Second Through Fifth Digits Second Through Fifth Digits

PA Lateral
Patient Position Patient Position
• Seat patient at end of radiographic table. • Seat patient at end of radiographic table.
Part Position Part Position
• Place extended digit of interest with palmar surface of hand down • Demonstrate position for patient. Ask patient to extend digit
on the IR. of interest and to close rest of digits into a fist.
• Separate digits slightly, and center the digit under examination to the • Adjust digit of interest parallel to IR plane.
center of the IR. • Rest digit on lateral or medial surface as needed to obtain
• Shield gonads. smallest possible OID.
Central Ray • Immobilize extended digit. (Use cotton swab or tape.)
• Perpendicular, entering PIP joint of digit being examined • Shield gonads.

Collimation: Central Ray

1 inch (2.5 cm) all sides of digit, including 1 inch (2.5 cm) proximal • Perpendicular, entering PIP joint
to MCP joint. Place side marker in the collimated exposure field. Collimation:
1 inch (2.5 cm) all sides of digit, including 1 inch (2.5 cm) proximal
to MCP joint. Place side marker in the collimated exposure field.
5 3

kVp: 63 Reference: 14th edition ATLAS p. 1:154. kVp: 63 Reference: 14th edition ATLAS p. 1:156.

Second Through Fifth Digits First Digit (Thumb)

PA oblique (lateral rotation) AP
Patient Position Patient Position
• Seat patient at end of radiographic table. • Seat patient at end of radiographic table.
Part Position Part Position
• Place patient’s hand in lateral position, ulnar side down and centered • Place affected hand in extreme internal rotation, with first digit cen-
to IR area. tered to IR area.
• Rotate palm 45 degrees toward IR until digits are resting on sponge • Adjust position of hand to ensure true AP projection of first digit.
support. • Extend and secure digits two through five to eliminate superimposi-
• Immobilize separated digits. tion over first digit.
• Shield gonads. • Shield gonads.
Central Ray Central ray
• Perpendicular, entering PIP joint • Perpendicular, entering MCP joint of first digit
Collimation: Collimation:
1 inch (2.5 cm) on all sides of digit, including 1 inch (2.5 cm) proxi- 1 inch (2.5 cm) on all sides of digit, including 1 inch (2.5 cm) proxi-
mal to MCP joint. Place side marker in the collimated exposure field. mal to CMC joint. Place side marker in the collimated exposure field.

kVp: 63 Reference: 14th edition ATLAS p. 1:158. kVp: 63 Reference: 14th edition ATLAS p. 1:160.
 First Digit (Thumb) First Digit (Thumb)
Lateral PA oblique
Patient Position Patient Position
• Seat patient at end of radiographic table. • Seat patient at end of radiographic table.
Part Position Part Position
• Have patient rest palmar surface of hand on IR. • Abduct first digit.
• Adjust arching of hand until true lateral position of first digit is • Place palmar surface of hand firmly against IR, and adjust first digit
achieved. to oblique position.
• Shield gonads. • Shield gonads.
Central Ray Central Ray
• Perpendicular, entering MCP joint of first digit • Perpendicular, entering MCP joint of first digit
Collimation: Collimation:
1 inch (2.5 cm) on all sides of digit, including 1 inch (2.5 cm) proxi- 1 inch (2.5 cm) on all sides of digit, including 1 inch (2.5 cm) proxi-
mal to CMC joint. Place side marker in the collimated exposure field. mal to CMC joint. Place side marker in the collimated exposure field.

kVp: 63 Reference: 14th edition ATLAS p. 1:160. kVp: 63 Reference: 14th edition ATLAS p. 1:160.

Hand Hand
PA PA oblique (lateral rotation)
Patient Position Patient Position
• Seat patient at end of radiographic table. • Seat patient at end of radiographic table.
Part Position Part Position
• Rest forearm on table with palmar surface of hand against IR. • Rest forearm on table with palmar surface of hand against IR.
• Spread digits slightly. • Rotate hand laterally (externally), and place digits on 45-degree
• Shield gonads. radiolucent support to show interphalangeal joints. Adjust digits
Central Ray parallel with IR.
• Perpendicular to third MCP joint • When metacarpals are area of primary interest, rotate hand laterally
so that fingertips touch IR.
Collimation: • Shield gonads.
1 inch (2.5 cm) all sides of hand including 1 inch (2.5 cm) proximal
to ulnar styloid. Place side marker in the collimated exposure field. Central Ray
• Perpendicular to third MCP joint
Collimation:
1 inch (2.5 cm) on all sides of hand including 1 inch (2.5 cm)
proximal to ulnar styloid. Place side marker in the collimated
exposure field.

kVp: 66 Reference: 14th edition ATLAS p. 1:168. kVp: 66 Reference: 14th edition ATLAS p. 1:170.
 Hand Wrist
Lateral PA
Patient Position Patient Position
• Seat patient at end of radiographic table. • Seat patient at end of table with axilla in contact with table.
Part Position Part Position
• Rest ulnar surface of forearm on table with hand in true lateral • Have patient rest forearm on table.
position. • Center wrist to IR area.
• Extend digits with first digit (thumb) placed at right angles to palm • Flex digits slightly to place wrist in contact with IR.
of hand. As an option, have patient “fan” fingers and place on posi- • Shield gonads.
tioning sponge to reduce superimposition of phalanges (as illus- Central Ray
trated). • Perpendicular to midcarpal area
• Center MCP joints to IR, and adjust palmar surface of hand perpen-
dicular to IR. Collimation:
• Shield gonads. 2.5 inches (6 cm) proximal and distal to wrist joint and 1 inch (2.5 cm)
on the sides. Place side marker in the collimated exposure field.
Central Ray
• Perpendicular to second MCP joint
Collimation:
1 inch (2.5 cm) on all sides of shadow of hand and thumb, including
1 inch (2.5 cm) proximal to ulnar styloid. Place side marker in the
collimated exposure field.
kVp: 66 Reference: 14th edition ATLAS p. 1:176.
kVp: 70 Reference: 14th edition ATLAS p. 1:172.

Wrist Wrist
Lateral PA oblique (lateral rotation)
Patient Position Patient Position
• Seat patient at end of table with axilla in contact with table. • Seat patient at end of table with axilla in contact with table.
Part Position Part Position
• Flex elbow 90 degrees, with forearm and arm in contact with table. • Rest anterior surface of wrist on IR.
• Center carpals to IR, and adjust hand so that wrist is in true lateral • Center wrist to IR area.
position. • Rotate wrist approximately 45 degrees laterally (externally) and
• Shield gonads. support on sponge.
Central Ray • Shield gonads.
• Perpendicular to wrist joint Central Ray
Collimation: • Perpendicular to IR, entering midcarpal area just distal to radius
2.5 inches (6 cm) proximal and distal to wrist joint and 1 inch (2.5 cm) Collimation:
on palmar and dorsal surfaces. Place side marker in the collimated 2.5 inches (6 cm) proximal and distal to wrist joint and 1 inch (2.5 cm)
exposure field. on sides. Place side marker in the collimated exposure field.

kVp: 70 Reference: 14th edition ATLAS p. 1:178. kVp: 66 Reference: 14th edition ATLAS p. 1:180.
 Wrist Wrist
PA: ulnar deviation PA axial STECHER METHOD
Patient Position Patient Position
• Seat patient at end of table with axilla in contact with table. • Seat patient with arm and axilla in contact with table.
Part Position Part Position
• Flex elbow 90 degrees, with forearm and arm in contact with table. • Place one end of IR on a support, and adjust so that finger end is
• Center wrist to IR area. elevated 20 degrees.
• Without moving the forearm, turn the hand outward until wrist is in • Adjust the wrist for a PA projection, and center wrist to IR.
extreme ulnar deviation. • Shield gonads. 20°
• Shield gonads. Central Ray
Central Ray • Perpendicular to table, and position to enter scaphoid
• Perpendicular to scaphoid Collimation:
NOTE: If necessary to delineate fracture, angle central ray 10 to 2½ inches (6 cm) proximal and distal to wrist joint and 1 inch (2.5 cm)
15 degrees proximally (toward elbow) or distally. on sides. Place side marker in the collimated exposure field.
Collimation:
2.5 inches (6 cm) proximal and distal to wrist joint and 1 inch
(2.5 cm) on sides. Place side marker in the collimated exposure field.

kVp: 66 Reference: 14th edition ATLAS p. 1:182. kVp: 66 Reference: 14th edition ATLAS p. 1:184.

Carpal Canal Forearm

Tangential GAYNOR-HART METHOD 25°–30° AP
Patient Position Patient Position
• Seat patient with forearm parallel with long axis of table. • Seat patient at end of table with arm extended and entire extremity
Part Position in same plane.
• Hyperextend wrist, and center it to center of IR. Part Position
• Place ¾-inch radiolucent pad under lower forearm for support, • Supinate hand, and center forearm to IR to include joint or joints of
if needed. interest.
• Adjust hand position to make long axis of hand as vertical as • Adjust rotation to place humeral epicondyles equidistant from IR.
possible. • Shield gonads.
• Have patient grasp digits with opposite hand to hold in extended Central Ray
position, or pull with a band (as shown). • Perpendicular to midpoint of forearm
• Shield gonads.
Collimation:
Central Ray 2 inches (5 cm) distal to wrist joint and proximal to elbow joint, and
• Direct to palm of hand 1 inch (2.5 cm) distal to base of third 1 inch (2.5 cm) on sides. Place side marker in the collimated exposure
metacarpal at 25- to 30-degree angle field.
Collimation:
1 inch (2.5 cm) on the three sides of shadow of wrist. Place side
marker in the collimated exposure field.

kVp: 70 Reference: 14th edition ATLAS p. 1:190. kVp: 70 Reference: 14th edition ATLAS p. 1:192.
 Forearm Elbow
Lateral AP
Patient Position Patient Position
• Seat patient at end of table with humerus and forearm in contact • Seat patient at end of table with arm extended and entire extremity
with table. in same plane.
Part Position Part Position
• Have patient flex elbow, and position entire extremity in same plane. • Extend elbow, supinate hand, and center elbow joint to IR.
• Flex elbow 90 degrees, and adjust hand to lateral position (thumb • Adjust humeral epicondyles to be equidistant from IR.
up). • Have patient lean slightly laterally if necessary to ensure
• Center forearm to IR to include joint or joints of interest. AP alignment.
• Shield gonads. • Shield gonads.
Central Ray Central Ray
• Perpendicular to midpoint of forearm • Perpendicular to elbow joint
Collimation: Collimation:
2 inches (5 cm) distal to wrist joint and proximal to elbow joint, and 3 inches (8 cm) proximal and distal to elbow joint and 1 inch (2.5 cm)
1 inch (2.5 cm) on sides. Place side marker in the collimated exposure on sides. Place side marker in the collimated exposure field.
field.

kVp: 70 Reference: 14th edition ATLAS p. 1:194.

kVp: 70 Reference: 14th edition ATLAS p. 1:195.

Elbow Elbow
Lateral AP oblique (medial rotation)
Patient Position Patient Position
• Seat patient at end of table with elbow flexed 90 degrees. • Seat patient at end of table with arm extended and entire extremity
Part Position in same plane.
• Have patient rest humerus and forearm on table, and position entire Part Position
extremity in same plane. • Extend elbow, supinate hand, and center elbow joint to IR.
• Center 90-degree flexed elbow joint to IR, and adjust wrist and hand • Rotate arm medially.
in lateral position. • Adjust anterior surface of elbow (epicondyles) to 45 degrees to IR.
• Adjust humeral epicondyles perpendicular to IR. • Shield gonads.
• Shield gonads. Central Ray
Central Ray • Perpendicular to IR, entering elbow joint
• Perpendicular to elbow joint Collimation:
Collimation: 3 inches (8 cm) proximal and distal to elbow joint and 1 inch (2.5 cm)
3 inches (8 cm) proximal and distal to elbow joint. Place side marker on sides. Place side marker in the collimated exposure field.
in the collimated exposure field.

kVp: 70 Reference: 14th edition ATLAS p. 1:196. kVp: 70 Reference: 14th edition ATLAS p. 1:198.
 Elbow Elbow
AP oblique (lateral rotation) AP partial flexion
Patient Position Patient Position
• Seat patient at end of table with arm extended and entire extremity • Seat patient at end of table with humerus resting on table for one
in same plane. image and forearm resting on table for the other image.
Part Position Part Position
• Extend elbow, supinate hand, and center elbow joint to IR. Distal humerus:
• Rotate arm laterally. • Place humerus on table, and support the elevated forearm.
• Adjust anterior surface of elbow (epicondyles) to 45 degrees to IR. • Support forearm.
• Shield gonads. • Supinate hand if possible.
Central Ray • Place IR under elbow and center to condyloid area of the humerus.
• Perpendicular to IR, entering elbow joint Proximal forearm:
Collimation: • Place dorsal surface of forearm on table.
3 inches (8 cm) proximal and distal to elbow joint and 1 inch (2.5 cm) • Place IR under elbow and center approximately 1 inch distal to
on sides. Place side marker in the collimated exposure field. humeral epicondyles.
• Shield gonads.
Central Ray
• Direct perpendicular to IR, entering appropriate portion of elbow joint
Collimation:
3 inches (8 cm) proximal and distal to elbow joint and 1 inch (2.5 cm)
kVp: 70 Reference: 14th edition ATLAS p. 1:199. on sides. Place side marker in the collimated exposure field.
kVp: 70 Reference: 14th edition ATLAS pp. 1:200-201.

Humerus Humerus
AP Lateral
Patient Position Patient Position
• Position patient upright or supine. • Position patient upright or supine.
Part Position Part Position
• Unless contraindicated, supinate hand. • Unless contraindicated, slightly abduct arm.
• Adjust humerus with epicondyles parallel with IR. • Center arm to IR. R
• If patient is recumbent, elevate and support opposite shoulder, if • Medially rotate arm until epicondyles are perpendicular to IR.
needed. • Shield gonads.
• Center humerus to IR. Respiration:
• Shield gonads. • Suspend.
Respiration: Central Ray
• Obtain radiograph during suspended respiration. • Perpendicular to midpoint of humerus
Central Ray Collimation:
• Perpendicular to midpoint of humerus 2 inches (5 cm) distal to elbow joint and superior to shoulder and
Collimation: 1 inch (2.5 cm) on sides. Place side marker in the collimated exposure
2 inches (5 cm) distal to elbow joint and superior to shoulder and 1 inch field.
(2.5 cm) on sides. Place side marker in the collimated exposure field.

kVp: 70 (non-grid) 75 (grid) Reference: 14th edition ATLAS p. 1:211.

kVp: 70 (non-grid) 75 (grid) Reference: 14th edition ATLAS p. 1:214.
 Proximal Humerus/Shoulder Shoulder
Transthoracic lateral LAWRENCE METHOD AP
Patient Position Patient Position
• Position patient upright or supine. • Position patient upright or supine.
Part Position Part Position
• Raise uninjured arm, and rest it on or beside head. • Center a point 1 inch (2.5 cm) inferior to coracoid process to IR.
• Elevate uninjured shoulder as much as possible. • Adjust hand in (1) external rotation: humeral epicondyles parallel
• Adjust patient to project humerus between vertebral column and to IR, (2) neutral rotation: epicondyles about 45 degrees to IR, or
sternum. (3) internal rotation: epicondyles perpendicular to IR, depending
• Unless contraindicated, adjust humeral epicondyles perpendicular to IR. on department protocol.
• Shield gonads.
Respiration:
• Suspend. Respiration:
• Suspend.
Central Ray
• Perpendicular to midcoronal plane, exiting surgical neck of affected Central Ray
humerus. If patient cannot elevate unaffected shoulder, angle central • Direct perpendicular to point 1 inch (2.5 cm) inferior to coracoid
ray 10 to 15 degrees cephalad. process
Collimation: Collimation:
Adjust to 10 ! 12 inches (24 ! 30 cm). Place side marker in the col- Adjust to 10 ! 12 inches (24 ! 30 cm). Place side marker in the
limated exposure field. collimated exposure field.
COMPENSATING FILTER
• Shoulder filter greatly improves image quality.
kVp: 85 Reference: 14th edition ATLAS p. 1:236.
kVp: 85 Reference: 14th edition ATLAS p. 1:227.

Shoulder Joint Shoulder (Scapular Y)

AP oblique GRASHEY METHOD PA oblique
Patient Position Patient Position
• Position patient upright or recumbent. • Position patient upright or prone. Upright position is preferred when
Part Position shoulder is tender.
• Center IR to scapulohumeral joint. The joint is 2 inches (5 cm) me- Part Position
dial and 2 inches (5 cm) inferior to superolateral border of shoulder. • Center anterior surface of affected shoulder to IR.
• Rotate body 35 to 45 degrees toward affected side. (Note: Greater • Palpate scapular borders, and rotate patient so that midcoronal plane
rotation may be needed to place plane of scapular body parallel to forms 45- to 60-degree angle from IR. (Note: Plane of scapular body
IR if patient is recumbent.) will be perpendicular to IR.)
• Abduct arm slightly with palm of hand on abdomen. • Shield gonads.
• Shield gonads. Respiration:
Respiration: • Suspend.
• Suspend. Central Ray
Central Ray • Perpendicular to shoulder joint at level of scapulohumeral joint
• Perpendicular to IR Collimation:
Collimation: Adjust to 12 inches (30 cm) in length and 1 inch (2.5 cm) to lateral
Adjust to 8 ! 10 inches (24 ! 30 cm). Place side marker in the colli- shadow. Place side marker in the collimated exposure field.
mated exposure field. COMPENSATING FILTER
• Shoulder filter greatly improves radiographic quality.
kVp: 85 Reference: 14th edition ATLAS p. 1:232.
kVp: 85 Reference: 14th edition ATLAS p. 1:243.
 Acromioclavicular Articulations
AP PEARSON METHOD
Patient Position
• Position patient upright if condition permits.
Part Position
• Adjust midpoint of IR to level of acromioclavicular (AC) joints.
• Center midsagittal plane of body to midline of IR if both AC joints
can be shown on one radiograph. Otherwise, center to each individ-
ual AC joint for two separate exposures.
• To show AC separation, attach sandbags of equal weight (5–10 lb) to
each wrist and also obtain a second radiograph without weights for
comparison.
Respiration:
• Suspend.
Central Ray
• Perpendicular to IR midway between AC joints (for one exposure)
or perpendicular to each AC joint (for two exposures)
Collimation:
Adjust to 6 ! 17 inches (15 ! 43 cm) for single exposure or 3.5 !
3.5 inches (9 ! 9 cm) for two exposures. Place side marker in the col-
limated exposure field.

kVp: 80 Reference: 14th edition ATLAS p. 1:253.