AP Axial

extend the neck so that the PARIETOACANTHIAL PROJECTION

occlussal plane is perpendicular (MODIFIED WATERS METHOD)
RP – C4
CR 15–20° cephalad modified Waters position so that the
Purpose petrous margins are dis placed
Presence & Absence of cervical ribs • IR centered at the level of the center of
IV spaces / interpedicute spaces the orbits
• patient’s head so that the midsagittal
C3-C7 / T1-T3 vert. bodies
plane is perpendicular
Degenerative Disease
• flexion of the patient’s neck so that the
OML forms an angle of 50 degrees with
the plane of the IR.
Lateral(Grandy Method
• Subluxation CR: Perpendicular through the mid-
orbits
• Hyperextend the chin a little so that the
mandibular rami will not superimpose the ACANTHIOPARIETAL PROJECTION
cervical spine (REVERSE WATERS METHOD)
• IV joints, articular pillars / lat.
masses, spinous process, • Used to show the facial bones when the
zygapophyseal joint, (C2-C7) patient cannot be placed in the prone
• 5-10 lbs. each arm to depress the shoulder position
• patient in the supine position Position
• 72” SID
of part
• Breathing technique – full expiration • patient’s chin up, adjust the extension
of the neck so that the OML forms a 37-
degree angle
P AXIAL OBLIQUE • Adjust the patient’s head so that the
PROJECTION(RPO/LPO midsagittal plane is perpendicular

POSITIONS) • CR: Perpendicular to enter the

acanthion
• rotate the head 450
• farthest/elevated/remote IVF are LATERAL PROJECTION R or L position
better demons. • anterior oblique position, seated
• 15–20° cephalad to C4 upright or recumbent.
Recommended by Barsóny and
Koppenstein • side of interest closest to the IR
• Demonstrates:Intervertebral • head position so that the
foramina and pedicles interpupillary line is perpendicular to
the IR
• Perpendicular, entering 2 inches (5
cm) superior to the EAM
SHOULER AP PROJECTION EXTERNAL • Structures shown:
ROTATION • sella turcica
• CR perpendicular to coracoid process 1 inch • anterior clinoid processes
inferior to the coracoid process • dorsum sellae o
• Laterally (Externally) rotate palm of the
• posterior clinoid processes are well
hand (extreme supination)
• Medial and lateral epicondyles are parallel
shown in the lateral projection
to the plane of cassette.
• Best demonstrate greater tubercle in profile AP PROJECTION AP
on the lateral aspect of the humerus CR: Perpendicular or directed to
• The true AP projection of the humerus in
the nasion
the anatomic position.
SHOULDER JOINT AP PROJECTION NEUTRAL
ROTATION AXIAL PROJECTION:
• Rest palm of hand against thigh/hip CR: Perpendicular or directed to
• Medial and lateral epicondyles at a 45 the nasion at an angle 15 degrees
degrees angle cephalad
• IR 2 in. above top of shoulder
• CR perpendicular to the coracoid process 1 Townes: central ray directed 30
inch (2.5 cm) inferior to the coracoid process
degrees to OML or 37 degrees to
PA OBLIQUE / SCAPULAR Y (RAO OR
IOML(Caudad)
LAO)
• rotate the px., midcoronal plane angle of 45- PA SKULL
60 PA: perpendicular to exit the
•CR horizontally to the vert. border to the
glenohumeral jt.
nasion.
• suspended respiration
• demonstrate the joint dislocations PA AXIAL PROJECTION: CR:
• relationship of the humeral head to glenoid
cavity
Directed through the center of the
• Described by Rubin orbits at a caudal angulation of 30
• Compensating filter used is boomerang (CR or degrees.
DR)
• Bankart Lesion - injury in the Ant. Aspect of
the glenoid labrum Caldwell: direct the central ray to
CLAVICLE AP PROJECTION exit the nasion at an angle of 15
• Patient in supine or upright position degrees caudad.
• Perpendicular to the midshaft of the
clavicle
• Demonstrates a frontal image of the
clavicle.
• AP projection is performed when the
patient cannot assume the prone
position.
 HUMERUS LATERAL HAND PAPROJECTION
•Rotate the arm medially
• CR perpendicular to the 3rd MCP
• Epicondylar line perpendicular joint
to the film. • 1 inch or 2.5 cm of distal forearm
• Flex elbow approximately 90° should be included in the radiograph.
• Flex elbow 90°.
(unless contraindicated) and place
palmar aspect of hand on the hip.
• A true lateral is confirmed by HAND LATERAL FAN LATERAL
the superimposed epicondyles.
• Best demonstrate the lesser • Align long axis of hand to long axis of
tubercle in profile. film
• Rotate hand and wrist into a lateral
HUMERUS AP position with the thumb side up (ulnar
side down).
• Supinate hand.
• Spread fingers and thumb into a fan
• Humeral epicondyles parallel position.
with plane of film. • Thumb should be projecting away
• Both epicondyles seen in profile. from the palm and parallel to the film.
• Best demonstrate the Greater HAND PA OBLIQUE
tubercle in profile
• Routine projection for the • CR perpendicular to 3rd MCP joint
• Flex elbow 90°.
humerus
• Pronate hand.
• Oblique hand toward the lateral so
that MCP joint form a 45° angle with
ELBOW AP PROJECTION plane of film.

• Fully extend elbow

• Supinate hand
• Humeral epicondyles parallel to IR.
• Demonstrate an open elbow joint space.
• Best demonstrates the humeral
epicondyles in profile.

CHEST PA PROJECTION
• image receptor is 1 ½-2 inches above
shoulders.
• Chin raised and resting against image
ELBOW LATERAL receptor.
• Flex elbow 90° • Flex arms and back of the hands low on the
• EXCEPTION: For soft tissue injury around hips with palms out so that scapula will move
the elbow is suspected. The elbow should laterally and will not superimpose over the lung
only be flexed 30-35° • Place hand in lateral fields.
position. • Depress shoulder to move clavicles below
• Humeral epicondyles perpendicular to IR. apices and rotated forward.
• Best demonstrate the olecranon process. • Exposure is made at the end of the 2 nd full
• Best demonstrate the posterior fat pad inspiration to ensure maximum expansion of
(visualization is a common indication of the lungs.
elbow joint pathology). • (SID) is 72 inches (183 cm) to decrease
• Demonstrate any tear drop sign. magnification of the heart and to increase
recorded detail of thoracic structures.
• CR perpendicular to level of T7
CHEST LATERAL PROJECTION
FOREARM AP •Left lateral position will demonstrate the
• Fully extend elbow, and supinate hand. heart, aorta and left sided pulmonary lesions.
• Humeral epicondyles parallel to
cassette. • Right lateral position will demonstrate right
•Best demonstrate the humeral sided pulmonary lesions.
epicondyles in profile.
• Hilum in the center of the image.

• Oblique and horizontal fissure fissures.

FOREARM LATERAL
• Flex elbow 90°
• Place hand in lateral position
• Humeral epicondyles perpendicular to CHEST PA OBLIQUE PROJECTION RAO
cassette. • Thumb side of the hand must be up. AND LAO POSITIONS
• Best demonstrates the olecranon process.
• Demonstrate the fat stripe of the wrist and fat • 45 degrees obliquity – Routine position.
pad of the elbow. • 60 degrees obliquity – studies of the heart
• Demonstrate the humeral epicondyles (LAO)
superimposed on each other • 15-20 degrees – better visualization of various
areas of the lungs for possible pulmonary
lesions.
• This position is used to demonstrate the
trachea, bronchial tree, heat and aorta free
from superimposition of the vertebral column.
WRIST • Best demonstrates side farthest from image
PA WRIST receptor.
• Slightly oblique projection of ulna.

WRIST AP PULMONARY APICES LORDOTIC POSITION

• Best demonstrate distal ulna & carpal LINDBLOM METHOD
interspaces. •Top of the IR 3-4 inches above shoulder.
• Patient standing 1 foot away from the vertical
cassette holder (VCH), facing forward and
leaning back with shoulders, neck and back of
head against IR.
WRIST LATERAL • CR perpendicular to mid sternum
• Flex elbow 90° • Used to demonstrate right middle lobe
• Best demonstrate the pronator fat pneumothorax.
stripe • Best demonstrate widening of • Preferred apical position for male patient.
the wrist joint due to fracture or • Pulmonary apices below clavicles
dislocation. THORACIC VERTEBREA
• Good projection to assess the
AP PROJECTION
relationship of capitate, lunate and distal
radius (normally in a straight line).
• RP T6 (T7 optimal)
• 1½ - 2” above the shoulder
• 2.5 cm./1” below the manubrial notch (3-4”
below”) /
 LATERAL PROJECTION HIP AP PROJECTION
• IV foramina, transfers processes, T1-T10 UNILATERAL
• CR 3-50 cephalad (if no foam pad use)
• CR perpendicular (if foam pad is used) • Patient in supine position.
• breathing technique, RP T6 • Medially rotate leg and feet 15°-20°
• 2 transverse processes • CR perpendicular to femoral neck
approximately 2 ½ distal to midpoint of ASIS
and symphysis pubis.
• Greater trochanter in profile
• Femoral head and neck
• Proximal 1/3 of the femur.

Abdominal
AP UPRIGHT PROJECTON
• Patient in erect position. SACRUM AP AND PA AXIAL
• Center the IR 2 inches (5 cm) above the PROJECTIONS
level of the iliac crests
• CR horizontal to 2-3 inches (5 cm) above
level of iliac crest • (AP) 15°CEPHALAD
• Top of IR at the level of the axilla. • (PA) 15°CAUDAD
• Px should be upright for 5 minutes but 10-
20 s is desirable.
• To a point 2 inches superior to the
• Most valuable for demonstrating free symphysis pubis.
intraperitoneal air.
• Best demonstrate air and fluid levels.
ABDOMEN AP SACRUM LATERAL PROJECTION
• Interiliac plane perpendicular to the table.
PROJECTION/KUB • CR perpendicular to the level of the ASIS at
a point 3 ½ inches posterior.
• Patient in supine position.
• CR perpendicular to the level of iliac crest
• Serves as a scout view for various
radiologic exams.

COCCYX AP AND PA AXIAL

PROJECTIONS
LUMBAR VERTEBRA AP PROJECTION
• Patient in supine position with knees flex. • (AP) 10°CAUDAD
• The knees are flexed to decrease the lordotic curve of the
• (PA) 10°CEPHALAD
lumbar.
CENTRAL RAY •To a point 2 inches superior to the symphysis
1. Perpendicular at the level of the iliac crest for lumbosacral pubis.
studies.
2. Perpendicular to L3 for Lumbar study.
• The erect position may be useful to demonstrate the
natural weight-bearing stance of the spine.
• Demonstrate the lumbar bodies, intervertebral disk COCCYX LATERAL PROJECTION
spaces. • Interiliac plane perpendicular to the table.
• CR perpendicular to the level of the ASIS at a
LUMBAR VERTEBRA LATERAL PROJECTION point 3 ½ inches posterior.
• Flex knees to straighten the spine and helps open
intervertebral disk spaces.
CENTRAL RAY:
• Lumbar Spine horizontal to table.
1. Perpendicular at the level of the iliac crest for lumbosacral
studies.
2. Perpendicular to L3 for Lumbar study.
• Lumbar spine not horizontal to table.
• 1. Male – 5 degrees caudad
• 2. Female – 8 degrees caudad
•Demonstrate the lumbar bodies, intervertebral disk spaces FEMUR AP PROJECTION
and transverse process,
• Best demonstrate the intervertebral foramina. • Rotate the leg by 5° if the knee is
•Good projection for demonstrating compression fractures. included
FEMORAL NECK AP OBLIQUE PROJECTION • Rotate the leg by 10°- 15° if proximal
MODIFIED CLEAVES BILATERAL PROJECTION femur is included.
• Patient in supine position
•Abduct the thighs 45 from the vertical.
•CR perpendicular to enter the patient’s MSP at
the level 1 inch superior to symphysis pubis. FEMUR LATERAL PROJECTION
• This projection is often called the bilateral frog • Patient in lateral recumbent position.
leg position.
• Flex knee 45°
• Commonly indicated for congenital hip disease
•Contraindicated in patients with suspected hip • Femoral epicondyles perpendicular to IR.
fractures. • Rotate pelvis 10°-15° posteriorly from the
• AP oblique projection of the femoral heads and lateral position.
neck.
• Lesser trochanter on medial side of femur.
•Femoral neck without superimposition of the
greater trochanter.

PELVIS AP PROJECTION KNEE AP PROJECTION

• supine position. • Patient in sitting or supine position.
• Medially rotate leg and feet 15°-20° to place • Rotate the leg medially 3°-5°
femoral necks parallel to IR. • Femoral epicondyles are parallel to IR.
• Heels should be placed 8-10 inches apart. • CR 5°-7° cephalad to ½ inch inferior to patellar
• Upper border of IR 1-1 ½ inches above iliac apex VARIATION IN CR 3°- 5° caudad
crest. • <18 cm below (thin thigh and buttocks) 0
•CR perpendicular midway between ASIS and degree
symphysis pubis 2 inches inferior to ASIS and • 19-24 cm (average thigh and buttocks) 3°- 5°
2 inches superior to symphysis pubis. cephalad
• Greater trochanter in profile. • > 24 cm (thick thigh and buttocks)
• Femoral head and neck.
• Provides a general survey of the bones of the
entire pelvis and proximal femur.
PELVIS LATERAL KNEE LATERAL PROJECTION
• Patient in lateral recumbent.
PROJECTION • Femoral epicondyles perpendicular to IR • Flex knee
20°-30° Purpose of degree of flexion 1. Relaxes the
• Patient in lateral recumbent position muscle. 2. Maximum volume of joint cavity.
• Pelvis in true lateral position. • CR 5°-7° cephalad 1 inch distal to medial condyle.
• CR perpendicular to level of soft tissue Purpose of 5°-7° cephalad angulation
depression 2 inches above greater trochanter. • Prevent the joint space from being obscured by the
• DORSAL DECUBITUS LATERAL PROJECTION magnified medial condyle. • Knee should not be flexed
more than 10° to prevent fragment separation for new
• Best demonstrate Gull-Wing sign in cases of
or unhealed patellar fractures.
fracture dislocation of the acetabular rim and
posterior dislocation of the femoral head.
 KNEE AP MEDIAL OBLIQUE FOOT LATERAL PROJECTION MEDIOLATERAL
• CR perpendicular to the base of the 3rd
PROJECTION metatarsal
• Patient in sitting or supine position.
• Flex knee of affected limb about 45 degrees.
• Rotate leg 45° medially.
• Femoral epicondyles form an angle of 45° to
LATEROMEDIAL
plane of image receptor.
• Uncomfortable but considered to be the true
• CR perpendicular to ½ inch inferior to patellar
lateral foot projection.
apex on average patient.
• The most common oblique projection of the
knee.
• Tibial plateau
FOOT AP OBLIQUE PROJECTION
• Best demonstrate the lateral femoral condyle. MEDIAL OBLIQUE
• Best demonstrate an open proximal • Rotate foot medially 30°- 45° to plane of IR.
tibiofibular joint space. • CR perpendicular to base of 3rd MT.
PATELLO-FEMORAL JOINT • 3 rd-5th MT bases free of superimposition.
SUNRISE/SKYLINE • Tuberosity of 5th MT well seen.
• Flex knees 40° - 45° • Best demonstrate the cuboid bone and
• 30° from the horizontal to Sinus tarsi
patellofemoral space FOOT AP OBLIQUE PROJECTION
• The major advantage to this method is it LATERAL OBLIQUE
does not require special equipment and • Rotate foot laterally 30°- 45° to plane of IR.
is relatively comfortable to the patient. • CR perpendicular to base of 3rd MT.
• The only disadvantage is in holding or • Alternative oblique projection of the foot.
supporting the cassette if the patient • Best demonstrate the 1st and 2nd MT.
cannot cooperate fully. • Best demonstrate the navicular bone.
• Space between 1st and 2 nd cuneiforms.

LEG AP PROJECTION
• Medially rotate leg 5° for true AP
projection.
• Femoral epicondyles are parallel to IR.
• Patient in sitting or supine position.
• IR must extend 1-1 ½ inch over beyond the
joints.

LEG LATERAL PROJECTION

• Patient in Lateral recumbent position.
• Flex the knee 45° and ensure that the leg
is true lateral position.
• Distal fibula lying posterior over half of the
tibia.
• Tibial tuberosity in profile
• Overlap tibia on the proximal fibular head.

ANKLE JOINT AP PROJECTION

• Adjust ankle joint in a true AP position by flexing the
ankle & foot (5 degree medial rotation of leg and foot).
• CR perpendicular to ankle joint, midway between
the two malleoli.
• Tibiotalar joint space should be seen.

ANKLE MORTISE PROJECTION

• CR perpendicular midway between the malleoli
• Intermalleolar plane is parallel to IR.
• Medially rotate leg & foot 15°–20°.
• Alternate or supplemental view for the ankle.
• Useful in evaluating pathology of the entire ankle
mortise.
• Common projection taken during open reduction
surgery of the ankle joint.
• Best demonstrate talofibular joint
•3 sides of the mortise joint well visualized.

ANKLE MEDIOLATERAL PROJECTION

• CR perpendicular to medial malleolus

• Best demonstrate anterior or posterior
displacements of bony structures.
• Best demonstrate tibiotalar joint

FOOT AP PROJECTION
DORSOPLANTAR
• CR perpendicular to the base of the 3rd
metatarsal.
• Dorsoplantar is the preferred name for the AP
projection of the foot.

FOOT AP AXIAL PROJECTION

• CR 10° posteriorly towards the calcaneus entering
the base of the 3rd MT.
• The purpose of the 10° posterior angulation is to
place the CR more perpendicular to the metatarsals
therefore reducing foreshortening.
• TMT joint spaces of the midfoot best
demonstrated.