X-RAY PROTOCOLS AND ROUTINE

SKULL (AP AND LATERAL)

SKULL AP
• OML perpendicular to the IR

• CR perpendicular to nasion.

AP Projection

A. Patient Position

➤ Patient is either in prone or seated position.

Midsaggital plane of the patient's body is center to the
grid.

B. Part Position

➤ Rest the patient's forehead and nose against the Table or

Bucky surface.
➤ Flex the patient's neck so that the OML is perpedicular
to the plane of the IR.
➤ Top of the image receptor is approximately 11⁄2 inches
(4cm) above the vertex of the skull.

C. Central Ray

➤ Perpendicular to the image receptor exiting at the

nasion.

D. Patient Instructions
 ➤ Suspended respiration.

E. Exam Rationale

➤ Petrous pyramids should fill the orbits. Anterior and

lateral walls of the cranium.
➤ Frontal bone, Cristal galli, ethmoid air cells.
➤  Skull fractures neoplastic processes and paget's
disease.

SKULL LATERAL
• MSP is parallel to IR

• IPL is perpendicular to IR

• IOML perpendicular to front edge of the cassette.

• CR perpendicular to 2 inches above EAM

PARANASAL SINUSES (WATERS, CALDWELL, LATERAL)

WATER’S METHOD
• Patient head is resting on chin.

• MML is perpendicular to IR

• OML forms an angle of 37° with the plane of the film.

• Tip of the nose ¾ inch from the image receptor

• CR directed to acanthion
2. Parietoacanthial Projection (Waters Method)

A. Patient Projection

➤ Patient is in prone or seated upright position

B. Part Position

➤ The neck is extended and the chin placed on the bucky

➤ The image receptor is centered to the acanthion MSP is
perpendicular to the midline of the image elstreceptor
➤ OML forms a 37° angle to the image receptor

 ➤ The average patient's nose will be about 3/4 inch away

from the image receptor

C. Central Ray

➤ Perpendicular exiting to the acanthione

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This projection is especially good for demonstrating

fractures of the orbit and depressed fractures of the nasal
wings.
➤ It also demonstrates orbits, maxillae and zygomatic
arches.

F. Structures Shown

➤ Inferior orbital rim

➤ Maxillae
➤ Nasal septum
➤ Zygomatic bones and bones
➤ Anterior nasal spine
CALDWELL METHOD
• CR 15° caudad to nasion

• Best projection to demonstrate the frontal sinuses and anterior ethmoidal sinuses.

• Petrous ridge are projected into lower 1/3 of the orbits.

PA Axial Projection (Caldwell Method)

A. Patient Projection

➤ Patient is in prone or seated upright position

B. Part Position

➤ Forehead and nose are resting against the table top

➤ MSP is perpendicular to the image receptor

➤ OML is perpendicular to the image receptor

➤ Ensure no rotation or tilt of the head

C. Central Ray

➤ 15° caudally exiting the nasion

➤ Petrous ridges are projected into the lower third of
the orbit
➤ 30° caudally exiting the nasion if for the
demonstration of the orbital rims in particular orbital
floors (sometimes referred to as Exaggerated
Caldwell)
➤ Petrous ridges are projected below the inferior margins
of the orbit

D. Patient Instructions
 ➤ Suspended respiration

E. Exam Rationale

➤ This projection is performed to demonstrate fractures of

the facial bones and is especially helpful to determine
alveolar ridge fractures.
➤ To demonstrates the orbital rim, the nasal septum and the
mandibular condyles, zygomatic bones and anterior nasal
spine.

F. Structures Shown

➤ Orbital rim Maxillae

➤ Nasal septum Zygomatic bones Anterior nasal spine

LATERAL
• CR perpendicular to ½ inch inferior to nasion

• Soft tissue structure of the nose.

• Nasal bones

• Nasofrontal suture

• Anterior nasal spin

Lateral Projection

A. Patient Projection

➤ Patient is in a semiprone or obliquely seated position

B. Part Position

➤ Head is in true lateral position 

➤ MSP is parallel to the image receptor
 ➤ IPL is perpendicular to the image receptor
➤IOML is parallel with the transverse axis of the image
receptor
➤ Image receptor is centered to the zygoma

C. Central Ray

➤ Perpendicular to the image receptor entering to the malar

surface of the zygomatic bone between the outer canthus.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This position is used to demonstrate the facial bones of

the side closest to the image receptor with the opposite
side superimposed.
➤ It is useful to demonstrate depressed fractures of the
frontal sinus, the orbital roof, sella turcica and mandible.

F. Structures Shown

➤ Superimposed facial bones

➤ Greater wings of the sphenoid

➤ Orbital roods
➤ Sella turcica
➤ Zygoma and mandible

TMJ

AP axial/ TOWNES
• supine - MSP & OML ┴

• C.R. 350 from the OML or 420 from IOML

• 3” above the nasion

 1. AP Axial Projection

A. Patient Projection

➤ Patient is in supine or seated erect position

B. Part Position

➤ MSP is perpendicular to the image receptor 

➤ OML is perpendicular to the image receptor

C. Central Ray

➤ 35° caudally entering at a point approximately 3 inches

(7.6 cm) above the nasion, centered between the TMJ's.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This projection is used to demonstrate the condyloid

processes of the mandible and of the mandibular fossae of
the temporal bones.

F. Structures Shown

➤ Condyle
➤ Temporomandibular articulation

LATERAL (OPEN AND CLOSE MOUTH)

• 15° caudad To dependent EAM closest to IR • Demonstration o

2. Axiolateral / Axial Transcranial Projection

A. Patient Projection

➤ Patient is in semi-prone position

B. Part Position

➤ Head in a lateral position

➤ TMJ's is centered to the image receptor 

➤ MSP is parallel to the image receptor

➤ IPL is perpendicular to the IR
➤ IOML is parallel to the transverse axis of the image
receptor
➤ Exposure shall be made with the patient's mouth closed
and open unless contraindicated.

C. Central Ray

➤ 25-30° caudally center to the image receptor, enters in

the about 1/2 inch (1.3 cm) anterior and 2 inches (5cm)
superior to the upside EAM and passes through the lower TMJ.

D. Patient Instructions

➤ Suspend respiration
if closed mouth: keep mouth close - if mouth open: keep
mouth open

E. Exam Rationale

➤ This projection better demonstrates the TMJ closest to

the image receptor.
 ➤ Demonstrate also the configuration of the condyle and
mandibular fossa and the direction and amount of movement.
➤ Can illustrate dislocation or small fractures of the
cortex of the condyle
➤ Both sides are taken in open and close mouth for
comparison

F. Structures Shown.

➤ Temporomandibular joints
➤ Mandibular condyle
- inferior to the articular tubercle

N.B

Degree of caudal angulation may vary due to shape of patient's head.

- for Brachycephalic, decrease caudal angulation approximately 15-20°

caudally

for Dolicocephalic, increase caudal angulation approximately 30-35°

caudally

ORBITS

RHESE METHOD (THE THREE POINT LANDING)

• Prone position

• Rest the ZYGOMA, NOSE and CHIN to the table.

• AML perpendicular to the plane of the film.

• MSP forms an angle 53° with the plane of the film.

• Demonstrate the OPTIC FORAMEN at the LOWER OUTER QUADRANT.

PA AXIAL
• Patient in prone position.

• Rest patient’s head on FOREHEAD and NOSE

• CR 20°-25° caudad to exit at the level of the inferior margin of the orbit.

• Best demonstrate the superior orbital fissure.

MANDIBLE

PA PROJECTION
(Forehead and nose)

• Rami and lateral portion of the body.

• CR perpendicular to tip of nose.

(Chin and nose)

• Frontal view of the body.

• For the mentum of the mandible.

• For general survey of the mandible

• CR perpendicular to lips

2. PA Projection
 A. Patient Projection

➤ Patient is either prone or upright position

B. Part Position

➤ Forehead and nose are touching the table top OML is

perpendicular to the image receptor MSP is perpendicular to
the image receptor

C. Central Ray

➤ Perpendicular to the image receptor exiting at the

junction of the lips.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This projection is used to demonstrate the mandibular nad

rami and body.

F. Structures Shown

➤ Mandibular rami and body

➤ Entire mandible

N.B.
If it used to demonstrate mentum, place the nose and chin against the
bucky with the MSP is perpendicular to the midline of the image
receptor.

LATERAL
• Head in true lateral position.

• 25° cephalad to pass directly through the mandibular region of interest.

CERVICAL SPINE (AP AND LATERAL)

CERVICAL SPINE AP
• Occlusal plane perpendicular to the base of the skull.

• CR 15˚- 20˚ cephalad, to enter at the level of the lower margin of thyroid cartilage to pass through C4.

1. AP Axial Projection

A. Patient Position
 ➤ Patient is in supine position with the mid-sagittal plane
of the body is center to the center line of the table.

B. Part Position

➤ Extend the neck so that the line from the lower edge of
the upper incisors to the mastoid tips (occlusal plane) is
perpendicular to the table top.

C. Central Ray

➤ 15 to 20° cephalad, directed to C4 or slightly inferior

to the most prominent point of the thyroid cartilage, to
open up the intervertebral disk spaces.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ Examination of the cervical spine may be indicated in the

investigation of the degenerative disease or in cases of
trauma.
➤ This projection demonstrates the lower five cervical
bodies, upper two or three thoracic bodies, interpedicute
spaces and intervertebral disk spaces.

F. Structures Shown

➤ Vertebral bodies

➤ Intervertebral disk spaces 

➤ Spinous process
➤ Mandibular angles
CERVICAL SPINE LATERAL
• Top of cassette about 1-2 inches above EAM.

• Long (72 inches or 180 cm) SID compensates for increased OID and provides for less magnification. •
CR horizontally directed to upper margin of thyroid cartilage (C4-C5).

2. Lateral Projection (Grandy Method)

A. Patient Position

➤ Patient is in lateral position either seated or standing

position with the left side against the image receptor. The
top of the image receptor will be 1 inch above the EAM.

B. Part Position

➤ Center the midcoronal plane to the midline of the image

receptor.
Rajse the chin slightly to prevent overlap of the mandibular
rami on the upper vertebrae.
➤ Rotate the shoulders anteriorly if the patient shoulder
is round or posteriorly according to the natural kyphosis of
the back.
➤ Adjust patient's shoulders to same horizontal level and
body to true lateral position.
➤ Weights may be attached to wrists to help lower
shoulders.

C. Central Ray

➤ Horizontal and Perpendicular to C4.

➤ The superior border of the image receptor should be
placed about 2 inches above the external auditory meatus
 (EAM).

D. Patient Instructions

➤ Suspended respiration on full expiration to obtain

maximum depression of the shoulders.

E. Exam Rationale

➤ This projection shows the vertebral bodies in a latera

position, the intervertebral joint spaces, the articula
pillars, the spinous process, and the articular facet of the
lower five vertebrae.

F. Structures Shown

➤ Cervical vertebral bodies

➤ Intervertebral joint spaces
➤ Articular pillars
➤ Spinous process
➤ Zygapophyseal joints

CERVICAL SPINE SERIES ( AP, OBLIQUE AND LATERAL)

CERVICAL SPINE AP
• Occlusal plane perpendicular to the base of the skull.

• CR 15˚- 20˚ cephalad, to enter at the level of the lower margin of thyroid cartilage to pass through C4.
1. AP Axial Projection

A. Patient Position

➤ Patient is in supine position with the mid-sagittal plane

of the body is center to the center line of the table.

B. Part Position

➤ Extend the neck so that the line from the lower edge of
the upper incisors to the mastoid tips (occlusal plane) is
perpendicular to the table top.

C. Central Ray

➤ 15 to 20° cephalad, directed to C4 or slightly inferior

to the most prominent point of the thyroid cartilage, to
open up the intervertebral disk spaces.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ Examination of the cervical spine may be indicated in the

investigation of the degenerative disease or in cases of
trauma.
➤ This projection demonstrates the lower five cervical
bodies, upper two or three thoracic bodies, interpedicute
spaces and intervertebral disk spaces.

F. Structures Shown

➤ Vertebral bodies
 ➤ Intervertebral disk spaces 

➤ Spinous process
➤ Mandibular angles

CERVICAL SPINE LATERAL

• Top of cassette about 1-2 inches above EAM.

• Long (72 inches or 180 cm) SID compensates for increased OID and provides for less magnification. •
CR horizontally directed to upper margin of thyroid cartilage (C4-C5).

2. Lateral Projection (Grandy Method)

A. Patient Position

➤ Patient is in lateral position either seated or standing

position with the left side against the image receptor. The
top of the image receptor will be 1 inch above the EAM.

B. Part Position

➤ Center the midcoronal plane to the midline of the image

receptor.
Rajse the chin slightly to prevent overlap of the mandibular
rami on the upper vertebrae.
➤ Rotate the shoulders anteriorly if the patient shoulder
is round or posteriorly according to the natural kyphosis of
the back.
➤ Adjust patient's shoulders to same horizontal level and
body to true lateral position.
➤ Weights may be attached to wrists to help lower
shoulders.

C. Central Ray

➤ Horizontal and Perpendicular to C4.

➤ The superior border of the image receptor should be
 placed about 2 inches above the external auditory meatus
(EAM).

D. Patient Instructions

➤ Suspended respiration on full expiration to obtain

maximum depression of the shoulders.

E. Exam Rationale

➤ This projection shows the vertebral bodies in a latera

position, the intervertebral joint spaces, the articula
pillars, the spinous process, and the articular facet of the
lower five vertebrae.

F. Structures Shown

➤ Cervical vertebral bodies

➤ Intervertebral joint spaces
➤ Articular pillars
➤ Spinous process
➤ Zygapophyseal joints

CERVICAL SPINE OBLIQUE BOTH SIDES

• Rotate body and head 45°

• 15˚-20° cephalad toC4

4. AP Axial Oblique Projection (RPO and LPO Position)

A. Patient Position

➤ Patient is either seated or standing position with the

body at a 45° angle facing the vertical cassette holder.

B. Part Position
 ➤ Adjust the whole body forms an angle of 45 degrees eg
with the plane of the image receptor.
➤ Place side of interest farthest from cassette

➤ Have the patient slightly extend the chin while looking

forward. Turning the chin to the side causes slight rotation
of the superior vertebrae and should be avoided.

C. Central Ray

➤ 15 to 20° cephalad, directed to C4.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This oblique projections demonstrate the cervical

intervertebral foramina and pedicles farthest from the image
receptor and other parts of the cervical vertebrae.

F. Structures Shown

➤ Intervertebral foramina
➤ Intervertebral disk spaces
➤ C1 to C7

N.B:
AP oblique projection (Hyperflexion and Hyperextension) is a functional
studies of the cervical vertebrae in the oblique to demonstrate
fractures of the articular processes as well as obscure dislocations and
subluxations. When acute injury has been sustained, manipuation of the
patient's head must be performed by a physician.

5. PA Axial Oblique Projection (RAO and LAO Positions)

A. Patient Position

➤ Patient is either erect or seated position with the body

at an angle of 45° from the PA position.

B. Part Position

➤ Rotate the patient's entire body to a 45 degree angle to

place the foramina closest the image receptor. 
 ➤ Adjust the position of the patient's head so that the
midsagittal plane is aligned with the plane of the spine.

C. Central Ray

➤ 15 to 20° caudally, directed to C4.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This position demonstrates the open intervertebral

foramina and pedicles closest to image receptor and other
parts of the cervical vertebrae.

F. Structures Shown

➤ Intervertebral foramina
➤ Intervertebral disk spaces
➤ Cervical Vertebrae

THORACIC VERTEBRA (AP AND LATERAL)

THORACIC VERTEBRA AP
• Top of cassette about 1 to 1 ½ inches, or 3 to 5 cm, above level of shoulder.

• CR perpendicular to T7

• Thoracic vertebral bodies, intervertebral joint spaces, spinous and transverse processes, posterior ribs,
and costovertebral articulations
1. AP Projection

A. Patient Position

➤ Patient is in supine position with the midsagittal plane

of the body is center to the midline of the table.

B. Part Position

➤ Flex the patient's hips and knees, to place thighs in

vertical position to reduce kyphosis.
➤ Superior border of the image receptor is 11⁄2 to 2 inches
above the shoulders.

C. Central Ray

➤ Perpendicular to T6, directed 3 to 4 inches below the

sternal notch appoximately halfway between the jugular notch
and xyphoid process.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration,

reduces air volume in thorax for more uniform density of
complete T spine.

E. Exam Rationale

➤ The most common indications for thoracic spine

examinations are trauma and degenerative disease. It is used
to demonstrate the thoracic bodies, intervertebral disk
spaces, transverse process, costovertebral articulations and
surrounding structures.

F. Structures Shown

➤ Thoracic Vertebrae

➤ Transverse Processes
➤ Pedicles and Intervertebral disk spaces
THORACIC VERTEBRA LATERAL
• Patient is allowed to continue breathing during exposure to blur out unwanted rib and lung markings
overlying the thoracic vertebra.

• Use at least 2 seconds exposure time.

• Perpendicular to T7 entering the posterior Half of the thorax

2. Lateral Projection

A. Patient Position

➤ Patient is in left lateral recumbent position to place

the heart closer to the image receptor which minimizes
overlapping of the vertebrae by the heart.

B. Part Position

➤ Place the long axis of the spine parallel to the table.

Midaxillary line should be centered to the table.

C. Central Ray

➤ Flex the patient's hops and knees for stability with

support between knees.
D. Patient Instructions

➤ Perpendicular to the film, directed to T7 enters the

posterior half of the thorax.
➤ The superior border of the image receptor should be 1⁄2
to 1 inch above the top of the shouder.

➤ Normal respiration to obliterate or diffuse the vascular

markings and ribs or suspend respiration at the end of full
expiration.

E. Exam Rationale

➤ The lateral projection of the thoracic spine demonstrates

vertebral bodies intervertebral disk spaces and
intervertebral foramina. The spinous 'processes are not well
visualized due to their superimposition on ribs. The upper
three to four vertebrae are not visualized due to
superimposition of from shoulder structures.

F. Structures Shown

➤ Thoracic Vertebrae
➤ Intervertebral disk spaces 

➤ Intervertebral foramina
LUMBAR VERTEBRA (AP AND LATERAL)

LUMBAR VERTEBRA AP
• 1. Perpendicular at the level of the iliac crest for lumbosacral studies.

• 2. Perpendicular to L3 for Lumbar study.

1. AP Projection

A. Patient Position

➤ Patient is in supine position with the mid- sagittal

plane of the body is center to the midline of the table.

B. Part Position

➤ Flex the patient's knees and hips to place back in firm

and help reduce the lumbar curvature.

C. Central Ray
 ➤ Perpendicular, directed above the level of the iliac
crest (L3) for the lumbar examination. At the level of the
iliac crest (L4) for the lumbo-sacral examination.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration.

E. Exam Rationale

➤ The most common indications for lumbar spine examinations

are trauma and degenerative disease. It is also used to
demonstrate the lumbar bodies, intervertebral disk spaces,
interpediculate spaces, laminae, spinous and transverse
processes.
➤ Some department protocols require collimation be open to
enables visualization of the liver, kidney, spleen and psoas
muscle margins along with air or gas patterns.

F. Structures Shown

➤ Lumbar Vertebral Bodies

➤ Transverse Processes
➤ Pedicles and Intervertebral disk spaces

LUMBAR VERTEBRA LATERAL

• 1. Perpendicular at the level of the iliac crest for lumbosacral studies.

• 2. Perpendicular to L3 for Lumbar study.

 2. Lateral Projection

A. Patient Position

➤ Patient is in left lateral recumbent with the knees and

hips flexed for comfort.

B. Part Position

➤ Align the midcoronal plane of the body to the midline of

the table.
Place a radiolucent support under the lower thorax as needed
to place the long axis of the spine near parallel to the
table.

C. Central Ray

➤ Perpendicular, directed to the level of the iliac crest.

When the spine cannot be adjusted to the horizontal central
ray angulation is required. In most intances an average of 5
degrees caudally for men and 8 degrees for women.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration.

E. Exam Rationale

➤ This projection demonstrates the lumbar bodies and their

interspaces, intervertebral foramina of L1-L4, the spinous
processes and the lumbo-sacral junction. L5 intervertebral
foramina left and right are not usually well visualized
because of their oblique direction

F. Structures Shown

➤ Vertebral Bodies
➤ Intervertebral disk spaces  

➤ Spinous Processes
➤ Intervertebral Foramina

SCOLIOSIS RADIOGRAPHY
LUMBAR VERTEBRA AP
• 1. Perpendicular at the level of the iliac crest for lumbosacral studies.

• 2. Perpendicular to L3 for Lumbar study.

1. AP Projection

A. Patient Position

➤ Patient is in supine position with the mid- sagittal

plane of the body is center to the midline of the table.

B. Part Position

➤ Flex the patient's knees and hips to place back in firm

and help reduce the lumbar curvature.

C. Central Ray

➤ Perpendicular, directed above the level of the iliac

crest (L3) for the lumbar examination. At the level of the
iliac crest (L4) for the lumbo-sacral examination.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration.

E. Exam Rationale

➤ The most common indications for lumbar spine examinations

are trauma and degenerative disease. It is also used to
demonstrate the lumbar bodies, intervertebral disk spaces,
interpediculate spaces, laminae, spinous and transverse
processes.
➤ Some department protocols require collimation be open to
enables visualization of the liver, kidney, spleen and psoas
muscle margins along with air or gas patterns.

F. Structures Shown

➤ Lumbar Vertebral Bodies

➤ Transverse Processes
➤ Pedicles and Intervertebral disk spaces
AP PROJECTION RIGHT AND LEFT BENDING
• Demonstrate structural change with right and left lateral flexion.

• Used in patients with early scoliosis

• CR perpendicular to the level of L3

PA or AP Upright (R and L Bending)

A. Patient Position

➤ Patient is in erect position either AP or PA.

B. Part Position

➤ Align midsagittal plane to the midline of the table.

➤ Lower margin of the cassette is 1 to 2 inches below the
iliac crest.

C. Central Ray

➤ Perpendicular to the midpoint of the film.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration.

E. Exam Rationale

➤ To determine the range of motion.

 F. Structures Shown

➤ Thoracic and Lumbar Spine

LATERAL HYPERFLEXION AND EXTENSION

• CR perpendicular to the spinal fusion area or L3.

• Projection is used to assess mobility at spinal fusion site.

Lateral Projection (R or L Position) (Hyperflexion and Hyperextension)

A. Patient Position

➤ Patient is in lateral recumbent position

➤ Center the midcoronal plane of the body to the
midline of the table.

B. Part Position

➤ For Hyperflexion:
o Have the patient get into fetal position (bend forward)
and draw legs up as far as possible. > For Hyperextension:
o Have the patient lean the thorax backward and posteriorly
extend the thighs and limbs as far as posssible.
➤ Ensure that there is no rotation of thorax or pelvis.

C. Central Ray

➤ Perpendicular to the spinal fusion area or at the level

of the lower costal margin.

D. Patient Instructions
 ➤ Suspended respiration at the end of full expiration.

E. Exam Rationale

➤ This hyperflexion and hyperextension studies used to

demonstrate anterior mobility at the fusion site and to
determine whether motion is present in the area of a spinal
fusion or to localize a herniated disk as shown by
limitation of motion at the site of the lesion.

F. Structures Shown

➤ Thoracic and Lumbar Spine

SACRUM AND COCCYX (AP, PA AND LATERAL)

AP AND PA
SACRUM

• (AP) 15°CEPHALAD

• (PA) 15°CAUDAD

• To a point 2 inches superior to the symphysis pubis.

AP Axial Projection

A. Patient Position

➤ Patient is in supine position with arms placed at the

patient's sides.

B. Part Position

➤ Midsagittal plane of the body is centered to themidline

of the table.
➤ The knees may flexed to place the posterior surface of
 the body in contact with the table and help reduce rotation
of the pelvis.

C. Central Ray

➤ 15° cephalad, directed to a point 2 inches superior to

the pubic symphysis.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration.

E. Exam Rationale

➤ The most common indication for sacrum examination is

trauma. It demonstrates the ala, promontory, anterior sacral
foramina and the L5-S1 joint space.

F. Structures Shown

➤ Sacrum
➤ Pubic bones

COCCYX

• (AP) 10°CAUDAD

• (PA) 10°CEPHALAD

• To a point 2 inches superior to the symphysis pubis.

AP Projection

A. Patient Position

➤ Patient is in supine position with midsagittal plane of

the body is center to the midline of the table.

B. Part Position

➤ Ensure there is no rotation of the pelvis

C. Central Ray
 ➤ 10° caudally, directed 2 inches superior to the symphysis
pubis

D. Patient Instructions

➤ Suspended respiration at the end of full expiration

E. Exam Rationale

➤ Demonstrate the coccyx free of superimposition

➤ The rectal and bladder shadows overlie the coccyx, it is

often desirable to have the patient void and defecate before
the radiographic examination.

F. Structures Shown

➤ Coccyx
➤ Symphysis Pubis

LATERAL
• Interiliac plane perpendicular to the table.

• CR perpendicular to the level of the ASIS at a point 3 ½ inches posterior.

Lateral Position

A. Patient Position
 ➤ Patient is in left lateral recumbent with hips and knees
are flexed for comfort.

B. Part Position

➤ Support under the body to place the long axis of spine

horizontally.

➤ Place pelvis and body in true lateral postion

C. Central Ray

➤ Perpendicular, directed 3 1⁄2 inches posterior to the

ASIS and 2 inches inferior.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration.

E. Exam Rationale

➤ The most common indication for the examination of

the coccyx is trauma.

F. Structures Shown

➤ Coccyxoi
➤ L5-S1

THORACIC CAGE (PA AND AP)

THORACIC CAGE (PA)

• Best demonstrate the anterior ribs above the diaphragm (ribs 1-9th or 10th visualized above the
diaphragm).

• CR perpendicular to T7

• Suspend at full inspiration to depress the diaphragm as much as possible. POSTERIOR R

THORACIC CAGE (AP)
RIBS ABOVE DIAPHRAGM

• ERECT

• SUSPEND AT FULL INSPIRATION

• Perpendicular to T7

• Top of IR1 ½ inches (4cm) above shoulder.

• SUPINE • SUSPEND AT FULL EXPIRATION.

• CR Perpendicular to T10

• Bottom of IR at the level of the iliac crest.

HAND (PA AND OBLIQUE)

HAND PA
• CR perpendicular to the 3 rd MCP joint

• 1 inch or 2.5 cm of distal forearm should be included in the radiograph.

• Flex elbow 90°.

PA
 A. Patient Position
➤ Patient seated at the edge of the table

B. Part Position
➤ Pronate the hand and wrist to place them flat on the IR
➤ Fingers extended and slightly spread

C. Central Ray
➤ Perpendicular to the base of the third MCP Joint.

D. Patient Instruction
➤ Normal respiration

E. Exam rationale
➤ The most common indications are trauma and joint
diseases
➤ Arthritis

➤ Gout 
F. Structures Shown
➤ phalangeal
➤ Metacarpals
➤ Carpals and all joints of the hand.
Note: AP projection may be substituted if the hand cannot
be flattened or the fingers extended. Better demonstrate
the bases of the metacarpals.

HAND OBLIQUE
• CR perpendicular to 3rd MCP joint

• Flex elbow 90°. • Pronate hand.

• Oblique hand toward the lateral so that MCP joint form a 45° angle with plane of film
PA Oblique (Lateral Rotation)

A. Patient Position
➤ Patient seated at the edge of the table

B. Part Position
➤ Hand pronated and rotate the radial side of the wrist

laterally 45° from the IR

➤ Fingers parallel to the IR and slightly spread to
prevent

excessive superimposition of bones on the image.

C. Central Ray
➤ Perpendicular to the third MCP joint.

D. Patient Instruction
➤ Normal respiration

E. Exam rationale
➤ It gives a different prospective from the PA, that of a
45° oblique
➤ Used for investigating functions and pathologic
conditions.

F. Structures Shown
➤ All phalanges

 ➤  Metacarpals
➤ Carpals and joints of the hand and wrist
WRIST (PA AND LATERAL)

WRIST AP/PA
WRIST PA

• Slightly oblique projection of ulna.

WRIST AP

• Best demonstrate distal ulna & carpal interspaces.

PA

A Patient Position
➤ Patient seated at the edge of the table.
 B. Part Position
➤ Pronate the hand and wrist to place them flat on the
image Receptor.

➤ Arch hand slightly to place wrist and carpal area in

close contact with the IR.

C. Central Ray
➤ Perpendicular to the midcarpal area / midway between the
Ulnar and radial styloid process

D. Patient Instruction
➤ Normal respiration

E. Exam rationale
➤ The most common indication is trauma

➤ It gives a slightly oblique rotation to the ulna

F. Structures Shown
➤ Mid and proximal metacarpals
➤ Carpals
➤ Distal radius and ulna

➤ Pertinent soft tissues

- Fat pads
- Fat stripes of the wrist joint.

Note:

AP
➤ To better demonstrate intercarpal spaces and the distal
radius and ulna.

PA
➤ To better demonstrate The scaphoid and capitate [Link]
30° towards the elbow. 

. ➤ To elongate's the capitate only C.R. is 30° towards the

finger tips.

WRIST LATERAL
• Flex elbow 90°

• Best demonstrate the pronator fat stripe

• Best demonstrate widening of the wrist joint due to fracture or dislocation.

Lateral (Lateromedial)

A. Patient Position
➤ Patient seated at the edge of the table with elbow
flexed at 90°.
➤ Shoulder, elbow and wrist be on same horizontal plane

B. Part Position
➤ Extend the fingers and place the hand and wrist at a 90°
angle to IR.
➤ Ulnar side down

C. Central Ray
➤ Perpendicular to the radial styloid process

D. Patient Instruction
➤ Normal respiration

E. Exam rationale
➤ Demonstrate anterior and posterior displacement of the
bony structures
Demonstrate widening of the wrist joint due to fracture or
dislocation

F. Structures Shown
➤ Proximal- metacarpals 

➤ Carpals
➤ Distal radius and ulna
 Rule out
* Barton's Fracture
- Distal portion of radius
* Colle's Fracture
- Post. Displacement of distal fragment 

* Smith's Fracture
- Ant. Displacement of distal fragment

FOREARM (AP AND LATERAL)

FOREARM AP
• Fully extend elbow, and supinate hand.

• Humeral epicondyles parallel to cassette.

AP Projection

A. Patient Position
➤Patient seated at the edge of the table with the hand and
arm fully extended

B. Part Position 

➤ Hand supinated, entire upper limb from the shoulder to

the hand should lie in the same horizontal plane

C. Central Ray
➤ Perpendicular to the mid- forearm
 D. Patient Instruction
➤ Normal respiration

E. Exam Rationale
➤ The most common indication for forearm examinations is
trauma
➤ Demons. the elbow joint, the radius ulna and proximal row
of slightly distorted carpal bones

F. Structures Shown

Note:
➤ Entire radius and ulna including portions of the wrist and elbow
joints PA projection is never performed because the radius and ulna
cross over each other.

FOREARM LATERAL
• Flex elbow 90°

• Place hand in lateral position

• Humeral epicondyles perpendicular to cassette.

• Thumb side of the hand must be up.

. Lateral Projection (Lateromedial)

A. Patient Position
➤ Patient seated at the edge of the table.

B. Part Position
➤ Flex the elbow 90° and place the hand, wrist, and elbow
 in a true lateral position resting on the ulnar
surface

C. Central Ray
➤ Perpendicular to the mid- forearm

D. Patient Instruction
➤ Normal respiration

E. Exam Rationale
➤The lateral is the second of two basic position s of the
forearm

F. Structures Shown
➤Entire radius and ulna, elbow joint and the proximal row
of carpal bones

ELBOW (AP AND LATERAL)

ELBOW AP
• Fully extend elbow

• Supinate hand

• Humeral epicondyles parallel to IR.

AP

A. Patient Position

➤ Patient seated at the edge of the table.

A. Part Position
➤ Extend the elbow, supinate the hand to prevent rotation
of the bones of the forearm and place the epicondylar line
parallel to the image receptor
 B. Central Ray
➤ Perpendicular to the elbow joint, midway between The
epicondyles

D. Patient Instruction

➤ Normal respiration

E. Exam Rationale

➤ The most common indication for elbow examination is

trauma

F. Structures Shown

➤Elbow joint space, proximal radius/ ulna, distal humerus

ELBOW LATERAL
• Flex elbow 90°

• EXCEPTION: For soft tissue injury around the elbow is suspected.

The elbow should only be flexed 30-35°

• Place hand in lateral position.

• Humeral epicondyles perpendicular to IR.

Lateral (Lateromedial) Projection

A. Patient Position
 ➤ Patient seated at the edge of the table.

A. Part Position

➤ Flex the elbow 90° and place the humerus and forearm flat
on the IR
1. The olecranon can be seen in profile
2. The elbow fat pads are the least compressed 

➤ Hand, wrist and elbow in a true lateral position with the

epicondylar line perpendicular to the IR
➤ On patient with muscular forearms. Elevate the wrist to
place the forearm parallel with the IR

B. Central Ray 
➤ Perpendicular to the elbow joint, centered to the
lateral epicondyle

C. Patient Instruction
➤ Normal respiration

D. Exam Rationale
➤ This is the routine position of the elbow that
demonstrate the elbow joint space, proximal radius/ulna.
E. Structures Shown
➤ Best visualization of the elecranon process
➤ Visualization of the posterior fat pad

Note:

 ➤ When injury to the soft tissue around the elbow is suspected. The
joint should be flexed only 30-35° degrees.

HUMERUS (AP AND LATERAL)

HUMERUS AP
• Supinate hand.

• Humeral epicondyles parallel with plane of film.

• Both epicondyles seen in profile.

 AP Projection

A. Patient Position
➤ Patient in a seated- upright or standing position with
posterior surface of the body against the IR

B. Part Position
➤ Abduct the arm slightly and supinate the hand so that
epicondyles of elbow are parallel to the film.

C. Central Ray
➤ To the midshaft of the humerus

D. Patient Instruction
➤ Normal respiration

E. Exam Rationale

➤ Shoulder and arm abnormalities, whether traumatic or

pathologic in origin, are extremely painful either standing
or seated should be used whenever possible.

F. Structures Shown

➤ Entire length of the humerus

➤ Greater tubercle seen laterally 

➤ Humeral head seen medially 

HUMERUS LATERAL
• Rotate the arm medially

• Epicondylar line perpendicular to the film.

• Flex elbow approximately 90° (unless contraindicated) and place palmar aspect of hand on the hip.
• A true lateral is confirmed by the superimposed epicondyles.

Lateromedial

A. Patient Position
➤ Patient in a seated-upright or standing position.

B. Part Position
➤ Flex the elbow partially
➤ Rotate the hand internally
➤ Place the patient's anterior hand on the hip to place the
humerus in lateral position

C. Central Ray
➤ To the midshaft of the humerus
D. Patient Instruction
➤ Normal respiration

D. Exam Rationale
➤ Demonstrate the entire length of the humerus
➤ The image confirmed by superimposed epicondyles

E. Structures Shown

➤ Elbow and shoulder joints

➤ Lesser tubercle
 ➤ Greater tubercle superimposed over the humeral head

SHOULDER (AP AND Y VIEW)

SHOULDER AP
• Rest palm of hand against thigh/hip

• Medial and lateral epicondyles at a 45 degrees angle to plane of cassette.

• IR 2 in. above top of shoulder.

• CR perpendicular to the coracoid process 1inch (2.5 cm) inferior to the coracoid process.

1. AP Projection Neutral

A. Patient Position
» Patient is supine or upright position with posterior
surface of the body against the IR

B. Part Position
» The palm of the hand placed against the hip
 Adjust the position of the IR so that its center is 1inch
(2 Sem) inferior to the coracoid process
 Place the epicondyles of the distal humerus at an
approximate 45 degree angle to the film.

C. Central Ray
» Perpendicular to the coracoid process 1inch inferior to the
coracoid process

D. Patient Instruction
» Suspended respi

E. Exam Rationale
» Shows the bony and soft structures of the shoulder and
proximal humerus in the anatomic position demons. the
scapulohumeral joint relationship and the region of the
subacromial bursa

F. Structures Shown
 » The frontal view of proximal humerus, lateral two thirds of
the clavicle and upper scapula including relationship of
humeral head to glenoid cavity.

SHOULDER Y VIEW PA Oblique / Scapular Y (RAO or LAO)

• Rotate patient’s body so that the midcoronal plane forms an angle of 45°-60° to the IR.

• CR perpendicular to the scapulohumeral joint.

• Alternate view of the shoulder used primarily with trauma patients to demonstrate possible shoulder
dislocations.

PA Oblique (RAO/LAO) (Scapular Y)

A. Patient Position

➤ Patient is either supine or upright position depending

patient condition with posterior surface of the body
against the IR when severly injured.

B. Part Position
> Anterior surface of the shoulder against the IR. 

O Rotate the patient body until the midcoronal plane

forms and angle of 45-60° to the IR. 

O abduct arm slightly so as not to superimpose

proximal humerus over ribs

C. Central Ray
► Perpendicular to the scapulohumeral joint

D. Patient Instruction
➤ Suspended respiration
 E. Exam Rationale
> Useful in the evaluation of suspected shoulder
dislocation
O This is an alternate view of the shoulder used
primarily with trauma patients for possible
dislocations of the head of the humerus.

F. Structures Shown
> Glenoid cavity
o Humeral head
o Subcoracoid

Anterior dislocation
> Humeral head beneath the coracoid process

Subacromial
> Posterior dislocation
> Humeral head beneath the acromion process

N.B.
The LPO is used for injuries to the right side and RPO for injuries to the
left side.

CLAVICLE (AP)

CLAVICLE (AP)
• Patient in supine or upright position

• Perpendicular to the midshaft of the clavicle

• Demonstrates a frontal image of the clavicle.

• AP projection is performed when the patient cannot assume the prone position
 AP Projection

A. Patient Position
> Patient is either supine or upright position
B. Part Position
> Arms along the sides of the body and adjust the shoulders
to lie on the same horizontal plane.

C. Central Ray
> Perpendicular to the mid clavicle

D. Patient Instruction
> Suspended respiration at the end of exhalation

E. Exam Rationale
> Shows the posterosuperior and postero lateral areas of
the Humeral head
> Demonstrate the posterior defects involving the
posterolateral head of the humerus "HILL-SACHS DEFECTS"

F. Structures Shown
> Clavicle
> Acromio-clavicular and sterno-clavicular joints

FOOT (AP, OBLIQUE AND LATERAL)

FOOT AP
• CR 10° posteriorly towards the calcaneus entering the base of the 3rd MT.

• The purpose of the 10° posterior angulation is to place the CR more perpendicular to the metatarsals
therefore reducing foreshortening.
AP Projection (Dorsoplantar)

A. Patient Position

➤ Patient is either seated or supine position on the

radiographic table, with the knee flexed.

B. Part Position

➤ Place the plantar surface of the foot flat on the image

receptor.
➤ Ensure that no rotation of the foot occurs.

C. Central Ray

➤ Perpendicular to the base of the third metatarsals. > 10

to 25° towards the ankle, directed to the navicular.

D. Patient Instruction

➤ Normal respiration

E. Exam Rationale

➤ This projection provides a general survey of the bones of

the foot, including demonstrating of the phalanges,
metatarsals, and the tarsals.
Show the tarso-metatarsal articulations. Localizing foreign
bodies.
➤ Determining the location of fragments in fractures of the
metatarsals and anterior tarsals.

F. Structures Shown

➤ Metatarsophalangeal joints
➤ Phalanges
➤ Tarsals distal to the talus
FOOT OBLIQUE
• Rotate foot medially 30°- 45° to plane of IR.

• CR perpendicular to base of 3rd MT.

• 3 rd-5th MT bases free of superimposition.

AP Oblique Projection (Medial Rotation)

A. Patient Position

➤ Patient is seated on the radiographic table with the knee

flexed.

B. Part Position

➤ Rotate the patient's leg medially until the plantar

surface of the foot forms an angle of 30 degrees. A greater
rotation can be helpful in demonstrating the joint spaces of
the foot.

C. Central Ray

➤ Perpendicular to the base of the third metatarsals

D. Patient Instruction

➤ Normal Respiration

E. Exam Rationale

➤ This projection shows the interspaces between the cuboid

and the calcaneus, cuboid and the fourth and fifth
metatarsals, cuboid and the lateral cunieform; talus and
navicular bone.

F. Structures Shown

➤ Phalanges 
 ➤ Metatarsals 

➤ Sinus tarsi
➤ Lateral tarsometatarsal and intertarsal joints.

FOOT LATERAL
• CR perpendicular to the base of the 3rd metatarsal

• Flex knee of affected limb about 45 degrees. LATEROMEDIAL

• Uncomfortable but considered to be the true lateral foot projection.

Lateral Projection (Mediolateral)

A. Patient Position

➤ Patient is in lateral recumbent on the affected side with

the unaffected leg behind the affected leg.

B. Part Position

➤ Dorsiflex the foot to form a 90 degree angle with the Its

lower leg.
➤ Lateral surface of the foot rest on the image receptor
until the plantar surface of the foot is perpendicular to
the film.

C. Central Ray

➤ Perpendicular to the base of the third metatarsals."

(Medial Cunieform)
 D. Patient Instruction

➤ Normal respiration

E. Exam Rationale

➤ The lateral taken at 90 degrees from the AP is used to

demonstrate the anterior/posterior displacements of bony
structure and to localize foreign bodies.

F. Structures Shown

➤ Entire foot
➤ Tibiotalar joint space
➤ Ankle joint
➤ Distal ends of the tibia and fibula

ANKLE (AP AND LATERAL) MORTISE (DOCTORS REQUEST)

ANKLE AP
• Adjust ankle joint in a true AP position by flexing the ankle & foot (5 degree medial rotation of leg and
foot).

• CR perpendicular to ankle joint, midway between the two malleoli.

AP Projection

A. Patient Position
 ➤ Patient in the supine position with the affected lower
limb fully extended

B. Part Position

➤ Ankle joint anatomic position to obtain a true AP

projection 

➤ Flex the ankle and foot enough to place the long axis of
the foot in the vertical position. Do not force Dorsiflexion
of the foot but allow it to remain in the natural position.

C. Central Ray

➤ Perpendicular to the ankle joint, midway between the

malleoli.

D. Patient Instructions

➤ No rotation, normal respiration

E. Exam Rationale

➤ Demonstrate the distal ends of the tibia and fibula,

proximal portion of the talus, the lateral and medial
malleoli and the proximal half of the metatarsals..
bells en down

F. Structures Shown

➤ Tibiotalar joint spaces

➤ Medial and lateral malleoli

➤ Proximal half of metatarsals

➤ Soft tissue.

ANKLE LATERAL
• CR perpendicular to medial malleolus.
 Lateral Projection

A. Patient Position

➤ Patient in the supine position, turn toward the affected

side until ankle.

B. Part Position

➤ Place the long axis of the leg parallel with the long
axis of the Image Receptor
➤ Lateral surface of the foot in in the contact with the
IR.
➤ Dorsiflex the foot so that the plantar surface is at
right
angle leg.
➤ Dorsiflexion is required to prevent lateral rotation of
the ankle

C. Central Ray

➤ Perpendicular to the ankle joint, directed to the

medial malleolus.

D. Exam Rationale

➤ This projection is useful in the evaluation of fractures,

dislocations and joint effusions associated with other joint
pathologies.

E. Structures Shown

➤ Ankle joint
➤ Tibiotalar joint
➤ Distal one third of tibia and fibula
➤ Tuberosity of the fifth metatarsals, navicular and
cuboid.

ANKLE MORTISE
• CR perpendicular midway between the malleoli • Intermalleolar plane is parallel to IR. • Medially
rotate leg & foot 15°–20°.

AP Oblique Projection (Mortise Joint)

A. Patient Position

➤ Patient in the supine position.

B. Part Position

➤ Do not Dorsiflex the foot. The plantar surface of the

foot should be placed at a right angle to the leg.  

➤ Rotate the entire leg and foot 15-20 degrees internally,

until the intermalleolar line is parallel to the IR.

C. Central Ray

➤ Perpendicular entering the ankle joint midway between the

malleoli.

D. Exam Rationale

➤ Proper obliquity of the mortise joint will open the

lateral and medial mortise joints and only minimal
superimposition should exist at the distal tibiofibular
joint.

E. Structures Shown

➤ Entire ankle mortise joint

Talofibular joint
➤ Distal one third of the tibia and fibula
➤ Proximal fifth metatarsals
LEG (AP AND LATERAL)

LEG AP
• Medially rotate leg 5° for true AP projection.

• Femoral epicondyles are parallel to IR.

• Patient in sitting or supine position.

AP Projection

A. Patient Position

➤ Patient is seated or supine position with the knee

extended.

B. Part Position

➤ Center the leg to the image receptor.

➤ Adjust the leg so that the femoral condyles are parallel
with the IR.
➤ Dorsiflex the foot so it is perpendicular to the image
receptor.

C. Central Ray

➤ Perpendicular to the midshaft of the leg

D. Patient Instructions

➤ Normal respiration

E. Exam Rationale
 ➤ Trauma is the most common indication of the lower leg. 

➤ Tibia and fibula should be slightly overlapped at both

the proximal and distal ends.

F. Structures Shown

➤ Tibia, fibula, knee and ankle joints.

LEG LATERAL
• Patient in Lateral recumbent position.

• Flex the knee 45° and ensure that the leg is true lateral position.

• Distal fibula lying posterior over half of the tibia.

• Tibial tuberosity in profile

• Overlap tibia on the proximal fibular head.

Lateral Projection

A. Patient Position

➤ Patient in lateral recumbent on the affected side

down.

B. Part Position

➤ Flex the leg about 45° and ensure that the leg is in true
lateral position.
➤ Adjust the rotation of the leg so that the patella is
perpendicular to the image receptor.
➤ For most adults the leg must be placed diagonally.

C. Central Ray
 ➤ Perpendicular to the midshaft of the leg

D. Patient Instructions

➤ Normal respiration

E. Exam Rationale

➤ The lateral taken at 90° from the AP is used to

demonstrate anterior and posterior displacements of bony
structures.

F. Structures Shown

➤ Tibia, fibula, knee and ankle joints.

NB 

The oblique is an alternative position of the leg that is Occasionally

requested to demonstrate the tibiofibular articulations.
Procedures:

KNEE (AP AND LATERAL)

SUNRISE/SKYLINE VIEW DOCTORS REQUEST

KNEE AP
• Commonly indicated for trauma and degenerative disease.

• Open femorotibial joint space.

• Proximal tibia overlap on head of the fibula.

 AP Projection

A. Patient Position

➤ Patient is seated or supine position on the radiographic

table with the knee extended

B. Part Position

➤ Rotate the leg internally 3 to 5° until the

interepicondylar line is parallel to the film.
➤ Center the knee joint 1⁄2 inch distal to the patellar
apex.

C. Central Ray

➤ 5 cephalad, to a point 1⁄2 inch below apex of the

patella.

D. Patient Instruction

➤ Normal respiration

E. Exam Rationale

➤ Radiographic examination of the knee is commonly

indicated in cases of trauma or degenerative joint disease.

F. Structures Shown

➤ Distal femur, proximal tibia and fibula, patella and knee

joint.

KNEE LATERAL
• Patient in lateral recumbent. • Femoral epicondyles perpendicular to IR • Flex knee 20°-30° Purpose of
degree of flexion 1. Relaxes the muscle. 2. Maximum volume of joint cavity.

Lateral Projection

A. Patient Position

➤ Patient is in lateral recumbent on the affected with the

unaffected leg may be placed in front of the affected knee.

B. Part Position

➤ Flex the knee 20 to 30° because this position relaxes the

muscle and shows the maximum volume of the joint cavity.
➤ Knee should not be flexed more than 10° to prevent
fragment separation in new or unhealed patellar fractures.

C. Central Ray

➤ 5 to 7° cephalad, directed 1 inch distal to the medial

epicondyle. This angulation prevent the joint space from
being obscured by the magnified image of the medial femoral
condyle.

D. Patient Instructions

➤ Normal respiration

E. Exam Rationale

➤ This radiograph shows a lateral image of the distal end

of the femur, patella, knee joint, proximal ends of the
tibia and fibula, and adjacent soft tissue.

F. Structures Shown
 ➤ Distal femur, proximal tibia, fibula, patella and
tibiofemoral joint and patellofemoral joints.

SUNRISE/SKYLINE VIEW
• Flex knees 40° - 45°

• 30° from the horizontal to patellofemoral space.

Tangential Projection (Sunrise / Skyline Method)

A. Patient Position

➤ Patient is either seated or supine position.

B. Part Position

➤ Flex the knees 40 to 45°

➤ The quadriceps femoris muscles must be relaxed to prevent
subluxation of the patella, wherein they are pulled into the
intercondylar sulcus or groove, which may result in false
readings.

C. Central Ray

➤ 30° from the horizontal, directed to the patellofemoral

joint spaces.

D. Patient Instructions

➤ Normal respiration

E. Exam Rationale
 ➤ This projection demonstrates fractures and subluxation of
the patella.

F. Structures Shown

➤ Axial view of the patella

Intercondylar sulcus Patellofemoral articulation

FEMUR (AP AND LATERAL)

FEMUR AP
• Rotate the leg by 5° if the knee is included

• Rotate the leg by 10°- 15° if proximal femur is included.

AP Projection

A. Patient Position

➤ Patient is in supine position with the knee extended.

B. Part Position

➤ Center the thigh to the midline of the table and position

it to include both joints when possible, the joint nearest
the site of injury or suspected pathology should be
included.
 ➤ When the distal femur is included rotate the
limb internally to place it in true anatomic position.

➤ When the proximal femur is included, rotate the limb

internally 10 to 15 degrees to place the femoral neck in
profile.

C. Central Ray

➤ Perpendicular, directed to the midshaft of the femur.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ The AP projection of the femur demonstrates the entire

length of the femur including knee and hip joint.

F. Structures Shown

➤ Mid and Distal femur, including knee joint.

FEMUR LATERAL
• Patient in lateral recumbent position.

• Flex knee 45°

• Femoral epicondyles perpendicular to IR.

• Rotate pelvis 10°-15° posteriorly from the lateral position.

Lateral Projection

A. Patient Position

➤ Patient is in lateral recumbent position on the affected

side.
➤ If the proximal femur is the area of interest the
unaffected leg is placed behind the affected leg; 

➤ If the distal femur is the area of interest, the

unaffected leg is flexed and in front of the affected leg.

B. Part Position

➤ Flex the affected knee 45°, and adjust the body rotation
to place the epicondyles perpendicular to the table top.

C. Central Ray

➤ Perpendicular, directed to the midshaft of the thigh.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This position shows a lateral projection of about three

fourths of the femur and the adjacent joint.

F. Structures Shown
 ➤ Entire length of the femur 

➤ Knee and hip joint.

PELVIS (AP)

PELVIS AP
• Patient in supine position.

• Medially rotate leg and feet 15°-20° to place femoral necks parallel to IR.

• Heels should be placed 8-10 inches apart.

• Upper border of IR 1-1 ½ inches above iliac crest.

• CR perpendicular midway between ASIS and symphysis pubis 2 inches inferior to ASIS and 2 inches
superior to symphysis pubis.

• Greater trochanter in profile.

• Femoral head and neck.

• Provides a general survey of the bones of the entire pelvis and proximal femur.

AP Projection

A. Patient Position

➤ Patient is in supine position

 B. Part Position

➤ Rotate the feet and the lower limbs about 15 degrees to

place the femoral necks parallel with the plane of the image
receptor.

➤ The heels should be placed about 8 to 10 inches

apart.

C. Central Ray

➤ Perpendicular between the ASIS and the pubic symphysis. 2

inches inferior to the ASIS and 2 inches superior to the
pubic symphysis.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This projection provides a general survey of the bones of

the pelvis and the head, neck, and greater trochanter of
each of the femora.
➤ Proximal 1/3 of the shaft of the femora.

F. Structures Shown

➤ Entire pelvis
➤ Greater trochanters
➤ Femoral necks and Ischial spines

HIP (AP AND LATERAL) IF TRAUMA AP VIEW ONLY

HIP AP
• Patient in supine position.

• Medially rotate leg and feet 15°-20°

• CR perpendicular to femoral neck approximately 2 ½ distal to midpoint of ASIS and symphysis pubis.

• Greater trochanter in profile

• Femoral head and neck • Proximal 1/3 of the femur.

AP Projection

A. Patient Position

➤ Patient is in supine position

B. Part Position

➤ Rotate the lower limb 15° medially to place the femoral

neck parallel with the plane of the image receptor.
➤ The sagittal plane 2 inches medial to the anterior
superior iliac spine of the affected side should be 10
centered to the midline of the table.

C. Central Ray

➤ Perpendicular, directed to the femoral neck,

approximately 2 inches medial to the ASIS of the affected
side at a level just above the greater trochanter.

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This position is often done to demonstrate the entire

pelvic girdle and both upper femora and the greater
trochanters should be fully visualized.
 F. Structures Shown

➤ Head, Neck, Trochanter and the proximal third of the

femoral shaft.

HIP LATERAL
• Patient in supine position

• Flex knee and hip of the affected side 900 angle to the hip bone.

Lateral Projection (Lauenstien Method)

A. Patient Position

➤ Patient is in supine position, rotate the patient

slightly toward the affected side to posterior oblique body
position.

B. Part Position

➤ Flex the affected knee and abduct the leg to place the
femur parallel to the image receptor.
 ➤ Extend the opposite limb.

C. Central Ray

➤ Perpendicular, to a point midway between ASIS and

symphysis pubis.
➤ For Hickey method, 20 to 25° cephalad

D. Patient Instructions

➤ Suspended respiration

E. Exam Rationale

➤ This examination is contraindicated for patients with a

suspected fracture of pathologic condition.
➤ This method is used to demonstrate the hip joint and the
relationship of the femoral head to the
acetabulum.

F. Structures Shown

➤ Hip joint, acetabulum and femoral head.

CHEST (PA) AND (PA AND LATERAL IF PEDIA OR DOCTORS REQUEST)

(LORDOTIC VIEW) (DECUBITUS VIEW)
CHEST PA
• The vertebra prominens which corresponds to the level of the apex of the lungs is the preferred
landmark for locating the central ray on a PA chest.

• The vertebra prominens also corresponds to the same level as the T1.

PA Projection

A. Patient Position

➤ Patient is in erect position, facing the vertical

cassette holder, weight equally distributed on both feet.
arms

B. Part Position

➤ Midsagittal plane of the body must center to the midline

of the film holder.
➤ Top of the image receptor is 1 1⁄2 to 2 inches above the
shoulders.
Back of hands on hips with palms facing outward, depress the
shoulders and hold them in contact with the grid.
➤ Shoulders rotated forward against the film holder to
allow the scapulae to move laterally clear of the lung
fields.

C. Central Ray

➤ Perpendicular to the MSP at the level of T7 with SID of

72 inches.
 D. Patient Instructions

➤ Suspended respiration at the end of the 2nd full

inspiration.

E. Exam Rationale

➤ The PA chest is performed to outline the anatomy of the

lungs, heart, great vessels and mediastinal wn structures to
detect the presence of chest lesions.

F. Structures Shown

➤ Lungs including both apices 

➤ Air-filled trachea, Bronchi

➤ Heart and great vessels
➤ Diaphragm, Costophrenic angles and Bony Thorax.

CHEST LATERAL
• Left lateral position will demonstrate the heart, aorta and left sided pulmonary lesions.

• Right lateral position will demonstrate right sided pulmonary lesions.

Lateral Projection

A. Patient Position
 ➤ Patient is in erect position with the left side against
the cassette unless otherwise specified.

B. Part Position

➤ Midsagittal and sagittal plane are parallel to the

cassette, coronal plane is perpendicular.
➤ Arms rest over the head with each hand grasping opposite
elbow.

➤ To determine rotation, examine the posterior aspects of

the ribs. Radiographs without rotation show superimposed
posterior ribs.

C. Central Ray

➤ Perpendicular to the mid thorax at the level of T7.

D. Patient Instructions

➤ Suspended respiration at the end of the 2nd full

inspiration.

E. Exam Rationale

➤ The lateral chest demonstrates the anatomy of the lungs,

heart, great vessels and mediastinal structures.

F. Structures Shown

➤ Lungs, Trachea, Heart and Great vessels

➤ Diaphragm, Posterior Costophrenic angles and bony Thorax

LORDOTIC POSITION
• Top of the IR 3-4 inches above shoulder.

• Patient standing 1 foot away from the vertical cassette holder (VCH), facing forward and leaning back
with shoulders, neck and back of head against IR.

AP Lordotic Position

A. Patient Position

➤ Patient is in erect position facing the tube, with 1 foot

away from the film holder and back with shoulders, neck, and
back of head against the film holder. 

➤ Superior border of the cassette should be approximately 3

inches above the shoulders.

B. Part Position

➤ Adjust the patient with the midsagittal plane of the

lesbody center to the midline of the film
➤ Hands on hip and rotate the shoulders forward.

C. Central Ray

➤ Perpendicular to the cassette, directed to the mid

sternum with 72 inches SID.

D. Patient Instructions
 ➤ Suspended respiration at the end of the 2nd full
inspiration..

E. Exam Rationale

➤ This position is used to demonstrate the apices free from

superimposition of the clavicles or to demonstrate a right
middle lobe pneumothorax.

F. Structures Shown

➤ Apices and Lungs

➤ Clavicles
➤ Interlobar effusions, calcification and masses beneath
the clavicles.

CHEST LATERAL DECUBITUS

• The patient must remain in this position 5 minutes before exposure to achieved best visualization so
that fluid may settle and air to rise.

• Demonstrates air-fluid levels.

• This position is used to demonstrate amounts of fluids in the pleural cavity which would be
demonstrated with the patient lying on the affected side.

• This position is used to demonstrate amounts of air in the pleural cavity which would be demonstrated
with the patient lying on the unaffected side. PULMONARY APICES LORDOTIC POSITION LINDBLOM
METHOD

• Top of the IR 3-4 inches above shoulder.

• Patient standing 1 foot away from the vertical cassette holder (VCH), facing forward and leaning back
with shoulders, neck and back of head against IR.

• CR perpendicular to mid sternum.

Lateral Decubitus Position

A. Patient Position

➤ Patient is in lateral recumbent position with both arms

raised over patient's head.

B. Part Position

➤ Ankles and knees on top of one another and the knees

flexed for support.
➤ Coronal plane is parallel to film with no body rotation. 

➤ Superior border of the cassette is 2 inches above the

shoulders.

C. Central Ray

➤ Horizontally, directed to the level of T7 with 72 inches

SID.

D. Patient Instructions

➤ Suspended respiration at the end of the 2nd full

inspiration.

E. Exam Rationale

➤ This position is used to demonstrate amounts of fluid in

the pleural cavity, which would be demonstrated with the
patient lying on the affected side, or amounts of air in the
pleural cavity, which would be demonstrated with the patient
lying on the unaffected side.

F. Structures Shown

➤ Pleural effusions
➤ Small amount of air or pneumothorax
ABDOMEN (SUPINE AND UPRIGHT)

ABDOMEN SUPINE (KUB)

• Patient in supine position. • CR perpendicular to the level of iliac crest

• Serves as a scout view for various radiologic exams.

AP Projection (KUB)

A. Patient Position

➤ Patient is in supine position with the mid-sagittal plane

of the body is center to the midline of the table with the
legs extended.

B. Part Position

➤ Shoulders must be same transverse plane The pelvis is

adjusted so that it is not rotated. Center the cassette at
the level of the iliac crests. Apply gonadal shielding as
appropriate. The knees may be flexed for patient comfort.

C. Central Ray

➤ Perpendicular to midpoint of the image receptor, at the

level of the iliac crest.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration.

E. Exam Rationale

➤ This projection often serves as a scout view for various,

radiologic exams. It is valuable for visualizing abdominal
masses, calcifications, foreign bodies, and intestinal
obstruction. The projection also provides a general survey
 of the abdominal pattern, soft tissue shadows, organ
configuration and skeletal structures.

F. Structures Shown

➤ Liver
➤ Spleen
➤ Kidneys
➤ Abnormal masses
➤ Calcifications or accumulations of gas beoog 

➤ Pelvis, Lumbar spine and Lower ribs

ABDOMEN UPRIGHT
• Patient in erect position.

• Center the IR 2 inches (5 cm) above the level of the iliac crests or high enough to include the
diaphragm.

• CR horizontal to 2-3 inches (5 cm) above level of iliac crest.

• Top of IR approximately at the level of the axilla.

• Patient should be upright for a minimum of 5 minutes but 10-20 minutes is desirable.

• Most valuable for demonstrating free intraperitoneal air.

• Best demonstrate air and fluid levels.

AP Upright Projection

A. Patient Position

➤ Patient is in erect position with the posterior surface

of the body is against the image receptor.

B. Part Position

➤ Center the midsagittal plane to the midline of the table

or in the upright grid device.
With the weight is equally distributed on both feet. 

➤ Shoulders in same transverse plane

➤ Adjust the height of the cassette 2 to 3 inches above the
iliac crest to include the diaphragm for the average patient
the top of the cassetteis at the level of the axilla.
C. Central Ray

➤ Horizontal to the midpoint of the image receptor, 2 to 3

inches superior to iliac crest.

D. Patient Instructions

➤ Suspended respiration at the end of full expiration

E. Exam Rationale

➤ This projection is most valuable for demonstrating free

intraperitoneal air and air/fluid levels. It is also good
for visualization of soft tissue structures, bowel gas
patterns and skeletal structures.

F. Structures Shown

➤ Liver, Spleen, Kidneys

➤ Abnormal Masses, Air-Fluid Levels

➤ Accumulations of gas or free intra-abdominal air.