lOMoARcPSD|45118941

Cluster III - SIR MEYNARD NOTES

Radiologic Technology (Liceo de Cagayan University)

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UPPER EXTREMITIES
PP = Part Position 9.) Dislocation/Luxation
RP = Reference Point  Bone is displace from a joint
CR = Central Ray 10.) Subluxation
SS = Structure Shown  Partial dislocation
ER = Examination Rationale 11.) Rolando Fx
┴ = Perpendicular  Comminuted fx of 1st MCP base
// = Parallel 12.) Bennett’s Fx
b/n = between  Transverse fx of 1st MCP base
13.) Boxer’s Fx
TRAUMA & FRACTURE TERMINOLOGY  4th-5th metacarpal neck fx
1.) Fracture 14.) Colles’ Fx/Dinnerfork/Bayonet
 A break in a bone  Fx of distal radius w/ posterior/dorsal
2.) Simple/Closed Fx displament
 Does not break through the skin 15.) Smith Fx/Reverse Colles’
3.) Compound/Open Fx  Fx of distal radius w/ anterior/palmar
 Portion of the bone protrudes through the displacement
skin 16.) Barton’s Fx
4.) Incomplete/Partial Fx  Fx of posterior lip of distal radius
 Does not traverse through entire bone 17.) Baseball/Mallet Fx
 Torus/Buckle Fx: buckle in the cortex with  Fx of distal phalanx
no complete break 18.) Hutchinson’s/Chaeffeur’s Fx
 Greenstick Fx/Willow Stick/Hickory  Intraarticular fx of the radial styloid process
Stick: fracture is on one side only 19.) Monteggia’s Fx
(commonly in children)  Fx of proximal half of the ulna with radial
5.) Complete Fx head dislocation
 Break is complete & bone is broken into two 20.) Nursemaid’s/Jerked Elbow
pieces  Partial dislocation of the radial head of a
 Transverse Fx: near right angle to long axis child
of the bone
 Oblique Fx: at an oblique angle to the bone\ A.) DIGITS (2nd-5th)
 Spiral Fx: bone is twisted apart & spirals
around the long axis of bone PA PROJECTION
6.) Comminuted Fx PP: Palmar surface down; separate the digits
 Bone is splintered or crushed (two or more slightly
fragments) RP: PIP joint
7.) Impacted Fx CR: ┴
 One fragment is firmly driven into the other SS: PA projection of affected digit
8.) Avulson Fx AP Projection: For suspected joint injury
 A fragment of bone is separated or pulled
away

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UPPER EXTREMITIES
LATERAL PROJECTION C.) FIRST CARPOMETACARPAL (CMC)
PP: Hand rest on radial surface (for 2nd-3rd digits) & JOINT
ulnar surface (for 4th-5th digits)
RP: PIP joint ROBERT METHOD
CR: ┴ AP PROJECTION
SS: Lateral projection of affected digit PP: Shoulder, elbow & wrist on same plane
(prevent carpal bones elevation & closing 1 st CMC
PA OBLIQUE PROJECTION joint); arm internally rotated; hand hyperextended;
PP: Hand pronated; lateral rotation (for 4th & 5th); dorsal aspect of thumb against IR
medial rotation (2nd & 3rd) RP: 1st CMC joint
RP: PIP joint CR: ┴; 10-15o proximally (Lewis Method); 15o
CR: ┴ proximally (Rafert-Long Method)
SS: PA oblique projection of affected digit SS: 1st CMC joint
ER: To demonstrate arthritic changes; fractures; 1st
B.) THUMB (1st Digit) CMC joint displacement; Bennett’s fracture
Angulation Rationale: To project soft tissue of the
AP PROJECTION hand away from 1st CMC joint; help open joint
PP: Hand in extreme internal rotation space
RP: 1st MCP joint
CR: ┴ BURMAN METHOD
SS: AP projection of thumb AP PROJECTION
PP: Hand hyperextended; opposite hand hold the
PA PROJECTION hyperextended hand or bandage loop around digits;
PP: Hand in lateral position; dorsal surface of hand rotated internally; thumb abducted
thumb // to IR RP: 1st CMC joint
RP: 1st MCP joint CR: 45otoward the elbow
CR: ┴ SS: Magnified 1st CMC joint
SS: Magnified PA projection of thumb ER: To provide a clearer image of 1st CMC than
standard AP
LATERAL PROJECTION
PP: Hand in its natural arched position; palmar FOLIO METHOD/SKIER’S THUMB
surface down PA PROJECTION
RP: 1st MCP joint PP: Hands rested on medial aspect; distal portion of
CR: ┴ both thumbs wrap around by a rubber band; thumb
SS: Lateral projection of thumb in PA plane
RP: b/n level of MCP joints of both hands
PA OBLIQUE PROJECTION CR: ┴
PP: Hand in slight ulnar deviation; thumb abducted SS: 1st CMC joint; bilateral MCP joints & MCP
RP: 1st MCP joint angles
CR: ┴ ER: Useful for diagnosis of ulnar collateral
SS: PA oblique projection of thumb ligament (UCL) rupture\

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UPPER EXTREMITIES
D.) HAND TANGENTIAL OBLIQUE PROJECTION
Kallen Recommendation
PA PROJECTION PP: Hand in PA position; hand rotated 40-45o
PP: Hand palmar surface down; spread finger toward ulnar surface & 40-45oforward; MCP joints
slightly flexed 75-80o; hand dorsum resting on IR
RP: 3rd MCP joint RP: MCP joint of interest
CR: ┴ CR: ┴
SS: PA oblique projection of the hand ER: To demonstrate metacarpal head fractures
AP Projection:
 Hand cannot be extended because of injury LATERAL PROJECTION
and pathologic conditions In Extension
 For metacarpal bones and MCP joints PP: Hand in lateral position; digits extended; ulnar
aspect down (lateromedial projection); radial aspect
PA OBLIQUE PROJECTION down (mediolateral projection; more difficult to
PP: Hand pronated; palmar surface down; MCP assume); thumb 90o to palm
joints 45o to IR; 45o foam wedge RP: 2nd MCP joint
RP: 3rd MCP joint CR: ┴
CR: ┴ SS: Lateral projection of the hand in extension
SS: PA oblique projection of the hand ER: To localize foreign bodies and metacarpal
ER: To investigate fractures and pathologic fracture displacement
conditions Fan Lateral Position: Eliminates superimposition
Foam Wedge: For interphalangeal joints of all phalanges (except proximal phalanges)
Fingertips Touching The Cassette: For
metacarpal bones LEWIS METHOD
Index Finger Elevation: PP: Hand rotated 5o posteriorly from true lateral
 Use of radiolucent material position (removes superimposition of 2nd-4th
 Opens joint spaces metacarpals); thumb extended;
 Reduces the degree of foreshortening of RP: Midshaft of 5th metacarpal
phalanges CR: ┴
ER: To better demonstrate fractures of 5th
REVERSE OBLIQUE PROJECTION metacarpal
Lane-Kennedy-Kuschner Recommendations
PP: Hand rotated 45o internally LATERAL PROJECTION
RP: 3rd MCP joint In Flexion
CR: ┴ PP: Hand in natural arch position; digits relaxed
ER: To demonstrate severe metacarpal deformities RP: 2nd MCP joint
fractures CR: ┴
SS: Lateral projection of the hand in flexion
ER: To demonstrate anterior or posterior
displacement in fractures of metacarpals

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UPPER EXTREMITIES
NORGAARD METHOD LATERAL PROJECTION
AP OBLIQUE PROJECTION Lateromedial
PP: Hand supinated; medial aspect against IR; 45o PP: Elbow flexed 90o; hand & forearm in
sponge support lateral position; ulnar surface against IR; radial
RP: b/n level of 5th MCP joints of both hands surface against IR (for comparison)
CR: ┴ RP: Midcarpal area
SS: AP oblique projection of both hands CR: ┴
ER: To diagnose rheumatoid arthritis SS: Proximal metacarpals & distal radius & ulna;
trapezium & scaphoid (more anterior)
E.) WRIST ER: To demonstrate anterior or posterior
displacement in fractures
PA PROJECTION
PP: Hand slightly arch (places wrist in close contact Burman & et al. Suggestions
with IR) PP: Wrist in palmar flexion (rotates the scaphoid in
RP: Midcarpal area dorsovolar position)
CR: ┴ RP: Scaphoid
SS: Slightly oblique rotation of ulna (AP should be CR: ┴
taken if ulna is under examination) SS: Lateral position of the scaphoid

Daffner-Emmerling-Buterbaugh Foille
Recommendation  First to describe carpe bossu (carpal boss), a
PP: Hand slightly arch (places wrist in close contact small bony growth occurring on the dorsal
with IR) surface of the 3rd CMC joint
RP: Midcarpal area  Best demonstrated in a lateral position of
CR: 30o toward the elbow; 30o toward the fingertips wrist in palmar flexion
SS: Elongated scaphoid & capitate (toward the
elbow); elongated capitate only (toward the PA OBLIQUE PROJECTION
fingertips) Lateral Rotation
ER: To better demonstrate the scaphoid & capitate PP: Palmar surface against IR; hand pronated &
rotated 45olaterally; wrist ulnar deviation (for
AP PROJECTION scaphoid only)
PP: Hand supinated; digits elevated (places wrist in RP: Midcarpal area
close contact with IR) CR: ┴
RP: Midcarpal area SS: Carpals on the lateral side (Scaphoid &
CR: ┴ Trapezium)
SS: Carpal interspaces better demonstrated; no
rotation of ulna AP OBLIQUE PROJECTION
Medial Rotation
PP: Dorsal surface against IR; hand supinated &
rotated 45omedially
RP: Midcarpal area

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UPPER EXTREMITIES
CR: ┴ RAFERT-LONG METHOD
SS: Carpals on the medial side (Pisiform, PA & PA AXIAL PROJECTIONS
Triquetrum & Hamate) In Ulnar Deviation
PP: Hand pronated; wrist in extreme ulnar
PA PROJECTION deviation
In Ulnar Deviation RP: Scaphoid
PP: Hand pronated; wrist in extreme ulnar CR: ┴; 10o; 20o; 30ocephalad
deviation SS: Scaphoid with minimal superimposition
RP: Scaphoid ER: To diagnose scaphoid fractures
CR: ┴; 10-15o proximally/distally (clear
delineation) CLEMENTS-NAKAYAMA METHOD
SS: Scaphoid; opens carpal interspaces on lateral PA AXIAL OBLIQUE PROJECTION
side PP: Palmar surface against 45o sponge; hand in
ER: To correctscaphoid foreshortening ulnar deviation; rotate elbow end of IR & arm 20o
away from CR (unable to achieve ulnar deviation)
PA PROJECTION RP: Anatomical snuffbox
In Radial Deviation CR: 45o distally
PP: Hand pronated; wrist in extreme radial SS: Trapezium
deviation ER: To demonstrate trapezoid fractures
RP: Midcarpal area
CR: ┴ LENTINO METHOD
SS: Opens carpal interspaces on medial side TANGENTIAL PROJECTION
PP: Hand palm upward; hand 90o to forearm
STECHER METHOD RP: 1.5in proximal to wrist joint
PA AXIAL PROJECTION CR: 45ocaudad
VARIATIONS: SS: Carpal bridge
 IR elevated 20o ER: To demonstrate fractures of scaphoid, lunate
 CR 20o toward elbow dislocation, dorsum of wrist calcifications and
 CR 20o toward digits foreign bodies & dorsal aspect of carpal bones chip
o Fracture line that angles fractures
superoinferiorly
 Clench the fist GAYNOR-HART METHOD
RP: Scaphoid TANGENTIAL PROJECTION
CR: ┴ PP: Wrist hyperextended; hand rotated slight
SS: Scaphoid toward the radial side (to prevent superimposition
ER (20o Angulation): of hamate & pisiform shadows); digits grasp w/
 To place scaphoid at right angles to the CR opposite hand
 To project scaphoid w/o self- RP: 1 in. distal to 3rd MCP base
superimposition CR: 20-30o to long axis of hand
Bridgman Method: Stecher Method with ulnar SS: Carpal canal/tunnel (Carpal sulcus+Flexor
deviation retinaculum)

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UPPER EXTREMITIES
ER: Hand Pronation:
 To demonstrate carpal tunnel syndrome  It crosses the radius over the ulna at its
 To demonstrate fractures of hook of hamate, proximal third
pisiform & trapezium  It rotates the humerus medially

Mcquillen Martensen Suggestion LATERAL PROJECTION

 For wrist that cannot be extended to w/in 15o PP: Elbow flexed 90o; forearm & hand in true
of vertical lateral; thumb must be up; humeral epicondyle ┴ to
 CR aligned // to palmar surface IR
 Angled an additional 15o toward the palm RP: Midshaft
CR: ┴
SUPEROINFERIOR PROJECTION SS: Elbow joints; radius & ulna; carpal bones
PP: Dorsiflex the wrist; lean forward (to place (proximal row)
carpal canal tangent to IR)  Superimposed radius & ulna at their distal
RP: Midpoint of the wrist end
CR: ┴  Superimposed radial head over the coronoid
SS: Carpal canal/tunnel process
ER: Taken when patient cannot assume/maintain  Superimposed humeral epicondyles
Gaynor-Hart Method  Radial tuberosity facing anteriorly

Marshall Suggestion G.) ELBOW

 For limited dorsiflexion of the wrist
 Placed 45o sponge under palmar surface of AP PROJECTION
the hand PP: Elbow extended; hand supinated; patient lean
o Slightly elevates the wrist to place laterally; humeral epicondyles & anterior surface of
the carpal canal tangent to CR elbow // to IR
 With slight degree of magnification due to RP: Elbow joint
increased OID CR: ┴
SS: Elbow joints; distal arm & proximal forearm
F.) FOREARM  Radial head, neck & tuberosity slightly
superimposed over the proximal ulna
AP PROJECTION
PP: Hand supinated; patient lean laterally; humeral LATERAL PROJECTION
epicondyles // to IR Lateromedial
RP: Midshaft PP: Elbow flexed 90o; elbow flexed 30-35o
CR: ┴ (suspected elbow injury); hand in lateral position;
SS: Elbow joints; radius & ulna; distorted carpal humeral epicondyles ┴ to IR
bones (proximal row) RP: Elbow joint
 Slight superimposition of radial head, neck CR: ┴
& tuberosity over the proximal ulna SS: Elbow joints; distal arm & proximal forearm
 Superimposed humeral epicondyles
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UPPER EXTREMITIES
 Radial tuberosity facing anteiorly JONES METHOD
 Radial head partially superimposing AP PROJECTION
coronoid process Acute Flexion
 Olecranon process in profile Distal Humerus
Griswold (Elbow flexing 90o): 2 reasons PP: Elbow fully (acutely) flexed
 Olecranon process seen in profile RP: 2 in. superior to olecranon process
 Elbow fat pads are least compressed CR: ┴ to humerus
SS: Olecranon process
AP OBLIQUE PROJECTION Proximal Forearm
Medial Rotation PP: Elbow fully (acutely) flexed
PP: Hand pronated or medially rotated 45o; anterior RP: 2 in. distal to olecranon process
surface of elbow 45o to IR CR: ┴ to flexed forearm
RP: Elbow joint SS: Elbow joint more open
CR: ┴
SS: Coronoid process in profile; trochlea RADIAL HEAD SERIES
LATERAL PROJECTION
AP OBLIQUE PROJECTION Four-Position Series
Lateral Rotation PP: Elbow flexed 90o; elbow joint in lateral
PP: Hand laterally rotated 45o; 1st & 2nd digits position; four exposures: 1.) hand supinated 2.)
touching the table; posterior surface of elbow 45 o to hand in lateral 3.) hand pronated 4.) hand internally
IR rotated
RP: Elbow joint RP: Elbow joint
CR: ┴ CR: ┴
SS: Radial head & neck in profile; capitulum SS: Radial head in varying degrees of rotation
 Radial head facing anteriorly (1st & 2nd
AP PROJECTIONS exposures)
In Partial Flexion  Radial head facing posterior (3rd & 4th
Distal Humerus exposures)
PP: Hand supinated; elbow partially flexed
RP: Elbow joint COYLE METHOD
CR: ┴ to humerus AXIOLATERAL PROJECTION
SS: Distal humerus when elbow cannot be fully PP:
extended  Seated: hand pronated
Proximal Forearm  Supine (trauma): distal humerus elevated;
PP: Hand supinated; dorsal surface of forearm IR vertical; humeral epicondyles ┴ to IR;
against IR; elbow partially flexed palmar aspect of hand facing anteriorly
RP: Elbow joint  Elbow flexed 90o (radial head) or 80o
CR: ┴ to forearm (coronoid process);
SS: Proximal forearm RP: Midelbow joint
ER (2 AP Projections): For patient cannot
completely extend the elbow
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UPPER EXTREMITIES
CR: H.) HUMERUS
 o
Seated: 45 toward the shoulder (radial
head); 45o away from the shoulder (coronoid AP PROJECTION
process) Upright
 Supine: horizontal; 45o cephalad (radial PP: Erect/seated-upright (more comfortable); arm
head); 45o caudad (coronoid process) abducted slightly; hand supinated; humeral
SS: Open elbow joint b/n radial head & capitulum epicondyles // to IR
or coronoid process & trochlea RP: Midshaft
ER: CR: ┴
 To demonstrate pathologic processes or SS: Humeral head & greater tubercle in profile
trauma in the area of radial head & coronoid
process LATERAL PROJECTION
 Cannot fully extend elbow for medial & Lateromedial Upright
lateral oblique PP: Erect/seated-upright (more comfortable); arm
rotated internally; elbow flexed approximately 90 o;
PA AXIAL PROJECTION palmar aspect of hand against hip; humeral
PP: Seated; arm rested vertically against IR; epicondyles ┴ to IR
forearm // to IR; humerus 75 o from forearm or 15o RP: Midshaft
from CR; hand supinated CR: ┴
RP: Ulnar sulcus SS: Lesser tubercle in profile; greater tubercle
CR: ┴ superimposed over humeral head
SS: Epicondyles; trochlea; ulnar sulcus (groove b/n Mediolateral Upright
medial epicondyle & trochlea); olecranon fossa PP: RAO/LAO; patient’s hand holding the broken
ER: arm
 Used in radiohumeral bursitis (tennis elbow) RP: Midshaft
 To detect otherwise obscured calcification CR: ┴
located in the ulnar sulcus SS: Lesser tubercle in profile; greater tubercle
Rafert-Long: AP oblique distal humerus for superimposed over humeral head
demonstration of ulnar sulcus ER: For patients with broken humerus

PA AXIAL PROJECTION AP PROJECTION

PP: Seated; arm 45-50o from vertical; hand Recumbent
supinated PP: Supine; unaffected shoulder elevated; hand
RP: Olecranon process supinated; humeral epicondyles // to IR
CR: ┴ or 20o toward the wrist RP: Midshaft
SS: Dorsum of olecranon process (┴); curved CR: ┴
extremity & articular margin of olecranon process SS: Humeral head & greater tubercle in profile
(20o)

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UPPER EXTREMITIES
LATERAL PROJECTION
Lateromedial Recumbent
PP:
Supine: arm abducted slightly; forearm rotated medially;
dorsal aspect of hand against patient’s side; humeral
epicondyles
┴ to IR; elbow flexed slightly (for comfort)
Lateral Recumbent: place IR closed to axilla; elbow
flexed (unless contraindicated); thumb surface of hand up
RP: Midshaft or distal humerus (lateral recumbent)
CR: ┴
SS: Distal humerus
ER (lateral recumbent): For patient with known or
suspected fracture

THE END
<BOARD EXAM is a matter of PREPARATION. If
you FAIL to prepare, you PREPARE to fail=
03/18/14

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LOWER EXTREMITIES
PATHOLOGY DIVISIONS OF FOOT
1.) Congenital Clubfoot 1.) Hindfoot – calcaneus & talus
 Talipes equinovarus 2.) Midfoot – cuboid, navicular & cuneiform
 Abnormal twisting of the foot usually 3.) Forefoot – metatarsals & phalanges
inward & downward
2.) Pott’s Fx A.) TOES
 Avulsion fx of the medial malleolus with
loss of the ankle mortise AP/AP AXIAL PROJECTION
3.) Jones Fx PP: Supine/Seated; knee flexed; 15o foam wedge
 Avulsion fx of the base of the fifth under foot
metatarsal RP: 3rd MTP joint
4.) Gout CR: ┴ or 15o posteriorly
 Hereditary form of arthritis in which uric SS: Phalanges & distal portion of metatarsals
acid is deposited in joints AP Axial (15o): Open IP joints & reduces
5.) Osgood-Schlatter Disease shortening
 Incomplete separation or avulsion of the
tibial tuberosity PA PROJECTION
6.) Giant Cell Tumor PP: Prone (IP joints // to CR); dorsal aspect against
 Osteoclastoma IR
 Lucent lesion in the metaphysic usually at RP: 3rd MTP joint
the distal femur CR: ┴
7.) Chondromalacia Patellae SS: IP joint spaces are well visualized
 Runner’s knee
 Softening of the cartilage under the patella AP OBLIQUE PROJECTION
8.) Joint Effusion Medial Rotation
 Accumulation of fluid in the joint cavity PP: Supine/seated; knee flexed; lower leg & foot
9.) Lisfranc Injury rotated medially 30-45o;
 Abnormal separation in the base of 1st & 2nd RP: 3rd MTP joint
metatarsal & cuneiform CR: ┴
10.) Reiter Syndrome SS: 2nd-5th MTP joint spaces; 1st-3rd toes
 Erosions of sacroiliac joints & lower limbs Lateral Rotation
11.) Hallux Valgus PP: Supine/seated; knee flexed; lower leg & foot
 Congenital abnormality of hallux rotated medially 30-45o;
RP: 3rd MTP joint
 Lateral deviation of great toe
CR: ┴
SS: 3rd-5th toes
ROUTINE
1.) Bony Injuries – AP, APO & Lateral
2.) Bony Pathology – AP & APO LATERAL PROJECTION
3.) Foreign Body Localization – AP & Lateral PP: Lateral recumbent; toe in true lateral
RP: IP joint (1st toe); proximal IP joint (2nd-4th toes)
CR: ┴
1
SS: Phalanges in profile; open IP joints spaces
0

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LOWER EXTREMITIES

B.) SESAMOIDS AP OBLIQUE PROJECTION

Medial Rotation
LEWIS METHOD PP: Supine; knee flexed; leg rotated medially;
TANGENTIAL PROJECTION plantar surface of foot 30o to IR
PP: Prone; dorsiflex great toe; ankle elevated; ball RP: 3rd MTP base
of foot ┴ IR CR: ┴
RP: 1st MTP joint SS:
CR: Perpendicular  Cuboid
SS: MT head & sesamoids in profile  Interspaces on lateral side of foot
 Sinus tarsi
HOLLY METHOD  Lateral cuneiform
TANGENTIAL PROJECTION  3rd-5th MT bases
PP: Seated; plantar 75o to IR; toe flexed & hold w/  5th MT tuberosity
strip gauze bandage; foot medial border ┴ to IR Lateral Rotation
RP: 1st MTP head PP: Supine; knee flexed; leg rotated laterally;
CR: ┴ plantar surface of foot 30o to IR
SS: MT head & sesamoids in profile RP: 3rd MTP base
CR: ┴
CAUSTON METHOD SS:
TANGENTIAL PROJECTION  Navicular
PP: Lateral recumbent; patient lie against
 Interspaces on medial side of foot
unaffected side; limb partially extended; foot in  Medial & intermediate cuneiform
lateral position; 1st MTP joint ┴ to IR
 1st -2nd MT bases
RP: Prominence of 1st MTP joint
CR: 40o toward the heel
LATERAL PROJECTION
SS: Sesamoids with slight overlap
Mediolateral
PP: Dorsiflex foot (┴ to lower leg); leg & foot in
C.) FOOT
lateral position; lateral side of foot against IR (more
comfortable)
AP/AP AXIAL PROJECTION
RP: 3rd MT base
PP: Supine; knee flexed; plantar surface against IR
CR: Perpendicular
RP: 3rd MTP base
SS: Entire foot in profile
CR: ┴ or 10o posteriorly
ER:
SS: MT & Tarsal (┴); TMT joint (10o)
 For localizing foreign body
ER:
 Degree of anterior & posterior displacement
 For localizing foreign bodies
of fx
 Location of fragments in fx of metatarsals &
Lateromedial
anterior tarsals
PP: LPO/RPO; medial surface against IR; plantar
 General surveys of the foot
o surface of foot ┴ to IR
10 Angulation: reduces foreshortening of
RP: 3rd MTP base
metatarsals
CR: Perpendicular
1
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LOWER EXTREMITIES

SS: True lateral projection of foot RP: Tarsals

CR: 15o posteriorly
WEIGHT-BEARING METHOD SS:
LATERAL PROJECTION  True relationship of bones & ossification
PP: Upright; feet elevated (use blocks); IR b/n feet; centers of tarsals
weight equally distributed on each foot  Degree of forefoot adduction & calcaneus
RP: Point above 3rd MTP base inversion
CR: Horizontal 15o Angulation: places CR ┴ to tarsals
SS: Status of longitudinal arch (pes planus);
Bohler’s critical angle (20-40o) KITE METHOD
Bohler’s Critical Angle: angle b/n superior apex of LATERAL PROJECTION
mid-calcaneus to anterior process of calcaneus Mediolateral
PP: Lateral recumbent; uppermost limb flexed &
WEIGHT-BEARING METHOD draw forward
AP AXIAL PROJECTION RP: Midtarsal area
PP: Upright; both feet against IR; weight equally CR: Perpendicular
distributed on each foot SS:
RP: b/n feet at 3rd MTP base level  Anterior talar subluxation
CR: 10o or 15o posteriorly  Degree of plantar flexion (equinus)
SS: Accurate evaluation & comparison of MT &
tarsals KANDEL METHOD
 Hallux valgus & lishfranc injury DORSOPLANTAR AXIAL PROJECTION
PP: Bending forward position; plantar surface
WEIGHT-BEARING COMPOSITE METHOD against IR
AP AXIAL PROJECTION RP: Lower leg
PP: Upright; 2 exposures CR: 40o anteriorly
 First Exposure: opposite foot step SS: Calcaneus
backward (for forefoot); tube in front Freiberger-Hersh-Harrison: CR 35o, 45o & 55o
 Second Exposure: opposite foot step for demonstration of sustentaculum talar joint
backward (for hindfoot); tube behind
RP: 3 MTP base (1st exposure); level of lateral
rd
E.) CALCANEUS
malleolus (2nd exposure)
CR: 15o posteriorly (1st exposure); 25o anteriorly AXIAL PROJECTION
(2nd exposure) Plantodorsal
SS: Full outline of the foot PP: Supine/Seated; leg fully extended; dorsiflex
foot w/ strip of gauze; foot ┴ to IR
D.) CONGENITAL CLUBFOOT RP: 3rd MT base
CR: 40o cephalad
KITE METHOD SS: Calcaneus & subtalar joint
AP PROJECTION Dorsoplantar
PP: Supine; hips & knees flexed; foot flat on IR; PP: Prone; ankle elevated; dorsiflex ankle; foot ┴
ankles slightly extended; legs are vertical 1 to IR; IR vertical
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LOWER EXTREMITIES

RP: Dorsal surface of ankle joint ISHERWOOD METHOD

CR: 40o caudad AP AXIAL OBLIQUE PROJECTION
SS: Calcaneus, subtalar joint & sustentaculum tali Medial Rotation Ankle
PP: Seated or semi-lateral recumbent (more
LILIENFELD METHOD comfortable); leg, foot & ankle rotated 30 o
WEIGHT-BEARING COALITION medially; dorsiflex foot
DORSOPLANTAR AXIAL PROJECTION RP: 1 in. distal & 1 in. anterior to lateral malleolus
PP: Upright; posterior surface of heel at edge of IR; CR: 10o cephalad
opposite foot one step forward SS: Middle subtalar articulation & <end on=
RP: Level of 5th MT base projection of sinus tarsi
CR: 45o anteriorly Lateral Rotation Ankle
SS: Calcaneotalar coaliation PP: Supine/seated; leg, foot & ankle rotated 30o
laterally; dorsiflex foot
LATERAL PROJECTION RP: 1 in. distal medial malleolus
Mediolateral CR: 10o cephalad
PP: Supine; patient turn toward affected side; SS: Posterior subtalar articulation
plantar surface // to IR
RP: 1 in distal to medial malleolus BRODEN METHOD
CR: ┴ AP AXIAL OBLIQUE PROJECTION
SS: Calcaneus & ankle joint Medial Rotation
PP: Supine; leg & foot rotated 45o medially;
WEIGHT BEARING METHOD dorsiflex foot; foot rested against 45o foam wedge
LATEROMEDIAL OBLIQUE PROJECTION RP: 2-3 cm to lateral malleolus
PP: Upright; leg perpendicular to IR; calcaneus CR: 10o, 20o, 30oor 40o cephalad
center to IR SS: Posterior articulation
RP: Lateral malleolus  Anterior portion (40o)
CR: 45o caudad (medially)  Posterior portion (10o)
SS: Calcaneal tuberosity  Talus & sustentaculum tali articulation (20-
ER: Usefuk in diagnosing stress fractures of 30o)
calcaneus or tuberosity Lateral Rotation
PP: Supine; leg & foot rotated 45o laterally;
F.) SUBTALAR JOINT dorsiflex foot; foot rested against 45o foam wedge
RP: 2 cm distal & 2 cm anterior to medial malleolus
ISHERWOOD METHOD CR: 15o cephalad
LATEROMEDIAL OBLIQUE PROJECTION SS: Posterior articulation
Medial Rotation Foot ER: To determine the presence of joint involvement
PP: Semisupine; foot & leg rotated 45o medially; in cases of comminuted fx
knee flexed
RP: 1 in. distal & 1 in. anterior to lateral malleolus
CR: ┴
SS: Anterior subtalar articulation
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G.) ANKLE CR: ┴ to ankle joint

SS: Superior aspect of calcaneus
AP PROJECTION ER: Useful in determining fxs
PP: Supine; leg & foot vertical & rotated 5o
medially (places malleoli equidistant) STRESS METHOD
RP: Point midway between malleoli AP PROJECTION
CR: ┴ to ankle joint PP: Seated; foot forcibly turned toward the opposite
SS: Ankle joint & tibiotalar joint space side; inversion & eversion stress to joint
RP: Ankle joint
LATERAL PROJECTION CR: ┴
Mediolateral ER: To evaluate the presence of ligamentous tear &
PP: Semisupine; lateral surface of foot against IR; joint separation
dorsiflex foot
RP: Medial malleolus WEIGHT-BEARING METHOD
CR: ┴ to ankle joint AP PROJECTION
SS: True lateral projection of lower third of tibia & PP: Upright; heels against the IR; IR vertical; toes
fibula, ankle joint & tarsals pointing toward the x-ray tube
 5th metatarsal base (identify Jones fx) RP: Midway at level of ankle joint
Lateromedial CR: Horizontal
PP: Semisupine; medial surface of foot against IR; ER: Identify ankle joint space narrowing; side-to-
dorsiflex foot side comparison of joint
RP: 0.5 in. superior to lateral malleolus
CR: ┴ to ankle joint H.) LEG
SS: Lateral projection of lower third of tibia &
fibula, ankle joint & tarsals AP PROJECTION
PP: Supine; femoral condyles // to IR; foot in
AP OBLIQUE PROJECTION vertical position;
Medial Rotation RP: Midshaft
PP: Supine; CR: ┴
 Leg & foot rotated 45o medially; dorsiflex SS: Tibia & fibula; ankle & knee joints
foot – to demonstrate bony structure
 Leg & foot rotated 15-20o medially; LATERAL PROJECTION
intermalleolar line // to IR – to demonstrate MEDIOLATERAL
mortise joint PP: Supine; RPO/LPO; patella ┴ to IR; femoral
RP: Point midway b/n malleoli condyles ┴ to IR;
CR: ┴ to ankle joint RP: Midshaft
SS: Distal ends of tibia, fibula & talus; tibiofubular CR: ┴
articulation; mortise joints SS: Tibia & fibula; ankle & knee joints
Lateral Rotation
PP: Supine; leg & foot rotated 45o laterally; AP OBLIQUE PROJECTION
dorsiflex foot PP: Supine; leg & foot rotated 45o medially or
RP: Point midway b/n malleoli 1
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RP: Midshaft  Perpendicular (19-24 cm)

CR: ┴  3-5ocephalad (>24 cm)
SS: Tibia & fibula; ankle & knee joints SS: Proximal tibiofibular joint; fibular head
Lateral Rotation
I.) KNEE PP: Supine; leg rotated 45o medially; hip of
unaffected side elevated
AP PROJECTION RP: 0.5 in inferior to patellar apex
PP: Supine; femoral epicondyles // to IR; leg 5o CR: 5o cephalad
inward (places interepicondylar line // to IR) SS: Tibial plateaus; medial femoral & tibial
RP: 0.5 in. inferior to patellar apex condyles
CR: depending on the measurement b/n ASIS &
table top WEIGHT-BEARING METHOD
 3-5ocaudad (<19 cm; thin pelvis) AP BILATERAL PROJECTION
 ┴ (19-24 cm) LEACH-GREGG-SIBER
 3-5ocephalad ( >24 cm; large pelvis) PP: Upright; knee fully extended; weight equally
SS: Knee joint space distributed on both feet; IR vertical
RP: 0.5 in. inferior to patellar apex
PA PROJECTION CR: Horizontal
PP: Prone; femoral epicondyles // to IR; leg 5 o SS: Knee joint spaces
inward (places interepicondylar line // to IR) ER:
RP: 0.5 in. inferior to patellar apex  To reveal narrowing of knee joint space
CR: 5-7ocaudad  To evaluate varus & valgus deformities &
SS: Knee joint space degenerative joint disease

LATERAL PROJECTION ROSENBERG METHOD

Mediolateral PA WEIGHT-BEARING
PP: Lateral recumbent; knee flexed 20-30o (relax STANDING FLEXION
muscle & shows maximum volume of joint cavity) PP: Upright; facing vertical IR; anterior surface of
or flexed <10o (for new or unhealed patellar fx); flexed knee against IR; femur 45o to IR
femoral epicondyles ┴ to IR RP: 0.5 in. inferior to patellar apex
RP: 1 in. distal to medial epicondyle CR: Horizontal or 10o caudad
CR: 5-7o cephalad ER: Useful for evaluating joint space narrowing &
SS: Knee joint space demonstrating articular cartilage disease

AP OBLIQUE PROJECTION J.) INTERCONDYLAR FOSSA

Medial Rotation
PP: Supine; leg rotated 45o medially; hip of HOLMBLAD METHOD
affected side elevated PA AXIAL PROJECTION
RP: 0.5 in. inferior to patellar apex TUNNEL VIEW
CR: depending on the measurement b/n ASIS & PP: Anterior surface of knee against IR; knee 60-
table top 70o from IR (20o difference from CR)
 3-5ocaudad (<19 cm) 1 3 positions:
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Standing; knee flexed & rested on a stool SS: Sharper image of patella (closer OID)
Standing at side of table; knee flexed &
rested over the IR LATERAL PROJECTION
 Kneeling on table; knee over the IR PP: Lateral recumbent; unaffected knee & hip
(Holmblad Method) flexed; unaffected foot in front; affected knee flexed
RP: Popletial depression 5-10o or flexed not >10 (for new or unhealed
CR: ┴ patellar fx); femoral epicondyles & patella ┴ to IR;
SS: Intercondylar fossa RP: Midpatellofemoral joint
CR: ┴
CAMP-COVENTRY METHOD SS: Patella & patellofemoral joint space
PA AXIAL PROJECTION
PP: Prone; knee flexed 40-50o from IR; femur PA OBLIQUE PROJECTION
against IR; with support under foot Medial Rotation
RP: Popletial depression PP: Prone; knee flexed 5-10o; knee 45-55o medially
CR: 40o (knee flexed 40o) or 50o (knee flexed 50o) RP: Patella
caudally CR: ┴
SS: Intercondylar fossa SS: Medial portion of patella free of femur
ER: Lateral Rotation
 To detect loose bodies <joint mice PP: Prone; knee flexed 5-10o; knee 45-55o laterally
 To evaluate split & displaced cartilage in RP: Patella
osteochoditis CR: ┴
 To evaluate flattening or underdevelopment SS: Lateral portion of patella free of femur
of lateral femoral condyles in congenital
slipped patella KUCHENDORF METHOD
PA AXIAL OBLIQUE PROJECTION
BECLERE METHOD Lateral Rotation
AP AXIAL PROJECTION PP: Prone; hip elevated 2-3 in.; knee flexed 10o
PP: Supine; knee flexed; femur 60o to long axis of (relax the muscles); knee rotated 35-40o laterally
tibia; curved cassette is used RP: Joint space b/n patella & femoral condyles
RP: 0.5 in. inferior to patellar apex CR: 25-30ocaudad
CR: ┴ to long axis of lower leg SS: Oblique patella free superimposition of femur
SS: Intercondylar fossa, intercondylar eminence,
knee joint & tibial plateau HUGHSTON METHOD
TANGENTIAL PROJECTION
K.) PATELLA PP: Prone; anterior surface of knee against IR; knee
flexed 50-60o; foot rested against collimator/support
PA PROJECTION RP: Patellofemoral joint
PP: Prone; heel 5-10o laterally (places CR: 45o cephalad
patella // to IR) SS: Patella; patellofemoral joint
RP: Midpopletial depression ER:
CR: Perpendicular  To demonstrate subluxation of patella &
1 patellar fx
 It allows assessment of femoral condyles 6 MERCHANT METHOD
TANGENTIAL PROJECTION
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PP: Supine; both knee flexed 40o or b/n 30-90o (to L.) FEMUR
demonstrate various patellar disorders); IR resting on
patient’s shins; uses IR holding device & axial AP PROJECTION
viewer device PP: Supine
RP: Midway b/n patellae at level of patellofemoral  Distal femur (knee included): leg rotated 5o
joint inward ( places limb in true anatomic position)
CR: 30o caudad from horizontal  Proximal femur (hip included): leg rotated
SS: Femoral condyle; intercondylar sulcus & 10-15o inward (places femoral neck in profile)
magnified nondistorted patellae RP: Midfemur
CR: ┴
SETTEGAST METHOD SS: Femoral neck & hip joint (10-15o); knee joint (5o)
TANGENTIAL PROJECTION
Disadvantage: Extreme flexion LATERAL PROJECTION
PP: Supine or prone (preferable); knee acutely Mediolateral
flexed until patella ┴ to IR; loop bandage around PP: Lateral recumbent; affected side against IR
ankle or foot to hold the leg in position  Distal femur (knee included): unaffected
RP: Joint space b/n patella & femoral condyles limb draw forward; pelvis in true lateral
CR: Perpendicular (if joint is ┴); 15-20o cephalad (if position; affected knee flexed 45o; femoral
joint isn’t ┴) epicondyles ┴ to IR;
 Angulation depends on knee flexion  Proximal femur (hip included): unaffected
SS: Patella; patellofemoral joint limb draw posteriorly; pelvis rolled 10-15o
ER: posteriorly
 Useful for demonstrating vertical & RP: Midfemur
transverse fx of patella CR: ┴
 Useful for investigating articulating surfaces SS: ¾ of femur & adjacent joints
of patellofemoral articulation
TRANSLATERAL PROJECTION
SUNRISE METHOD CROSSTABLE LATERAL
TANGENTIAL PROJECTION PP: Dorsal decubitus; IR placed vertically against
MOUNTAIN/SKYLINE VIEW medial/lateral surface of femur;
PP: Supine/Sitting; knee flexed 40-45o RP: Medial side of midfemur
RP: Patellofemoral joint CR: Horizontal
CR: 30o from horizontal SS: Entire femur & knee joint
ER: Joint space b/n patella & femoral condyles ER: For patient who can’t tolerate routine lateral
position because of fractures or destructive disease

 THE END 
<BOARD EXAM is a matter of PREPARATION. If
you FAIL to prepare, you PREPARE to fail=
TOPOGRAPHIC LANDMARKS
1.) Cervical Region
 C1 – mastoid tip
1  C2-C3 – gonion
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 C5 – thyroid cartilage 2.) Kyphosis
 C7 – vertebral prominens  Exaggerated thoracic curvature
2.) Thoracic Region  Humpback or hunchback
 T1 – 2 in. superior to sternal notch  Increase anterior concavity or posterior
 T2-T3 – manubrial notch/superior margin of convexity
scapula/suprasternal notch 3.) Scoliosis
 T4-T5 – sternal angle  Lateral curvature
 T7 – inferior angle of scapula  S-shaped
 T9-T10 – xiphoid process/ensiform 4.) Gibbus
 T10 – xiphoid tip  Posterior angulation of the spine
3.) Lumbar Region
 L3 – lower costal margin PATHOLOGY
 L3-L4 – level of umbilicus 1.) Clay Shoveler’s Fx
 L4 – most superior aspect of iliac crest  Avulsion fx of the spinous process in the
4.) Sacrum & Pelvic Region lower cervical & upper thoracic region
 S1 – ASIS 2.) Compression Fx
 Coccyx – pubic symphysis & greater  Fx that causes compaction of bone & a
trochanter decrease in length or width
3.) Hangman’s Fx
SPINAL CURVATURES  Fx of the anterior arch of C2 due to
1.) Cervical & Lumbar Curve hyperextension
 Convex anteriorly & concave posteriorly 4.) Jefferson’s Fx
 Secondary/compensatory curve: develop  Comminuted fx of the ring of C1
after birth 5.) Herniated Nucleus Pulposus
 Cervical: when baby starts holding the head  Rupture or prolapsed of the nucleus
 Lumbar: when baby learns to walk pulposus into the spinal canal
2.) Thoracic & Pelvic Curve 6.) Kyphosis
 Convex posterior & concave anteriorly  Abnormally increased convexity in the
 Primary curve: present at birth thoracic curvature
7.) Lordosis
ABNORMAL CURVATURES  Abnormally increased concavity of the
1.) Lordosis cervical & lumbar spine
 Exaggerated lumbar curvature 8.) Osteopetrosis
 Swayback  Increased density of atypically soft bone
 Increase anterior convexity or posterior 9.) Osteoporosis
concavity  Loss of bone density
10.) Scheuerrmann’s Disease
 Adolescent kyphosis
 Kyphosis with onset in adolescence

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11.) Scoliosis ER: Alternative projection when a patient cannot be

 Lateral deviation of the spine with possible adjusted in the open-mouth position
vertebral rotation
12.) Spina Bifida B.) DENS
 Failure of the posterior encasement of the
spinal cord to close FUCHS METHOD
13.) Spondylolisthesis AP PROJECTION
 Forward displacement of a vertebra over a PP: Supine; chin extended; chin tip & mastoid tip ┴
lower vertebra, usually L5-S1 to IR; MSP ┴ to IR RP:
14.) Spondylolysis Distal to chin tip CR: ┴
 Separation of the pars interarticularis SS: Dens w/in foramen magnums
15.) Odontoid Fx ER: Recommended when upper half of dens is not
 Disruption of the arches of C1 clearly shown in open-mouth position
16.) Teardrop Burst Fx
 Comminuted vertebral body with triangular KASABACH METHOD
fragments avulsed from anteroposterior AP AXIAL OBLIQUE PROJECTION
border caused by compression with R & L head rotations
hyperflexion in the cervical region PP: Supine; head rotated 40-45o; IOML ┴
17.) Transitional Vertebra RP: Midway b/n outer canthus & EAM
 It occurs when the vertebra takes on a CR: 10-15o caudad
characteristic of the adjacent region of the SS: Dens
spine ER: Recommended in conjuction with AP & lateral
18.) Chance Fx projections
 Fx through the vertebral body caused by
hyperflexion force C. ATLAS (C1) & AXIS (C2)
19.) Whiplash Injury
ALBERS-SCHOBERG & GEORGE METHOD
 Damage to the ligaments, vertebrae or spinal
cord caused by sudden jerking back of the AP <OPEN-MOUTH" PROJECTION
PP: Supine; MSP ┴; open mouth as wide as
head & neck
possible;
RP: Midpoint of open mouth
A.) ATLANTO-OCCIPITAL JOINTS
CR: ┴
SS: Atlas & axis
AP OBLIQUE PROJECTION
R & L head rotations
PP: Supine; head rotated 45-60o away from side of LATERAL PROJECTION
PP: Supine (dorsal decubitus); IR vertical; MSP //
interest; IOML ┴ to IR
to IR; MSP ┴ to table; neck slightly extended
RP: 1 in. anterior to the EAM
(mandibular rami does not overlap atlas or axis)
CR: ┴
RP: 1 in. distal to mastoid tip
SS: Atlanto-occipital joints b/n orbit & ramus of
mandible CR: ┴
SS: Atlas & axis; atlanto-occipital joints
 Dens is well demonstrated
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Pancoast, Pendergrass & Schaeffer  Hyperflexion: head drop forward; draw

Recommendation: chin as close as possible to the chest
 Head rotated slightly  Hyperextension: chin elevated as much as
 Rationale: to prevent superimposition of possible
laminae & atlas RP: C4
CR: Horizontal
D.) CERVICAL VERTERBRAE SS: IV disks & zygapophyseal joints
SS in Hyperflexion:
AP AXIAL PROJECTION  C1-C7
PP: Supine/upright; chin extended; occlusal plane  Elevated & widely separated spinous
┴ to IR (prevents superimposition of mandible & processes
midcervical vertebrae) SS in Hyperextension:
RP: C4  C1-C7
CR: 15-20o cephalad  Depressed spinous processes
SS: C3-T2 ER:
 Interpediculate spaces  For functional studies (motility) of cervical
 IV disk spaces vertebrae
 Superimposed transverse & articular  To demonstrate normal AP movement or
processes absence of movement
ER: Used to demonstrate the presence or absence of
cervical ribs AP AXIAL OBLIQUE PROJECTION
Barsony & Koppenstein: described this projection
GRANDY METHOD PP: Supine or upright (more comfortable);
LATERAL PROJECTION RPO/LPO; body rotated 45o; chin
PP: Seated/upright; patient in true lateral position; protruded/elevated
shoulder rotated posteriorly or anteriorly (round RP: C4
shouldered); chin slightly elevated (prevents CR: 15-20o cephalad
superimposition of mandibular rami & spine); MSP SS: Intervertebral foramina & pedicles (farthest from
// to IR IR)
RP: C4 Boylston Suggestion:
CR: Horizontal  Functional studies in oblique projection
SS: C1-C7  Rationale: to demonstrate fx of articular
 Articular pillars process dislocation/subluxation
 Zygapophyseal joints (C3-C7)
 Spinous processes PA AXIAL OBLIQUE PROJECTION
PP: Prone or upright (more comfortable);
LATERAL PROJECTION RAO/LAO; body rotated 45o; shoulder rested against
Hyperflexion & Hyperextension IR; chin protruded/elevated
PP: Seated/upright; patient in true lateral position; RP: C4
MSP // to IR CR: 15-20o caudad

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SS: Intervertebral foramina & pedicles (closest to IR) VERTEBRAL ARCH/PILLAR/LATERAL

MASS PROJECTION
OTTONELLO/CHEWING/WAGGING JAW AP AXIAL OBLIQUE PROJECTION
METHOD R & L head rotations
AP PROJECTION PP: Supine; head rotated 45-50o (C2-C7 articular
PP: Supine; MSP ┴ to IR; chin elevated; upper processes) or 60-70o (C6-T4 articular processes); turn
incisors & mastoid tips ┴ to IR; mandible in chewing jaw away from side of interest;
motion during exposure RP: C7
RP: C4 CR: 35o caudad; 30-40o caudad (ranges)
CR: ┴ SS: Vertebral arch structures
SS: Entire cervical column ER: Used to demonstrate vertebral arches when the
ER: To blurred the mandibular shadow to patient cannot hyperextend head for AP/PA axial
demonstrate all cervical vertebrae projection

VERTEBRAL ARCH/PILLAR/LATERAL TWINNING & PAWLOW METHOD

MASS PROJECTION SWIMMER’S TECHNIQUE
AP AXIAL PROJECTION LATERAL PROJECTION
PP: Supine; shoulder depressed; MSP ┴ to IR; neck PP: Humeral head moved anteriorly or posteriorly;
hyperextended; depress shoulder away from IR; MSP // to IR;
RP: C7 breathing technque
CR: 25o caudad; 20-30o caudad (range)  Lateral recumbent (Pawlow): head
SS: Vertebral arch structures elevated on patient’s arm;
 Superior & inferior articular processes  Upright (Twinning): arm closes to IR
(pillars) extended; elbow flexed; forearm rested on
 Zygapophyseal joints b/n articular head
processes RP: C7-T1 interspace
 Upper three of thoracic vertebrae CR: ┴ (shoulder well depressed); 3-5o caudad (can’t
 Laminae be depressed sufficiently)
 Spinous processes SS: Cervicothoracic region (C7-T1)
ER: Useful for demonstrating the cervicothoracic ER: Performed when shoulder superimposition
spinous processes in patients with whiplash injury obscures C7 on a lateral cervical spine projection
Monda Recommendation:
VERTEBRAL ARCH/PILLAR/LATERAL  CR 5-15o cephalad
MASS PROJECTION  To better demonstrate IV disk spaces
AP AXIAL PROJECTION
PP: Prone; head rested against IR; neck fully E.) THORACIC VERTEBRAE
extended; MSP ┴ to IR
RP: C7 AP PROJECTION
CR: 40o cephalad; 35-45o cephalad (range) PP: Supine/upright; MSP ┴ to IR; hips & knees
SS: Vertebral arch structures flexed (to reduce kyphosis); place support under
knees
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RP: T7 (b/n jugular notch & xiphoid process) F.) LUMBAR-LUMBOSACRAL VERTEBRAE
CR: ┴
SS: T1-T12 AP PROJECTION
 IV disk spaces PP: Supine/upright; elbow flexed; hands on upper chest
 Transverse processes  Hips & knees flexed
 Costovertebral articulation o Reduces lumbar lordosis
o Places back in contact w/ table
LATERAL PROJECTION o Reduces distortion of vertebral
PP: Lateral recumbent or upright (Oppenheimer); bodies
left side against the table (places heart closer to IR) o Better delineation of IV disk
RP: L4 (for lumbosacral); L3 (for lumbar spine only)
MSP // to IR; hips & knees flexed; arms at right
angle to body (to elevate ribs enough); place support CR: ┴
SS: Lumbar bodies
under lower thoracic spine
RP: T7  IV disk spaces
CR: ┴ (w/ support); 10-15o cephalad (w/o support);  Interpediculate spaces
10o (female) or 15o (male)  Laminae
SS: T1-T12  Spinous & transverse processes
 IV disk spaces  Sacrum, coccyx & pelvic bones (larger IR)
 Intervertebral foramina
 Lower spinous processes LATERAL PROJECTION
PP: Lateral recumbent or upright; affected side
FUCHS METHOD against IR; hips & knees flexed; MCP ┴ to IR; place
AP OBLIQUE PROJECTION support under lower thorax (places spine in true
PP: Supine/upright; RPO/LPO; body rotated 20o horizontal position)
posteriorly; MCP 70o from IR RP: L4 (for lumbosacral); L3 (for lumbar spine only)
RP: T7 CR: ┴ (w/ support); 5-8o caudad (w/o support); 5o
CR: ┴ (male) or 8o (female)
SS: Zygapophyseal/apophyseal joints (farthest from SS: Intervertebral foramina of L1-L4 only; L5
IR) intervertebral foramina (Oblique Projection)

OPPENHEIMER METHOD F.) L5-S1 LUMBOSCRAL JUNCTION

PA OBLIQUE PROJECTION
PP: Prone/upright; RAO/LAO; body rotated 20o LATERAL PROJECTION
anteriorly; MCP 70o from IR PP: Lateral recumbent or upright; affected side
RP: T7 against IR; hips & knees flexed; MCP ┴ to IR; place
CR: ┴ support under lower thorax (places spine in true
SS: Zygapophyseal/apophyseal joints (closest to IR) horizontal position)

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RP: 2 in. posterior to ASIS & 1.5 in. inferior to iliac H.) LUMBOSACRAL JOINTS & SACRAL
crest JOINTS
CR: ┴ (w/ support); 5-8o caudad (w/o support); 5o
(male) or 8o (female) FERGUSON METHOD
SS: Lumbosacral junction AP AXIAL PROJECTION
PP: Supine; lower limb extended; thigh abducted;
G.) ZYGAPOPHYSEAL JOINTS RP: 1.5 in. superior to pubic symphysis
CR: 45o cephalad (Ferguson); 30-35o cephalad; 30o
AP OBLIQUE PROJECTION (male) or 35o (female);
PP: Semisupine/upright; RPO/LPO; body rotated 45o SS: Lumbosacral joint; symmetric sacroiliac joints
or 60o (L5-S1 zygapophyseal joints & articular Meese Recommendation:
processes);  PP: Prone (places sacroiliac joints nearly //
RP: to CR)
Lumbar region: 2 in. medial to elevated ASIS &  RP: 2 in. distal to L5 (level of ASISs)
1.5 in. superior to iliac crest (L3)  CR: ┴
5th zygapophyseal joint: 2 in. medial to elevated
ASIS & midway b/n iliac crest & ASIS FERGUSON METHOD
CR: ┴ PA AXIAL PROJECTION
SS: Zygapophyseal/apophyseal joints (closest to IR) PP: Prone
 Scottie dog RP: L4
o Superior articular process (ear) CR: 35o caudad
o Transverse process (nose) SS: Lumbosacral joint; symmetric sacroiliac joints
o Pedicle (eye)
o Part interarticularis (neck) I.) SACROILIAC JOINTS
o Lamina (body)
o Inferior articular process (foot)
AP OBLIQUE PROJECTION
Note:
PP: Semisupine; RPO/LPO; body rotated 25-30o
 Majority (L3-S1) of zygapophyseal joints
RP: 1 in. medial to elevated ASIS
(45o body rotation)
CR: ┴
 L1-L2 & L2-L3 (AP; 25% only) SS: Sacroiliac joint (farthest from IR)
 L4-L5 & L5-S1 (LATERAL; small %age)
AP AXIAL OBLIQUE PROJECTION
PA OBLIQUE PROJECTION PP: Semisupine; RPO/LPO; body rotated 25-30o
PP: Semiprone/upright; RAO/LAO; body rotated 45o RP: 1 in. distal to elevated ASIS
or 60o (L5-S1 zygapophyseal joints & articular CR: 20-25o cephalad
processes) SS: Sacroiliac joint (farthest from IR)
RP: 1.5 in. superior to iliac crest & 2 in. lateral to
palpable spinous process PA OBLIQUE PROJECTION
CR: ┴ PP: Semiprone; RAO/LAO; body rotated 25-30o
SS: Zygapophyseal/apophyseal joints (farthest from RP: 1 in. medial to elevated ASIS
IR) CR: ┴
 Scottie dog
2 SS: Sacroiliac joint (closest to IR)
J.) PUBIC SYMPHYSIS 3 CHAMBERLAIN METHOD
PA PROJECTION
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PP: Upright; standing on two blocks SS: Sacrum
 First exposure: remove one blocks; one
leg hangs with no muscular resistance L.) COCCYX
 Second exposure: replace support under
foot that was hanging; remove the opposite AP/PA AXIAL PROJECTION
one; second leg hanging free PP: Supine or prone (patient w/
RP: Pubic symphysis painful injury/destructive disease)
CR: ┴ RP: 2 in. superior to pubic symphysis (supine);
SS: Pubic symphysis Palpable coccyx (prone)
Chamberlain Recommendations: CR: 10o caudad (supine); 10o cephalad (prone)
 For abnormal sacroiliac motion SS: Coccyx free of superimposition
 Lateral Projection:
o Upright LATERAL PROJECTION
o Centered to lumbosacral junction PP: Lateral recumbent; interiliac plane ┴ to IR;
 2 PA Projections of Pubic bones: pelvis & shoulder in true lateral position
o Upright RP: 3.5 in. posterior & 2 in. inferior to ASIS
o Weight-bearing on alternate limbs CR: ┴
o To demonstrate pubic symphysis SS: Coccyx
reaction by a change in the normal
relation of pubic bones
M.) LUMBAR INTERVERTEBRAL

K.) SACRUM
DISKS WEIGHT-BEARING METHOD
PA PROJECTION
AP/PA AXIAL PP: Upright; patient bending to right & left; lean
PROJECTION
directly lateral as far as possible
PP: Supine or prone (patient w/
RP: L3
painful injury/destructive disease)
CR: 15-20o caudad
RP: 2 in. superior to pubic symphysis (supine);
SS: Lower thoracic & lumbar region
visible sacral curve (prone)
ER: Perform for demonstration of the mobility of
CR: 15o cephalad (supine); 15o caudad (prone)
intervertebral joints
SS: Sacrum free of foreshortening
Duncan & Hoen Recommendation:
 PA projection be used
LATERAL PROJECTION
 Rationale: IV disks more nearly // to CR
PP: Lateral recumbent; interiliac plane ┴ to IR;
pelvis & shoulder in true lateral position
RP: 3.5 in. posterior to ASIS
CR: ┴

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RULES OF OBLIQUE
Anatomy of
Projection Position/Degrees Structure Shown Central Ray
Interest
LPO – 45o Right IF (side up) 15-20o cephalad
CERVICAL AP Oblique
RPO – 45o Left IF (side up) 15-20o cephalad
(Intervertebral
LAO – 45o Left IF (side down) 15-20o caudad
Foramina) PA Oblique
RAO – 45o Right IF (side down) 15-20o caudad
LPO – 70o Right ZJ (joints up) ┴
THORACIC AP Oblique
RPO – 70o Left ZJ (joints up) ┴
(Zygapophyseal
LAO – 70o Left ZJ (joints down) ┴
Joints) PA Oblique
RAO – 70o Right ZJ (joints down) ┴
LPO – 45o Left ZJ (joints down) ┴
LUMBAR AP Oblique
RPO – 45o Right ZJ (joints down) ┴
(Zygapophyseal
LAO – 45o Right ZJ (joints up) ┴
Joints) PA Oblique
RAO – 45o Left ZJ (joints up) ┴
LPO – 25-30o Right SIJ (joint up) ┴
AP Oblique
SACROILIAC RPO – 25-30o Left SIJ (joint up) ┴
JOINTS LAO – 25-30o Left SIJ (joint down) ┴
PA Oblique
RAO – 25-30o Right SIJ (joint down) ┴
LPO – 45o Left AR (side down) ┴
AP Oblique
RPO – 45o Right AR (side down) ┴
AXILLIARY RIBS
LAO – 45o Right AR (side up) ┴
PA Oblique
RAO – 45o Left AR (side up) ┴

ZYGAPOPHYSEAL INTERVERTEBRAL
ANATOMY
JOINTS FORAMINA
Cervical Lateral Oblique – 45o
Thoracic Oblique – 70o Lateral
Lumbar Oblique – 45 o
Lateral

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PATHOLOGY
1.) Aspiration/Foreign Body
 Inspiration of a foreign material into the airway
2.) Atelectasis
 A collapse of all or part of the lung
3.) Bronchiectasis
 Chronic dilatation of the bronchi & bronchioles
4.) Bronchitis
 Inflammation of the bronchi
5.) Chronic Obstructive Pulmonary Disease
 Chronic condition of persistent obstruction of bronchial airflow
6.) Cystic Fibrosis
 Widespread dysfunction of the exocrine glands
 Abnormal secretion of sweat & saliva & accumulation of thick mucus in the lungs
7.) Emphysema
 Enlargement of alveolar wall caused by alveolar wall destruction & loss of elasticity
8.) Epiglottitis
 Inflammation of the epiglottis
9.) Histoplasmosis
 Infection caused by the yeastlike organism
Histoplasma capsulatum
10.) Sarcoidosis
 Condition of unknown origin often associate with pulmonary fibrosis
11.) Tubercolosis
 Chronic infection of the lungs due to the
tubercle bacillus
12.) Hyaline Membrane Disease/Respiratory Distress Syndrome
 Underaeration of the lungs due to a lack of surfactant
13.) Metastases
 Transfer of a cancerous lesion from one area to another

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14.) Pleural Effusion/Hydrothorax

 Collection of fluid in the pleural cavity
15.) Pneumoconiosis
 Lung diseases resulting from inhalation of industrial substances
Anthracosis
 Coal miner’s lung or black lung
 Inflammation caused by inhalation of coal dust (anthracite)
Asbestosis
 Inflammation caused by inhalation of asbestos
Silicosis
 Inflammation caused by inhalation of silicon dioxide
16.) Pneumonia
 Acute infection in the lung parenchyma
Aspiration
 Pneumonia caused by inhalation of foreign particles
Interstitial/Viral/Pneumonitis
 Pneumonia caused by a virus & involving alveolar walls & interstitial structures
Lobar/Bacterial
 Pneumonia involving the alveoli of an entire lobe without involving the bronchi
Lobular/Bronchopneumonia
 Pneumonia involving the bronchi and scattered throughout the lung
17.) Pneumothorax
 Accumulation of air in the pleural cavity resulting in collapse of the lung
18.) Pulmonary Edema
 Replacement of air with fluid in the lung interstitium & alveoli

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BONY THORAX

A.) TRACHEA  Sharp outline of heart

 Sharp outline of diaphragm (expiration)
AP PROJECTION  Ten posterior ribs above diaphragm
PP: Supine/upright; neck slightly extended; MSP ┴ Upright Position Rationale:
to IR; exposure during slow inspiration  Diaphragm at its lowest position
RP: Manubrium  Air-fluid levels are seen
CR: ┴  Avoid engorgement of the pulmonary
SS: Air-filled trachea vessels

LATERAL PROJECTION AP PROJECTION

PP: Seated/upright; hands clasped behind the body; PP: Supine/upright; back against IR; place hands on
shoulder rotated posteriorly (prevents hips; elbow flexed; hand pronated
superimposition of arms & superior mediastinum); RP: 3 in. inferior to jugular notch
neck extended slightly; exposure during slow CR: ┴
inspiration SS: Somewhat similar to PA but magnified
RP: Midway b/n jugular notch & midcoronal plane  Magnified heart & great vessels
(for trachea); 4-5 in. lower (for superior
 Lung fields appear shorter
mediastinum)
 Clavicle projected higher
CR: ┴
 Ribs assume horizontal position
SS: Air-filled trachea & superior mediastinum
Resnick Recommendation:
ER: described by Eiselbeg & Sgalitzer
 CR 30o caudad to midsternal region
 Used to demonstrate restrosternal extensions
 Rationale: to free basal portions of the lung
of the thyroid gland
fields from superimposition by anterior
 Thymic enlargement in infants (recumbent
diaphragmatic, abdominal & cardiac
position)
structures
 Opacified larynx & upper esophagus
 Outline of trachea & bronchi
LINDBLOM METHOD
For foreign body localization
AP AXIAL PROJECTION
PP: Upright; step 1 foot in front; lean backward in
B.) CHEST
extreme lordosis; elbow flexed; pronate hands
beside the hips; shoulder against IR;
PA PROJECTION
RP: Midsternum
PP: Upright/seated-upright (always); chin extended
CR: ┴ or 15-20o cephalad (no leaning backward)
upward; dorsal aspect of hands against the hips
SS: Lung apices inferior to shadow of clavicles
(rotates scapulae laterally; depress shoulder; pull
 Demonstrate interlobar effusions
breast upward & laterally (female); exposure after
ER: Used in preference to PA axial projection in
second full inspiration (general) or end of full
hyperstenic patient & whose clavicles occupy a
inspiration & expiration (for presence of
high position
pneumothorax & foreign body)
RP: T7
CR: ┴
SS: Entire lung field 3
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PA AXIAL PROJECTION  RAO:

PP: Upright; chin rested against the IR; elbow o Maximum area of left lung
flexed; pronate hands on hips; depress shoulder & o Trachea
rotated forward; exposure at end of full inspiration o Entire left branch of bronchial tree
RP: T3 o Best image of left atrium, anterior
CR: 10-15o cephalad portion of apex of left ventricle &
SS: Lung apices superior to shadow of clavicles right retrocardiac space
o Esophagus (if barium filled)
LATERAL PROJECTION  Medial part of right middle lobe & lingula of
PP: Upright/seated-upright; left side against the IR the left upper lobe free from hilum (CR 10-
(for heart & left lung) or right side against the IR 20o)
(for right lung); MSP // to IR; MCP ┴ to IR; arms
extended directly upward; elbow flexed; forearm AP OBLIQUE PROJECTION
resting on elbows PP: Upright/supine; LPO/RPO (affected side
RP: T7 down); body rotated 45o toward affected side;
CR: ┴ shoulder of affected side against IR
SS: RP: 3 in. inferior to jugular notch
 Heart, aorta & left-sided pulmonary lesions CR: ┴
(left lateral) SS:
 Right-sided pulmonary lesions (right lateral)  LPO: maximum area of left lung; similar to
ER: RAO
 Employed to demonstrate the interlobar  RPO: maximum area of right lung; similar
fissures to LAO
 To differentiate the lobes ER:
 To localize pulmonary lesions  Used when patient is too ill to be turned in
prone position
PA OBLIQUE PROJECTION  Supplementary position in investigation of
PP: Upright/seated-upright; LAO/RAO (affected specific lesions
side up); body rotated 45o toward unaffected side;  Used with recumbent patient in contrast
55-60o (for cardiac series; )10-20o (for study of studies of the heart & great vessels
pulmonary diseases); shoulder of unaffected side
against IR AP/PA PROJECTION
RP: T7 R or L Lateral Decubitus
CR: ┴ PP: Lateral decubitus; patient lie on affected side
SS: (for pleural effusion) or unaffected side
 LAO: (pneumothorax); body elevated 2-3 in.; arms well
o Maximum area of right lung above the head; remain in position for 5 minutes
o Trachea & carina before exposure
o Entire right branch of bronchial tree RP: 3 in. inferior to jugular notch (AP) or T7 (PA)
o Heart, descending aorta & aortic arch CR: Horizontal
o Esophagus (if barium filled)
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ER:  Sternum projected over the heart

 Used to demonstrate the change in fluid AP Oblique Projection:
position (pleural effusion)  LPO position
 Reveals any previously obscured pulmonary  For trauma patients in supine position
areas
 Demonstrate the presence of any free air MOORE METHOD
(pneumothorax) PA OBLIQUE PROJECTION
Ekimsky Recommendation: PP: Modified prone position; tube positioned over
 Patient leaning laterally 45o the patient’s right side; patient stand at the side of
 Rationale: for demonstration of small table; bend at the waist; arms above shoulders;
pleural effusions palms down on table
RP: level of T7 & 2 in. to the right of spine
LATERAL PROJECTION CR: 25o toward MSP; large patient (less
R or L Position angulation); small patient (more angulation)
Ventral/Dorsal decubitus Position SS: Sternum free of superimposition from vertebral
PP: Supine/prone; thorax elevated 2-3 in.; remain in column
position 5 minutes before the exposure; extend arms ER: Perform on an ambulatory patient who is
well above the head; affected side against the IR having acute pain to provide comfort & to produce
RP: 3 in. inferior to jugular notch (ventral high-quality sternum image
decubitus) or T7 (dorsal decubitus)  Sternum projected over the heart
CR: Horizontal
ER: LATERAL PROJECTION
 Used to demonstrate the change in fluid R or L Position
position PP: Lateral recumbent/upright or dorsal decubitus
 Reveals pulmonary areas that obscured by (for patient with severe injury); patient in true
fluid in standard projection lateral position; broad surface of sternum ┴ to IR;
suspended deep inspiration
C.) STERNUM RP: Lateral border of midsternum
CR: ┴
PA OBLIQUE PROJECTION SS: Best demonstrate the entire length of sternum &
PP: Prone or upright (trauma patient); RAO; body its surrounding tissue
rotated 15-20o (prevents superimposition of sternum
& vertebrae); long exposure time: slow, shallow D.) STERNOCLAVICULAR JOINTS
breaths during exposure; short exposure time:
suspend breathing at the end of expiration PA PROJECTION
RP: T7 of elevated side of posterior thorax & 1 in. PP: Prone or upright (trauma patient); arms along
lateral to MSP the sides; palms facing upward; head turned facing
CR: ┴ the affected side for unilateral examination (rotates
SS: Best projection to demonstrate sternum the spine slightly away from side of interest); head
 Sternum free of superimposition from rested on chin for bilateral examination
vertebral column RP: T3
3 CR: ┴
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BONY THORAX

SS: Sternoclavicular joints RP: T7

CR: ┴ or 10-15o caudad (to demonstrate 7th-9th
KURZBAUER METHOD ribs)
LATERAL PROJECTION SS: Anterior ribs (1st-9th) above the diaphragm
PP: Lateral recumbent; affected side against IR;
hips & knee flexed; arm of affected grasp the end of AP PROJECTION
table (for support); arm of unaffected side grasp the PP:
dorsal surface of hip (depressed shoulder); anterior  Upright: to image ribs above diaphragm; IR
surface of manubrium ┴ to IR top board 1.5 in. above shoulder; shoulder
RP: Lowermost sternoclavicular articulation rotated forward; suspend at full inspiration
CR: 15o caudad (to depress diaphragm)
SS: Unobstructed sternoclavicular joint  Supine: to image ribs below diaphragm;
shoulder in the same transverse plane;
PA OBLIQUE PROJECTION suspend at full expiration (to elevate
Body Rotation Method diaphragm)
PP: Prone or seated-upright (trauma patient); RP: T7 (upper ribs) or T10 (lower ribs)
RAO/LAO; body rotated 10-15o toward affected CR: ┴
side (projects vertebrae well behind the SC joint) SS: Posterior ribs above the diaphragm (1st-10th) &
RP: Level of T2-T3 (3 in. distal to vertebral below the diaphragm (8th-12th)
prominens) & 1-2 in. lateral from MSP
CR: ┴ AP OBLIQUE PROJECTION
 Entrance: right side (left SC joint); left side PP: RPO/LPO; body rotated 45o (affected side
(right SC joint) down); arm of affected side abducted; opposite
SS: Sternoclavicular joints hand on hip
 Upright: to image ribs above diaphragm;
PA OBLIQUE PROJECTION hand rested on head; suspend at full
Central Ray Angulation Method inspiration (to depress diaphragm)
PP: Prone or seated-upright (trauma patient); chin  Supine: to image ribs below diaphragm; hip
rested on table or rotated toward the side of interest elevated; suspend at full expiration (to
RP: Level of T2-T3 (3 in. distal to vertebral elevate diaphragm)
prominens) & 1-2 in. lateral from MSP RP: T7 (upper ribs) or T10 (lower ribs)
CR: 15o toward MSP CR: ┴
 Entrance: right side (left SC joint); left side SS: Axilliary ribs closest from IR
(right SC joint)
SS: Sternoclavicular joints PA OBLIQUE PROJECTION
PP: RAO/LAO; body rotated 45o (affected side up)
D.) RIBS  Upright: to image ribs above diaphragm;
forearm of affected side rested on grid
PA PROJECTION device; suspend at full inspiration (to
PP: Upright/prone; hands rested against hips; palms depress diaphragm)
turned outward; chin rested on chin; suspend at full
inspiration (depresses diaphragm) 3
 S 3 p
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SKULL
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SKULL
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RP: T7 (upper ribs) or T10 (lower ribs)
a CR: ┴
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SKULL
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SKULL
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RP: 2 in. superior to xiphoid process c
CR: 20o cephalad e
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SKULL
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SKULL
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SKULL
SKULL PLANES, POINTS & LINE
 Midsagittal plane (MSP) 11.) TMJ Syndrome
 Interpupillary line (IPL)  Dysfunction of the temporomandibular joint
 Acanthion
 Outer canthus A.) SKULL
 Infraorbital margin
 External acoustic meatus (EAM) PA PROJECTION
 Orbitalmeatal line (OML) PP: Prone; forehead & nose against IR; MSP &
 Infraorbitomeatal line (IOML)/Frankpurt OML perpendicular to IR
Line RP: Nasion
 Acanthiomeatal line (AML) CR: Perpendicular
 Mentomeatal line (MML) SS: Petrous pyramid completely filled the orbits;
 Between OML & IOML: 7o difference frontal bone
 Between OML & GML: 8o difference
AP PROJECTION
PATHOLOGY PP: Supine; MSP & OML perpendicular to IR
1. ) Basal Fx RP: Nasion
 Fx located at the base of the skull CR: Perpendicular
2) Blowout Fx SS: Same as PA, but the image is MAGNIFIED
 Fx of the floor of the orbit
3.) Contre-Coup Fx MODIFIED CALDWELL METHOD
 Fx to one side of a structure caused by PA AXIAL PROJECTION
trauma to the other side PP: Prone; forehead & nose against IR; OML
4.) Depressed Fx perpendicular to IR; MSP perpendicular to IR
 Fx causing a portion of the skull to be RP: Nasion
depressed into the cranial cavity CR: 15o caudad
5.) Le Fort Fx SS:
 Bilateral horizontal fxs of the maxillae -General Survey Examination:
6.) Linear Fx  Anterior & side walls of the cranium
 Irregular or jagged fx of the skull  Temporal fossae
7.) Tripod Fx  Frontal sinuses & anterior ethmoid sinus
 Fx of the zygomatic arch & orbital floor/rim  Crista galli
& dislocation of the frontozygomatic suture  Upper 2/3 of orbits
8.) Mastoiditis  Petrous pyramid to lower 1/3 of orbit
 Inflammation of mastoid antrum & air cells -Superior orbital fissure/sphenoid fissure (20-25o
9.) Paget’s Disease caudad) & foramen rotundum (25-30o caudad)
 Thick, soft bone marked by bowing fxs
10.) Sinusitis AP AXIAL PROJECTION
 Inflammation of one or more of the PP: Supine; OML perpendicular to IR
paranasal sinuses RP: Nasion
CR: 15o cephalad
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SKULL

SS: Same as PA axial but orbits are magnified & the SS:
distance b/n lateral margin of orbits & temporal -<SPDOP=
bones are less on AP than PA  Symmetric petrous pyramid
 Posterior portion of foramen magnum
TRUE/ORIGINAL CALDWELL  Dorsum sellae & posterior clinoid process
PP: Prone; forehead & nose against IR; GML w/in shadow of foramen magnum
perpendicular to IR; MSP perpendicular to IR  Occipital bone
RP: Nasion  Posterior portion of parietal bone
CR: 23o caudad -Tomographic studies of ears, facial canal, jugular
SS: Same as above foramina & rotundum foramina
-Entire foramen magnum jugular foramina (40-60o
LATERAL PROJECTION caudad to OML)
PP: Semiprone; MSP & IOML parallel to IR; IPL -Posterior portion of cranial vault (CR ┴ to midway
perpendicular to IR
b/n frontal tuberosities)
RP: 2 in. Above EAM or midway b/n inion &
glabella TOWNE/ALTSCHUL/GRASHEY/CHAMBER
CR: Perpendicular LAINE METHOD
SS: AP AXIAL PROJECTION
-General survey examination PP: Lateral decubitus; OML/IOML & MSP
 Sella turcica perpendicular to IR
 Anterior & posterior clinoid processes, RP: 2.5-3 in. above glabella
 Dorsum sellae CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
 Superimposed mandibular rami SS: Same as above
 Mastoid region ER: For patient w/ pathologic condition, trauma or
 EAM & TMJ deformity (strongly accentuated dorsal kyphosis)

CROSSTABLE LATERAL HAAS METHOD

PP: Dorsal decubitus (Robinson, Meares & Goree PA AXIAL PROJECTION
recommendation); MSP perpendicular to IR PP: Prone; MSP & OML perpendicular to IR;
RP: 2 in. Above EAM forehead & nose against the table; IR center 1 in. to
CR: Horizontal nasion
ER: For traumatic sphenoid sinus effusion (basal RP: 1.5 in. below inion (entrance); 1.5 in. superior
skull fx) to nasion (exit)
CR: 25o cephalad to OML
TOWNE/ALTSCHUL/GRASHEY/CHAMBER SS:
LAINE METHOD  Occipital bone
AP AXIAL PROJECTION  Symmetric petrous pyramid
PP: Supine; OML/IOML & MSP perpendicular to
 Dorsum sellae & posterior clinoid processes
IR;
w/in shadow of foramen magnum
RP: 2.5-3 in. above glabella ER: For obtaining image of sellar structures (DS &
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
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PCP) w/in FM on hypersthenic & obese patient

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SCHULLER/PFEIFFER METHOD LYSHOLM METHOD

SUBMENTOVERTICAL PROJECTION AXIOLATERAL METHOD
PP: Supine or Seated-upright (more comfortable); PP: Semiprone; MSP parallel to IR; IOML parallel
IOML parallel to IR; MSP perpendicular to IR; head to transverse axis of IR; IPL perpendicular to IR
rested on vertex; neck hyperextended RP: 1 in. distal to lower EAM (exit)
RP: ¾ in. anterior to EAM (sella turcica) CR: 30-35o caudad
CR: Perpendicular to IOML; MSP of throat b/n SS: Oblique position of lateral aspect of cranial base
gonion (entrance) closest to IR
SS: Cranial base ER: For patients who cannot extend their head
 Foramen ovale & spinosum (best enough for a satisfactory SMV projection
demonstrated)
 Symmetric petrosae VALDINI METHOD
 Mastoid processes PA AXIAL PROJECTION
 Carotid canals PP: Recumbent or seated-erect (more comfortable);
 Sphenoidal & ethmoidal sinuses upper frontal region of skull against IR; MSP
 Mandible perpendicular to IR; head acutely flexed; IOML
 Bony nasal septum 50o/OML 50o; line extending from inion to 0.5 cm
 Dens of axis distal to nasion form 28o to CR
 Occipital bone RP: 0.5 cm distal to nasion (dorsum sellae);
 Maxillary sinus superimposed over the foramen magnum/slightly above level of EAM
mandible (petrosae)
 Zygomatic arches (well demonstrated if CR: Perpendicular; inion (entrance); 0.5 cm distal to
exposure factors are decreased) nasion (exit)
 Axial tomography of orbits, optic canals, SS:
ethmoid bone, maxillary sinuses & mastoid  DILA (IOML 50o): Dorsum sellae; Internal
processes Auditory Meatus (IAM); LAbyrinth
 ETB <EaT Bulaga= (OML 50 o): External
SCHULLER METHOD auditory meatus; Tymphanic cavity; Bony
VERTICOSUBMENTAL PROJECTION part of Eustachian tube
PP: Prone; chin fully hyperextended; MSP  Dorsum sellae & posterior clinod processes
perpendicular to IR within or above shadow of foramen magnum
 Tubeculum sellae, anterior clinoid processes
RP: ¾ in. anterior to EAM (sella turcica)\
& sella turcica below shadow of foramen
CR: Perpendicular to IOML; MSP of throat b/n
magnum
gonion (entrance)
SS: Same as SMV  Mastoid pneumatization
 Distorted & magnified basal structures
B.) SELLA TURCICA
 Useful for anterior cranial base &
sphenoidal sinuses
LATERAL PROJECTION
o IR in contact with the throat
PP: Semiprone; MSP & IOML parallel to IR; IPL
o Reduces magnification & distortion
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perpendicular to IR

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RP: ¾ in. anterior & ¾ in. superior to EAM SS: Dorsum sellae, tuberculum sellae, anterior &
CR: Perpendicular posterior clinoid processes through frontal bone
SS: Superimposed anterior & posterior clinoid above ethmoidal sinuses
processes; dorsum sellae
C.) OPTIC CANAL/FORAMEN
TOWNE METHOD
PP: Supine; OML/IOML & MSP perpendicular to RHESE METHOD
IR; PARIETO-ORBITAL OBLIQUE
RP: 2.5-3 in. above glabella PROJECTION
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) PP: Prone; affected orbit closest to IR; zygoma,
SS: Sellar region nose & chin against IR (3-pt Lower Landing); AML
 Dorsum sellae, tuberculum sellae & anterior perpendicular to IR; MSP 53 o angle to IR
clinoid processes through occipital bone RP: Affected orbit closest to IR
above shadow of foramen magnum (30o CR: Perpendicular
caudad) SS: Optic canal/foramen (inferior & lateral quadrant
 Dorsum sellae & posterior clinoid processes of orbital shadow)
w/in shadow of foramen magnum (37o  PAZAM: Prone; Affected orbit against IR;
caudad) Zynoch; AML ┴; MSP 53o to IR
 Symmetric petrous pyramid
RHESE METHOD
HAAS METHOD ORBITO-PARIETAL OBLIQUE
PROJECTION
PA AXIAL PROJECTION
PP: Supine; affected orbit away from IR; AML
PP: Prone; MSP & OML perpendicular to IR;
perpendicular to IR; MSP 53 o angle to IR
forehead & nose against the table; IR center 1 in. to
RP: Inferior and lateral margin of uppermost orbit
nasion
CR: Perpendicular
RP: 1.5 in. below inion (entrance); 1.5 in. superior
SS: Magnified optic canal/foramen
to nasion (exit)
 Increased radiation dose to lens of eye
CR: 25o cephalad to OML
SS:
 Dorsum sellae & posterior clinoid processes ALEXANDER METHOD
w/in shadow of foramen magnum ORBITO-PARIETAL OBLIQUE
 Symmetric petrous pyramid PROJECTION
ER: For obtaining image of sellar structures (DS & PP: Erect/supine; IR 15o angle from vertical; MSP
PCP) w/in FM on hypersthenic & obese patients 40o to IR; AML perpendicular to IR
RP: Inferior and lateral margin of uppermost orbit
PA PROJECTION CR: Perpendicular
PP: Prone; forehead & nose against IR; MSP & SS: Optic canal/foramen
OML perpendicular to IR
RP: Glabella
CR: 10o cephalad
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MODIFIED LYSHOLM METHOD  Well demonstrated at 15o caudal angle

ECCENTRIC ANGLE PARIETO-ORBITAL (Caldwell)
OBLIQUE PROJECTION  Petrous portions at or below the inferior
PP: Prone; forehead & nose against IR; IOML orbital margin
perpendicular to IR; MSP 20 o from vertical;
RP: Affected orbit (exit) F.) INFERIOR ORBITAL FISSURES
CR: 20o caudad or 30o caudad
SS: Optic canal/foramen & anterior clinoid BERTEL METHOD
processes (20o); superior orbital fissure (30o) PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; IOML
D.) SPHENOID STRUT perpendicular to IR
-the inferior root of lesser wing of sphenoid RP: Nasion
bone- CR: 20-25o cephalad
SS: Inferior orbital fissures
HOUGH METHOD  b/n shadows of pterygoid process of
PARIETO-ORBITAL OBLIQUE sphenoid bone & mandibular ramus
PROJECTION  Anterior image of each orbital floor
PP: Prone; superciliary ridge/arch & side of the nose
against IR; IOML perpendicular to IR; MSP 20 o G.) EYE- FOREIGN BODY LOCALIZATION
from vertical; MSP 20o toward the side of interest
RP: Affected orbit (exit) LATERAL PROJECTION
CR: 7o caudad PP: Semiprone; MSP parallel to IR; IPL
SS: Unobstructed & undistorted image of the perpendicular to IR; instruct patient to look straight
sphenoid strut (lie b/n sphenoidal sinus & combined ahead during exposure
shadows of anterior clinoid processes & lesser wing RP: Outer canthus
of sphenoid bone) CR: Perpendicular
SS: Superimposed orbital roofs
E.) SUPERIOR ORBITAL/SPHENOID
FISSURES PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; MSP &
CALDWELL METHOD OML perpendicular to IR; instruct patient to close
PA AXIAL PROJECTION the eyes
PP: Prone; forehead & nose against IR; OML RP: Midorbits
perpendicular to IR CR: 30o caudad
RP: Nasion SS: Petrous pyramids lying below orbital shadows
CR: 20-25o caudad or 15o caudad
SS: Superior orbital fissures MODIFIED WATERS METHOD
 Lying on the medial side of orbits b/n PARIETOACANTHIAL PROJECTION
greater & lesser wings of sphenoid) PP: Prone; chin against IR; MSP perpendicular to
IR; OML 50o to IR (new); OML 25-37o to IR (old);
instruct patient to close the eyes
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RP: Midorbits  CR perpendicular

CR: Perpendicular  CR 15-25o cephalad
SS: Petrous pyramids lying well below orbital
shadows PFEIFFER-COMBERG METHOD
 A leaded contact lens is placed directly over
VOGT-BONE-FREE POSITION the cornea
 Taken to detect small or low density foreign  Apparatus:
particles located in the anterior segment of o Contact lens localization device
the eyeball/eyelids o Pedestal type of film holder
 2 Projections: lateral & superoinferior  2 Projections:
 2 Movements: o Waters Method:
o Vertical: 2 exposures (for lateral)  CR horizontal
 Look up as far as possible o Lateral:
 Look down as far as possible  CR perpendicular
o Horizontal: 2 exposures (for
superoinferior) H.) FACIAL BONE
 Look to extreme right
 Look to extreme left LATERAL PROJECTION
PP: Semiprone; MSP & IOML parallel to IR; IPL
PARALLAX METHOD perpendicular to IR
 First described by Richards RP: Zygoma/malar bone
 It determines whether the foreign body is CR: Perpendicular
located within the eyeball requires no SS: Superimposed facial bones
special apparatus  Superimposed mandibular rami & orbital
 Not considered as precision localization roofs
procedure
 Widely used as preliminary check only WATERS METHOD
 2 Projections: PARIETO-ACANTHIAL PROJECTION
o Lateral: 2 exposures PP: Prone; MSP & MML perpendicular to IR;
OML 37o to IR; nose ¾ in. (1.9 cm) away from IR
o PA: 2 exposures RP: Acanthion (exit)
CR: Perpendicular
SWEET METHOD SS: Orbits, maxillae & zygomatic arches
 It determines the exact location of a foreign  Best projection for facial bones
body by use of a geometric calculations  Petrous ridges below the maxillae
 Apparatus:  Blow out fractures
o Sweet localizing device
o Sweet film pedestal MODIFIED WATERS
 1 Projection: PP: Prone; MSP & MML perpendicular to IR;
o Lateral: 2 exposures OML 55o to IR
RP: Acanthion (exit)
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CR: Perpendicular  External orbital wall

SS: Facial bones w/ less axial angulation
 Petrous ridges below the inferior border of
orbits

REVERSE WATERS METHOD

AP AXIAL PROJECTION
PP: Supine; MSP & MML perpendicular to IR;
OML 37o to IR; chin up
RP: Acanthion (exit)
CR: Perpendicular
SS: Superior facial bones; same as True/Original
Waters, but the image is MAGNIFIED
ER: For patient who cannot be placed in the prone
position

CALDWELL METHOD
PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; OML
perpendicular to IR
RP: Nasion
CR: 15o caudad or 30o caudad (Exaggerated
Caldwell)
SS: Orbital rims, maxillae, nasal septum, zygomatic
bones & anterior nasal spine
 Petrous ridges at lower third of orbits (15o
caudad)
 Petrous ridges below the inferior orbital
margins (30o caudad)
 Orbital floors (30o caudad)

LAW METHOD
PA OBLIQUE AXIAL PROJECTION
PP: Semiprone; zygoma, nose & chin against IR;
unaffected side against IR; OML perpendicular to
IR; Center IR 2 in. above floor of maxillary sinuses
RP: Lower antrum
CR: 25-30o cephalad; posterior to gonion (entrance)
SS: Floor & posterior wall of maxillary sinus
(antrum) of side down
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ER: Displacement of bony nasal septum &
 Zygomatic bone
depressed fx of nasal wings
 Anterior wall of maxillary sinus of side up

I.) NASAL BONE

LATERAL

PROJECTION
PP: Semiprone; MSP & IOML parallel to IR; IPL
perpendicular to IR
RP: ¾ in. (old) or ½ in. (new) distal to nasion
CR: Perpendicular
SS: Nasal bones of side down & soft tissue
structures

TANGENTIAL PROJECTION
PP:
 Extraoral Film (Cassette): prone; chin
rested on sandbags; chin fully extended;
MSP & GAL perpendicular to IR
 Intraoral Film (Occlusal Film): supine;
head elevated; MSP perpendicular to
sponge; GAL parallel to sponge &
perpendicular to film
RP: Glabelloalveolar line
CR: Perpendicular
SS: Nasal bones with minimal superimposition
ER: For demonstration of any medial or lateral
displacement of fragments in fractures
Contraindications:
 Children or adults who have very short
nasal bones, concave face or protruding
upper teeth

WATERS METHOD
PARIETO-ACANTHIAL
PROJECTION
PP: Prone; MSP & MML perpendicular to IR;
OML 37o to IR; nose ¾ in. (1.9 cm) away from
IR RP: Acanthion (exit)
CR: Perpendicular
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J.) ZYGOMATIC ARCHES SS: Bilateral symmetric zygomatic arches free of

superimposition
SCHULLER/PFEIFFER METHOD
SUBMENTOVERTICAL PROJECTION K.) MANDIBLE
PP: Supine or Seated-upright (more comfortable);
IOML parallel to IR; MSP perpendicular to IR; head PA PROJECTION
rested on vertex; neck hyperextended PP: Prone; forehead & nose against IR; OML &
RP: 1 in. posterior to outer canthi MSP perpendicular to IR
CR: Perpendicular to IOML; MSP of throat b/n RP: Acanthion (exit)
gonion (entrance) CR: Perpendicular
SS: Best demonstrates bilateral symmetric SS: Mandibular rami
zygomatic arches ER: To demonstrate any medial or lateral
displacement of fragments in fractures of the rami
MODIFIED TITTERINGTON METHOD
PA AXIAL (SUPEROINFIOR) PROJECTION PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; OML &
PP: Prone; nose & chin against IR; MSP
MSP perpendicular to IR
perpendicular to IR
RP: Acanthion (exit)
RP: Vertex midway b/n zygomatic arches
CR: 20 or 25o cephalad
CR: 23-38o caudad
SS: Condylar processes; mandibular rami
SS: Well shown zygomatic arches
ER: To demonstrate any medial or lateral
displacement of fragments in fractures of the rami
MAY METHOD
TANGENTIAL PROJECTION
PA PROJECTION
PP: Prone/seated; neck fully extended; IOML PP: Prone; nose & chin against IR; AML & MSP
parallel to IR; MSP rotated 15o toward the side of perpendicular to IR
interest; head tilted 15o RP: Level of lips
RP: Zygomatic arch at 1.5 in. posterior to outer CR: Perpendicular
canthus SS: Mandibular body
CR: Perpendicular to IOML
SS: Zygomatic arch free of superimposition PA AXIAL PROJECTION
ER: Useful with patients who have depressed PP: Prone; nose & chin against IR; AML & MSP
fractures or flat cheekbones perpendicular to IR; fill the mouth with air to
obtained better contrast around TMJs (Zanelli
MODIFIED TOWNE METHOD recommendation)
AP AXIAL PROJECTION RP: Midway b/n TMJs
JUG HANDLE VIEW CR: 30o cephalad
PP: Supine; OML/IOML & MSP perpendicular to SS: Mandibular body; TMJs; condylar processes
IR;
RP: Glabella (1 in. above nasion)
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
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AXIOLATERAL OBLIQUE PROJECTION PANORAMIC TOMOGRAHY/

PP: Seated/semiprone/semisupine; head in true PANTOMOGRAPHY/ROTATIONAL
lateral & IPL perpendicular to IR (ramus); head TOMOGRAPHY
rotated 30o toward IR (body); head rotated 45o -technique employed to produced tomograms of
toward IR (symphysis); head rotated 10-15o toward curved surfaces-
IR (general survey); mouth closed; neck extended  Provides panoramic image of the entire
(prevent superimposition of cervical spine) mandible, TMJ, dental arches
RP: Mandibular region of interest  Provides distortion-free lateral image of the
CR: 25o cephalad entire mandible
SS: Mandibular body & TMJs  Patients who sustained severe mandibular or
ER: To place the desired portion of the mandible TMJ trauma
parallel with the IR  Useful for general survey studies of dental
Muscular/Hypersthenic Patients: MSP 15o & CR abnormalities
10o cephalad  Adjuvant for pre-bone marrow transplant
 To reduce the possibility of projecting
shoulder over the mandible L.) TEMPOROMANDIBULAR JOINTS

SCHULLER/PFEIFFER METHOD TOWNE METHOD

SUBMENTOVERTICAL PROJECTION AP AXIAL PROJECTION
PP: Supine or Seated-upright (more comfortable); PP: Supine; MSP & OML perpendicular to IR
IOML parallel to IR; MSP perpendicular to IR; head  Closed-mouth Position: posterior teeth in
rested on vertex; neck hyperextended contact not incisors
RP: Midway b/n gonions o Rationale: prevents mandibular
CR: Perpendicular to IOML protrusion & condyles to be carried
SS: Mandibular body; coronoid & condyloid out of mandibular fossae
processes of rami  Opened-mouth Position: open as wide as
possible
SCHULLER METHOD o Mandible not protruded (jutted
VERTICOSUBMENTAL PROJECTION forward)
PP: Prone; chin fully hyperextended; IR against o Not perform in trauma patients
RP: 3 in. above nasion
throat; MSP perpendicular to IR
CR: 35o caudad
RP: Level just posterior to outer canthi
SS: Mandibular condyles & mandibular fossae of
CR: Perpendicular to IOML or occlusal plane
temporal bones
SS: Condyle & neck of condylar processes are
 Closed-mouth: condyle lying in mandibular
better shown (CR ┴ occlusal plane)
fossa
 Opened-mouth: condyles lying inferior to
articular tubercle

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AXIOLATERAL PROJECTION SS: TMJ

PP: Semiprone; head in lateral position; IPL
perpendicular to IR; MSP parallel to IR; closed- ZANELLI METHOD
mouth & opened-mouth position LATERAL TRANSFACIAL POSITION
RP: 0.5 in. anterior & 2 in. superior to upside EAM PP: Lateral recumbent; head in true lateral; head
CR: 25-30o caudad resting on parietal region; MSP 30o to IR
SS: TMJ anterior to EAM RP: Uppermost gonion (entrance)
 Closed-mouth: condyle lying in mandibular CR: Perpendicular
fossa SS: TMJ
 Opened-mouth: condyles lying inferior to
articular tubercle M.) SINUSES
Cross & Flecker: pointed out the value of erect
SCHULLER METHOD position
AXIOLATERAL OBLIQUE/LATERAL  To demonstrate presence or absence of fluid
TRANSCRANIAL/AXIAL TRANSCRANIAL  To differentiate between shadows caused by
PROJECTION fluid & those caused by pathology
PP: Semiprone; MSP rotated 15o toward the IR;
AML parallel to transverse axis of IR; LATERAL PROJECTION
RP: 1.5 in. superior to upside EAM PP: Upright RAO/LAO or dorsal decubitus (can’t
CR: 15o caudad; TMJ of sidedown (exit) assume upright); head in true lateral; MSP parallel to
SS: Condyles & neck of the mandible IR; IPL perpendicular to IR; IOML parallel to
 Closed-mouth: fracture of the neck & transverse axis of IR;
condyle of ramus RP: 0.5-1 in. posterior to outer canthus
 Opened-mouth: mandibular fossa; inferior & CR: Perpendicular
anterior excursion of the condyle SS: All paranasal sinuses

INFEROSUPERIOR TRANSFACIAL PA PROJECTION

POSITION PP: Upright; forehead & nose against IR; MSP &
OML perpendicular to IR
PP: Semiprone; head in true lateral; IPL 10-15o
from perpendicular; MSP 15o from IR RP: Nasion (┴); glabella (10o cephalad); midregion
of maxillary sinuses (┴)
RP: Uppermost gonion
CR: 30o cephalad CR: Perpendicular; 10o cephalad; perpendicular
SS: TMJ SS:
CR: 20o cephalad
ALBERS-SCHONBERG METHOD
LATERAL TRANSFACIAL POSITION
PP: Semiprone; head in true lateral; IPL
perpendicular to IR; MSP parallel to IR; IOML
parallel to transverse axis of IR
RP: TMJ closes to IR (exit)
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 Posterior ethmoid sinuses inferior to cranial
bones & superior to anterior ethmoid sinuses
(┴)
 Sphenoidal sinuses through frontal bone &
superior to frontal & ethmoid sinuses
 Maxillary sinuses inferior to cranial base

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CALDWELL METHOD SCHULLER METHOD

PA AXIAL PROJECTION SUBMENTOVERTICAL PROJECTION
PP: Upright PP: Upright; IOML parallel to IR; MSP
 Angle grid technique: nose & forehead perpendicular to IR; head rested on vertex; neck
against IR; IR tilted 15o; MSP & OML hyperextended
perpendicular to IR RP: ¾ in. anterior to EAM (sella turcica)
 Vertical grip technique: nose against IR; CR: Perpendicular to IOML; MSP of throat b/n
OML 15o from IR; sponge b/n forehead & gonion (entrance)
IR; MSP perpendicular to IR SS: Sphenoidal & ethmoidal sinuses
RP: Nasion  Anterior portion of the base of the skull
CR: Horizontal
SS: Frontal sinuses & anterior ethmoidal sinuses SCHULLER METHOD
VERTICOSUBMENTAL PROJECTION
WATERS METHOD PP: Seated-erect; chin fully hyperextended; MSP
PARIETOACANTHIAL PROJECTION perpendicular to IR
PP: Upright; neck hyperextended & rested against RP: ¾ in. anterior to EAM (sella turcica)
IR; OML 37o to IR; MML perpendicular to IR CR: Perpendicular to IOML; MSP of throat b/n
RP: Acanthion gonion (entrance)
CR: Horizontal
SS: Sphenoidal sinuses
SS: Maxillary sinuses
 Posterior ethmoidal sinuses
 Petrous pyramids inferior to floor of
 Maxillary sinuses
maxillary sinus
 Nasal fossae
 Foramen rotundum
 Distorted frontal & ethmoidal sinuses
PIRIE METHOD
AXIAL TRANSORAL POSITION
OPEN-MOUTH WATERS METHOD
PP: Upright (prone; nose & chin against IR; mouth
PARIETOACANTHIAL PROJECTION
wide open; MSP perpendicular to IR; phonate <ah=
PP: Upright; neck hyperextended & rested against during exposure
IR; OML 37o to IR; MML perpendicular to IR;
RP: ¾ in. anterior to EAM (sella turcica)
mouth wide open
CR: Perpendicular
RP: Acanthion
SS: Sphenoidal sinuses projected through open
CR: Horizontal
mouth
SS: Sphenoidal sinuses projected through open
 Maxillary sinuses
mouth
 Nasal fossae
 Petrous pyramids inferior to floor of
maxillary sinus
RHESE METHOD
ER: For the patients who cannot be placed in PA OBLIQUE POSITION
position for SMV PP: Seated-erect; zygoma, nose & chin against IR; AML
perpendicular to IR; MSP 53o from IR
RP: Upper parietal region
CR: Perpendicular

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SS: Oblique image of posterior & anterior SS: Mastoid cells

ethmoidal sinuses  Sigmoid sinus
 Frontal & sphenoidal sinuses  Lateral portion of pars petrosa
 Profile image of the optic canal  Tegmen tymphani
 Superimposed internal & external auditory
LAW METHOD meatuses
PA OBLIQUE POSITION  Mastoid emissary vessel (when present)
PP: Seated-erect; zygoma, nose & chin against IR;
neck fully extended MODIFIED HICKEY METHOD
RP: Uppermost gonion AP TANGENTIAL POSITION
CR: 25-30o cephalad PP: Supine; tape auricles forward; face rotated away
SS: Relationship of teeth to maxillary sinuses from side of interest; MSP 55o from IR or 35o from
vertical; IOML perpendicular to IR; IR caudally
N.) MASTOID inclined 15o
RP: 1 in. superior to tip of mastoid process
LAW METHOD CR: 15o caudad
AXIOLATERAL POSITION SS: Mastoid process free of superimposition
Double Angulation Method  Projected below the shadow of occipital
PP: Prone; head in true lateral; tape auricle forward; bone
MSP & IOML parallel to IR; IPL perpendicular to
IR PA TANGENTIAL POSITION
RP: 2 in. posterior & 2 in. superior to uppermost PP: Prone; IR cranially inclined 15o; tape auricles
EAM forward; cheek against IR; face rotated away from
CR: 15o caudad & 15o anterior side of interest; MSP 55o from IR or 35o from
Lange Recommendations: vertical; IOML perpendicular to IR
 25o caudad & 20o anterior RP: 1 in. superior to tip of mastoid process
 Auricles taped forward CR: 15o cephalad
Single Angulation Method SS: Mastoid process free of superimposition
PP: Prone; tape auricle forward; MSP rotated 15o  Projected below the shadow of occipital
toward IR bone
RP: 2 in. posterior & 2 in. superior to uppermost TOWNE METHOD
EAM AP AXIAL PROJECTION
CR: 15o caudad PP: Supine; OML/IOML & MSP perpendicular to
Part Angulation Method IR;
PP: Prone; head rested on flat surface of cheek; tape RP: 2 in. above glabella or 2.5 in. above nasion
auricle forward; MSP rotated 15o towards IR; IPL CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
15o from vertical SS:
RP: 2 in. posterior & 2 in. superior to uppermost  Internal auditory canals
EAM  Petrous portion of temporal bone
CR: ┴  Labyrinths

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 Mastoid antrum  Labyrinths

 Middle ears  Mastoid antrum
 Dorsum sellae w/in foramen magnum  Middle ears
 Dorsum sellae w/in shadow of foramen
HENSCHEN, SCHULLER, & LYSHOLM magnum
METHODS
AXIOLATERAL POSITIONS HAAS METHOD
PP: Semiprone; head in true lateral; MSP parallel to PA AXIAL PROJECTION
IR; IPL perpendicular to IR; IOML parallel to PP: Prone; MSP & OML perpendicular to IR;
transverse axis of IR; auricles taped forward forehead & nose against the table; IR center 1 in. to
RP: Dependent EAM closest to IR nasion
CR: 15o caudad (Henschen/Cushing); 25o caudad RP: Nasion
(Schuller); 35o caudad (Lysholm/Runstrom II) CR: 25o cephalad
SS: Mastoid & petrous portion SS: Symmetric axial frontal image of petrous
 Mastoid cells, mastoid antrum, IAM & portions projected above the base of the skull
EAM & tegmen tympani (Henschen)  IAM
 Tumors of the acoustic nerve (Cushing)  Labyrinths
 Pneumatic structures of mastoid process,  Mastoid antrums
mastoid antrum, tegmen tympani, IAM &  Middle ears
EAM, sinus & dural plates & mastoid  Dorsum sellae & posterior clinoid processes
emissary when present (Schuller) w/in shadow of foramen magnum
 Mastoid cells, matoid antrum, IAM & EAM, ER: For patients who cannot assume AP axial
tegmen tympani, labyrinthine area & carotid position
canal (Lysholm/Runstrom II)
Runstrom Recommendation: VALDINI METHOD
 Exposure made with open mouth PA AXIAL PROJECTION
 For visualization of petrous apex between PP: Recumbent or seated-erect (more comfortable);
anterior wall of EAM & mandibular condyle upper frontal region of skull against IR; MSP
perpendicular to IR; head acutely flexed; IOML
O.) PETROUS PORTION 50o/OML 50o; line extending from inion to 0.5 cm
distal to nasion form 28o to CR
TOWNE METHOD RP: 0.5 cm distal to nasion (dorsum sellae);
AP AXIAL PROJECTION foramen magnum at or slightly above level of EAM
PP: Supine; OML/IOML & MSP perpendicular to (petrosae)
IR; CR: Perpendicular; inion (entrance); 0.5 cm distal to
RP: MSP b/n EAMs nasion (exit)
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) SS:
SS: Petrosae above base of the skull  DILA (IOML 50o): Dorsum sellae; Internal
 IAM Auditory Meatus (IAM); LAbyrinth
 Arcuate eminences

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SKULL

 ETB <EaT Bulaga= (OML 50 o): External  Mastoid antrum

auditory meatus; Tymphanic cavity; Bony Owen Modifications: cited by Pendergrass,
part of Eustachian tube Schaeffer & Hodes
 PP: MSP 40o to IR; IR & head angled 10o
SCHULLER/PFEIFFER METHOD caudally
SUBMENTOVERTICAL (SUBBASAL)  CR: 28o caudally
PROJECTION Owen Modifications: described by Etter & Cross
PP: Supine or Seated-upright (more comfortable);  PP: MSP 30o to IR
OML parallel to IR or CR perpendicular to OML  CR: 25-30o caudally
Owen Modifications: described by Compere
(cannot fully extend the neck) or supraorbitomeatal  PP: MSP 30-45o to IR
line (SOML) parallel to IR; MSP perpendicular to
IR; head rested on vertex; neck hyperextended  CR: 30o caudally
RP: ¾ in. anterior to EAM (sella turcica) Owen Modifications: used by Zizmor
CR: Perpendicular to OML at midway b/n EAMs or  PP: MSP 15o to IR
15-20o anteriorly at MSP of throat 1 in. anterior to  CR: 35o caudally
EAMs
SS: Symmetric petrosae STENVERS METHOD
 Mastoid processes POSTERIOR PROFILE POSITION
 Labyrinths PP: Prone; forehead, nose & zygoma against IR (3-
 EAMs pt Upper Landing); IOML parallel to transverse axis
 Tympanic cavities of IR; face rotated away from side of interest; MSP
 Acoustic/auditory ossicles 45o to IR
Hirtz Method: RP: 1 in. anterior to EAM closest to IR (exit)
 RP: Midway b/n & 1 in. anterior to EAMs CR: 12o cephalad
 CR: 5o anteriorly SS: Pars petrosa closest to IR
 Petrous ridge
MAYER METHOD  Cellular structure of mastoid process
AXIOLATERAL OBLIQUE PROJECTION  Mastoid antrum
PP: Supine; auricles taped forward; outer side of IR  Area of tympanic cavity
elevated (reduces part-film distance); MSP 45 o from  Labyrinth
IR; chin depressed; IOML parallel to IR  IAM
RP: Dependent EAM  Cellular structure of petrous apex
CR: 45o caudad
SS: Axial oblique of petrosa ARCELIN METHOD
 Petrosa inferior to mastoid air cells ANTERIOR PROFILE POSITION
 EAM REVERSE STENVERS METHOD
 Tympanic cavity & ossicles PP: Supine; IOML perpendicular to IR; face rotated
 Epitympanic recess (attic) away from side of interest; MSP 45o to IR
 Aditus
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PELVIC GIRDLE
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PELVIC GIRDLE
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PELVIC GIRDLE
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PELVIC GIRDLE
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PELVIC GIRDLE
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I 4

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PELVIC GIRDLE
projection of pelvis
PATHOLOGY
1.) Ankylosing Spondylitis
 Rheumatoid arthritis variant involving the
sacroiliac joints & spine
2.) Congenital Hip Dysplasia
 Malformation of the acetabulum causing
displacement of the femoral head
3.) Legg-Calve Perthes Disease
 Flattening of the femoral head due to
vascular disruption
4.) Slipped Epiphysis
 Proximal portion of femur dislocated from
distal portion at the proximal epiphysis

A.) PELVIS & UPPER FEMORA

AP PROJECTION
PP: Supine; feet & leg rotated 15-20o medially
(places femoral neck // to IR); heels 8-10 in. (20-24
cm) apart
RP: 2 in. inferior to ASIS or 2 in. superior to pubic
symphysis
CR: ┴
SS: Greater trochanter in profile
Lesser trochanter: seen if feet & leg are rotated
laterally

LATERAL PROJECTION
PP:
 Lateral recumbent: place support under
lumbar spine; vertebral column // with table;
pelvis in true lateral
 Upright: patient stand straight; weight
equally distributed on feet; MSP // to IR
RP: 2 in. above greater trochanter
CR: ┴
SS: Lateral radiograph of lumbosacral junction;
sacrum; coccyx; superimposed upper femora
Berkebile, Fischer & Albrecht:
 Recommended dorsal decubitus lateral
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PELVIC GIRDLE
 Demonstration of <gull-wing sign= in cases nearly vertical position); thigh abducted 25-45o
of fracture dislocation of the acetabular rim from vertical; feet turn inward; soles against each
& posterior dislocation of femoral head other
RP: 1 in. superior to pubic symphysis
B.) CONGENITAL HIP

DISLOCATION MARTZ-TAYLOR

METHOD
 Recommendations: 2 AP projections of
pelvis
 CR: ┴ to pubic symphysis (1st projection)
o To detect any lateral or superior
displacement of the femoral
head
 CR: ┴ to 45o to pubic symphysis
(2nd projection)
o Anterior displacement:
femoral head above acetabulum
o Posterior displacement:
femoral head below acetabulum
 SS: Relationship of femoral head to
the acetabulum
 ER: For patients with congenital
hip dislocation

ANDREN-VON ROSEN APPROACH

 Bilateral hip projection
 PP: Both legs forcibly abducted 45o;
femora rotated inward
 ER: For diagnosing congenital
hip dislocation in new borns

C.) FEMORAL NECKS

MODIFIED CLEAVES
METHOD AP OBLIQUE
PROJECTION
Bilateral Frog Leg Position
PP: Supine; ASISs equidistant from table; hips &
knees flexed & feet draw up (places femora in

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PELVIC GIRDLE
CR: ┴  Femoral neck free of superimposition
SS: Acetabulum, femoral head, femoral neck & (Hickey)
trochateric areas ER: To demonstrate hip joint & relationship of
Unilateral Projection femoral head to the acetabulum
PP: Supine; affected hip & knee flexed & feet
draw up; soles against opposite knee; thigh DANELIUS-MILLER METHOD
abducted 45o laterally AXIOLATERAL PROJECTION
RP: 1 in. superior to femoral neck Cross-table/Surgical-lateral Projection
CR: ┴ PP: Supine; pelvis elevated; knee & hip of
SS: Acetabulum, femoral head, femoral neck & unaffected side flexed; leg of unaffected side rested
trochateric areas on support; foot & leg of affected side rotated 15-
20o; IR vertical; IR // to long axis of femoral neck
ORIGINAL CLEAVES METHOD RP: Femoral neck
AXIOLATERAL PROJECTION CR: Horizontal
PP: Same position as Modified Cleaves SS: Hip joint; acetabulum, femoral head & neck;
RP: 1 in. superior to pubic symphysis trochanters
CR: 25-45o
SS: Acetabulum, femoral head, femoral neck & CLEMENTS-NAKAYAMA MODIFICATION
trochateric areas MODIFIED AXIOLATERAL PROJECTION
PP: Supine; limb in neutral or slightly rotated
D.) HIP position; IR vertical & its top back tilted 15o; IR //
to long axis of femoral neck
AP PROJECTION RP: Femoral neck
PP: Supine; ASISs equidistant from table; foot & CR: 15o posteriorly
leg rotated medially 15-20o (places femoral neck // SS: Lateral hip; acetabulum; femoral head & neck;
to IR); trochanters
RP: Femoral neck ER:
CR: ┴  Useful when patient cannot be positioned in
SS: Hip joint Danelius-Miller method
 Perform on patient with bilateral hip
LAUENSTEIN & HICKEY METHODS fractures, bilateral hip arthroplasty or
LATERAL PROJECTION limitation of movement of unaffected leg
Mediolateral
PP: Supine; patient rotated toward affected side; CHASSARD-LAPINE METHOD
knee flexed & thigh draw up; opposite side AXIAL PROJECTION
extended PP: Seated; patient lead directly forward; posterior
RP: Hip joint surface of knee against edge of table; vertical axis
CR: ┴ (Lauenstein); 20-25o cephalad (Hickey) of pelvis tilted 45o; patient grasp the ankles;
SS: Hip joint RP: Lumbosacral region (level of greater
 Femoral neck superimposed over greater trochanter)
trochanter (Lauenstein)
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PELVIC GIRDLE
CR: ┴ or ┴ to coronal plane of symphysis pubis (if SS: Fovea capitis; superoposteior wall of
body flexion if restricted) acetabulum
SS:
 Relationship b/n femoral heads & JUDET METHOD
acetabulum AP OBLIQUE PROJECTION
 Pelvic bones Judet & Letournel: described two 45o posterior
 Opacified rectosigmoid (Barium Enema) oblique position
ER: For measuring the transverse or biischial PP:
diameter in pelvimetry  Internal Oblique: semisupine; LPO (places
hip in internal oblique); affected hip up;
LEONARD-GEORGE METHOD MSP 45o from table
PP: Supine; pelvis elevated (places greater  External Oblique: semisupine; RPO
trochanter 4 in. above table top); unaffected side hip (places hip in external oblique); affected hip
& knee flexed; thigh abducted; foot rotated 15-20o down; MSP 45o from table
internally (to overcome anterversion of femoral RP:
neck); IR vertical; uses curved cassette  Internal Oblique: 2 in. inferior to ASIS of
RP: Depression superior to greater trochanter affected side
CR: Medially & inferiorly perpendicular  External Oblique: pubic symphysis
SS: Femoral head & neck; trochanteric area CR: ┴
SS: Acetabular rim
FRIEDMAN METHOD ER:
AXIOLATERAL PROJECTION  Useful in diagnosing fxs of acetabulum
PP: Lateral recumbent; affected side against IR;  Internal Oblique: For patient with
affected limb in true lateral; unaffected limb rolled suspected fx of iliopubic column (anterior)
10o posteriorly; & posterior rim of acetabulum
RP: Femoral neck  External Oblique: For patient suspected fx
CR: 35o cephalad of ilioischial column (posterior) & anterior
SS: Femoral head & neck; trochanteric area; rim of acetabulum
proximal shaft of femur Rafert-Long Modification:
 Modified Judet Method
E.) ACETABULUM  Same position as Judet Method
 CR: Horizontal (for external oblique) &
TEUFEL METHOD Perpendicular/Vertical (for internal oblique)
PA AXIAL OBLIQUE PROJECTION
PP: Semiprone; RAO/LAO; unaffected side F.) ANTERIOR PELVIC BONES
elevated; MSP 38o from table; knee of elevated side
flexed PA PROJECTION
RP: Acetabulum or inferior level of coccyx (2 in. PP: Prone; IR center to greater trochanter (level of
lateral to MSP toward side of interest) pubic symphysis)
CR: 12o cephalad RP: Distal coccyx
CR: ┴
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ABDOMEN

SS: Pubic symphysis & ischia; obturator foramina c & ischial bones
e  Symphysis pubis
TAYLOR METHOD p
AP AXIAL <OUTLET= h G.) ILIUM
PROJECTION a
PP: Supine; ASISs equidistant from table; knee l AP OBLIQUE PROJECTION
flexed slightly a PP: Supine; RPO/LPO; unaffected
RP: 2 in. distal to superior border of pubic d side elevated 40o (places broad
symphysis surface of the wing of affected
S ilium // to IR); shoulder, hip & knee
CR: 20-35o cephalad (males); 30-45o (females)
S elevated
SS: Pelvic outlet
: RP: Level of ASIS
 Superior & inferior rami
CR: ┴
without foreshortening
P SS:
e  Unobstructed projection of
BRIDGEMAN METHOD
l ala & sciatic notches
SUPEROINFERIOR AXIAL
v  Profile image of acetabulum
<INLET= PROJECTION
i  Broad surface of the iliac
PP: Supine; ASISs equidistant from table; knee
c wing without rotation
flexed slightly; IR center at level of greater
trochanters
r PA OBLIQUE PROJECTION
RP: level of
i PP: Supine; RAO/LAO; unaffected
ASISs CR: 40o
n side elevated 40o (places affected
caudad SS: Pelvic
g ilium ┴ to IR); patient rested on
ring/inlet
/ forearm; knee of elevated side
i flexed
LILIENFELD METHOD
n RP: Level of ASIS
SUPEROINFERIOR PROJECTION
l CR: ┴
PP: Seated-erect; knees slightly flexed; patient
e SS:
lean backward 45-50o; arch the back (places pubic t  Ilium in profile
arch in vertical position)
 A  Femoral head within
RP: 1.5 in. superior to symphysis pubis n acetabulum
CR: ┴ t
SS: Pelvic ring/inlet e
 Anterior pubic & ischial bones r
i  THE END 
 Symphysis pubis
o <BOARD EXAM is a matter of
r PREPARATION. If you FAIL to
STAUNIG METHOD prepare, you PREPARE to fail=
INFEROSUPERIOR p 03/26/14
PROJECTION u
PP: Prone b
RP: Symphysis i
1 c
pubis CR: 35o
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ABDOMEN
PATHOLOGY A.) ABDOMEN
1.) Abdominal Aortic Aneurysm
 Localized dilatation of the abdominal aorta AP PROJECTION
2.) Biliary Stenosis PP:
 Narrowing of the bile ducts  Supine: arms over chest area; place support
3.) Bowel Obstruction under knees (to relieve strain); center IR at
 Blockage of the bowel lumen level of iliac crest; pubic symphysis
4.) Cholecystitis included
 Acute/chronic inflammation of the gall  Upright: arms at the sides; weight equally
bladder distributed on both feet; center IR 2 in.
5.) Choledocholithiasis superior to iliac crest or level of iliac crest
 Calculus in the common bile duct (bladder included)
6.) Cholelithiasis RP: Level of iliac crest (supine); 2 in. superior to
 Presence of gallstones iliac crest (upright)
7.) Ileus CR: ┴ (supine); horizontal (upright)
 Failure of bowel peristalsis SS:
8.) Pancreatitis  Size & shape of liver
 Acute/chronic inflammation of the pancreas  Spleen & kidneys
9.) Pancreatic Pseudocyst  Intraabdominal calcifications
 Collection of debris, fluid, pancreatic  Evidence of tumor masses
enzymes & blood as a complication of acute PA Projection:
pancreatitis  Performed when the kidneys are not of
10.) Pneumoperitoneum primary interest
 Presence of air in the peritoneal cavity  Rationale: greatly reduces patient gonadal
dose
RADIOGRAPHIC PROJECTION Miller Recommendation:
1.) Supine AP Projection (KUB)  Patient kept in left lateral position for 10-20
 It includes kidney, ureter & bladder minutes or 5 minutes before taking
2.) Upright AP Projection (Flat) radiograph
3.) Three-way/Acute Abdominal Series  Rationale:
 AP supine (KUB), AP upright & PA chest o It allow gas to rise into the area
 Purpose: To rule out free air, bowel under the right hemidiaphragm
obstruction & infections o To demonstrate small amounts of
 PA Chest: to detect free air that may intraperitoneal gas in acute
accumulate under the diaphragm abdominal cases (10-20 mins)
4.) Left Lateral Decubitus o To demonstrate larger amounts free
 If patient cannot stand for AP upright air (5 mins)
5.) Dorsal Decubitus
If the patient cannot assumed lateral
decubitus

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ABDOMEN
THE END
LATERAL PROJECTION
<BOARD EXAM is a matter of PREPARATION. If you
R or L Position FAIL to prepare, you PREPARE to fail= 04/09/14
PP: Lateral recumbent; knees flexed; elbows
flexed; hands under head;
RP: Level of iliac crest; 2 in. superior to iliac crest
(diaphragm included)
CR: ┴ SS:
Prevertebral space (occupied by abdominal aorta)
Intraabdominal calcifications
Tumor masses

LATERAL PROJECTION
R or L Dorsal Decubitus Position
PP: Supine; arms across upper chest & behind the head;
knees flexed
RP: 2 in. superior to iliac crest
CR: Horizontal
SS: Prevertebral space
ER: To determine the air-fluid levels in the abdomen

BARIUM-FILLED GI TRACT
Purpose:
To demonstrate origin & extend of fistulae (abnormal
passages b/n two internal organs)
To demonstrate sinus (abnormal channels leading to
abscesses)
Barium Enema: fistulae involving the colon
Barium Swallow (thin): fistulae involving the small bowel
Bladder-filled w/ iodinated contrast media: fistulae
involving the bladder
Iodinated contrast media introduced through small
diameter catheter: for cutaneous fistulas & sinus tracts

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