RADIOGRAPHIC POSITIONING (LABORATORY)

Lecturer: Errol John S. Gongora, RRT, RSO

ANATOMICAL POSITION SPECIAL PLANES
→ Standing upright/erect → INTERILIAC PLANE
→ Face and eyes directed forward ▪ Transects the pelvis
→ Arms extended by the sides at the top of the iliac
→ Palms turned forward crest
→ Heels together ▪ LEVEL: L4 spinous
→ Toes pointing anteriorly process
▪ USED IN
BODY PLANES AND SPECIAL PLANES POSITIONING OF:
FOUR (4) FUNDAMENTAL BODY PLANES • Lumbar
→ SAGITTAL Spine
▪ Right and Left • Sacrum
▪ MIDSAGITTAL: equal right and left • Coccyx
▪ PARASAGITTAL: unequal right and left → OCCLUSAL PLANE
→ CORONAL ▪ Formed by biting
▪ Anterior and Posterior surfaces of the upper
▪ MIDCORONAL/MIDAXILLARY PLANE: equal and lower teeth with
anterior and posterior jaws closed
→ HORIZONTAL ▪ USED IN POSITIONING
▪ Right angle to the long axis of the body OF:
▪ Cross – sectional/Transverse/Axial Plane • Odontoid
→ OBLIQUE Process
▪ At any angle among the three • Some head projections
SURFACE LANDMARKS

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
ANATOMIC RELATIONSHIP TERMS PROXIMAL vs. DISTAL
ANTERIOR vs. POSTERIOR → PROXIMAL
→ ANTERIOR/VENTRAL ▪ Parts nearest the
▪ Forward or front part of point of
the body or organ attachment/origin
→ POSTERIOR/DORSAL/NOTAL → DISTAL
▪ Back part of the body or ▪ Parts farthest from
organ the point of
attachment/origin
CAUDAD vs. CEPHALAD
→ CAUDAD
▪ Parts away from the head of the body EXTERNAL vs. INTERNAL
→ CEPHALAD → EXTERNAL
▪ Parts towards the head of the body ▪ Parts outside of an
organ/body
→ INTERNAL
▪ Parts inside of an
organ/body

SUPERIOR vs. INFERIIOR

→ SUPERIOR SUPERFICIAL vs. DEEP
▪ Nearer to the head or → SUPERFICIAL
situated above ▪ Parts near the skin or
→ INFERIIOR surface
▪ Nearer to the feet or → DEEP
situated below ▪ Parts far from the
surface
CENTRAL vs. PERIPHERAL
→ CENTRAL
▪ Midarea or main part
of the organ PARIETAL vs. VISCERAL
→ PERIPHERAL → PARIETAL
▪ Parts at or near the ▪ Wall or lining of a body
surface, edge, or cavity
outside of the body → VISCERAL
part ▪ Covering of an organ

MEDIAL vs. LATERAL

→ MEDIAL IPSILATERAL vs. CONTRALATERAL
▪ Parts towards the → IPSILATERAL
median plane or ▪ Parts on the same side of
toward the middle of the body
the body → CONTRALATERAL
→ LATERAL ▪ Parts on the opposite
▪ Parts away from the side of the body
median plane or away
from the middle part
of the body

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
PALMAR vs. DORSUM (HAND) → AXIAL PROJECTION
→ PALMAR/VOLAR ▪ There is a longitudinal
▪ Palm of the hand angulation of CR with the
→ DORSUM long axis of the body
▪ Back or posterior ▪ 10 degrees or more
surface of the hand → AP AXIAL PROJECTION

PLANTAR vs. DORSUM (FEET) → TANGENTIAL PROJECTION

→ PLANTAR ▪ CR is directed toward
▪ Sole of the foot the outer margin of a
→ DORSUM curved body surface
▪ Top or anterior ▪ CR skims the surface of
surface of the foot the body
RADIOGRAPHIC POSITIONING TERMINILOGY ▪ To project the part free
MOST COMMONLY USED POSITIONING TERMS: of superimposition
→ PROJECTION
→ POSITION → LATERAL PROJECTION
→ VIEW ▪ CR enters one side of
→ METHOD the body and exits the
opposite side
PROJECTION
→ Path of the central ray as it goes through the patient
to the IR (e.g. AP or PA projection)
→ The entrance and exit points in the body
→ LATEROMEDIAL PROJECTION
→ Based on the anatomical position

→ ANTEROPOSTERIOR (AP) PROJECTION

▪ A perpendicular CR
enters the front
(anterior) body surface
and exit the back
(posterior) body surface

→ POSTEROANTERIOR (PA) PROJECTION

▪ A perpendicular CR
enters the back
(posterior) body surface
and exit the front
(anterior) body surface
→ OBLIQUE PROJECTION
▪ CR enters the body from
a side angle following an
→ Relationship formed between the central ray and the
oblique plane (e.g. AP or
body (e.g. Axial and Tangential
PA Oblique Projections)
Projection)

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ AP OBLIQUE PROJECTION → FOWLERS POSITION
▪ CR enters the anterior ▪ Supine position with head higher than feet
surface and exits
posteriorly

→ PA OBLIQUE PROJECTION → SIMS POSITION

▪ CR enters the posterior ▪ A recumbent position with the patient lying on
surface and exits the left anterior side (semiprone) and the right
anteriorly knee and thigh partially flexed

POSITION
→ Identifies the overall posture or the general body
position
→ The specific placement of the body part in relation to
→ LITHOTOMY POSITION
the radiographic table/image receptor
▪ A supine position with knees and hip flexed and
→ e.g. Upright, Supine, or Seated
thighs abducted and rotated externally
→ UPRIGHT POSITION
▪ Erect or marked by a vertical
position
→ SEATED – UPRIGHT POSITION
▪ Sitting on a chair or stool
→ LATERAL POSITION
→ RECUMBENT POSITION
▪ Always named according to the side closest to
▪ General term referring to lying down in any
the IR
position

→ SUPINE POSITION
▪ Lying on the back
→ OBLIQUE POSITION
▪ Achieved when the
entire body is rotated
so that the coronal
→ PRONE POSITION
plane is not parallel
▪ Lying face down
with the radiographic
table or IR

→ TRENDELENBURG POSITION
▪ Supine position with head lower than feet

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ DECUBITUS POSITION HYPEREXTENSION vs. HYPERFLEXION
▪ Indicates that the patient is lying down → HYPEREXTENSION
▪ CR horizontal and parallel with the floor (e.g. ▪ Forced or excessive extension of a limb or joints
ventral, dorsal, or lateral decubitus) → HYPERFLEXION
▪ Used to demonstrate air – fluid levels or free – ▪ Forced overflexion of a limb or joints
air in the chest and abdomen

EVERSION vs. INVERSION

→ LORDOTIC POSITION → EVERT/EVERSION
▪ Achieved by having the ▪ Outward turning of the foot at
patient lean backward the ankle
while in upright position
so that shoulders are in → INVERT/INVERSION
contact with the IR ▪ Inward turning of the foot at the
▪ Used for visualization of ankle
pulmonary apices
SUPINATION vs. PRONATION
→ VIEW → SUPINATE/SUPINATION
▪ Used to describe the body part as seen by the IR ▪ Rotation of the forearm so that the palm is up
▪ Exact opposite of projection → PRONATE/PRONATION
→ METHOD ▪ Rotation of the forearm so that the palm is down
▪ Named after individuals in recognition of their
development of a method to demonstrate a
specific anatomic part (e.g. Water, Caldwell, or
Townes)
BODY MOVEMENT TERMINOLOGY
ABDUCTION vs. ADDUCTION
→ ABDUCT/ABDUCTION
▪ Movement of a part
away from the → ROTATE/ROTATION
central axis of the ▪ Turning or rotating of the
body body around its axis (e.g.
→ ADDUCT/ADDUCTION Medial Rotation or
▪ Movement of a part Lateral Rotation)
toward the central
axis of the body

EXTENSION vs. FLEXION

→ EXTENSION
▪ Straightening a joint → CIRCUMDUCTION
▪ The normal position of ▪ A turning away from the
a joint regular standard or
→ FLEXION course
▪ Act of bending a joint
▪ Opposite of extension

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
TILT vs. DEVIATION
→ TILT
▪ Tipping or slanting a
body part slightly
▪ Related to the long axis
of the body

→ DEVIATION
▪ A turning away
from the regular
standard or
course

PROTRACTION vs. RETRACTION

→ PROTRACTION
▪ A movement of part of
the body anteriorly in
a transverse plane
→ RETRACTION
▪ A movement of part of
the body posteriorly in
a transverse plane

ELEVATION vs. DEPRESSION

→ ELEVATION
▪ Upward movement of a
part of the body
→ DEPRESSION
▪ Downward movement
of a part of the body

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
UPPER EXTREMITIES ▪ Palmar aspect below the neck
ANATOMY → MC HEAD (KNUCKLES)
→ HAND
▪ Phalanges JOINTS OF THE HANDS AND WRIST
▪ Metacarpals → INTERPHALANGEAL (IP) JOINT
▪ Carpals ▪ For 1st digit only
→ FOREARM ▪ Between phalanges
▪ Radius ▪ Proximal IPJ and Distal IPJ (for 2 nd to 5th digits)
▪ Ulna → METACARPOPHALANGEAL (MCP) JOINT
→ ARM ▪ Between phalanges and metacarpals
▪ Humerus ▪ 1st to 5th MCP
→ PECTORAL/SHOULDER joints
GIRDLE → CARPOMETACARPAL
▪ Clavicle (CMC) JOINT
▪ Scapula ▪ Between
metacarpals and
HAND carpals
→ Consists of 27 bones ▪ 1st to 5th MCP
→ PHALANGES joints
▪ Bones of the
digits (fingers and WRIST (CARPAL) BONES
thumb) → Eight (8) carpal bones
→ METACARPALS → Short bones
▪ Bones of the → Divided into two (2) horizontal rows
palm ▪ Proximal
→ CARPALS ▪ Distal
▪ Bones of the → PROXIMAL ROWS
wrist ▪ Scaphoid
▪ Lunate
DIGITS ▪ Triquetrum
→ From LATERAL to MEDIAL ▪ Pisiform
→ FIRST DIGIT (THUMB) → DISTAL ROWS
▪ 2 phalanges (Proximal and Distal) ▪ Trapezium
→ SECOND DIGIT (INDEX FINGER) ▪ Trapezoid
▪ 3 phalanges (Proximal, Middle, and Distal) ▪ Capitate
→ THIRD DIGIT (MIDDLE FINGER) ▪ Hamate
▪ 3 phalanges (Proximal, Middle, and Distal)
→ From LATERAL to MEDIAL
→ FOURTH DIGIT (RING FINGER)
→ PROXIMAL ROW
▪ 3 phalanges (Proximal, Middle, and Distal)
(SLTP)
→ FIFTH DIGIT (SMALL FINGER)
▪ Some
▪ 3 phalanges (Proximal, Middle, and Distal)
▪ Lovers
▪ Try
METACARPALS
▪ Position
→ Form the bones of the palm
→ DISTAL ROW (TTCH)
→ They are long bones
▪ That
▪ Head, Body, and Base
▪ They
→ 1st to 5th MC (from lateral to medial side)
▪ Cannot
→ 1st MC
▪ Handle
▪ Contains two (2) sesamoids

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ TROCHLEAR/SEMILUNAR NOTCH: concave
depression
→ RADIAL NOTCH: depression on the lateral aspect of
coronoid process

DISTAL END
→ HEAD: rounded process on
the lateral side
→ ULNAR STYLOID PROCESS
▪ A conic projection
▪ Posteromedial side of
→ CARPAL SULCUS the head
▪ Concavity formed
from the anterior RADIUS
or palmar surface PROXIMAL END
of the wrist → HEAD: flat disk – like
→ FLEXOR → NECK: constricted area
RETINACULUM: below the radial head
▪ Attaches medially → RADIAL TUBEROSITY
to pisiform and ▪ Roughened process
hook of hamate ▪ Inferior to neck and
▪ Attaches laterally to on medial side of the
tubercles of scaphoid body
and trapezium
→ CARPAL CANAL (TUNNEL) DISTAL END
▪ The passageway → RADIAL STYLOID
created between the PROCESS: conic projection
carpal sulcus and on the lateral surface
flexor retinaculum → ULNAR NOTCH:
→ CARPAL TUNNEL depression on the medial aspect of distal ulna
SYNDROME ARM
▪ Median nerve → One (1) bone
compression inside ▪ Humerus
the carpal canal → A long bone
▪ Body and
FOREARM two (2)
→ Two (2) bones articular
▪ RADIUS: lateral side endsa
▪ ULNA: medial side → PROXIMAL
→ They are long bones HUMERUS:
▪ Body and two (2) articular articulate with the
ends shoulder girdle
→ DISTAL
ULNA HUMERUS:
→ BODY: long and slender presents
numerous processes and depressions
PROXIMAL END
→ OLECRANON AND CORONOID DISTAL END OF HUMERUS (HUMERAL CONDYLE)
PROCESS: two beak – like processes → TROCHLEA: smooth elevation on the medial side
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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ CAPITULUM: smooth elevation on the lateral side THREE (3) FAT PADS
→ PURPOSE: for articulation → SUPINATOR FAT PADS
→ LATERAL EPICONDYLE: above the capitulum ▪ Anterior to and
→ MEDIAL EPICONDYLE: above the trochlea parallel with the
→ CORONOID FOSSA anterior aspect of
▪ Receives the coronoid process of ulna proximal humerus
▪ Anterior and superior to trochlea → POSTERIOR FAT PADS
→ RADIAL FOSSA ▪ Cover largest area
▪ Receives the radial head (elbow flexed) ▪ Within olecranon
▪ Lateral to coronoid fossa and proximal to fossa of posterior
capitulum humerus
→ OLECRANON FOSSA → ANTERIOR FAT PADS
▪ Deep depression behind coronoid fossa ▪ Superimposed
▪ Receives olecranon process (elbow extended) coronoid and radial
fat pads
PROXIMAL END OF HUMERUS ▪ Within the
→ HEAD coronoid and radial fossae of anterior humerus
▪ Large, smooth, and rounded
▪ Lies in oblique plane on superomedial side → Significant
→ ANATOMICAL NECK radiographically when an
▪ Narrow, constricted area below the humeral elbow injury causes
head effusion and displaces
→ SURGICAL NECK the fat pads and alter
▪ Constriction of the body below the tubercles their shape
▪ Site of many fractures → NORMAL ELBOW
→ LESSER TUBERCLE ▪ Posterior fat pads are not visualized
▪ Located on the anterior surface TRAUMA AND FRACTURE TERMINOLOGY
▪ Below the anatomical neck → FRACTURE (FX)
→ GREATER TUBERCLE ▪ A break in a bone
▪ Located on the lateral surface → SIMPLE/CLOSED FRACTURE
▪ Below the anatomical neck ▪ Does not break through the skin
→ INTERTUBERCULAR GROOVE → COMPOUND/OPEN FRACTURE
▪ Deep depression ▪ Portion of the bone protrudes through the skin
▪ Separates greater and lesser tubercles → INCOMPLETE/PARTIAL FRACTURE
▪ Does not traverse through entire bone
UPPER LIMB ARTICULATIONS ▪ TORUS/BUCKLE FRACTURE: buckle in the cortex
with no complete break
▪ GREENSTICK FRACTURE/WILLOW
STICK/HICKORY STICK: fracture is on one side
only (commonly in children)
→ COMPLETE FRACTURE
▪ Break is complete, and bone is broken into two
pieces
▪ TRANSVERSE FRACTURE: near right angle to long
axis of the bone
▪ OBLIQUE FRACTURE: at an oblique angle to the
FAT PADS bone
→ Can be visualized only in lateral projection ▪ SPIRAL FRACTURE: bone is twisted apart and
spirals around the long axis of bone
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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ COMMINUTED FRACTURE
▪ Bone is splintered or crushed (two or more
fragments)
→ IMPACTED FRACTURE
▪ One fragment is firmly driven into the other
→ AVULSON FRACTURE
▪ A fragment of bone is separated or pulled away LATERAL PROJECTION
→ DISLOCATION/LUXATION → PP: Hand rest on
▪ Bone is displaced from a joint radial surface (for 2nd to
→ SUBLUXATION 3rd digits) and ulnar
▪ Partial dislocation surface (for 4th to 5th
→ ROLANDO FRACTURE digits)
▪ Comminuted fracture of 1st MCP base → RP: PIP joint
→ BENNETT’S FRACTURE → CR: Perpendicular
▪ Transverse fracture of 1st MCP base → SS: Lateral projection of affected digit
→ BOXER’S FRACTURE
▪ 4th to 5th metacarpal neck fracture
→ COLLES’ FRACTURE/DINNERFORK/BAYONET
▪ Fracture of distal radius with posterior/dorsal
displacement
→ SMITH FRACTURE/REVERSE COLLES’
▪ Fracture of distal radius with anterior/palmar
displacement
→ BARTON’S FRACTURE PA OBLIQUE PROJECTION
▪ Fracture of posterior lip of distal radius → PP: Hand pronated; lateral
→ BASEBALL/MALLET FRACTURE rotation (for 4th and 5th); medial
▪ Fracture of distal phalanx rotation (2nd and 3rd)
→ HUTCHINSON’S/CHAEFFEUR’S FRACTURE → RP: PIP joint
▪ Intraarticular fracture of the radial styloid → CR: Perpendicular
process → SS: PA oblique projection of
→ MONTEGGIA’S FRACTURE affected digit
▪ Fracture of proximal half of the ulna with radial
head dislocation
→ NURSEMAID’S/JERKED ELBOW
▪ Partial dislocation of the radial head of a child
DIGITS (2ND TO 5TH)
PA PROJECTION
→ PP: Palmar surface down;
separate the digits slightly
→ RP: PIP joint
→ CR: Perpendicular
→ SS: PA projection of
affected digit

AP PROJECTION
→ For suspected joint injury

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
THUMB (1ST DIGIT) ▪ RAFERT – LONG MODIFICATION: 15° proximally
AP PROJECTION ▪ LEWIS MODIFICATION: 10° to 15° proximally
→ PP: Hand in extreme → EXAM RATIONALE: used to demonstrate
internal rotation ▪ Arthritic changes
→ RP: 1st MCP joint ▪ Fractures
→ CR: Perpendicular ▪ 1st CMC joint
→ SS: AP projection of thumb displacement
▪ Bennett’s fracture
PA PROJECTION → ANGULATION RATIONALE
→ PP: Hand in lateral position; ▪ To project soft tissue
dorsal surface of thumb // to IR of the hand away
→ RP: 1st MCP joint from 1st CMC joint
→ CR: Perpendicular ▪ Help open joint space
→ SS: Magnified PA projection
of thumb

LATERAL PROJECTION
→ PP: Hand in its natural
arched position; palmar
surface down
→ RP: 1st MCP joint
→ CR: Perpendicular
→ SS: Lateral projection of
thumb BURMAN METHOD (AP PROJECTION)
→ PP: Hand hyperextended;
PA OBLIQUE PROJECTION opposite hand holds the
→ PP: Hand in slight ulnar hyperextended hand or bandage
deviation; thumb abducted loop around digits; hand rotated
→ RP: 1st MCP joint internally; thumb abducted
→ CR: Perpendicular → RP: 1st CMC joint
→ SS: PA oblique projection of → CR: 45° toward the elbow
thumb → SS: Magnified concavoconvex
FIRST CARPOMETACARPAL JOINT outline of 1st CMC joint
ROBERT METHOD (AP PROJECTION) → ER: To provide a clearer
→ PP image of 1st CMC than standard
▪ Shoulder, elbow, and AP
wrist on same plane
▪ Prevent carpal bones
elevation and closing 1st FOLIO METHOD/SKIERS THUMB (PA PROJECTION)
CMC joint → BB Hands rested on medial
▪ Arm internally rotated; aspect; distal portion of both
hand hyperextended; thumbs wrap around by a rubber
dorsal aspect of thumb band; thumb in PA plane
against IR → RP: Between level of MCP joints
→ RP: 1st CMC joint of both hands
→ CR: → CR: Perpendicular
▪ ROBERT METHOD: → SS: 1st CMC joint; bilateral
Perpendicular MCP joints and MCP angles

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ ER: Useful for diagnosis of ulnar collateral ligament ▪ Opens joint spaces
(UCL) rupture ▪ Reduces the degree of foreshortening of
phalanges

LATERAL PROJECTION (LATEROMEDIAL IN EXTENSION)

→ PP: Hand in lateral
position; digits extended;
ulnar aspect down
HAND (lateromedial projection);
PA PROJECTION radial aspect down
→ PP: Hand palmar surface down; (mediolateral projection;
spread finger slightly more difficult to assume);
→ RP: 3rd MCP joint thumb 90° to palm
→ CR: Perpendicular → RP: 2nd MCP joint
→ SS: PA oblique projection of the → CR: Perpendicular
thumb → SS: Lateral projection of
the hand in extension
AP PROJECTION → ER: To localize foreign bodies and
→ Hand cannot be extended because metacarpal fracture displacement
of injury and pathologic conditions FAN LATERAL POSITION
→ For metacarpal bones and MCP → Eliminates superimposition of all
joints phalanges (except proximal
phalanges)
PA OBLIQUE PROJECTION (LATERAL ROTATION)
→ PP: Hand pronated
and rotated laterally;
palmar surface down;
MCP joints 45° to IR;
45° foam wedge
→ RP: 3rd MCP joint
→ CR: Perpendicular
→ SS: PA oblique
projection of the hand LATERAL PROJECTION (LATEROMEDIAL IN FLEXION)
→ ER: To investigate → PP: Hand in natural arch
fractures and position; digits relaxed
pathologic conditions → RP: 2nd MCP joint
→ REVERSE PA → CR: Perpendicular
OBLIQUE: For severe → SS: Lateral projection of the
metacarpal hand in flexion
deformities → ER: To demonstrate anterior
→ FOAM WEDGE: For or posterior displacement in
interphalangeal joints fractures of
→ FINGERTIPS TOUCHING THE metacarpals
CASSETTE: For metacarpal
bones
→ INDEX FINGER ELEVATION:
▪ Cannot tolerate the
mentioned above
▪ Use of radiolucent material

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
NORGAARD METHOD (AP OBLIQUE PROJECTION) – → CR: Perpendicular
BALL CATCHERS POSITION → SS: Proximal metacarpals and distal radius and ulna;
→ PP: Hand supinated and trapezium and scaphoid (more anterior)
medially rotated; medial → ER: To demonstrate anterior or posterior
aspect against IR; 45° sponge displacement in fractures
support WRIST IN PALMAR FLEXION
→ RP: Between level of 5th BURMAN METHOD
MCP joints of both hands → Wrist in palmar flexion (for
→ CR: Perpendicular lateral scaphoid)
→ SS: AP oblique projection of FOILLE
both hands → First to describe carpe
→ ER: To diagnose rheumatoid bossu (carpal boss; 3rd CMC
arthritis joint)
→ Best demonstrated in a
WRIST lateral position of wrist in
PA PROJECTION palmar flexion
→ PP: Hand slightly
arch (places wrist in PA OBLIQUE PROJECTION (LATERAL ROTATION)
close contact with IR) → PP: Palmar surface against
→ RP: Midcarpal IR; hand pronated and rotated
area 45° laterally; wrist ulnar
→ CR: Perpendicular deviation (for scaphoid only)
→ SS: Open → RP: Midcarpal area
radioulnar joint → CR: Perpendicular
space; slightly oblique rotation of ulna → SS: Carpals on the lateral
(AP should be taken if ulna is under examination) side (Scaphoid and
Trapezium)
AP PROJECTION
→ PP: Hand
supinated; digits
elevated (places
wrist in close
contact with IR)
→ RP: Midcarpal
area
→ CR: Perpendicular AP OBLIQUE PROJECTION (MEDIAL ROTATION)
→ SS: Carpal interspaces better demonstrated; no → PP: Dorsal surface against IR;
rotation of ulna hand supinated and rotated 45°
medially
LATERAL PROJECTION (LATEROMEDIAL PROJECTION) → RP: Midcarpal area
→ PP: Elbow → CR: Perpendicular
flexed 90°; hand → SS: Carpals on the medial side
and forearm in (Pisiform, Triquetrum, and
lateral position; Hamate)
ulnar surface
against IR; radial
surface against IR
(for comparison)
→ RP: Midcarpal area

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
PA PROJECTION (IN ULNAR DEVIATION) ▪ To place scaphoid at
→ PP: Hand pronated; wrist in right angles to the CR
extreme ulnar deviation ▪ To project scaphoid
→ RP: Scaphoid without self –
→ CR: Perpendicular; 10° to 15° superimposition
proximally/distally (clear → BRIDGMAN METHOD:
delineation) Stecher Method with ulnar
→ SS: Scaphoid; opens carpal deviation
interspaces on lateral side
→ ER: To correct scaphoid RAFERT – LONG METHOD (PA AND PA AXIAL
foreshortening PROJECTION) SCAPHOID SERIES IN ULNAR DEVIATION
→ PP: Hand pronated; wrist in
extreme ulnar deviation
→ RP: Scaphoid
→ CR: Perpendicular; 10°, 20°,
and 30° cephalad
→ SS: Scaphoid with minimal
superimposition
→ ER: To diagnose scaphoid
fractures
PA PROJECTION (IN RADIAL DEVIATION)
→ PP: Hand pronated; wrist in
extreme radial deviation
→ RP: Midcarpal area
→ CR: Perpendicular
→ SS: Opens carpal interspaces on
medial side

CLEMENTS – NAKAYAMA METHOD (PA AXIAL OBLIQUE

PROJECTION)
→ PP: Palmar
surface against 45°
sponge; hand in
STECHER METHOD (PA AXIAL PROJECTION) ulnar deviation
→ VARIATIONS: → RP: Anatomical
▪ IR elevated 20° snuffbox
▪ CR 20° toward elbow → CR: 45° distally
▪ CR 20° toward digits ▪ Rotate elbow end
▪ Fracture line that of IR and arm 20°
angles superoinferiorly away from CR (if
▪ Close the fist unable to achieve
→ RP: Scaphoid ulnar deviation)
→ CR: Perpendicular → SS: Trapezium
→ SS: Scaphoid → ER: To demonstrate
→ ER (20° ANGULATION): trapezium fractures

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RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
LENTINO METHOD (TANGENTIAL PROJECTION) SUPEROINFERIOR PROJECTION
→ PP: Hand palm upward; → PP: Dorsiflex the wrist; lean
hand 90° to forearm forward (to place carpal canal
→ RP: 1.5 inches (3.8 cm) tangent to IR)
proximal to wrist joint → RP: Midpoint of the wrist
→ CR: 45° caudad → CR: Perpendicular
→ SS: Carpal bridge → SS: Carpal canal/tunnel
→ ER: Used to demonstrate → ER: Taken when patient
▪ Fractures of scaphoid cannot assume/maintain
▪ Lunate dislocation Gaynor – Hart Method
▪ Dorsum of wrist
calcifications
▪ Foreign bodies
▪ Chip fractures (dorsal
aspect of carpal FOREARM
bones) AP PROJECTION
→ MODIFIED METHOD: If the → PP: Hand supinated;
wrist is too painful patient lean laterally;
humeral epicondyles // to
IR
→ RP: Midshaft
→ CR: Perpendicular
→ SS: Elbow joints; radius and ulna; distorted carpal
bones (proximal row)
▪ Slight superimposition of radial head, neck, and
tuberosity over the proximal ulna
→ HAND PRONATION
▪ It crosses the radius
GAYNOR – HART METHOD (TANGENTIAL PROJECTION) over the ulna at its
→ PP: Wrist hyperextended; proximal third
hand rotated slight toward the ▪ It rotates the
radial side (to prevent humerus medially
superimposition of hamate and
pisiform shadows); digits grasp LATERAL PROJECTION
with opposite hand → PP: Elbow flexed
→ RP: 1 inch distal to 3 rd MCP 90°; forearm and
base hand in true lateral;
→ CR: 25° to 30° to long axis thumb must be up;
of hand humeral epicondyle
→ SS: Carpal canal/tunnel perpendicular to IR
(Carpal sulcus + Flexor → RP: Midshaft
retinaculum) → CR: Perpendicular
→ ER: Used to demonstrate → SS: Elbow joints; radius and ulna; carpal bones
▪ Carpal tunnel (proximal row)
syndrome ▪ Superimposed radius and ulna at their distal end
▪ Fractures of hook of ▪ Superimposed radial head over the coronoid
hamate, pisiform, and process
trapezium ▪ Superimposed humeral epicondyles
▪ Radial tuberosity facing anteriorly

cscc | 15
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
ELBOW AP OBLIQUE PROJECTION (LATERAL ROTATION)
AP PROJECTION → PP: Hand laterally rotated 45°; 1st and 2nd digits
→ PP: Elbow extended; hand touching the table;
supinated; patient lean laterally; posterior surface of
humeral epicondyles and elbow 45° to IR
anterior surface of elbow // to IR → RP: Elbow joint
→ RP: Elbow joint → CR: Perpendicular
→ CR: Perpendicular → SS: Radial head
→ SS: Elbow joints; distal arm and neck in profile;
and proximal forearm capitulum and lateral epicondyle
▪ Radial head, neck, and
tuberosity slightly TWO AP PROJECTIONS
superimposed over AP PROJECTIONS (IN PARTIAL FLEXION) – DISTAL
the proximal ulna HUMERUS
→ PP: Hand supinated;
LATERAL PROJECTION (LATEROMEDIAL) elbow partially flexed
→ PP: Elbow flexed 90°; elbow → RP: Elbow joint
flexed 30° to 35° (for suspected → CR: Perpendicular to
elbow injury); hand in lateral humerus
position; humeral epicondyles → SS: Distal humerus when
perpendicular to IR elbow cannot be fully
→ RP: Elbow joint extended
→ CR: Perpendicular
→ SS: Elbow joints; distal arm and AP PROJECTIONS (IN PARTIAL FLEXION) – PROXIMAL
proximal forearm FOREARM
▪ Superimposed humeral → PP: Hand supinated;
epicondyles dorsal surface of forearm
▪ Radial tuberosity facing against IR; elbow partially
anteriorly flexed
▪ Radial head partially → RP: Elbow joint
superimposing coronoid → CR: Perpendicular to
process forearm
▪ Olecranon process in → SS: Proximal forearm
profile when the elbow cannot be fully extended
→ GRISWOLD
→ Two (2) reasons for flexing elbow 90° 2 AP PROJECTIONS
▪ Olecranon process seen in profile → For patients cannot completely extend the elbow
▪ Elbow fat pads are least compressed

AP OBLIQUE PROJECTION (MEDIAL ROTATION)

→ PP: Hand pronated
or medially rotated
45°; anterior surface
of elbow 45° to IR
→ RP: Elbow joint
→ CR: Perpendicular
→ SS: Coronoid process in profile; trochlea and medial
epicondyle

cscc | 16
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
JONES METHOD (AP PROJECTION) ▪ Radial tuberosity facing anteriorly (1st and 2nd
→ When fractures around the elbow are being treated exposures)
using the Jones orthopedic technique (complete flexion), ▪ Radial tuberosity facing posterior (3rd and 4th
the lateral position offers little difficulty, but the frontal exposures)
projection must be made through the superimposed
bones of the AP arm and PA forearm

JONES METHOD (AP PROJECTION) – ACUTE FLEXION

DISTAL HUMERUS
→ PP: Elbow fully (acutely) flexed
→ RP: 2 inches superior to
olecranon process
→ CR: Perpendicular to humerus
→ SS: Olecranon process

COYLE METHOD (AXIOLATERAL PROJECTION)

→ PP:
JONES METHOD (ACUTE FLEXION) – PROXIMAL ▪ SEATED: Hand
FOREARM pronated
→ PP: Elbow fully (acutely) flexed ▪ SUPINE (TRAUMA):
→ RP: 2 inches distal to olecranon distal humerus
process elevated; IR vertical;
→ CR: Perpendicular to flexed humeral epicondyles
forearm perpendicular to IR;
→ SS: Elbow joint more open palmar aspect of hand
facing anteriorly;
elbow flexed 90°
(radial head) or 80°
(coronoid process)
→ RP: Midelbow joint
→ CR:
RADIAL HEAD SERIES (LATERAL PROJECTION) – FOUR ▪ SEATED: 45° toward
POSITION SERIES the shoulder and 90°
→ PP: Elbow flexed 90°; flexion (radial head); 45°
elbow joint in lateral away from the shoulder and
position; four exposures: 80° flexion (coronoid
▪ Hand supinated process)
▪ Hand in lateral ▪ SUPINE: Horizontal; 45°
▪ Hand pronated cephalad (radial head); 45°
▪ Hand internally caudad (coronoid process)
rotated → SS: Open elbow joint between
→ RP: Elbow joint radial head and capitulum or
→ CR: Perpendicular coronoid process and trochlea
→ SS: Radial head in varying → ER: Used to demonstrate
degrees of rotation

cscc | 17
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ Pathologic processes or trauma in the area of HUMERUS
radial head and coronoid process AP PROJECTION
▪ Cannot fully extend elbow for medial and lateral → PP: Erect/seated – upright (more
oblique comfortable); arm
abducted slightly;
PA AXIAL PROJECTION hand supinated;
→ PP: Seated; arm rested humeral epicondyles
vertically against IR; forearm // to // to IR
IR; humerus 75° from forearm or → RP: Midshaft
15° from CR; hand supinated → CR: Perpendicular
→ RP: Ulnar sulcus → SS: Humeral head and greater
→ CR: Perpendicular tubercle in profile
→ SS: Epicondyles; trochlea; ulnar
sulcus (groove between medial LATERAL PROJECTION (LATEROMEDIAL UPRIGHT)
epicondyle and trochlea); → PP: Erect/seated
olecranon fossa – upright (more
→ ER: comfortable); arm
▪ Used in radiohumeral rotated internally;
bursitis (tennis elbow) elbow flexed
▪ To detect otherwise approximately 90°;
obscured calcification palmar aspect of hand against hip;
located in the ulnar sulcus humeral epicondyles perpendicular
to IR
→ PP: Seated; arm 45° to 50° → RP: Midshaft
from vertical; hand supinated → CR: Perpendicular
→ RP: Olecranon process → SS: Lesser tubercle in profile; greater tubercle
→ CR: Perpendicular or 20° superimposed over humeral head
toward the wrist → MEDIOLATERAL UPRIGHT: For patients with broken
humerus
→ PP: Seated; arm 45° to
50° from vertical; hand AP PROJECTION (RECUMBENT)
supinated → PP: Supine; unaffected
→ RP: Olecranon process shoulder elevated; hand
→ CR: Perpendicular or 20° supinated; humeral
toward the wrist epicondyles // to IR
→ SS: Dorsum of olecranon → RP: Midshaft
process (perpendicular); → CR: Perpendicular
curved extremity and → SS: Humeral head and
articular margin of greater tubercle in profile
olecranon process (20°)
LATERAL PROJECTION (LATEROMEDIAL)
→ PP:
▪ SUPINE: arm
abducted slightly;
forearm rotated
medially; dorsal
aspect of hand
against patient’s
side; humeral

cscc | 18
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
epicondyles
perpendicular 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: Perpendicular
→ SS: Distal humerus
→ ER (LATERAL RECUMBENT): For patient with known or
suspected fracture

cscc | 19
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
SHOULDER GIRDLE
ANATOMY

→ HUMERUS
▪ PROXIMAL
HUMERUS
→ Head
→ Greater tubercle
(tuberosity)
→ Intertubular groove → SCAPULA (ANTERIOR VIEW)
(bicipital groove)
→ Surgical neck
→ Anatomic neck
→ Lesser tubercle
(tuberosity)
→ Deltoid tuberosity
→ Body (shaft)
→ CLAVICLE

→ SCAPULA (POSTERIOR VIEW)

→ SCAPULA
▪ THREE BORDERS
→ Superior
→ Medial (vertebral)
→ Lateral (axillary)

→ SCAPULA (LATERAL VIEW)

▪ LATERAL
(SCAPULAR Y)
→ Acromion
→ Coracoid
Process
→ Inferior Angle

cscc | 20
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ Scapular Spine → MOVEMENT TYPES OF SHOULDER GIRDLE JOINT
→ Body of Scapula JOINT MOVEMENT TYPE
→ Scapulohumeral Spheroidal or ball and
socket (greater freedom
of movement)
→ Sternoclavicular Plane or gliding
→ AP SCAPULA ANATOMY → Acromioclavicular Plane or gliding

→ LATERAL SCAPULA – CR PERPENDICULAR

→ INFEROSUPERIOR AXIAL SHOULDER

→ JOINTS OF SHOULDER GIRDLE

→ JOINTS OF SHOULDER GIRDLE – SYNOVIAL &

DIARTHRODIAL
ACROMIOCLAVICULAR (AC)

SCAPULOHUMERAL STERNOCLAVICULAR (SC) cscc | 21

RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
PATHOLOGY → RP: 1 inch inferior to coracoid
→ HILL – SACHS DEFECT process
▪ Compression fracture of the articular surface of → CR: Perpendicular
the posterolateral aspect of the humeral head → SS: Shoulder and proximal
→ BANKART LESION humerus
▪ Avulsion fracture of anteroinferior aspect of ▪ Greater tubercle
glenoid rim ▪ Site of insertion of
→ IMPINGEMENT SYNDROME supraspinatus tendon
▪ Impingement of the greater tuberosity and soft ▪ AP proximal humerus
tissues on the coracoacromial ligamentous and
osseous arch AP PROJECTION (INTERNAL ROTATION)
→ AC SEPARATION → PP: Upright (more comfortable)
▪ Partial or complete tear of the AC and or supine; patient slightly rotated;
coracoclavicular ligaments scapula // to IR
→ IDIOPATHIC CHRONIC ADHESIVE CAPSULITIS ▪ INTERNAL ROTATION:
▪ Frozen shoulder dorsal/posterior aspect of
▪ Disability of the shoulder joints caused by hand against hip; humeral
chronic inflammation of the joint epicondyles perpendicular
→ SHOULDER DISLOCATION to IR
▪ Traumatic removal of humeral head from the → RP: 1 inch inferior to coracoid
glenoid cavity process
SHOULDER → CR: Perpendicular
AP PROJECTION (NEUTRAL ROTATION) → SS: Shoulder and proximal
→ PP: Upright (more comfortable) or humerus
supine; patient slightly rotated; ▪ Lesser tubercle
scapula // to IR ▪ Site of the insertion of the
▪ NEUTRAL ROTATION: subscapular tendon
palmar/anterior aspect of ▪ Proximal humerus in true lateral position
hand placed against the hip;
humeral epicondyles 45° to IR AP PROJECTION (NEUTRAL, EXTERNAL, AND INTERNAL
→ RP: 1 inch inferior to coracoid ROTATION)
process → RP: 1 inch inferior to coracoid
→ CR: Perpendicular process
→ SS: Shoulder and proximal humerus → CR: Perpendicular
▪ Greater tubercle partially → SS: Shoulder and proximal
superimposing humeral head humerus
▪ Posterior part of
supraspinatus insertion LAWRENCE METHOD (TRANSTHORACIC LATERAL
▪ Oblique proximal humerus PROJECTION) – R OR L LATERAL
→ PP: Upright (more comfortable) or supine; patient in
AP PROJECTION (EXTERNAL ROTATION) lateral position; uninjured arm
→ PP: Upright (more comfortable) or raised; forearm rested on
supine; patient slightly rotated; head; midcoronal plane
scapula // to IR perpendicular to IR; full
▪ EXTERNAL ROTATION: hand inspiration (improves contrast
supinated; humeral and reduces exposure) or
epicondyles // to IR; arm breathing technique (slow,
abducted slightly deep breathing)
→ RP: Level of surgical neck

cscc | 22
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ CR: Horizontal or 10° to 15° placed against the neck; head turn away from side of
cephalad (cannot elevate interest
unaffected shoulder) → RP: Axilla
→ SS: Proximal humerus → CR: Horizontal; 15°
(projected through thorax) medially (passing AC
→ ER: Used when joint)
▪ Trauma exists and the → SS: Coracoid process
arm cannot be rotated pointing anteriorly;
or abducted lesser tubercle in profile
because of an injury → ER: Hill – Sachs
▪ Demonstrate compression fracture (defect)
proximal humerus
in 90° from AP WEST POINT METHOD (INFEROSUPERIOR AXIAL
projection PROJECTION)
▪ Show its → PP: Prone; shoulder
relationship to the scapula and clavicle elevated (3 inches); head
turn away from side of
LAWRENCE METHOD (INFEROSUPERIOR AXIAL interest; arm abducted
PROJECTION) 90°; forearm rested over
→ PP: Supine; head, shoulder, the edge of table; IR
and elbow elevated (3 placed vertically
inches); arm abducted 90°; → RP: Axilla
humerus rotated externally; → RP: 5 inches (13 cm)
IR placed against the neck; inferior and 1.5 inches
head turn away from side of (3.8 cm) medial to
interest acromial edge
→ RP: Axilla → CR: 25° anteriorly and
→ CR: Horizontal; 15° to 25° medially
30° medially (greater → SS: Humeral head
abduction, greater angle) projected free of the
→ SS: coracoid process
▪ Proximal humerus → ER:
▪ Scapulahumeral ▪ Used when
joint chronic instability
▪ Lateral portion of of shoulder is suspected
coracoids process ▪ To demonstrate Bankart’s Lesion and associated
▪ Acromioclavicular (AC) articulation Hills – Sachs defect
▪ Insertion site of subscapular tendon
▪ Point of insertion of teres minor tendon CLEMENTS MODIFICATION (INFEROSUPERIOR AXIAL
PROJECTION)
RAFERT – LONG METHOD (INFEROSUPERIOR AXIAL → PP: Lateral recumbent;
PROJECTION) unaffected side against IR;
→ PP: Supine; head, shoulder, affected arm abducted 90°; IR
and elbow elevated (3 inches); against superior aspect of
arm abducted 90°; shoulder
exaggerated external rotation → RP: Midaxillary region
of the arm; hand 45° to IR; → CR: Horizontal or 5° to 15°
thumb pointing downward; IR medially (patient cannot
abduct arm 90°)

cscc | 23
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ SS: Acromioclavicular joint; scapulohumeral joint; SCAPULAR Y (PA OBLIQUE PROJECTION)
glenohumeral joint → PP: Upright/recumbent; RAO/LAO; MCP 45° to 60° to
→ ER: When prone IR; scapular
(Westpoint) or supine flat surface
(Lawrence and Rafert – Long) perpendicular
position is not possible to IR;
→ This modification requires RPO/LPO (for
less arm abduction and less severely
manipulation of x – ray tube injured
patient)
SUPEROINFERIOR AXIAL PROJECTION → RP: Scapulohumeral joint
→ PP: Seated; patient lean → CP: Perpendicular
laterally; elbow flexed 90° → SS: Scapular body (form
and rested on table; hand the vertical component);
pronated; humeral acromion and coracoid
epicondyles perpendicular processes (form the upper
to table limbs)
→ RP: Shoulder joint ▪ Superimposed
→ CR: 5° to 15° toward the humeral head and
elbow (cannot extend glenoid cavity
shoulder = greater angle) ▪ Superimposed humeral shaft and scapular body
→ SS: Relationship of the ▪ Coracoid process superimposed or projected
proximal end of the humerus below the clavicle
to the glenoid cavity → ER: Useful in evaluation of suspected shoulder
▪ Acromioclavicular dislocations
(AC) articulation ▪ ANTERIOR/SUBCORACOID DISLOCATION:
▪ Outer portion of the humeral head beneath the coracoid process
coracoid process ▪ POSTERIOR/SUBACROMIAL DISLOCATION:
▪ Points of insertion of humeral head beneath the acromion process
the subscapularis muscle and teres minor muscle
▪ Coracoids process above clavicle STRYKER NOTCH (AP AXIAL PROJECTION)
▪ Lesser tubercle in profile → PP: Supine; arm flexed
slightly beyond 90°; palm of
AP AXIAL PROJECTION hand on top of head with
→ PP: Upright/supine; fingertips resting on head
scapulohumeral joint (places humerus in a slight
centered to IR internal rotation); body of
→ RP: Scapulohumeral joint humerus // to MSP of body
→ CR: 35° cephalad → RP: Coracoid process
→ SS: Relationship of the → CR: 10° cephalad
head of humerus to the → SS: Posterosuperior and
glenoid cavity posterolateral areas of
▪ Scapula humeral joint humeral head
▪ Proximal humerus → ER: Useful for
▪ Clavicle projected demonstration of
above the superior Hill–Sachs defect
angle of scapula
→ ER: Useful in diagnosing
cases of posterior dislocation

cscc | 24
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
GLENOID CAVITY → CR: 45° caudad
GRASHEY METHOD (AP OBLIQUE PROJECTION) → SS: Glenoid cavity
→ PP: Upright (more (scapulohumeral joint)
comfortable) or supine; ▪ Humeral head
RPO/LPO; body rotated 35° to ▪ Coracoid process
45° (upright) or more than 45° ▪ Scapular head and
(supine) toward the affected neck
side; scapula // to IR; arm → ER:
slightly abducted; palm of ▪ For acute
hand on abdomen shoulder trauma
→ RP: 2 inches (5 cm) medial ▪ For identifying posterior
and 2 inches (5 cm) inferior to scapulohumeral
superolateral border of dislocations
shoulder ▪ Glenoid fractures
→ CR: Perpendicular ▪ Hill – Sachs
→ SS: Glenoid cavity lesions/defect
(scapulohumeral joint) ▪ Soft tissue calcification
▪ Open joint space ▪ POSTERIOR
between humeral head DISLOCATION:
and SHJ humeral head
projected
APPLE METHOD (AP OBLIQUE PROJECTION) superiorly from
→ PP: Upright; RPO/LPO; glenoid cavity
body rotated 35° to 45° ▪ ANTERIOR
toward the affected side; DISLOCATION:
scapula // to IR; patient humeral head
hold 1 lb. weight; arm projected inferiorly
abducted 90° from glenoid cavity
→ RP: Level of coracoid
SUPRASPINATUS OUTLET/CORACOACROMIAL ARCH
process
NEER METHOD (TANGENTIAL PROJECTION)
→ CR: Perpendicular
→ PP: Seated/upright;
→ SS: Glenoid cavity
RAO/LAO; unaffected side
(scapulohumeral joint)
rotated 45° to 60° away from IR;
→ ER: To
arm at side
demonstrate a
→ RP: Superior aspect of
loss of articular
humeral heads
cartilage in the
→ CR: 10° to 15° caudad
scapulohumeral
→ SS: Posterior surface of
joint
acromion and Acromioclavicular
→ Similar to
(AC) joint
Grashey method
→ ER:
but uses
▪ Useful to demonstrate
weighted abduction
tangentially the
coracoacromial
GARTH METHOD (AP AXIAL OBLIQUE PROJECTION)
arch/outlet (superior
→ PP: Supine/seated/upright; RPO/LPO; body rotated
border)
45° toward the affected side; elbow flexed; arm placed
▪ To diagnose shoulder
across the chest
impingement
→ RP: Scapulohumeral joint

cscc | 25
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
TERES MINOR, INFRASPINATUS, SUBSCAPULARIS
INSERTION

INTERTUBERCULAR GROOVE
FISK MODIFICATION (TANGENTIAL PROJECTION)
→ PP:
▪ SUPINE: chin
extended; head
rotated away
from affected
BLACKETT – HEALY METHOD (PA PROJECTION)
side; hand
→ PP:
supinated; IR
▪ PRONE: arms
against superior
along sides; head
surface of
rested on
shoulder
chin/cheek of
▪ UPRIGHT
affected side;
(ORIGINAL;
arm in extreme
GREATER OID):
internal
elbow flexed;
rotation;
posterior surface
elbow flexed;
of forearm
hand at the
against table;
back; IR
patient grasps
center 1 inch
the IR; sandbag
inferior to
under hand; IR
coracoid process
horizontal;
→ RP: Head of humerus
patient lean
→ CR: Perpendicular
forward;
→ SS: Tangential image of
humerus 10° to
the insertion of teres
15° from vertical
minor
→ RP: Intertubercular
▪ This position
groove
rotates the
→ CR: Perpendicular
humeral head so
(upright) or 10° to 15°
that the greater
posteriorly (downward
tubercle is
from horizontal) to long
brought
axis of humerus (supine)
anteriorly
→ SS: Intertubercular groove
cscc | 26
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
BLACKETT – HEALY METHOD (AP PROJECTION) → RP: Between
→ PP: level of AC joints;
▪ SUPINE: arms directed at each
along sides; ACJ (broad –
unaffected shouldered
shoulder patients)
elevated 15° → CR:
with sandbag; Perpendicular
abduct the → SS: Bilateral AC joints
affected arm; → ER: Used to
elbow flexed; demonstrate dislocation,
hand pronated separation, and function
(arm rotated of the ACJ
internally) → Avoid having the
→ RP: Shoulder joints patient hold weight in
→ CR: Perpendicular each hand
→ SS: Image of the → RATIONALE:
subscapularis insertion at ▪ Make sure the shoulder contract
the lesser tubercle ▪ Reduce the possibility of demonstrating small AC
separation
AP AXIAL PROJECTION
→ PP: ALEXANDER METHOD (AP AXIAL PROJECTION)
▪ SUPINE: affected arm at the side; arm in external → PP: Upright/seated –
rotation (to open upright; coracoid process
the subacromial centered to IR
space); arm → RP: Coracoid process
rotated in neutral → CR: 15° cephalad (AC joints
position and in above acromion)
complete internal → SS: AC joints above acromion
rotation (allow full → ER: For demonstration of suspected AC subluxation or
evaluation of dislocation
humeral head)
→ RP: Coracoid process
→ CR: 25° caudad
→ SS: Profile the greater
tubercle, site of infraspinatus tendon and opens
subacromial space
ACROMIOCLAVICULAR JOINTS
PEARSON METHOD (BILATERAL AP PROJECTION)
→ PP: Upright/seated –
ALEXANDER METHOD (PA AXIAL OBLIQUE PROJECTION)
upright (ACJ reduces itself
→ PP: Upright; RAO/LAO
in recumbent)
▪ MCP 45° to 60°
▪ Arms hanging at
from IR; scapula
sides
perpendicular to IR
(unsupported)
▪ Hand of affected
▪ 2 exposures: with
side under
and without
opposite axilla
weight (5 – 10 lbs.)
▪ Affix the weights to patient wrists
cscc | 27
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ Lean affected shoulder against IR ▪ Suspend at the
▪ Arm pulled firmly across the chest end of full
→ Draws scapula inspiration (to
laterally and further elevate
forward and and angle the
places joint close clavicle)
to IR → RP: Midshaft of clavicle
→ Scapula and → CR: 0° to 15° cephalad
ACJ in lateral (upright); 15° to 30°
position cephalad (supine)
→ RP: AC joints ▪ Thinner patients
→ CR: 15° caudad (more angulation)
→ SS: AC joint ▪ To project clavicle
▪ Relationship of the bones of the shoulder off the scapula
and ribs
CLAVICLE
→ SS: True/Axial projection of clavicle
AP PROJECTION
▪ Clavicle projected above the ribs; true/exact
→ PP: Supine (reduces
axial projection of clavicle
the possibility of
▪ Slightly distorted image (due to angulation)
fragment
▪ Medial and overlapping 1st and 2nd ribs
displacement/additional
injury) or upright
PA AXIAL PROJECTION
▪ Arms along the
→ PP: same with previous except
sides
prone/standing
▪ Clavicle center
→ RP: Midshaft of clavicle
to IR
→ CR: 15° to 30° caudad
→ RP: Midshaft of
→ SS: same with previous
clavicle
→ CR: Perpendicular
TANGENTIAL PROJECTION
→ SS: Frontal image of
→ PP: Supine; arms
clavicle
along sides; shoulder
→ PA PROJECTION:
depressed; head turn
Reduces OID and
away from side of
improved image
interest
contrast
→ RP: Between clavicle
▪ Well accepted
and chest wall
by patient who
→ CR: 25° to 40° from
can stand
horizontal/cephalad
▪ Places CR nearly
AP AXIAL PROJECTION (LORDOTIC POSITION)
// to rib cage
→ PP:
→ SS: Inferior image of
▪ UPRIGHT: 1 foot in front; lean backward
the clavicle
(lordotic); neck and
▪ Clavicle
shoulder against IR;
projected
neck in extreme
free of the
flexion
chest wall
▪ SUPINE: cannot
assumed lordotic
position

cscc | 28
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
TARRANT METHOD (TANGENTIAL PROJECTION) on head or across upper chest
→ PP: Seated; patient lean → For demonstration of scapular body
slightly forward; increased MAZUJIAN SUGGESTION: arm
SID recommended (due to across the upper chest (grasping
increased OID) opposite shoulder)
→ RP: Midshaft of clavicle → RP: Midmedial border of
→ CR: 25° to 35° protruding scapula
anteroinferiorly to midshaft → CR: Perpendicular
of clavicle → SS: Lateral image of scapula
→ SS: Clavicle ▪ No superimposition of
above the thoracic scapular body on ribs
cage ▪ Superimposed lateral and
→ ER: Useful with medial border
patients who
cannot assume LORENZ AND LILIENFIELD METHODS (PA OBLIQUE
lordotic or PROJECTION)
recumbent → PP: Upright/Lateral recumbent
position ▪ LORENZ METHOD:
arm of affected side
SCAPULA
90° to long axis of
AP PROJECTION
body; elbow flexed;
→ PP: Supine/upright; arm
hand rested against
abducted 90° with the body
head
(draw scapula laterally);
▪ LILIENFELD
elbow flexed; IR 2 inches
METHOD: arm of
above top of shoulder
affected side
→ RP: 2 inches inferior to
obliquely upward;
coracoid process
hand rested against
→ CR: Perpendicular
head
→ SS: Scapula
→ RP: Between chest wall and midarea of protruding
▪ Lateral portion of
scapula
scapula free of
→ CR: Perpendicular
superimposition
→ SS: Oblique image of scapula
LATERAL PROJECTION
→ PP: Upright/seated; RAO/LAO (more
difficult to perform); 45° to 60° from IR;
RPO/LPO (magnified scapula; for
trauma patient)
ARM PLACEMENT:
▪ Elbow flexed and
arm on posterior
AP OBLIQUE PROJECTION
chest
→ PP: Supine/Upright
→ For demonstration
▪ RPO/LPO
of acromion and
▪ Shoulder rotate 15°
coracoid process
to 25° away from
▪ Arm extended
affected side or 25°
upward and
to 35° (steeper
forearm rested
oblique)

cscc | 29
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ Arm extended SCAPULAR SPINE
superiorly LAQUERRIERE – PIERQUIN METHOD (TANGENTIAL
▪ Elbow flexed PROJECTION)
▪ Hand supinated → PP: Supine; scapular body
under head // (horizontal) to IR; head
▪ Arm of affected side turned away from side of
across anterior interest (prevent
chest superimposition)
→ RP: Midscapular area ▪ FUNKE: use of 15°
→ CR: Perpendicular to lateral border of rib cage radiolucent
→ SS: Oblique image of scapula free or nearly free of rib wedge for
superimposition patient with
small breast
(angle the
shoulder
caudally)
▪ Prevent
clavicular superimposition
→ RP: Scapular spine (posterosuperior region of
shoulder)
→ CR: 45° caudad; 35° caudad (for obese and round –
shouldered patients)
→ SS: Scapular spine in profile and free of
CORACOID PROCESS
superimposition
AP AXIAL PROJECTION
→ PP: Supine; arm of
TANGENTIAL PROJECTION
affected side slightly
→ PP:
abducted; hand supinated
▪ PRONE: arms along sides;
→ RP: Coracoid process
head rested on chin/cheek
→ CR: 15° to 45° cephalad
of affected side; hand
▪ KWAK – ESPINIELLA
supinated; scapular // to IR
– KATTAN
▪ UPRIGHT: back rested
RECOMMENDATION: CR 30°
against the end of table; IR
▪ GREATER ANGLE:
placed 45° from table
round shouldered
(wedge support)
patient
→ RP: Scapular spine
▪ LESSER ANGLE:
→ CR: 45° cephalad (prone); 45°
straight back
posteroinferiorly (upright;
→ SS: Coracoid process with
increased SID recommended
minimal self –
because of increased OID)
superimposition (slight
→ SS: Scapular spine in profile
elongated)
and free of superimposition of
▪ Cast a shadow on
scapular body
direct AP
projection of
shoulder
▪ RATIONALE:
because the
clavicle is curved on itself

cscc | 30
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
LOWER EXTREMITIES
ANATOMY
→ BONES OF FOOT

CALCANEUS

→ JOINTS OF FOOT

TALUS AND CALCANEUS

→ SESAMOID BONES
▪ Embedded in tendons
▪ Present near joints
▪ Plantar surface of foot NAVICULAR, CUNEIFORMS, AND CUBOID
→ PHALANGES (14)
→ METATARSALS (5)
→ TARSALS (7)
▪ Calcaneus
▪ Talus
▪ Navicular bone
▪ Cuboid
▪ Cuneiforms (3)
→ Medial cuneiform
→ Intermediate cuneiform
→ Lateral cuneiform

cscc | 31
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
ARCHES OF FOOT TIBIA AND FIBULA (LATERAL VIEW)
→ LONGITUDINAL ARCH → Articular Facets (tibial
→ TRANSVERSE ARCH plateau) (10° to 20°)
→ Apex of Styloid Process
→ Body (shaft) of Fibula
→ Body (shaft) of Tibia
→ Fibular Head
→ Lateral Malleolus
→ Medial Malleolus
→ Fibular Neck
→ Tibial Tuberosity

FEMUR (ANTERIOR VIEW)

→ Longest and Strongest Bone
→ Patella ½ inch (1.25 cm) above joint

ANKLE JOINT

ANKLE JOINT (AXIAL VIEW)

FEMUR (POSTERIOR VIEW)

→ Note 5° to 7° angle is shown at distal, medial, and
TIBIA AND FIBULA (ANTERIOR VIEW) lateral condyles
→ Anterior Crest
→ Articular Facets (Tibial
plateau)
→ Body of Fibula
→ Fibular Notch (of tibia)
→ Intercondylar Eminence
(medial and distal
intercondylar tubercles)
→ Lateral Condyle
→ Lateral Malleolus
→ Medial Condyle
→ Tibial Tuberosity

cscc | 32
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
PATELLA

KNEE JOINT (OBLIQUE VIEW)

→ Femorotibial and
Patellofemoral Joints SURFACES OF FOOT
→ Four (4) Major → Dorsiflexion
Ligaments: → Plantar Flexion
▪ Posterior → Inversion (Varus)
Cruciate → Eversion (Valgus)
▪ Anterior Cruciate
▪ Fibular Collateral MOTIONS OF FOOT AND ANKLE
▪ Tibial Collateral

KNEE JOINT (ANTERIOR VIEW)

MENISCI (SUPERIOR AND SAGITTAL VIEWS)

JOINTS OF LOWER LIMB

PATHOLOGY
→ CONGENITAL CLUBFOOT
▪ Talipes equinovarus

cscc | 33
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ Abnormal twisting of the foot usually inward and → PP: Supine/seated;
downward knee flexed; 15° foam
→ POTT’S FRACTURE wedge under foot
▪ Avulsion fracture of the medial malleolus with → RP: 3rd MTP joint
loss of the ankle mortise → CR: Perpendicular
→ JONES FRACTURE (15° foam wedge) or
▪ Avulsion fracture of the base of the fifth 15° posteriorly
metatarsal → SS: Phalanges and
→ GOUT distal portion of
▪ Hereditary form of arthritis in which uric acid is metatarsals
deposited in joints ▪ AP AXIAL (15°):
→ OSGOOD – SCHLATTER DISEASE Open IP joints
▪ Incomplete separation or avulsion of the tibial and reduces
tuberosity foreshortening
→ GIANT CELL TUMOR
▪ Osteoclastoma
▪ Lucent lesion in the metaphysic usually at the
distal femur
→ CHONDROMALACIA PATALLAE
▪ Runner’s knee
▪ Softening of the cartilage under the patella
→ JOINT EFFUSION
▪ Accumulation of fluid in the joint cavity
→ LISFRANC INJURY
▪ Abnormal separation in the base of 1st and 2nd
metatarsal and cuneiform
→ REITER SYNDROME
▪ Erosions of sacroiliac joints and lower limbs
→ HALLUX VALGUS
▪ Congenital abnormality of hallux
▪ Lateral deviation of great toe
PA PROJECTION
ROUTINE
→ PP: Prone (IP joints // to
→ BONY INJURIES
CR); dorsal aspect against IR
▪ AP, APO, and Lateral
→ RP: 3rd MTP joint
→ BODY PATHOLOGY
→ CR: Perpendicular
▪ AP and APO
→ SS: MTP and IP joint spaces
→ FOREIGN BODY LOCALIZATION
are well visualized
▪ AP and Lateral
▪ The x – ray beam
DIVISIONS OF FOOT coincides closely
→ HINDFOOT with the position
▪ Calcaneus and talus of the toes
→ MIDFOOT
▪ Cuboid, navicular, and cuneiform AP OBLIQUE PROJECTION (MEDIAL ROTATION)
→ FOREFOOT → PP: Supine/seated; knee
▪ Metatarsals and phalanges flexed; plantar surface 30° to
TOES 45° from IR (lower leg and foot
AP/AP AXIAL PROJECTION rotated medially)
→ RP: 3rd MTP joint

cscc | 34
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ CR: Perpendicular
→ SS: 2nd to 5th MTP
joint spaces; 1st to 3rd
toes
▪ 1st MTP joint
(not always
open)

AP OBLIQUE PROJECTION (LATERAL ROTATION)

→ PP: Supine/seated; knee flexed; plantar surface 30°
to 45° from IR (lower leg and foot rotated laterally)
→ RP: 3rd MTP joint
→ CR: Perpendicular
→ SS: 3rd to 5th toes; MTP joints overlapped
▪ JUST REVERSE THE PREVIOUS POSITION

PA OBLIQUE PROJECTION (MEDIAL ROTATION) SESAMOIDS

→ PP: Lateral recumbent LEWIS METHOD (TANGENTIAL
(affected side down); PROJECTION)
affected limb partially → PP: Prone; dorsiflex great toe;
extended; ball of foot 30° ankle elevated; ball of foot
to horizontal perpendicular to IR
→ RP: 3rd MTP joint → RP: 1st MTP joint
→ CR: Perpendicular → CR: Perpendicular
→ SS: 2nd to 5th MTP joint → SS: MT head and sesamoids in
spaces; 1st to 3rd toes profile
▪ 1st MTP joint (not
always open) HOLLY METHOD (TANGENTIAL PROJECTION)
→ PP: Seated (more comfortable);
LATERAL PROJECTION plantar surface 75° to IR; toe flexed
(MEDIOLATERAL/LATEROMEDIAL PROJECTION) and hold with strip gauze bandage;
→ PP: Lateral recumbent medial border of foot to IR
(unaffected side down); toe → RP: 1st MTP head
in true lateral; use 4x4 gauze → CR: Perpendicular
pad or tape (to separate the → SS: MT head and sesamoids in
toes) profile
→ RP: IP joint (1st toe);
proximal IP joint (2nd to 4th CAUSTON METHOD (TANGENTIAL PROJECTION)
toes) → PP: Lateral recumbent
→ CR: Perpendicular (unaffected side down);
→ SS: Phalanges in profile; open IP joints spaces knees flexed; limb partially
▪ LATEROMEDIAL: 1st to 2nd toes extended; foot in lateral
▪ MEDIOLATERAL: 3rd to 5th toes position; 1st MTP joint
perpendicular to IR
→ RP: Prominence of 1st
MTP joint
→ CR: 40° toward the heel
→ SS: Sesamoids projection
axiolaterally with slight overlap

cscc | 35
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ Sinus tarsi (well demonstrated)
▪ Interspaces
between:
→ Cuboid and
calcaneus
→ Cuboid and 4th
and 5th MT
→ Talus and
navicular bone

AP OBLIQUE PROJECTION (LATERAL ROTATION)

→ PP: Supine; knee flexed;
leg rotated laterally; plantar
surface of foot 30° to IR
→ RP: 3rd MTP base
FOOT → CR: Perpendicular
AP/AP AXIAL PROJECTION → SS:
→ PP: Supine; knee flexed; ▪ Navicular in profile
plantar surface against IR ▪ Interspaces
→ RP: 3rd MTP base between:
→ CR: Perpendicular or 10° → 1st and 2nd MT
posteriorly → Medial and
→ SS: MT and Tarsal Intermediate
(perpendicular); MT joint cuneiforms
(10°) ▪ Separates 1st to
→ ER: 2nd MT bases
▪ For localizing
foreign bodies LATERAL PROJECTION (MEDIOLATERAL PROJECTION)
▪ Location of (more comfortable for patient)
fragments in → PP: Dorsiflex foot (perpendicular to lower leg); leg and
fracture of foot in lateral position;
metatarsals and lateral side of foot against IR
anterior tarsals → RP: 3rd MT base
▪ General surveys of → CR: Perpendicular
bones of the foot → SS: Entire foot in profile
→ 10° ANGULATION: → ER:
Reduces foreshortening of ▪ For localizing foreign
metatarsals body
▪ Degree of anterior and posterior displacement of
AP OBLIQUE PROJECTION (MEDIAL ROTATION) fracture
→ PP: Supine; knee flexed;
leg rotated medially; LATERAL PROJECTION (LATEROMEDIAL PROJECTION)
plantar surface of foot 30° (more difficult to assume)
to IR → PP: LPO/RPO (affected
→ RP: 3rd MTP base side up); medial surface
→ CR: Perpendicular against IR; plantar surface of
→ SS: foot perpendicular to IR
▪ Cuboid in profile → RP: 3rd MTP base
→ CR: Perpendicular

cscc | 36
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ SS: True lateral projection of foot apex of mid–calcaneus to anterior process of
▪ MT more superimposed than mediolateral calcaneus

GRASHEY METHOD (PA OBLIQUE PROJECTION) – WEIGHT – BEARING METHOD (AP AXIAL PROJECTION)
MEDIAL AND LATERAL ROTATION → PP: Upright; both feet
→ PP: Prone; foot elevated; against IR; weight equally
dorsal surface against IR; heel distributed on each foot
rotated medially 30°; heel → RP: Between feet at 3rd
rotated laterally 20° MT base level
→ RP: 3rd MTP base → CR: 10° or 15°
→ CR: Perpendicular posteriorly
→ SS: Interspaces at the → SS: Accurate
proximal ends of metatarsal evaluation and
▪ 1st and 2nd MT (30° comparison of MT and
medially) tarsals
▪ Interspaces between ▪ Hallux valgus and
2nd to 3rd, 3rd to 4th, Lisfranc injury
and 4th to 5th MT (20°
laterally)

WEIGHT – BEARING COMPOSITE METHOD (AP AXIAL

PROJECTION)
→ PP: Upright; 2 exposures
WEIGHT – BEARING METHOD (LATERAL PROJECTION) – ▪ FIRST EXPOSURE:
LONGITUDINAL ARCH unaffected foot step
→ PP: Upright (natural backward (to prevent
position); feet elevated (use superimposition of leg
blocks); IR between feet; shadow on ankle joint)
weight equally distributed tube in front
on each foot → For exposure of forefoot
→ RP: Point above 3rd MTP (phalanges and MT)
base ▪ SECOND EXPOSURE:
→ CR: Horizontal unaffected foot step
→ SS: Structural status of forward; tube behind;
longitudinal arch (pes exposure factor increases
planus); Bohler’s critical (increase CR angulation
angle (between 20° to 40°); and thickness of part)
calcaneal fracture (less than → For hindfoot (talus and
20°) calcaneus)
▪ BOHLER’S CRITICAL → RP: 3rd MTP base (1st exposure);
ANGLE: angle level of lateral malleolus (2nd
between superior exposure)

cscc | 37
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ CR: 15° posteriorly (1st → RP: Midtarsal area
exposure); 25° anteriorly (2nd → CR: Perpendicular
exposure) → SS:
→ SS: Full outline of the foot free ▪ Anterior talar
of the leg subluxation
▪ Degree of plantar
flexion (equinus)

CONGENITAL CLUBFOOT
TALIPES EQUINOVARUS
→ THREE (3) DEVIATIONS:
▪ Plantar flexion and inversion of calcaneus
(EQUINUS)
▪ Medial displacement of the forefoot
(ADDUCTION)
▪ Elevation of the medial border of the foot
(SUPINATION)
KANDEL METHOD (DORSOPLANTAR AXIAL
→ PRIMARY OBJECTIVE: No attempt be made to change
PROJECTION)
the abnormal alignment of the foot when placing it on
→ PP: Bending forward
the IR
position; plantar surface
→ RATIONALE: Even slight rotation of the foot can result
against IR
in marked alteration in the radiographically projected
→ RP: Lower leg
relation of the ossification centers
→ CR: 40° anteriorly
→ SS: Suroplantar projection
KITE METHOD (AP PROJECTION)
of congenital clubfoot (same
→ PP: Supine; hips and knees
as taking calcaneus)
flexed; foot flat on IR; ankles
▪ FREIBERGER – HERSH
slightly extended; legs are
– HARRISON: CR 35°,
vertical
45°, and 55° for
→ RP: Tarsals
demonstration of sustentaculum talar joint
→ CR: 15° posteriorly
fusion
→ SS:
▪ Degree of forefoot
CALCANEUS
adduction and
AXIAL PROJECTION (PLANTODORSAL PROJECTION)
calcaneus inversion
→ PP: Supine/seated; leg
(equinus)
fully extended; dorsiflex foot
▪ 15° ANGULATION:
with strip of gauze; foot
places CR
perpendicular to IR
perpendicular to
→ RP: 3rd MT base
tarsals
→ CR: 40° cephalad to long
▪ IMPORTANCE OF
axis of foot
PERPENDICULAR CR:
→ SS: Calcaneus and
to project the true
subtalar joint
relationship of the
bones and ossification centers

KITE METHOD (LATERAL PROJECTION) – MEDIOLATERAL

→ PP: Lateral recumbent; uppermost limb flexed and
draw forward
cscc | 38
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
AXIAL PROJECTION (DORSOPLANTAR PROJECTION)
→ PP: Prone; ankle
elevated; dorsiflex ankle;
foot perpendicular to IR; IR
vertical
→ RP: Dorsal surface of
ankle joint
→ CR: 40° caudad
→ SS: Calcaneus, subtalar
joint, and sustentaculum
tali
▪ CT is usually used
to demonstrate
calcaneus WEIGHT – BEARING METHOD (LATEROMEDIAL
OBLIQUE PROJECTION)
→ PP: Upright; leg
perpendicular to IR;
calcaneus center to IR
→ RP: Lateral malleolus
→ CR: 45° caudad
(medially)
→ SS: Calcaneal
tuberosity
→ ER: Useful in
diagnosing stress
fractures of calcaneus
LILIENFELD METHOD (DORSOPLANTAR AXIAL or tuberosity
PROJECTION) – WEIGHT – BEARING COALITION
POSITION SUBTALAR JOINT
→ PP: Upright; posterior PA AXIAL OBLIQUE PROJECTION (LATERAL ROTATION)
surface of heel at edge of → PP: Lateral position;
IR; unaffected foot one patient lie on affected side
step forward (to prevent in; heel elevated 1.5 inches
superimposition of leg (3.8 cm) from exact lateral
shadow) position; ball of foot
→ RP: Level of 5th MT base (metatarsophalangeal area)
→ CR: 45° anteriorly angled 25° forward
→ SS: Calcaneotalar → RP: Ankle joint
coalition → CR: 5° anterior and 23° caudad
→ SS: Middle and posterior articulation
LATERAL PROJECTION (MEDIOLATERAL PROJECTION)
→ PP: Supine; patient turn
toward affected side; plantar
surface // to IR
→ RP: 1 inch distal to medial
malleolus (at subtalar joint)
→ CR: Perpendicular
→ SS: Calcaneus and ankle
joint; sinus tarsi

cscc | 39
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
BRODEN METHOD (AP AXIAL OBLIQUE PROJECTION) – ISHERWOOD METHOD (FEIST – MANKIN METHOD)
MEDIAL ROTATION (LATEROMEDIAL OBLIQUE PROJECTION) – MEDIAL
→ PP: Supine; leg and ROTATION FOOT
foot rotated 45° medially; → PP: Semisupine; foot
dorsiflex foot (to obtain and leg rotated 45°
right angle flexion); foot medially; knee flexed; 45°
rested against 45° foam foam wedge under
wedge elevated leg
→ RP: 2 to 3 cm → RP: 1 inch distal and 1
caudoanteriorly to inch anterior to lateral
lateral malleolus malleolus
→ CR: 10°, 20°, 30°, or → CR: Perpendicular
40° cephalad → SS: Anterior subtalar
→ SS: Posterior articular surface
articulation ▪ Oblique projection
▪ Anterior of tarsals
portion (40°)
▪ Posterior ISHERWOOD METHOD (FEIST – MANKIN METHOD) (AP
portion (10°) AXIAL OBLIQUE PROJECTION) – MEDIAL ROTATION
▪ Talus and sustentaculum tali articulation (20° to ANKLE
30°) → PP: Seated or semi –
lateral recumbent (more
comfortable); leg, foot, and
ankle rotated 30° medially;
dorsiflex foot; 30° foam
wedge
→ RP: 1 inch distal and 1
inch anterior to lateral
malleolus
→ CR: 10° cephalad
→ SS: Middle subtalar
articular surface and “end
BRODEN METHOD (AP AXIAL OBLIQUE PROJECTION) – on” projection of sinus
LATERAL ROTATION tarsi
→ PP: Supine; leg and foot
rotated 45° laterally; dorsiflex ISHERWOOD METHOD (FEIST – MANKIN METHOD) (AP
foot; foot rested against 45° AXIAL OBLIQUE PROJECTION) – LATERAL ROTATION
foam wedge ANKLE
→ RP: 2 cm distal and 2 cm → PP: Supine/seated; leg,
anterior to medial malleolus foot, and ankle rotated 30°
→ CR: 15° cephalad laterally; dorsiflex foot
→ SS: Posterior articulation → RP: 1 inch distal medial
→ ER: To determine the malleolus
presence of joint involvement → CR: 10° cephalad
in cases of comminuted → SS: Posterior subtalar
fracture articular surface

cscc | 40
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
ANKLE AP OBLIQUE PROJECTION (MEDIAL ROTATION)
AP PROJECTION → PP: Supine; leg and foot
→ PP: Supine; leg and foot rotated 45° laterally;
vertical and rotated 5° dorsiflex foot
medially (places malleoli → RP: Point midway
equidistant) between malleoli
→ RP: Point midway → CR: Perpendicular to
between malleoli ankle joint
→ CR: Perpendicular to → SS: Distal ends of tibia
ankle joint and fibula (often
→ SS: Ankle joint and superimposed over talus)
tibiotalar joint space ▪ Tibiofibular
▪ TRUE AP: articulation
Inferior
tibiofibular and
talofibular AP OBLIQUE PROJECTION (LATERAL ROTATION)
articulations not in profile (normal) → PP: Supine; leg and foot
rotated 45° laterally; dorsiflex
LATERAL PROJECTION (MEDIOLATERAL PROJECTION) foot
→ PP: Semisupine; lateral → RP: Point midway between
surface of foot against IR; malleoli
dorsiflex foot (prevent lateral → CR: Perpendicular to ankle
rotation of the ankle) joint
→ RP: Medial malleolus → SS: Superior aspect of
→ CR: Perpendicular to calcaneus; subtalar joint
ankle joint → ER: Useful in determining
→ SS: True lateral fractures
projection of lower third of
tibia and fibula, ankle joint MORTISE JOINT (AP OBLIQUE PROJECTION) – MEDIAL
and tarsals ROTATION
▪ 5th metatarsal base → PP: Supine
(identify Jones fracture) ▪ Leg and foot rotated
▪ Tibiotalar joint (well visualized) 15° to 20° medially
(intermalleolar line //
LATERAL PROJECTION (LATEROMEDIAL PROJECTION) to IR); plantar surface
→ PP: Semisupine; medial right angle to leg
surface of foot against IR; → RP: Point midway between
dorsiflex foot malleoli
→ RP: 0.5 inch superior to → CR: Perpendicular to ankle
lateral malleolus joint
→ CR: Perpendicular to ankle → SS: Mortise joints (three
joint sides must
→ SS: Lateral projection of visualized)
lower third of tibia and fibula,
ankle joint, and tarsals
▪ Exact positioning of
ankle is more easily
and more consistently
obtained

cscc | 41
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
STRESS METHOD (AP PROJECTION) (take after an LATERAL PROJECTION (MEDIOLATERAL PROJECTION)
inversion and eversion injury) → PP: Supine; RPO/LPO;
→ PP: Seated; foot patella perpendicular to IR;
forcibly turned toward femoral condyles
the opposite side perpendicular to IR
→ RP: Ankle joint → RP: Midshaft
→ CR: Perpendicular → CR: Perpendicular
→ ER: To evaluate the → SS: Tibia and fibula; ankle
presence of ligamentous and knee
tear and joint separation (widening of the joint spaces) ▪ Cross – table lateral
if patient cannot be
positioned in supine

WEIGHT – BEARING METHOD (AP PROJECTION) AP OBLIQUE PROJECTION (MEDIAL/LATERAL

→ PP: Upright; heels ROTATION)
against the IR; IR vertical; → PP: Supine; leg and foot
toes pointing toward the rotated 45° medially or
x–ray tube laterally
→ RP: Midway at level of → RP: Midshaft
ankle joint → CR: Perpendicular
→ CR: Horizontal → SS:
→ ER: identify ankle joint ▪ MEDIAL
space narrowing; side-to- ROTATION:
side comparison of joint → Proximal and distal
tibiofibular articulation
→ Maximum
interosseous apace
between tibia and fibula
LEG ▪ LATERAL ROTATION:
AP PROJECTION → Fibula superimposed
→ PP: Supine; femoral by lateral portion of tibia
condyles // to IR; foot in
vertical position
→ RP: Midshaft
→ CR: Perpendicular
→ SS: Tibia and fibula; ankle
KNEE
and knee joints
AP PROJECTION
→ PP: Supine; femoral
epicondyles // to IR; leg 5°
inward (places
interepicondylar line // to
IR)
→ RP: 0.5 inch inferior to
patellar apex
cscc | 42
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ CR: Depending on the measurement between ASIS fracture); femoral epicondyles to
and table top IR
▪ 3° to 5° caudad → RP: 1 inch distal to medial
(<19 cm; thin epicondyle
pelvis) → CR: 5° to 7° cephalad
▪ Perpendicular (19 → SS: Knee joint space
– 24 cm)
▪ 3° to 5° cephalad AP OBLIQUE PROJECTION (MEDIAL ROTATION)
(>24 cm; large → PP: Supine; leg rotated 45°
pelvis) medially; hip of affected side
→ SS: Knee joint space elevated
→ RP: 0.5 inch inferior to
patellar apex
→ CR: Depending on the
measurement between ASIS
and table top
▪ 3° to 5° caudad (<19
cm)
▪ Perpendicular (19 –
24 cm)
▪ 3° to 5° cephalad
(>24 cm)
→ SS: Proximal tibiofibular joint; fibular head
PA PROJECTION ▪ Lateral femoral condyle
→ PP: Prone; femoral
epicondyles // to IR; leg 5° AP OBLIQUE PROJECTION (LATERAL ROTATION)
inward (places → PP: Supine; leg rotated 45°
interepicondylar line // to IR) medially; hip of unaffected side
→ RP: 0.5 inch inferior to elevated
patellar apex → RP: 0.5 inch inferior to
→ CR: 5° to 7° caudad patellar apex
→ SS: Knee joint space → CR: 5° cephalad
→ SS: Tibial plateaus;
medial femoral and tibial
condyles

AP OBLIQUE PROJECTION (PA OBLIQUE)

→ PP: Knee flexed 10° (Holmblad;
for lateral rotation)
LATERAL PROJECTION (MEDIOLATERAL PROJECTION) → RP: O.5 inch inferior to patellar
→ PP: Lateral recumbent; apex
knee flexed 20° to 30° → CR: Perpendicular
(relax muscle and shows → SS: Opposite of previous
maximum volume of joint
cavity) or flexed <10° (for
new or unhealed patellar

cscc | 43
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
WEIGHT – BEARING METHOD (AP BILATERAL ▪ Kneeling on
PROJECTION) – LEACH – GREGG – SIBER table; knee over
→ PP: Upright; knee fully the IR (Homblad
extended; weight equally Method)
distributed on both feet; → RP: Popletial
IR vertical depression
→ RP: 0.5 inch inferior to → CR: Perpendicular
patellar apex → SS: Intercondylar
→ CR: Horizontal fossa
→ SS: Knee joint spaces
→ ER:
▪ To reveal
narrowing of
knee joint space
▪ To evaluate varus
and valgus
deformities and degenerative joint disease

ROSENBERG METHOD (PA WEIGHT – BEARING) – CAMP – COVENTRY METHOD (PA AXIAL PROJECTION)
STANDING FLEXION → PP: Prone; knee flexed
→ PP: Upright; facing 40° to 50° from IR; femur
vertical IR; anterior surface against IR; with support
of flexed knee against IR; under foot
femur 45° to IR → RP: Popliteal
→ RP: 0.5 inch inferior to depression
patellar apex → CR: 40° (knee flexed
→ CR: Horizontal or 40°) or 50° (knee flexed
10° caudad 50°) caudally
→ ER: Useful for → SS: Intercondylar fossa
evaluating joint space → ER:
narrowing and ▪ To detect loose
demonstrating bodies joint mice
articular cartilage ▪ To evaluate split
disease and displaced
cartilage in
INTERCONDYLAR FOSSA
osteochondritis
HOMBLAD METHOD (PA AXIAL PROJECTION) – TUNNEL
▪ To evaluate
VIEW
flattening or
→ PP: Anterior surface of
underdevelopment
knee against IR; knee 60°
of lateral femoral
to 70° from IR (20°
condyles in
difference from CR)
congenital
THREE (3) POSITIONS:
slipped patella
▪ Standing; knee
flexed and rested
on a stool
▪ Standing at side of
table; knee flexed
and rested over
the IR
cscc | 44
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
BECLERE METHOD (AP AXIAL METHOD) PA OBLIQUE PROJECTION (MEDIAL ROTATION)
→ PP: Supine; knee → PP: Prone; knee flexed 5° to 10°; knee 45° to 55°
flexed; femur 60° to long medially
axis of tibia; curved → RP: Patella
cassette is used → CR: Perpendicular
→ RP: 0.5 inch inferior to → SS: Medial portion of patella free of femur
patellar apex
→ CR: Perpendicular to
long axis of lower leg
→ SS: Intercondylar
fossa, intercondylar
eminence, knee joint, and
tibial plateau
PA OBLIQUE PROJECTION (LATERAL ROTATION)
→ PP: Prone; knee flexed
5° to 10°; knee 45° to 55°
laterally
→ RP: Patella
→ CR: Perpendicular
→ SS: Lateral portion of
patella free of femur
PATELLA
PA PROJECTION
→ PP: Prone; heel 5° to 10°
laterally (places patella // to
IR)
→ RP: Midpopliteal
depression
→ CR: Perpendicular
→ SS: Sharper image of
KUCHENDORF METHOD (PA AXIAL OBLIQUE
patella (closer OID)
PROJECTION) – LATERAL ROTATION
→ PP: Prone; hip elevated
2 to 3 inches; knee flexed
10° (relax the muscles);
knee rotated 35° to 40°
laterally
LATERAL PROJECTION
→ RP: Joint space
→ PP: Lateral recumbent;
between patella and
unaffected knee and hip
femoral condyles
flexed; unaffected foot in
→ CR: 25° to 30° caudad
front; affected knee flexed 5°
→ SS: Oblique patella free
to 10° or flexed not >10 (for
superimposition of femur
new or unhealed patellar
fracture); femoral epicondyles
and patella perpendicular to IR
→ RP: Midpatellofemoral joint
→ CR: Perpendicular
→ SS: Patella and patellofemoral
joint space

cscc | 45
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
HUGHSTON METHOD (TANGENTIAL PROJECTION) perpendicular to IR; loop
→ PP: Prone; anterior surface of knee against IR; knee bandage around ankle or
flexed 50° to 60°; foot foot to hold the leg in
rested against position
collimator/support → RP: Joint space
→ RP: Patellofemoral between patella and
joint femoral condyles
→ CR: 45° cephalad → CR: Perpendicular (if
→ SS: Patella; joint is perpendicular);
patellofemoral joint 15° to 20° cephalad (if
→ ER: joint isn’t perpendicular)
▪ To demonstrate ▪ Angulation
subluxation of depends on knee
patella and flexion
patellar fracture → SS: Patella; patellofemoral joint
▪ It allows assessment of femoral condyles → ER:
▪ Useful for demonstrating vertical fractures
MERCHANT METHOD (TANGENTIAL PROJECTION) ▪ Useful for investigating articulating surfaces of
→ PP: Supine; both knee flexed 40° patellofemoral articulation
or between 30° to 90° (to
demonstrate various patellar
disorders); IR resting on patient’s
shins; uses IR holding device and
axial viewer device
→ RP: Midway between patellae at
level of patellofemoral joint
→ CR: 30° caudad from horizontal
→ SS: Femoral condyle; intercondylar
sulcus, and magnified nondistorted
patellae

SUNRISE METHOD (TANGENTIAL PROJECTION) –

MOUNTAIN/SKYLINE VIEW
→ PP: Supine/sitting;
knee flexed 40° to 45°
→ RP: Patellofemoral
SETTEGAST METHOD (TANGENTIAL PROJECTION) joint
→ DISADVANTAGE: Extreme → CR: 30° from
flexion horizontal
→ PP: Supine or prone → ER: Joint space
(preferable); knee acutely between patella and
flexed until patella femoral condyles

cscc | 46
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
FEMUR → RP: Medial side of midfemur
AP PROJECTION → CR: Horizontal
→ PP: Supine → SS: Entire femur and knee joint
▪ DISTAL FEMUR → ER: For patient who can’t tolerate routine lateral
(KNEE INCLUDED): position because of fractures or destructive disease
leg rotated 5°
inward (places
limb in true
anatomic position)
▪ PROXIMAL FEMUR (HIP INCLUDED): leg rotated
10° to 15°
inward
(places
femoral neck
in profile)
→ RP: Midfemur
→ CR: Perpendicular
→ SS: Femoral neck
and hip joint (10° to
15°); knee joint (5°)

LATERAL PROJECTION (MEDIOLATERAL PROJECTION)

→ PP: Lateral recumbent;
affected side against IR
▪ DISTAL FEMUR
(KNEE INCLUDED):
unaffected limb
draw forward;
pelvis in true lateral
position; affected
knee flexed 45°;
femoral
epicondyles
perpendicular to IR
▪ PROXIMAL FEMUR
(HIP INCLUDED):
unaffected limb
draw posteriorly;
pelvis rolled 10° to
15° posteriorly; IR
level of ASIS
→ RP: Midfemur
→ CR: Perpendicular
→ SS: ¾ of femur and
adjacent joints

TRANSLATERAL PROJECTION (CROSSTABLE LATERAL)

→ PP: Dorsal decubitus; IR placed vertically against
medial/lateral surface of femur

cscc | 47
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
PELVIC GIRDLE PELVIS
ANATOMY
→ FEMUR
→ PELVIC GIRDLE
→ PELVIS
→ HIP BONE

HIP AND PROXIMAL FEMUR

HIP BONE: THREE (3) PARTS

PROXIMAL FEMUR
ILIUM

ANGLES OF PROXIMAL FEMUR

→ Neck to Shaft (≈125°)
→ Longitudinal (≈10°) ISCHIUM
→ Anterior Angle (≈15° to 20°)

cscc | 48
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
PUBIS (PUBIC BONE) BIRTH CANAL (FRONT AND SIDE VIEWS)

GENDER DIFFERENCES OF PELVIS

→ General Shape
BODY LANDMARKS OF PELVIS
→ Angle of Pubis Arch
→ Shape of Inlet

TRUE AND FALSE PELVIS

SACROILIAC AND SYMPHYSIS PUBIS JOINTS: CORONAL

VIEW OF TRANSVERSE SECTION

BIRTH CANAL

JOINTS OF PELVIS

cscc | 49
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
CLASSIFICA MOBILITY MOVEMENT ANATOMIC POSITION
JOINTS
TION TYPE TYPE → Lesser trochanters visible
Sacroiliac (2) Synovial Amphiarthrodial Limited
Hip (2) Synovial Diarthrodial Spheroidal
Symphysis
Cartilaginous Amphiarthrodial Limited
Pubis
Union of
Cartilaginous Synarthrodial
Acetabulum Immovable
(2)

HIP LOCALIZATION METHOD

→ (H) Head – 1 ½ inch (4 cm) EXTERNAL ROTATION (RELAXED POSITION)
→ (N) Neck – 2 ½ inch (6 – 7 cm) → Lesser trochanters in profile

FEMORAL HEAD AND NECK LOCALIZATION TRUE AP PROJECTION

→ Lesser trochanters NOT visible
→15° to 20° internal rotation

ASYMMETRIC ROTATION (HIP FRACTURE)

→ Affected limb with lesser trochanter in profile
ANATOMIC POSITION (TRUE AP OF KNEE, LEG, AND
ANKLE – NOT HIP)

PATHOLOGY
INTERNAL ROTATION vs. EXTERNAL ROTATION → ANKYLOSING SPONDYLITIS
▪ Rheumatoid arthritis variant involving the
sacroiliac joints and spine
→ CONGENITAL HIP DYSPLASIA
▪ Malformation of the acetabulum causing
displacement of the femoral head
→ LEGG – CALVE PERTHES DISEASE

cscc | 50
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ Flattening of the femoral head due to vascular → RP: 2 inches above
disruption greater trochanter
→ SLIPPED EPIPHYSIS → CR: Perpendicular
▪ Proximal portion of femur dislocated from distal → SS: Lateral
portion at the proximal epiphysis radiograph of
lumbosacral junction;
PELVIS AND UPPER FEMORA sacrum; coccyx;
AP PROJECTION superimposed upper
→ PP: Supine; feet and leg rotated femora
15° to 20° medially (place femoral → BERKEBILE, FISCHER, AND ALBRECHT:
neck // to IR); heels 8 to 10 inches ▪ Recommended dorsal decubitus lateral
(20 to 24 cm) apart projection of pelvis
→ RP: 2 inches inferior to ASIS or 2 ▪ Demonstration of “gull – wing sign” in cases of
inches superior to pubic fracture dislocation of the acetabular rim and
symphysis posterior dislocation of femoral head
→ CR: Perpendicular
CONGENITAL HIP DISLOCATION
→ SS: Greater trochanter in
MARTZ – TAYLOR METHOD
profile
→ RECOMMENDATIONS: 2 AP projections of pelvis
▪ LESSER TROCHANTER:
→ CR: Perpendicular to pubic symphysis (1st projection)
seen if feet and leg are
▪ To detect any
rotated laterally
lateral or
superior
displacement
of the femoral
head
→ CR: Perpendicular
to 45° to pubic
symphysis (2nd
projection)
▪ ANTERIOR DISPLACEMENT: femoral head above
acetabulum
▪ 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

LATERAL PROJECTION
PROJECTION)
→ PP:
→ PP: Both legs
▪ LATERAL RECUMBENT: place support under
forcibly abducted 45°;
lumbar spine;
femora rotated inward
vertebral column //
→ ER: For diagnosing
with table; pelvis in
congenital hip
true lateral
dislocation in
▪ UPRIGHT: patient
newborns
stand straight;
weight equally
distributed on feet;
MSP // to IR

cscc | 51
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
FEMORAL NECKS HIP
MODIFIED CLEAVES METHOD (AP OBLIQUE AP PROJECTION
PROJECTION) – BILATERAL FROG LEG POSITION → PP: Supine; ASISs
→ PP: Supine; ASISs equidistant from table; foot
equidistant from table; hips and leg rotated medially 15°
and knees flexed and feet to 20° (places femoral neck
draw up (places femora in // to IR)
nearly vertical position); → RP: Femoral neck
thigh abducted 25° to 45° → CR: Perpendicular
from vertical; feet turn → SS: Hip joint
inward; soles against each
other
→ RP: 1 inch superior to
pubic symphysis
→ CR: Perpendicular
→ SS: Acetabulum,
femoral head, femoral
neck, and trochanteric areas

MODIFIED CLEAVES METHOD (AP OBLIQUE

PROJECTION) – UNILATERAL PROJECTION
→ PP: Supine; affected
hip and knee flexed and
feet draw up; soles
against opposite knee; LAUENSTEIN AND HICKEY METHOD (LATERAL
thigh abducted 45° PROJECTION) – MEDIOLATERAL PROJECTION
laterally → PP: Supine; patient rotated toward affected side; knee
→ RP: 1 inch superior to flexed and thigh draw up; opposite side extended
femoral neck → RP: Hip joint
→ CR: Perpendicular → CR: Perpendicular
→ SS: Acetabulum, (Lauenstein); 20° to 25°
femoral head, femoral cephalad (Hickey)
neck, and trochanteric areas → SS: Hip joint
▪ Femoral neck
ORIGINAL CLEAVES METHOD (AXIOLATERAL superimposed over
PROJECTION) greater trochanter
→ PP: Same position as (Lauenstein)
Modified Cleaves ▪ Femoral neck free of superimposition (Hickey)
→ RP: 1 inch superior to → ER: To demonstrate hip joint and relationship of
pubic symphysis femoral head to the acetabulum
→ CR: 25° to 45°
→ SS: Acetabulum, DANELIUS – MILLER METHOD (AXIOLATERAL
femoral head, femoral PROJECTION) – CROSS–TABLE/SURGICAL–LATERAL
neck, and trochanteric PROJECTION
areas → PP: Supine; pelvis elevated;
knee and hip of unaffected side
flexed; leg of unaffected side
rested on support; foot and leg

cscc | 52
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
of affected side rotated 15° to 20°; IR vertical; IR // to CHASSARD – LAPINE METHOD (AXIAL PROJECTION)
long axis of femoral neck → PP: Seated; patient lead
→ RP: Femoral neck directly forward; posterior
→ CR: Horizontal surface of knee against
→ SS: Hip joint; acetabulum, edge of table; vertical axis
femoral head, and neck; of pelvis tilted 45°; patient
trochanters grasp the ankle
→ RP: Lumbosacral region
(level of greater
trochanter)
→ CR: Perpendicular or
Perpendicular to
coronal plane of
symphysis pubis (if
body flexion is
restricted)
CLEMENTS – NAKAYAMA MODIFICATION (MODIFIED → SS:
AXIOLATERAL PROJECTION) ▪ Relationship between femoral head and
→ PP: Supine; limb in acetabulum
neutral or slightly rotated ▪ Pelvic bones
position; IR vertical and ▪ Opacified rectosigmoid (Barium Enema)
its top back tilted 15°; IR → ER: For measuring the transverse or biischial diameter
// to long axis of femoral in pelvimetry
neck
→ RP: Femoral neck LEONARD – GEORGE METHOD (AXIOLATERAL
→ CR: 15° posteriorly PROJECTION)
→ SS: Lateral hip; → PP: Supine; pelvis elevated (places greater trochanter
acetabulum, femoral 4 inches above table top); unaffected side hip and knee
head, and neck; flexed; thigh abducted; foot rotated 15° to 20° internally
trochanters (to overcome anterversion of femoral neck); IR vertical;
→ ER: uses curved cassette
▪ Useful when → RP: Depression superior to greater trochanter
patient cannot → CR: Medially and inferiorly perpendicular
be positioned in → SS: Femoral head and neck trochanteric area
Danelius – Miller
method FRIEDMAN METHOD (AXIOLATERAL PROJECTION)
▪ Perform on → PP: Lateral recumbent;
patient with affected side against IR;
bilateral hip affected limb in true lateral;
fractures, unaffected limb rolled 10°
bilateral hip posteriorly
arthroplasty or → RP: Femoral neck
limitation of → CR: 35° cephalad
movement of → SS: Femoral head and neck;
unaffected leg trochanteric area; proximal
shaft of femur

cscc | 53
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
HSIEH METHOD (PA OBLIQUE PROJECTION) ▪ EXTERNAL OBLIQUE: semisupine; RPO (places
→ PP: RAO/LAO; hip in external
unaffected side elevated oblique); affected
40° to 45°; knee flexed; hip down; MSP
elevated forearm flexed 45° from table
→ RP: Between posterior → RP:
surface of iliac blade and ▪ INTERNAL
dislocated femoral head OBLIQUE: 2
→ CR: Perpendicular inches inferior to
→ SS: Ilium, hip joint, and ASIS of affected side
proximal femur ▪ EXTERNAL OBLIQUE:
→ ER: For demonstrating pubic symphysis
posterior dislocations of → CR: Perpendicular
the femoral head (in cases → SS: Acetabular rim
other than acute fracture → ER:
dislocations) ▪ Useful in diagnosing
fractures of acetabulum
▪ INTERNAL OBLIQUE: for
TEUFEL METHOD (PA AXIAL OBLIQUE METHOD) patient with suspected
→ PP: Semiprone; fracture of iliopubic
RAO/LAO; unaffected column (anterior) and
side elevated; MSP 38° posterior rim of
from table; knee of acetabulum
elevated side flexed ▪ EXTERNAL OBLIQUE: for
→ RP: Acetabulum or patient suspected
inferior level of coccyx (2 fracture of ilioischial
inches lateral to MSP column (posterior) and
toward side of interest) anterior rim of acetabulum
→ CR: 12° cephalad
→ SS: Fovea capitis; JUDET METHOD (AP OBLIQUE PROJECTION) – RAFERT –
superoposterior wall of LONG MODIFICATION (MODIFIED JUDET METHOD)
acetabulum →Same position as Judet Method
→ CR: Horizontal (for external oblique) and
Perpendicular/Vertical (for internal oblique)
→ ER: Trauma patient
JUDET METHOD (AP OBLIQUE PROJECTION)
→ JUDET AND LETOURNEL: Described two 45° posterior ANTERIOR PELVIC BONES
oblique position PA PROJECTION
→ PP: → PP: Prone; IR center to
▪ INTERNAL OBLIQUE: semisupine; LPO (places hip greater trochanter (level
in internal oblique); affected hip up; MSP 45° of pubic symphysis)
from table → RP: Distal coccyx
→ CR: Perpendicular
→ SS: Pubic symphysis
and ischia; obturator
foramina

cscc | 54
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
TAYLOR METHOD (AP AXIAL “OUTLET” PROJECTION) ILIUM
→ PP: Supine; ASISs AP OBLIQUE PROJECTION
equidistant from table; knee → PP: Supine;
flexed slightly RPO/LPO; unaffected
→ RP: 2 inches distal to side elevated 40°
superior border of pubic (places broad surface of
symphysis the wing of affected
→ CR: 20° to 35° cephalad ilium // to IR); shoulder,
(males); 30° to 45° (females) hip, and knee elevated
→ SS: Pelvic outlet → RP: Level of ASIS
▪ Superior and → CR: Perpendicular
inferior rami → SS:
without ▪ Unobstructed
foreshortening projection of
ala and sciatic
BRIDGEMAN METHOD (SUPEROINFERIOR AXIAL notches
“INLET” PROJECTION) ▪ Profile image of
→ PP: Supine; ASISs equidistant acetabulum
from table; knee flexed slightly; ▪ Broad surface
IR center at level of greater of the iliac wing
trochanters without
→ RP: Level of ASISs rotation
→ CR: 40° caudad
→ SS: Pelvic ring/inlet

LILIENFELD METHOD (SUPEROINFERIOR AXIAL

PROJECTION)
→ PP: Seated/erect; knees
slightly flexed; patient lean
backward 45° to 50°; arch the
back (places pubic arch in
vertical position)
→ RP: 1.5 inches superior to
symphysis pubis PA OBLIQUE PROJECTION
→ CR: Perpendicular → PP: Supine; RAO/LAO; unaffected side elevated 40°
→ SS: Pelvic ring/inlet (places affected ilium perpendicular to IR); patient rested
▪ Anterior pubic on forearm; knee of elevated side flexed
and ischial → RP: Level of ASIS
bones → CR: Perpendicular
▪ Symphysis pubis → SS: Ilium in profile
▪ Femoral head within acetabulum
STAUNIG METHOD (PA AXIAL INLET PROJECTION) → JUST REVERSE THE PREVIOUS POSITION
→ PP: Prone
→ RP: Symphysis pubis
→ CR: 35° cephalad
→ SS: Pelvic ring/inlet
▪ Anterior pubic and
ischial bones
▪ Symphysis pubis

cscc | 55
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
VERTEBRAL COLUMN SCOLIOSIS (ABNORMAL LATERAL CURVATURES)
ANATOMY
→ CERVICAL AND THORACIC SPINE
▪ VERTEBRAL COLUMN: FIVE (5) DIVISIONS
→ Cervical Vertebrae
→ Thoracic Vertebrae
→ Lumbar Vertebrae
→ Sacrum
→ Coccyx
▪ NORMAL SPINAL CURVATURES
▪ ABNORMAL CURVATURES
CERVICAL AND THORACIC SPINE
VERTEBRAL COLUMN: FIVE DIVISIONS

TYPICAL VERTEBRA

NORMAL SPINAL CURVATURES

TYPICAL VERTEBRAL ANATOMY

LORDOSIS AND KYPHOSIS (ABNORMAL CURVATURES)

cscc | 56
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
TYPICAL VERTEBRA (ARTICULAR PROCESSES) CERVICAL VERTEBRAE (7 VERTEBRAE)
→ C3 – C6 are typical cervical vertebrae

TYPICAL CERVICAL VERTEBRAE (C3 – C6)

▪ 3 unique characteristics
→ Bifid spinous process
ZYGAPOPHYSEAL JOINTS AND INTERVERTEBRAL → Articular pillar
FORAMINA → 3 foramina
→ Superior and inferior vertebral notches form
intervertebral foramina

INTERVERTEBRAL DISK (SAGITTAL VIEW OF VERTEBRAE)

INTERVERTEBRAL FORAMINA

cscc | 57
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
ATLAS THORACIC CHARACTERISTICS
→ DISTINCTIVE FEATURES:
▪ Rib articulations (facets and demifacets)
▪ Caudally pointed spinous processes

ATLAS AND AXIS – AXIS

T10 TO L2 RIB ARTICULATIONS

ATLAS AND AXIS

COSTOVERTEBRAL AND COSTOTRANSVERSE JOINTS

(RIBS 1 – 10)
AP OPEN MOUTH PROJECTION
→ Review anatomy parts A – G

cscc | 58
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
TYPICAL THORACIC VERTEBRAE (LATERAL OBLIQUE RADIOGRAPHIC ANATOMY REVIEW
VIEW) AP AXIAL PROJECTION

LATERAL CERVICAL SPINE

TYPICAL THORACIC VERTEBRA (LATERAL OBLIQUE

VIEW)

TYPICAL THORACIC VERTEBRAE (ZYGAPOPHYSEAL OBLIQUE CERVICAL SPINE POSITION

JOINTS AND INTERVERTEBRAL FORAMINA)

cscc | 59
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
AP THORACIC SPINE RIGHT INTERVERTEBRAL FORAMINA LPO

LATERAL THORACIC SPINE ZYGAPOPHYSEAL JOINTS

→ 70° to 75° LPO (20° to 25° from lateral)

ZYGAPOPHYSEAL JOINTS (LEFT LATERAL) INTERVERTEBRAL FORAMINA

→ Lateral view of thoracic spine

cscc | 60
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
POSITION – ANATOMY DEMONSTRATED ▪ T9 – T10 – Xiphoid process/ensiform
INTERVERTEBRAL ZYGAPOPHYSEAL ▪ T10 – Xiphoid tip
FORAMINA JOINTS → LUMBAR REGION
45° oblique (upside, ▪ L3 – Lower costal margin
Cervical Lateral
posterior oblique) ▪ L3 – L4 – Level of umbilicus
70° oblique (upside, ▪ L4 – Most superior aspect of iliac crest
Thoracic Lateral
posterior oblique)
→ SACRUM AND PELVIC REGION
CERVICAL SPINE TOPOGRAPHIC LANDMARKS ▪ S1 – ASIS
▪ COCCYX – Pubic symphysis and greater
trochanter
PATHOLOGY
→ CLAY SHOVELER’S FRACTURE
▪ Avulsion fracture of the spinous process in the
lower cervical and upper thoracic region
→ COMPRESSION FRACTURE
▪ Fracture that causes compaction of bone and a
decrease length or width
→ HANGMAN’S FRACTURE
▪ Fracture of the anterior arch of C2 due to
hyperextension
→ JEFFERSON’S FRACTURE
T – SPINE TOPOGRAPHIC LANDMARKS ▪ Comminuted fracture of the ring C1
→ HERNIATED NUCLEUS PULPOSUS
▪ Rupture or prolapsed of the nucleus pulposus
into the spinal canal
→ KYPHOSIS
▪ Abnormally increased convexity in the thoracic
curvature
→ LORDOSIS
▪ Abnormally increased concavity of the cervical
and lumbar spine
→ OSTEOPETROSIS
▪ Increased density of atypically soft bone
→ OSTEOPOROSIS
▪ Loss of bone density
→ SCHEUERRMANN’S DISEASE
TERMINOLOGY AND PATHOLOGY ▪ Adolescent kyphosis
TOPOGRAPHIC LANDMARKS ▪ Kyphosis with onset in adolescence
→ CERVICAL REGION → SCOLIOSIS
▪ C1 – Mastoid tip ▪ Lateral deviation of the spine with possible
▪ C2 – C3 – Gonion vertebral rotation
▪ C5 – Thyroid cartilage → SPINA BIFIDA
▪ C7 – Vertebral prominens ▪ Failure of the posterior encasement of the spinal
→ THORACIC REGION cord to close
▪ T1 – 2 inches superior to sternal notch → SPONDYLOLISTHESIS
▪ T2 – T3 – Manubrial notch/superior margin of ▪ Forward displacement of a vertebra over a
scapula/suprasternal notch lower vertebra, usually L5 – S1
▪ T4 – T5 – Sternal angle → SPONDYLOLYSIS
▪ T7 – Inferior angle of scapula ▪ Separation of the pars interarticularis
cscc | 61
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ ODONTOID FRACTURE JUDD METHOD (PA PROJECTION)
▪ Disruption of the arches of C1 → PP: Prone; neck extended; chin against the table; IR
→ TEARDROP BURST FRACTURE centered to throat
▪ Comminuted vertebral body with triangular (level of upper
fragments avulsed from anteroposterior border margin of thyroid
caused by compression with hyperflexion in the cartilage); OML 37°
cervical region to IR; MSP
→ TRANSITIONAL VERTEBRA perpendicular to
▪ It occurs when the vertebra takes on a IR; chin and
characteristic of the adjacent region of the spine mastoid tip
→ CHANCE FRACTURE perpendicular
▪ Fracture through the vertebral body caused by → RP: Distal to
hyperflexion force level of mastoid
→ WHIPLASH INJURY tips at MSP
▪ Damage to the ligaments, vertebrae, or spinal → CR: Perpendicular
cord caused by sudden jerking back of the head → SS: Dens and atlas within foramen magnum
and neck
KASABACH METHOD (AP AXIAL OBLIQUE PROJECTION)
ATLANTO – OCCIPITAL JOINTS
– R AND L HEAD ROTATIONS
AP OBLIQUE PROJECTION (R AND L HEAD ROTATIONS)
→ PP: Supine; head rotated
→ PP: Supine; head
40° to 45°; IOML
rotated 45° to 60° away
perpendicular
from side of interest;
→ RP: Midway between
IOML perpendicular to IR
outer canthus and EAM
→ RP: 1 inch anterior to
→ CR: 10° to 15° caudad
the EAM
→ SS: Dens
→ CR: Perpendicular
→ ER: Recommended in
→ SS: Atlanto – occipital
conjunction with AP and
joints between orbit and
Lateral projections
ramus of mandible
▪ Dens is well
demonstrated
→ ER: Alternative
ALBERS – SCHONBERG AND GEORGE METHOD (AP
projection when a patient
“OPEN – MOUTH” PROJECTION)
cannot be adjusted in the open – mouth position
→ PP: Supine; MSP
perpendicular; open
C1 AND C2
mouth as wide as
FUCHS METHOD (AP PROJECTION)
possible
→ PP: Supine; chin extended;
→ RP: Midpoint of
chin tip and mastoid tip
open mouth
perpendicular to IR; MSP
→ CR: Perpendicular
perpendicular to IR
→ SS: Atlas and axis
→ RP: Distal to chin tip
→ CR: Perpendicular
→ SS: Dens within
foramen magnum
→ ER: Recommended
when upper half of dens
is not clearly shown in
open – mouth position
cscc | 62
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
LATERAL PROJECTION (prevents superimposition of mandibular rami & spine);
→ PP: Supine (dorsal MSP horizontal to IR
decubitus); IR vertical; MSP → RP: C4
// to IR; MSP perpendicular → CR: Horizontal
to table; neck slightly → SS: C1 – C7
extended (mandibular rami ▪ Articular pillars
does not overlap atlas or ▪ Zygapophyseal
axis) joints (C3 – C7)
→ RP: 1inch distal to ▪ Spinous
mastoid tip processes
→ CR: Perpendicular
→ SS: Atlas and axis; LATERAL PROJECTION (HYPERFLEXION AND
atlanto – occipital joints HYPEREXTENSION)
→ PANCOAST, PENDERGRASS AND SCHAEFFER → PP: Seated/upright;
RECOMMENDATION: patient in true lateral
▪ Head rotated slightly position; MSP horizontal to IR
▪ RATIONALE: to prevent superimposition of ▪ HYPERFLEXION:
laminae and atlas head drop forward;
draw chin as close as
CERVICAL VERTEBRAE
possible to the chest
AP AXIAL PROJECTION
▪ HYPEREXTENSION:
→ PP: Supine/upright;
chin elevated as
chin extended; occlusal
much as possible
plane perpendicular to
→ RP: C4
IR (prevents
→ CR: Horizontal
superimposition of
→ SS: IV disks and zygapophyseal
mandible and
joints
midcervical vertebrae)
▪ HYPERFLEXION:
→ RP: C4
→ C1-C7
→ CR: 15° to 20°
→ Elevated and widely
cephalad
separated spinous processes
→ SS: C3 – T2
▪ HYPEREXTENSION:
▪ Interpediculate
→ C1-C7
spaces
→ Depressed spinous
▪ IV disk spaces
processes
▪ Superimposed
→ ER:
transverse and
▪ For functional studies
articular processes
(motility) of cervical
→ ER: Used to demonstrate
vertebrae
the presence or absence of
▪ To demonstrate normal AP
cervical ribs
movement or absence of
movement
GRANDY METHOD (LATERAL PROJECTION)
→ PP: Seated/upright;
patient in true lateral
position; shoulder
rotated posteriorly or
AP AXIAL OBLIQUE PROJECTION
anteriorly (round
→ BARSONY AND KOPPENSTEIN: described this
shouldered); chin
projection
slightly elevated
cscc | 63
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ PP: Supine or upright OTTONELLO/CHEWING/WAGGING JAW METHOD (AP
(more comfortable); PROJECTION)
RPO/LPO; body rotated → PP: Supine; MSP
45°; chin perpendicular to IR; chin
protruded/elevated elevated; upper incisors
→ RP: C4 and mastoid tips
→ CR: 15° to 20° cephalad perpendicular to IR;
→ SS: Intervertebral mandible in chewing
foramina & pedicles (farthest motion during exposure
from IR) → RP: C4
→ BOYLSTON SUGGESTION: → CR: Perpendicular
▪ Functional studies in → SS: Entire cervical
oblique projection column
→ RATIONALE: to → ER: To blur the
demonstrate fracture of articular process mandibular shadow to
dislocation/subluxation demonstrate all cervical
vertebrae

VERTEBRAL ARCH/PILAR/LATERAL MASS PROJECTION

(AP AXIAL PROJECTION)
→ PP: Supine; shoulder
depressed; MSP
perpendicular to IR;
neck hyperextended
→ RP: C7
→ CR: 25o caudad; 20°
PA AXIAL OBLIQUE PROJECTION to 30o caudad (range)
→ PP: Prone or upright → SS: Vertebral arch
(more comfortable); structures
RAO/LAO; body rotated ▪ Superior and
45°; shoulder rested inferior articular
against IR; chin processes
protruded/elevated (pillars)
→ RP: C4 ▪ Zygapophyseal
→ CR: 15° to 20° caudad joints between articular processes
→ SS: Intervertebral ▪ Upper three
foramina and pedicles of thoracic
(closest to IR) vertebrae
▪ Laminae
▪ Spinous
processes
→ ER: Useful for
demonstrating the
cervicothoracic
spinous processes in
patients with
whiplash injury

cscc | 64
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
VERTEBRAL ARCH/PILAR/LATERAL MASS PROJECTION ▪ UPRIGHT
(PA AXIAL PROJECTION) (TWINNING): arm
→ PP: Prone; head rested against IR; neck fully extended; closes to IR
MSP perpendicular to IR extended; elbow
→ RP: C7 flexed; forearm
→ CR: 40o cephalad; 35° to 45o cephalad (range) rested on head
→ SS: Vertebral arch structures → RP: C7 – T1 interspace
→ JUST REVERSE THE PREVIOUS POSITION → CR: Perpendicular
(shoulder well depressed);
VERTEBRAL ARCH/PILAR/LATERAL MASS PROJECTION 3° to 5o caudad (can’t be
(AP AXIAL OBLIQUE PROJECTION) – R AND L HEAD depressed sufficiently)
ROTATIONS → SS: Cervicothoracic
→ PP: Supine; head region (C7 – T1)
rotated 45° to 50o (C2 – → ER: Performed when shoulder superimposition
C7 articular processes) obscures C7 on a lateral cervical spine projection
or 60° to 70o (C6 – T4 → MONDA RECOMMENDATION:
articular processes); ▪ CR: 5° to 15o cephalad
turn jaw away from ▪ To better demonstrate IV disk spaces
side of interest
→ RP: C7 THORACIC VERTEBRAE
→ CR: 35o AP PROJECTION
caudad; 30° to 40o → PP: Supine/upright; MSP
caudad (ranges) perpendicular to IR; hips
→ SS: Vertebral and knees flexed (to reduce
arch structures kyphosis); place support
→ ER: Used to under knees
demonstrate → RP: T7 (between jugular
vertebral arches notch and xiphoid process)
when the patient → CR: Perpendicular
cannot → SS: T1 – T12
hyperextend head for AP/PA axial projection ▪ IV disk spaces
▪ Transverse processes
VERTEBRAL ARCH/PILAR/LATERAL MASS PROJECTION ▪ Costovertebral
(PA AXIAL OBLIQUE PROJECTION) articulation
→ Reverse the CR (cephalad)
LATERAL PROJECTION
SWIMMER’S TECHNIQUE (LATERAL PROJECTION) → PP: Lateral recumbent or
→ PP: Humeral head upright (Oppenheimer); left
moved anteriorly or side against the table (places
posteriorly; depress heart closer to IR) MSP
shoulder away from IR; horizontal to IR; hips and
MSP horizontal to IR; knees flexed; arms at right
breathing technique angle to body (to elevate ribs
▪ LATERAL enough); place support under
RECUMBENT lower thoracic spine
(PAWLOW): → RP: T7
head elevated
on patient’s
arm;

cscc | 65
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ CR: Perpendicular LUMBAR-LUMBOSACRAL VERTEBRAE
(with support); 10° to AP/PA PROJECTION (PA PROJECTION) – OPTIONAL)
15o cephalad (without → PP: Supine/upright;
support); 10o (female) elbow flexed; hands on
or 15o (male) upper chest
→ SS: T1 – T12 ▪ Hips & knees
▪ IV disk spaces flexed
▪ Intervertebral → Reduces
foramina lumbar lordosis
▪ Lower spinous → Places back in
processes contact with table
→ Reduces
distortion of
vertebral bodies
→ Better
delineation of IV
disk
→ RP: L4 (for
lumbosacral); L3 (for lumbar
spine only)
FUCHS METHOD (AP OBLIQUE PROJECTION) → CR: Perpendicular
→ PP: Supine/upright; RPO/LPO; body rotated 20 o → SS: Lumbar bodies
posteriorly; MCP 70o from IR ▪ IV disk spaces
→ RP: T7 ▪ Interpediculate
→ CR: Perpendicular spaces
→ SS: Zygapophyseal or apophyseal joints (farthest from ▪ Laminae
IR) ▪ Spinous and
transverse processes
▪ Sacrum, coccyx, and pelvic bones (larger IR)

OPPENHEIMER METHOD (PA OBLIQUE PROJECTION)

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

cscc | 66
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ RP: L4 (for ZYGAPOPHYSEAL JOINTS
lumbosacral); L3 (for AP OBLIQUE PROJECTION
lumbar spine only) → PP: Semisupine/upright;
→ CR: Perpendicular RPO/LPO; body rotated 45o
(with support); 5° to or 60o (L5 – S1 zygapophyseal
8o caudad (without joints and articular
support); 5o (male) or processes)
8o (female) → RP:
→ SS: Intervertebral ▪ LUMBAR REGION: 2
foramina of L1-L4 inches medial to
only; L5 intervertebral elevated ASIS & 1.5
foramina (Oblique inches superior to
Projection) iliac crest (L3)
▪ 5TH
ZYGAPOPHYSEAL
JOINT: 2 inches
medial to
elevated ASIS &
midway between
iliac crest and
ASIS
L5 – S1 LUMBOSACRAL JUNCTION → CR: Perpendicular
LATERAL PROJECTION → SS: Zygapophyseal
→ PP: Lateral /apophyseal joints
recumbent or (closest to IR)
upright; affected ▪ Scottie dog
side against IR; hips → Superior
and knees flexed; articular process
MCP perpendicular (ear)
to IR; place support → Transverse
under lower thorax process (nose)
(places spine in true → Pedicle (eye)
horizontal position) → Part interarticularis (neck)
→ RP: 2 inches posterior → Lamina (body)
to ASIS and 1.5 inches → Inferior articular
inferior to iliac crest process (foot)
→ CR: Perpendicular (with → NOTE:
support); 5° to 8o caudad ▪ Majority (L3 – S1) of
(without support); 5o zygapophyseal joints
(male) or 8o (female) (45o body rotation)
→ SS: Lumbosacral ▪ L1 – L2 and L2 – L3
junction (AP; 25% only)
▪ L4 – L5 and L5 – S1
(LATERAL; small %
age)

PA OBLIQUE PROJECTION
→ PP: Semiprone/upright; RAO/LAO; body rotated 45o or
60o (L5 – S1 zygapophyseal joints & articular processes)

cscc | 67
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ RP: 1.5 inches → CR: 45o cephalad
superior to iliac crest (Ferguson); 30° to 35o
and 2 inches lateral cephalad; 30o (male)
to palpable spinous or 35o (female);
process → SS: Lumbosacral
→ CR: Perpendicular joint; symmetric
→ SS: Zygapophyseal sacroiliac joints
/apophyseal joints → MEESE RECOMMENDATION:
(farthest from IR) ▪ PP: Prone
▪ Scottie dog (places
sacroiliac joints
nearly
horizontal to
CR)
▪ RP: 2 inches
distal to L5 (level
of ASISs)
▪ CR: Perpendicular
FIFTH LUMBAR
KOVACS METHOD (PA AXIAL OBLIQUE PROJECTION)
→ PP: Lateral
recumbent; RAO/LAO;
pelvis rotated 30o
anteriorly from lateral;
sandbags under the FERGUSON METHOD (PA AXIAL PROJECTION)
flexed uppermost knee → PP: Prone
(prevent too much → RP: L4
rotation of the hips) → CR: 35o caudad
→ RP: L5; superior edge → SS: Lumbosacral
of the crest (entrance) joint; symmetric
→ CR: 15° to 30o caudad sacroiliac joints
→ SS: L5 intervertebral
foramina

SACROILIAC JOINTS
AP OBLIQUE PROJECTION
→ PP: Semisupine; RPO/LPO;
body rotated 25° to 30o
→ RP: 1 inch medial to
elevated ASIS
LUMBOSACRAL AND SACROL JOINTS → CR: Perpendicular
FERGUSON METHOD (AP AXIAL PROJECTION) → SS: Sacroiliac joint (farthest
→ PP: Supine; lower limb extended; thigh abducted from IR PA OBLIQUE: closest to
→ RP: 1.5 inches superior to pubic symphysis IR)

cscc | 68
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
remove the opposite one; second leg hanging
free
→ RP: Pubic symphysis
→ CR: Perpendicular
→ SS: Pubic symphysis
→ CHAMBERLAIN
RECOMMENDATIONS:
▪ For abnormal
AP AXIAL OBLIQUE PROJECTION sacroiliac motion
→ PP: Semisupine; RPO/LPO; body rotated 25° to 30o ▪ LATERAL
→ RP: 1 inch distal to elevated ASIS PROJECTION:
→ CR: 20° to 25o cephalad → Upright
→ SS: Sacroiliac joint (farthest from IR) → Centered to
lumbosacral
PA OBLIQUE PROJECTION junction
→ PP: Semiprone; ▪ 2 PA PROJECTIONS OF PUBIC BONES:
RAO/LAO; body rotated → Upright
25° to 30o → Weight – bearing on alternate limbs
→ RP: 1 inch medial to → To demonstrate pubic symphysis reaction by
elevated ASIS a change in the normal relation of pubic bones
→ CR: Perpendicular
→ SS: Sacroiliac joint SACRUM
(closest to IR) AP/PA AXIAL PROJECTION
→ PP: Supine or prone
(patient with painful
injury/destructive
disease)
→ RP: 2 inches
superior to pubic
symphysis (supine);
visible sacral curve (prone)
→ CR: 15o cephalad (supine); 15o caudad (prone)
→ SS: Sacrum free of foreshortening

PUBIC SYMPHYSIS
CHAMBERLAIN METHOD (PA PROJECTION)
→ PP: Upright; standing on two
blocks
▪ FIRST EXPOSURE: LATERAL PROJECTION
remove one blocks; one → PP: Lateral
leg hangs with no recumbent; interiliac
muscular resistance plane perpendicular to
▪ SECOND EXPOSURE: IR; pelvis and shoulder in
replace support under true lateral position
foot that was hanging;

cscc | 69
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ RP: 3.5 inches posterior to ASIS SACRAL VERTEBRAL CANAL AND SACROILIAC JOINTS
→ CR: Perpendicular NOLKE METHOD (AXIAL PROJECTION)
→ SS: Sacrum → PP: Seated; MCP of body perpendicular to horizontal
axis of Bucky; MSP perpendicular to midline of the grid;
lean forward (to place upper, middle or lower portion of
sacral canal vertical); grasp the legs/ankles
→ RP: Sacrum
→ CR: Perpendicular to long axis of sacrum
→ SS:
▪ SPINE SLIGHTLY FLEXED:
→ Lower sacral vertebral
canalà
COCCYX → Junction of sacrum and
AP/PA AXIAL PROJECTION coccyx and last lumber
→ PP: Supine or prone vertebra
(patient with painful ▪ MODERATE FLEXION (BENDING FORWARD):
injury/destructive → Cross section of
disease) upper and lower sacral
→ RP: 2 inches superior vertebral canal
to pubic symphysis → Sacroiliac joints
(supine); Palpable ▪ ACUTE FLEXION
coccyx (prone) (BENDING FORWARD):
→ CR: 10o caudad (supine); → Upper sacral vertebral canal projected into
10o cephalad (prone) the angle formed by ascending rami of ischial
→ SS: Coccyx free of bones just posterior
superimposition to pubic symphysis
→ Spinous process of
L5 projected across
the shadow of the
LATERAL PROJECTION canal
→ PP: Lateral
recumbent; interiliac
plane perpendicular to
IR; pelvis and shoulder in
true lateral position
→ RP: 3.5 inches
posterior and 2 inches
inferior to ASIS
→ CR: Perpendicular
→ SS: Coccyx

LUMBAR INTERVERTEBRAL DISK

WEIGHT – BEARING METHOD (PA PROJECTION) – R AND
L BENDING
→ PP: Upright; patient bending to right and left; lean
directly lateral as far as possible
→ RP: Perpendicular to L3

cscc | 70
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ CR: 15° to 20o caudad Right SIJ
LPO - 25° (joint
→ SS: Lower thoracic and to 30° up) ┴
lumbar region AP Oblique RPO - 25° Left SIJ ┴
→ ER: to 30° (joint
SACROILIAC up)
▪ Perform for JOINTS Left SIJ
LAO - 25°
demonstration of to 30°
(joint
the mobility of down) ┴
PA Oblique
Right SIJ ┴
intervertebral RAO - 25°
(joint
to 30°
joints down)
Left AR
▪ Involvement of the (side
joints (Patient with LPO - 45° down) ┴
AP Oblique RPO - 45° Right AR ┴
IV disk protrusion)
(side
→ DUNCAN & HOEN AXILLIARY RIBS down)
RECOMMENDATION: Right AR
▪ PA projection be PA Oblique
LAO - 45° (side up) ┴
RAO - 45° Left AR ┴
used (side up)
▪ RATIONALE: IV
ZYGAPOPHYSEAL INTERVERTEBRAL
disks more nearly ANATOMY
JOINT FORAMINA
horizontal to CR
Cervical Lateral Oblique - 45°
RULES OF OBLIQUE Thoracic Oblique - 70° Lateral
ANATOMY OF Lumbar Oblique - 45° Lateral
PROJECTION POSI/° SS CR
INTEREST
15-20o
Right IF cephalad
LPO - 45° (side up)
AP Oblique RPO - 45° Left IF 15-20o
(side up) cephalad
CERVICAL
(Intervertebral
Left IF 15-20o
Foramina) (side caudad
LAO - 45° down)
PA Oblique
RAO - 45° Right IF 15-20o
(side caudad
down)
Right ZJ
(joints
LPO - 70° up) ┴
AP Oblique RPO - 70° Left ZJ ┴
(joints
THORACIC
up)
(Zygapophyseal
Left ZJ
Joints) (joints
LAO - 70° down) ┴
PA Oblique
RAO - 70° Right ZJ ┴
(joints
down)
Left ZJ
(joints
LPO - 45° down) ┴
AP Oblique RPO - 45° Right ZJ ┴
(joints
LUMBAR
down)
(Zygapophyseal
Right ZJ
Joints) (joints
LAO - 45° up) ┴
PA Oblique
RAO - 45° Left ZJ ┴
(joints
up)

cscc | 71
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
SKULL ▪ Fracture of the zygomatic arch and orbital
ANATOMY floor/rim and dislocation of the frontozygomatic
→ CRANIAL BONES (8) suture
▪ Frontal Bone → MASTOIDITIS
▪ Ethmoid Bone ▪ Inflammation of mastoid antrum and air cells
▪ Parietal Bones → PAGET’S DISEASE
▪ Sphenoid Bone ▪ Thick, soft bone marked by bowing fractures
▪ Occipital Bone → SINUSITIS
▪ Temporal Bones ▪ Inflammation of one or more of the paranasal
→ FACIAL BONES (14) sinuses
▪ Nasal Bones → TMJ SYNDROME
▪ Lacrimal Bones ▪ Dysfunction of the temporomandibular joint
▪ Maxillary Bones
CRANIUM
▪ Zygomatic Bones
LATERAL PROJECTION
▪ Palatine Bones
→ PP: Seated erect/semiprone;
▪ Inferior Canal Conchae
Midsagittal plane parallel to IR;
▪ Vomer
IOML is perpendicular to front
▪ Mandible
edge of IR; Interpupillary line is
SKULL PLANES POINTS & LINE perpendicular to IR
→ Midsagittal plane (MSP) → RP:
→ Interpupillary line (IPL) ▪ 2 inches superior to
→ Acanthion EAM – general survey
→ Outer canthus ▪ ¾ inch superior and ¾
→ Infraorbital margin inch anterior to the
→ External acoustic meatus (EAM) EAM – sella turcica
→ Orbitalmeatal line (OML) → CR: Perpendicular
→ Infraorbitomeatal line (IOML)/Frankpurt Line → SS: Sella turcica
→ Acanthiomeatal line (AML)
→ Mentomeatal line (MML) LATERAL PROJECTION (DORSAL DECUBITUS OR SUPINE
→ Between OML & IOML: 7o difference LATERAL POSITION)
→ Between OML & GML: 8o difference → PP: Seated
erect/semiprone;
PATHOLOGY
Midsagittal plane
→ BASAL FRACTURE
parallel to IR; IOML is
▪ Fracture located at the base of the skull
perpendicular to front
→ BLOWOUT FRACTURE
edge of IR; Interpupillary
▪ Fracture of the floor of the orbit
line is perpendicular to
→ CONTRE–COUP FRACTURE
IR
▪ Fracture to one side of a structure caused by
→ RP: 2 inches superior
trauma to the other side
to EAM
→ DEPRESSED FRACTURE
→ CR: Perpendicular
▪ Fracture causing a portion of the skull to be
→ SS: Sella turcica
depressed into the cranial cavity
→ LE FORT FRACTURE
▪ Bilateral horizontal fractures of the maxillae
→ LINEAR FRACTURE
▪ Irregular or jagged fracture of the skull
→ TRIPOD FRACTURE

cscc | 72
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
CALDWELL METHOD (PA AND PA AXIAL PROJECTION) perpendicular to IR;
→ PP: Seated erect/semiprone; Have the patient rest on When the patient
forehead and nose; cannot flex neck, place
Midsagittal plane IOML perpendicular to
perpendicular to midline of IR and then increase CR
grid device; OML is angulation 7°; Place top
perpendicular to IR of IR at the level of
→ RP: To exit nasion cranial vertex
→ CR: → RP: 2 ½ inches superior to glabella and passes through
▪ PA: Perpendicular the level of EAM
▪ CALDWELL METHOD: → CR:
15° caudad ▪ OML: 30° caudad
▪ SUPERIOR ORBITAL ▪ IOML: 37° caudad
FISSURES: 20° to 25° ▪ FORAMEN MAGNUM AND JUGULAR
caudad FORAMINA: 40° to 60°
▪ FORAMEN ROTUNDUM: 25° to 30° caudad ▪ POSTERIOR PORTION OF THE CRANIAL VAULT:
perpendicular
→ SS: (Remember: SPPOP)
▪ Symmetric view of the petrous pyramid
▪ Posterior portion of the foramen magnum
▪ Posterior clinoid processes within the shadow of
the foramen magnum and dorsum sellae
CALDWELL METHOD (AP AND AP AXIAL PROJECTION) ▪ Occipital bone
→ PP: Supine; Midsagittal ▪ Posterior portion of the parietal bones
plane and OML → RESPIRATION: Suspended
perpendicular to midline
of grid device; Place arms
at sides or across chest
→ RP: Nasion
→ CR:
• AP: Perpendicular
• AP AXIAL: 15°
cephalad
HAAS METHOD (PA AXIAL PROJECTION)
→ PP: Seated
erect/prone; Have
the patient rest head
on forehead and
nose; Place arms in
comfortable
position; Adjust
TOWNE METHOD (AP AXIAL PROJECTION) shoulders to lie in
→ PP: Seated erect/supine; same transverse
Center midsagittal plane to plane; Adjust head
midline of grid device and so that MSP and OML are perpendicular to IR
adjust to make → RP: 1 ½ inches inferior to external occipital
perpendicular; Have the protruberance (inion) and exiting 1 ½ inches superior to
patient’s neck flexed, and nasion
adjust the OML → CR: 25° cephalad

cscc | 73
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ SS: SCHULLER METHOD (VERTICOSUBMENTAL
▪ Dorsum sellae within the shadow of the foramen PROJECTION) (use when SMV is contraindicated)
magnum → PP: Prone; Rest the patient’s chin on the table with
▪ Occipital region of the cranium neck fully extended; Position midsagittal plane
▪ Symmetric view of the petrous pyramid perpendicular to midline of
→ RESPIRATION: Suspended grid device; Place arms at
sides
→ RP:
▪ Sella turcica
perpendicular to
IOML entering
between angles of
CRANIAL BASE mandible
SCHULLER METHOD (SUBMENTOVERTICAL ▪ ¾ inch anterior to
PROJECTION) the level of EAM
→ PP: Seated erect at head → CR: Perpendicular
unit/supine on elevated → SS: Cranial base and sphenoidal sinuses
table support; Have the
patient extend neck and LYSHOLM METHOD (AXIOLATERAL POSITION)
rest head on vertex; Center → PP: Seated-erect/semiprone; Center the EAM of the
and adjust MSP side being examined to the midline of the table and
perpendicular to IR; Adjust adjust the head in a true lateral position; Extend neck and
IOML parallel to plane of IR place the IOML parallel with the transverse axis of the
if possible cassette
→ RP: → CR: 1 inch (2.5 cm) distal to the lower EAM at an angle
▪ Sella turcica of 30° to 35° caudad
perpendicular to → SS:
IOML entering ▪ An oblique position of the lateral aspect of the
between angles of base of the cranium closest to film is
mandible demonstrated
▪ ¾ inch anterior to the ▪ Lysholm is recommended for patients who
level of EAM cannot extend their head enough for a
→ CR: Perpendicular satisfactory submentovertical projection
→ SS: CRANIUM, SELLA TURCICA, AND EAR
▪ Symmetric projection of the petrosae VALDINI METHOD (PA AXIAL POSITION)
▪ Mastoid processes → PP: Seating; Rest the patient’s upper frontal region of
▪ Auditory tubes (eustachian tubes) the skull on the table and adjust it so that the MSP is
▪ Foramina ovale and spinosum- perpendicular to the midline of the grid; IOML 50 degrees
best shown with IR for demonstration of dorsum sellae, internal
▪ Carotid canals auditory canals and labyrinths of the ear; OML 50
▪ Sphenoidal sinuses degrees with the IR for demonstration of the external
▪ Mandible auditory canals, tympanic cavities and eustachian tubes
▪ Maxillary sinuses → CR: Perpendicular to IR
▪ Nasal septum ▪ Center to a point 0.5 cm distal to the nasion for
▪ Dens of the axis demonstration of dorsum sellae
▪ Atlas ▪ Center to the foramen magnum at or slightly
→ RESPIRATION: Suspended above the level of the EAM to demonstrate of
the petrosae

cscc | 74
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
SELLA TURCICA PA AXIAL PROJETION
LATERAL PROJECTION → IR: 8 x 10 inches
→ IR: 8 x 10 inches → PP: Patient prone or
→ PP: Seated- seated erect; Arms in
upright/semiprone; MSP comfortable position;
parallel to the plane of the IR; Forehead and nose
Radiolucent sponge is rested against the VCH;
required for obese patients; OML perpendicular to IR;
MSP parallel to IR and IPL MSP perpendicular to IR
perpendicular to IR; IOML → RP: To exit glabella
parallel with transverse axis → CR: 10° cephalad
of the IR → SS: Tuberculum sellae
→ RP: ¾ inch anterior and ¾ and clinoid process
inch superior to the EAM
→ CR: Perpendicular
→ SS: Sella turcica
region of the cranium

DORSUM SELLAE AND POSTERIOR CLINOID PROCESSES

AP AXIAL PROJECTION
→ IR: 8 x 10 inches
→ PP: Seated upright or
supine; Arms alongside the
body; MSP perpendicular to
the midline of the grid
device; IOML perpendicular
to the plane of the IR OPTIC CANAL AND FORAMEN
→ RP: Entering the upper RHESE METHOD (PARIETOORBITAL OBLIQUE
forehead and passing PROJECTION)
through the head at the level → IR: 8 x 10 inches
of the EAM → PP: Seated erect or
→ CR: semiprone; Center affected
▪ 37 degrees caudal orbit to IR; Have patient
projects the dorsum rest head on zygoma, nose
sellae and posterior and chin; Adjust AML
clinoid processes perpendicular to IR; Rotate
within the foramen MSP 53° from IR
magnum → RP: 1 inch superior and 1
▪ 30 degrees caudal to inch posterior to elevated
IOML projects the TEA
dorsum and → CR: Perpendicular
tuberculum sellae → SS: Optic canal, and optic foramen
and anterior clinoid
processes through
the occipital bone
above the level of the
foramen magnum
→ SS: Sellar region and petrous pyramid

cscc | 75
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
RHESE METHOD (ORBITOPARIETAL OBLIQUE INFERIOR ORBITAL FISSURES
PROJECTION) BERTEL METHOD (PA AXIAL PROJECTION)
→ IR: 8 x 10 inches → IR: 8 x 10 inches
→ PP: Seated-upright → PP: Prone or seated-
or supine position; upright; Patient’s arms
Arms alongside the alongside the body;
body; Rotate head so Patient’s forehead and
that MSP forms an nose rested against the
angle of 53° to the VCH; MSP perpendicular
plane of the IR; AML to IR; IOML
perpendicular to IR perpendicular to IR
→ RP: Enters the → RP:
uppermost orbit at ▪ To enter
inferior and lateral approximately 3
quadrant inches below
→ CR: Perpendicular the external
→ SS: Optic canal “on end” and optic foramen occipital
protruberance
▪ Exiting to the
nasion
→ CR: 20° to 25° cephalad
→ SS: Orbital floor, orbital fissure, pterygoid lamina
EYE
SUPERIOR ORBITAL FISSURES LATERAL PROJECTION
PA AXIAL PROJECTION → IR: 8 x 10 inches
→ IR: 8 x 10 inches → PP: Semi-prone; MSP
→ PP: Prone or seated- parallel to the plane of
upright; Forearms the IR; OML
alongside the head with perpendicular to IR
elbows flexed; Patient’s → RP: Through the outer
forehead and nose canthus
rested against the grid → CR: Perpendicular
device with MSP → SS: Orbital region
centered and → NOTE: Instruct the
perpendicular to IR; OML patient to look straight
perpendicular to IR ahead for the exposure
→ RP: Exiting at the level
of the inferior margin of
the orbit PA AXIAL PROJECTION
→ CR: 20° to 25° caudad → IR: 8 x 10 inches
→ SS: Petrous portion temporal bone → PP: Seated erect or
prone; Forehead and
nose in contact with the
IR; Arms alongside the
head; OML perpendicular
to IR
→ RP:
▪ ¾ inch distal to
the nasion through the mid orbits
cscc | 76
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ Instruct the patient plane of the IR; Average patient’s nose will be about ¾
to close the eyes inch away from the grid device
and to concentrate → RP: Exit to the acanthion
on holding them → CR: Perpendicular
still for the → SS: Orbit, maxillae and zygomatic arches
exposure
→ CR: 30° caudad MODIFIED WATERS METHOD (MODIFIED
PARIETOACANTHIAL PROJECTION)
→ IR: 8 x 10 inches
→ PP: Seated-erect or
FACIAL BONE
prone; Arms alongside the
LATERAL PROJECTION – R OR L POSITION
body; Rest the patient head
→ IR: 8 x 10 inches
on the tip of the extend
→ PP: Semiprone or
chin; OML must form 55° in
obliquely seated before a
relation to the plane of the
vertical grid device; MSP
IR
parallel to plane of the IR;
→ RP: Exit to the
IPL perpendicular to IR
acanthion
→ RP: Entering the lateral
→ CR: Perpendicular
surface of the zygomatic
→ SS: Orbit, maxillae
bone halfway between outer canthus and the EAM
and zygomatic arches
→ CR: Perpendicular
→ SS: Bone of the face
REVERSE WATERS METHOD (ACANTHIOPARIETAL
PROJECTION)
→ IR: 8 x 10 inches
→ PP: Supine position; The patient’s chin up, adjust the
extension of the neck so that the OML forms a 37° to the
FACIAL PROFILE
plane of the IR; MML perpendicular to the IR
LATERAL PROJECTION
→ RP: Enter the acanthion
→ IR: 8 x 10 inches
→ CR: Perpendicular
→ PP: Semiprone or
→ SS: Superior facial Bone
seated position
before a VCH; Head in
lateral position and
MSP parallel and IPL;
Perpendicular to the plane of the IR
→ RP: Lateral surface of the zygomatic bone and halfway
between the outer canthus and the EAM
→ CR: Perpendicular
→ SS: Bony and Tissue structure
CALDWELL METHOD (PA AXIAL PROJECTION)
→ PP: Seated erect or
WATERS METHOD (PARIETOACANTHIAL PROJECTION)
semiprone; Have
→ IR: 8 x 10 inches
patient rest head on
→ PP: Seated-erect or
forehead and nose;
prone; Arms alongside the
Position midsagittal
body; Rest the patient
plane perpendicular to
head on the tip of the
midline of grid device;
extend chin; OML must
form 37° in relation to the
cscc | 77
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
OML is perpendicular to IR → RP: Entering to the throat at the level of 1 inch
→ RP: To exit nasion posterior to the outer canthi
→ CR: → CR: Perpendicularly directed to IOML
▪ Caldwell method: 15° caudad → SS: Zygomatic arch
▪ For the demonstration of orbital rims,
particularly the orbital floor, 30 degrees caudal is
used. (exaggerated Caldwell method)

TANGENTIAL PROJECTION
→ IR: 8 x 10 inches
→ PP: Seated or supine
▪ SEATED: Neck
hyperextended
NASAL BONE and head resting
LATERAL PROJECTION – R AND L POSITION on vertex; IOML
→ IR: 8 x 10 inches parallel as
→ PP: Semiprone position; possible to the
MSP parallel and IPL plane of the IR;
perpendicular to the plane Rotate the MSP approximately 15° toward the
of the IR; Support the side being examine; Tilt the top of the head
mandible to prevent approximately 15° away from the side being
rotation examine; This rotation and tilt ensure that the CR
→ RP: ½ inch distal to the is tangent to the lateral surface of the skull
nasion placing the zygomatic arch onto the IR
→ CR: perpendicular ▪ SUPINE: Head resting on the vertex; IOML nearly
directed to the bridge of parallel to IR; Rotate and tilt 15° towards the side
the nose being examine
→ SS: Nasal bone, soft → RP: 1 inch posterior to outer canthus
structure of the bone → CR: Perpendicular to the IOML
→ SS: Zygomatic arch

ZYGOMATIC ARCHES
SUBMENTOVERTICAL PROJECTION
→ IR: 8 x 10 inches
→ PP: Seated-upright or
supine; Hyperextend the
neck so that IOML is nearly
parallel with the IR; Rest the
head on its vertex

cscc | 78
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
MAY METHOD (TANGENTIAL PROJECTION) MANDIBULAR SYMPHYSIS
→ IR: 8 x 10 inches AP AXIAL PROJECTION
→ PP: Seated upright → IR: 2 ¼ x 3 inches
or prone; Completely → PP: Patient seating at 1
extend the patient’s edge of the radiographic
neck so that the IOML table; Elevate the film
is as parallel with IR as packet or IR on a suitable
possible; Rotate the support so that the
MSP approximately patient can extend the
15° away from the neck and sustain the chin in a horizontal plane
side being examined; Tilt the top of the head away from → RP: To the mandibular symphysis (midway between
the side being examined approximately 15° the lips and the tip of the chin)
→ CR: Perpendicular → CR: 40° to 45°
→ RP: 1 ½ inches posterior to outer canthus → SS: Mandibular symphysis and mental foramina
→ SS: Patient who have depressed fracture flat cheek
bone

MANDIBULAR RAMI
PA PROJECTION
→ IR: 8 x 10 inches
→ PP: Seated erect or prone; Have patient rest forehead
and nose on the grid
device; Adjust head so that
MODIFIED TOWNE METHOD (AP AXIAL PROJECTION)
MSP is perpendicular to IR;
→ IR: 8 x 10 inches
OML is perpendicular to IR
→ PP: Seated-upright
→ RP: Exit to the acanthion
or supine; Center the
→ CR: Perpendicular
center of the body to
→ SS: Mandibular body
the midline of VCH;
and rami
MSP center the VCH;
→ RESPIRATION: Suspended
Chin slightly
depressed so that
OML is perpendicular
to IR
→ RP: 1 inch above the nasion
→ CR:
▪ 30° caudad
▪ 37° caudad for patients who cannot flex neck
→ SS: Zygomatic arch
PA AXIAL PROJECTION
→ IR: 8 x 10 inches
→ PP: Seated erect or
prone; Position MSP
perpendicular to IR; OML is

cscc | 79
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
perpendicular to IR; Have the → PP: Seated erect,
patient head rest forehead and semisupine, or
nose on IR holder semiprone; Place the
→ RP: Exiting acanthion head in lateral position
→ CR: 20° to 25° cephalad with interpupillary line
→ SS: Mandibular rami perpendicular to IR.
→ RESPIRATION: Suspended Have patient close
mouth and keep teeth
MANDIBLE BODY
together; Extend neck
PA PROJECTION
enough that long axis of
→ IR: 8 x 10 inches
mandibular body is
→ PP: Prone position or
parallel with the
seated upright; Rest the
transverse axis of IR,
head on nose and chin so
preventing
that the anterior surface of
superimposition of
the mandibular symphysis
cervical spine; If
is parallel to the plane of
projection is being
the IR; This place the AML nearly perpendicular to the IR
performed on tabletop,
plane
position IR so that
→ RP: To the level of the lips
complete body of
→ CR: Perpendicular
mandible is positioned
→ SS: Mandibular body
on IR; Adjust the
rotation of the head so
that the area of interest
is parallel to IR as
follows: 1) ramus: keep
the head in true lateral
position; 2) body: rotate
head 30° toward IR 3)
PA AXIAL PROJECTION
symphysis: rotate head
→ IR: 8 x 10 inches
45° toward IR
→ PP: Prone position or
→ RP: To pass through mandibular region of interest
seated upright before a
→ CR: 25° cephalad
VCH; Rest the head on
→ SS: Region of mandible of interest
nose and chin so that
mandibular symphysis will
be placed parallel to the
plane of the IR; MSP is perpendicular to the plane of the
IR
→ CR: 30° cephalad
→ RP: Midway between TMJs
→ SS: Mandibular body and TMJ
→ MOUTH SHOULD BE FILLED WITH AIR
SUBMENTOVERTICAL PROJECTION
MANDIBLE → IR: 8 x 10 inches
AXIOLATERAL OBLIQUE PROJECTION → PP: Seated-upright or
→ The goal of this projection is to place the desired supine; Hyperextend the
portion of the mandible parallel to the IR neck so that IOML is nearly
→ IR: 8 x 10 inches parallel with the IR; Rest the
head on its vertex

cscc | 80
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
→ RP: Entering to the throat at the level of 1 inch → SS: Condyles of mandible, mandibular fossae of the
posterior to the outer canthi temporal bone
→ CR: Perpendicularly directed to IOML
→ SS: Coronoid and condyloid processes of the rami

VERTICOSUBMENTAL PROJECTION AXIOLATERAL PROJECTION

→ PP: Prone or seated; → IR: 8 x 10 inches
Rest the patient’s chin → PP: Seated erect or
on the table with neck semiprone; Center a
fully extended; Position point ½ inch anterior to
midsagittal plane EAM to IR; Rotate MSP
perpendicular to midline 15° toward IR; Adjust
of grid device; IOML AML parallel with the
parallel to IR; Place arms transverse axis of IR;
at sides IPL is perpendicular to
→ RP: Through the MSP IR; After first exposure
entering at the level just with patient’s mouth
posterior to the outer closed, do not permit
canthi patient to move;
→ CR: Perpendicular Change IR, and, make
the 2nd exposure with
patient’s mouth fully
open
→ RP: 1 inch anterior
and 2 inches superior to the upside EAM
→ CR: Perpendicularly directed at 25° to 30˚
→ SS: TMJs in an open and closed mouth

TEMPOROMANDIBULAR ARTICULATION
AP AXIAL PROJECTION
→ IR: 8 x 10 inches
→ PP: Patient in supine
or seated-upright
position with the
posterior aspect of the
skull in contact with the
VCH
→ RP:
▪ Midway between TMJ’s
▪ 3 inches above the nasion
→ CR: Directed 35° caudad

cscc | 81
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
AXIOLATERAL OBLIQUE PROJECTION → SS: Frontal and anterior ethmoidal sinuses
→ IR: 8 x 10 inches → RESPIRATION: Suspended
→ RP: Exits through the
TMJ closest, about 1 ½
inches superior to the
upside EAM
→ CR: 15° caudad
→ SS: Condyles and
neck of mandibles

MAXILLARY AND SPHENOIDAL SINUSES

WATERS METHOD (PARIETOACANTHIAL PROJECTION) –
OPEN AND CLOSED MOUTH
→ IR: 8 x 10 inches
→ PP: Seated erect; Center
and adjust MSP
perpendicular to IR and
have patient rest head on
extended neck; Adjust OML
PARANASAL SINUSES to form 37 degrees to IR;
LATERAL PROJECTION MML is perpendicular to IR;
→ IR: 8 x 10 inches Center IR to acanthion
→ PP: Seated erect; Adjust ▪ OPEN MOUTH
head to true lateral OPTION: Have
position; MSP is parallel, patient fully open
and IPL is perpendicular to mouth to
IR; Adjust IOML horizontal demonstrate the
and parallel with sphenoid and maxillary sinuses
transverse axis of the IR → RP: Exiting acanthion
→ RP: Entering the patient’s head to ½ to 1 inch posterior → CR: Horizontal and perpendicular to IR
to the outer cantus → SS: Sphenoidal and maxillary sinuses for an open
→ CR: Perpendicular/Horizontal mouth and maxillary sinuses for a closed mouth
→ SS: Paranasal sinuses
→ RESPIRATION: Suspended
FRONTAL AND ANTERIOR ETHMOIDAL SINUSES
CALDWELL METHOD (PA AXIAL PROJECTION)
→ IR: 8 x 10 inches
→ PP: Tilt vertical grid device down 15°; Have patient rest
head on forehead and nose; Position MSP perpendicular
to midline of IR; OML is perpendicular to IR; This
positioning places OML 15° from horizontal central ray
→ RP: To exit nasion
→ CR: Perpendicularly directed to the plane of the IRv

cscc | 82
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
ETHMOIDAL AND SPHENOIDAL SINUSES → To exit glabella
SUBMVENTOVERTICAL PROJECTION ▪ FOR MAXILLARY SINUSES:
→ IR: 8 x 10 inches → Midway between infraorbital margins and
→ PP: Seated erect at head acanthion
unit; Extend neck and have → CR:
patient’s head rest on vertex; ▪ FOR POSTERIOR ETHMOIDAL SINUSES:
Center and adjust MSP → Horizontal and perpendicular to IR
perpendicular to IR; Adjust ▪ FOR SPHENOIDAL SINUSES:
IOML parallel to IR → 10° cephalad passing through the sphenoidal
→ RP: ¾ inch anterior to the sinuses
level of the EAM ▪ FOR MAXILLARY SINUSES:
→ CR: Horizontal and → Horizontal and perpendicular to IR.
perpendicular to the IOML → SS: Ethmoidal, sphenoidal and maxillary sinuses
→ SS: Ethmoidal and
PETROMASTOID PORTION
Sphenoidal sinuses
ORIGINAL LAW METHOD (AXIOLATERAL OBLIQUE
→ RESPIRATION: Suspended
PROJECTION) DOUBLE–TUBE ANGULATION
→ IR: 8 x 10 inches
→ PP: Head in a true
lateral; IPL
perpendicular to IR;
MSP and IOML
parallel to the plane
ETHMOIDAL, SPHENOIDAL, AND MAXILLARY SINUSES of IR
PA PROJECTION → RP: Enters
→ IR: 8 x 10 inches approximately 2
→ PP: Seated erect inches to, and 2 inches above, the upper most of external
▪ FOR POSTERIOR acoustic meatus (EAM) and exits downside the mastoid
ETHMOIDAL process
SINUSES: → CR: Directed at the angle of 15° caudad and 15°
→ Center nasion to IR anteriorly
→ Patient’s head is → SS: Mastoid cells, the lateral portion of the petrous
resting on forehead pyramid and the superimposed internal acoustic meatus
and nose against VCH (IAM)
→ OML is perpendicular to IR
▪ FOR SPHENOIDAL SINUSES: MODIFIED LAW METHOD (AXIOLATERAL OBLIQUE
→ Center glabella to IR PROJECTION) SINGLE–TUBE ANGULATION
→ Patient’s head is resting on forehead and nose → IR: 8 x 10 inches
against VCH → PP: Seated erect or
→ OML is perpendicular to IR semiprone; Position
▪ FOR MAXILLARY SINUSES: head in lateral
→ Center IR midway between the infraorbital position with affected
margins and the acanthion side closer to IR; From
→ Patient’s head is resting on forehead and nose true lateral position,
against VCH rotate MSP 15°
→ OML is perpendicular to IR toward IR; IOML is
→ RP: parallel with the transverse axis of IR; IPL is perpendicular
▪ FOR POSTERIOR ETHMOIDAL SINUSES: to IR
→ To exit to the nasion → RP:
▪ FOR SPHENOIDAL SINUSES:
cscc | 83
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ Enters 2 inches posterior and 2 inches superior → RP:
to EAM farthest from IR ▪ Entering 3 to 4 inches posterior and ½ inch
▪ Exits 1 inch posterior to the EAM of the affected inferior to upside EAM.
side ▪ Exiting 1 inch anterior to downside EAM
→ CR: perpendicularly directed at 15° caudad → CR: 12° cephalad
→ SS: Mastoid cells, the lateral portion of the petrous → SS: Petromastoid portion in profile
pyramid and the superimposed internal acoustic meatus
(IAM) and external acoustic meatus (EAM)

HENSCHEN, SCHULLER, AND LYSHOLM METHODS

(AXIOLATERAL PROJECTION)
→ IR: 8 x 10 inches
→ PP: Prone position
or preferably, seated
before VCH; Patient’s
head in true lateral
position; MSP parallel
to the plane of the IR;
IPL perpendicular to
IR; IOML parallel to
the transverse axis of IR
→ RP: Exits the EAM closest to IR ARCELIN METHOD (AXIOLATERAL OBLIQUE
→ CR: PROJECTION)
▪ HENSCHEN METHOD: 15° caudad → IR: 8 x 10 inches
▪ SCHULLER METHOD: 25° caudad → PP: Seated erect or
▪ LYSHOLM METHOD: 35° caudad supine centered to
table; Rotate MSP 45°
away from side being
examined
→ RP: 1 inch anterior
to the EAM and ¾ inch
above it
→ CR: 10° cephalad
→ SS: Petrous portion

STENVERS METHOD (AXIOLATERAL OBLIQUE

PROJECTION)
→ IR: 8 x 10 inches
→ PP: Seated erect
or prone; Have
patient rest head
on forehead, nose,
and zygoma; Adjust
IOML parallel to IR
and MSP at 45°

cscc | 84
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
MAYER METHOD (AXIOLATERAL OBLIQUE PROJECTION) → RESPIRATION: Suspended
→ IR: 8 x 10 inches
→ PP: Supine
position or seated
laterally before VCH;
Rotate head so that
MSP will be 45° to
the plane of IR, with
side under study
closest to IR;
Depressed patient’s chin to place IOML parallel to the
transverse axis of the IR
→ CR: 45° caudad
→ RP: Exits to the EAM closest to IR
→ SS: Tympanic cavity and ossicles

STYLOID PROCESSES
CAHOON METHOD (PA AXIAL PROJECTON)
→ IR: 8 x 10 inches
→ PP: Seated-upright or
prone position; Patient’s
head resting on the
forehead and nose; MSP
perpendicular to IR; OML
perpendicular to IR
→ RP: Nasion
→ CR: Directed at angle of 25° cephalad
→ SS: Styloid process

TOWNE METHOD (AP AXIAL PROJECTION)

→ IR: 8 x 10 inches
→ PP: Seated erect
or supine; Center
midsagittal plane JUGULAR FORAMINA
to midline of grid KEMP HARPER METHOD AND ERASO MODIFICATION
device and adjust (SUBMENTOVERTICAL AXIAL PROJECTION)
to make → IR: 8 x 10 inches
perpendicular; → PP:
Have the patient’s ▪ KEMP HARPER
neck flexed, and METHOD: For
adjust the OML perpendicular to IR; When the patient SMV axial
cannot flex neck, place IOML perpendicular to IR; Place projection,
top of IR at the level of cranial vertex Supine or
→ RP: 2 ½ inches superior to nasion and passes through seated-upright
the level of EAM position; Trunk must be elevated; MSP of the
→ CR: 30° caudad to OML or 37° caudad to IOML body and head to the midline of the grid;
→ SS: Internal acoustic canal, arcuate eminenses, Patient’s head resting on vertex; OML parallel to
labyrinths, mastoid anthrums, and middle ears the plane of IR

cscc | 85
RADIOGRAPHIC POSITIONING (LABORATORY)
Lecturer: Errol John S. Gongora, RRT, RSO
▪ ERASO MODIFICATION: Same position; MSP of
the body and head to the midline of the grid;
Patient’s head resting on vertex; OML place 25°
to IR
→ RP:
▪ KEMP HARPER METHOD: 1 inch distal to the
mandibular
▪ ERASO MODIFICATION: 2 inches distal to the
mandibular
→ CR:
▪ KEMP HARPER METHOD: 20°
▪ ERASO MODIFICATION: Perpendicular
→ SS: Jugular foramina

HYPOGLOSSAL CANAL
MILLER METHOD
→ IR: 8 x 10 inches
→ RP: 1 inch directly
anterior to and ½ inch
inferior to the level of
EAM
→ CR: Directed at
angle of 12° caudad
→ SS: Mandibular
condyle

cscc | 86