POSITIONING

NOTES
HUMERUS

AP PROJECTION
adjust the IR, place upper margin about 1.5 inch
above head of humerus
supinate hand, abduct arm slightly
epicondyles is parallel to the IR

perpendicular midportion of the humerus

shows the entire length of the humerus the accuracy of

position is shown in epicondyles.

LATERAL PROJECTION
PP 1: rotate arm internally, flex elbow 90 degrees,
anterior hand on the hip.

PP2: rotate forearm medially, the posterior hand

against the patient side.

Perpendicular to the mid portion of humerus

Show the entire length of humerus, image confirmed by

superimposed epicondyles

CLAVICLE

AP PROJECTION
patient in supine or upright position
center clavicle in the IR

perpendicular to mid shaft clavicle

shows the frontal image or clavicle

IF PA PROJECTION: useful when improved recorded

detail, advantage is that the clavicle is closer to image
receptor.

AXIAL PROJECTION LORDOTIC POSITION

lean backward, rest neck and shoulder against vertical
grid, neck in extreme flexion.
center clavicle in the IR

• Enter mid shaft of the clavicle

• standing 0 to 15 degrees
• Supine 15 to 30 degrees

Shows the axial image of clavicle above the ribs

TANGENTIAL PROJECTION
depress shoulder and place clavicle in horizontal
turn the patient’s head away from side being examined
IR is on top of the shoulder

perpendicular to the plane of IR at 25 to 45 degrees

so that CR will pass between clavicle and chest wall

Shows the inferosuperior image of the clavicle , free

for, superimposition.
TANGENTIAL PROJECTION TARRANT
METHOD
IR projected in the clavicle area, have the patient
hold
the IR
lean slightly forward

anterior and inferior to mid shaft of clavicle at 25

to 35 degree

Shows the clavicle above the thoracic cage

SCAPULA

AP PROJECTION
abduct arm to a right angle to draw scapula
laterally
flex elbow and support hand in comfortable
position
Top of IR 2 inch above the top of the shoulder

perpendicular to mid scapular approx 2 inches

inferior to the coracoid process

Shows the scapula at AP projection

LATERAL PROJECTION
RAO or LaAO body position
adjust patient in rao or lao position, affected
scapula in centered grid
45 to 69 degree rotation required for px
flex elbow and place the back of hand on
posterior thorax

perpendicular to midmedial border of protruding

scapula

Shows the lateral image of scapula by this

projection

PA OBLIQUE PROJECTION LORENZ AND

LILIENFILED METHODS RAO or LAO position
patient in lateral position, center scapula to the
midline
of gride device

Lorenz Method: arm at the affected side at a

right angle, flex elbow rest hand against px’s
hand

LILIENFIELD METHOD
extend arm of the affect side obliquely upward, let
the patient rest the hand on her head
rotate body slightly forward

perpendicular to IR between chest wall and mid

area of protruding scapula

shows the obl image of scapula, the degree of

obliquity depends on position of arm.
CORACOID PROCESS
AP AXIAL PROJECTION
patient in supine position with arms along
side of
the body

-center affected coracoid process in midline

of grid
abduct arm of the affect slightly, supine the
hand

directed to enter coracoid process an angle

of 15 to 45 degrees cephalad

Shows a slightly elongated inferosuperior

image of coracoid process

TANGENTIAL PROJECTION
LAQUERRIERE -PEIRQUIN METHOD
center shoulder in the midline of grid
turn head away from the shoulder being
examined

directed through posterosuperior region if

the shoulder ang at 45 degrees caudad

Shows the spine of scapula and fee form

bony superimpositioned, except for lateral
end of clavicle.
SESAMOIDS 2
TANGENTIAL PROJECTION ( LEWIS AND
HOLLY METHODS)
• patient in prone position
• great toe on the table in dorsiflexion position,
• adjust to place ball of the foot
• perpendicular to horizontal plane

CR: perpendicular and tangential to the 1st

metatarsophalangeal joint

SS: Shows tangential projection of metatarsal head in

profile and sesamoid

TANGENTIAL PROJ: CAUSTIN METHOD

• patient in lateral recumbent, on the unaffected side
• flex the knees
• partially extend the limb while examining,
• sandbags under knee and foot
• IR under distal metatarsal region

CR: directed to prominence of 1st MPJ in an angle of

40 degrees towards the heel

SS: shows the sesamoid bones projected axiolaterally

with slight overlap

FOOT: 7

AP OR AP AXIAL PROJECTION
• patient in supine
• flex knee, rest sole of foot firmly on table
• center IR to the base of 3rd metatarsal

CR: perpendicular to the base of 3rd metatarsal

• 2.10 degrees towards the heel to base of 3rd
metatarsal

SS:
• AP PROJECTION of tarsal anterior to talus,
metatarsals and phalanges
• Used for localizing foreign bodies, determining
fragment locations in fx of metatarsals and anterior
tarsals.
• Used in general surveys of bones of the foots
• Shows interspaces between (1) CUBOID AND
CALCANEUS. (2) CUBOID AND 4TH AND 5H
METATARSAL. (3) CUBOID AND LATERAL
CUNEIFORM. (4) TALUS AND NAVICULAR
BONE

AP OBL PROJECTION Medial Rotation

• patient in supine
• flex knee of affected side to have plantar surafce of
foot rest firmly on table
• rotate leg medially until plantar surface form 30
degrees to the IR

CR: perpendicular to base of 34d metatarsal

AP OBL PROJECTION Lateral Rotation
• rotate leg laterally
• plantar surface of foot at an angle of 30 degrees to
IR

CR: perpendicular to base of 3rd metatarsal

SS: shows interspaces between:

• 1st and 2nd Metatarsals
• Medial and intermediate cunieforms

PA OBL PROJ GRASHEY METHODS

MEDIAL OR LATERAL ROTATIONS
• patient in prone
• adjust elevation of foot to it’s dorsal surface in
contact with IR
• demonstrate interspaces1st and 2nd
metatarsals: rotate heel medially approx: 30 deg.
• demonstrate interspaces between 2nd-3rd,
3rd-4th, 4th-5th metatarsals: rotate heels
laterally 20 deg

CR: perpendicular base of 3rd metatarsal

SS: medial rot:

• 1st-2nd metatarsal base free of superimposition
• Medial cuneiform projected w/out superimposition
• navicular bone is seen

Lat rot:
• 3rd- 5th metatarsal ses free of superimposition
• tuberosity of 5th metatarsal and cuboid

Lateral Projection Mediolateral

• patient lie on table turn towards affected side
• center IR to midarea of foot
• Dorsiflex foot to form 90 deg with lower leg

CR: perpendicular o base of 3rd metatarsal

SS: shows entire foot, ankle joint, distal end of tibia and
fibula

Lateral Projection Lateromedial

• Patient p’s body in LPO OR RPO position
• medial side of the foot is in contact with IR

CR: perpen to base of 3rd metatarsal

SS:shows true lateromedial proj of foot, ankle joint,

distal end of tibia and fibula
Longitudinal Arch Lateral Projection
Weight Bearing Method
• patient stand in natural position
• one foot each slide of IR
• body weight equally distributed on the feet

CR: perpendicular to a point above the base of 3rd

metatarsal

SS: shows lateromedial proj of bones of foot with weight

bearing
• demonstrate the structural status of longitudinal arch.
• Right and left are examined for comparison.

AP Axial Proj Weight Bearing Composite Method

• place patient in upright position
• Opposite foot:one step backward for exposure pf the
forefoot
• one step forward for exposure of hind foot or calcaneus

CR:
• Directed to base of 3rd metatarsal with 15 deg posterior
angulation
• directed to posterior surface of ankle 25 deg anterior
angulation

SS:
• Shows weight bearing image of AP axial proj bones pf
foot
• full outline of foot projected free of the leg

CONGENITAL CLUBFOOT
AP and Lateral Projection
KITE METHOD
• demonstrate the anatomy of the foot and bone or
ossification centers of the tarsal

CR: 15 deg posterior angle for AP PROJ

perpendicular to the mid tarsal for lat projection

AXIAL PROJECTION Dorsoplantar KANDEL METHOD

• infant in vertical position
• Plantar surface of foot should rest on IR

CR: 40 degrees anteriorly thru lower leg,usual dorsoplantar

proj of calcaneus.

CALCANEUS 2

AXIAL PROJECTION PLANTODORSAL

• IR under the px’s ankle centered midline of ankle
• patient grasp the gauze to hold ankle in right angle
dorsiflexion

CR: midpoint of IR at cephalic angle of 40 degrees to long

axis of foot. CR enters at the base of 3rd metatarsal

SS: shows the axial proj of the calcaneus

Axial Projection Dorsoplantar
• patient in prone position
• elevate patient’s sandbags, flex dorsiflex
• long axis of foot perpen to table top
• IR against the plantar surface pf the foot

CR: enters dorsal surface of ankle joint at caudal angle 40 deg

to long axis of foot

SS: shows the axial proj of calcaneus and subtalar jt.

ANKLE 6

AP PROJECTION
• patient in supine
• adjust ankle in anatomic position to obtain true ap proj
• flex ankle, foot to place long axis of the foot in the vertical
position

CR: perpen thru ankle jt point midway between the malleoli

SS:
• shows tru ap proj of ankle jt,
• distal ends of tibia and fibula
• Proximal portion of talus

Lateral Projection
Mediolateral

• dorsiflex the foot and adjust in lat position

CR: perpen to ankle jt, entering the medial malleolus

SS: shows a true lateral proj of lower third tibia and

fibula, ankle jt and tarsals

AP OBL PROJ Medial Rotation

• dorsiflex the foot to place ankle at right angle flexion
• obl proj is required & foot is medially rotated 45 degrees

CR: perpen to ankle jt, entering midway between malleolus

SS: 45 degr med obl demonstrates distal ends of tibia and

fibula
the tibiofibular articulation should be demonstrated

Mortise Joint AP OBL Medial Rotation

• internally rotate the entire leg and foot 15- 20 deg
until the intermalleolar plane is parallel with IR
• plantar surface of foot should be at right angle to the leg

CR: perpen, entering ankle jt midway between malleoli

SS: shows entire ankle mortise jt. 3 sides of mortise jt should

be visualized
SS:
AP ANKLE: shows the overlap of the anterior tubercle and
superolateral talus over fhe fibula
AP OBLIQUE ANKLE - 15 to 20 deg medial rotation for
demo of ankle mortise. Parallel to IR.
AP OBL ANKLE -45 Deg med rotation. Shows tibiofibular jt
and entire distal fibula in profile. Wider space created between
the tibia and fibula.

AP PROJECTION STRESS METHOD

• inversion of eversion of foot to verify the presence of
ligamentous tear.

AP PROJECTION WEIGHT BEARING METHOD

“STANDING”
this projection is performed to identify ankle jt space narrowing
with weight bearing

LEG 2

AP PROJECTION
• adjust leg so femoral condyles are parallel with IR
• foot is vertical, flex ankle until foot is vertical

CR: perpen to center of leg

SS: Shows image of fibula, tibia and adjacent joints

LATERAL PROJECTION MEDIOLATERAL

• px’s toward unaffected side w/ leg on IR
• rotate body where patella can be perpen to IR

CR: perpen to midpoint leg

SS: Shows the tibia, fibula and adjacent jts.

 Lateral Projection Mediolateral
KNEE 6 • flex knee 20 to 30 deg
• patella is perpen to the IR
AP PROJECTION
• patient’s leg by placing femoral epicondyle CR: 1 inch distal to the medial epicondyle in an angle of 5 to 7
parallel with IR for true ap proj deg

CR: 1/2 inch inferior to patellar apex. SS: shows lateral image of distal end femur, patella, knee jt,
• thin pelvis - 3 to 5 degrees caudad proximal end of tibia and fibula, adjacent tissue
• Average size pelvis- 0 deg
• Large pelvis - 3 to 5 degrees cephalad

SS: shows image of an ap projection of the knee

structure

PA Projection Rosenberg Method Weight

Bearing
• flex knees to place femurs in an angle of 45 deg

CR: horizontal and perpen to the center of IR

SS: for evaluating joint space narrowing de

demonstrating articular cartilage disease

AP PROJECTION WEIGHT BEARING

METHOD
“For arthritic knees”

• patient in upright position, knees fully

extend AP OBL PROJECTION LAT ROT
• weight equally distributed on the feet
• rotate limbs 45 degrees
CR: horizontal, perpendicular to center of IR • elevate hip of unaffected side enough to rotate affected limb (if necessary)
entering a point 1/2 inch below the apices of
patellae CR: 1/2 inch inferior to patella apex
• thin pelvis - 3 to 5 degrees caudad
• Average size pelvis- 0 deg
SS: shows the joint spaces of the knees
• Large pelvis - 3 to 5 degrees cephalad

SS: shows AP obl proj of the lateral rotated femoral condyle, patella, tibial
condyles and head of fibula
• Fibula superimposed over the lateral half of the tibia.
INTERCONDYLAR FOSSA
“CAM BEC HOM”

1. PA AXIAL or TUNNEL PROJ (HOLMBLAD

METHOD)
2. Standing, Knee flexed and resting on stool, beside rad
table
2. Standing, side of rad table, affected side placed front
of IR
3. Kneeling on the rad table, affected knee over the IR

Pp: Ir against the anterior surface of px knee, IR in the

apex of patella
Knee 70 deg extension (20 deg difference from central
ray)

perpen to lower leg, midpoint of IR all 3 positions

Shows the intercondylar fossa in femurs and the

medial and lateral inercondylar tubercles of
intercondylar profiles

2. PA AXIAL PROJ (CAMP- COVENTRY METHOD)

Prone position, Knee 40 or 50 deg angle, foot on a
suitable support

• Perpen to long axis leg, centered to knee joint

• 40 deg if knee is 40 deg and 50 deg if knee of 50
deg angulation

Shows the intercondylar fossa

3. AP AXIAL PROJ (BECLERE METHOD)

supine, flex affected knee
long axis of femur in 60 deg to long axis of tibia

perpen to long axis of tibia, entering 1/2 inch below

the patella apex

Shows the resulting image of intercondylar fossa

PATELLA
FEMUR:

AP PROJECTION
• patient in supine position
• rotate px’s limb internally for the projection of distal
projection
• Bottom of IR 2 inches below the knee joint

For the projection of proximal femur

• Top of IR at the level of ASIS
• Rotate limb internally 10 to 15 degrees to see femoral
neck in profile

CR: perpen to midfemur and center of the IR

SS: shows AP proj of femur, knee joint and hip.

LATERAL PROJECTION
MEDIOLATERAL
• draw px’s uppermost limb forward, for distal femurs proj
• adjust pelvis in true lateral position
• Affected knee about 45 degrees
• IR approx. 2inch beyond the knee

For the projection of proximal femur

• top of IR at the level of ASIS
• draw upper limb posteriorly
• pelvis rolled posteriorly 10- 15 deg from lat position

Cr: perpen to midfemur and center of the IR

SS: shows the lat projection of femur