot APOB: Carpals on the medial side of the wrist (Triquetrum,
Pisiform and Hamate)
WRIST: PA
Ulnar Deviation: Corrected foreshortening from SCAPHOID lateral carpals
-10°-15° CR angulation to provide clear delineation
Radial Deviation: Carpals on the medial side
SCAPHOID - PAX
Stecher PA Axial ⊥ to the Scaphoid free
(20° elevation of SCAPHOID from
IR)
superimposition
Rafert-Long PA AND PA 0°-10°-20°-30° Scaphoid FX
Axial (Hand in to the
Ulnar Deviation) SCAPHOID
Bridgeman recom: wrist in Ulnar Deviation---Stetcher 2nd method: 20° towards the elbow, 3rd: px
clenches fist to widen fracture line; FF-SS: Flexion-Foreshortening-Scaphoid-
Subsuperimposition
TRAPEZIUM
Clements- PA Axial 45° distally to Trapezium FX
Nakayama Oblique ana. snuffbox
What’s up and through
Clements the
Nakayama! TRAPEZIUM
(bcoz of the px can’t deviate: rot.
hand! Yow elbow 30°
yow)
CARPAL
Lentino/Carpal Tangential 45° caudal, 1 Scaphoid fx,
lunate disc, FB
Bridge ½” to the wrist and Chip FX on the
joint dorsal asp of
carpals
Gaynor-Hart Tangential - 25°-30° to the CARPAL CANAL;
Hook of hamate
Inferosuperior long axis of the
hand, 1” distal
to the base of
3rd MC
Tangential - 20°-35° to the CARPAL CANAL;
Hamulus of
Superoinferior hand from the hamate
TEMPLETON long axis of the
& ZIM forearm
Marshall recommendation: Placing a 45° sponge under palmar
surface of the hand to place the carpal canal TANGENT to the
CR.
FOREARM:
AP – Hand is SUPINATED
Oblique – Hand is PRONATED
Lateral: demonstrates Modelling’s deformity (Midshaft curvature)
ELBOW:
AP – Radial head, neck and tuberosity slightly superimposed over the
proximal ulna
Lateral - 90° flexion; 30°-35° flexion for soft tissue injury
- Demonstrates the Olecranon Process
- Fat Pads are least compressed at this position
- Visualization of posterior fat pad is a pathologic sign
(GRISWOLD)
ELBOW: APOB (MCLaRa – UlTroch – RadCapi)

Medial Rotation: coronoid process free from superimposition;
superimposed ulna by radial head
Lateral Rotation: radial head and neck free from superimposition of the
ulna
Pag PA nang wrist – 8 carpal bones

Pag AP nang wrist – carpal interspaces are best demonstrated.
Pag lateral nang wrist – FM –foreign body and metacarpal fracture displacement
Pag PA oblique – scaphoid and trapezium
Pag AP oblique – pisiform is best seen as well as triquetrum and hamate
Pag PA ulnar flexion/deviation – scaphoid pa din saka carpal interspaces in the lateral side of the wrist
Pag PA radial flexion-deviation – spaces in the medial side of the wrist
Pag stecher method – scaphoid pa din
Pag bridgeman method – scaphoid pa din
Pag rafert-Long method – Scaphoid pa din
Pag clements nakayama method- trapezium ang tandaan
Pag gaynor hart method – carpal canal or carpal tunnel
Pag Lentino method – carpal bridge (un ung carpal bridge sa book niyo lentino tawag dun) now u know
Pag templeton and zim – carpal canal and carpal bridge.
PROXIMAL FOREARM & DISTAL HUMERUS
PART PROJECTION FLEXION CR SD
DISTAL AP PARTIAL ⊥ Distal
Humerus
HUMERUS ⊥ to the Olecranon
AP ACUTE
Jones humerus, Process and
2” FX of the
Technique
superior elbow
to
olecranon
process
PA Axial 75° ⊥ to ulnar Ulnar sulcus;
sulcus radiohumeral
bursitis
(tennis
elbow)
PROXIMAL AP PARTIAL ⊥ Proximal
Forearm
FOREARM ⊥ to the Olecranon
PA ACUTE
Jones flexed Process and
forearm, FX of the
Technique
2” distal elbow
to
olecranon
process
Holly: AP projection of the radial head thru AP Distal Humerus
- Wrist 30° from the horizontal
RADIAL HEAD
4-Position Lateral ⊥ to the elbow Radial head in
Series joint varying
degrees of
rotation
1. Hand is rotated externally/supinated as much as possible
2. Hand is in lateral position/thumbs up
3. Hand is pronated (Coyle)
4. Hand is rotated internally/thumbs down
Greenspan and Norman recom: CR is directed 45° medially for clearer projection of
radial head with reduced superimp.
OLECRANON PROCESS: PA AXIAL PROJECTION

- 45°-50° flexion of the arm
- ⊥ CR: Dorsum of the olecranon process
- CR: 20° towards the wrist - curved extremity and articular margin of
the olecranon process
TRAUMA – CAL.45ToRaAwCo
Coyle Axial 45° towards Radial Head
Lateromedial the shoulder 90 deg. Flex
45° away from Coronoid

the shoulder Process
80 deg. flex
HUMERUS
- Upright: best for pxs with shoulder & arm abnormalities
- AP: Greater Tubercle in profile
- Lateral: Lesser Tubercle in profile
- Mediolateral: BD pxs with broken humerus
- Lateromedial (Supine): BD for pxs w/ known/suspected fx; IR is
between the medial surface of arm and chest
SHOULDER: AP, ⊥--1” inf. to coracoid process; PH-APOL-ENI

• Ext Rot:
- GT is visualized
- Site of insertion of the supraspinatus tendon is also visualized.
- Proximal Humerus: AP
• Neutral Rot:
- Posterior part of the supraspinatus insertion
- Partial profile of GT
- Proximal Humerus: Oblique
• Int Rot:
- Subscapular insertion visualized
- LT in profile
- Proximal Humerus: Lateral
IDEA: Int Rot-Subdeltoid Bursa Ext. Rot.-Subacromial Bursa
GLENOID CAVITY/SCAPULOHUMERAL JOINT - GAG
METHOD PROJECTION BODY CR
ROTATION
Grashey APOB 35°-45° ⊥ to GC, 2” MI and INF
to the superolateral
border of the shoulder
Apple APOB 35°-45° (holding
(loss of articular ⊥ to CP
1 lb of weight)
cartilage in SHJ)
Garth AP Axial 45°
(recom for acute Oblique
shoulder trauma, Hill- 45° caudal to SHJ
Sachs defect &
posterior SH disc)
HILL-SACHS DEFECT – Recon Special Warfare Group

POSITION
Rafert MOD Inferosuperior Supine 15° medially to the
axilla
Axial
Stryker-Notch AP Axial Supine 10° cephalad to CP
(Proximal Humerus)
West-Point Inferosuperior Prone 25° ANT and MED; 5”
inf and 1 ½“ med to
Axial acr. edge; bony
abnormalities of the
anterior inferior rim of
the glenoid in pxs w/
instability of the
shoulder
Garth AP Axial Erect 45° caudal to SHJ
Oblique
Hall, Isaac and Booth: described the notch projection as being useful in identifying the
cause of shoulder disc
ROTATOR CUFF MUSCLES

METHOD PROJECTION BODY CR SD
POSITION
Neer Tangential RAO/LAO; 10°-15° caudad Supraspinatus
45°-60°;
to the most “Outlet”;
superior aspect Shoulder
Erect of humeral head Impingement
AP Axial Supine 25° caudad to CP Infraspinatus
Insertion
Blackett- PA Prone ⊥ to the head of Teres Minor
humerus Insertion
Healy ⊥ to the SJ, entering
AP Supine Subscapular
the coracoid
process
Insertion
INTERTUBERCULAR GROOVE (PROXIMAL HUMERUS)
POSITION
Fisk MOD Tangential Erect; 10°-15° ⊥ to IR
if erect humerus to CR
If not modified, CR is 10°-15° posterior to the long axis of humerus when supine
AC JOINTS
POSITION
Pearson AP Erect; 2 exp. – ⊥ to the ML of the
(Bilateral) body, at the level of
w/o & holding 5-8 ACJ
lbs of weights
AP Axial Erect 15° cephalad to the
Alexander CP
PA Axial 45°-60° MCP 15° caudad to ACJ
Oblique
CLAVICLE
POSITION
Tarrant (for Tangential Seated 25°-35° ANT and INF
multiple injuries) to midshaft of clavicle
SCAPULAR SPINE
POSITION
Laquerriere- Tangential Supine 35° (for obese and
round shouldered pxs) -
Pierquin 45° caudad to
posterosuperior region
of the shoulder
SCAPULA – Oblique image of Scapula
POSITION
Lorenz (folded arm) PAOB RAO/LAO ⊥ to the protruding
scapula
& Lillienfeld Tulog-Dapa
(extended arm)
SHOULDER—LAWRENCE METHOD
Transthoracic Lateral Projection – Full inspiration; ⊥ or 10°-15° cephalad if
shoulder cannot be elevated
Inferosuperior Axial Projection – Ext rot., 15°-30° thru the axilla; SD: insertion
site of subscapularis tendon on the lesser tubercle
Clements MOD SUPERMAN: Inferosuperior Axial---Lateral Recumbent, abd.
arm 90° towards the ceiling; CR is 5°-15° if px cannot abduct arm/⊥ to the MCP
Shoulder Impingement: Hobbs MOD & Neer Method
Superoinferior Axial (SUPERO – Kobe – Crossover – Air MAMBA):
5°-15° through the SJ and towards the elbow; rel. bet. humerus and GC
AP Axial: 35° cephalad to SHJ; rel. bet. humerus and GC – useful in
diagnosing cases of posterior disc
CLAVICLE
AP Axial – CEPHALAD
• 0°-15° - standing LORDOTIC
• 15°-30° - SUPINE
PA Axial – 15°-30° CAUDAD
• Tangential
- 25°-40° from the horizontal (supine)
- 15°-25° - medial third of the clavicle
SCAPULA
✓ Exposure made at SHALLOW BREATHING to obliterate detail
• AP
➢ 2” INF to coracoid – SCAPULA
➢ 1” INF to coracoid – SHOULDER
• Lateral
➢ Back of the hand @ posterior chest: ACROMION & CORACOID
PROCESS
➢ Px grasping the opp shoulder or arm extended upward/forearm
resting on head/across the upper chest: SCAPULAR BODY -
Mazujian
❖ APOB – rotation is away from the aff. side; ⊥ to the lateral border of
scapula
❖ 15°-25° rot
- Scapula FREE from superimposition
❖ 25°-35° rot for steeper projection
- Scapula NEARLY FREE from superimposition
❖ SCAPULA Y – suspected shoulder disc; described by Green, Gray

and Rubin; 45°-60°; ⊥ to SHJ; RGGY-PAOB
SCAPULAR SPINE
❖ Tangential Projection – PRONE/UPRIGHT; 45° cephalad through
the scapular spine/ 45° posteroinferior angle through the
anterosuperior aspect of shoulder
CORACOID PROCESS
❖ AP Axial Projection
- 15°-45° cephalad to CP
Kwak, Espiniella and Kattan recommendation - 30° cephalad to the CP
LOWER EXTREMITIES
TOES: AP/AP AXIAL
- ⊥ /15° posteriorly to the 3rd MTP joint
- Angulated CR to open joint spaces/reduce foreshortening
DORSOPLANTAR WEIGHT BEARING

- Demonstrates Hallux Valgus
SESAMOIDS
METHOD PROJECTION POSITION CR
Lewis Prone;
Dorsiflexed toe ⊥ to the 1st
Holly Supine; Plantar
75° to IR; toe MTP
Tangential flexed with
joint/head-
strip gauze
bandage
bone for
HOLLY
Causton Lateral 40° to MTP towards
recumbent (on the heel
the unaffected
side)
FOOT
AP – FB & location of fragments; ⊥/10° to the 3rd MTBase
AP Axial - 10°-25° posteriorly to reduce foreshortening
- ⊥ CR: for forefoot demonstration
APOB
Medial Rot:
- 30° rot
- ⊥ to the 3rd MTBase
- CUBOID in profile and interspaces/bones on lat. aspect of the
foot; SINUS TARSI
Lateral Rot:
- 30° rot
- ⊥ to the 3rd MTBase
- NAVICULAR and interspaces/bones on med. aspect of the foot
METHOD PROJECTION POSITION CR SD

⊥ to 3
Prone: 30° rd 1st and 2nd MTB;
Grashey PAOB med. rot
Medial
cuneiform &
Prone: 20°
MTB navicular
3rd to 5th MTB;
Cuboid
lat. rot
PAOB-Med. Rot.: 45° plantar surface towards IR; CR is ⊥ to 5th MTB; A

more oblique projection than obtained with the Grashey method ; 3rd – 5th MT
bases and the tarsals
DORSOPLANTAR OBLIQUE: BD Lisfranc fx

FOOT: MEDIOLATERAL & LATEROMEDIAL
- demonstrates entire foot in lateral position
- Tibiotalar joint
Lateromedial is the EXACT LATERAL; rot. is toward the unaff. side
FOOT: LATEROMEDIAL WEIGHTBEARING

- Demonstrates longitudinal arch/pes planus & Bohler’s critical
angle
- Bohler’s critical angle/tuber’s angle: angle bet. superior apex
of mid-calcaneus to anterior process of hamulus
- Normal: 20°-40°; FX: 20°
Weight-Bearing 10°-15° towards Accurate evaluation of
Composite
AP the heel at the
level of 3rd MTB
1st: 15°
tarsals and
metatarsals; shows
ALL bones of the foot
Axial posteriorly to 3rd

MTB; 2nd: 25°
anteriorly to
Full outline of the foot
projected free from leg
posterior surface
of the ankle
TALIPES EQUINOVARUS
AP Supine ⊥ (true rel. of
Rel. of
Kite the bones and tarsal

ossi.
centers)/15°
bones and
ossification
posteriorly centers;
to TARSALS Equinus &
adduction
Lateral Lateral ⊥ to the Anterior
midtarsal talar
area subluxation
and degree
of plantar
flexion
Axial Erect 40°
Kandel anteriorly
Bilateral Dorsoplantar/Suroplantar thru the -
lower leg
Freiberger, Hersh, and Harrison: three radiographs with varying CR
angulations (35°-45°-55°) to demonstrate sustentaculum talar joint fusion
• Plantar Flexion and Inversion of the Calcaneus - Equinus

• Medial displacement of the forefoot – Adduction
• Elevation of the medial border of the foot - Supination
CALCANEUS/OS CALCIS
Plantodorsal: 40° cephalad towards the long axis of the foot
- Calcaneus, subtalar joint (supine)
Dorsoplantar: 40° caudal towards the heel
- Calcaneus, subtalar joint, sustentaculum tali (prone)
CALCANEOTALAR COALITION
METHOD POSITION CR RECOMMENDATION
Weight- Upright- 45° anteriorly to
Bearing Standing/Coalition the posterior
LILIENFELD
surface of the
“Coalition Position ankle
Method”
Weight-Bearing Upright; one foot 45° caudad to Useful for diagnosis
Lateromedial away from IR enter the lateral of stress fxs of
calcaneus and
Oblique Proj. malleolus tuberosity
SUBTALAR JOINT
Broden AP Axial Medial 40° cephalad to lateral Anterior portion of
Posterior ST Joint malleolus posterior facet
Oblique 20°-30° cephalad to Middle facet (talus
Si APOM AMP ang
may ari ng APOLPOM (45° foam - lateral malleolus and sustentaculum
supine) tali)
10° cephalad to lateral Posterior portion of
malleolus posterior facet
AP Axial Lateral 15° cephalad to Posterior facet and
medial malleolus middle facet
Oblique
(45° foam -
supine)
Isherwood ⊥ to 1 inch distal and Anterior articulation
Anterior ST Joint
LMO Medial anterior to lateral of subtalar joint and
rot. FOOT mallelolus oblique tarsals; similar
Si MERF DAL ay 1 y.o (45° foam) to Feist-Mankin
Ang ANKLE ni MERA method
10° cephalad, 1 inch Middle articulation;
at LARA ay si FEIST
MANKIN. Si MERA at
APAXO distal and anterior to “end-on” projection of
si LARA ay parehas Medial rot. lateral malleolus sinus tarsi
10 years old at ANKLE
parehas ding MAARTI 10° cephalad, 1 inch Posterior articulation
Sila ay laging APAXO distal to medial of subtalar joint
sinasamahan ni tita Lateral rot. mallelolus
DAL at DM sa CR sa
2nd floor ng bahay.
ANKLE
PA AXIAL OB – Lat. Rot.: 25 deg ball of the foot to the IR; 5 deg anterior &
23 deg. caudal to ankle joint; SD: “end-on” image of sinus tarsi
APOB: MEDIAL/INTERNAL
- Demonstrates Maissoneuve’s FX – FX of the distal tibia and
proximal fibula
ANKLE
AP – inferior tibiofibular & talofibular will not be “open”
- a positive sign for radiologists because it indicates that the px
has no ruptured ligaments or other type of separations
MEDIOLATERAL – TRUE Lateral projection of the lower third of tibia and
fibula, ankle joint and tarsals; entering MM
LATEROMEDIAL – Lateral projection of the lower third of tibia and fibula,
ankle joint and tarsals; UNAFFECTED SIDE rot. ½ superior to LM
Talocrural joint/Mortise joint/Ankle joint
APOB
Medial Rot.: 45° rot; demonstrates distal tibiofibular joint; BONY STUDY
Medial Rot.: 15°-20° rot; demonstrates entire mortise joints; talofibular
joint space & JONES FX; JOINT STUDY ni JONES FX
Lateral Rot.: 45° rot; demonstrates the superior aspect of calcaneus,
subtalar joint and calcaneal sulcus; also for determining FXs
SWAP mo ANKLE
Stress - Ligamentous tear
NakakaSTRESS *With local anesthesia
magkaroon ng administered at sinus
LIGAMENTOUS tarsi
TEAR. Nung *putting a strip
ginagamot ako bandage around the
nilagyan ng LOCAL ball of foot
ANESTHESIA sa
sinus tarsi then after
ay STRIP BANDAGE
naman sa PAA! AP
⊥
Weight-Bearing Side to side
comparison of the joints
(BILATERAL) (narrowing joint
MMO-LMC spaces); MEDIAL
Mary Mediatrix MORTISE – OPEN
OSPITAL – Laguna LATERAL MORTISE -
Medical Center; CLOSED
DERETSO LANG –
TWO WAY (for BILAT.)
ANKLE: LATERAL – demonstrates TRIMALLEOLAR FX

LEG: APOB – Medial Rot.: Proximal and Distal tibiofibular articulations, ankle
and knee joints; Lat. Rot.: Fibula SUPERIMPOSED by lateral portion of tibia
KNEE
Rosenberg Method Weight-Bearing: PA
- 45° flexion of knee (femurs to IR); ⊥/ 10° caudal sometimes
- Evaluating joint space narrowing and demonstrating articular
cartilage disease
AP - 5° inward
- RP: ½” inf. to patellar apex
- CR:
Thin pelvis (<19 cm): 3°-5° caudad
Thick pelvis (>24 cm): 3°-5° cephalad
Normal pelvis (19-24 cm): ⊥
- SD: open femorotibial joint space
PA – 5°-7° caudal to ½ inch inferior to patellar apex; open femorotibial
joint space
LATERAL
- 5°-7° cephalad to 1” distal to medial epicondyle;
- 20°-30° flexion – relaxes the muscle
- <10° flexion – for unhealed patellar FX
- For Osgood-Schlatter disease
APOB
Medial & Lateral rot.
- 45° rot
- Thin pelvis (<19 cm): 3°-5° caudad
- Thick pelvis (>24 cm): 3°-5° cephalad
Normal pelvis (19-24 cm): ⊥
PAOB
- 5°-(10°- Holmblad) knee flexion
- 45° rot
- ⊥
AP Standing Flexion: Weight-Bearing Method (AHLBACK-BILAT.)
- Bilateral; for demonstration for varus (<>) and valgus (><)
deformities; CR is to 1/2” below patellar apices
Leach, Gregg and Siber: recommended using this method to evaluate
arthritic knees/ narrowing of joint space; Si Leach, Gregg at Siber ay may
narrowing of the joint space/arthritic knees kaya sila nagpapaxray ng AP
WEIGHTBEARING kay AHLBACK BILAT
INTERCONDYLAR FOSSA – TUNNEL VIEW
Holmblad PA Axial ⊥, 70° knee
flexion (widens
Tunnel Proj joint space- Open fossa, intercondylar
improved image) eminence and knee joint
⊥, 60° knee space
Beclere AP Axial
flexion; curved
cassette
Camp- PA Axial 40° caudad for (1) joint mice;

40° flexion; (2) evaluate split &
Conventry 50° caudad for displaced cartilage in
50° flexion osteochondritis
desecans;
(3) underdevelopment of
lateral femoral
condyle on slipped
patella
Intercondylar Fossa- Hayden-Bayola-Chito- Holmblad-Beclere-Camp
Conventry (Kung MALIBOG ka baka applicable sayo)
Facts about HAYDEN:
+ Longest ETITS (70 deg knee flexion)
+ Multiple sex positions – Standing w/ 2 legs, Standing w/ 1 leg, DOGSTYLE (PA Axial lahat -
kneeling) -----these are positions of the knees towards IR
+ His EMINENCE ang palayaw nya (intercondylar eminence)
Facts about BAYOLA:
+ Next to LONGEST (kahit di tunay hehe – 60 deg. knee flexion) at medyo nakacurve yung
ETITS (curved cassette)
+ Sex Positions ------- woman on top/COWGIRL (nakasupine and px----AP AXIAL)
+ His EMINENCE din ang palayaw niya; Pwede mo rin siyang tawaging KNEE JOINT kasi
KALBO naman siya (gets? YUNG knee MAKINTAB tapos PABILOG? KORNI GA? AWTS GEGE)
Facts about CHITO:
+ Shortest ETITS (40-50 deg knee flexion)
+ Sex Position – PRONE BONE (yung nakadapa yung babae tapos yung lalake tinitira yung
babae na parang dinadaganan—nakaPRONE din yung px); dahil PABABA ang padali, CAUDAL
CAMP CONVENTRY – Pinakamaraming SD (Dahil ang CAMP sa LPU ay marami ding alam)
PATELLA
PA – BD patella - closer OID results in sharper detail; 5-10° lateral heel
rot. to place PT // to IR
AP – joint effusion
PAOB
- 5°-10° knee flexion
- 45°-55° rot
- ⊥
Kuchendorf PA Axial 25°-30° caudal Slightly oblique PA
between patella and projection of patella
Oblique-Lateral
PAAXKo ,
Rot.
femoral condyles
(10° flexion of knee;
free from
superimposition
mga 25-30 cm kahaba, naka
Lateral Rot ng 35-40 deg., 35°-40° rotation to
ang diperenseya ay 10 deg. lateral)

Hughston Prone; 50°- 45° cephalad Patellar
*he also through subluxation and
recommended to 60° flexion patellofemoral FX
examine both knees
for comparison
joint
Merchant Supine; 40° knee Bilat. Tangential
flexion; image---axial
projection of the
relaxation of 30° patellae and
quadriceps caudad patellofemoral
Tangential femoris is
critical for
from the joints
accurate horizontal
diagnosis
*can be varied from 30°-
90° to demonstrate
various patellofemoral
disorders – (Merchant)
⊥
Settegast Supine/Prone Vertical FX of
patella;
(preferred); patellofemoral
slow, even when articulation;
flexion the joint is chondromalacia
*this projection should not perpendicular/
be attempted until a
transverse fx of the 15°-20° if not
patella has been ruled
out or if the patient is in
pain
Her Majesty’s Ship – P-S-S/P
Merchant
- Nakarelax ang position nito nakabukaka, kaya RELAXATION OF QUARICEPS
FEMORIS IS CRITICAL
- Nnng nagtrabaho, 40 pesos lang kinita ng MERCHANT, nung naglako ay napagod
kaya nagkaroon ng patellofemoral disorder
Settegast
- Tegast-TIGAS-TUWID-Perpendicular CR-Vertical FX-OPPOSITE is
CHONDROMALACIA (softening)
SUNRISE METHOD
TANGENTIAL PROJECTION
MOUNTAIN/SKYLINE VIEW
PP: Supine/Sitting; knee flexed 40-45o
RP: Patellofemoral joint
CR: 30o from horizontal
ER: Joint space b/n patella & femoral condyles
FEMUR
AP
➢ Proximal Femur: rotate the limb internally 10°-15° to the place
the femoral neck in profile; IR – at the level of ASIS
➢ Distal Femur: rotate the patient’s limb internally (knee included);
IR – below the knee joint
Lateral
➢ Proximal Femur: 10°-15° rotation from the lateral position
➢ Distal Femur: 45° knee flexion
PELVIS
AP
- rotate both entire lower limbs internally for about 15°-20° to place
the femoral necks // to IR
- CR is ⊥, midpoint of the IR/midway bet. ASIS and symphysis
pubis
Lateral
- Berkebile, Fischer and Albrecht recommendation: dorsal
decubitus lateral projection of the pelvis for the demonstration of
“gull-wing sign” in cases of fracture disc of the acetabular rim and
posterior disc of the femoral head
PELVIS AND HIP JOINTS

CHASSARD-LAPINE/JACK KNIFE/KNEE-CHEST: Axial
- CR is ⊥ through the LS region at the level of GTr
- SD:
✓ Bi-ischial diameter in pelvimetry
✓ Demonstrates the rel. of femoral head to acetabulum
✓ BD opacified rectosigmoid colon
FEMORAL NECKS
METHOD PROJECTION POSITION CR
Modified APOB BL: Supine; frog leg BL: ⊥, 1”
Cleaves 45° abduction of the leg superior to PS
to place the FN // to IR
(can be done
UL: Have the px flex UL: ⊥ to the FN
unilaterally or
bilaterally) the hip and knee and
draw the foot up to the
opp. knee
Original Cleaves Axiolateral Supine; frog leg 25°-45°
cephalad
My name is MC APOB and I’m from SOCAL. I’m a modified, single (1”), straight to the point
(Perpendicular to PS/FN) guy! I hope to get married within ages 25-45 and I like frog legs
HIPS
Danellius Miller & Lorenz Method: Axiolateral Inferosuperior/Lateral
- 15°-20° FN to IR, Horizontal Beam; For trauma cases; Hip joint,
acetabulum, FH & FN & GL Trochanters

Lauenstein Supine-Obl ⊥ to the hip joint, Femoral head and
midway bet, ASIS neck overlapped
La-La (Affected and symphysis by GTr
Lateral side pubis
Hickey (Hi-La will set Femoral neck free
you free)
abducted) 20°-25° cephalad from
(20-25 y.o. and
free) superimposition
Danellius- (DMAx-CNAx- Supine: knee is Acetabulum,
FAx) flexed and hip of ⊥ to the long axis head, neck and
Miller the unaff. side is of the FN trochanters of the
elevated in a femur
vertical pos.
Clements- Supine: limb in Demonstrates
Axiolateral neutral position 15° posteriorly bilateral hip
Nakayama to FN arthroplasty, fx
15 y.o
and limitation of
movement
Friedman Lateral Axiolateral
35 y.o recumbent; roll 35° cephalad to projection of the
the px’s upper FN (Kisch head, neck,
body 10° recom: 15°-20° trochanters and
posteriorly w/o cephalad) proximal body of
moving the femur the femur
Hsieh PAOB RAO/LAO; Prone;
Chinese-MMA- elevate the unaff.
side 40°-45°; flex ⊥ to the midway
Posterior
40-45 hits!!
(RAO! And LAO! knee and forearm bet. posterior disc. of the
Sounds like they of the elevated surface of the femoral head
do when training- side iliac blade and KAKAMARTIAL
and BLADES!) Coz disc. FH ARTS NA INJURY!
they’re CHINESE!
SPFH 40-45-Hsieh-
Sounds like SIEH-
Post. Femoral
Head
⊥
Urist APOB RPO/LPO; Posterior rim of
60 y.o. Supine; injured the acetabulum in
UPA-Urist- hip is elevated acute fx-disc
Posterior 60°; the IR is injuries of the
Acetabulum centered @ the hip
upper border of
GTr
Lilienfeld Mediolateral RAO/LAO; lat Mediolateral obl.
recumbent on the projection of the
Obl aff. side; roll the ilium, acetabulum
elevated side 15° and proximal
to separate the 2 femur
sides of pelvis PAI
Colonna recommendation: same position as for the Lilienfeld method EXCEPT the px is placed on
the unaff. side; the aff. Side is rotated 17° anteriorly from true lateral position. It separates the
shadows of the hip joints and gives the optimum projection of the slope of the acetabular roof
and depth of socket
False profile: demonstrates the anterior acetabular roof
Examinations contraindicated for px with suspected fx or pathologic

conditions: F-O-L-L-C
➢ Friedman
➢ Original & MOD. Cleaves
➢ Lillienfeld
➢ Lauenstein & Hickey
➢ Chassard-Lapine
Congenital Disc. of the Hip

❖ Andren-von Rosén approach (Bilateral Hip): both legs forcibly
abducted to at least 45° with appreciable inward rotation of the femora
Knake & Kuhns: described the construction of a device that controlled the
degree of abduction and rotation of both limbs
❖ AP
- CR: ⊥ - lateral/superior displacement of FH
- CR: 45° to symphysis pubis – anterior & posterior displacement
ACETABULUM - TJ
RAO/LAO; 12° cephalad Fovea capitis and
Teufel PAAxialOB elevate the thru the superoposterior
TFC-3812 unaff. side 38°; acetabulum wall of acetabulum
Teufel for Fovea prone
Capitis
RPO/LPO; semi- ⊥, 2” inf. To the Acetabular rim;
supine 45°; aff. ASIS of the aff. Suspected fx of
Side up (Int side (Int Obl) Iliopubic column
Judet APOB Obl) and posterior rim
(Int Obl);
JARIPPINT & 45°; aff. side ⊥, to the pubic Acetabular rim;
JARISAREXT down (Ext. Obl) symphysis (Ext Suspected fx of
UP & DOWN Obl) Ilioischial column
and anterior rim
(Ext Obl)
Judet R., Judet L., and Letournel: described two 45° posterior oblique positions that are useful in
diagnosing fx of the acetabulum: Int Obl and Ext Obl positions
Iliopubic column (anterior): composed of a short segment of the ilium and the pubis and
extends up as far as the anterior spine of the ilium and extends from the symphysis pubis and
obturator foramen through acetabulum to ASIS
Ilioischial column (posterior): composed of the vertical portion of the ischium and the portion of
the ilium immediately above the ischium and extends from the obturator foramen through the
posterior aspect of the acetabulum
ANTERIOR PELVIC BONES

PA – BD Obturator Foramen
Taylor AP Axial Supine 20°-35°, 2” distal Rami w/o
to the superior foreshortening
“Outlet” border of pubic seen in PA or AP
symphysis for due to the CR
males and 30°- more ⊥ to the rami
45°, 2” for
females
Lilienfeld Superoinferior Seated- ⊥, 1 ½ superior Superoinferior
to pubic axial projection of
Axial “Inlet” upright; symphysis the anterior pubic
flexed knees, and ischial bones
lean and the pubic
symphysis
backward
45°-50°
Staunig PA Axial Prone 35° cephalad to PA Axial projection
pubic symphysis of pubic, ischial
“Inlet” at the level of bones and pubic
GTr symphysis
Bridgeman: 40° caudad also demonstrates the INLET in supine position
Tactical Laser System – Anterior Pelvic Bones
ILIUM
APOB
- RPO/LPO; supine; unaff side elevated 40°; ⊥
- SD: Unobstructed projection of ala and sciatic notches; profile
image of acetabulum; Broad surface of the iliac wing w/o
rotation
PAOB
- RAO/LAO; prone; unaff. side elevated 40°; ⊥
- SD: Ilium in profile; femoral head within the acetabulum
VERTEBRAL COLUMN – Suspend Respiration

V LATERAL OBLIQUE CR MSP BEST
PROJ.
C AP IF 15°-20° 45° PAOB
T IF AP ⊥ 70° PAOB
L IF AP ⊥ 45° APOB
SI - SI ⊥ 25°-30° PAOB
Cervical Lumbar
Thoracic PAOB – CLOSEST Chest PAOB - FARTHEST
Iliac APOB - FARTHEST Ribs APOB – CLOSEST
ATLANTOOCCIPITAL ARTICULATIONS
❖ APOB – R & L head rotations (45°-60°) away from the side of interest,
IOML ⊥ to IR – 1” ANT to EAM
- Dens & open atlantooccipital articulations
Buetti recom. – head is turned 45°-50° with mouth wide open, the chin is
drawn down as much as the open mouth allows; ⊥ to the open mouth
❖ PA – Prone; FN on the table; OML ⊥ to IR; CR is ⊥; ATLOC Joints thru

the MX Sinuses
DENS
⊥
Fuchs Demonstrates dens
AP
when its upper half is w/in the foramen
not clearly shown in magnum
the open-mouth
position
Kasabach (R & L 10°-15° caudad; For use in
rot.)
AP Axial midway bet. outer conjunction with the
canthus and EAM AP & lateral
Obl 40-45 deg. projections
Smith & Abel: for demonstration of laminae and articular facets of upper cervical vertebrae –
slightly extend the px’s neck and open mouth wide; rotate the head 10° to the side; CR is 35°
caudad to C3
Hermann & Stender: for demonstration of the atlantooccipital-dens relationship; head is
adjusted as for Kasabach method and the CR is directed vertically midway bet. mastoid
process at the level of atlantooccipital joints
ATLAS AND AXIS

Albers- AP Open ⊥ to the open Atlas and axis
Schönberg & mouth thru the open
George Mouth mouth
Phonate “ahh”
A 30” SID is often used for this projection to increase the FOV of the
odontoid area
Judd ⊥ at the level of Atlas and axis
37 OML PA mastoid tips w/in the foramen
magnum
Parang Waters
View
LATERAL – R/L Position

- Supine; crosstable; extend neck; ⊥ to a point 1” distal to the
mastoid tip
Pancoast, Pendergrass & Schaeffer recom.: head should be rotated
slightly to prevent superimposition of the atlas. They further recom. a slight
horizontal tilt of the head for the demonstration of the arches of the atlas
CERVICAL
❖ AP Axial
- Supine/upright; elevate chin to place occlusal plane ⊥ to IR
- CR: 15°-20° cephalad to C4
- SD: lower 5 CB & upper 2 or 3 TB; presence or absences of
cervical ribs
❖ Lateral– R/L
- Hyperflexion and hyperextension
- CR: ⊥ to C4
- SD: shows motility/ for functional studies; demonstrates normal
apophyseal movement/absence of movement resulting from
trauma/disease
⊥ to
Grandy All 7 CV (interspaces,
Lateral articular pillars, lower
AP & spinous
processes) (C3-C7)
Ottonello
AP Wagging
C4 All 7 CV with blurring of
mandible to further
visualize the atlas and
axis
Jaw
CERVICAL AND UPPER THORACIC VERTEBRAE
❖ Vertebral Arch (Pillars)
❖ AP Axial
- Px’s neck is hyperextended
- CR: 25° caudad to C7 (20°-30° range)
- The CR angulation is determined by cervical lordosis: ↑ angle =
curve is accentuated; ↓ angle = curve is diminished
- SD: BD Vertebral Pillars; useful for pxs with whiplash injury
❖ AP Axial Obl – Supine; used when the px cannot HPE; both sides are
taken for comparative study
- Px’s head rotated 45°-50° (the articular process of C2-C7 and T1);
60°-70° (articular process of C6 and T1-T4)
- CR: 35° caudad to C7 (30°-40° range)
- SD: Vertebral arches/pillars when the px cannot hyperextend the
head for AP or PA Axial Projection
❖ PA Axial Obl – Prone

- MSP-Neck: 45°; Flexed neck: demonstrates C2-C5; head
extended: C5-C7 & T1-T4
- CR: 35° cephalad to C7 (30°-40° range)
CERVICOTHORACIC REGION
Twining R/L; upright ⊥ to C7 & T1 if
elevate the arm, shoulders are well
flex the elbow, & depressed; 5°
the rest the caudad if not
forearm on px’s
Pawlow and Lateral head
R/L; recumbent; 3°-5° caudad to
C5-T4
MOD extend the px’s C7 and T1
Pawlow arm in which the
Swimmer’s Lateral px is lying, to the
Pos. head
Monda MOD: 5°-15° cephalad due to the slope of the spine and a non-elevated lower spine (IV
Disks)
THORACIC VERTEBRAE
• AP
- Supine; flexed knees and hips to reduce kyphotic curvature;
shallow breathing
- Upright; CR: ⊥ → Oppenheimer recom.
- SD: All 12 TVB, w/ disk spaces, transverse processes &
costovertebral articulations
• Lateral
- Supine/erect; shallow breathing
- CR: ⊥ to T7 when VC is elevated; 10° cephalad for females and
15° cephalad for males due to greater shoulder width
- SD: IF; T1-T3 not well visualized
LUMBAR – LUMBOSACRAL VERTEBRAE (Flexed Elbow; Place the hands on the upper
chest so the forearms do not lie w/in the exp. field)
• AP
- Supine; flex the px’s knees and hips to reduce distortion
- Upright position for pxs who experience excruciating pain to
reduce physical discomfort
- CR: ⊥ to L4 – LS; ⊥ , 1 ½” above the IC (L3) – Lumbar x-ray
- SD: lumbar bodies, IDS, interpediculate spaces, laminae, spinous
and transverse processes
• PA
- Places the IDS // to the divergence of beam
- Reduces px dose
• Lateral
- Recumbent/upright
- CR: ⊥ to L4; 5°-8° caudad if no lead rubber (5° for men/8° for
women)
- SD: L1-L4 IF, L5 IF is not well visualized
• L5-S1: Lateral Projection

- Recumbent; CR is ⊥, 2” posterior to ASIS & 1 ½” inferior to IC/ 5°-
8° caudad if no lead rubber (5° for men/8° for women); SD: L4/L5
– upper sacrum
True LS – L1 – 2/3 of Sacrum
Whole Spine – C7 – L5
LUMBAR – ZYGAPOPHYSEAL JOINTS

• APOB - RPO/LPO
- Recumbent/upright; rot. of 45° toward the aff. side (articular
process) / 30° (lumbosacral processes)
- CR: Lumbar region – 2” medial to elevated ASIS and 1 ½”
above the iliac crest; 5th AP – 2” medial to elevated ASIS; both
⊥
- SD: AP joints closest to IR; “Scottie dog” sign
• PAOB – RAO/LAO
- Recumbent/upright; semiprone
- CR: ⊥ to L3
- SD: AP joints farthest from IR; “Scottie dog” sign
FIFTH LUMBAR
RAO/LAO; lateral
recumbent; extend
the upper arm,
Kovacs PA Axial rotate the pelvis 30° 15°-30° Open L5

anteriorly from the caudad to IF
lateral position;
Obl place a sandbag
under the knee to
L5
prevent excessive
rotation of the hip
LUMBOSACRAL JUNCTION AND SACROILIAC JOINTS

• AP/PA Axial – knees and hips ARE NOT FLEXED!
- Supine: CR is 30°-35° cephalad, 1 ½” superior to PS
- 30° for males, 35° for females
- SD: LS Joint; SI Joint free from superimposition
- Prone: CR is 35° caudad to L4
Meese recom: prone for SI Joints because their obliquity places them with
the divergence of the beam; CR is ⊥ at the level of ASIS
• APOB
- Supine; LPO/RPO; elevate the side of interest 25°-30°, and
support the shoulder, lower thorax and upper thigh
- CR: ⊥ 1” medial to elevated ASIS
- SD: SI Joints farthest from the IR
• PAOB
- Semiprone; RAO/LAO; rotate the side of interest 25°-30°; forearm
and flexed knee support the position
- CR: ⊥ 1” medial to ASIS closest to IR
- SD: SI Joints closest to the IR
PUBIC SYMPHYSIS
Chamberlain PA Upright; facing the ⊥ to the pubic Abnormal SI
VCH, standing on symphysis motion; SI
2 blocks; replace slippage or
one block on after relaxation
the other
(standing one
leg)
SACRUM AND COCCYX

• AP/PA Axial
- A. Sacrum: Supine/prone; CR: 15° cephalad, 2” superior to PS
(supine); 15° caudad to sacral curve (prone)
- B. Coccyx: Supine/prone; CR: 10° caudad, 2” superior to PS
(supine); 10° cephalad to coccyx
- SD: Sacrum/coccyx free from superimposition
• Lateral
- Lateral recumbent; flexed hips and knees
- CR: Sacrum - ⊥ at the level of ASIS to a point 3 ½” posterior
Coccyx - ⊥, at the level of ASIS to a point 3 ½” posterior
and 2” inferior
- SD: Lateral projection of the sacrum/coccyx
SACRAL VERTEBRAL CANAL AND SI JOINTS

Seated; px should ⊥ to the long axis Sacral vertebral
Nolke Axial lean forward and
should also grasp
the legs or ankle
of the sacrum canal
SADBOI :/ pos.
LUMBAR INTERVERTEBRAL DISKS

IV Joint mobility;
to localize the
involved joint as
Weight-
Bearing PA Upright facing the
the right and left

15°-20° caudad
VCH; px bends to to L3/L4-L5/L5-
S1
shown by
limitation of
motion at the
site of lesions in
pxs with disk
protrusion
Duncan and Hoen recom: PA Projection be used because in this direction the divergent rays are
more nearly parallel with the IDS
SCOLIOSIS RADIOGRAPHY
• PA & Lateral – demonstrate the amount/degree of curvature that
occurs with the force of gravity acting on the body; PPLP
- PA/AP upright
- PA/AP upright w/ lateral bending
- Lateral upright w/ or w/o bending
- PA/AP prone or supine
*Bending studies are often used to differentiate primary from compensatory
curves
Frank and Kuntz/Frank et al., - PA Projection for scoliosis radiography
(protecting the breasts) – to reduce exposure to sensitive organs
THORACOLUMBAR SPINE: SCOLIOSIS

⊥
Ferguson PA Seated/standing For comparison
st 1 : normal of T & L
seating/standing vertebrae which
position are used to
2nd: elevate the hip distinguish the
or foot on the deforming or
convex side of the primary curve
primary curve 3”/4” from the
compensatory
curve in pxs with
scoliosis
Young, Oestrich and Goldstein recom: addition of a lateral position, in upright to show
spondylolisthesis or demonstrate exaggerated degrees of kyphosis or lordosis
Kittleson and Lim: described Ferguson and Cobb methods of measurement of scoliosis
LUMBAR SPINE: SPINAL FUSION

• AP – R & L Bending
- Make the 1st radiograph with maximum right bending, followed by
maximum left bending
- Cross the px’s leg on the opposite side to be flexed over the other
leg in order to obtain equal bending force throughout the spine
- CR: ⊥ to L3, 1 to 1 ½” above the iliac crest
- SD: These studies are employed to pxs with early scoliosis to
determine the presence of structural change when bending to the
R & L. It is also used to localize a herniated disk as shown by
limitation of movement at the side of lesion and to demonstrate
whether there is motion in the area of spinal fusion
• Lateral
- Lateral recumbent; lean forward and draw the thighs up to forcibly
flex the spine as much as possible, and then lean the thorax
backward and posteriorly extend the thighs and limbs as much as
possible
- Apply a compression band across the pelvis to prevent movement
- CR: ⊥ to L3
- SD: determine whether motion is present in the area of a spinal
fusion or to localize a herniated disk as shown by limitation of
motion at the site of lesion
BONY THORAX
STERNUM
• PAOB (RAO Pos) *30” SID to blur posterior ribs
- Prone/Upright for trauma pxs; 15°-20° body rot.; shallow
breathing/suspended breathing at EOE for more uniform density
- CR: ⊥ to T7 and 1” lat. to the MSP
- SD: Slightly oblique projection of the sternum; obliterated
pulmonary markings on use of breathing motion

Moore PA Obl Modified prone; px’s 25° to T7 Slightly oblique
arms above projection of the
shoulders w/ palms and sternum
down; center sternum approx. 2”
to IR; shallow to the right
breathing
of spine
(Small px <
Large px >)
• Lateral – R/L pos

A. Upright
- Rot. the shoulders posteriorly, and have the px lock hands behind
back; center the sternum to the midline of grid; breathing is
suspended DI
- CR: ⊥
- SD: Lateral image of the entire length of sternum shows
superimposed SC joints and medial ends of the clavicles
- 72” SID is used to reduce magni. & distortion
B. Recumbent
- Flex the px’s hips and knees; elevate px’s arms over the head;
center the sternum to the midline of the grid; breathing is
suspended at the end of DI
- CR: ⊥
- SD: Lat. aspect of entire length of sternum
- Use the dorsal decub. for pxs with severe injury
SC ARTICULATIONS
• PA*crosswise IR
- Prone/upright for trauma pxs; px’s arms along the sides w/ palms
facing up; center the IR at the level of the spinous process of T3
(lies post. to jugular notch)
- BL: rest the px’s head on the chin; UL: turn the head to the
affected side and rest the cheek to rotate the spine slightly away to
the side examined
- CR: ⊥ to T3
- SD: SC Joints and medial portions of clavicles

RAO/LAO;
Prone or seated ⊥ to T2-T3, 3”
Body PAOB; upright/ upright distal to vert.
Rotation crosswise IR for trauma pxs; prom. and 1”-2”
10°-15°; lat. from the MSP
breathing is
suspended at Slightly
EOE
Prone/upright for oblique
trauma px; grid
IR positioned
projection
directly under 15° lat. from
upper chest; ext. the MSP at the
of the SC
Central Ray PAOB; Non-
the px’s arms
level of T2-T3, joint
along the side of
Angulation bucky the body w/ palms 3” distal to
facing upward; vert. prom.
rest head on chin/ and 1”-2” lat.
rotate the chin to the MSP
towards the aff.
side
Lat. recum. on the
aff. side w/ SC
region centered;
flexed hip and
knees; fully ext.
arm of aff. side 15° caudad Unobstructed
and place the
other arm along to the SC axiolateral
Kurzbauer Axiolateral the side of body joint closest projection of
grasping the the SC joint
dorsal surface of to IR
the hip to prevent closest to IR
sup. of the two
articulations;
breathing is
suspended at EFI
UPPER ANTERIOR RIBS

• PA
- Upright (fluid levels demonstrated), seated-upright (diaphragm
descends)/prone (rest px’s head on chin); px’s hands against hips
w/ the palms turned outward to rotate scapula away from the rib
cage; breathing is suspended at FI to depress diaphragm AMAP
- CR: ⊥ to T7/ 10°-15° caudad to show 7th, 8th and 9th ribs
- SD: Anterior ribs above diaphragm in greater detail
POSTERIOR RIBS
• AP
- Upright/recum
A. Ribs above diaphragm
- Rest the px’s hands, palms outward, against the hips; This
position moves the scapula off the ribs/ Extend the arms to the
vertical position with the hands under the head; breathing is
suspended at FI to depress the diaphragm
B. Ribs below diaphragm
- Place the IR crosswise w/ the lower edge pos. at the level of iliac
crests; place the px’s arms in a comfortable position; breathing is
suspended at FE to elevate the diaphragm
- CR: ⊥
- SD: Posterior ribs above/below the diaphragm, acc. to the region
examined, in greater detail
AXILLARY RIBS
• APOB – RPO/LPO pos
- Upright/recum.; aff. side closest to IR w/ 45° body rot.; abduct the
arm of the affected side and elevate it to carry the scapula away
from the rib cage; rest the px’s hand on head/under or above the
head in recum. pos.; Breathing is suspended at EDE for ribs
below and EFI for ribs above the diaphragm
- CR: ⊥
- SD: Axillary portion of the ribs are projected free from
superimposition
• PAOB – RAO/LAO pos

- Upright/recum.; aff. side away from the IR w/ 45° body rot.; have
the px rest on the forearm and flexed knee on elevated side
(recum); Breathing is suspended at EFE for ribs below and EFI
for ribs above the diaphragm
- CR: ⊥
- SD: Axillary portion of the ribs are projected free from
superimposition
COSTAL JOINTS
AP Axial *recom. for demonstration of the costal joints in pxs with rheumatoid spondylitis
- Supine; px’s head rest directly on the table to avoid accentuating
the dorsal kyphosis; if the px has pronounced dorsal kyphosis,
extend the arms over the head/place the arms along the sides of
the body; apply compression to the thorax if necessary; Breathing
is suspended at EFI
- CR: 20° cephalad and 2” above the xiphoid process; increase
the angulation by 5°-10° to pxs w/ pronounced dorsal kyphosis
- SD: Costovertebral & costotransverse joints
THORACIC VISCERA
TRACHEA
• AP
- Supine/upright; extend the px’s neck slightly; center the IR at the
level of manubrium; inhale slowly during exp.
- CR: ⊥ at the center of the IR
- SD: Outline of the air-filled trachea
TRACHEA & SUPERIOR MEDIASTINUM

• Lateral – R/L
- Seated/standing; clasp the hands behind the body and then rot.
the shoulders pos. AFAP; inhale slowly during exp.
- CR: ⊥ midway bet. jugular notch and MCP, 4-5” lower for
demonstration of sup. mediastinum
- SD: Lateral projection of air-filled trachea and the regions of
thyroid and thymus glands
Eiselberg and Sgalitzer: Demonstrate retrosternal extensions of the
thyroid gland, thymic enlargement in infants (in recumbent position), and
the opacified pharynx and upper esophagus, as well as an outline of the
trachea and bronchi. It is also used in foreign body localization
TRACHEA & PULMONARY APEX

R/L; seated or
standing w/ aff.
side towards the
IR; elevate the
arm adjacent to
the IR in extreme 15° caudad Axiolateral
abduction, flex through the projection
Twining Axiolateral the elbow, and
place the forearm
adjacent
supraclavicular
demonstrates the
air-filled trachea
behind the head; impression and the apex of
depress the the lung closer
opp. shoulder to the IR
AMAP
Trachea: slow
inspiration
Lung apex: exp.
made at FI
CHEST
LUNGS AND HEART
• PA
- Full inspiration; The exposure is made after the second full
inspiration to ensure maximum expansion of the lungs. The lungs
will expand transversely, anteroposteriorly, and vertically, with
vertical being the greatest dimension.
- CR: ⊥ to T7
- SD: Air-filled trachea, the lungs, the diaphragmatic domes, the
heart and aortic knob, and, if enlarged laterally, the thyroid or
thymus gland
• Lateral
- Full inspiration; The exposure is made after the second full
inspiration to ensure maximum expansion of the lungs.
- CR: ⊥ to T7, MCP/ Inferior aspect of scapula
- SD: LL – heart, aorta and left-sided pulmonary lesions
RL – right-sided pulmonary lesions
*these projections are employed extensively to demonstrate the
interlobar fissures, to differentiate the lobes, and to localize
pulmonary lesions
• PAOB – RAO/LAO
- Similar to PA; let arms hang free; 45° towards the unaff. side;
place the arm on the hip outward and the opposite hand to raise it
to shoulder level and grasp the top of the VCH for support
- Use a 55°-60° obl pos. when the examination is performed for a
cardiac series. This projection is usually performed with barium
contrast medium. The px swallows the barium just before
exposure; breathing is made after second FI
- CR: ⊥ to T7
- SD: LAO – max. area of RLF along with the thoracic viscera; the
anterior portion of the left lung is superimposed by the spine; also
shown are the trachea, carina, and the entire RB of the
bronchial tree; heart, descending aorta and aortic arch
RAO – max. area of LLF along with the thoracic viscera; the
anterior portion of the right lung is superimposed by the spine;
also shown are the trachea and entire LB of bronchial tree;
gives the best image of the LA, the anterior portion of the apex
of the LV, and the right retrocardiac space
*the esophagus is shown clearly when filled with BaSO4
*A lesser-degree oblique position has been found to be of particular value in the study of pulmonary
diseases. The px is turned only slightly (55°-60°) from the RAO/LAO body position. This slight degree
of obliquity rotates the superior segment of the respective lower lobe from behind the hilum and
displays the medial part of the right middle lobe or the lingula of the left upper lobe free from the
hilum. These areas are not clearly shown in the standard “cardiac oblique” of 45°-60° rotation, largely
because of superimposition of the spine.
• APOB – RPO/LPO
- RPO/LPO pos. are used when the px is too ill to be turned to
the prone pos. and sometimes as supplementary pos. in the
investigation of specific lesions. They are also used with the
recumbent px in contrast studies of the heart and great
vessels
- 45° body rot.; flex the px’s elbows, place the hands on the hips w/
palms upward; exp. made after the second FI
- CR: ⊥ at a level 3” below the jugular notch’ exiting T7
- SD: APOB projection of the thoracic viscera similar to PAOB
CHEST
• AP
- The supine pos. is used when the px is too ill to be turned to the
prone pos. It is sometimes used as a supplementary projection
in the investigation of certain pulmonary lesions.
- If possible, flex the px’s elbows, pronate hands, and place it on the
hips to draw the scapulas laterally; exp. made after the second FI
- CR: ⊥ to the long axis of sternum, 3” below the jugular notch
- SD: AP projection similar to PA; the heart and great vessels are
magnified, as well as engorged, and the lung fields appear
shorter because abdominal compression moves the
diaphragm to a higher level. The clavicles are projected
higher, and the ribs assume a more horizontal appearance
Resnick recom: angled AP projection free the basal portions of the lung
fields from superimposition by the anterior diaphragmatic, abdominal, and
cardiac structures; this projection also differentiates middle lobe and lingular
processes from lower lobe disease; the px may be either upright or supine,
and the CR is 30° caudad to the midsternal region
PULMONARY APICES
Lordotic; Upright; ⊥ to midsternum; AP axial and AP
standing approx. exp. made after axial obl images
1 ft from the VCH the second FI of the lungs
(adjusted to 3” demonstrate the
above the upper apices and
border of the conditions such
Lindblom AP shoulders) as interlobar

effusions
Obl lordotic: 30°
Axial rot., aff. side
towards the IR; px
flexed elbows and
place hands w/
palms upward on
the hips; lean
backward of
extreme lordosis
PULMONARY APICES
• PA/PA Axial*crosswise IR; 72” SID
- Seated/standing; flex the elbows and place the hands, palms out,
on the hips; depress the px’s shoulders and rotate them forward;
keep the px’s shoulders in contact with the IR; exp. made at
EFI/optionally FI; clavicles are elevated by inspiration and
depressed by expiration; the apices move a little, if at all, during
either phase of respiration
- CR: 10°-15° cephalad to T3 (inspiration)
⊥ to T3
- SD: The apices are projected above the shadows of clavicles
in PA Axial and PA
• AP Axial*crosswise IR; 72” SID

- Upright/supine; place the px’s shoulders against the grid; flex the
elbows, hands on hips with palms out/pronated; exp. made at FI
- CR: 15° or 20° cephalad to T2, entering the manubrium
- SD: AP Axial projections shows apices lying below clavicles
the AP Axial projection is used in preference to the PA Axial in hypersthenic pxs and pxs whose
clavicles occupy a high position; the AP Axial separates the apical and clavicular shadows without
distortion
LUNGS AND PLEURAE

• AP/PA – R/L, lat. decub.
- Advise the px to remain in the pos. for 5 mins before the exp.; if
the px is lying on the affected side, elevate the body 5–8 cm; exp.
made after the second FI
PE: Aff. side down; PNTHX: Aff. side up
- CR: Horizontal, ⊥, 3” below the jugular notch (AP)/ T7 (PA)
- SD: AP/PA lat. decub pos. shows change in fluid pos. and
reveals any obscured pulmonary areas, or in the case of
suspected pneumothorax, the presence of free air
Ekimsky recom: An exp. made w/ the px leaning directly laterally from the
upright PA pos. is sometimes useful for demonstrating fluid levels in
pulmonary cavities; px leaning 45° for demonstrating small PEs; inclined
pos. is simpler to perform than the decub. pos. and is equally satisfactory
• Lateral – R/L, ventral/dorsal decub.

- Prone/supine; thorax elevated 2”–3”; advise the px to remain in
the pos. for 5 mins before the exp.; exp. made after the second
FI
- CR: Horizontal, enters MCP, ⊥, 3”-4” below the jugular notch
(DD)/ T7 (VD)
- SD: Lat. projection in the decub. pos. shows a change in the
position of fluid and reveals pulmonary areas that are
obscured by the fluid in standard projections
SKULL
Cranium
• Lateral – R/L
- Seated-upright/semiprone; rest forearm and knee of the elevated
side (semiprone); side of int. closest to IR;
- IOML // to IR; IPL ⊥ to IR
- CR: ⊥, 2” sup. to EAM
- SD: Lat. images of superimposed halves of cranium shows the
detail of the side adjacent to IR. PADS - Posterior clinoid
processes, Anterior clinoid processes, Dorsum sellae and Sella
turcica are well demonstrated
- EC: Mandibular rami should superimposed
• Lateral – R/L; Dorsal decub./supine lat. pos; HEST LATERAL

- Robinson, Meares and Goree recom: Dorsal decub. lat.
projection for demonstration of traumatic sphenoid sinus
effusion; this finding may be the only clue to the presence of
basal skull fx
- IOML // to IR; IPL ⊥ to IR
- CR and SD are same as prev. described for Lateral R/L pos.
METHOD PROJECTION POSITION

CR SD
Orbits are
filled by the
margins of the
Prone/seated; ⊥ to IR, petrous
Caldwell PA OML ⊥ to IR; exiting pyramids;

PECFF –
forehead and nasion Posterior
nose on table Ethmoidal air
cells, Crista
galli, Frontal
bone & Frontal
sinuses
FRONTAL
BONE
Same as PA
Axial +
Caldwell 15° caudad, petrous
method PA Axial exiting nasion ridges are
projected into
the lower
third of the
orbits
20°-25° caudad thru the midorbits Superior
orbital
fissures
25°-30° caudad exiting nasion Rotundum
foramina
Lat. decub – for trauma pxs; same pos. and CR
CRANIUM AND CRANIAL BASE

AP/AP Axial – REVERSE MODIFIED CALDWELL
- OML ⊥ to IR; CR is ⊥/15° cephalad to nasion
- SD: Same as seen on PA but orbits are magnified due to
increased OID
SP3DOM –
Symmetric
petrous pyramids,
Posterior portion
of the foramen
magnum, Dorsum
Towne Supine/seated; 30° depressed
sellae and
Grashey AP OML(flexed chin/ 37°

Posterior clinoid
processes
projected w/in FM,
neck) ⊥ to IR; caudad to
Altschul Axial suspended OML/IOML,
Occipital bone and
Posterior portion of
parietal bones; also
respiration 2 ½” above
Chamberlain glabella
used for
tomographic
studies of ears,
facial canal,
jugular foramina,
and rotundum
foramina
40°-60° caudad to OML Entire FM
Haas (for obtaining an image of the sellar Prone/seated- 25° cephalad, 1 SDP – Symmetric
structures projected w/in the FM on upright; OML ⊥ to ½” below the ext. petrous pyramids,
IR; forehead and occ. prot. (inion) Dorsum sellae
hypersthenic, obese or other px who cannot PA Axial exiting 1 ½” sup. and Posterior
be adjusted correctly for the Towne nose on table;
projection) opposite of Towne’s suspended to nasion clinoid processes
respiration
Symmetric
petrosae,
Supine (increased ⊥ to sella turcica, mastoid
FOSCASEM-MONDS intracranial bet. angles of processes,
Schüller/Pfeiffer SMV pressure)/seated

upright; IOML // to
IR; suspended
mandible ¾”
anterior to the
level of the EAMs
foramina ovale
and spinosum,
carotid canals,
Full Basal respiration sphenoidal &
ethmoidal
sinuses,
mandible, bony
nasal septum,
dens & occipital
bone
⊥ to sella turcica, Same as SMV but
bet. angles of structures in the
mandible ¾” midbasal region
anterior to the are somewhat
Schüller/Pfeiffer VSM Prone; suspended
respiration
level of the EAMs distorted &
magnified due to
Full Basal increased OID;
useful in studies
xxxx of anterior
cranial base and
sphenoidal
sinuses
ACBSS
SELLA TURCICA
• Lateral – R/L
- Seated-upright/semiprone; IOML // to IR; suspended respiration
- CR: ⊥, ¾” sup. & ant. to EAM
- SD: Lateral projection of the sellar region of the cranium
SELLA TURCICA, DORSUM SELLAE & POSTERIOR CLINOID PROCESSES

• AP Axial
- Seated-upright/supine; IOML ⊥ to IR; Suspended respiration
- CR: 30°/ 37° caudad to upper forehead passing thru the head at the level of EAM
- SD: Dorsum sellae and posterior clinoid processes w/in the FM (37°)/ Dorsum &
tuberculum sellae and the anterior clinoid processes thru the OB above the level of FM
(30°); SELLAR REGION & PETROUS PYRAMIDS
• PA Axial
- Prone/seated; forehead and nose on VCH/table: OML ⊥ to IR;
suspended respiration
- CR: 10° cephalad to glabella
- SD: Dorsum & tuberculum sellae and the posterior & anterior
clinoid processes are projected thru the FB just above the
ethmoidal sinuses
ORBIT
Optic Canal and Foramen
Optic canal
“on end” and
the optic
Semiprone/seated ⊥, 1” sup. & foramen lying
Parietoorbital upright; Zygoma, pos. to the in the inf. and
Nose & Chin on upside TEA, lat. quad. of the
Obl table/VCH; AML exiting thru the projected orbit;
⊥ to IR; 53° MSP orbit closest to a parietoorbital
to IR, 37° to CR; IR projection of
suspended the FES
respiration sinuses are
also
demonstrated
Rhese Optic canal
“on end” and
Seated- ⊥ to the optic
Orbitoparietal upright/supine; uppermost foramen lying
Obl AML ⊥ to IR; 53° orbit at its inf. in the inf. and
MSP to IR; and lat. quad. lat. quad. of the
suspended projected orbit;
respiration exact reverse
of PO
projection
SUPERIOR ORBITAL FISSURES

• PA Axial
- Prone/seated-upright; Forehead and nose on IR; OML ⊥ to IR;
Suspended respiration
- CR: 20°-25° caudad exiting at the level of inferior margin of the
orbit
- SD: The superior margin of the petrous portions of the temporal
bones should be projected at or just below the inferior margin of
the orbits. The SOF are seen as elongated dark areas lying on
the medial side of the orbits bet. the greater and lesser wings of
the sphenoid bones. The margins of the SOF, although somewhat
narrowed, are frequently well shown on the 15° caudad PA Axial
of the skull.
INFERIOR ORBITAL FISSURES

A PA Axial
projection of each
Seated- 20°-25° orbital floor and
upright/prone; F-N cephalad, 3” IOF is
on VCH/table; below EOP, demonstrated bet.
Bertel PA Axial IOML ⊥ to IR; exiting nasion the shadows of
suspended the lateral
respiration pterygoid lamina
of the sphenoid
bone and the
condylar process
of mandible
EYE
• Lateral, PA & Bone-free studies are taken to determine whether a
radiographically demonstrable FB is present; recumbent/seated-
upright
• Lateral – R/L
- Semiprone/seated-upright, outer canthus of the aff. eye close to
IR; MSP //, IPL ⊥ to IR; suspended respiration
- CR: ⊥ to outer canthus; instruct to px to look straight ahead for the
exp.
- SD: Loc. Of FB; superimposed orbital roofs
• PA Axial
- FN on IR; OML ⊥ to IR; suspended respiration
- 30° caudad to the orbits; instruct the px to close the eyes and
holding still for the exp.
- SD: Petrous pyramids lying below orbital shadows
• Parietoacanthial – MOD Waters

- Rest the px’s chin; OML forms 50° to the IR; suspend respiration
- CR: ⊥ to the midorbits; instruct the px to close the eyes and
holding still for the exp.; SD is same as PA Axial
FB LOCALIZATION
VOGT-BONE-FREE POSITION
• Taken to detect small or low density foreign particles located in the
anterior segment of the eyeball/eyelids
• 2 Projections: lateral & superoinferior
• 2 Movements:
o Vertical: 2 exposures (for lateral)
▪ Look up as far as possible
▪ Look down as far as possible
o Horizontal: 2 exposures (for superoinferior)
▪ Look to extreme right
▪ Look to extreme left
PARALLAX METHOD
• First described by Richards
• It determines whether the foreign body is located within the eyeball
requires no special apparatus
• Not considered as precision localization procedure
• Widely used as preliminary check only
• 2 Projections:
o Lateral: 2 exposures
o PA: 2 exposures
SWEET METHOD
• It determines the exact location of a foreign body by use of a geometric
calculations
• Apparatus:
o Sweet localizing device
o Sweet film pedestal
• 1 Projection:
o Lateral: 2 exposures
▪ CR perpendicular
▪ CR 15o -25o cephalad
PFEIFFER-COMBERG METHOD
• A leaded contact lens is placed directly over the cornea
• Apparatus:
o Contact lens localization device
o Pedestal type of film holder
• 2 Projections:
o Waters Method:
▪ CR horizontal
o Lateral:
▪ CR perpendicular
FACIAL BONES
• Lateral – R/L
- Semiprone/obliquely seated; MSP & IOML //, IPL ⊥ to IR;
suspended respiration
- CR: ⊥ to ZB, bet. OC and EAM
- SD: Lateral image of facial bones, with R & L side superimposed
- Also used in facial profile (STL)

Prone/seated- Orbits, MX &
Waters Parietoacanthial upright; Rest ZA
chin; HPE neck,
37° OML to IR; MORZA
SR ⊥, exiting
Same as Waters acanthion Petrous ridges
but req. less are projected
extension of the immediately
neck (55° OML to below the
IR); SR inferior border of
the orbits at a
level midway
Modified Modified thru the MX
Waters Parietoacanthial sinuses
Dems. Blow out

fx – inf.
displacement
of orbital floor
and the
commonly
opacified MX
sinus
Supine; HPE; Superior facial
Reverse Acanthioparietal
HPE neck, 37° ⊥, entering bones;
OML to IR; MML acanthion magnified
Waters and MSP ⊥ IR compared to
Waters
15° caudad, Petrous ridges
exiting nasion projected into
the lower third
of the orbits
Prone/seated; FN
to IR; OML ⊥ IR; 30° caudad Orbital rims,
Caldwell PA Axial SR (exaggerated MX, ZB and the
Caldwell) ant. nasal
spine; petrous
MORZBA ridges are
projected below
the inf.
margins of the
orbits
Floor & post.
wall of MX sinus
25°-30° (antrum) of side
Semiprone; ZNC cephalad, down FP-
Law PA Axial Obl to IR; OML ⊥ IR entering pos. to
gonion AZE
External orbital
wall, ZB & ant.
wall of MX sinus
of side up
NASAL BONES
• Lateral – R/L; CW for 2-in-1 exp./ occlusal film for each
- Semiprone; MSP and IOML //; SR
- CR: ⊥ to the bridge of the nose ½” distal to nasion
- SD: Nasal bones and soft tissue structures of the side near to IR
• Tangential
- Extraoral Film (Cassette): prone; chin rested on sandbags; chin
fully extended; MSP & GAL perpendicular to IR
- Intraoral Film (Occlusal Film): supine; head elevated; MSP
perpendicular to sponge; GAL parallel to sponge & perpendicular
to film
- CR: ⊥ to GAL; SD: For demonstration of any medial or lateral
displacement of fragments in fractures
ZYGOMATIC ARCHES
• SMV
- Supine/seated-upright; IOML //; SR
- CR: ⊥ to IOML, 1” post. to outer canthi
- SD: Bilateral symmetric SMV images free from superimposition
• Tangential – TiTa RoTo 15

- Seated/supine; HPE neck, IOML // to IR; rot. the head 15o
towards side being examined; tilt the top of the head 15o away
from the side; SR
- CR: ⊥ to IOML, 1” post. to outer canthi
- SD: Tangential image of 1 ZA free from superimposition. Useful in
pxs with depressed fx or flat cheek bones
3M
Prone/seated;
IOML // to IR;
rest the px chin
on device; rot.
May Tangential*crosswise the head 15o ⊥ to IOML ZA free from
IR away side being thru the ZA, 1 superimposition;
examined; tilt ½” post. to Useful in pxs with
the top of the outer canthus depressed fx or
head 15o away flat cheek bones
from the side;
SR
MOD Towne AP Axial Seated- 30o caudad Bilateral

upright/supine; to glabella, symmetric ZA
OML ⊥ to IR; 1” above the images free from
SR nasion superimposition
MOD PA Axial 23o-38o
caudad
Titterington Superoinferior/Jug Prone; NC on IR vertex Well shown ZA
Handle View midway bet.
ZA
MANDIBULAR SYMPHYSIS
• AP Axial
- Seated/supine; place the film packet or IR, with its pebbled surface
placed under the chin
- CR: 40o-45o post./caudad when supine to mandibular symphysis
- SD: Mandibular symphysis, mental foramina, and roots of lower
incisors and canines
MANDIBLE
• PA/PA Axial – RAMI/ MO
- Prone/seated; FN on IR; OML ⊥ to IR; SR
- CR: ⊥, exiting acanthion/ CR: 20o-25o cephalad, exiting
acanthion
- SD: Mandibular body and rami; usually employed to dems. medial
or lateral displacement of fragments in fx of rami
• PA/PA Axial – BODY/ MA

- Prone/seated; NC on IR placing the MS // to IR; AML nearly ⊥ to
IR; SR
- CR: ⊥ to the level of lips/30o cephalad to midway bet. TMJs
- SD: Mandibular body
- Zanelli recom.: better contrast around the TMJs could be
obtained if the px was instructed to fill the mouth w/ air
• Axiolateral Obl.
- Seated/semiprone/semisupine; IPL ⊥ to IR
A. Ramus – TL
B. Body - 30o towards the IR
C. Symphysis - 45o towards the IR
- CR: 25o cephalad to pass directly thru mandibular region of
interest
- SD: Region of mandible // with the IR
*To reduce the possibility of projecting the shoulder over the mandible when radiographing muscular
or hypersthenic pxs, adjust the MSP of the px’s skull w/ an approx. 15o angle, open inferiorly. The
cephalad angulation of 10o of the CR maintains the optimal 25o CR/part angle relationship.
• SMV
- Upright/supine; IOML // to IR; SR
- CR: ⊥ to IOML midway bet. angle of the mandible
- SD: Coronoid and condyloid processes of MR
• VSM
- Prone/seated; IOML // to IR; SR
- CR: ⊥ to IOML/ occlusal plane, at the level just post. to outer
canthi
- SD: Mandible as seen from above the px; CPs are easily visible
on either image, but the condyle and neck of CPs are better
shown with the greater angle
TMJs
• AP Axial
- Supine/seated-upright w/ post. skull in contact with VCH; OML ⊥
to VCH; SR
- CR: 35o caudad, midway bet. TMJs, and entering at a point 3”
above nasion
- SD: Condyles of mandible and the mandibular fossae of the
temporal bones
- EC: Min. superimposition of pars petrosa in CM; MC and TMJ
below pars petrosa OM
• Axiolateral/ Axial TC/ SCHULLER – R/L

- Semiprone/seated; Mark each cheek at a point ½” ant. to EAM
and 1” inf. to EAM to localize TMJ if needed w/ aff. side closest to
IR; MSP // & IPL ⊥; SR
- After making the exp. w/ px’s mouth closed, change the IR; then,
unless contraindicated, have the px open the mouth wide
- CR: 25o-30o caudad, ½” ant. and 2” sup. to EAM
- SD: TMJs when the mouth is open and closed
• Axiolateral Obl/ Lat. TC/ MOD. Law – R/L

- Semiprone/seated, make exp. on closed and open (if not CI)
mouths; rot. the head 15o towards the IR; AML // to IR; SR
- CR: 15o caudad and exiting thru the TMJ closest to IR; entering 1
½” sup. to upside EAM
- SD: Relationship of mandibular fossa and condyle; Open mouth:
mandibular fossa and the inf. & ant. excursion of the condyle – MC
lying inferior to articular tubercle; fx of the neck and condyle of
ramus – MC lying in the mandibular fossa

Albers- Semiprone; TL; 10ocephalad
MSP & IOML // to exiting TMJ
Schonberg IR; IPL ⊥ to IR closest to IR
LTF Axiolateral
Lateral
recumbent; TL; ⊥ to the
TMJ
Zanelli head resting on uppermost
OblTF parietal region; gonion
MSP 30o to IR
PANORAMIC TOMOGRAHY/ PANTOMOGRAPHY/ROTATIONAL

TOMOGRAPHY - technique employed to produced tomograms of curved surfaces
✓ Provides panoramic image of the entire mandible, TMJ, dental arches
✓ Provides distortion-free lateral image of the entire mandible
✓ Patients who sustained severe mandibular or TMJ trauma
✓ Useful for general survey studies of dental abnormalities
✓ Adjuvant for pre-bone marrow transplant
PNS
Cross & Flecker: pointed out the value of erect position
➢ To demonstrate presence or absence of fluid
➢ To differentiate between shadows caused by fluid & those caused by pathology
• Lateral – R/L
- Seated (RAO/LAO for TL); MSP & IOML // to IR, IPL ⊥ to IR; SR
- CR: ⊥ entering ½” to 1” pos. to the outer canthus
- SD: All PNS
• SMV
- IOML // to IR, HPE neck; SR
- CR: ⊥ to IOML thru the sella turcica, entering approx. ¾” to the
level of EAM
- SD: Symmetric image of the ant. portion of skull base; SS and
EAC
• PA
- Seated-upright; FN to IR; MSP & OML ⊥ to IR; SR
- CR: ⊥, exiting nasion/ 10o cephalad, exiting glabella/ ⊥, exiting midway bet. infraorbital
margins and the acanthion
- SD: Posterior ethmoid sinuses are projected sup. to ant. ethmoid sinuses (nasion)/
Sphenoidal sinuses through frontal bone (glabella)/ Maxillary sinuses inferior to cranial
base (IOM & AC)

Seated
Angled grid: Tilt
the VCH down to
form a 15° angle;
FN rested on
VCH; MSP &
OML ⊥ to IR; SR
Caldwell PA Axial Vertical grid: Ext. ⊥, exiting FS & ant. EAC
px’s neck; rest
the tip of nose
nasion
on the VCH;
OML forms 15°
angle w/ the CR;
place sponge
bet. forehead
and VCH; SR
Seated; HPE the
neck just enough
to place the
dense petrosae Sinusitis of the MS/ MS, w/ the petrous ridges
immediately lying inf. to the floor of sinuses;
Waters Parietoacanthial below the foramen rotundum; distorted FS & EAC
maxillary sinus
floors; Chin
rests on VCH;
OML forms 37°
and MML ⊥ to
VCH; SR
Same as Waters
⊥, exiting SS projected thru the open mouth along with the
Open-Mouth
+ px slowly open acanthion MS
the mouth wide
Waters open while
holding the pos.
Upright; Prone; SS projected thru the open mouth; MS; Nasal
NC to IR; open ⊥, ¾” ant. to EAM fossae
Pirie Axial Transoral mouth; phonate (sella turcica)
“ah” during exp.
Seated-upright: ⊥ to upper Obl image of post & ant ES; FS & SS; profile
Rhese POObl. ZNC to IR; AML parietal region image of optic canal
⊥ to IR; MSP 53°
Seated-erect; 25°-30° cephalad Relationship of MS to teeth
Law PA Axial Obl ZNC to IR; neck to uppermost
HPE gonion
TEMPORAL BONE: MASTOID

DT Ang.; TL;
Mastoid closest 15° caudad and
to IR; IOML & 15° ant., 2” post.
Law: Original MSP //, IPL ⊥ to & 2” sup the
IR; Tape auricles uppermost EAM Mastoid cells, lateral portion of
forward; SR petrous pyramid, superimposed
ST. Ang.; Prone; IAM and EAM, and when present,
IOML //, IPL ⊥ to mastoid emissary vessel
Axiolateral IR; 15° rot of the 15°
Law: MOD Obl head to the IR; caudad,” MECLASIE
Tape auricles
forward; SR
Part. Ang; Prone;
Law: Part Ang.

Head rests on
cheek; MSP &
⊥, ”
IPL 15° from IR &
vertical; SR
Mastoid cells, mastoid antrum,
15° caudad, IAM & EAM
Henschen exiting EAM MACIE
closest to IR Cushing: demonstrating tumors of
Prone/seated; TL; the acoustic nerve
IOML & MSP //,
Axiolateral IPL ⊥ to IR; Tape
25°
Pneumatic structure of the
mastoid process, mastoid
Schüller auricles forward;
antrum, IAM & EAM, sinus & dural
SR caudad,” plates, and when present, the
mastoid emissary vessel
MES MAPIEDS
(Runström II) 35° Mastoid cells, mastoid antrum,
Lysholm caudad,” EAM, labyrinth area and carotid
canal
MACCLE
Runström recom: exp. made w/ mouth open for visualization of the petrous apex bet. the ant. wall of EAM and the mandibular
condyle
Petrosa in the direction of its long
axis demonstrates the EAM,
tympanic cavity & ossicles,
epitympanic recess, aditus, and
mastoid antrum closest to IR
OMATEERA
Owen mod1: Stated that it is
sometimes advantageous to vary
head rot. and/or CR angulation
Supine/seated;
45°
Mayer
Rot. the head 45°
Axiolateral O1, cited by Pendergrass,
to the IR; Depress caudad,” Schaeffer & Hodes: MSP 40° from
Obl the chin – IOML //
to IR; SR
the IR; Head rot. 10° caudally; CR
28° caudally
O1, cited by Etter & Cross: MSP of

head 30° to the IR; CR 25°- 30°
caudally
O1, cited by Compere: Head rot.
30°- 45° to the IR; CR 30° caudally
Prone/seated;
FNC w/ side ex. Petrous ridge, cellular structure
closest to the IR; 12° cephalad, of the mastoid process, mastoid
IOML // to IR; entering 3” – 4” antrum, area of labyrinth, internal
Stenvers: Posterior MSP of head 45° post. & ½” inf. to acoustic canal and the cellular
to IR; DC skull: upside EAM structure of the petrous apex
Profile 54° = <; BC skull: *if correctly positioned, petrous pyramid //
3 Point Upper Landing Axiolateral 40° = >; SR to IR
Supine; Rot. px’s
Obl face away from
Arcelin: Anterior side ex. - 45° w/ 10° caudad, Petrous portion of TB
the IR; IOML // to entering 1” ant. &
Profile*exact opposite of IR; DC skull: 54° - 3/4” sup. to EAM farthest from the IR
Stenvers = <; BC skull: 40°
= >; SR
Supine; face rot.
away from side
on interest; MSP 15° caudad, 1” Mastoid process free from
MOD Hickey AP 35° from the IR/
MSP 45° from
sup. to tip of
mastoid process
superimposition; projected below
the shadow of occipital bone
Tangential vertical; IOML ⊥
to IR; IR 15°
caudally
inclined; SR
Supine/seated- Petrosas projected above the skull
upright; MSP & 30° caudad to base; demonstrates the internal
Towne AP Axial OML/IOML OML/ 37° caudad

(cannot flex neck, to IOML; enters 2
acoustic canals, arcuate
eminences, labyrinths, mastoid
compensate w/ 7° ½” above the antrums, and middle ears;
caudal ang. on nasion dorsum sellae w/in the FM
CR) ⊥ to IR; SR
SMV*Basilar projection Seated/supine;
for petromastoids – project (1) adjust the ext. 5° ant., midway Mastoid processes, labyrinths,
the long axis of the EAMs,
tympanic cavities & of neck so that bet. 1” ant. to EAM, tympanic cavities and
Hirtz osseous part of the
auditory tubes immediately
behind mandibular
OML is // to IR,
(2) angle the CR
EAMs acoustic ossicles
condyles ant. until ⊥ to IR; MAPELTA

SR
• SMV
- Same PJ., Pos & SD for Hirtz
- CR: ⊥ to OML, centered on MSP of the throat at the level of EAMs
DILA (IOML 50o):
Recumbent/seated-erect; Dorsum sellae; Internal
upper frontal region of Auditory Meatus (IAM);
skull against IR; head Labyrinth
Valdini PA Axial acutely flexed; MSP⊥ to
IR; IOML 50o/OML 50o;
⊥, entering inion, exiting
0.5 cm distal to nasion ETB “EaT Bulaga” (OML
line extending from inion 50o): External auditory
to 0.5 cm distal to nasion meatus; Tymphanic
forming 28o to CR; SR cavity; Bony part of
Eustachian tube
STYLOID PROCESS
Symmetric image of the
Seated-upright/prone; styloid processes of the
Cahoon PA Axial FN on VCH; Flex neck,
OML & MSP ⊥ to IR; SR
25° cephalad to nasion temporal bones
projected w/in or just
above the maxillary
sinuses
JUGULAR FORAMINA
Supine/seated-upright; 20° posterior, 1” distal Both SMV projections
Kemp Harper MSP ⊥, OML // to IR; SR to the mandibular demonstrate jugular
symphysis foramina projected at or
Similar to KH + 25° OML ⊥, 2” distal to near the level of angles
Eraso MOD SMV Axial

from the IR mandibular symphysis of the mandible
*When a px with a prominent
mandible is being examined, the
angulation of the CR may be
increased from 5°- 10° caudally;
Eraso mod. Project the JF at ang
angle 5° greater than KH
Strickler mod.: The neck is extended until a line passing thru the infratragal notch and a point 2 cm
distal to the mandibular symphysis is ⊥ to the plane of the film. The CR coincides this line.
HYPOGLOSSAL CANAL
Delineate the HC in a px
with hypoglossal nerve
Supine/seated; Rot. the tumor
MSP of the head 45°
away from the side being 12° caudal, entering 1” Mandibular condyle is
examined, IOML // to IR; ant., ½” inf. to the level projected inf. and ant. to
Miller Axiolateral Have the px softly

phonate ah-h-h to
of EAM farthest from the
IR
the canal when the px
can open the mouth wide
Obl immobilize the mouth
in the open pos/SR
enough; because of
normal anatomic
variations, the ideal
image is not always
obtained.
Kirdani, Valvassori and Kirdani recom: Hypoglossal canal be examined by tomographic
sectioning in the SMV, semiaxial AP, and Stenvers positions; These studies also provide
excellent demonstration of the jugular foramina
Recorded detail: - Applying immobilization field (about 5 cm from)
- Geometry Decreasing the length of exposure despite proper beam
- Film time is the best way to control both limitation
- Distance voluntary and involuntary motion - If the clinical objective of
- Screen the examination is not
- FSS No matter which projections is compromised
- Motion performed, and no matter what position - If the px has a reasonable
Shape Distortion: the patient is in, if a R marker is used it reproductive potential
- Alignment must be placed on the right side of the Destructive diseases (Radiolucent)
- Anatomic part patient’s body. If a L marker is used it - Old age
- Angulation must be placed on the left side of the - Pneumothorax
- CR patient’s body. - Emphysema
- IR - Emaciation
Size Distortion: Indications for angulation of CR: - Degenerative arthritis
- OID and SID - When overlying or - Atrophy
Bowel Prep: underlying structures must - Osteoporosis
- Limited diet not be superimposed - Bowel obstruction
- Laxative - When a curved structure - Cancer
- Enema such as the sacrum or - Osteolytic metastases
Involuntary motion is caused by: coccyx must not be Additive/Constructive diseases
- Heart pulsation stacked on itself (Radiopaque)
- Chill - When projection thru the - Edema
- Peristalsis angled joints such as knee - Enlarged heart
- Tremor joint and lumbosacral - PNA
- Spasm junction is needed - PE
- Pain - When projection thru - Ascites
Voluntary motion is caused by - angled structures must be - Hydrocephalus
FAMBEND: obtained w/o shortening - Aortic aneurysm
- Fear or elongation, such as - Atelectasis
- Age with a lateral image of the - Cirrhosis
- Mental illness neck of the femur - Hypertrophy
- Breathing 40” – 1 m - Osteoblastic metastases
- Excitability SSD – shall not be less than 12” and - Sclerosis
- Nervousness should not be less than 15” per NCRP
- Discomfort regulation
Controlled by:
- Giving clear instructions Gonadal shielding:
- Providing patient comfort - If the gonads lie within or
- Adjusting support devices close to the primary x-ray

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UPPER EXTREMITIES

1st CMC JOINT

Angulation of the Central Ray:

1st MCP JOINT

Fiolle: Carpal Boss (Carpe Bossu)

WRIST: PAOB and APOB

ELBOW: APOB (MCLaRa – UlTroch – RadCapi)

Pag PA nang wrist – 8 carpal bones

OLECRANON PROCESS: PA AXIAL PROJECTION

45° away from Coronoid

SHOULDER: AP, ⊥--1” inf. to coracoid process; PH-APOL-ENI

HILL-SACHS DEFECT – Recon Special Warfare Group

ROTATOR CUFF MUSCLES

❖ SCAPULA Y – suspected shoulder disc; described by Green, Gray

DORSOPLANTAR WEIGHT BEARING

METHOD PROJECTION POSITION CR SD

PAOB-Med. Rot.: 45° plantar surface towards IR; CR is ⊥ to 5th MTB; A

DORSOPLANTAR OBLIQUE: BD Lisfranc fx

FOOT: LATEROMEDIAL WEIGHTBEARING

Axial posteriorly to 3rd

Kite the bones and tarsal

• Plantar Flexion and Inversion of the Calcaneus - Equinus

ANKLE: LATERAL – demonstrates TRIMALLEOLAR FX

Camp- PA Axial 40° caudad for (1) joint mice;

METHOD PROJECTION POSITION CR SD

PELVIS AND HIP JOINTS

METHOD PROJECTION POSITION CR SD

Examinations contraindicated for px with suspected fx or pathologic

Congenital Disc. of the Hip

ANTERIOR PELVIC BONES

VERTEBRAL COLUMN – Suspend Respiration

❖ PA – Prone; FN on the table; OML ⊥ to IR; CR is ⊥; ATLOC Joints thru

ATLAS AND AXIS

LATERAL – R/L Position

❖ PA Axial Obl – Prone

• L5-S1: Lateral Projection

LUMBAR – ZYGAPOPHYSEAL JOINTS

Kovacs PA Axial rotate the pelvis 30° 15°-30° Open L5

LUMBOSACRAL JUNCTION AND SACROILIAC JOINTS

SACRUM AND COCCYX

SACRAL VERTEBRAL CANAL AND SI JOINTS

LUMBAR INTERVERTEBRAL DISKS

the right and left

THORACOLUMBAR SPINE: SCOLIOSIS

LUMBAR SPINE: SPINAL FUSION

METHOD PROJECTION POSITION CR SD

• Lateral – R/L pos

METHOD PROJECTION POSITION CR SD

UPPER ANTERIOR RIBS

• PAOB – RAO/LAO pos

TRACHEA & SUPERIOR MEDIASTINUM

TRACHEA & PULMONARY APEX

Lindblom AP shoulders) as interlobar

• AP Axial*crosswise IR; 72” SID

LUNGS AND PLEURAE

• Lateral – R/L, ventral/dorsal decub.

• Lateral – R/L; Dorsal decub./supine lat. pos; HEST LATERAL

METHOD PROJECTION POSITION

Caldwell PA OML ⊥ to IR; exiting pyramids;

Lat. decub – for trauma pxs; same pos. and CR

CRANIUM AND CRANIAL BASE

Grashey AP OML(flexed chin/ 37°

Schüller/Pfeiffer SMV pressure)/seated