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Position
PA
Projection
CR
CR is perpendicular to IR and centered to
midsagital place at level of T7 (7 to 8
inches below vertebrae promines/
inferior angle of scapula)
IR centered to CR
Left Lateral
Position
CR is perpendicular, directed to
midthorax at level of T7 (3 to 4 inches
below level of jugular notch)
AP
Projection
Left Lateral
Decubitis
AP Lordotic
RAO/LAO
(Anterior
Oblique)
RPO/LPO
(Posterior
Oblique)
CR is perpendicular to level of T7
Demonstrates
Included are both lungs from apices to
costophrenic angles and the air-filled
trachea from T1 down. Hilum region
markings, heart, great vessels, and bony
thorax are demonstrated
Included are the entire lungs from apices
to the costophrenic angles and from the
sternum anteriorly to the posterior ribs
and thorax posteriorly
Same as PA projection except: the heart
appears larger as a result of increased
magnification from a shorter SID and
increased OID of the heart. Possible
pleural effusion, and the lungs appear
more dense because they are not as fully
aerated
Entire lungs, including apices, both
costophrenic angles, and both lateral
borders of ribs should be included
*Extras*
Shield btw PT
and tube
Shield btw PT
and tube
Marker goes in
front
Never do
because lots of
radiation
If PT cant stand
Apices FSI
Angle pt or tube
20-30
RAO- PA with
right shoulder
against IR
CR is perpendicular to center of IR at
level of C6 to C7, midway between the
laryngeal prominence of the thyroid
cartilage and jugular notch
AP
Projection
(Upper
Airway)
CR is perpendicular to center of IR at
level of T1-2, about 1 inch above the
jugular notch
PA
Projection
(on a
stretcher if
the patient
can't
stand)
Abdominal Radiography
Position
AP
Projection
(Supine)
KUB
CR
CR is perpendicular to and directed to
center of IR (to level of iliac crest) and
MSP
14x17 LW
Breathe in breathe out hold it out
Demonstrates
*Extras*
Outline of liver, spleen, kidneys, and airfilled stomach and bowel segments and
the arch of the symphysis pubis for the
urinary bladder region
Shield breast
PA
projection
(prone)
Outline of liver, spleen, kidneys, and airfilled stomach and bowel segments and
the arch of the symphysis pubis for the
urinary bladder region
Lateral
Decubitus
Alternate for
erect
Air levels
Fluid side=down
Air side=up
Erect
Abdomen
CR is horizontal to center of IR
2 inches above Iliac crest and MSP
include diaphragm
Shield btw
patient and tube
Do PA expect
KUB
Dorsal
Decubitus
(Left
lateral)
CR is horizontal to center of IR
2 inches above iliac crest and to MSP
PT is supine
Film on the side on pt on table
14x17 CW
Lateral
Position
Alternate for
erect
Fluid side=down
Air side=up
Always do left
Shield on Pt side
in btw tube and
Pt
Hand Radiography
Position
CR
Demonstrates
PA
Projection
PA Oblique
Projection
"Fan"
Lateral
Projection
Lateral in
Extension
and Flexion
*Extras*
IP and MCP joints
Base of 3-5
metacarpals FSI
1st digit seen in
PA oblique
position
1st and 2nd
metacarpal FSI
Use step wedge
so DIP joint isnt
closed
Anterior and
posterior
phalanges
IP and MCP joints
open
Soft tissue
foreign bodies
AP Oblique
Bilateral
Projection
(Norgaurd)
Finger Radiography
Position
CR
Demonstrates
PA
Projection
Interphalangeal
and MCP joints
open
Anterior/posterior
displacement
PA Oblique
Projection
Lateral
projection
AP
Projection
(Thumb)
*Extras*
Attempt to free
the base of the
carpometacarpal
region of soft
tissue
superimposition
PA Oblique
Projection
(Thumb)
Lateral
Position
(Thumb)
AP Axial
Projection
(Modifiied
Robert's
Method:
Thumb)
PA Stress
thumb
projection
Place hand in PA
and collimate in
Interphalangeal
and MCP joints
open
Bennetts vs
Rolando FX
Better
demonstrate 1st
CMC joint
Make sure you
remesaure SID
Wrist Radiography
Position
CR
PA
projection
PA Oblique
Projection
Demonstrates
Midmetacarpals and proximal
metacarpals, distal radius, ulna, and
associated joints and pertinent soft
tissues of the wrist joint such as fat pads
and fat stripes are visible. All the
intercarpal spaces do not appear open
because of irregular shapes that result in
overlapping
Distal radius, ulna, carpals, and at least
to midmetacarpal area are visible.
Trapezium and scaphoid should be well
visualized, with only slight
superimposition of other carpals on their
medial aspects
*Extras*
Hamate,
capatate,
scaphoid (prox)
-Make fist
Trapezium and
trapezoid
Lateral
Projection
PA Ulnar
Deviation/
Modified
Stetchers
PA Hand
elevated
and ulnar
deviation/
True
Stetcher
PA
Projection/
Radial
Deviation
Carpal
Canal
(Tunnel)/
Gaynor
Heart
Projection
Carpal
Bridge/
Tangential
Projection
Rotated back a
little bit
See anterior vs
posterior
displacement
Use sponge to
elevate hand 200
Center at snuff
box
Scaphoid
Pressure on
median nerve
Make sure no
calcifications or
osificiation
Center at snuff
box
Elongates
scaphoid
Angle tube
Ulnar side of
carpals
AP
Clenched
Intercarpal faces
Stresses tendons
Forearm Radiography
Position
CR
AP
Projection
(Forearm)
Lateral
Projection
(Forearm)
Demonstrates
AP projection of the entire radius and
ulna is shown, with a minimum of
proximal row carpals and distal humerus
and pertinent soft tissues such as fat
pads and stripes of the wrist and elbow
joints
Lateral projection of entire radius and
ulna, proximal row of carpal bones,
elbow, and distal end of the humerus are
visible as well as pertinent soft tissue,
such as fat pads and stripes of the wrist
*Extras*
Medial/lateral
displacement
Include both
joints
Humeral
epicondyles are
superimposed
Head of radius
and ulna
SID 40
superimposed
*Extras*
Medial
epicondyle FSI
See olecronon
fossa
1/3
to of the
proximal radius
will still be SI by
the ulna
Elbow Radiography
Position
CR
Demonstrates
AP
Projection
(Elbow
fully
extended)
CR is perpendicular to IR
Directed to mid-elbow joint
Hand supinated/palm up
Fist clenched
10x12 LW
AP
Projection
(Elbow
cannot be
fully
extended)
AP Oblique
Projection/
Lateral
(external
rotation)
AP Oblique
Projection/
Medial
(internal
rotation)
CR is perpendicular to IR
Directed to mid-elbow joint
Hand pronated/palm down
Make sure epicondyles are rotated
medially
10x12 LW
Lateral
Projection
CR is perpendicular to IR
Directed to mid-elbow joint
Elbow at a 900 angle
Humerus and elbow on the same plane
Hand and wrist in lateral position
10x12 LW
Acute
Flexion
Projection
Head, neck,
tubercle of radius
Lateral
epicondyle
Capitulum
Coronoid process
trochlea
medial
epicondyle
Joint space FSI
Olecranon
process
Trochelar notch
Fat pads
See Hershey
kiss
Cut of the
olecranon
Flex arm as much
as possible
Trauma
Axial
Lateral
(Coyle
Method)
Axial
lateral
projections
(Coyle
Method)
Radial
Head
Laterals/
Lateromedi
al
projection
Radial head,
neck, and
capitulum
Coronoid process
and trochlea
Humerus Radiography
Position
CR
Demonstrates
*Extras*
AP Projection
Rotational
lateral
projection
Trauma
horizontal beam
lateral/laterome
dial projection
CR is perpendicular to midpoint of
distal two-thirds of humerus
Transthoracic
lateral
projection
(trauma)
Transthoracic
lateral
projection
(proximal
humerus)
shield in front
Include both
elbow and
shoulder joint
Arm abducted
Hand supinated
shield in front
Include both
elbow and
shoulder joint
Include
glenohumeral
joints
Shoulder Radiography
Position
CR
AP
Projection/extern
al rotation (nontrauma)
AP
Projection/intern
al rotation (nontrauma)
Inferosuperior
Axial Projection
(non-trauma) or
Lawrence
Direct CR medially 25 to 30
degrees centered horizontally to
axilla and humeral head
You have to move the whole tube
10x12 CW
PA transaxillary
projection/
Nobbs
modification
(non-trauma)
Inferosuperior
axial
projection/Cleme
nts modification
(non-trauma)
CR is directed perpendicularly to
the axilla and the humeral head to
pass through the glenohumeral
joint
8x10 CW
Direct horizontal CR perpendicular
to IR. If patient cannot abduct the
arm 90 degrees, angle the tube 5
to 15 degrees toward the axilla
8x10 CW
Demonstrates
AP projection of prox humerus and
lateral 2/3 clavicle and upper
scapula
Relationship of the humeral head to
the glenoid cavity
FX/dislocation of proximal humerus/
osteophytes/ bursal
Lateral view of proximal humerus
and lateral 2/3 clavicle and upper
scapula
Relationship of the humeral head to
the glenoid cavity
FX/dislocation of proximal humerus/
osteophytes/ bursal
*Extras*
Greater tubercle in
profile
Bank heart lesion
Lesser tubercle
inferior medial in
profile
Hill sacks
Orothopedics choice
of a lateral
Coracoid process
and lesser tubercle
Film against neck
Have to build
shoulder up
PT erect PA
Head turned away
Affected arm
straight up
PT laying down IR
next to neck
Affected arm up
straight
Posterior oblique
position/gelnoid
cavity (nontrauma)
Grashey
Tangential
projection/interc
ular (bicipital)
groove (nontrauma) Fisk
Humeral tubercles
and intertubercular
groove
No SI of acromin
process
AP
projection/neutra
l rotation
(trauma)
AP Scapulary Y
lateral (trauma)
PA Scapulary Y
lateral (trauma)
Neer Y Scapulary
lateral (trauma)
Tangential
projection/
supraspinatus
outlet (trauma)
Humeral head
posterior/acromial
450 Affected side
away
Humeral head
anterior/coracoid
process
450 toward affected
side
Subacromial space
Supraspinatus outlet
450 toward affected
side
AP apical oblique
axial projection/
Garth (trauma)
AP projection
(clavicle)
CR perpendicular to midclavical
10x12 LW
AP axial
projection
(clavicle)
AP projection (AC
joints)
CR is perpendicular to midpoint
between AC joints, 1 inch above
jugular notch
14x17 CW or 2 8x10
1st exposure without weights
2nd exposure with weights
Anytime there is an angle of 15 degrees or more then you see the subacromial space
Finger looking bone- coracoid
Garth 45-45- glenoid and subacromial space
Grayshey- glenoid space
PA Y- anterior and coracoid
AP Y- posterior and acromion
Neer Y- subacromial space and supraspinatus outlet
AP external- proximal humerus/ greater tubercle
PA external- proximal humerus/ lesser tubercle
Inferosuperior axial- orthopedics choice of a lateral
AP axial- clavical above ribs
45-450
Glenoid, humeral
head, subacromial
space
Long bone so you
need to include both
joints
Collimate long and
skinny
Entire clavicle above
the scapula and ribs
Clavicle looks
horizontal
Rule out FX before
with weight
projection
Weights need to be
tied to wrists
Foot Radiography
Position
CR
Demonstrates
AP Projection
(dorsoplantar
projection)
AP Oblique
projection
(medial rotation)
Lateral/mediolat
eral or
lateromedial
projection
*Extras*
A high arch
requires a
greater angle
and a low arch
needs 5 degrees
to be
perpendicular to
the metatarsals.
For foreign body,
CR should be
perpendicular to
IR with no CR
angle
AP weightbearing
projection
Lateral weightbearing
projection
Toe Radiography
Position
AP
Projection
AP oblique
(medial or
lateral
rotation)
Lateralmediolater
al
CR
Angle CR 10-15 degrees toward
calcaneus
CR is perpendicular to phalanges
If a 15 degree wedge is placed under the
foot for the parallel part-film alignment
the CR is perpendicular to the IR
Center CR to MTP joint in question
CR is perpendicular to IR, directed to
MTP joint in question
CR is perpendicular to IR
CR directed to interphalangeal joint for
first digit and to proximal
interphalangeal joint for second to fifth
digits
Demonstrates
*Extras*
Fractures or
dislocation of
toes
Osteoarthritis
Tangential
projection
(sesamoids
)
Calcaneus
Position
Plantodors
al (axial
projection)
Lateralmediolater
al
projection
CR
Direct CR to base of third metatarsal to
emerge at a level just distal to lateral
malleolous
Angle CR 40 degrees cephalad from long
axis of foot (which also would be 40
degrees from vertical if long axis of foot
is perpendicular to IR
CR angulation must be increased if long
axis of plantar surface of foot is not
perpendicular to IR
CR perpendicular to IR, directed to a
point 1 inch inferior to medial malleolus
Demonstrates
*Extras*
Ankle Radiography
Position
CR
AP
Projection
AP mortise
projection
(15-20
degrees
medial
rotation)
AP oblique
projection
(45 degree
medial
rotation)
Demonstrates
Distal one-third of tibia-fibula, lateral and
medial malleoli, and talus and proximal
half of metatarsals should be
demonstrated
*Extras*
Lateralmediolater
al (or
lateromedi
al)
projection
AP stress
projections
(Inversion
and
eversion
position)
CR
AP
Projection
(leg)
Lateralmediolater
al
projection
Demonstrates
Entire tibia and fibula must include ankle
and knee joints on this projection (or two
if needed)
The exception is alternative routine on
follow-up examinations
Entire tibia and fibula must include ankle
and knee joints on this projection (or two
if needed)
The exception is alternative routine on
follow-up examinations
*Extras*
CR
Align CR parallel to articular facets (tibial
plateau) for average sized patient, CR is
perpendicular to IR
Direct CR to a point inch distal to apex
of patella
To see if CR is parallel to articular facets
for open joint space is to measure
distance from anterior superior iliac
spines to tabletop to determine the CR
angle as follows:
<19 cm: 3 to 5 caudad (thin thighs and
buttocks)
19 to 24 cm: 0 degree angle (average)
Demonstrates
Distal femur and proximal tibia and
fibula are shown
Femorotibial joint space should be open
with the articular facets of the tibia seen
on end with only minimal surface area
visualized
*Extras*
AP Oblique
AP Oblique
projection
(lateral,
external
rotation)
Lateralmediolater
al
projection
AP weight
bearing
bilateral
knee
projection
CR is perpendicular to IR or 5 to 10
degrees caudad on thin patient directed
midpoint between knee joints at a level
below apex of patellae
PA Axial
weightbearing
bilateral
knee
projection
PA Axial
projection
(tunnel
view)
intercondyl
ar fossa
AP axial
projection
(intercondy
lar fossa )
PA
projection
(patella)
CR is perpendicular to IR
Direct CR to midpatella area which is
usually at approximately the midpoint
crease
Lateralmediolater
al
projection
(patella)
CR is perpendicular to IR
Direct CR to midpatella joint
CR
Angle CR caudad, 30 degrees from
horixontal (CR 30 degrees to femora)
adjust CR angle if needed for true
tangential projection of femoropatellar
Demonstrates
Intercondylar sulcus (trochlear groove)
and patella of each distal femur should
be visualized in profile with
femoropatellar joint space open
*Extras*
Merchant
bilateral
method
Tangential
patella
Inferosuperio
r projection
Hughston
method
joint spaces
Direct CR to a point midway between
patellae
Direct CR inferosuperiorly, at 10-15
degrees angle from lower legs to be
tangential to femoropatellar joint.
Palpate borders of patella to determine
specific CR angle required to pass
through infrapatellar joint space
Align CR approximately 15-20 degrees
from long axis of lower leg (tangential
to femoropatellar joint)
Direct CR to midfemoropatellar joint
Settegast
method
Hobbs
modification
superoinferio
r sitting
tangential
method
Align CR to be perpendicular to IR
(tangential to femoropatellar joint)
Direct CR to midermoropatellar joint
Minimum SID is 48 to 50 inches to
reduce maginification because of
increased OID
Patient supine,
45 degree knee
flexion
Patient prone, 55
degree knee
flexion
Patient prone, 90
degree knee
flexion
Rule out fracture
before acute
flexion of knee is
done
Patient sitting,
>90 degree knee
flexion
Femur Radiography
Position
CR
Demonstrates
*Extras*
AP
Projection
(femur-mid
and distal)
Lateralmediolater
al or
lateromedi
al
projection
(femurmid-and
distal)
Lateralmediolater
al
projection
(femurmid-and
proximal)
Hip Radiography
Position
AP Pelvis
projection
(bilateral
hips)
PA axial
oblique
projection
(acetabulu
m) teufel
method
AP
unilateral
hip
projection
(hip and
proximal
femur)
Axiolateral
inferosuper
ior
projection
(hip and
proximal
femur
trauma)
DaneliusMiller
method
Unilateral
frog-leg
projectionmediolater
al (hip and
proximal
femur)
Modified
CR
CR is perpendicular to IR, directed
midway between level of ASIS and the
symphysis pubis. This is approximately 2
inches inferior level of ASIS
Center IR to CR
When anatomy of interest is downside,
direct CR perpendicular and centered to
1 inch superior to the level of the greater
trochanter, apporox 2 inches lateral to
the midsagittal plane
Angle CR 12 degrees cephalad
Demonstrates
Pelvic girdile, L5, sacrum, and coccyx,
femoral heads and neck, and greater
trochanters are visible
*Extras*
cleaves
method
Modified
axiolateralpossible
trauma
projection
(hip and
proximal
femur)
CR
Demonstrates
*Extras*
Different angles
caused by
difference in the
shape of male
and female
pelvis
Posterior
oblique
positions
(LPO and
RPO)
CR
Angle CR 30-35 degrees cephalad (males
about 30 and females 35, with an
increase in the lumbosacral curve)
Direct CR to midline about 2 inches
below level of ASIS
Center IR to CR
CR is perpendicular to IR
Direct CR 1 inch medial to upside of ASIS
Center IR to CR
Demonstrates
*Extras*
To demonstrate
the interior or
distal part of the
joint more
clearly, the CR
may be angled
15-20 degrees
cephalad
CR
CR perpendicular to IR, centered to 3 to
4 inches below jugular notch
IR centered to level of CR (top of IR
should be about 1 inches above
shoulders)
65-70 kVp
Demonstrates
Above diaphragm: ribs 1 through 10
should be visualized
*Extras*
Unilateral
rib study
(AP-PA
position)
Posterior
or anterior
oblique
(Axillary
ribs)
CR
CR perpendicular to IR
CR directed to center of sternum (1 inch
to left of midline and midway between
the jugular notch and xiphoid process)
Demonstrates
Sternum is visualized, superimposed on
heart shadow
*Extras*
Lateral
position/ R
or L lateral
CR perpendicular to IR
CR directed to center of
sternum (midway between the jugular
notch and xiphoid process)
SID of 60-72 inches is recommended to
reduce magnification of sternum caused
by increased object image receptor
distance
Center IR to CR
CR
PA
projection
Demonstrates
Lateral aspect of manubrium and medial
portion of the clavicals visualized lateral
to vertebral column through
superimposing ribs and lungs
*Extras*
Anterior
oblique
position
(RAO/LAO)
CR
Demonstrates
*Extras*
AP axial
sacrum
projection
AP axial
coccyx
projection
Lateral
Sacrum
and Coccyx
position
Lateral
coccyx
position
CR perpendicular to IR
Direct CR 3-4 inches posterior to ASIS
(centering for sacrum)
Center IR to CR
CR perpendicular to IR
Direct CR 3-4 inches posterior and 2
inches distal to ASIS (centering for
coccyx)
Center IR to CR
Coccyx
Projection may
also be
preformed prone
(angle 10
degrees
cephalad) with
CR centered at
the coccyx which
can be located
using the greater
trochanter
High scatter so
close collimation
AP axial
projection
Anterior
oblique
position
Posterior
oblique
position
Lateral
position
Lateral
position,
horizontal
beam
(trauma
CR
CR perpendicular to IR
Direct CR through center of open mouth
Center IR to CR
Angle CR 15-20 degrees cephalad
Direct CR to enter at the level of the
lower margin of thyroid cartilage to
pass through C4
Center IR to CR
Direct CR 15 degrees caudad to C4
(level of upper margin of thyroid
cartilage)
Direct CR 15 degrees caudad to C4
Center IR to CR
CR perpendicular to IR
Direct CR horizontally to C4 (level of
upper margin of thyroid cartilage)
Center IR to CR
CR perpendicular to IR
Direct CR horizontally to C4 (level of
upper margin of thyroid cartilage)
Center IR to CR
Demonstrates
Dens (odontoid process) and vertebral
body of C2, lateral masses and
transverse processes of C1 and
atlantoaxial joints demonstrated
through open mouth
C3 to T2 vertebral bodies; space
between pedicles and intervertebral
disk spaces clearly seen
*Extras*
Angle 15 when
supine
Angle 20 when
erect
72 SID
compensates for
increased OID
and provides for
greater spatial
resolution
Longer SID
results in less
magnification
with increased
image sharpness
patient)
Swimmers
lateral
position (C5T3 region)
Lateral
position
(hyperflexion
and
hyperextensi
on)
AP projection
for C1/C2
(dens)
Fuchs
method
PA projection
for C1/C2
(dens)
CR perpendicular to IR
Direct CR to T1 which is approx 1 inch
above level of jugular notch anteriorly
and at level of vertebra prominens
posteriorly
Center IR to CR
CR perpendicular to IR
Direct CR horizontally to C4 (level of
upper margin of thyroid cartilage)
Center IR to CR
angles of mandible
Center IR to CR
AP Wagging
jaw
projection
AP axial
projection
(vertebral
arch/pillars)
CR perpendicular to IR
Direct CR horizontally to C4 (level of
upper margin of thyroid cartilage)
Center IR to CR
AP Projection
Lateral position
CR
CR perpendicular to IR
Direct CR to T7 (3 to 4 inches below
jugular notch or 1-2 inches below
sternal angle)
Center IR to CR
CR perpendicular to long axis of
thoracic spine
Direct CR to T7 (3 to 4 inches below
jugular notch or 7-8 inches below
vertebra prominens)
Center IR to CR
Demonstrates
Thoracic vertebrae bodies,
intervertebral joint spaces, spinous
and transverse processes, posterior
ribs, and costovertebral articulations
Thoracic vertebral bodies,
intervertebral joint spaces, and
intervertebral foramina. T1 to T3 will
not be well visualized
Obtain a lateral image using a
swimmers lateral if the upper thoracic
vertebrae are of special interest
*Extras*
Oblique
position
(anterior/poster
ior oblique)
CR perpendicular to IR
Direct CR to T7 (3 to 4 inches below
jugular notch or 1-2 inches below
sternal angle)
Center IR to CR
AP or PA
projection
CR
CR perpendicular to IR
Larger IR (35x43): direct CR to level of
iliac crest (L4-L5 interspace) this larger
IR will include lumbar vertebrae, sacrum,
and possibly coccyx
Smaller IR (30x35): direct CR to level of
L3, which may be localized by palpation
of the lower costal margin (1.5 inches
above iliac crest) this smaller IR will
include primarily the 4 lumbar vertebrae
Center IR to CR
Demonstrates
*Extras*
Obliques
posterior
or anterior
oblique
position
Lateral
position
AP Axial
L5-S1
projection
Cholangiogram Radiography
Position
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
Esophagus Radiography
Position
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
Sinus Radiography
Position
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
Orbits Radiography
Position
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
Mandible Radiography
Position
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
CR
Demonstrates
*Extras*
Skull Radiography
Position
CR
Demonstrates
*Extras*