Irregular

● Vertebrae, pelvis
(1) General Anatomy and Radiographic Positioning ● Attachment for muscles, tendons and ligaments or they attach to
Terminology other bones to create joints
Sesamoid
❖ GENERAL ANATOMY: ● Patella
● Develop inside and beside tendon
Anatomy = science of the structure of the body.
● Very small and oval
Physiology = study of the function of the organs ● Protect the tendon from excessive wear
Osteology = detailed study of the knowledge relating to the bones of the
body. ❖ ARTHROLOGY:
❖ BODY PLANES: Functional Classifications:
● Sagittal Plane ● Synarthroses: immovable joints
● Midsagittal Plane ● Amphiarthroses: slightly movable
● Coronal Plane ● Diarthroses: freely movable
● Midaxillary Plane Structural Classifications:
● Horizontal Plane ● Fibrous joints
● Transverse or Axial Plane ● Cartilaginous joints
● Synovial joints
Surface Landmarks
C1– mastoid tip ❖ STRUCTURAL CLASSIFICATIONS OF JOINTS
C2-C3 – gonion Fibrous Joints - Do not have a joint cavity
C5 – thyroid cartilage or Adam’s apple - Strongest joints in the body
C7 – vertebra prominens 1. Syndemosis = tibiofibular
T1 – 2” superior to sternal notch 2. Suture = skull
T2-T3 –manubrial or suprasternal notch, superior margin of scapula 3. Gomphosis = roots of teeth
T4-T5 – sternal angle Cartilagionus Joints
T7 – inferior angle of scapula ● They do not have a joint cavity
T9-T10 – xiphoid process ● They are virtually immovable
T10 – xiphoid tip 1. Symphysis = pubic symphysis
L3 – lower costal margin 2. Synchondrosis = epiphyseal plate found between the
L3-L4 – level of umbilicus epiphysis and diaphysis
Synovial Joint
L4 –most superior aspect of iliac crest
● Gliding (plane) = intercarpal and intertarsal
S1 – ASIS
● Hinge (ginglymus) = elbow, knee and ankle
C – pubic symphysis & greater trochanter
● Pivot (trochoid) = atlas and axis
● Ellipsoid (condyloid)
❖ BODY HABITUS - Determines the size, shape, and position of the ● Saddle (sellar) between trapezium and 1st metacarpal
organs of the thoracic and abdominal cavities. ● Ball and Socket = hip and shoulder

❖ OSTEOLOGY: ❖ FRACTURES:
Bones Closed = does not break through skin
● Attachment for muscles Open = serious fracture in which the broken bone or bones project through
● Mechanical Basis or movement the skin
● Protection of internal organs Nondisplaced = which the bone retains its normal alignment
● A frame to support the body Displaced = the bones are not in anatomic alignment
● Storage for calcium, phosphorous, and other salts
● Production of red and white blood cells
❖ RADIOGRAPHIC POSITIONING TERMINOLOGY:
❖ BONE DEVELOPMENT Projection = the path of the central ray as it exits the x-ray tube and goes
Ossification = term given to the development and formation of bones through the patient to the IR.
Intramembranous ossification ● AP Projection
● Skulls, clavicles, mandibles, and sternum ● PA Projection
Endochondral ossification ● Axial Projection
● Tangential Projection
● Short, irregular and long bones
● Lateral Projection
● Primary ossification: Diaphysis
● Oblique Projection
● Secondary ossification: Epiphysis
● Complex Projections
● True Projections
❖ CLASSIFICATION OF BONES:
Position = overall posture of the patient of the general body positions.
Long
● Upright
● Femur, humerus ● Seated
● To provide support ● Recumbent
Short o Dorsal recumbent, ventral recumbent or lateral recumbent
● Tarsals, wrist ● Supine
● Allow minimum flexibility and motion in a short distance ● Prone
Flat ● Trendeleneburg’s position
● Diploe ● Fowler’s position
● Cranium, sternum, scapula Position = also refers to the specific placement of the body in relation to
● Provides protection, and their board surfaces allow muscle the radiographic table or IR during imaging
attachment ● Lateral Position
● Oblique Position
● Decubitus Postion
 ● Lordotic Position ❖ FIRST CARPOMETACARPAL JOINT
View = used to describe the body part as seen by the IR AP Projection – Robert Method
Method = specifies the x-ray projection and body position, and it may Robert first described the projection of the first CMC joint in 1936
include specific items such as IR and central ray position ● CR: Perpendicular entering at the first CMC joint.

Lewis modified the CR in 1988

(2) Upper Limb
● CR: 10 to 15 degrees proximally along the long axis of the thumb and
❖ DIVISIONS OF THE UPPER LIMB
entering the first MCP joint.
● Hand
● Forearm Long and Rafert further modified the CR in 1995
● Arm ● 15 degrees proximally along the long axis of the thumb and entering
● Shoulder girdle the first CMC joint.
27 bones ● This projection commonly performed to demonstrate arthritic
− Phalanges (14) changes, fractures, displacement of the first CMC joint, and the
− Metacarpals (5) Bennett’s fracture.
− Carpals (8) NOTE: R – perp to CMC
− Bones of the digits (14) LR – 15 deg CMC
● 1st digit – Thumb L – 10-15 deg MCP
● 2nd digit – Index finger
● 3rd digit – Middle finger AP Projection – Burman Method
● 4th digit – Ring finger ● If hyperextension of the wrist is not contraindicated
● 5th digit – Small finger ● SID: 18 inches to produce a magnified image that creates a greater
− Bones of the palm (5) field of view of the concavoconvex aspect of the first CMC joint.
● Radial shift of the carpal tunnel view.
❖ GENERAL PROCEDURES ● CR: Through the first CMC joint at a 45 degree angle toward the
● Remove accessories that might obstruct the image elbow.
● Make the position of the patient ● Magnified concavoconvex view
● Shield gonads
● Use right or left markers and all other vital identification markers PA Projection – Folio Method
● Unless otherwise specified, CR is at right angle to the cassette. UCL rupture and Skier’s Thumb
● Perform proper collimation. CR: Perp to both hands level of MCP Joint
● For bilateral examination, radiograph each side separately.
❖ HAND
❖ DIGITS (SECOND THORUGH FIFTH)
PA Projection
PA Projection
● CR: Perpendicular to the third MCP joint
● CR: Perpendicular to the PIP Joint of the affected limb ● AP is used instead of PA if the hand cannot extend enough to place
● Note: Digits that cannot be extended can be examined in small palmar surface in contact with the cassette because of injury or
sections with dental films. When injury is suspected, an AP pathological condition.
projection is used instead of PA. PA Oblique Projection – (Lateral Rotation)
Lateral Projection
● 45 degree angulation of the hand
● Lateromedial or Mediolateral ● Hand rotated laterally to open the MCP
● CR: Perpendicular to the PIP Joint of the affected limb ● CR: Perpendicular to the third MCP
● Fingernail in profile, if visualized and normal ● Lane, Kennedy, and Kuschner = reverse oblique projection to
● Concave, anterior surfaces of the phalanges demonstrate severe metacarpal deformities or fractures. Hand is
● No rotation of the phalanges rotated 45 degrees medially (internally).
PA Oblique Projection ● Kallen = tangential oblique projection to demonstrate metacarpal
● CR: Perpendicular to the PIP Joint of the affected limb head fractures. MCP joints are flexed 75 to 80 degrees; hand is
● 45 degree external angulation of the hand rotated 40 to 45 degreest towards the ulnar surface; CR is directed
● Some radiographers rotate the second digit medially for tangentially to the MCP joint of interest.
improved recorded detail and increased ability to see fractures. NOTE: PAO – evaluate function and pathologic condition of the hand

❖ FIRST DIGIT (THUMB) Lateral Projection (Mediolateral, Lateromedial, and fan lateral)
ALL CR: 1st MCP JOINT ● Fan lateral is used to prevent superimposition of proximal phalanges.
AP Projection ● CR: Perpendicular to second digit MCP joint.
● For AP, hand is in extreme internal rotation ● For foreign body localization and metacarpal fracture displacement.
● Lewis suggested CR directed 10 to 15 degrees along the long ● Lewis = for better demonstration of fifth metacarpal fractures, rotate
axis of the thumb towards the wrist to demonstrate the hand 5 degrees posteriorly from true lateral position to remove
metacarpal free of superimposition superimposition of the second through fourth metacarpals.
● CR: Perpendicular to the MCP joint
PA Projection Lateral projection ( Lateromedial in flexion)
● If PA of the first CMC joint, place the hand in lateral position and ● Hand in natural arch position
abduct the thumb ● CR: Perpendicular to the MCP Joints, Entering MCP joint of the
● Magnified image second digit.
● CR: Perpendicular to the MCP joint AP Projection – Norgaard Method
Lateral Projection ● Ball-catcher’s position
● Hand in natural arch position with the palmar surface down ● For detecting early radiologic changes needed to diagnose
● CR: Perpendicular to the MCP joint rheumatoid arthritis
● Extremely fine-grain intensifying screen is used to demonstrate high
PA Oblique Projection resolution with low kVp (60 to 65) to obtain necessary contrast.
● Hand in prone position ● Stapczynski = recommended this for fractures of the base of the fifth
● CR: Perpendicular to the MCP joint metacarpal.
● Both hands half-supinated 45 degrees
● CR: Perpendicular point midway between both hands at the level of Show: Elongated view of scaphoid
the MCP joint for either of the two positions.
NOTE FAN LATERAL : Fx of the Phalanges Scaphoid Series
EXTENDED LATERAL: Foreign Body localization ● PA and PA Axial Projections
PA OBLIQUE: to evaluate function and pathologic conditions Rafert-Long Method (1991)
− Scaphoid fractures account 60% of all carpal bone injuries
❖ WRIST − Four-image multiple-angle central ray series
− CR directed to the scaphoid with 0, 10, 20, 30 degrees
PA Projection
● Slightly arch the hand at the MCP joints
Trapezium – PA Axial Oblique Projection – Clements-Nakayama
● CR: Perpendicular to midcarpal area
● Ulna is slightly oblique. When ulna is under examination, AP Method
projection should be taken. ● Fractures of trapezium and evaluation to treat osteoarthritic patient
● Daffner, Emmerling, Buterbaugh = to better demonstrate the ● Articulations of the trapezium with the carpal bones except for the
scaphoid and capitate, hand should be in PA with CR 30 degrees scaphoid
towards the elbow. ● CR: 45 degrees distally to enter the anatomic snuffbox of the wrist
AP Projection and pass through the trapezium.
● Patient should lean laterally to prevent rotation of the wrist.
● CR: Perpendicular to the mdicarpal area. ❖ CARPAL BRIDGE
● Carpal interspaces should be demonstrated in AP than in PA. Tangential Projection
SHOW: Carpal Interspaces ● CR: Directed to a point of about 1 ½ inches (3.8 cm) proximal to the
wrist joint at a caudal angle of 45 degrees
Lateral Projection (lateromedial) Demonstration of:
● Flex elbow 90 degrees. − Fractures of scaphoid
● CR: Perpendicular to the wrist joint. − Lunate dislocations
● Can also demonstrate anterior or posterior displacement in fractures. − Calcifications and foreign bodies in the dorsum of the wrist
● Burman = lateral position of the scaphoid should be obtained with the − Chip fractures of the dorsal aspect of the carpal bones
wrist in palmar flexion
● Fiolle = first to describe a small bony growth occurring on the dorsal ❖ CARPAL CANAL
surface of the third CMC joint. He termed the condition carpe bossu Tangential Projections – Gaynor-Hart Method
(carpal boss) and found that it is demonstrated best in lateral ● Fractures of the hook of the hamate, pisiform and trapezium
position with the wrist in palmar flexion. - CARPAL TUNNEL SYNDROME
Demonstrate:
Colle’s Fracture: L – likod (Posterior disloc) Inferiosuperior:
Smith’s Fracture: H – harap (Anterior disloc) − CR: directed to the palm of the hand at a point approximately 1 in (2.5
cm) distal to the base of the third metacarpal and at an angle of 25 to
PA Oblique Projection (Lateral Position) 30 degrees to the long axis of the hand.
● Pronate hands, rotate the wrist laterally (externally) 45 degrees
● CR: Perpendicular to the midcarpal area. It enters just distal to the Superioinferior:
radius. − CR: Tangential to the carpal canal at the level of the midpoint of the
● Demonstrates the carpals on the lateral side of the wrist particularly
wrist.
trapezium and scaphoid.
● Scaphoid superimposed on itself in the direct PA projection. - Angled toward the hand approximately 20 to 35 degrees from the long
DEMONSTRATE: axis of the forearm
PA OBLIQUE – Trapezium and scaphoid / Anatomic snuffbox /
Triangular depression ❖ FOREARM
AP OBLIQUE – Pisiform AP Projection
● Hand is supinated
PA Projection – Ulnar Deviation (flextion) ● Pronation of the hand crosses the radius over the ulna at its
● Also called ulnar flexion in radiography proximal third and rotates humerus medially.
● CR: Perpendicular to the scaphoid ● CR: Perpendicular to the midpoint of the forearm
● Clear delineation sometimes requires a central ray of 10 to 15 Lateral Projection (Lateromedial)
degrees proximally or distally. ● Flex the elbow 90 degrees
● Carpal interspaces adjacent to scaphoid should be open. ● CR: Perpendicular to the midpoint of the forearm
● Corrects foreshadowing of scaphoid ● Superimposed humeral epicondyles

Show: Elongated view of the scaphoid ❖ ELBOW

PA Projection – Radial Deviation (Flexion) AP Projection
● Also termed as Radial Flexion in radiography textbooks ● Hand supinated
● CR: Perpendicular to the midcarpal area. ● CR: Perpendicular to the elbow joint
● Opens the insterspaces between carpals on the medial side of the EPICONDYLES ARE PARALLEL TO IR
wrist.
Lateral Projection (Lateromedial)
Scaphoid – PA Axial Projection – Stecher Method ● Griswold gave two reasons for the importance of flexing the elbow 90
● Finger end of the cassette is elevated 20 degrees degrees:
● CR: perpendicular to the table and directed to enter the scaphoid − The olecranon process can be seen in profile
● Variations: − The elbow fat pads are the least compressed
● Cassette and wrist horizontally and CR is directed 20 degrees ● CR: Perpendicular to the elbow joint, regardless of its location on the
towards the elbow. cassette
● To demonstrate a fracture line that angles superioinferiorly, the wrist ● If there is suspected injury, flex elbow 30 to 35 degrees only
is angled inferiorly and CR maybe angled towards the digits.
● Have the patient clench the first to elevate the distal end of the AP Oblique Projection (Medial Rotation)
scaphoid so that it lies parallel with the cassette and to widen the ● Medially (internally) rotate or pronate the hand 45 degrees
fracture line. No CR angulation. ● CR: Perpendicular to the elbow joint.
● Coronoid process free of superimposition w/ radial head.
Best Demons: Coronoid Process ❖ HUMERUS
Note: Surgical Neck most Fractures
AP Oblique Projection ( Lateral Rotation)
AP Projection (Upright)
● Rotate the hand laterally (externally) 45 degrees
● Respiration: Suspended
● CR: Perpendicular to the elbow joint
● Upper margin about 1 ½ inches (3.8 cm) above head of humerus
● Radial head, neck and tuberosity projected free of ulna
● Epicondyles should be parallel to the cassette
● Open elbow joint
● CR: Perpendicular to the midportion of the humerus and the center of
Best demons: radial head, neck and tuberosity
the cassette.
NOTE: MCLR
Medial – coronoid
Lateral Projection (Lateromedial, Upright)
Lateral – radial head
● Respiration: Suspended
Distal Humerus – AP Projection – Partial Flexion (2nd) ● Upper margin about 1 ½ inches (3.8 cm) above head of humerus
● CR: Perpendicular to the mid humerus and the center of the cassette.
● CR: Perpendicular to the humerus, transversing the elbow joint
AP Projection (Recumbent)
− Depending on the degree of flexion, angle the central ray distally into
the joint ● Upper margin about 1 ½ inches (3.8 cm) above head of humerus
− Closed elbow joint ● Supinate the hands, epicondyles parallel with the cassette
● Respiration: Suspended
Proximal Forearm – AP Projection – Partial Flexion (1st) ● CR: Perpendicular to the midportion of the humerus and the center of
the cassette.
● CR: Perpendicular to the elbow joint and long axis of the forearm
Lateral Projection (Lateromedial, Recumbent)
● Partially open elbow joint
Holly = described a method AP projection of the radial head. Elbow is ● Upper margin about 1 ½ inches (3.8 cm) above head of humerus
extended and forearm is supinated to place the wrist 30 degrees to ● Rotate forearm medially; posterior aspect of the hand against the
the horizontal. patient’s side/hip
● Epicondyles perpendicular to the cassette
JONES METHOD: ● CR: Perpendicular to the midpoint of the humerus and the center of
Distal Humerus- AP Projection – Acute Flexion the cassette.
Lateral Projection (Lateromedial, Lateral Recumbent)
● Jones Orthopedic Technique (Complete Flexion)
● CR: Perpendicular to the humerus approximately 2 inches (5 cm) ● Place the cassette close to the axilla; flex elbow; hands face up
superior to the olecranon process. (unless contraindicated)
Proximal Forearm – PA Projection – Acute Flexion ● Respiration: Suspended
● CR: Directed to the center of the cassette, which exposes only the
● CR: Perpendicular to the flexed forearm, entering approximately 2
distal humerus
inches (5 cm) distal to the olecranon process.
● Epicondyles superimposed
JONES : OLECRANON PROCESS
❖ Proximal Humerus
❖ Radial Head
Transthoracic Lateral Projection – Lawrence Method (R or L position)
Lateral Projection – Lateromedial (Four-Position Series)
● Used when trauma has occurred and the arm cannot be abducted or
For the demonstration of the entire circumference of the radial head free of rotated for the AP or lateral projection.
superimposition: ● Can be performed upright or supine.
● Flex elbow 90 degrees ● Raise the uninjured arm and rest on the forehead.
● 1st exposure – hand supinated ● Cassette centered to surgical neck of the affected humerus.
● 2nd exposure – hand in lateral position ● Respiration: Full inspiration or slow deep breathing
● 3rd exposure – hand pronated ● CR: Perpendicular to the cassette ant the level of the surgical neck
● 4th exposure – extreme internal rotation − If the patient cannot elevate unaffected shoulder, 10 to 15O cephalad
● CR: Perpendicular to the elbow joint ● Lateral projection of the proximal half or two thirds of the humerus
Greenspan and Norman – CR: 45 degrees medially (toward the shoulder)
(3) Shoulder Girdle
❖ DISTAL HUMERUS
PA Axial Projection Shoulder girdle
● Flex elbow; supinate hands ● Formed by clavicle and scapula
● Humerus forms an angle of approximately 75 degrees from the ● To connect the upper limb to the trunk
forearm Shoulder Girdle Articulations
● CR: perpendicular to the ulnar sulcus, entering at a point just
● Scapulohumeral Articulation
medial to the olecranon process
● Acromioclavicular Articulation
● This projection is used in radiohumeral bursitis (tennis elbow) to
● Sternoclavicular Articulation
detect otherwise obscured calcifications located in ulnar sulcus.
NOTE: Acromion = posterior
❖ OLECRANON PROCESS
Coracoid = anterior
PA Axial Projection
● Arm is 45 to 50 degrees from the vertical position ❖ SHOULDER
● CR: Perpendicular to the olecranon process to demonstrate the
ALL AP: CR: 1 inch below Coracoid
dorsum of the curved extremity and articular margin of the
olecranon process. AP Projection (External Rotation) (supinate)
● 20 degrees toward wrist to demonstrate curved extremity and ● Center the cassette 1 inch (2.5 cm) inferior to the coracoid process
articular margin of the olecranon process. ● Scapula parallel to the plane of the cassette
COYLE METHOD ● Epicondyles parallel to the plane of the cassette.
Coronoid = Elbow 80 deg, CR: 45 away shoulder ● Abduct arms and supinate hands.
Radial Head = elbow 90 deg, CR: 45 toward shoulder ● CR: perpendicular to a point of 1 inch (2.5 cm) inferior to the coracoid
REVIEW: Angled 45 degree projections: process.
o Burman ● Respiration: Suspended.
o Clements nakayama AP Projection (Neutral Rotation) (palm in hip)
o Coyle ● Center the cassette 1 inch (2.5 cm) inferior to the coracoid process.
● Epicondyles 45 degrees to the plane of the cassette.
● Palm of hands against thigh. ● Respiration: Suspended.
● CR: perpendicular to a point of 1 inch (2.5 cm) inferior to the coracoid Used if Prone or supine is not possible
process. If cant 90 = 5 – 15 deg medially
● Respiration: Suspended
AP Projection (Internal Rotation) (post. of palm in hip)
Superioinferior Axial Projection
● Center the cassette 1 inch (2.5 cm) inferior to the coracoid process.
● Epicondyles perpendicular to the plane of the cassette ● Flex the elboe 90 degrees and hand in prone position.
● Flex elbow somewhat to place the back of the hand on the hip. ● Tilt head toward the unaffected side.
● Proximal humerus is in true lateral position ● May use curved cassete
● CR: perpendicular to a point of 1 inch (2.5 cm) inferior to the coracoid ● CR: Angled 5 to 15 degrees through the shoulder joint toward the
process. elbow.
● Respiration: Suspended Shows: relationship of proximal humerus to glenoid cavity
NOTE:
Neutral : Scapulohumeral Joint Axial Projection – Cleaves Method with Rolled Film
Internal Rotation: Lesser Tubercle ● When patient cannot or should not abduct arms.
Extrenal Rot: Greater tubercle ● Tube approximately 2 inches (5 cm) in diameter.
Show: Rotator Cuff Calcification ● CR: Perpendicular to the shoulder, entering 3/8 inch (1 cm) posterior
to the acromioclavicular joint.
Transthoracic Lateral Projection – Lawrence Method (R or L position) Variations:
● Used when trauma has occurred and the arm cannot be abducted or − Directed to the acromioclavicular articulation at a 5-degree medical
rotated for the AP or lateral projection. angulation to demonstrate the lesser tubercle and intertubercular
● Can be performed upright or supine. (bicipital) groove and at a5 degree lateral angulation to demonstrate
● Raise the uninjured arm and rest on the forehead. the coracoid process.
● Cassette centered to surgical neck of the affected humerus. ● Respiration: Suspended.
● Respiration: Full inspiration or slow deep breathing
● CR: Perpendicular to the cassette at the level of the surgical neck. AP Axial Projection
− If the patient cannot elevate unaffected shoulder, 10 to 15O cephalad. ● Patient is supine or upright.
● Lateral projection of the proximal half or two thirds of the humerus. ● Center scapulohumeral joint
● CR: Directed through the scapulohumeral joint at a cephalic angle of
❖ SHOULDER JOINT 35 degrees.
● Respiration: Suspend.
Inferiosuperior Axial Projection – Lawrence Method
SHOW : relationship bet humeral head and glenoid cavity
● Patient supine - Posterior dislocation
● Humerus in external rotation.
● Turn head away from the affected side. Scapular Y – PA oblique Projection (RAO or LAO Position)
● Use vertical cassette.
● Described by Rubin, Gray, and Green.
● CR: Horizontally through the axilla to the region of the
● The body of the scapula forms the vertical component of Y, and the
acromioclavicular articulation. The degree of medial angulation
acromion and coracoid process from the upper limbs.
depends on the degree of abduction of the arm 15 to 30
● Useful in evaluation of suspected shoulder dislocations
degrees. The greater the abduction, the greater the angle.
● Respiration: Suspend.
● Respiration: suspend.
● Patient’s midcoronal plane forms 45 to 60 degrees to the cassette.
● CR: Perpendicular to the scapulohumeral joint.
Inferiosuperior Axial Projection – Rafert Modification
● In anterior dislocations (subcoracoid), the humeral head is beneath
● Patient supine the coracoid process. In posterior dislocations, it is projected beneath
● Turn head away from the affected area. the acromion process.
● Hill-Sachs defect = wedge-shaped compression fracture of the NOTE: MCP – 45 – 60 deg, Show oblique image of shoulder
articular surface of the head. Fracture will be located on the
posterolateral humeral head. Glenoid Cavity – AP Oblique Projection – Grashey Method (RPO or
● Exaggerated external rotation = hand 45 degrees
LPO)
● CR; Horizontal and angled approximately 15 degrees medially,
entering the axilla and passing through the acromioclavicular joint. ● Rotate the body approximately 35 to 45 degrees toward the affected
● Respiration: Suspended side.
SHOW: Hill Sachs Defect ● Scapula parallel to the plane of the cassette.
● Abduct the arm slightly in internal rotation, and place palm of the hand
Inferosuperior Axial Projection – West Point Method on the abdomen.
● Respiration: Suspend.
● Patient in prone position.
● CR: Perpendicular to the glenoid cavity at a point 2 inches (5 cm)
● Turn patient head away from the affected area.
inferior to the superolateral border of the shoulder.
● Abduct the affected arm 90 degrees.
● Space between the humeral head and the glenoid cavity
● CR: Directed at a dual angle of 25 degrees anteriorly from the
(scapulohumeral joint).
horizontal and 25 degrees medially. Central ray enters approximately
● Kornguth and Salazar = apical oblique projection with caudal
5 inch (13 cm) inferior and 1 ½ inch (3.8 cm) medial to the acromial
angulation of 45 degrees.
edge and exits the glenoid cavity.
SHOW: Glenoid Cavity in Profile and SHJ
SHOW: bony abnormalities with shoulder instability
AP NEUTRAL = also shows SHJ
Westpoint – prone
CR: 25 anterior 25 medial 5 in inferior 1 ½ medial to acromial edge
Supraspinatus “Outlet” – Tangential Projection – Neer Method (RAO
Inferiosuperior Axial Projection – Clements Modification or LAO)
● If prone or supine is not possible ● To demonstrate tangentially the coracoacromial arch or outlet to
● Lateral recumbent position lying on the unaffected side. diagnose shoulder impingement.
● Flex the patient’s hips and knees. ● Body is 45 to 60 degrees from the plane of the film.
● Abduct affected arm 90 degrees pointing to the ceiling. ● Respiration: Suspend.
● CR: Horizontal to the midcoronal plane passing through the ● CR: Angled 10 to 15 degrees caudad, entering the superior aspect of
midaxillary region of the shoulder. the humeral head.
− Angled 5 to 15 degrees medially when the patient cannot abduct the SHOW : Diagnose Coracoacromial arch or Outlet / Shoulder
arm a full 90 degrees. impingement
 ● Upright, seated or standing
❖ PROXIMAL HUMERUS ● Weight of the body is equally distributed on the feet
Proximal Humerus – AP Axial Projection – Stryker “Notch” Method ● 2 exposures: first without weights, second with weights tied to each
wrist.
● Dislocation of the shoulder caused by posterior defects involving
● Respiration: Suspend.
posterolateral head of the humerus.
● CR: Perpendicular to the midline of the body at the level of the
● Described by Hall, Isaac, and Booth from the ideas expressed by W.S
acromioclavicular joints for a single projection. If 2 exposures for
Stryker.
broad-shouldered patient, center it to the acromioclavicular joint.
● Patient in supine
● Coracoid process of the affected shoulder should be centered.
AP Axial Projection – Alexander Method
● Flex arm slightly beyond 90 degrees and place the palm of the hand
on top of the head with fingertips resting on the head. ● Patient in upright position
● CR: Angled 10 degrees cepalad, entering the coracoid process. ● Respiration: Suspend.
SHOW: Posterior humeral head ● CR: Directed to the coracoid process at a cephalic angle of 15
degrees. (Projects acromioclavicular joint above the acromion)
● Alexander suggested that both AP and PA axial oblique projections
Intertubercular Groove – Tangential Position – Fisk Modification
be used in cases of suspected acromioclavicular subluxation or
● Patient in supine, seated, or standing. dislocation.
● With patient supine, place the cassette against the superior surface of CR: 15 deg cephalad
the shoulder.
● Respiration: Suspend. PA Axial Oblique Projection – Alexander Method (RAO or LAO)
● CR: Angled 10 to 15 degrees posterior (Downward from the
● Stand or sit. Affected hand should be placed under the opposite
horizontal) to the long axis of the humerus for the supine position.
axilla.
● Fisk Modification: Patient standing. Greater OID. Instruct the patient
● Midcoronal plane of the body is rotated 45 to 60 degrees to place the
to flex the elbow. Have the patient lean forward or backward as
scapula perpendicular to the cassette.
required to place the vertical humerus at an agle of 10 to 15 degrees.
● CR: Directed through the acromioclavicular joint at an angle of 15
● CR: Perpendicular to the cassette when the patient is leaning forward
degrees caudad.
and the vertical humerus is 10 to 15 degrees.
CR: 15 deg caudad
SHOW: Intertubercular Groove

AP Oblique -APPLE METHOD ❖ CLAVICLE

- Same to GRASHEY but with Weighted abduction AP Projection
- 35-45 deg ● Supine or upright position
DEMONSTRATE: Loss of articular cartilage in SHJ ● Respiration: Suspend at the end of exhalation to obtain a more
uniform density image.
AP APICAL OBLIQUE - GARTH METHOD ● CR: Perpendicular central ray exits midshaft of the clavicle.
- For acute shoulder trauma, posterior SH disloc, glenoid fx and PA Projection
hill sachs lesions and calcifications ● Closer OID. Improved recorded detail.
- Body 45 to affected side, elbow across chest ● Patient is prone or standing upright (back to the x-ray tube)
CR: 45 caudad to SHJ ● CR: Perpendicular central ray exits midshaft of the clavicle.
AP Axial Projection – Lordotic Position
Teres Minor Insertion – PA Projection – Blackett–Healy Method ● If the patient cannot assume lordotic position, PA Axial projection can
● Patient in prone position, arms along the sides of the body and the be used for improved recorded detail.
head resting on the cheek of the affected side. ● The patient seat or stand 1 foot in front of the vertical cassette device
● Turn the arm to a position of extreme internal rotation. If possiblem and have the patient lean backward.
flex the elbow and place the hand on the patient’s back. ● Respiration: Suspend at the end of full inspiration to further elevate
● Respiration: Suspend at the end of exhalation for a more uniform and angle the clavicle.
density. ● CR: Directed to enter the midshaft of the clavicle.
● CR: Perpendicular to the head of the humerus. − Thinner patients require more angulation to project the clavicle off
SHOW : Teres minor Insertion (loc at greater tubercle) the scapula ribs.
RESP: suspend at end of expi − For standing, 0 to 15 degrees is recommended.
− For supine, 15 to 30 degrees is recommended.
Subscapular insertion – AP Projection – Blackett–Healy Method SUPINE: 15-30 cephalad
● Patient in supine position. STAND: 0 – 15 cephalad
● Abduct the affected arm to the long axis of the body, flex the elbow,
and rotate the arm internally pronating the hand. PA Axial Projection
● Respiration: Suspend. ● Similar to AP Axial projection
● CR: Perpendicular to the shoulder joint, entering the coracoid ● Differences:
SHOW : Subscapularis Insertions − Patient is prone or standing, facing the vertical grid device.
BLACKETT HEALY − The central ray is angled 15 to 30 degrees caudad.
NOTE: Or: 10 – 15 Caudad (sir maynard)
AP – Subscapularis Insertion
PA- Teres Minor Insertion Tangential Projection
● Similar to AP axial projection, however increase angulation is required
Infraspinatus Insertion – AP Axial Projection placing the CR nearly parallel to the rib cage. The clavicle is projected
● Patient in supine position with the affected arm by the patient’s side. free of the chest wall.
● Turn the arm in external rotation to open the subacromail space. ● Patient is supine.
● Rotate the arm to neutral position and then in complete internal ● CR: 25 to 45 degrees from the horizontal passing between the
rotation to allow full evaluation of the humeral head. clavicle and the chest wall.
● CR: Direct the central ray to enter the coracoid process at an angle of − If medial third of the clavicle is in question, it is necessary to
25 degrees caudad. angle the central ray laterally, 15 to 25 degrees.
−
❖ ACROMIOCLAVICULAR ARTICLUATIONS Tangential Projection – Tarrant Method
Bilateral AP Projection – Pearson Method ● For patients who have multiple injuries or who cannot assume the
● SID: 72 inches (183 cm) lordotic positon.
● Ask the patient to lean forward and let him/ her hold the cassette on ● CR: Directed through the posterosuperior region of the shoulder at an
his lap. angle of 45 degrees caudad
● Respiration: Suspend. ● (35 degrees for the obese and round-shouldered patients)
● CR: Directed anterior and inferior to the midshaft of the clavicle at a
25 to 35 degree angle. It should pass perpendicular to the longitudinal Tangential Projection – Prone position
axis of the clavicle. ● Supinate the hands of the affected side.
● Increased SID is needed to reduce magnification. ● Rest the head on the cheek.
Show: Clavicle above thoracic cage ● Respiration: Suspend.
● CR: Direct through the scapular spine at an angle of 45 degrees
❖ SCAPULA cephalad.
AP Projection ● CR exits at the anterosuperior aspect of the shoulder.
● Upright or supine position. Tangential
● Abduct the arm at right angle with the body to draw the scapula Supine – Laquerrie – 45 deg caudad (35 obese)
laterally. Flex the elbow, and support the hand. Prone – 45 deg cephalad
● Position the top of the cassette 2 inches (5 cm) above the top of the Tangential Projection – Upright position
shoulder. ● Increased SID.
● Respiration: Make this exposure during slow breathing to obliterate ● Casette is in 45 degrees.
lung detail. ● Respiration: Suspend.
● CR: Perpendicular to midscapular area at a point approximately 2 ● CR: Directed through the anterosuperior aspect of the shoulder at a
inches (5 cm inferior to the coracoid process) posteroinferior angle of 45 degrees. (Perpendicular to the plane of the
cassette.)
Lateral Projection – (RAO or LAO)
● Patient upright facing the vertical grid. (4) Lower Limb
● Body rotation 45 to 60 degrees.
● For acromion and coracoid process – flex elbow and place the hand ❖ DIVISIONS OF THE LOWER LIMB
on the posterior thorax.
Foot
● Mazujian suggested that the patient place the arm across the upper
chest by grasping the opposite shoulder. ● Phalanges (14) - Bones of the toes (14)
● Respiration: Suspend. ● Metatarsals (5) - Bones of the instead (5)
● CR: Perpendicular to the midmedial border of the protruding scapula. ● Tarsals (7) - Bones of the ankle – (7)
DEMONS. Calcaneus Talus
Body of scapula: forearm on head Navicular bone Cuboid
Acromion and coracoid- hand at the back Medial Cuneiform Intermediate Cuneiform
Lateral Cuneiform
Leg - Tibia and Fibula
PA Oblique Projection – Lorenz and Lillienfeld Methids – (RAO or
Ankle
LAO)
Femur
● Upright or lateral recumbent
● Lorenz = arm of the affected side at right angle to the body, flex Patella
elbow, and rest the hand against the patient’s head. Rotate body Knee Joint
slightly forward and have the patient grasp the side of the table. ● Posterior Cruciate Ligament
● Lilienfeld = Extend the arm of the affected side obliquely upward, ● Anterior Cruciate Ligament
and have the patient rest the hand on his or her head. ● Tibial Collateral Ligament
● Respiration: Suspend. ● Fibular Collateral Ligament
● CR: Perpendicular to the cassette, between the chest wall and the
midarea of the protruding scapula. ❖ TOES
SHOWS SCAPULA IN OBLIQUE AP or AP Axial Projections
● Supine or seated
AP Oblique Projection – (RPO or LPO) ● Flex the knees, separate feet about 6 inches (15 cm)
● Supine or upright ● CR; Perpendicular through the 3rd metatarsophalangeal joint.
● For moderate APO projection – flex elbow, place supinated hand ● For joint spaces, direct 15 degrees posteriorly or use 15-foam wedge
under the head or have the patient extend affected arm across and CR is perpendicular.
anterior chest. Patient turn away from the affected side to rotate PA Projection
shoulder 15 to 25 degrees. ● Patient in prone
● For steeper oblique projection – rotate body 25 to 35 degrees. ● CR: Perpendicular to the midpoint of the cassette entering the 3rd
● For direct lateral projection of the scapula – draw the arm across the metatarsophalangeal joint.
chest and adjust the body rotation to place the scapula perpendicular AP Oblique Projection – Medial Rotation
to the cassette.
● Supine or seated.
● Respiration: Suspend.
● Flex knee of the affected side. Medially rotate the lower leg and foot
● CR: Perpendicular to the lateral border of the rib cage at the
to form 30 to 45-degree angle.
midscapular area.
● Center the proximal phalanx of the 3rd toe to the cassette.
Coracoid Process – AP Axial Projection
● CR: Perpendicular and entering the 3rd metatarsophalangeal joint.
● Supine PA Oblique Projection – Medial Rotation
● Abduct arm slight and supinate the hands.
● Patient in lateral recumbent on the affected side.
● Respiration: Suspend at the end of exhalation for more uniform
● Ball of the foot forms 30 degrees from the horizontal.
density.
● CR: Perpendicular to the third metatarsophalangeal joint.
● CR: Coracoid process at an angle of 15 to 45 degrees cephalad.
Lateral Projections – (Mediolateral or Lateromedial)
● Kwak, Espiniella and Kattan recommended 30 degrees.
(Round-shouldered patients require more angulation) ● Lateral recumbent position on the unaffected side.
● CR: Perpendicular to the plane of the cassette or film, entering the
metatarsophalangeal joint of the great toe or the proximal
❖ SCAPULAR SPINE
interphalangeal joint of the lesser toes.
Tangential Projection – Laquerriere Pierquin Method
● Supine
● Respiration: Suspend
❖ SESAMOIDS ● 1st exposure: 15 degrees posteriorly to the base of the 3rd metatarsal
Tangential Projection – Lewis and Holly Method ● 2nd exposure: 25 degrees anteriorly to the posterior surface of the
Lewis ankle.
● Patient in prone.
● Elevate the ankle and perform dorsiflexion. ❖ CONGENITAL CLUBFOOT
● CR: Perpendicular and tangential to the first metatarsophalangeal Talipes Equinovarus
joint. ● Plantar flexion and inversion of the calcaneus (equinus)
Holly ● Medial displacement of the forefoot (adduction)
● Patient is seated. ● Elevation of the medial border of the foor (supination)
● Plantar surface is at 75 degrees with the plane of the cassette, let the AP Projection – Kite Method
patient hold a strip of gauze bandage. ● Demonstrates the degree of adduction of the forefoot and the degree
● CR is directed perpendicular to the head of the first metatarsal bone. of inversion of the calcaneus.
Tangential Projection – Causton Method ● CR: 15 degrees posteriorly through the tarsals
● Patient in lateral recumbent position on the unaffected side, and flex Lateral Projection (Mediolateral) – Kite Method
knees. ● Demonstrates the anterior talar subluxation and the degree of plantar
● CR: Direxted to the prominence of the first metatarsophalangeal joint flexion (equinus).
at an agle of 40 degrees toward the heel ● CR: Perpendicular to the midtarsal area.
Axial Projection (Dorsoplantar) Kandel Method
❖ FOOT ● Infant is held vertical or bending forward.
AP or AP Axial Projection ● CR: 40 degrees anterior through the lower leg.
● CR: Directed on of the two ways
● 10 degrees toward the heel to the base of the third metatarsal. ❖ CALCANEUS
● Perpendicular to the cassette and toward the base of third metatarsal. Axial Projection – Plantodorsal
● Used for localizing foreign bodies, determining the location of ● Patient is in supine or seated with legs fully extended.
fragments in fractures of the metatarsals and anterior tarsals, and ● Long strip of gauze around the ball of the foot.
performing general surveys of the bones of the foot. ● Perform dorsiflexion.
AP Oblique Projection – Medial Rotation ● CR: cephalic angle of 40 degrees to the long axis of the foot and
● Patient in supine position enters the base of the third metatarsal.
● Rotate leg medially until foot forms 30 degrees from the plane of the Axial Projection – Dorsoplantar
cassette. ● Patient in Prone
● CR: Perpendicular to the base of the third metatarsal. ● CR: 40 degrees caudally to the long axis of the foot, enters the dorsal
● Sinus tarsi are seen on profile. surface of the ankle.
AP Oblique Projection – Lateral Rotation Weight-Bearing ‘Coalition Method’
● Patient in supine ● Described by Lilienfeld.
● Rotate leg laterally until plantar surface of the foot forms 30 degrees ● Used to demonstrate the calcaneotalar coalition.
to the cassette. ● CR: Angled exactly 45 degrees anteriorly through the posterior
● CR: Perpendicular to the base of the third metatarsal. surface of the flexed ankle to a point on the plantar surface at the
PA Oblique Projections – Grashey Methods – (Medial or Lateral level of the base of the 5th metatarsal.
Rotations) Lateral Projection – Mediolateral
● Patient in prone ● Supine and turn the patient toward the affected side.
● Rotate heel 30 degrees medially – For interspace between 1st and 2nd ● CR: Perpendicular to the midportion of the calcaneus, which is about
metatarsal. 1 inch (2.5 cm) distal to the medial malleolus.
● Rotate heel 20 degrees laterally – for interspace between 2nd and 3rd, ● Sinus Tarsi.
3rd and 4th, 4th and 5th Lateromedial Oblique Projection – Weight-Bearing Method
● CR: Perpendicular to the midline of the foot at the level of the base of ● Medially at a caudal angle of 15 degrees to enter the lateral
the 5th metatarsal. malleolus.
PA Oblique Projections – Medial Rotation ● For diagnostic stress fractures of the calcaneus or tuberosity.
● Patient in lateral recumbent on the affected side. ● Sinus tarsi, calcaneal tuberosity, cuboid
● Turn the patient toward the prone position until the foot forms 45
degrees to the cassette. ❖ SUBTALAR JOINT
● CR: Perpendicular to the midline of the foot at the level of the base of Calcaneus has 3 articular surfaces; anterior, middle, and posterior
the 5th metacarpal.
− Located superior calcaneus and articulate with the inferior talus.
Lateral Projection – Mediolateral
PA Axial Oblique Projection – Lateral Rotation
● Routinely used
● Best demonstrates the anterior and posterior articulations.
● Patient lie and turn toward the affected side until leg and foot are
● Lie on the affected side in the lateral position
lateral.
● Ball of the foot is 25 degrees.
● CR: Perpendicular to the base of the 3rd metatarsal.
● CR: Directed to the ankle joint at a double angle of 5 degrees anterior
Lateral Projection – Lateromedial
and 23 degrees caudad.
● Supine, turn the patient onto the unaffected side, the patient’s body ● ‘end-on’ image of the sinus tarsi
will be in RPO or LPO. AP Axial Oblique Projection – Broden Method – (Medial Rotation)
● CR: Perpendicular to the base of the third metatarsal.
● Lateromedial and mediolateral right-angle oblique projections for the
demonstrationsof the posterior articular facet of the calcaneus to
Longitudinal Arch – Lateral Projection (Lateromedial) –
determine the presence of joint involvement in cases of comminuted
Weight-bearing Method (Standing)
fracture.
● CR: Perpendicular to a point just above the base of the 3rd metatarsal.
● Patient in supine
● Used to demonstrate the structural status of the longitudinal arch.
● CR: Angle cephalad 40, 30, 20, 10 degrees. Four separate images. 2
● AP Axial Projection – Weight-bearing Method (Standing)
or 3 cm caudoanteriorly to the lateral malleolus.
● SID: 48 inches (122 cm)
AP Axial Oblique Projection – Broden Method – (Lateral Rotation)
● CR: Angled 10 degrees toward the heel, between feet at the level of
the base of the 3rd metatarsal. ● Patient in supine, rotate leg and foot 45 degrees laterally.
AP Axial Projection – Weight-bearing Composite Method (Standing) ● CR: Directed to a point 2 cm and 2 cm anterior to the medial
malleolus, at a cephalad angle of 15 degrees for the first exposure.
CR:
● 2 or 3 times images may be made with 3 or 4 degree difference in ● Perpendicular to the center of the leg.
CR. Lateral Projection – (Mediolateral)
● Posterior facet of the calcaneus. The articulation between the talus ● CR: Perpendicular to the midpoint of the leg.
and the sustentaculum tali. AP Oblique Projections – (Medial and Lateral Rotations)
Isherwood Method ● Patient in supine
● Medial rotation foot = position for the demonstration of the anterior ● Rotate the leg 45 degrees medially for medial rotation; 45 degrees
talar articular surface. laterally for lateral rotation
● Medial rotation ankle = position for the middle talar articular surface ● CR: Perpendicular to the midpoint of the cassette.
● Lateral rotation ankle = for the posterior articular surface
Lateromedial Oblique Projection – Isherwood Method – (Medial ❖ KNEE
Rotation Foot) AP Projection
● Semisupine or seated ● Patient in supine
● 45-degree foam wedge under elevated leg. ● Center the cassete aboud ½ inch (1.3 cm) below the patellar apex
● CR: Perpendicular to a point 1 inch (2.5 cm) distal and 1 inch (2.5 cm) ● Femoral epicondyles parallel to the cassette.
anterior to the lateral malleolus ● CR: Directed to a point ½ inch (1.3 cm) inferior to the patellar apex.
● “Fiest-Mankin” method produces a similar image representation PA Projection
● Anterior talar surface articulation
● Patient in prone position
AP Axial Oblique Projection – Isherwood Method – (Medial Rotation
● CR: Perpendicular to exit a point ½ inch (1.3 cm) inferior to the
Ankle) patellar apex
● Seated and flex hip and thigh of the affected side. Lateral Projection (Mediolateral)
● CR: Directed to a point 1 inch (2.5 cm) distal and 1 inch (2.5 cm) ● Patient supine and turn to the affected side.
anterior to the lateral malleolus at an angle of 10 degrees cephalad. ● Flex knee 20 to 30 degrees is preferred because it relaxes the
● Middle articulation of the subtalar joint and an “end-on” image of the muscles and shows the maximum volume of joint cavity.
sinus tarsi. ● To prevent fragment separation in new or unhealed patellar fractures,
AP Axial Oblique Projection – Isherwood Method – (Lateral Rotation the knee should not be flexed more than 20 degrees.
Ankle) ● CR: Directed to the knee joint 1 inch (2.5 cm) to the medial
● Supine or seated epicondyle at an angle of 5 to 7 degrees cephalad.
● CR: Directed to a point 1 inch (2.5 cm) distal to the malleolus at an AP Projection – Weight-Bearing Method (Standing)
angle 10 degrees cephalad. ● Leach, Gregg, and Sibeer = recommended that a
● Posterior subtalar articulation bilateral-weight-bearing AP Projection be routinely included in the
radiographic examination of the arthritic knees.
❖ ANKLE ● CR: Horizontal and perpendicular to the center of the cassette,
AP Projection entering at a point ½ inch (1.3 cm) below the apices of the patellae.
● CR: Perpendicular to the ankle joint at a point midway between the PA Projection – Weight-Bearing Method (Standing Flexion)
malleoli. ● Flex knees to place the femurs at an angle of 45 degrees.
● The inferior tibiofibular articulation and the talofibular articulation will ● CR: horizontal and angled 10 degrees caudad through the tibiofibular
not be “open” nor shown in the true AP projection. joint spaces located ½ inch (1.3 cm) below the patellar apices.
Lateral Projection – (Mediolateral) ● For a weight-bearing study of single knee, the patient puts full weight
● Patella perpendicular to the horizontal. on the affected side.
● CR: Perpendicular to the ankle joint, entering the medial malleolus. AP Oblique Projection – (Lateral Rotation)
Lateral Projection – (Lateromedial) ● Externally rotate the limb 45 degrees.
● Medial side of the ankle should be in contact with the cassette ● CR: Directed ½ inc (1.3 cm) inferior to the patellar apex.
(recommended) AP Oblique Projection – (Medial Rotation)
● CR: Perpendicular through the ankle joint entering ½ inch (1.3 cm) ● Medially rotate limb 45 degrees.
superior to the lateral malleolus ● CR: Directed ½ inc (1.3 cm) inferior to the patellar apex.
AP Oblique Projection (Medial Rotation) PA Oblique Projection – (Lateral Rotation)
● Supine ● Patient in prone
● Rotate leg and foot 45 degrees medially. ● Elevate hip of the affected side.
● CR: Perpendicular to the ankle joint, entering midwat between the ● Rotate totes and knees 45 degrees.
malleoli. ● Holmblad recommended that the knee be flexed about 10 degrees.
Mortise Joint – AP Oblique (Medial Rotation) ● CR: Perpendicular through the joint a level ½ inch (1.3 cm) below the
● Supine patellar apex.
● Rotate leg and foot 15 to 20 degrees internally until the intermalleolar PA Oblique Projection – (Medial Rotation)
plane is parallel with the cassete. ● Patient in prone
● CR: Perpendicular, entering the ankle joint midway between the ● Elevate hip of the unaffected side
malleoli. ● Medially rotate leg and foot 45 degrees medially.
● Useful in determining fractures and demonstrating the superior aspect ● CR: Perpendicular through the knee joint at the level ½ inch (1.3 cm)
of the calcaneus. below the apex of the patella.
AP Projection – (Lateral Rotation)
● Laterally rotate leg and foot 45 degrees. ❖ INTERCONDYLAR FOSSA
● CR: Perpendicular, entering the ankle joint midway between the PA Axial Projection – Holmblad Method
malleoli. ● “tunnel” projection, described by Holmblad in 1937.
● Useful in determining fractures and demonstrating the superior aspect ● Keeling position
of the calcaneus. ● In 1983, was modified for standing position.
● 3 variations:
AP Projection – Stress Method ● Upright with knee on stool
● Obtained after inversion or eversion injury to verify presence of ● Standing using horizontal central ray
ligamentous tear. ● Kneeling on radiographic table
● Flex the knee 70 degrees from full extension (20-degree difference
❖ LEG from CR.)
● CR: Perpendicular to the lower leg, entering midpoint of the cassette
AP Projection
for all three positions.
● Patient in supine
PA Axial Projection – Camp-Conventry Method ❖ FEMUR - LARGEST BONE IN THE BODY
● Patient in prone position AP Projection
● Flex the patient’s knees 40 or 50 degrees rest the foot on suitable ● Patient in supine.
support. ● Ensure that pelvis is not rotated.
● CR: Perpendicular to the long axis of the leg and centered to the knee ● Rotate limbs internally 10 to 15 degrees.
joint ● CR: perp to midfemur
● Angled 40 degrees when the knee is flexed 40 degrees and 50
degrees when knee is flexed 50 degrees. Lateral Projection – (Mediolateral)
● Used to detect loose bodies (joint mice). ● Turn into the affected side.
● Used in evaluating split and displaced cartilage in osteochndristis ● Flex knees 45 degrees.
dissecans and flattening, or underdevelopment, of the lateral femoral ● CR: Perpendicular to the midfemur and the center cassette,
condyle in congenital slipped patella. ● For danger of fracture displacement, vertical cassettes may be used.
AP Axial Projection – Beclere Method NOTE:
● Curved cassete is preferred. AP – epicondyles parallel to IR
● Patient in supine.
LATERAL – part are lateral
● Long axis of the femur 60 degrees to the long axis of the tibia.
● CR: Perpendicular to the long axis of the tibia, entering the knee joint
½ inch (1.3 cm) below the patellar apex. (5) Pelvis and Upper Femora
❖ PATELLA ❖ PELVIS
PA Projection − Serves as a base for the trunk and a girdle for the attachment of the
● Prone position. lower limb.
● Rotate heel 5 to 10 degrees laterally. − Pelvis consists of 2 hip bones, the sacrum, and the coccyx.
● CR: Perpendicular to the midpopliteal area exiting the patella. − Pelvic girdle is composed of only 2 hip bones.
Lateral Projection – Mediolateral
● Patient in lateral recumbent position and turn onto the affected side. ❖ HIP BONE
● Flex affected knee approximately 5 to 10 degrees. − Os coxae or innominate bone
● CR: Perpendicular to cassette, entering the knee at the − Consist of ilium, pubis, and ischium
midpatellofemoral joint. Male Female
PA Oblique Projection – (Medial Rotation) Heavier Lighter
● Patient in prone Narrower Wider
● Flex affected knee approximately 5 to 10 degrees. Deeper Shallower
● Medially rotate knee 45 to 55 degrees from the prone position.
Inlet is smaller Inlet is larger
● CR: Perpendicular to cassette, exiting the palpated patella.
More heart-shaped More oval shaped
PA Oblique Projection – (Lateral Rotation)
Sacrum is narrower Sacrum is wider and curves more posteriorly
● Patient in prone
● Flex affected knee 5 to 10 degrees and externally rotate knee 45 to
55 degrees. ❖ LOCALIZING ANATOMIC STRUCTURES
● CR: Perpendicular to the cassette exiting the palpated patella. ● Iliac Crest
PA Axial Oblique Projection – Kuchendorf Method – (Lateral Rotation) ● ASIS
● Prone and elevate the affected hip 2 or 3 inches. ● Pubic Symphysis
● Rotate knee 35 to 40 degrees laterally. ● Greater Trochanter of the femur
● CR: Directed to the joint space between the patella and the femoral ● Ischial Tuberosity
condyles at an angle of 25 to 30 degrees caudad. ● Tip of the coccyx
Ilium ischium pubis (acetabulum) – articulate with femur
ACETABULUM – vinegar’s cup
❖ PATELLA AND PATELLOFEMORAL JOINT
Pelvis prominences
For Patellar Subluxation
- ASIS
● Laurin = Knee flexed 20 degrees
- AIIS
● Fodor, Malott, and Weinberf and Merchant = Knee flexion of 45
degrees. - PIIS
● Hughston = Knee flexed 55 degrees, CR 45 degrees. - PSIS
Tangential Projection – Hughston Method Largest foramen in skull – foramen magnum
● Prone Largest for in bod – obturator foramen
● Leg forms 50 to 60 degrees from the table and rest foot against Ischial – sitting bone
collimator. 4 Types of Pelvis
● CR: 45 degrees cephalad and directed through the patellofemoral Android Gynecoid
joint.
Antropoid Platypelloid
Tangential Projection – Merchant Method
Open-Book Fx - Fx of pubic symphysis
● SID: 6 ft (2 m) to reduce magnification.
● Knee flexion 40 degrees (may vary from 30 to 90) Chip Fx - Avulsion Fx
● Used axial viewer device. ❖ PELVIS AND UPPER FEMORA
● CR: Perpendicular to the cassette AP Projection
● With 40 degree knee flexion, angle the CR 30 degrees caudad from ● Supine
the horizontal plane. ● Flex elbow and rest hands on the upper chest
Tangential Projection – Settegast Method ● Rotate feet 15 to 20 degrees medially to place the femoral necks
● This should not be attempted until a transverse fracture of patella has parallel with the plane of the cassette.
been ruled out with lateral image. ● Center the cassette midway between the ASIS and pubic symphysis
● Acute flexion. 2 inches (5 cm) inferior to the ASIS, and 2 inches (5 cm) superior to
● CR; Perpendicular to the joint space between the patella and the the pubic symphysis.
femoral condyles when the joint is perpendicular. ● Respiration: Suspend.
TANGENTIAL ● CR: Perpendicular to a point approximately 2 inches superior to the
- SKYLINE SUNRISE MOUNTAIN VIEW pubic symphysis 2 inch superior ASIS
● Martz and Taylor = 2 AP projections: to demonstrate the relationship ● Demonstrate the hip joint and the relationship of the femoral head of
of the femoral head to the acetabulum in patients with congenital hip the acetabulum.
dislocation. ● Supine then rotate patient toward the affected side.
− 1st: obtained with the CR perpendicular to the pubic symphyisi = ● Respiration: Suspend.
to detect any lateral or superior displacement of the femoral ● CR: Lauenstein = Perpendicular through the hip joint (midway
head. between ASIS and pubic symphysis).
− 2nd: 45 degrees cephalad to the pubic symphysis = to detect ● Hickey = cephalic angle of 20 to 25 degrees. (cephalad)
anterior and posterior displacement. Show hip joint and relationship between femoral head and
acetabulum
Lateral Projection – (Right or Left)
● Lateral recumbent, dorsal decubitus, or upright position Axiolateral Projection – Danelius-Miller Method
● Berkebile, Fischer, and Albrecht = recommended dorsal decubitus ● Supine.
lateral projection of the “gull-wing sign” in cases of fracture dislocation ● Flex the knee and hip of the unaffected side to elevate the thigh in
of the acetabular rim and posterior dislocation of the femoral head. vertical position.
● Respiration: Suspend. ● Rotate foot medially 15 to 20 degrees.
● CR: Perpendicular to a point centered at the level of the soft tissue ● Place cassette in the vertical position with its upper border in the
depression just above the greater trochanter (approximately 2 inches crease above the iliac crest.
or 5 cm) ● Respiration: Suspend.
● CR: Perpendicular to the long axis of the femoral neck. The CR
❖ PELVIS AND HIP JOINTS enters midthigh and passes through the femoral neck about 2 ½
Axial Projection – Chassard-Lapine Method inches (6.4 cm) below the point of intersection fo the localization lines.
Known as OR or Surgical Projection - for px who cant lateral
● 3 Purposes:
− Measuring the horizontal, or biischial diameter in pelvimetry.
Axiolateral Projection – Clements-Nakayama Modification
− Determine the relationship of the femoral head to the
acetabulum. ● Patients with bilateral hip fractures, bilateral hip arthoplasty, or
− Demonstrate the opacified rectosigmoid portion of the colon. limitation of movement of the unaffected leg.
● Contraindicated for patients with suspected fracture or pathologic ● Limbs in neutral position.
condition. ● Respiration: Suspend.
● Posterior part of the knee is in contact with the edge of the table. ● CR: Directed 15 degrees posteriorly and aligned perpendicular to the
● Pelvis is tilted 45 degrees. femoral neck and grid cassette.
● CR: Perpendicular through the lumbosacral region at the level of the
greater trochanters. Axiolateral Projection – Leonard-George Method
● Supine
❖ FEMORAL NECKS ● Flex the hip and knee of the unaffected side and abduct the thigh.
AP Oblique Projection – Modified Cleaves Method ● Place the cassette in the vertical position, well up between the thighs
and center to the femoral neck of the affected side.
● Bilateral “frog leg” position
● Rotate foot internally 15 to 20 degrees. (to overcome anteversion of
● Contraindicated for patient suspected of having a fracture or other
the femoral neck)
pathologic condition.
● Respiration: Suspend.
● Abduct thigh, approximately 45 degrees.
● CR: Lateromedially and perpendicular to the long axis of the femoral
● Respiration: Suspend.
neck.
● CR: Perpendicular to enter the patient’s midsagittal plane at the level
Show head neck and trochanteric area of femur
of 1 inch (2.5 cm) superior to the pubic symphysis.
● For unilateral, direct CR to the femoral neck.
SHOW OBLIQUE PROJECTION Axiolateral Projection – Friedman Method
● Contraindicated for patient suspected of having a fracture or other
Axiolateral Projection – Original Cleaves Method pathologic condition.
● Patient in supine position. ● Lateral recumbent position on the affected side.
● Contraindicated for patient suspected of having a fracture or other ● Upper side of posterior limb 10 deg
pathologic condition. ● Respiration: Suspend.
● Respiration: Suspend. ● CR: Directed to the femoral neck at an angle of 35 degrees cephalad.
● CR: Parallel with the femoral shafts (may vary from 25 to 45 degrees) Lat. Rec – on affected
SHOW AXIOLAT PROJECTION OF HUMERAL HEAD NECK AND
TROCHANTERS PA Oblique Projection – Hsieh Method (RAO or LAO)
● Demonstration of posterior dislocations of the femoral head in cases
Congenital Hip Dislocation other than acute fracture dislocations.
● Semiprone position on the affected side.
● Andren-von Rosen Approach = bilateral hip projection with both
● Elevate unaffected side 40 to 45 degrees.
legs forcibly abducted to at least 45 degrees and inward rotation of
● Respiration: Suspend.
the femora.
● CR: Perpendicular to the midpoint of the cassette passing between
● Kanke and Kuhns = construction of a device that controlled the
the posterior surface of the iliac bladde and the dislocated femoral
degree of abduction and rotation of both limbs.
head.
● Urist = right or left posterior oblique (AP) position for the
❖ HIP
demonstration of the acetabulum in acute fracture dislocation injuries
AP Projection of the hip.
● Patient is supine. SHOW POSTERIOR DISLOCATIONS OF FH
● Rotate lower limb and foot medially 15 to 20 degrees.
● Respiration: Suspend. Mediolateral Oblique Projection – Lilienfeld Method (RAO or LAO)
● CR: Perpendicular to the femoral neck. ● Contraindicated for patient suspected of having a fracture or other
FEMORAL NECK @ 2 inches medial to asis and greater trochanter pathologic condition.
● Lateral recumbent on the affected side.
Lateral Projection – (Mediolateral) – Lauenstein and Hickey Method ● Roll the upper body slightly forward about 15 degrees.
● Contraindicated for patient suspected of having fracture or other ● CR: Perpendicular to the midpoint of the cassette, traversing the
pathologic condition. affected hip joint.
● Respiration: Suspend.
● Colonna = affected side up, (body rotated 17 degrees anteriorly)
− Separates the shadows of the hip joints ❖ ILIUM
− Gives the optimum projection of the slope of the acetabular roof AP and PA Oblique Projections
and depth of socket.
RPO and LPO
● Patient is supine.
❖ ACETABULUM
● Elevate the unaffected side approximately 40 degrees.
PA Oblique Projection – Teufel Method (RAO or LAO) ● Respiration: Suspend
● Semiprone on the affected side.
● Elevate the unaffected side so that the anterior surface of the body RAO and LAO
forms 38 degrees from the table ● Patient is prone
● Respiration: Suspend. ● Elevate the unaffected side approximately 40 degrees.
● CR: Directed through the acetabulum at an angle of 12 degrees ● Respiration: Suspend.
cephalad. CR enters at the inferior level of the coccy and ● CR: Perpendicular to IR
approximately 2 inches (5 cm) lateral to the midsagittal plane toward - Ilium in profile
the side being examined. WIDE PELVIS ADD 3-5 DEG CEPHALAD
SHOW FOVEA CAPITIS AND SUPEROPOSTERIOR ACETABULUM

AP Oblique Projection – Judet Method – (RPO or LPO) (6) Bony Thorax

● Judet and Letournel described two 45-degree posterior oblique
positions useful in diagnosing fractures of the acetabulum. ❖ BONY THORAX
− Internal oblique (affected side up 45 deg) position − Supports the wall of the pleural cavity and diaphragm used in
- Show posterior rim of acetabulum respiration.
- fx in iliopubic column − Serves to protect the heart and lungs
− External oblique (affected side down 45 deg) position − Formed by the sternum, 12 pairs of ribs, and the 12 thoracic
- Show anterior rim of acetabulum vertebrae.
- Fx in iloischial column TRUE RIB 1 – 7
IU- PIP FALSE RIB – 8 9 10 ribs
ED- AIS
FLOATING – 11 and 12th
RPO LPO
- Left up – posterior rim - IP Left down – anterior rim IS BODY OF MANUBRIUM – GLADIOLUS
- Right down – anterior rim - IS Right up – posterior rim IP CHEST PA criteria
● CR: Perpendicular through the acetabulum. - Costophrenic angle shown
Costophrenic angle can’t be shown = pulmonary effusion
Axiolateral Projection – Dunlan, Swanson, and Penner Method TB – occurs at apex of lungs bec of higher Oxygen concentration and TB
● 2 exposures is made on the same image receptor. The patient should is an airborne disease
not move.
● Seated-upright.
❖ STERNUM
● Respiration: Suspend.
● CR: Respiration: Suspend. PA Oblique Projection – RAO position
● CR: Directed to the crest of the ilium at a medial angle of 30 degrees ● SID: 30 inch (to blur the posterior ribs)
(first from one side and the from the other). ● Average body rotation 15 to 20 degrees.
● Respiration: slow shallow breaths, or suspend at the end of
❖ ANTERIOR PELVIC BONES expiration
● CR: Perpendicular to the midsternum and entering the elevated side
PA Projection
of posterior thorax at the level of the 7th thoracic vertebra and
● Patient in prone position approximately 1 inch lateral to the MSP.
● Respiration: Suspend. STERNUM ONLY RAO IN HOSP
● CR: Perpendicular to the midpoint of the cassette. CR enters the - Needs superimposition to add contrast to sternum and show it
distal coccyx and exits the pubic symphysis.
PA Oblique Projection – Moore Method (Modified prone Position)
AP Axial Projection – Taylor Method
● SID: 30 inches (76 cm) to blur the posterior ribs.
● Patient in supine position ● Prone
● Respiration: Suspend. ● Bend at waist and center the sternum.
● CR: ● Arms above the shoulders and palms down the table.
− Males = 20 to 35 degrees cephalad and centered to a point 2 ● Respiration: slow shallow breaths, or suspend at the end of
inches (5 cm) distal to the superior border of the pubic symphysis. expiration
− Females = 30 to 45 degrees cephalad and centered to a point of ● CR: 25 degrees at the level of T7 and approximately 2 inches to the
2 inches (5 cm) distal to the upper border of the pubic symphysis. right of spine.
Superoinferior Axial Projection – Lilienfeld Method Lateral Projection (R or L – Upright)
● Seated-upright position ● SID: 72 inches
● Flex knees, lean backward 45 or 50 degrees. ● Seated or standing
● Respiration: Suspend. ● Respiration: Suspended deep inspiration.
● CR: Perpendicular to the midpoint of the image receptor and entering ● CR: Perpendicular to the center of the cassette and entering the
1 ½ inches (3.8 cm) superior to the pubic symphysis. lateral border of the midsternum.
TAYLOR – OUTLET How to know if PA is Oblique a little and not true PA
LILIENFELD – INLET - Sternoclavicular articulation is not equidistant
STAUNIG - INLET
Lateral Projection – (R or L – Recumbent)
PA Axial Projection – Staunig Method
● SID: 72 inches
● Prone position. ● Lateral recumbent, flex hips and knees.
● Respiration: Suspend. ● Respiration: Suspend at the end of deep inspiration.
● CR: 35 degrees cephalad exiting the pubic symphysis on the ● Dorsal Decubitus is performed for severely injured patients.
midsagittal plane anteriorly at the level of the greater trochanters.
● CR: Perpendicular to the center of the cassette, entering the lateral ● CR: Perpendicular to T7 for upper projection; T10 for the lower
border of the midsternum.. projection.

❖ STERNOCLAVICULAR ARTICULATIONS ❖ COSTAL JOINTS

PA Projection AP Axial Projection
● Prone ● Demonstration of the costal joints in patients with rheumatoid
● Rest head on chin spondylitis.
● Respiration: Suspend at the end of expiration ● Supine
● CR: Perpendicular to the sternoclavicular joint closest to the cassette ● Respiration: Suspend at the end of full inspiration because the lung
(enters at the level of T2-T3 and 1 to 2 inches lateral from the MSP) markings are less prominent at the phase of breathing.
PA Oblique Projection – Central Ray Angulation Method (Non-Bucky) ● CR: 20 degrees cephalad 2 inches above xiphoid process.
● Joint is closer to the cassette ● For large-boned patients, alternately rotate the sides of the body 10
● Prone degrees medially. Elevated side is best demonstrated.
● CR: 15 degrees towards MSP entering at the level of T2-T3 and 1 to ● Hohmann and Gasteigher = 30 degrees cephalad for average
2 inches lateral to MSP. patients; 35 to 40 degrees for accentuated kyphosis. \
PA OBLIQUE - RAO AND LAO
- Px prone MSP 15 deg side interest closest to IR (7) Thoracic Viscera
CR – perp to T3
RAO – best demons right join
Thoracic Cavity
LAO – best demons left joint
Respiratory System
Axiolateral Projection – Kurzbauer Method − Pharynx
● Lateral recumbent position on the affected side. − Trachea
● Flex Hips and knees. − Bronchi
● Respiration: Suspend at the nd of full inspiration. − 2 lungs
● CR: 15 degrees caudad to SCJ Mediastinum
− Heart
❖ RIBS − Great Vessels
− Trachea
Oblique projections = axillary portion of the ribs
− Esophagus
Lateral projections = fluid or air levels are evaluated after rib fractures − Thymus
LAO or RPO = ribs free of heart − Lymphatics
Not sure (seen on xray) − Nerves
Anterior - horizontal − Fibrous Tissue
Posterior ribs – almost vertical − Fat

❖ GENERAL POSITIONING CONSIDERATIONS

❖ UPPER ANTERIOR RIBS
● For radiography of heart and lungs, upright is preferred whenever
PA Projection
possible.
● Upright or recumbent − Prevent engorgement of the pulmonary vessels and to allow gravity to
● Upright is valuable for demonstrating fluid levels of the chest. depress the diaphragm.
● Prone ❖ BREATHING INSTRUCTIONS
● Respiration: Suspend at the end full inspiration to depress the
Normal inspiration = costal muscles pull the ribs anteriorly and superiorly
diaphragm as much as possible.
● CR: Perpendicular to the level of T7 shoulders rise and thorax expands
❖ POSTERIOR RIBS Deep inspiration = causes the diaphragm to move inferior and causes
● AP Projection elongation of the heart.
● Upright or recumbent Pneumothorax = one exposure at the full end of inspiration, and the other
● Respiration: is at the end of full expiration.
− Ribs above diaphragm = suspend at full inspiration to depress Inspiration and expiration = used to demonstrate movement of
diaphragm.
diaphragm, the occasional presence of foreign bodies, and atelectasis
− Ribs below diaphragam = suspend at full expiration depress
diaphragm.
● CR: Perpendicular at the level of T7. ❖ TRACHEA
● AP Projection
❖ AXILLARY RIBS ● Supine or upright
AP Oblique Projection – (RPO or LPO) ● Respiration: Instruct the patient to inhale slowly during the exposure
to ensure that the trachea is filled with air.
● Upright or recumbent
● CR: Perpendicular through the manubrium
● Upright to image ribs above diaphragm, recumbent to image ribs
below the diaphragm.
● 45-degree oblique projection ❖ TRACHEA AND SUPERIOR MEDIASTINUM
● Affected side closest to the cassette. Lateral Projection – (R or L)
● Abduct the arm of the affected side. ● Lateral position; seated or standing
● Respiration: Suspend at the end of deep expiration for ribs below the ● Clasp the hands behind the body and rotate posteriorly.
diaphragm; at the end of full inspiration for ribs above the diaphragm. ● Respiration: Make the exposure during slow inspiration to ensure
● CR: Perpendicular at T7 for the upper projection; T10 for the lower that the trachea is filled with air.
projection. ● CR: Horizontal through a point midway between the jugular notch
PA Oblique Projection – RAO or LAO Position and the midcoronal plane, and through a point 4 or 5 inches lower for
● Upright or recumbent demonstration of the superior mediastinum.
● 45 degree PA Oblique projection ● Eiselberg and Sgalitzer = used for ddemonstration of retrosternal
● Place the affected side away from the cassette. extensions of the thyroid gland, thymic enlargements in infants, an the
● Respiration: Suspend at the end of full expiration for ribs below the opacified pharynx and upper esophagus, outline of trachea and
diaphragm; at the end of full inspiration for ribs above diaphragm. bronchi. Also used for foreign body localization.
SHOW THYMUS GLAND
 ● CR: Perpendicular to the long axis of the sternum (3 inches below the
❖ TRACHEA AND PULMONARY APEX jugular notch at the level of T7.)
● Axiolateral Projection – Twining Method – (R or L) ● Resnick = recommended an angle AP projection (30 degrees
● For patients who cannot rotate their shoulders posteriorly enough for caudad) to free the basal portions of lung fields from superimposition
the lateral projection by the anterior diaphragmatic, abdominal and cardiac structures.
● Elevate the arm adjacent to the cassette in extreme abducton.
● Respiration: PULMONARY APICES
− For the trachea = instruct the patient to inspire slowly during AP Axial Projection – Lindblom Method – Lordotic Position
exposure. ● SID: minimum of 72 inches
− For the lung apex – make the exposure at the end of full ● Upright, patient standing approximately 1 foot from the vertical grid
inspiration ● Upper margin of the cassette is about 3 inches above the upper
● CR: Directed to the center of the cassette through the adjacent border of the shoulder.
supraclavicular impression at angle of 15 degrees caudad. ● Oblique Lordotic position = rotate body 30 degrees toward the
affected side
❖ CHEST: LUNGS AND HEART ● Respiration: Full inspiration. The exposure is made after the second
PA Projection full inspiration.
● SID: minimum 72 inches ● CR: Perpendicular to the midsternum
● Upright, either standing or seating
● Respiration: Full inspiration. The exposure is made after the second PA Axial Projection
full inspiration. ● SID: 72 inches minimum
● CR: Perpendicular to the MSP at the level of T7. ● Upright, standing, or seated
TRUE PA IF STERNOCLAVICULAR ARTICULATION IS ● Respiration: Make the exposure at the end of full inspiration or
EQUIDISTANT WITH EACH OTHER optionally at full expiration.
● CR:
Lateral Projection – (R or L) − Inspiration = 10 to 15 degrees cephalad through T3
● SID: Minimum 72 inches − Expiration = perpendicular to T3
● Left lateral for the left lung and heart. SHOW APICES ABOVE CLAVICLE
● Right lateral for right lung.
● Respiration: Full inspiration. The exposure is made after the second AP Axial Projection
full inspiration. ● SID: minimum 72 inches
● CR: Perpendicular to the midcoronal plane at he level pf T7. ● Upright or supine
● 2 inches anterior to the midaxillary line ● Respiration: Expose at the end of full inspiration.
● Demonstration of interlobar fissures, to differentiate the lobes, and to ● CR: directed at an angle of 15 to 20 degrees cephalad entering the
localize pulmonary lesions. manubrium
TRUE LATERAL IF THERE IS SUPERIMPOSITION OF THE ● Preferred for hypersthenic patients and patients whose clavicles
POSTERIOR RIBS occupy a high position.
PA Axial Projection – Fleischner Method – (Lordotic Position)
PA Oblique Projection (RAO and LAO) ● SID: minimum 72 inhe
● SID: minimum 72 inches ● Upright facing the vertical grid.
● Standing or seated ● Thorax inclined posteriorly 45 degrees (extreme lordosis)
● 45 degrees to the left for LAO; 45 degrees to the right (RAO) ● Respiration: Make the exposure at the end of full inspiration.
● Lesser degree of obliquity (10 to 20 degrees) for the study of ● CR: Perpendicular to T4.
pulmonary diseases. ● Can be in prone with CR 45 degrees caudad.
● Side of interest is farther from the cassette. ● Kjelberg = prone position with 30-degree caudal angulation of CR for
● Respiration: Full inspiration. The exposure is made after the second demonstration of minimal mitral disease.
full inspiration.
● CR: Perpendicular to T7 LUNGS AND PLEURA
LAO – RIGHT LUNG FIELD , HEART, TRACHEA AP or PA Projection – (R or L Lateral Decubitus Positions)
(SIDE FARTHER FROM IR)
● Lateral decubitus position
RAO – LEFT LUNG FIELD, LEFT ATRIUM , APEX OF LV AND
● Fluid demonstration = lie on the affected side
RETROCARDIAC SPACE
● Demonstration of free air = lie on the unaffected side.
(SIDE FAR)
● Let the patient remain in the position for 5 minutes.
● If patient lying on the affected side, elevate the body 5 to 8 cm.
AP Oblique Projection – (RPO and LPO)
● Respiration: Full inspiration. The exposure is made after the second
● If the patient is too ill to be turned to prone; used as supplementary full inspiration.
position in the investigation of specific lesions; used for recumbent ● CR: Horizontal and perpendicular to the cassette at a level of 3
patients for contrast studies of the heart and great vessels. inches below the jugular notch for the AP and T7 for the PA.
● Demonstrates the greatest area of lung closest to the cassette. ● Ekimsky = patient lean laterally 45 degrees for the demonstration of
● RPO correspond to LAO; LPO corresponds to RAO small pleural effusion.
● Body rotation:45 degrees Lateral Projection – (R or L) – Ventral or Dorsal Decubitus Positions
● Respiration: Full inspiration. The exposure is made after the second
● Prone or supine, elevate thorax 2 to 3 inches
full inspiration.
● Let the patient remain in the position for 5 minutes
● CR: Perpendicular to the center of the cassette at a level of 3 inches
● Affected side against the vertical grid
(7.6 cm) below the jugular notch (exits at T7)
● Respiration: Full inspiration. The exposure is made after the second
full inspiration.
❖ CHEST
● CR: Horizontally and enters at the level of the midcoronal plane and 3
AP Projection to 4 inches below the jugular notch for the dorsal decubitus and at T7
● If the patient is too ill to be turned to prone; used as supplementary for the ventral decubitus.
position in the investigation of specific lesions.
● SID: 72 inches (8) Vertebral Column
● Supine or upright
● Respiration: Full inspiration. The exposure is made after the second
full inspiration. Functions:
− Encloses and protects the spinal cord.
− It acts as a support for the trunk. − Costovertebral
− It supports skull superiorly. − Costotransversee
− Provides for attachment for the deep muscles of the back and ribs − Intervertebral
laterally. − Zygapophyseal
In early life, 33 vertebrae: − Sacrococcygeal
− Cervical (7)
− Thoracic (12) ❖ ATLANTO-OCCIPITAL ARTICULATIONS
− Lumbar (5) AP Oblique Projection – (R and L head rotations)
− Sacrum (5) ● Supine
− Coccyx (vary from 3 to 5) ● Rotate head 45 to 60 degrees away from the side being examined.
Cervical Vertebrae ● IOML perpendicular to the cassette.
− Atlas (C1) ● Respiration: Suspend.
− Axis (C2) ● CR: Perpendicular to the midpoint of the cassette. It enters 1 inch
− Seventh vertebra (C7) (2..5 cm) anterior to the EAM and emerges at the atlanto-occipital
− Typical cervical vertebrae (C3 to C6) articulation.
Typical Cervical Vertebrae ● Buetti = 45 to 50 degrees to one side and mouth wide open. The chin
− Has a small transversely located, oblong body with slightly elongated is drawn down as much as the open mouth allows. The CR is directed
anteroinferior borders. vertically through the open mouth to the dependent mastoid tip.
− Transverse processes are short and wide. PA Projection
− Have right and left transverse foramina and the vertebral foramen. ● Prone
− Intervertebral formanina is at 45 degree angle to MSP. ● Flex the elbows, place the arms in comfortable position.
Primary Curves (present at birth) ● Respiration: Suspend.
- Thoracic and Pelvis ● CR: Perpendicular to the midpoint of the cassette. It enters back of
Secondary Curves (after birth) the neck on MSP and exits at the level of the infraorbital margin.
- Cervical and Lumbar
❖ DENS
Kyphosis – concave anteriorly (thoracic and pelvic) AP Projectiosn – Fuchs Method
Lordosis - convex anteriorly (cervical and lumbar) ● For the demonstration of the dens when its upper half is not clearly
Intervertebral Disk – shock absorber shown in the open-mouth position.
Made up of: ● Must not be attempted if fracture or degenerative disease of the upper
- Nucleus pulposus cervical region is suspected.
- Anulus fibrosus ● Supine, extended the chin until the tip of the chin and mastoid
Spondylolysis – fx of the spine process is vertical.
Spondylolisthesis – forward slipping of spine ● Respiration: Suspend.
SPINA BIFIDA – congenital defect where the spine protrudes ● CR: Perpendicular to the midpoint of the cassette. It enters the neck
on the MSP just distal to the tip of the chin.
Positioning rotations needed for demonstration of intervertebral ● Smith and Abel = method for demonstrating the laminae and
foramina and zygapophyseal joints articular facets of the upper cervical vertebrae. Extend neck, mouth
opened wide and CR directed 35 degrees caudad to [Link] is
Area of spine Intervertebral Zygapophyseal made with the head passively rotated 10 degrees to the side.
foramina joints AP Axial Oblique Projection – Kasabach Method (R or L head
Cervical spine 45 degrees oblique Lateral rotations_
AP – side up ● In cases of fractures, the head should not be rotated but the entire
PA – side down body.
Thoracic spine Lateral 70 degrees ● Supine
AP – side up ● Rotate head 40 to 45 degrees. IOML is perpendicular.
PA – side down ● Respiration: Suspend.
Lumbar spine Lateral 30-50 degrees ● CR: 10 to 15 degrees caudad point midway between the outer
AP – side down canthus and the EAM.
PA – side up ● Hermann and Stender = demonstration of the atlantoocipital-dens
relationship: same as Kasabach but the CR is directed vertically
midway between the mastoid process at the level of the
Thoracic Vertebrae
atlanto-occipital joints.
− Increase in size from 1st to 12th.
− Postrolateral margins of each body have costal facets and
❖ ATLAS AND AXIS
demifacets.
AP Projection – Open Mouth
− Transverse processes of thoracic vertebrae project oblique, laterally
- 30 in SID to increase FOV of odontoid
and posteriorly.
● Described by albers-Schonberg in 1910 and by George in 1919.
− Laminae are broad and thick and they overlap adjacent lamina.
● Open mouth
− Spinous process are long
● Respiration: Instruct the patient to keep the mouth wide open and to
− Zygapophyseal joint angle anteriorly 15 to 20 degrees to form 70 to
softly phonate “ah” during the exposure. (will place the tongue on the
75 degrees to the MSP.
floor and prevent movement of the mandible.)
Lumbar Vertebrae
● CR: Perpendicular to the center of the cassette and entering the
− Large, bean-shaped bodies that increase in size from the 1st to 5th.
midpoint of the open mouth.
− Bodies are deeper anteriorly than posteriorly.
− Thransverse processes are smaller than those of thoracic vertebrae.
Lateral Projection – (R or L position)
− Spinous process are large, thick, and blunt.
● Supine
− Mammillary process
● Cassette in vertical position, parallel to the MSP of the neck.
− Accessory process
● Respiration: Suspend.
− Lumbar pedicles are strong and dedicated posteriorly
● SID: 72 inches.
− Zygapophyseal joints inclined posteriorly 30 to 50 degrees to MSP
● CR: Perpendicular to a point 1 inch (2.5 cm) distal to the adjacent
Vertebral Articulations
mastoid tip.
− Atlanto-occipital
● Pancoast, Pendergrass, and Sheaffer = head be rotated slightly to
− Atlantoaxial
prevent superimposition of the laminae of the atlas. Slight horizontal
− Lateral (2)
tilt of the head for demonstration of the arches of the atlas.
− Medial (1)
❖ ATLAS AND DENS ● Supine.
PA Projection – Judd Method ● Rotate head away from the interest 45 to 50 degrees.
● Must not attempt with patients who has an unhealed fracture or who ● CR: Direct to exit the spinous process of C7 at an average angle of
has degenerative disease or suspected fracture of the upper cervical 35 degrees caudad (range: 30 to 40 degrees
region. ● Respiration: Suspend.
● Prone. 45-50 DEG – DEMONS ARTICULAR PROCESS OF C2-C7 AND T1
● Flex the patient’s elbow, 60-70 – PROCESSES OF C6 AND T1-T4
● Extend neck and rest chin on the table.
● Chin and mastoid tips are vertical. OML is approximately 37 degrees. Vertebral Arch (Pillars) – PA Axial Oblique Projections – R and L head
● Respiration: Suspend. rotations)
● CR: Perpendicular to the midpoint of the cassette. It enters on the ● Prone.
midsagittal plane just distal to the level of the mastoid tips. ● Respiration: Suspend.
● CR: C7 at an average angle of 35 degrees cephalad (range 30 to 40
❖ CERVICAL VERTEBRAE degrees) exiting at the level of mandibular symphysis.
AP Axial Projection
● Supine or upright position. ❖ CERVICAL VERTEBRAE: TRAUMA
● Respiration: Suspend. Lateral Projection – Dorsal Decubitus Position
● CR: Through C4 at an angle of 15 to 20 degrees cephalad. The CR ● CR: horizontally to C4.
enters at or slightly inferior to the most prominent point of the thyroid ● SID: 69 to 72 inches (152 cm to 183 cm)
cartilage. ● Respiration: Suspend.
● Demonstrate the presence or absence of cervical ribs.
Lateral Projection – Grandy Method (R or L) AP Axial Projection
● SID: 60 to 72 inches ● CR: 15 to 20 degrees cephalad = for the demonstration of the
● Elevate the chin slightly and depress shoulders. (weights tied on the vertebral bodies and their interspaces.
wrist)
AP Axial Oblique Projection (RPO and LPO Positions)
● Respiration: Suspend respiration at the end of full expiration to ● Demonstration of the pedicles and intervertebral foramina.
obtain maximum depression of the shoulders. ● CR: opposite side to C4 at a compound angle of 45 degrees medial
● CR: Horizontal and perpendicular to C4. and 15 to 20 degrees cephalad.
Lateral Projection – Hyperflexion and Hyperextension (R or L)
● Must not be attempted until cervical spine pathology or fracture has ❖ CERVICOTHORACIC REGION
been ruled out. Lateral Projection – Twining Method (R or L Position Upright)
● Functional studies of the cervical vertebrae in lateral position are ● “Swimmer’s Lateral”
performed to demonstrate normal anteroposterior movement or an ● Seated or standing
absence of movement resulting from trauma or disease. ● Elevate the arm near the grid and depress shoulders
● SID: 60 to 72 inches. ● Respiration: Suspend.
● Respiration: Suspend. ● CR: Directed to the interspaces of C7 and T1
● CR: horizontal and perpendicular to C4. − Perpendicular if the shoulder is well depressed
− Caudal angle of 5 degrees if the shoulder cannot be well
❖ CERVICAL INTERVERTEBRAL FORAMINA depressed.
AP Axial Oblique Projection (RPO and LPO) Lateral Projection – Pawlow Method and Modified Pawlow Method (R
● First described by barsony and koppenstein or L) (Recumbent)
● SID: 60 to 72 inches (152 to 183 cm) ● Lateral recumbent position.
● Supine or upright ● Respiration: Suspend
● Adjust body at 45-degree angle. ● CR: Directed to the interspcace of C7 and T1 at an angle of 3 to 5
● Respiration: Suspend. degrees caudad.
● CR: 15 to 20 degrees cephalad through C4 ● Monda = modified CR by angling it 5 to 15 degrees cephalad.
● Open intervertebral foramina farthest from the cassette.
AP Oblique Projection – Hyperflexion and hyperextension CERVICAL OBLIQUE SHOWS – INTERVERTEBRAL FORAMINA
● Boylston = functional studies of cervical vertebrae in the oblique to CERVICAL OBLIQUE - 45
demonstrate fractures of the articular processes as well as obscure THORACIC OBLIQUE – 70
dislocations and subluxations. LUMBAR OBLIQUE – 45
PA Axial Oblique Projection – (RAO and LAO)
● SID: 60 to 72 inches (152 to 183 cm) ❖ THROACIC VERTEBRAE
● Prone or upright AP Projection
● Rotate body 45 degrees. ● Supine or upright
● Respiration: Suspend. ● Respiration: Patient allowed to take shallow breaths, otherwise
● CR: 15 to 20 degrees caudad to C4 respiration suspended at the end of full expiration.
● Open intervertebral foramina closest to the cassette ● Supine: Flex hip and knees.
● Upright: Weight equally distributed on both feet.
❖ CERVICAL VERTEBRAE ● CR: Perpendicular to T7 approximately halfway between the jugular
AP Projection – Ottonello Method notch and xyphoid process.
● “Chewing” or “wagging” technique FUCHS – USE HEEL EFFECT (CATHODE NEAR FEET)
● Supine TO REDUCE KYPHOSIS = FLEX KNEE AND HIPS
● Respiration: Suspend. CR = T6
● CR: Perpendicular to C4 TO SHOW ZYGAPHOPHYSEAL JOINTS- LATERAL
TO SHOW FORAMENS – OBLIQUE
❖ CERVICAL AND UPPER THORACIC VERTEBRAE
AP AXIAL - SUPINE Lateral Projection (R or L)
- CR: AT C7 25 DEGREES (20 – 30) CAUDAD ● Recumbent or Upright
- SHOW: POSTERIOR CERVICAL AND UPPER THORAX WITH ● Oppenheimer = use upright to reproduce the physiologic conditions
ARTICULAR AND SPINOUS PROCESS and reported that the patient is allowed to stand in normal position.
● Recumbent: Flex hips and knees.
Vertebral Arch (Pillars) – AP Axial Oblique Projection – (R and L head ● Upright: Raise arms at right angles.
Rotations)
● CR: Perpendicular to the midaxillary plane at the level of T7 located ● Upright or recumbent prone.
approximately 3 inches below the sternal angle. ● Demonstrates joints farthest from the cassette.
THORACIC LATERAL – INTERVERTEBRAL FORAMINA ● Body rotation 45 degrees for lumbar region, 30 degrees for
Thoracic oblique – zygapophyseal joint lumbosacral zygapophyseal joint.
● “Scottie dog”
❖ ZYGAPOPHYSEAL JOINTS ● Respiration: Suspend at the end of expiration.
AP or PA Oblique Projection (RAO and LAO or RPO and LPO) ● CR: Perpendicular to enter L3(1 to 1 ½ inches above iliac crest)
(Upright recumbent positions)
● Oppenheimer – PA Oblique Projections = demonstration of joints ❖ FIFTH LUMBAR INTERVERTEBRAL FORAMEN
closest to the cassette. PA Axial Oblique Projection – Kovacs Method – (RAO and LAO)
● Fuchs – AP Oblique Projections = demonstration of joints farthest ● Lateral recumbent on the affected side.
from the cassette. ● Pelvis rotated 30 degrees.
● Rotate body until coronal plane forms 70 degrees. (20 deg posterior ● Respiration: Suspend.
from coronal plane) ● CR: 15 to 30 degrees caudad through L5
● Respiration: Suspend the end of expiration. SHOWS L5
● CR: Perpendicular to the cassette exiting T7.
❖ LUMBOSACRAL JUNCTION AND SACROILIAC JOINTS
❖ LUMBAR-LUMBOSACRAL VERTEBRAE AP or PA Axial Projection
AP Projection ● Supine.
● Clear the intestine if possible and empty urinary bladder. ● Respiration: Suspend.
● Flex hips and knees to prevent lordotic curve. ● CR: lumbosacral joint at 30 to 35 degrees cephalad (1 ½ inches
● SID: 48 inches (122 cm) superior PS on the MSP)
● Recumbent or upright. ● Can be modified for prone position, just direct the CR caudad.
● Flex patients elbow and place hands on the upper chest. ● Messe = recommended the prone position for examinations of the
● Respiration: Suspend at the end of expiration. sacroiliac joints because their obliquity places them in a position more
● CR: nearly parallel with the divergence of the beam.
− Lumbosacral examination = perpendicular to the MSP at AP AXIAL – 30-35 CEPHALAD
the level of iliac crests (L4) PA AXIAL – 35 CAUDAD
− Lumbar examination = 1 ½ inches (3.8 cm) above the Note: KOVACHS SHOW L5 INTERVERTEBRAL FORAMINA
iliac crests (L3)
PA Projection STUDY SACROILIAC JOINTS VS JUDET
● Optional
Lateral Projection – (R or L) ❖ SACROILIAC JOINTS
● Upright or recumbent. AP Oblique Projection – (RPO and LPO)
● Respiration: Suspend at the end of expiration. ● Supine
● CR: Perpendicular to the midaxillary line at the level of the crest of ● LPO for the right joint, RPO for the left joint.
ilium. ● Demonstrates the side farther from the cassette.
LATERAL - Show L1 – L4 only bec L5 cant be shown because its ● Elevate the side being examined approximately 25 to 30 degrees.
oblique ● Respiration: Suspend.
● CR: Perpendicular to the center of the cassette, entering 1 inch
LUMBAR SPINE medual to the elevated ASIS.
AP – R AND L BENDING ● For AP Axial Oblique = CR: 20 to 25 degrees cephalad, entering 1
LATERAL - CR: L3 inch medial and 1 ½ inches distal to the elevated ASIS.

HYPERFLEXION AND HYPEREXTENSION AP OBLIQUE - RPO LPO PA Oblique Projection – (RAO and LAO)
- BODY 45 DEG ● Semiprone
CR: LUMBAR: PERP 2 INCH MEDIAL TO ELEVATED ASIS AND 1 ½ ● RAO ffor the right joint, LAO for the left joint
INCH ABOVE ILIAC CREST ● Demonstrates the side closer to the cassette.
ZYGAPOPHYSEAL – 2 INCH MEDIAL TO THE ELEVATED ASIS ● Body rotation 25 to 30 degrees.
STRUCTURE SHOWN: SHOWS THE SCOTTY DOG SIGN ● Respiration: Suspend.
● CR: Perpendicular to the cassette and centered 1 inch medial to the
❖ L5-S1 LUMBOSACRAL JUNCTION ASIS closest to the cassette.
Lateral Projection – (R or L) ● PA Axial Oblique = CR: 20 to 25 degrees caudad.
● Lateral recumbent position SI JOINTS CLOSEST TO IR = RAO LAO
● Respiration: Suspend SI JOINTS FARTHEST = RPO LPO
● CR: At the level of ASIS RAO = RIGHT SI JOINT IS PERP BEC ITS CLOSEST TO THE
− If spine is not in true horizontal, CASSETTE
− Male = 5 degrees caudally LPO = LEFT SI JOINT IS PERP BEC ITS CLOSEST TO CASSETTE
− Female = 8 degrees caudally
❖ PUBIC SYMPHYSIS
❖ ZYGAPOPHYSEAL JOINTS PA Projection – Chamberlain Method for Abnormal Sacroiliac Motion.
AP Oblique Projection – (RPO and LPO) ● 2 projections
● Articular processes of the lumbar vertebrae forms 30 to 50 degrees to − 1 conventional lateral
MSP − 2 PA projections (Upright and alternate weight-bearing)
● Between last lumbar vertebrae and sacrum forms 30 degrees to MSP ● Place the patient upright facing the grid.
● Supine and turn 45 degrees to the affected side ● Respiration: Suspend
● Demonstrate joint closest to the cassette. ● CR: Perpendicular and centered to the pubic symphysis.
● “scottie dog”
● Respiration: Suspend at the end of expiration. ❖ SACRUM AND COCCYX
● CR: Perpendicular to the midpoint of cassette AP and PA Axial Projections
− Lumbar region = 2 inches medial to the elevated ASIS and 1 and ½ ● Colon must be free of gas and fecal material.
inches above iliac crest (L3) ● Supine or prone.
− 5th zygapophyseal joint = 2 inches medial to the elevated ASIS and ● Respiration: Suspend
then up to a point midway between iliac crest and ASIS. ● CR: Sacrum
PA Oblique Projection – (RAO and LAO)
 − Supine = 15 degrees cephalad to a point 2 inches superior to the ● To determine the presence of structural change when bending to the
pubic symphysis. right or left.
● Prone = 15 degrees caudad and center to visible sacral curve. ● Localize a herniated disk.
▪ Coccyx Lateral Projection – (R or L) Hyperflexion and Hyperextension
− Supine = 10 degrees caudad to a point 2 inches superior to the ● Lateral Recumbent
pubic symphysis. ● 1st radiograph = Lean forward and draw thighs up to forcibly flex the
− Prone = 10 degrees cephalad to easily palpable coccyx spine
CR: SACRUM – 2 INC PS 15 DEG CEPHALAD ● 2nd radiograph = lean the thorax backward and posteriorly extend the
CAUDAD – 2 INCH PS 15 DEG CAUDAD thighs and limbs.
● Respiration: Suspend
Lateral Projections – (R or L) ● CR: Perpendicular to the spinal fusion or L3.
● Turn onto the indicated side, flex hips and knees to comfortable
position. (9) Other Radiographic Procedures
● Respiration: Suspend
● CR:
Orthoroenterography – used to measure long bones
− Sacrum = Perpenicular to the level of ASIS and to a point 3 ½
Contrast Arthrography
inches posterior.
● Contrast Arthrography of the knee – Vertical Ray Method
− Coccyx = Perpendicular and directed toward a point 3 ½ inches (9
● Double-Contrast Arthrography of the Knee – Horizontal Ray Method
cm) posterior to the ASIS and 2 inches inferior.
● Wrist Arthrography
● Hip Arthrography
❖ SACRAL VERTEBRAL CANAL AND SACROILIAC JOINTS
● Shoulder Arthrography
● Temporomandibular Joint Arthrography
Axial Projection – Nolke Method
● Lean the patient forward
Foreign Body Localization
● Respiration: Suspend
● Aspirated and Swallowed Objects
● CR: Perpendicular to the cassette and the long axis of the sacrum.
● Penetrating Bodies
Slightly flexed = show lower sacral vertebral canal
Moderate = corss section of upper and lower sacral vertebral canal
Foreign Body Localization For Penetrating Bodies
Hyperflexion = shows upper sacral vertebral canal and spinous
● Radiographic Localization Technique
process
● Fluoroscopic Localization Technique
❖ LUMBAR INTERVERTEBRAL DISKS
Radiographic Localization Technique
PA Projection – Weight-Bearing Method (R and L Bending)
● Right-angle projections
● Duncan and Hoen = recommended PA because the divergent rays
− Right-angle AP, PA, and lateral projections with the central ray
are more parallel with the intervertebral disk spaces/
directed through the foreign body.
● Respiration: Suspend
● Oblique Projections
● CR: perpendicular to L3 at 15 to 20 degrees caudad
− Used to separate overlapping structure in any region.
− Particularly useful in determining the relationship of the
❖ SCOLIOSIS RADIOGRAPHY
superimposed bone and foreign body images to demonstrate
● Scoliosis is an abnormal lateral curvature of the vertebral column with
whether the object is embedded in the bone or is lodged in the
some associated rotation of the vertebral bodies at the curve.
adjacent soft tissues.
● Typical Scoliosis Study:
● Tangential Projections
− PA (or AP) upright
− Useful in the evaluation of superficial foreign bodies in limbs.
− PA (or AP) upright with lateral bending
● Single-image Triangulation
− Lateral Upright (with or without bending)
− Depth localization
− PA (AP) Prone or supine
● The PA (or AP) and lateral upright projections demonstrate the
Fluoroscopic Localization Technique
amount/degree of curvature that occurs with the force of gravity acting
● Parallax Method
on the body.
● Right-angle Method
Lateral = degree of lordosis/kyphosis
● Profunda Method
Parallax Method
❖ THORACOLUMBAR SPINE: SCOLIOSIS
− Based on the principle that the images cast by two objects equidistant
PA or Lateral Projections – Ferguson Method
from the fluoroscopic screen will move together at the same
● Seated or standing
amplitude when the fluoroscope and tub are simultaneously moved
● 1st radiograph = normal position
back and forth.
● 2nd radiograph = elevate the hip or foot on the convex side about 3 or
− For patients who cannot be turned to right-angle projections.
4 inches
− Used for depth localization in the shoulder, buttocks, and upper thigh
● Respiration: Suspend
regions.
● CR: Perpendicular to the midpoint of the cassette.
Right-angle method
● Another scoliosis series (4 images)
− Applicable when movement is not precluded by the patient’s
− Direct PA standing
condition or the nature or location of the foreign body.
− Direct PA prone
Profunda method (continuous fluoroscopic exposure)
− PA with alternate right or left lateral flexion in prone
− Removal of the foreign body under fluoroscopic guidance.
● Yoing, Oestreich, and Goldstein = additional of lateral upright to
show sponndylolisthesis or demonstrate exaggerated degrees of
Trauma Cases
kyphosis or lordosis,
− Reversing or Modifying a projection
❖ LUMBAR SPINE: SPINAL FUSION
Radiographic Pelvimetry and Cephalometry
AP Projection – Right and Left Bending
● Colcher-Sussman Method
● Supine
− AP Projection
● 2 images
− Lateral Position
● Respiration: Suspend
● Thomas Method
● CR: Perpendicular to the level of the third lumbar vertebra, 1 or 1 ½
− Inlet Position
inches above iliac crest on the MSP.
− Lateral Position
● Ball Method
 − AP position - CR: 2 inch above EAM
− Lateral Position Show all Sinuses, Sella turcica
Sella Turcica Parts - Ant clinoid process
(10) Skull Dorsum Sellae - Post clinoid Process
W/ Injury = cross table or horizontal
Skull, Cranium, or Calvarium– 22 bones
Lateral – Dorsal Decubitus – Cross Table Lateral
● 8 Cranial, Braincase, Neurocranium
- Show traumatic sphenoid sinus effusion
− Parietal Bones (wall) (2) - squamous suture
Cr: 2 in above EAM
− Temporal Bones (2)
− Frontal Bone (forehead) (1) - coronal (corona/crown) suture
AP Axial / Semi Axial– Towne’s/ Chamberlaine / Grashey
− Ethmoid Bone (1) - sieve-like
- Supine chin depressed
− Sphenoid Bone (1) - butterfly like
- 30 deg caudad OML
− Occipital Bone (back of head) (1) - lambdoid suture
- sella turcica and anterior clinoid process above FM
● 14 Facial bones or Viscerocranium
- 37 deg caudad to IOML
Petromastoid Portion
- dorsum sella and post clinoid process within FM
Ear
CR: 2 ½ in above glabella
● External Ear
SHOW ENTIRE FORAMEN MAGNUM
− Auricle
CR: 40- 60 deg caudal to OML
− EAM
Demons: Occipital Bone, Mastoid air, Petrous py, Dorsum and PCP,
● Middle Ear
Sphenoid, Cranial Foramina
− Tympanic membrane
− Tympanic cavity
SMV / Full Basal/ Basilar Proj
− Auditory ossicls (malleus, incus, stapes)
- IOML Parallel
● Internal Ear
Show Zygomatic Arches
− Cochlea
CR: gonion to vertex
− Vestibule
Basal Projection – basal foramina foramen ovale foramen spinosum
Facial Bone
foramen lacerum cranial base
● Nasal Bones (2)
Demons: Zygomatic Arches, SMV, Basilar, Tangential
● Lacrimal Bones (2)
● Maxillary Bones (2) - jawbone or upperjaw
VSM - Anterior cranial base
● Zygomatic Bones (2) - cheekbone
- Sphenoid sinuses
● Palatine Bones (2)
● Inferior Nasal Conchae (2) - conch shell
PA Axial – Haas Method
● Vomer (1)
- Opposite of Towne’s
● Mandible (1) - lower jaw or jaw
- Prone
Hyoid Bone - u-shaped
- Forehead and nose touching
Paranasal Sinuses
OML Perp
- Frontal Sinus
CR: 25 deg ceph 1 ½ below inion exit 1 ½ superior nasion
- Ethmoidal Sinus
Demons: Occipital region, PM, DSPCP within FM
- Spheniodal Sinus
- Maxillary Sinus
❖ CRANIUM
- Mastoid Air Cells - additional
Lateral Projection – R or L
Articulations of the Skull
● Seated-upright or semiprone.
● Sutures
● IPL is perpendicular to the cassette.
● Gomphoses
● Respiration: Suspend.
● TMJ
● CR: Perpendicular to 2 inches (5 cm) superior to the EAM.
Skull Topography
● Sella turcuca, anterior clinoid process, dorsum sellae, posterior clinoid
● Midsagittal (MSP)
process
● Interpupillary line (IP)
Lateral Projection – (Dorsal Decubitus or Supine Lateral Position; R
● Acanthion
or L)
● Outer Canthus
● Dorsal Decubitus
● Infraorbital Margin
− Robinson, Meares, and Goree = recommended using the dorsal
● External Acoustic Meatus (EAM)
decubitus lateral projection for the demonstration of the traumatic
● Orbitomeatal Line (OML)
sphenoid sinus effusion. They stated that this finding may be the only
● Infraorbitomeatal Line (IOML)
clue to the presence of basal skull fracture.
● Acanthiomeatal Line (AML)
● Supine lateral
− Supine or semi-prone, turn the head toward the side being examined.
AP - Show crista gali and posterior portion of the cranial vault
PA Projection and PA Axial Projection (Caldwell Method)
- Perp to OML
● Rest patient’s head and nose on the table or upright bucky.
Note: there is magnification when the object is far
● Center the cassette to the nasion.
● Respiration: Suspend.
PA - Primary interest is the frontal bone
● OML is perpendicular to the cassette.
- CR. perp and exit nasion
● CR:
- Forehead and nose touching the table
− PA = Perpendicular to exit the nasion.
− Caldwell – exit nasion at an angle of 15 degrees caudad
AP and PA
− For the demonstration of superior orbital fissures, CR through orbits
Baseline: OML or the radiographic baseline
at 20 to 25 degrees caudad.
− For demonstration of rotundum foramina, CR through nasion at 25
Caldwell - 15 caudad to nasion
to 30 degrees caudad.
- Petrous ridges @ lower third of orbit
AP Projection or AP Axial Projection
Superior orbital fissure: 20 – 25 deg caudad to mid orbits
● Supine
Foramen Rotundum : 25-30 deg caudad to nasion
● OML perpendicular to the cassette
● CR: Perpendicular through the nasion or at angle of 15 degrees
Lateral - IOML and IPL Perpendicular
cephalad.
- MSP parallel
AP Axial Projection – Towne’s Method − 30-degree caudal angulation ray to IOML – projects the dorsum and
● Supine or seated-upright tuberculum sellae and the anterior clinoid processes through the
● OML perpendicular to the cassette. If cannot flex neck, IOML should occipital bone above the level of foramen magnum.
be perpendicular and increase angulation of CR by 7 degrees.
● Respiration: Suspend.
● CR: foramen magnum at a caudal angle of 30 degrees to OML or 37 PA Axial Projection
degrees to IOML. Enters approximately 2 ½ inches (6.3 cm) above ● Prone or seated
the glabella and passes through the level of EAM. ● Rest patient’s head and nose against upright Bucky.
PA Axial Projection – Haas Method ● MSP and OML is perpendicular to the cassette.
● To obtain image of the sellar structures projected within the foramen ● Respiration: Suspend.
magnum in hypersthenic, obese, or other patients who cannot be ● CR: Directed 10 degrees cephalad to the glabella.
adjusted correctly for AP axial (Towne) projection.
● Prone or seated-upright. ❖ OPTIC CANAL AND FORAMEN
● Rest patient’s forehead and nose on the table Parietoorbital Oblique Projection – Rhese Method
● OML is perpendicular to the cassette. ● Patient in semiprone, or seated-upright
● Respiration: Suspend. ● Center the affected orbit, rest the zygoma, nose and chin.
● CR: cephalad angle of 25 degrees to enter a point 1 ½ inches below ● AML perpendicular to the cassette.
the external occipital protuberance (inion) and to exit approximately 1 ● MSP forms 53 degrees to the cassette.
½ inches superior to the nasion. ● Respiration: Suspend.
● CR: Perpenduclar to 1 inch superior and posterior to the Upside TEA.
❖ CRANIAL BASE The CR exits through the affected the orbit closest to the cassette.
Submentovertical Projection – Schuller Method ● Demonstrates the optic canal “on end” and the optic foramen lying in
● IOML parallel to the cassette. the inferior and lateral quadrant of the projected orbit.
● Rest the head on the vertex. Orbitoparietal Oblique Projection – Rhese Method
● Respiration: Suspend. ● Seated-upright or supine
● CR: Directed through the sella turcica perpendicular to the IOML. The ● MSP 53 degrees to the plane of the cassette.
CR enters the MSP of the throat between the angles of the mandible ● AML is perpendicular to the cassette.
and passes through a point ¾ inch anterior to the level of EAMs. ● Respiration: Suspend.
Verticosubental Projection – Schuller Method ● CR: Perpendicular to enter the uppermost orbit at its inferior and
● Used when SMV is contraindicated. lateral quadrant.
● Prone, patient’s chin fully extended. ● Used for patients who cannot turn to prone position.
● Respiration: Suspend.
● CR: Directed through the sella turcica perpendicular to the IOML. CR ❖ SPHENOID STRUT
passes through a point ¾ inch anterior to the level of the EAMs. Parietoorbital Oblique Projection – Hugh Method
● Sphenoid strut = term used to describe the inferior root of the lesser
❖ CRANIAL SELLA TURCICA, AND EAR wing of the sphenoid bone.
PA Axial Projection – Valdini Method ● Prone or seated
● Method using perpendicular CR to project the dorsum sella in the ● Center affected orbit; rest patient’s head and nose
foramen magnum without angular distortion. ● IOML is perpendicular to the cassette.
● Excellent projection of the organs of hearing and is obtained by this ● MSP is rotated 20 degrees towards the side being examined.
method. ● Respiration: Suspend.
● Prone or seated-upright. ● CR: Directed 7 degrees caudad to exit affected orbit.
● Head rested on the frontal region.
● IOML forms 50 degrees with the cassette for dorsum sella or ❖ SUPERIOR ORBITAL FISSURES
demonstration of the internal acoustic canals and labyrinths. PA Axial Projection
● OML forms 50 degrees with the cassette for external acoustic canals, ● Prone or seated-upright
tympanic cavities, and bony part of auditory tubes. ● Rest patient’s forehead and nose
● Respiration: Suspend. ● MSP and OML is perpendicular
● CR: Perpendicular to the cassette at a level slightly above EAM. ● Respiration: Suspend.
● CR: Directed to the MSP at an angle of 20 to 25 degrees caudad and
❖ SELLA TURCICA – HORSESHOE/ SADDLE exiting at the level of the inferior margin of the orbit.
Projections
1. Lateral (Hest) - ¾ anterior and superior EAM ❖ INFERIOR ORBITAL FISSURES
2. Towne’s PA Axial Projection – Bertel Method
Note: Lateral – there will always be superimposition ● Seated-upright or prine.
● Rest patient’s forehead and nose.
Lateral Projection – (R or L) ● MSP and IOML is perpendicular to the cassette.
● Semiprone or seated-upright ● Respiration: Suspend.
● MSP parallel and IP is perpendicular to the cassette. ● CR: Directed at an angle of 20 to 25 degrees cephalad and exiting
● IOML, parallel with the transverse axis of the cassette. the nasion. CR enters the midline approximately 3 inches below the
● Respiration: Suspend. external occipital protuberance.
● CR: Perpendicular to a point ¾ inch anterior and ¾ inch superior to
EAM. ❖ LOCALIZATION OF FOREIGN BODIES WITHIN ORBIT OF EYE
● Vogt Bone-Free – superoinferior tangential projection
❖ SELLA TURCICA, DORSUM SELLAE, AND POSTERIOR CLINOID ● Sweet Method – mathematical or geometric calculations
PROCESSES. ● Pfeiffer-Comberg Method – lead contact lens
AP Axial Projection ● Parallax Method – fluoroscopic examination
● Seated upright or prone
● IOML perpendicular to the cassette. ❖ EYE
● Respiration: Suspend. Lateral – (R or L)
● CR: Directed to MSP, entering the upper forehead and passing Semiprone or seated-upright
through the head at the level of the EAM. ● Non-grid
− 37-degree caudal angulation – projects the dorsum sellae and ● MSP of head is parallel with the cassette.
posterior clinoid processes within the foramen magnum. ● IP is perpendicular to the cassette.
● Respiration: Suspend.
● CR: Perpendicular through the outer cantus. − 2 films exposed: 1st one is on regular exposure other one is place in a
● Instruct patient to look straight ahead for exposure. light-tight nonscreened film holder and a place on top of the cassette.
− Lateral facial bone projection.
PA Axial Projection ● Semiprone or seated.
● Non-grid ● MSP is parallel and IP is perpendicular to the plane of the cassette.
● Prone ● IOML is parallel with the transverse axis of the cassette.
● Rest patient’s forehead and nose and center ¾ inch (1.9 cm) distal to ● Respiration: Suspend.
the nasion. ● CR: Perpendicular to the lateral surface of the zygomatic bone and
● OML perpendicular to the cassette. halfway between the outer canthus and the EAM.
● Respiration: Suspend.
● CR: Through the center of the orbits at a caudal angulation of 30 ❖ NASAL BONES
degrees. Lateral Projection – (R and L)
● instruct patient to close the eyes and to concentrate on holding them ● Seated upright or semiprone
still for the exposure. ● MSP parallel and IP is perpendicular to the cassette.
● IOML parallel with the transverse axis of the cassette.
Parietoocanthial Projection – Modified Waters Method ● Respiration: Suspend.
● Prone ● CR: Perpendicular to the bridge of the nose at a point ½ inch (1.3 cm)
● MSP perpendicular to the cassette. distal to the nasion.
● OML forms 50 degrees with the plane of the cassette.
● Respiration: Suspend. Tangential Projection
● CR: Perpendicular through the midorbits. ● Recumbent or seated
● Instruct the patient to close the eyes and to concentrate on holding ● Extraoral cassette
them still for the exposure. − Glabelloalveolar line peropendicular to the cassette.
− MSP is perpendicular to the cassette.
(11) Facial Bones ● Intraoral fil,
− MSP is vertical and glabelloalveolar line is horizontal.
● Respiration: Suspend.
❖ FACIAL BONES
● CR: Parallel to the glabelloalveolar line and perpendicular to the
● Nasal Bones (2)
plane of IR.
● Lacrimal Bones (2)
● Used to demonstrate medial or lateral displacement of fragments in
● Maxillary Bones (2)
fractures.
● Zygomatic Bones (2)
● Palatine Bones (2)
❖ ZYGOMATIC ARCHES
● Inferior Nasal Conchae (2)
Submentovertical Projection
● Vomer (1)
● Seated upright or supine
● Mandible (1)
● Place IOML as nearly as parallel to the plane of the cassette as
possible.
❖ FACIAL BONES
● Rest head on vertex.
Lateral Projection – (R or L)
● MSP is perpendicular to the plane of the cassette.
● Semiprone or obliquely seated position.
● Respiration: Suspend.
● MSPof head is parallel with the cassette.
● CR: Perpendicular to the IOML and entering the MSP of the throat at
● IP is perpendicular to the cassette.
a level of approximately 1 inch posterior to the outer canthi.
● IOML is parallel with the transverse axis of the cassette.
Tangential Projection
● Respiration: Suspend.
● Seated upright or supine
● CR: Perpendicular and entering the lateral surface of the zygomatic
● Place IOML as nearly as parallel to the plane of the cassette as
bone halfway between the outer canthus and the external auditory
possible.
meatus (EAM).
● Rest head on vertex.
Parietoacanthial Projection – Waters Method
● MSP is perpendicular to the plane of the cassette.
● Prone or seated upright
● Respiration: Suspend.
● Rest patient’s head on the tip of extended chin.
● CR: Perpendicular to the IOML and entering the MSP of the throat at
● OML forms 37 degrees with the plane of the cassette.
a level of approximately 1 inch posterior to the outer canthi.
● MSP is perpendicular to the cassette.
Tangential Projection – May Method
● Respiration: Suspend.
● Prone or seated
● CR: Perpendicular to exit the acanthion.
● IOML is parallel as possible to the IR.
● Demonstrates orbits, maxillae and zygomatic arches.
● MSP 15 degrees away from the side being examined.
Modified Parietoacanthial Projection – Modified Waters Method
● Respiration: Suspend.
● “shallow” Waters
● CR: Perpendicular to the IOML and through the zygomatic arch at a
● OML forms 55 degrees with the cassette.
point approximately 1 ½ inches posterior to the outer canthus.
● Less extension of the neck.
● Zygomatic arch free of superimposition.
● Less axial angulation.
● Useful in patients with depressed fractures or flat cheekbones.
Acanthioparietal Projection – Reverse Waters Method
PA Axial Projection – Modified TItterington Method
● Used to demonstrate the facial bones when the patient cannot be
● Prone or seated
placed in prone position.
● Rest the patient’s nose and chin.
● Supine.
● MSP is perpendicular to IR>
● Chin up and extended neck so that OML forms 37 degrees.
● Respiration: Suspend.
● MML is approximately perpendicular to the cassette.
● CR: Directed at a caudal angle oof 23 to 38 degrees and entering the
● MSP is perpendicular.
vertex midway between the zygomatic arches.
● Respiration: Suspend.
AP Axial Projection – Modified Towne Method
● CR: Perpendicular to enter the acanthion.
● Seated-upright or supine
● For trauma patients: CR adjusted so that it will be parallel with the
● OML and MSP is perpendicular to IR.
MML.
● Respiration: Suspend.
● CR: Directed to enter the glabella approximately 1 inch above the
❖ FACIAL PROFILE
nasion at an angle of 30 degrees caudad.
Lateral Projection – (R or L)
● If patient is unable to flex enough, place IOML perpendicular to IR
● Relationship of bony and soft tissue contours.
and CR 37 degrees caudad.
 ● Shows coronoid and condyloid processes of the rami.
❖ MANDIBULAR SYMPHYSIS Verticosubmental Projection
AP Axial Projection ● Prone or seated.
● Upright ● Fully extend patient’s neck and rest chin on the cassette.
− Seat the patient at the end of the radiographic table. ● MSP is vertical and IOML parallel to IR.
− MSP of head is perpendicular to IR. ● Respiration: Suspend.
− Respiration: Suspend. ● CR: Directed through the midsagittal plane and entering at the
− CR: 40 to 45 degrees posteriorly and center to the mandibular level just posterior to the outher canthi, perpendicular to either
symphysis. the IOML or the occlusal plane.
● Supine
− Rest head on occiput, with MSP vertical. ❖ TEMPOROMANDIBULAR ARTICULATIONS
− Respiration: Suspend. AP Axial Projectuon
− CR: Mandibular symphysis at 40 to 45 degrees caudad ● Supine or seated-upright position with the posterior skull
● MSP of head is perpendicular to the cassette.
❖ MANDIBULAR RAMI ● OML is perpendicular to the plane of the cassette.
PA Projecction ● Respiration: Suspend.
● Prone or seated ● CR: Directed 35 degrees caudad, centered midway between the
● Reest patient’s forehead and nose. TMJs, and entering at a point approximately 3 inches above the
● OML perpendicular to the cassette. nasion.
● MSP is perpendicular. ● Closed and open mouth.
● Respiration: Suspend. Axiolateral Projection – (R or L)
● CR: Perpendicular to exit the acanthion. ● Semiprone, or seat the patient before a vertical grid.
● Demonstrates medial or lateral displacement of fragments in fractures ● MSP is parallel with the plane of the cassette.
of the rami. ● IP is perpendicular to the cassette,
PA Axial Projection ● Respiration: Suspend.
● Prone or seated ● CR: about ½ inch anterior and 2 inches superior to the upside
● Rest the patient’s forehead and nose. EAM, 25 or 30 degrees caudad.
● MSP or OML perpendicular to the plane of the cassette. ● Closed and open mouth.
● Respiration: Suspend. Axiolateral Oblique Projection – (R and L)
● CR: Directed 20 or 25 degrees cephalad to exit the acanthion. ● Semiprone, or seated.
● Demonstrate medial or lateral displacement of fragments in fractures ● Closed and open mouth.
of the rami. ● MSP of the head approximately 15 degrees toward the cassette
● IP is perependicular to the cassette.
❖ MANDIBULAR BODY ● AML is parallel to the transverse axis of the cassette.
PA Projection ● Respiration: Suspend.
● Prone or seated-upright. ● CR: 15 degrees caudad and exiting through the TMJ closest to
● Rest the head on nose and chin so that the mandibular symphysis is the cassette (CR enters about 1 ½ inches superior to the upside
parallel to the plane of the cassette. EAM.)
● MSP is perpendicular to IR. ● Open mouth demonstrates the condyles of the neck of the
● Respiration: Suspend. mandible.
● CR: Perpendicular to the level of the lips. ● Closed mouth demonstrates fractures of the neck and condyle of
PA Axial Projection the ramus.
● Prone or seated-upright.
● Rest the head on nose and chin so that the mandibular symphysis is ❖ PANORAMIC TOMOGRAHY (missing in notes)
parallel to the plane of the cassette.
● MSP is perpendicular to IR. (12) Paranasal Sinuses
● Respiration: Suspend.
● CR: Directed midway between the TMJ at angle of 30 degrees
❖ SINUSES
cephalad.
● Serve as a resonating chamber for the voice
● Zanelli recommended that better contrast around the TMJs could be
● Decrease the wight of the skull by containing air
obtained if the patient was instructed to fill the mouth with air.
● Help to warm and moisten inhaled air
● Possible control of the immune system
❖ MANDIBLE
Frontal (2)
Axiolateral Oblique Projection
Ethmoidal (2)
● The goal of this projection place the desired portion of the mandible
Sphenoidal (normally paired)
parallel with the cassette.
Maxillary (2)
● Seated, semiprone, or semisupine.
● IP perpendicular to the cassette.
❖ PARANASAL SINUSES
● Mouth should be closed with teeth together.
Lateral Projection – (R or L)
● Ramus: Keep the head in true lateral position.
● Seat (RAO or LAO body position)
● Body: Rotate head 30 degrees toward the cassette.
● MSP of the head is parallel with the plane of the cassette.
● Symphysis: Rotate the patient’s head 45 degrees toward the
● IP is perpendicular to the cassette.
cassette.
● IOML is parallel with the transverse axis of the cassette.
● CR: 25 degrees to pass directly through the mandibular region of
● Respiration: Suspend.
interest. (Enters slightly posteriorly to the mandibular angle on the
● CR: Perpendicular and entering ½ to 1 inch posterior to the outer
side farthest from the film, directed at an angle of 25 degrees
canthus.
cephalalad.)
● If patient cannot assume, use dorsal decubitus.
Submentovertical Projection
● Upright or supine
❖ FRONTAL AND ANTERIOR ETHMOIDAL SINUSES
● Neck fully extended,rest head on vertex and adjust head so that
PA Axial Projection – Caldwell Method
MSP is vertical.
● Seated-upright
● IOML is parallel as possible to the cassette.
− Angled grid technique
● Respiration: Suspend.
− Tilt vertical grid 15 degrees
● CR: Perpendicular to the IOML and centered midway between
− Rest patient’s nose and forehead.
the angles of the mandible.
− MSP and OML of the patient’s head is perpendicular to the cassette.
 − Respiration: Suspend. ● Respiration: Suspend.
● Vertical Grid Technique ● CR: Directed to exit the EAM closest to the cassette at following
− Rest tip of nose on the grid caudal angles.
− OML 15 degrees to the horizontal, MSP is perpendicular to the − Henschen Method = 15 degrees caudad (tumors of the acoustic
cassette. nerve)
− Respiration: Suspend. − Schuller Method = 25 degrees caudad
− CR: horizontal to exit the nasion. − Lysholm = 35 degrees caudad
▪ Runstorm recommended mouth open for visualization of petrous
❖ MAXILLARY SINUSES apex between the anterior wall of the EAM and the mandibular
Parietoacanthial Projection – Waters Method condyle.
● Hyperextended neck just enough to place the petrosae immediately Axiolateral Oblique Projection – Stenvers Method – Posterior Profile
below the maxillary sinus floors. ● Prone or seated
● OML 37 degrees to the plane of the cassette. ● Rest head on the forehead, nose and cheek with the side being
● MML is approximately perpendicular to the cassette. examined closest to the cassette.
● Respiration: Suspend. ● IOML parallel to the transverse axis of the cassette.
● CR: Perpendicular to the cassette and exiting the acanthion. ● MSP 45 degrees to the plane of cassette.
● Respiration: Suspend.
❖ MAXIALLR AND ETHMOIDAL SINUSES ● CR: 12 degrees cephalad 3 to 4 inches posterior and ½ inch inferior
Parietoacanthial Projection – Open-Mouth Waters Method to the upside EAM and exits about 1 inch anterior to the downside
● Pirie Method EAM.
● Projects sphenoid sinuses through the open mouth. ● Demonstrates petromastoid portion closest to the cassette.
● OML forms 37 degrees from the plane of cassette. Axiolateral Oblique Projection – Arcelin Method – Anterior Profile
● MML will not be perpendicular. ● Useful in children and adults who cannot be placed in prone.
● Slowly open the mouth while holding the position. ● Petromastoid portion is more magnified.
● Respiration: Suspend. ● Supine.
● CR: Perpendicular to the cassette and exiting the acanthion. ● Rotate patient head away from sie being examined so the MSP is 45
degrees with the plane of the cassette.
❖ ETHMOIDAL AND SPHENOIDAL SINUSES ● IOML perpendicular to the cassette.
Submentovertical Projection ● Respiration: Suspend.
● Place IOML as parallel as possible to the plane of cassette. ● CR: 1 inch anterior to EAM and ¾ inch above it at an angle of 10
● MSP is perpendicular to the cassette. degrees caudad.
● Respiration: Suspend. ● Exact reverse of Stenvers = demonstrates the petrous portion
● CR: Perpendicular to the IOML through the sella turcica, entering on farthest from the cassette.
the MSP approximately ¾ inch anterior to the level of the EAM.
Axiolateral Oblique Projection – Mayer Method
❖ ETHMOIDAL, SPHENOIDAL AND MAXILLARY SINUSES ● Supine or seat the patient laterally
PA Projections ● Tape the auricles forward
● Seated upright ● MSP of head is 45 degrees, side of interest is closest to the cassette.
● MSP and OML is perpendicular to the pane of the cassette. The petrous pyramid is perpendicular to the cassette.
● Respiration: Suspend. ● Respiration: Suspend.
● CR: ● CR: Directed at an angle of 45 degrees caudad to exit the EAM
− Posterior Ethmoidal Sinuses = perpendicular to nasion. closest to the cassette.
− Sphenoidal Sinuses = 10 degrees cephalad, passing through the Modifications of Mayer Method
sphenoidal sinuses exiting the glabella. ● Owen modification cited by Pendergrass, Schaeffer, and Hodes
− Maxillary Sinuses = perpendicular to midway between the − MSP of head is 40 degrees to the cassette.
infraorbital margins and the acanthion. − Tabletop and cassette head is angled 10 degrees caudally.
− CR: angled 28 degrees caudally.
(13) Temporal Bone ● Owen modification described by Etter and Cross
− MSP of head is 30 degrees caudally.
− CR: 25 to 30 degrees caudally.
❖ PETROMASTOID PORTION
● Owen modification described Compere
Axiolateral Oblique Projection – Original Law Method – Double Tube
− Head rotation varied from 30 to 45 degrees to plane of
Angulation
cassette.
● IP perpendicular to the cassette.
− CR: Directed caudally at an angle of 30 degrees.
● IOML and MSP parallel to the plane of the cassette.
AP Axial Projection – Towne Method
● Respiration: Suspend.
● Supine or seated-upright
● CR: Directed 15 degrees caudad and 15 degrees anteriorly, entering
● MSP perpendicular to the grid
approximately 2 inches posterior to, and 2 inches above, the
● OML perpendicular to the plane of the cassette.
uppermost EAM and exits the downside mastoid process.
● When the patient cannot flexed to extent, adjust IOML to be
Axiolateral Oblique Projection – Modified Law Method – Single-tube
perpendicular just increase CR angulation by 7 degrees.
Angulation
● Respiration: Suspend.
● Prone or seated, Tape the auricles forward
● CR: Directed at a caudal angle of 30 degrees to OML or 37 degrees
● Head in lateral position with the affected side closest to the cassette.
to the IOML. CR enters approximately 2 ½ inches above the nasion
● IOML is parallel and IP is perpendicular to the cassette.
and passes through at the level of EAMs.
● MSP of head is 15 degrees toward the cassette.
Submentovertical Projection and Hirtz Modification
● Respiration: Suspend.
● To project the long axis of the EAMs, the tympanic cavities and the
● CR: Directed to the midpoint of the grid at an angle 15 degrees
osseous part of the auditory tubes immediately behind the mandibular
caudad to exit the downside mastoid tip approximately 1 inch
condyles.
posterior to EAM. CR eanters approximately 2 inches posterior to,
● Seated-upright or supine.
and 2 inches, to uppermost EAM.
● Rest head on vertex. MSP is perpendicular to the grid.
● OML is parallel to the cassette. (if not possible, angle CR anteriorly
Axiolateral Projections – Henschen, Schuller, and Lysholm Methods
until it is perpendicular to OML.
● Prone or seated, tape the auricles forward
● Respiration: Suspend.
● MSP of head is in parallel with the plane of the cassette.
● CR:
● IP is perpendicular to the cassette.
● IOML is parallel to the cassette.
 − SMV = perpendicular to OML and centered to sagittal plane of the ❖ JUGULAR FORAMINA
throat at the level of EAMs. Submentovertical Axial Projection – Kemp Harper Method – Eraso
− Hirtz = midway between and 1 inch anterior to the EAMs at an Modification
anterior angle of 5 degrees. ● Kemp Harper Method
− Supine or seated upright
− Head on vertex, OML is parallel with the plane of the cassette and
MSP is perpendicular to the cassette.
❖ MASTOID PROCESS − Respiration: Suspend.
AP Tangential Projection – Hickey Method − CR: Directed 1 inch distal to the mandibular symphysis at a
● Supine or seated-upright. 20-degree posterior angle
● Tape the auricles forward. ● Eraso Modification
● Tilt the vertical grid device 15 degrees. − OML at 25 degrees with the cassette, MSP is perpendicular
● Rotate patient’s face away from the side being examined until MSP is − CR: Perpendicular to midpoint of cassette approximately 2 inches
55 degrees with the plane of the cassette. distal mandibular symphysis.
● IOML is perpendicular to the front edge of the cassette.
● Respiration: Suspend. AP Axial Projection (Transoral) – Chausse H Method
● CR: Perpendicular, entering the anterior border of the mastoid ● Supine
process at the junction of the auricle of the ear and the head, 1 inch ● Rotate MSP of head 10 degrees toward the side being examined.
superior to palpable tip of the mastoid. ● AML at an angle of 10 degrees superior from the vertical.
● Mastoid process free of superimposition. ● Ask patient to open mouth as wide as possible.
● Respiration: The patient can usually immobilize the mouth in the
PA Tangential Projection open position by softly phonating ah-h-h. if not, ask the patient to
● Seated-upright or prone, tape the auricles forward. suspend respiration for the exposure.
● Upright, tilt grid device, 15 degrees away from the patient. ● CR: Through the open mouth at an angle of 25 degrees cephalad.
● Prone, place cassette on the 15-degree-inclined angle block. ● Strickler = Suggessted two transoral positions: bilateral and
● Rotate face away from side being examined until MSP is 55 degrees unilateral.
to the plane of the cassette.
● Respiration: Suspend. ❖ HYPOGLOSSAL CANAL
● CR: Perpendicular to the head, entering the posterior border of the Axiolateral Oblique Projection – Miller Method – Anterior Profile
dependent mastoid process 1 inch superior to the palpable tip of the ● Used for patients with hypoglossal nerve tumor.
mastoid process. ● Supine or seated-upright.
● Mastoid process free of superimposition. ● Rotate MSP of the head 45 degrees away from the side being
examined.
❖ STYLOID PROCESSES ● IOML is parallel with the transverse axis of the cassette.
AP Projection – Fuchs Method ● Instruct the patient to open mouth wide.
● Seated-upright or supine ● Respiration: Phonate softly ah-h-h or suspend respiration.
● Angle the top of the grid device 13 degrees downward toward the ● CR: 12 degrees caudad to enter 1 inch directly anterior to, and ½ inch
patient. inferior to, the level of EAM on the side farthest from the cassette.
● MSP and AML is perpendicular to the plane of cassette.
● Instruct the patient to open mouth,
● Respiration: Suspend.
● CR: Perpendicular to headthrough the MSP and parallel with a line
extending through the EAMs.

PA Axial Projection – Cahoon Method

● Seated-upright or proone
● Rest the patient’s forehead and nose on the grid device.
● MSP and OML is perpendicular to cassette.
● Respiration: Suspend.
● CR: Directed to nasion at an angle of 25 degrees cephalad.

AP Oblique Projection – Wigby-Taylor Method

● Supine.
● Rotate the MSP of head 12 degrees toward the side being examined.
● Instruct patient to open mouth.
● Respiration: Ask the patient to phonate Ah-h-h. if not, suspend
respiration.
● CR: 8 degrees cephalad along a line passing approximately ¼ inch
distal to the tip of the mastoid process of the side adjacent to
cassette.

Axiolateral Oblique Projection – Fuchs Method

● Semiprone
● Center EAM to the cassette, and head in lateral position.
● MSP is parallel with the plane of the cassette. IP is perpendicular to
the cassette.
● AML is parallel with the transverse axis of the cassette.
● Instruct patient to open mouth wide (to move coronoid and mandible
inferiorly)
● Respiration: Suspend.
● CR: Directed to the EAM closest to the cassette at an angle of 10
degrees cephalad and 10 degrees anteriorly