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Positioning Review of

Upper and Lower


Extremities
Reference
Images in this presentation are from:
Merrill’s Atlas of Radiographic Positioning and
Procedures.
Eugene Frank, Bruce Long, Barbara Smith
Fingers
PA

Fifth Digit
Second Digit

Third Digit Fourth Digit

CR - PIP
Lateral

Fifth Digit
Second Digit
Third Digit Fourth Digit
Thumb
AP

CR – MCP
Lateral
Hand
AP

CR – 3rd MCP
PA Oblique
Lateral

Fan
Lateral

Extension
Lateral
Wrist
PA
1. Scaphoid = Navicular
2. Lunate= Semilunar
3. Triquetrum = Triquetral,
Triangular
4. Pisiform

5. Trapezium = Greater
Multangular
6. Trapezoid = Lesser

Multangular
7. Capitate = Os Magnum
8. Hamate = Unciform

CR – Mid Carpal
Lateral
PA Oblique
AP Oblique
Ulna Deviation – Ulna Flexion
Stecher Method – Cassette
raised
Stecher Method – Tube angled
Carpal Tunnel (Tangential
Projection) - Gaynor-Hart
Method
Forearm
AP
Lateral
Elbow
AP

Epicondyles are parallel to the IR


Lateral

Epicondyles are perpendicular to the IR


Medial (Internal) Rotation Oblique
Lateral (External) Rotation Oblique
Distal Humerus – Partial Flexion
AP
Proximal Forearm – Partial Flexion
AP
Humerus
AP
Lateral
Transthoracic Lateral
Lower Extremity
Toes
AP – Perpendicular CR

CR - 3rd MTP
AP Axial
AP Oblique – Medial Rotation
Foot
AP Axial

CR - Base of 3rd metatarsal


AP Oblique – Medial Rotation
Lateral - Mediolateral
Ankle
AP
Lateral - Mediolateral
Medial Rotation (Internal) Oblique
for bony structures
15-20 degree Medial Rotation for
Ankle Mortise Joint
Lateral (External) Rotation Oblique
Stress Method

For verification
of ligament tear

Everson Stress Inversion Stress


Calcaneus
Axial – Plantodorsal

CR - base of 3rd metatarsal


Lateral Calcaneus

CR - 1” distal to medial
malleoulus
Lower Leg
AP
Lateral
Knee
AP – Sthenic Patient

CR - 1/2” distal to
apex of patella
AP - Hypersthenic Patient
AP - Asthenic Patient
Lateral
AP Oblique - Lateral (External)
Rotation
AP Oblique – Medial (Internal)
Rotation
Bilateral knees – weight- bearing
Patella
PA

CR - mid patella
Lateral Patella
Settegast Method for Patella
“Sunrise or Skyline View”

Typical tube angle is


15-20 degrees
Hughston Method for Patella
Lower leg forms 50-60
degree angle from table
Intercondylar Fossa - PA Axial
Projection (Holmblad Method)

Femur is at 20
degree angle

“Tunnel”
projection
Camp-Coventry Method

If knee is flexed 40 degrees,


the tube is angled 40
Femur
AP Projection (for distal femur)
AP Projection (for proximal femur)
Lateral femur to include knee
Lateral Projection (for proximal femur)