UPPER EXTREMITIES
1st CMC JOINT
METHOD
Robert
Rafert-Long
PROJECTION
AP
Lewis
Burman
CR
⊥ to the 1st
CMC Joint
15° entering
1st CMC
Joint
10-15°
entering 1st
CMC Joint
45° entering
1st CMC
Joint
SD
First CMC Joint
free from
superimposition of
the soft tissues of
the hand
Magnified
concavo-convex
outline of the 1st
CMC Joint
Angulation of the Central Ray:
1.)
May help to project soft tissue of the hand away from the first CMC Joint
2.)
It can help open the joint space when they are not shown on a ⊥ CR.
1st MCP JOINT
METHOD
Folio
PROJECTION
CR
PA
⊥ midway bet.
hands at the
level of MCP
joints
SD
For diagnosis
of UCL
rupture/Skier’s
Thumb
METACARPAL FRACTURES
METHOD
PROJECTION
POSITION
Lane-Kennedy
Reverse
PALM DOWN;
and Kuschner
Oblique
rotation of
Recommendation
Projection
hand 45°
medially
Kallen
Tangential
FLEX MCP
Recommendation
Projection
Joints 75-80°;
40-45° rot to
ULNAR side;
40-45° forward
SD
Severe MC
deformities or
FX
MC Head FX
HAND: Lateral
Lewis Recommendation: rotate the hand 5° posteriorly
- Removes superimposition of MCS
RHEUMATOID ARTHRITIS
METHOD
PROJECTION
CR
SD
NORGAARD
APOB
⊥ midway bet. For early
detection of
hands at the
RHEUMATOID
level of MCP
ARTHRITIS
joints
Stapczynski recommendation: for demonstration of FX of the
base of the 5th MC
WRIST
PA – slightly oblique rotation of ulna
AP – BD ulna and C. interspaces (better)
SCAPHOID/CAPITATE
METHOD
POSITION
Daffner,
Emmerling and
Butterbaugh
PA
CR
30° towards
the elbow
SD
Elongates
scaphoid and
capitate
30° towards
Elongates
the fingertips capitate
WRIST: Lateral
Burman recommendation: lateral position of the SCAPHOID should be
obtained with the wrist in PALMAR FLEXION
SD: Carpal Boss
- Rotates the bone anteriorly into a dorsoalveolar postion
Fiolle: Carpal Boss (Carpe Bossu)
- Small bony growth on the dorsal surface of the 3rd CMC joint
WRIST: PAOB and APOB
Lateral Rot PAOB: Carpals on the lateral side of the wrist (Trapezium
and Scaphoid)
Medial Rot APOB: Carpals on the medial side of the wrist (Triquetrum,
Pisiform and Hamate)
WRIST: PA
Ulnar Deviation: Corrected foreshortening from SCAPHOID lateral carpals
-10°-15° CR angulation to provide clear delineation
Radial Deviation: Carpals on the medial side
SCAPHOID
METHOD
Stecher
Rafert-Long
PROJECTION
CR
PA Axial
⊥ to the
SCAPHOID
PA AND PA
Axial
0°-10°-20°-30°
to the
SCAPHOID
TRAPEZIUM
METHOD
PROJECTION
CR
Clements-Nak
PA Axial
45° distally to
ayama
Oblique
ana. Snuffbox
and through
the
TRAPEZIUM
CARPAL SULCUS
METHOD
PROJECTION
CR
Lentino
Tangential
45° caudal, 1
½” to the wrist
joint
Gaynor-Hart
SD
Scaphoid free
from
superimposition
Scaphoid FX
SD
Trapezium FX
SD
Scaphoid fx,
lunate disc, FB
and Chip FX on the
dorsal asp of
carpals
CARPAL CANAL;
Hook of hamate
Inferosuperior 25°-30° to the
long axis of the
hand, 1” distal
to the base of
3rd MC
Superoinferior 20°-35° to the CARPAL CANAL;
Hamulus of
hand from the hamate
long axis of the
forearm
Marshall recommendation: Placing a 45° sponge under palmar
surface of the hand to place the carpal canal TANGENT to the
CR.
FOREARM:
AP – Hand is SUPINATED
Oblique – Hand is PRONATED
FOREARM Lateral: demonstrates Modelling’s deformity (Midshaft
curvature)
ELBOW:
AP – Radial head, neck and tuberosity slightly superimposed over the
proximal ulna
Lateral - 90° flexion; 30°-35° flexion for soft tissue injury
- Demonstrates the Olecranon Process
- Fat Pads are least compressed at this position
- Visualization of posterior fat pad is a pathologic sign
(GRISWOLD)
ELBOW: APOB (MCLaRa – UlTroch – RadCapi)
Medial Rotation: coronoid process free from superimposition;
superimposed ulna by radial head
Lateral Rotation: radial head and neck free from superimposition of the
ulna
PROXIMAL FOREARM & DISTAL HUMERUS
PART
PROJECTION
FLEXION
CR
DISTAL
AP
PARTIAL
⊥
HUMERUS
⊥ to the
AP
ACUTE
Jones
Technique
PROXIMAL
FOREARM
PA Axial
75°
AP
PARTIAL
PA
ACUTE
Jones
Technique
SD
Distal
Humerus
Olecranon
Process and
FX of the
elbow
humerus,
2”
superior
to
olecranon
process
⊥ to ulnar Ulnar sulcus;
radiohumeral
sulcus
bursitis
(tennis
elbow)
Proximal
⊥
Forearm
Olecranon
⊥ to the
Process and
flexed
forearm, FX of the
2” distal elbow
to
olecranon
process
Holly: AP projection of the radial head thru AP Distal Humerus
- Wrist 30° from the horizontal
RADIAL HEAD
METHOD
PROJECTION
CR
4-Position
Lateral
⊥ to the elbow
Series
joint
SD
Radial head in
varying
degrees of
rotation
1. Hand is rotated externally/supinated as much as possible
2. Hand is in lateral position/thumbs up
3. Hand is pronated (Coyle)
4. Hand is rotated internally/thumbs down
OLECRANON PROCESS: PA AXIAL PROJECTION
- 45°-50° flexion of the arm
- ⊥ CR: Dorsum of the olecranon process
- 20° towards the wrist CR: curved extremity and articular margin of
the olecranon process
TRAUMA
METHOD
Coyle
PROJECTION
CR
Axial
45° towards
Lateromedial the shoulder
45° away from
the shoulder
SD
Radial Head
Coronoid
Process
HUMERUS
- Upright: best for pxs with shoulder & arm abnormalities
- AP: Greater Tubercle in profile
- Lateral: Lesser Tubercle in profile
- Mediolateral: BD pxs with broken humerus
- Lateromedial (Supine): BD for pxs w/ known/suspected fx
SHOULDER: AP
● Ext Rot:
- GT is visualized
- Site of insertion of the supraspinatus tendon is also visualized.
- Proximal Humerus: AP
● Neutral Rot:
- Posterior part of the supraspinatus insertion
- Partial profile of GT
- Proximal Humerus: Oblique
● Int Rot:
- Subscapular insertion visualized
- LT in profile
- Proximal Humerus: Lateral
GLENOID CAVITY
METHOD
PROJECTION
BODY
ROTATION
35°-45°
Grashey
APOB
Apple
APOB
35°-45° (holding
1 lb of weight)
AP Axial
Oblique
45°
(loss of articular
cartilage in SHJ)
Garth
(recom for acute
shoulder trauma,
Hill-Sachs defect &
posterior SH disc)
CR
⊥ to GC, 2” MI and INF
to the superolateral
border of the shoulder
⊥ to CP
45° caudalf to SHJ
HILL-SACHS DEFECT
METHOD
PROJECTION BODY POSITION
CR
15° medially to the
Rafert MOD
Inferosuperior
Supine
axilla
Axial
10° cephalad to CP
Stryker-Notch
AP Axial
Supine
25° ANT and MED
West-Point
Inferosuperior
Prone
Axial
45° to SHJ
Garth
AP Axial
Prone
Oblique
Hall, Isaac and Booth: described the notch projection as being useful in
identifying the cause of shoulder disc
ROTATOR CUFF MUSCLES
METHOD
PROJECTION
Neer
Tangential
-
AP Axial
BODY
POSITION
RAO/LAO;
45°-60°;
Erect
Supine
Blackett-Hea
ly
PA
Prone
AP
Supine
CR
SD
10°-15° caudad
Supraspinatus
to the most
Outlet
superior aspect of
humeral head
25° caudad to CP Infraspinatus
⊥ to the head of
humerus
⊥ to the SJ,
entering the
coracoid process
Insertion
Teres Minor
Insertion
Subscapular
Insertion
INTERTUBERCULAR GROOVE (PROXIMAL HUMERUS)
METHOD
PROJECTION BODY POSITION
Fisk MOD
Tangential
Erect; 10°-15°
humerus to CR
AC JOINTS
METHOD
Pearson
PROJECTION
AP
(Single)
Alexander
(Bilateral)
AP Axial
BODY POSITION
Erect; holding 5-8
lbs of weights
Erect
PA Axial
Oblique
45°-60°
PROJECTION
Tangential
BODY POSITION
Seated
SCAPULAR SPINE
METHOD
PROJECTION
Laquerriere-Pier
Tangential
quin
BODY POSITION
Supine
SCAPULA
METHOD
Lorenz &
Lillienfeld
BODY POSITION
RAO/LAO
CLAVICLE
METHOD
Tarrant (for multiple
injuries)
PROJECTION
PAOB
CLAVICLE
● 0°-15° - standing LORDOTIC
● 15°-30° - SUPINE
● PA Axial – CEPHALAD
● AP Axial – CAUDAD
CR
⊥ to IR
CR
⊥ to the ML of the body,
at the level of ACJ
15° cephalad to the
CP
15° caudad to ACJ
CR
25°-30° ANT and INF
to midshaft of clavicle
CR
35°-45° caudad to
posterosuperior region
of the shoulder
CR
⊥ to the protruding
scapula
● Tangential
- 25°-40° from the horizontal (supine)
- 15°-25° - medial third of the clavicle
SCAPULA
✔ Exposure made at SHALLOW BREATHING
● AP
⮚ 2” INF to coracoid – SCAPULA
⮚ 1” INF to coracoid – SHOULDER
● Lateral
⮚ Back of the hand @ posterior chest: ACROMION & CORACOID
PROCESS
⮚ Px grasping the opp shoulder or arm extended upward/forearm
resting on head: SCAPULAR BODY
❖ APOB
❖ 15°-25° rot
- Scapula FREE from superimposition
❖ 25°-35° rot for steeper projection
- Scapula NEARLY FREE from superimposition
❖ SCAPULA Y – suspected shoulder disc; described by Green, Gray
and Rubin
SCAPULAR SPINE
❖ Tangential Projection – PRONE/UPRIGHT; 45° cephalad through
the scapular spine
CORACOID PROCESS
❖ AP Axial Projection
- 15°-45° cephalad to CP
Kwak, Espiniella and Kattan recommendation - 30° cephalad to the CP
Shoulder Impingement: Hobbs MOD & Neer Method
Superoinferior Axial: 5°-15° through the SJ and towards the elbow; rel.
bet. humerus and GC
AP Axial: 35° cephalad to SHJ; rel. bet. humerus and GC
LOWER EXTREMITIES
TOES: AP/AP AXIAL
- ⊥ /15° posteriorly to the 3rd MTP joint
- Angulated CR to open joint spaces/reduce foreshortening
DORSOPLANTAR WEIGHT BEARING
- Demonstrates Hallux & Valgus
SESAMOIDS
METHOD
Lewis
Holly
PROJECTION
Tangential
Causton
POSITION
CR
Prone;
Dorsiflexed toe
Supine; Plantar
75° to IR; toe
flexed with
strip gauze
bandage
Lateral
recumbent
⊥ to the
1st MTP
joint
40° towards
the heel
FOOT
AP – FB & location of fragments
AP Axial - 10°-25° posteriorly to reduce foreshortening
- ⊥ CR: for forefoot demonstration
APOB
Medial Rot:
- 30° rot
- ⊥ to the 3rd MTP Joint
- CUBOID and interspaces on lat. aspect of the foot
Lateral Rot:
- 30° rot
- ⊥ to the 3rd MTP Joint
- NAVICULAR and interspaces on med. aspect of the foot
METHOD
PROJECTION
Grashey PAOB
POSITION
Prone: 30°
med. rot
Prone: 20°
lat. rot
CR
SD
⊥ to 3rd
MTB
1st and 2nd MTB;
Medial
cuneiform &
navicular
2nd to 5th MTB;
Cuboid
DORSOPLANTAR OBLIQUE: BD Lisfranc fx
FOOT: MEDIOLATERAL & LATEROMEDIAL
- demonstrates entire foot in lateral position
- Tibiotalar joint
FOOT: LATEROMEDIAL WEIGHTBEARING
- Demonstrates longitudinal arch/pes planus & Bohler’s critical
angle
- Bohler’s critical angle: angle bet. superior apex of
mid-calcaneus to anterior process of hamulus
- Normal: 20°-40°; FX: 20°
METHOD
Weight-Bearing
Composite
PROJECTION
AP
Axial
TALIPES EQUINOVARUS
METHOD
PROJECTION
AP
Kite
CR
10°-15° to the 3rd
MTB
1st: 15°
posteriorly to 3rd
MT; 2nd: 25°
anteriorly to 3rd
MT
POSITION
Supine
SD
Accurate evaluation of
tarsals and
metatarsals; shows
ALL bones of the foot
Full outline of the foot
free from
superimposition
CR
⊥/15°
posteriorly
SD
Rel. of
tarsal
bones and
ossification
centers
Lateral
Kandel
Lateral
⊥ to the
midtarsal
area
40°
anteriorly
thru the
lower leg
Axial
Erect
Dorsoplantar/Suroplantar
Anterior
talar
subluxation
and degree
of plantar
flexion
Calcaneus
Freiberger, Hersh, and Harrison: three radiographs with varying CR
angulations (35°-45°-55°) to demonstrate sustentaculum talar joint fusion
CALCANEUS/OS CALCIS
Plantodorsal: 40° cephalad towards the long axis of the foot
- Calcaneus, subtalar joint (supine)
Dorsoplantar: 40° caudal towards the heel
- Calcaneus, subtalar joint, sustentaculum tali (prone)
CALCANEOTALAR COALITION
METHOD
POSITION
Weight-Bearin Upright-Standing/
g “Coalition Coalition Position
Method”
METHOD
Weight-Bearing
CR
45° anteriorly to
the posterior
surface of the
ankle
RECOMMENDATION
LILIENFELD
POSITION
CR
Upright; one foot 45° caudad to
away from IR
enter the lateral
malleolus
SUBTALAR JOINT
METHOD
POSITION
Broden
AP Axial Medial
Oblique
(45° foam supine)
CR
40° cephalad to lateral
malleolus
20°-30° cephalad to
lateral malleolus
SD
Useful for diagnosis
of stress fxs of
calcaneus and
tuberosity
SD
Anterior portion of
posterior facet
Middle facet (talus
and sustentaculum
tali)
Isherwood
AP Axial Lateral
Oblique
(45° foam supine)
Medial rot.
FOOT
(45° foam)
Medial rot.
ANKLE
Lateral rot.
ANKLE
10° cephalad to lateral
malleolus
15° cephalad
Posterior portion of
posterior facet
Posterior facet and
middle facet
⊥ to 1 inch distal and
anterior to lateral
mallelolus
Anterior articulation
of subtalar joint and
oblique tarsals; similar
to Feist-Mankin
method
Middle articulation;
“end-on” projection of
sinus tarsi
Posterior articulation
of subtalar joint
10° cephalad, 1 inch
distal and anterior to
lateral malleolus
10° cephalad, 1 inch
distal to medial
mallelolus
APOB: MEDIAL/INTERNAL
- Demonstrates Maissoneuve’s FX – FX of the distal tibia and
proximal fibula
ANKLE
AP – inferior tibiotalar & talofibular will not be “open”
- a positive sign for radiologists because it indicates that the px
has no ruptured ligaments or other type of separations
MEDIOLATERAL – Lateral projection of the lower third of tibia and fibula,
ankle joint and tarsals
LATEROMEDIAL - Medial projection of the lower third of tibia and fibula,
ankle joint and tarsals
APOB
Medial Rot.: 45° rot; demonstrates distal tibiofibular joint
Medial Rot.: 15°-20° rot; demonstrates entire mortise joints; talofibular
joint space
Lateral Rot.: 45° rot; demonstrates the superior aspect of calcaneus,
subtalar joint and calcaneal sulcus; also for determining FXs
METHOD
Stress
PROJECTION
AP
CR
-
SD
Ligamentous tear
*With local anesthesia
administered at sinus
tarsi
*putting a strip
bandage around the
ball of foot
Weight-Bearing
AP
⊥
Side to side
comparison of the joints
(narrowing joint
spaces); MEDIAL
MORTISE – OPEN
LATERAL MORTISE CLOSED
ANKLE: LATERAL – demonstrates TRIMALLEOLAR FX
KNEE
Rosenberg Method Weight-Bearing: PA
- 45° flexion of knee; ⊥/ 10° caudal sometimes
- Evaluating joint space narrowing and demonstrating articular
cartilage disease
AP - 5° inward
- RP: inf patellar apex
- CR:
Thin pelvis (<19 cm): 3°-5° caudad
Thick pelvis (>25 cm): 3°-5° cephalad
Normal pelvis (19-24 cm): ⊥
- SD: open femorotibial joint space
PA – 5°-7° caudal to 1½ inch to inferior patellar apex; open femorotibial
joint space
LATERAL
- 5°-7° cephalad to 1 inch distal to medial epicondyle;
- 20°-30° flexion – relaxes the muscle
- <10° flexion – for unhealed patellar FX
- For Osgood-Schlatter disease
AP: Weight-Bearing Method
- Bilateral; for demonstration for varus (<>) and valgus (><)
deformities
Leach, Gregg and Siber: recommended using this method to evaluate
arthritic knees/ narrowing of joint space
INTERCONDYLAR FOSSA
METHOD
PROJECTION
CR
Holmblad
PA Axial
⊥, 70° knee
flexion (widens
joint
space-improved
image)
Beclere
AP Axial
⊥, 60° knee
flexion; curved
cassette
Camp-Conven
try
PA Axial
SD
Open fossa, intercondylar
eminence and knee joint
space
40° caudad for
40° flexion;
50° caudad for
50° flexion
PATELLA
PA – BD patella- closer OID results in sharper detail
(1)
(2)
joint mice;
(3)
underdevelopment of
lateral femoral
condyle on slipped
patella
evaluate split &
displaced cartilage in
osteochondritis
desecans;
AP – joint effusion
PAOB
Medial rot. & Lateral rot.
- 5°-10° knee flexion
- 45°-55° rot
- ⊥
METHOD
Kuchendorf
METHOD
Hughston
PROJECTION
PA Axial
Oblique
PROJECTION
*he also
recommended to
examine both knees
for comparison
Merchant
Tangential
CR
SD
25°-30° caudal
between patella and
femoral condyles
(10° flexion of knee;
35°-40° rotation to
lateral)
POSITION
Prone;
50°-60°
flexion
Supine; 40° knee
flexion; relaxation
of quadriceps
femoris is critical
for accurate
diagnosis
CR
Slightly oblique PA
projection of patella
free from
superimposition
SD
45° cephalad
Patellar
through
subluxation and
patellofemoral FX
joint
Patellofemoral
disorders
⊥
*can be varied from
30°-90° to demonstrate
various patellofemoral
disorders – (Merchant)
Settegast
Supine/Prone;
slow, even
flexion
*this projection should not
be attempted until a
transverse fx of the
patella has been ruled
out or if the patient is in
pain
FEMUR
AP
⊥
Vertical FX of
patella;
patellofemoral
articulation;
chondromalacia
⮚ Proximal Femur: rotate the limb internally 10°-15° to the place
the femoral neck in profile
⮚ Distal Femur: rotate the patient’s limb internally
Lateral
⮚ Proximal Femur: 10°-15° rotation from the lateral position
⮚ Distal Femur: 45° knee flexion
PELVIS
AP
- rotate both entire lower limbs internally for about 15°-20° to place
the femoral necks // to IR
- CR is ⊥, midway bet. ASIS and symphysis pubis
Lateral
- Berkebile, Fischer and Albrecht recommendation: dorsal
decubitus lateral projection of the pelvis for the demonstration
of “gull-wing sign” in cases of fracture disc of the acetabular rim
and posterior disc of the femoral head
PELVIS AND HIP JOINTS
CHASSARD-LAPINE/JACK KNIFE/KNEE-CHEST: Axial
- CR is ⊥ through the LS region at the level of GTr
- SD:
✔ Bi-ischial diameter in pelvimetry
✔ Demonstrates the rel. of femoral head to acetabulum
✔ BD opacified rectosigmoid colon
FEMORAL NECKS
METHOD
PROJECTION
Modified
APOB
Cleaves
(can be done
unilaterally or
bilaterally)
Original Cleaves
Axiolateral
POSITION
BL: Supine; frog leg
45° abduction of the leg
to place the FN // to IR
UL: Have the px flex
the hip and knee and
draw the foot up to the
opp. knee
Supine; frog leg
CR
BL: ⊥, 1”
superior to PS
UL: ⊥ to the FN
25°-45° cephalad
HIPS
Danellius Miller & Lorenz Method: Axiolateral Inferosuperior/Lateral
- 15°-20° FN to IR, Horizontal Beam; For trauma cases; Hip joint,
acetabulum, FH & FN & GL Trochanters
METHOD
Lauenstein
PROJECTION
Lateral
POSITION
CR
SD
⊥ to the hip joint, Femoral head and
midway bet, ASIS neck overlapped
by GTr
and symphysis
pubis
20°-25°
cephalad Femoral head free
Hickey
from
superimposition
Supine: knee is
Acetabulum,
⊥ to the long axis
Danellius-Mil
flexed and hip of
head, neck and
of the FN
ler
the unaff. side is
trochanters of the
elevated
femur
Supine: limb in
15° posteriorly
Demonstrates hip
Clements-Na
neutral position
to FN
arthroplasty or
Axiolateral
kayama
limitation of
movement
Lateral recumbent 35° cephalad to
Axiolateral
Friedman
FN (Kisch
projection of the
recom: 15°-20°
head, neck,
cephalad)
trochanters and
proximal body of
the femur
RAO/LAO; Prone; ⊥ to the posterior Posterior disc. of
Hsieh
PAOB
elevate the unaff.
the femoral head
surface of the
side 40°-45°; flex
iliac blade
knee and forearm
of the elevated
side
RPO/LPO;
Posterior rim of
Urist
APOB
Supine; injured
the acetabulum in
hip is elevated 60°
acute fx-disc
injuries of the
hip
RAO/LAO; lat
Mediolateral obl.
Lilienfeld
Mediolateral
recumbent on the
projection of the
Obl
unaff. side; roll the
ilium, acetabulum
elevated side 15°
and proximal
to separate the 2
femur
sides of pelvis
Colonna recommendation: same position as for the Lilienfeld method EXCEPT the px is placed on
the unaff. side; the aff. Side is rotated 17° anteriorly from true lateral position. It separates the
shadows of the hip joints and gives the optimum projection of the slope of the acetabular roof
and depth of socket
False profile: demonstrates the anterior acetabular roof
Supine-Obl
(Affected
side
abducted)
⊥
Examinations contraindicated for px with suspected fx or pathologic
conditions: F-O-L-LH
⮚ Friedman
⮚ Original Cleaves
⮚ Lillienfeld
⮚ Lauenstein & Hickey
Congenital Disc. of the Hip
❖ Andren-von Rosén approach (Bilateral Hip): both legs forcibly
abducted to at least 45° with appreciable inward rotation of the femora
Knake & Kuhns: described the construction of a device that controlled the
degree of abduction and rotation of both limbs
❖ AP
- CR: ⊥ - lateral/superior displacement of FH
- CR: 45° to symphysis pubis – anterior & posterior displacement
ACETABULUM
METHOD
PROJECTION
Teufel PAAxialOB
Judet
APOB
POSITION
CR
SD
RAO/LAO;
elevate the
unaff. side 38°;
prone
RPO/LPO;
semi-supine 45°;
aff. Side up (Int
Obl)
12° cephalad
thru the
acetabulum
Fovea capitis and
superoposterior
wall of acetabulum
⊥, 2” inf. To the
ASIS of the aff.
side (Int Obl)
Acetabular rim;
Iliopubic column
and posterior rim
(Int Obl);
Acetabular rim;
Ilioischial column
and anterior rim
(Ext Obl)
Judet R., Judet L., and Letournel: described two 45° posterior oblique positions that are useful in
diagnosing fx of the acetabulum: Int Obl and Ext Obl positions
Iliopubic column (anterior): composed of a short segment of the ilium and the pubis and
extends up as far as the anterior spine of the ilium and extends from the symphysis pubis and
obturator foramen through acetabulum to ASIS
Ilioischial column (posterior): composed of the vertical portion of the ischium and the portion of
the ilium immediately above the ischium and extends from the obturator foramen through the
posterior aspect of the acetabulum
ANTERIOR PELVIC BONES
PA – BD Obturator Foramen
45°; aff. side
down (Ext. Obl)
⊥, to the pubic
symphysis (Ext
Obl)
METHOD
Taylor
PROJECTION
AP Axial
“Outlet”
Lilienfeld
Superoinferior Seated-uprig
Axial “Inlet”
ht; flexed
knees, lean
backward
45°-50°
PA Axial
Prone
“Inlet”
Staunig
POSITION
Supine
CR
SD
20°-35°, 2” distal
to the superior
border of pubic
symphysis for
males and
30°-45°, 2” for
females
⊥, 1 ½ superior
to pubic
symphysis
Rami w/o
foreshortening
seen in PA or AP
due to the CR
more ⊥ to the rami
35° cephalad to
pubic symphysis
at the level of
GTr
Superinferior
axial projection of
the anterior pubic
and ischial bones
and the pubic
symphysis
PA Axial projection
of pubic, ischial
bones and pubic
symphysis
Bridgeman: 40° caudad
ILIUM
APOB
- RPO/LPO; supine; unaff side elevated 40°; ⊥
- SD: Unobstructed projection of ala and sciatic notches; profile
image of acetabulum
PAOB
- RAO/LAO; prone; unaff. side elevated 40°; ⊥
- SD: Ilium in profile; femoral head within the acetabulum
VERTEBRAL COLUMN – Suspend Respiration
V
LATERAL OBLIQUE
CR
C
AP
IF
15°-20°
T
IF
AP
⊥
MSP
45°
70°
BEST POS
PAOB
PAOB
L
SI
Cervical
Thoracic
Iliac
IF
-
AP
SI
PAOB – CLOSEST
APOB - FARTHEST
45°
APOB
⊥
25°-30°
PAOB
⊥
Lumbar
Chest
PAOB - FARTHEST
Ribs
APOB – CLOSEST
ANTLANTOOCCIPITAL ARTICULATIONS
❖ APOB – R & L head rotations (45°-60°), IOML ⊥ to IR – 1” ANT to
EAM
- Dens & open antlantooccipital articulations
Buetti recom. – head is turned 45°-50° with mouth wide open, the chin is
drawn down as much as the open mouth allows; ⊥ to the open mouth
❖ PA – Prone; forehead & nose on the table; OML ⊥ to IR; CR is ⊥
DENS
METHOD
Fuchs
PROJECTION
AP
CR
SD
⊥
Demonstrates dens
w/in the foramen
magnum and when its
upper half is not clearly
shown in the
open-mouth position
For use in
conjunction with the
AP & lateral
projections
Smith & Abel: for demonstration of laminae and articular facets of upper cervical vertebrae –
slightly extend the px’s neck and open mouth wide; rotate the head 10° to the side; CR is 35°
caudad to C3
Hermann & Stender: for demonstration of the antlantooccipital-dens relationship; head is
adjusted as for Kasabach method and the CR is directed vertically midway bet. mastoid
process at the level of antlantooccipital joints
Kasabach (R & L
rot.)
ATLAS AND AXIS
METHOD
AP Axial
Obl
10°-15° caudad;
midway bet. outer
canthus and EAM
PROJECTION
CR
SD
Albers-Schönbe
rg & George
Atlas and axis
thru the open
mouth
A 30” SID is often used for this projection to increase the FOV of the
odontoid area
Judd
Atlas and axis
⊥ at the level of
w/in the foramen
mastoid tips
magnum
AP Open
Mouth
⊥ to the open
mouth
PA
LATERAL – R/L Position
- Supine; crosstable; ⊥ to a point 1” distal to a mastoid tip
Pancoast, Pendergrass & Schaeffer recom.: head should be rotated
slightly to prevent superimposition of the atlas. They further recom. a slight
horizontal tilt of the head for the demonstration of the arches of the atlas
CERVICAL
❖ AP Axial
- Supine/upright; elevate chin
- CR: 15°-20° cephalad to C4
- SD: lower 5 CB & upper 2 or 3 TB; presence or absences of
cervical ribs
❖ Lateral– R/L
- Hyperflexion and hyperextension
- CR: ⊥ to C4
- SD: shows motility/ for functional studies; demonstrates normal
apophyseal movement/absence of movement resulting from
trauma/disease
METHOD
Grandy
Ottonello
PROJECTION
Lateral
AP
CR
SD
⊥ to
C4
All 7 CV (interspaces,
articular pillars, lower
AP & spinous
processes) (C3-C7)
All 7 CV with blurring of
mandible to further
visualize the atlas and
axis
CERVICAL AND UPPER THORACIC VERTEBRAE
❖ Vertebral Arch (Pillars)
❖ AP Axial
- Px’s neck is hyperextended
- CR: 25° caudad to C7 (20°-30° range)
- The CR angulation is determined by cervical lordosis: ↑ angle =
curve is accentuated; ↓ angle = curve is diminished
- SD: BD Vertebral Pillars; useful for pxs with whiplash injury
❖ AP Axial Obl – Supine
- Px’s head rotated 45°-50° (the articular process of C2-C7 and
T1); 60°-70° (articular process of C6 and T1-T4)
- CR: 35° caudad to C7 (30°-40° range)
- SD: Vertebral arches/pillars when the px cannot hyperextend the
head for AP or PA Axial Projection
❖ PA Axial Obl – Prone
- MSP-Neck: 45°; Flexed neck: demonstrates C2-C5; head
extended: C5-C7 & T1-T4
- CR: 35° cephalad to C7 (30°-40° range)
CERVICOTHORACIC REGION
METHOD
PROJECTION POSITION
R/L; upright
Twining
CR
SD
⊥ to C7 & T1 if
shoulders are well
depressed; 5°
caudad if not
elevate the arm,
flex the elbow, &
the rest the
forearm on px’s
head
R/L; recumbent;
3°-5° caudad to
Pawlow and
extend the px’s
C7 and T1
MOD
arm in which the
Pawlow
px is lying, to the
head
Monda MOD: 5°-15° cephalad due to the slope of the spine and a non-elevated lower spine (IV
Disks)
Lateral
C5-T4
THORACIC VERTEBRAE
● AP
- Supine; flexed knees to reduce kyphotic curvature; shallow
breathing
- Upright; CR: ⊥ → Oppenheimer recom.
- SD: All 12 TVB, w/ disk spaces, transverse processes &
costovertebral articulations
● Lateral
- Supine/erect; shallow breathing
- CR: ⊥ to T7 when VC is elevated; 10° cephalad for females and
15° cephalad for males due to greater shoulder width
- SD: IF; T1-T3 not well visualized
LUMBAR – LUMBOSACRAL VERTEBRAE
● AP
- Supine; flex the px’s knees and hips to reduce distortion
- Upright position for pxs who experience excruciating pain to
reduce physical discomfort
- CR: ⊥ to L4 – LS; ⊥ to L3 – Lumbar x-ray
- SD: lumbar bodies, IDS, interpediculate spaces, laminae, spinous
and transverse processes
● PA
- Places the intervertebral disk spaces // to the divergence of beam
- Reduces px dose
● Lateral
- Recumbent/upright
- CR: ⊥ to L4; 5°-8° caudad if no lead rubber (5° for men/8° for
women)
- SD: L1-L4 IF, L5 IF is not well visualized
● L5-S1: Lateral Projection
- Recumbent; CR is ⊥, 2” posterior to ASIS & 1 ½” inferior to iliac
crest
LUMBAR – ZYGAPOPHYSEAL JOINTS
● APOB - RPO/LPO
- Recumbent/upright; rot. of 45° toward the aff. side (articular
process) / 30° (lumbosacral processes)
- CR: Lumbar region – 2” medial to elevated ASIS and 1 ½”
above the iliac crest; 5th AP – 2” medial to elevated ASIS; both
⊥
- SD: AP joints closest to IR; “Scottie dog” sign
● PAOB – RAO/LAO
- Recumbent/upright; semiprone
- CR: ⊥ to L3
- SD: AP joints farthest from IR; “Scottie dog” sign
FIFTH LUMBAR
METHOD
PROJECTION
Kovacs PA Axial
Obl
POSITION
CR
SD
RAO/LAO; lateral
recumbent; extend
the upper arm,
rotate the pelvis 30°
anteriorly from the
lateral position;
place a sandbag
under the knee to
prevent excessive
rotation of the hip
15°-30°
caudad to
L5
Open L5
IF
LUMBOSACRAL JUNCTION AND SACROILIAC JOINTS
● AP/PA Axial
- Supine: CR is 30°-35° cephalad, 1 ½” superior to pubic
symphysis
- 30° for males, 35° for females
- SD: LS Joint; SI Joint free from superimposition
- Prone: CR is 30°-35° caudad to L4
Meese recom: prone for SI Joints because their obliquity places them with
the divergence of the beam; CR is ⊥ at the level of ASIS
● APOB
- Supine; LPO/RPO; elevate the side of interest 25°-30°, and
support the shoulder, lower thorax and upper thigh
- CR: ⊥ 1” medial to elevated ASIS
- SD: SI Joints farthest from the IR
● PAOB
- Semiprone; RAO/LAO; rotate the side of interest 25°-30°; forearm
and flexed knee support the position
- CR: ⊥ 1” medial to elevated ASIS
- SD: SI Joints closest to the IR
PUBIC SYMPHYSIS
METHOD
PROJECTION
Chamberlain
PA
POSITION
CR
SD
Upright; facing the
VCH, standing on
2 blocks; replace
one block on after
the other
(standing one leg)
⊥ to the pubic
symphysis
Abnormal SI
motion; SI
slippage or
relaxation
SACRUM AND COCCYX
● AP/PA Axial
- A. Sacrum: Supine/prone; CR: 15° cephalad, 2” superior to PS
(supine); 15° caudad to sacral curve (prone)
- B. Coccyx: Supine/prone; CR: 10° caudad, 2” superior to PS
(supine); 10° cephalad to coccyx
- SD: Sacrum/coccyx free from superimposition
● Lateral
- Lateral recumbent; flexed hips and knees
- CR: Sacrum - ⊥ at the level of ASIS to a point 3 ½” posterior
Coccyx - ⊥, 3 ½” posterior to the ASIS and 2” inferior
- SD: Lateral projection of the coccyx
SACRAL VERTEBRA CANAL AND SI JOINTS
METHOD
PROJECTION POSITION
CR
SD
Nolke Axial
Seated; px should
lean forward and
should also grasp
the legs or ankle
LUMBAR INTERVERTEBRAL DISKS
METHOD
PROJECTION POSITION
⊥ to the long axis
of the sacrum
Sacral vertebral
canal
CR
SD
IV Joint mobility;
to localize the
involved joint as
Upright facing the
15°-20° caudad
shown by
VCH; px bends to
to
limitation of
the right and left
L3/L4-L5/L5-S1
motion at the site
of lesions in pxs
with disk
protrusion
Duncan and Hoen recom: PA Projection be used because in this direction the divergent rays are
more nearly parallel with the IDS
WeightBearing
PA
SCOLIOSIS RADIOGRAPHY
● PA & Lateral – demonstrate the amount/degree of curvature that
occurs with the force of gravity acting on the body
- PA/AP upright
- PA/AP upright w/ lateral bending
- Lateral upright w/ or w/o bending
- PA/AP prone or supine
*Bending studies are often used to differentiate primary from compensatory
curves
Frank and Kuntz/Frank et al., - PA Projection for scoliosis radiography
(protecting the breasts) – to reduce exposure to sensitive organs
THORACOLUMBAR SPINE: SCOLIOSIS
METHOD PROJECTION
POSITION
Seated/standing
Ferguson
PA
st
1 : normal
seating/standing
position
2nd: elevate the hip
or foot on the
convex side of the
primary curve 3”/4”
CR
⊥
SD
For comparison
of T & L
vertebrae which
are used to
distinguish the
deforming or
primary curve
from the
compensatory
curve in pxs with
scoliosis
Young, Oestrich and Goldstein recom: addition of a lateral position, in upright to show
spondylolisthesis or demonstrate exaggerated degrees of kyphosis or lordosis
Kittleson and Lim: described Ferguson and Cobb methods of measurement of scoliosis
LUMBAR SPINE: SPINAL FUSION
● AP – R & L Bending
- Make the 1st radiograph with maximum right bending, followed by
maximum left bending
- Cross the px’s leg on the opposite side to be flexed over the other
leg in order to obtain equal bending force throughout the spine
- CR: ⊥ to L3, 1 to 1 ½” above the iliac crest
- SD: These studies are employed to pxs with early scoliosis to
determine the presence of structural change when bending to the
R & L. It is also used to localize a herniated disk as shown by
limitation of movement at the side of lesion and to
demonstrate whether there is motion in the area of spinal
fusion
● Lateral
- Lateral recumbent; lean forward and draw the thighs up to forcibly
flex the spine as much as possible, and then lean the thorax
backward and posteriorly extend the thighs and limbs as much as
possible
- Apply a compression band across the pelvis to prevent movement
- CR: ⊥ to L3
- SD: determine whether motion is present in the area of a spinal
fusion or to localize a herniated disk as shown by limitation of
motion at the site of lesion
BONY THORAX
STERNUM
● PAOB (RAO Pos) *30” SID to blur posterior ribs
- Prone/Upright for trauma pxs; 15°-20° body rot.; shallow
breathing/suspended breathing at EOE for more uniform density
- CR: ⊥ to T7 and 1” lat. to the MSP
- SD: Slightly oblique projection of the sternum; obliterated
pulmonary markings on use of breathing motion
METHOD
Moore
PROJECTION
PA Obl
POSITION
Modified prone; px’s
arms above
shoulders w/ palms
down; center sternum
to IR; shallow
breathing
CR
25° to T7
and
approx. 2”
to the right
of spine
SD
Slightly oblique
projection of the
sternum
(Small px <
Large px >)
● Lateral – R/L pos
A. Upright
- Rot. the shoulders posteriorly, and have the px lock hands behind
back; center the sternum to the midline of grid; breathing is
suspended DI
- CR: ⊥
- SD: Lateral image of the entire length of sternum shows
superimposed SC joints and medial ends of the clavicles
- 72” SID is used to reduce magni. & distortion
B. Recumbent
- Flex the px’s hips and knees; elevate px’s arms over the head;
center the sternum to the midline of the grid; breathing is
suspended at the end of DI
- CR: ⊥
- SD: Lat. aspect of entire length of sternum
- Use the dorsal decub. for pxs with severe injury
SC ARTICULATIONS
● PA*crosswise IR
- Prone/upright for trauma pxs; px’s arms along the sides w/ palms
facing up; center the IR at the level of the spinous process of T3
(lies post. to jugular notch)
- BL: rest the px’s head on the chin; UL: turn the head to the
affected side and rest the cheek to rotate the spine slightly away
to the side examined
- CR: ⊥ to T3
- SD: SC Joints and medial portions of clavicles
METHOD
PROJECTION
POSITION
CR
SD
Body
Rotation
Central Ray
Angulation
Kurzbauer
PAOB;
crosswise IR
PAOB;
Non-bucky
Axiolateral
RAO/LAO;
Prone or seated
⊥ to T2-T3, 3”
upright/ upright for
distal to vert.
trauma pxs;
prom. and 1”-2”
10°-15°;
lat. from the MSP
breathing is
suspended at
EOE
Prone/upright for
trauma px; grid
IR positioned
directly under
15° lat. from
upper chest; ext. the MSP at the
the px’s arms
level of T2-T3,
along the side of
3” distal to
the body w/ palms
vert. prom.
facing upward;
rest head on chin/ and 1”-2” lat.
rotate the chin
to the MSP
towards the aff.
side
Lat. recum. on the
aff. side w/ SC
region centered;
flexed hip and
knees; fully ext.
arm of aff. side
15° caudad
and place the
to the SC
other arm along
the side of body joint closest
grasping the
to IR
dorsal surface of
the hip to prevent
sup. of the two
articulations;
breathing is
suspended at EFI
Slightly
oblique
projection
of the SC
joint
Unobstructed
axiolateral
projection of
the SC joint
closest to IR
UPPER ANTERIOR RIBS
● PA
- Upright (fluid levels demonstrated), seated-upright (diaphragm
descends)/prone (rest px’s head on chin); px’s hands against hips
w/ the palms turned outward to rotate scapula away from the
rib cage; breathing is suspended at FI to depress diaphragm
AMAP
- CR: ⊥ to T7/ 10°-15° caudad to show 7th, 8th and 9th ribs
- SD: Anterior ribs above diaphragm in greater detail
POSTERIOR RIBS
● AP
- Upright/recum
A. Ribs above diaphragm
- Rest the px’s hands, palms outward, against the hips; This
position moves the scapula off the ribs/ Extend the arms to the
vertical position with the hands under the head; breathing is
suspended at FI to depress the diaphragm
B. Ribs below diaphragm
- Place the IR crosswise w/ the lower edge pos. at the level of iliac
crests; place the px’s arms in a comfortable position; breathing is
suspended at FE to elevate the diaphragm
- CR: ⊥
- SD: Posterior ribs above/below the diaphragm, acc. to the region
examined, in greater detail
AXILLARY RIBS
● APOB – RPO/LPO pos
- Upright/recum.; aff. side closest to IR w/ 45° body rot.; abduct the
arm of the affected side and elevate it to carry the scapula away
from the rib cage; rest the px’s hand on head/under or above the
head in recum. pos.; Breathing is suspended at EDE for ribs
below and EFI for ribs above the diaphragm
- CR: ⊥
- SD: Axillary portion of the ribs are projected free from
superimposition
● PAOB – RAO/LAO pos
- Upright/recum.; aff. side away from the IR w/ 45° body rot.; have
the px rest on the forearm and flexed knee on elevated side
(recum); Breathing is suspended at EFE for ribs below and EFI
for ribs above the diaphragm
- CR: ⊥
- SD: Axillary portion of the ribs are projected free from
superimposition
COSTAL JOINTS
AP Axial *recom. for demonstration of the costal joints in pxs with rheumatoid spondylitis
- Supine; px’s head rest directly on the table to avoid accentuating
the dorsal kyphosis; if the px has pronounced dorsal kyphosis,
extend the arms over the head/place the arms along the sides of
the body; apply compression to the thorax if necessary; Breathing
is suspended at EFI
- CR: 20° cephalad and 2” above the xiphoid process; increase
the angulation by 5°-10° to pxs w/ pronounced dorsal kyphosis
- SD: Costovertebral & costotransverse joints
THORACIC VISCERA
TRACHEA
● AP
- Supine/upright; extend the px’s neck slightly; center the IR at the
level of manubrium; inhale slowly during exp.
- CR: ⊥ at the center of the IR
- SD: Outline of the air-filled trachea
TRACHEA & SUPERIOR MEDIASTINUM
● Lateral – R/L
- Seated/standing; clasp the hands behind the body and then rot.
the shoulders pos. AFAP; inhale slowly during exp.
- CR: ⊥ midway bet. jugular notch and MCP, 4-5” lower for
demonstration of sup. mediastinum
- SD: Lateral projection of air-filled trachea and the regions of
thyroid and thymus glands
Eiselberg and Sgalitzer: Demonstrate retrosternal extensions of the
thyroid gland, thymic enlargement in infants (in recumbent position), and
the opacified pharynx and upper esophagus, as well as an outline of the
trachea and bronchi. It is also used in foreign body localization
TRACHEA & PULMONARY APEX
METHOD
PROJECTION
POSITION
CR
SD
Twining Axiolateral
R/L; seated or
standing w/ aff.
side towards the
IR; elevate the
arm adjacent to
the IR in extreme
abduction, flex
the elbow, and
place the forearm
behind the head;
depress the
opp. shoulder
AMAP
15° caudad
through the
adjacent
supraclavicular
impression
Axiolateral
projection
demonstrates the
air-filled trachea
and the apex of
the lung closer
to the IR
Trachea: slow
inspiration
Lung apex: exp.
made at FI
CHEST
LUNGS AND HEART
● PA
- Full inspiration; The exposure is made after the second full
inspiration to ensure maximum expansion of the lungs. The lungs
will expand transversely, anteroposteriorly, and vertically, with
vertical being the greatest dimension.
- CR: ⊥ to T7
- SD: Air-filled trachea, the lungs, the diaphragmatic domes, the
heart and aortic knob, and, if enlarged laterally, the thyroid or
thymus gland
● Lateral
- Full inspiration; The exposure is made after the second full
inspiration to ensure maximum expansion of the lungs.
- CR: ⊥ to T7, MCP/ Inferior aspect of scapula
- SD: LL – heart, aorta and left-sided pulmonary lesions
RL – right-sided pulmonary lesions
*these projections are employed extensively to demonstrate the
interlobar fissures, to differentiate the lobes, and to localize
pulmonary lesions
● PAOB – RAO/LAO
- Similar to PA; let arms hang free; 45° towards the unaff. side;
place the arm on the hip outward and the opposite hand to raise it
to shoulder level and grasp the top of the VCH for support
- Use a 55°-60° obl pos. when the examination is performed for a
cardiac series. This projection is usually performed with barium
contrast medium. The px swallows the barium just before
exposure; breathing is made after second FI
- CR: ⊥ to T7
- SD: LAO – max. area of RLF along with the thoracic viscera; the
anterior portion of the left lung is superimposed by the spine; also
shown are the trachea, carina, and the entire RB of the
bronchial tree; heart, descending aorta and aortic arch
RAO – max. area of LLF along with the thoracic viscera; the
anterior portion of the right lung is superimposed by the spine;
also shown are the trachea and entire LB of bronchial tree;
gives the best image of the LA, the anterior portion of the apex
of the LV, and the right retrocardiac space
*the esophagus is shown clearly when filled with BaSO4
*A lesser-degree oblique position has been found to be of particular value in the study of pulmonary
diseases. The px is turned only slightly (55°-60°) from the RAO/LAO body position. This slight degree
of obliquity rotates the superior segment of the respective lower lobe from behind the hilum and
displays the medial part of the right middle lobe or the lingula of the left upper lobe free from the
hilum. These areas are not clearly shown in the standard “cardiac oblique” of 45°-60° rotation, largely
because of superimposition of the spine.
● APOB – RPO/LPO
- RPO/LPO pos. are used when the px is too ill to be turned to
the prone pos. and sometimes as supplementary pos. in the
investigation of specific lesions. They are also used with the
recumbent px in contrast studies of the heart and great
vessels
- 45° body rot.; flex the px’s elbows, place the hands on the hips w/
palms upward; exp. made after the second FI
- CR: ⊥ at a level 3” below the jugular notch’ exiting T7
- SD: APOB projection of the thoracic viscera similar to PAOB
CHEST
● AP
- The supine pos. is used when the px is too ill to be turned to the
prone pos. It is sometimes used as a supplementary projection
in the investigation of certain pulmonary lesions.
- If possible, flex the px’s elbows, pronate hands, and place it on
the hips to draw the scapulas laterally; exp. made after the
second FI
- CR: ⊥ to the long axis of sternum, 3” below the jugular notch
- SD: AP projection similar to PA; the heart and great vessels are
magnified, as well as engorged, and the lung fields appear
shorter because abdominal compression moves the
diaphragm to a higher level. The clavicles are projected
higher, and the ribs assume a more horizontal appearance
Resnick recom: angled AP projection free the basal portions of the lung
fields from superimposition by the anterior diaphragmatic, abdominal, and
cardiac structures; this projection also differentiates middle lobe and lingular
processes from lower lobe disease; the px may be either upright or supine,
and the CR is 30° caudad to the midsternal region
PULMONARY APICES
METHOD
PROJECTION
Lindblom
AP
Axial
PULMONARY APICES
POSITION
Lordotic; Upright;
standing approx.
1 ft from the VCH
(adjusted to 3”
above the upper
border of the
shoulders)
Obl lordotic: 30°
rot., aff. side
towards the IR; px
flexed elbows and
place hands w/
palms upward on
the hips; lean
backward of
extreme lordosis
CR
SD
⊥ to midsternum;
exp. made after
the second FI
AP axial and AP
axial obl images
of the lungs
demonstrate the
apices and
conditions such
as interlobar
effusions
● PA/PA Axial*crosswise IR; 72” SID
- Seated/standing; flex the elbows and place the hands, palms out,
on the hips; depress the px’s shoulders and rotate them forward;
keep the px’s shoulders in contact with the IR; exp. made at
EFI/optionally FI; clavicles are elevated by inspiration and
depressed by expiration; the apices move a little, if at all, during
either phase of respiration
- CR: 10°-15° cephalad to T3 (inspiration)
⊥ to T3
- SD: The apices are projected above the shadows of clavicles
in PA Axial and PA
● AP Axial*crosswise IR; 72” SID
- Upright/supine; place the px’s shoulders against the grid; flex the
elbows, hands on hips with palms out/pronated; exp. made at FI
- CR: 15° or 20° cephalad to T2, entering the manubrium
- SD: AP Axial projections shows apices lying below clavicles
the AP Axial projection is used in preference to the PA Axial in hypersthenic pxs and pxs whose
clavicles occupy a high position; the AP Axial separates the apical and clavicular shadows without
distortion
LUNGS AND PLEURAE
● AP/PA – R/L, lat. decub.
- Advise the px to remain in the pos. for 5 mins before the exp.; if
the px is lying on the affected side, elevate the body 5–8 cm; exp.
made after the second FI
PE: Aff. side down; PNTHX: Aff. side up
- CR: Horizontal, ⊥, 3” below the jugular notch (AP)/ T7 (PA)
- SD: AP/PA lat. decub pos. shows change in fluid pos. and
reveals any obscured pulmonary areas, or in the case of
suspected pneumothorax, the presence of free air
Ekimsky recom: An exp. made w/ the px leaning directly laterally from the
upright PA pos. is sometimes useful for demonstrating fluid levels in
pulmonary cavities; px leaning 45° for demonstrating small PEs; inclined
pos. is simpler to perform than the decub. pos. and is equally satisfactory
● Lateral – R/L, ventral/dorsal decub.
- Prone/supine; thorax elevated 2”–3”; advise the px to remain in
the pos. for 5 mins before the exp.; exp. made after the second
FI
- CR: Horizontal, enters MCP, ⊥, 3”-4” below the jugular notch
(DD)/ T7 (VD)
- SD: Lat. projection in the decub. pos. shows a change in the
position of fluid and reveals pulmonary areas that are
obscured by the fluid in standard projections
SKULL
Cranium
● Lateral – R/L
- Seated-upright/semiprone; rest forearm and knee of the elevated
side (semiprone); side of int. closest to IR;
- IOML // to IR; IPL ⊥ to IR
- CR: ⊥, 2” sup. to EAM
- SD: Lat. images of superimposed halves of cranium shows the
detail of the side adjacent to IR. PADS - Posterior clinoid
processes, Anterior clinoid processes, Dorsum sellae and Sella
turcica are well demonstrated
● Lateral – R/L; Dorsal decub./supine lat. pos
- Robinson, Meares and Goree recom: Dorsal decub. lat.
projection for demonstration of traumatic sphenoid sinus
effusion; this finding may be the only clue to the presence of
basal skull fx
- IOML // to IR; IPL ⊥ to IR
- CR and SD are same as prev. described for Lateral R/L pos.
METHOD
PROJECTION
POSITION
CR
Caldwell PA Axial
Prone/seated;
OML ⊥ to IR;
forehead and
nose on table
Caldwell
method
⊥ to IR,
exiting
nasion
15° caudad,
exiting nasion
SD
Orbits are
filled by the
margins of the
petrous
pyramids;
PCFF –
Posterior
ethmoidal air
cells, Crista
galli, Frontal
bone & Frontal
sinuses
Same as PA
Axial +
petrous
ridges are
projected into
the lower
third of the
orbits
20°-25° caudad thru the midorbits
Superior
orbital
fissures
25°-30° caudad exiting nasion
Rotundum
foramina
Lat. decub – for trauma pxs; same pos. and CR
CRANIUM AND CRANIAL BASE
AP/AP Axial
- OML ⊥ to IR; CR is ⊥/15° cephalad to nasion
- SD: Same as seen on PA but orbits are magnified due to
increased OID
METHOD
PROJECTION
Towne
Grashey
Altschul
Chamberlain
AP
Axial
POSITION
CR
Supine/seated;
30°/ 37°
OML(flexed
caudad to
neck) ⊥ to IR; OML/IOML, 2
½” above
suspended
glabella
respiration
40°-60° caudad to OML
Haas (for obtaining an image of the
sellar structures projected w/in the FM
on hypersthenic, obese or other px
who cannot be adjusted correctly for
the Towne projection)
Schüller
PA Axial
SMV
Prone/seated-uprig
ht; OML ⊥ to IR;
forehead and nose
on table;
suspended
respiration
Supine (increased
intracranial
pressure)/seated
upright; IOML // to
IR; suspended
respiration
SD
SPDPOP –
Symmetric
petrous pyramids,
Posterior portion
of the foramen
magnum, Dorsum
sellae and
Posterior clinoid
processes
projected w/in FM,
Occipital bone and
Posterior portion of
parietal bones; also
used for
tomographic
studies of ears,
facial canal,
jugular foramina,
and rotundum
foramina
Entire FM
25° cephalad, 1
½” below the ext.
occ. prot. (inion)
exiting 1 ½” sup.
to nasion
SDP – Symmetric
petrous pyramids,
Dorsum sellae
and Posterior
clinoid processes
⊥ to sella turcica,
bet. angles of
mandible ¾”
anterior to the
level of the EAMs
Symmetric
petrosae,
mastoid
processes,
foramina ovale
and spinosum,
carotid canals,
sphenoidal &
ethmoidal
Schüller
VSM
Prone; suspended
respiration
⊥ to sella turcica,
bet. angles of
mandible ¾”
anterior to the
level of the EAMs
sinuses,
mandible, bony
nasal septum,
dens & occipital
bone
Same as SMV but
structures in the
midbasal region
are somewhat
distorted &
magnified due to
increased OID;
useful in studies
of anterior
cranial base and
sphenoidal
sinuses
SELLA TURCICA
● Lateral – R/L
- Seated-upright/semiprone; IOML // to IR; suspended respiration
- CR: ⊥, ¾” sup. & ant. to EAM
- SD: Lateral projection of the sellar region of the cranium
SELLA TURCICA, DORSUM SELLAE & POSTERIOR CLINOID PROCESSES
● AP Axial
- Seated-upright/supine; IOML ⊥ to IR; Suspended respiration
- CR: 30°/ 37° caudad to upper forehead passing thru the head at the level of EAM
- SD: Dorsum sellae and posterior clinoid processes w/in the FM (30°)/ Dorsum &
tuberculum sellae and the anterior clinoid processes thru the OB above the level of FM
(37°); SELLAR REGION & PETROUS PYRAMIDS
● PA Axial
- Prone/seated; forehead and nose on VCH/table: OML ⊥ to IR;
suspended respiration
- CR: 10° cephalad to glabella
- SD: Dorsum & tuberculum sellae and the posterior & anterior
clinoid processes are projected thru the FB just above the
ethmoidal sinuses
ORBIT
Optic Canal and Foramen
METHOD PROJECTION
Parietoorbital
Obl
POSITION
Semiprone/seated
upright; Zygoma,
Nose & Chin on
table/VCH; AML
⊥ to IR; 53° MSP
to IR; suspended
respiration
CR
⊥, 1” sup. &
pos. to the
upside TEA,
exiting thru the
orbit closest to
IR
Rhese
Orbitoparietal
Obl
Seated-upright/su
pine; AML ⊥ to
IR; 53° MSP to
IR; suspended
respiration
⊥ to
uppermost
orbit at its inf.
and lat. quad.
SD
Optic canal
“on end” and
the optic
foramen lying
in the inf. and
lat. quad. of the
projected orbit;
a parietoorbital
projection of
the FES
sinuses are
also
demonstrated
Optic canal
“on end” and
the optic
foramen lying
in the inf. and
lat. quad. of the
projected orbit;
exact reverse
of PO
projection
SUPERIOR ORBITAL FISSURES
● PA Axial
- Prone/seated-upright; Forehead and nose on IR; OML ⊥ to IR;
Suspended respiration
- CR: 20°-25° caudad exiting at the level of inferior margin of the
orbit
- SD: The superior margin of the petrous portions of the temporal
bones should be projected at or just below the inferior margin
of the orbits. The SOF are seen as elongated dark areas lying
on the medial side of the orbits bet. the greater and lesser wings
of the sphenoid bones. The margins of the SOF, although
somewhat narrowed, are frequently well shown on the 15°
caudad PA Axial of the skull.
INFERIOR ORBITAL FISSURES
METHOD
PROJECTION POSITION
Bertel
PA Axial
Seated-upright/pro
ne; F-N on
VCH/table; IOML
⊥ to IR;
suspended
respiration
CR
20°-25°
cephalad, 3”
below EOP,
exiting nasion
SD
A PA Axial
projection of each
orbital floor and
IOF is
demonstrated bet.
the shadows of
the lateral
pterygoid lamina
of the sphenoid
bone and the
condylar process
of mandible
EYE
● Lateral, PA & Bone-free studies are taken to determine whether a
radiographically demonstrable FB is present;
recumbent/seated-upright
● Lateral – R/L
- Semiprone/seated-upright, outer canthus of the aff. eye close to
IR; MSP //, IPL ⊥ to IR; suspended respiration
- CR: ⊥ to outer canthus; instruct to px to look straight ahead for the
exp.
- SD: Loc. Of FB; superimposed orbital roofs
● PA Axial
- FN on IR; OML ⊥ to IR; suspended respiration
- 30° caudad to the orbits; instruct the px to close the eyes and
holding still for the exp.
- SD: Petrous pyramids lying below orbital shadows
● Parietoacanthial – MOD Waters
- Rest the px’s chin; OML forms 30° to the IR; suspend respiration
- CR: ⊥ to the midorbits; instruct the px to close the eyes and
holding still for the exp.; SD is same as PA Axial
FB LOCALIZATION
VOGT-BONE-FREE POSITION
● Taken to detect small or low density foreign particles located in the
anterior segment of the eyeball/eyelids
● 2 Projections: lateral & superoinferior
● 2 Movements:
o Vertical: 2 exposures (for lateral)
▪ Look up as far as possible
▪ Look down as far as possible
o Horizontal: 2 exposures (for superoinferior)
▪ Look to extreme right
▪ Look to extreme left
PARALLAX METHOD
● First described by Richards
● It determines whether the foreign body is located within the eyeball
requires no special apparatus
● Not considered as precision localization procedure
● Widely used as preliminary check only
● 2 Projections:
o Lateral: 2 exposures
o PA: 2 exposures
SWEET METHOD
● It determines the exact location of a foreign body by use of a geometric
calculations
● Apparatus:
o Sweet localizing device
o Sweet film pedestal
● 1 Projection:
o Lateral: 2 exposures
▪ CR perpendicular
▪ CR 15o -25o cephalad
PFEIFFER-COMBERG METHOD
● A leaded contact lens is placed directly over the cornea
● Apparatus:
o Contact lens localization device
o Pedestal type of film holder
● 2 Projections:
o Waters Method:
▪ CR horizontal
o Lateral:
▪ CR perpendicular
FACIAL BONES
● Lateral – R/L
- Semiprone/obliquely seated; MSP & IOML //, IPL ⊥ to IR;
suspended respiration
- CR: ⊥ to ZB, bet. OC and EAM
- SD: Lateral image of facial bones, with R & L side superimposed
- Also used in facial profile (STL)
METHOD
Waters
PROJECTION
Parietoacanthial
POSITION
Prone/seated-u
pright; Rest
chin; HPE neck,
37° OML to IR;
SR
Same as Waters
but req. less
extension of the
neck (55° OML to
IR); SR
Modified
Waters
Modified
Parietoacanthial
CR
SD
Orbits, MX &
ZA
⊥, exiting
acanthion
Petrous ridges
are projected
immediately
below the
inferior border of
the orbits at a
level midway
thru the MX
sinuses
Reverse
Waters
Acanthioparietal
Supine; HPE;
HPE neck, 37°
OML to IR; AML
and MSP ⊥ IR
⊥, entering
acanthion
15° caudad,
exiting nasion
Caldwell
Law
PA Axial
Prone/seated; FN
to IR; OML ⊥ IR;
SR
PA Axial Obl
Semiprone; ZNC
to IR; OML ⊥ IR
30° caudad
(exaggerated
Caldwell)
25°-30°
cephalad,
entering pos. to
gonion
Dems. Blow out
fx – inf.
displacement
of orbital floor
and the
commonly
opacified MX
sinus
Superior facial
bones;
magnified
compared to
Waters
Petrous ridges
projected into
the lower third
of the orbits
Orbital rims,
MX, ZB and the
ant. nasal
spine; petrous
ridges are
projected below
the inf. margins
of the orbits
Floor & post.
wall of MX sinus
(antrum) of side
down
External orbital
wall, ZB & ant.
wall of MX sinus
of side up
NASAL BONES
● Lateral – R/L; CW for 2-in-1 exp./ occlusal film for each
- Semiprone; MSP and IOML //; SR
- CR: ⊥ to the bridge of the nose ½” distal to nasion
- SD: Nasal bones and soft tissue structures of the side near to IR
● Tangential
- Extraoral Film (Cassette): prone; chin rested on sandbags; chin
fully extended; MSP & GAL perpendicular to IR
- Intraoral Film (Occlusal Film): supine; head elevated; MSP
perpendicular to sponge; GAL parallel to sponge & perpendicular
to film
- CR: ⊥ to GAL; SD: For demonstration of any medial or lateral
displacement of fragments in fractures
ZYGOMATIC ARCHES
● SMV
- Supine/seated-upright; IOML //; SR
- CR: ⊥ to IOML, 1” post. to outer canthi
- SD: Bilateral symmetric SMV images
● Tangential
- Seated/supine; HPE neck, IOML // to IR; rot. the head 15o
towards side being examined; tilt the top of the head 15o away
from the side; SR
- CR: ⊥ to IOML, 1” post. to outer canthi
- SD: Tangential image of 1 ZA free from superimposition. Useful in
pxs with depressed fx or flat cheek bones
METHOD
May
PROJECTION
Tangential*crosswise
IR
MOD Towne
AP Axial
MOD
PA Axial
Titterington Superoinferior/Jug
Handle View
MANDIBULAR SYMPHYSIS
POSITION
CR
Prone/seated;
IOML // to IR;
rest the px chin
on device; rot.
the head 15o
⊥ to IOML
towards side
thru the ZA, 1
being examined;
½” post. to
tilt the top of the outer canthus
head 15o away
from the side;
SR
Seated-upright/s
upine; OML ⊥ to
IR; SR
Prone; NC on IR
30o caudad
to glabella,
1” above the
nasion
23o-38o
caudad
vertex
midway bet.
ZA
SD
ZA free from
superimposition;
Useful in pxs with
depressed fx or
flat cheek bones
Bilateral
symmetric ZA
images free from
superimposition
Well shown ZA
● AP Axial
- Seated/supine; place the film packet or IR, with its pebbled
surface placed under the chin
- CR: 40o-45o post. to mandibular symphysis
- SD: Mandibular symphysis, mental foramina, and roots of lower
incisors and canines
MANDIBLE
● PA
- Prone/seated; FN on IR; OML ⊥ to IR; SR
- CR: ⊥, exiting acanthion
- SD: Mandibular body and rami; usually employed to dems. medial
or lateral displacement of fragments in fx of rami
● PA Axial
- Prone/seated; FN on IR; OML ⊥ to IR; SR
- CR: 20o-25o cephalad, exiting acanthion
- SD: Mandibular body and rami; usually employed to dems. medial
or lateral displacement of fragments in fx of rami
● PA
- Prone/seated; NC on IR placing the MS // to IR; AML nearly ⊥ to
IR; SR
- CR: ⊥ to the level of lips
- SD: Mandibular body
● PA Axial
- Prone/seated; NC on IR placing the MS // to IR; AML nearly ⊥ to
IR; SR
- CR: 30o cephalad to midway bet. TMJs
- SD: Mandibular body
Zanelli recom.: better contrast around the TMJs could be obtained if the px
was instructed to fill the mouth w/ air
● Axiolateral Obl.
- Seated/semiprone/semisupine; IPL ⊥ to IR
A. Ramus – TL
B. Body - 30o towards the IR
C. MS - 45o towards the IR
- CR: 25o cephalad to pass directly thru mandibular region of
interest
- SD: Region of mandible // with the IR
*To reduce the possibility of projecting the shoulder over the mandible when radiographing muscular
or hypersthenic pxs, adjust the MSP of the px’s skull w/ an approx. 15o angle, open inferiorly. The
cephalad angulation of v of the CR maintains the optimal 25o CR/part angle relationship.
● SMV
- Upright/supine; IOML // to IR; SR
- CR: ⊥ to IOML midway bet. angle of the mandible
- SD: Coronoid and condyloid processes of MR
● VSM
- Prone/seated; IOML // to IR; SR
- CR: ⊥ to IOML/ occlusal plane, at the level just post. to outer
canthi
- SD: Mandible as seen from above the px; CPs are easily visible
on either image, but the condyle and neck of CPs are better
shown with the greater angle
TMJs
● AP Axial
- Supine/seated-upright w/ post. skull in contact with VCH; OML ⊥
to VCH; SR
- CR: 35o caudad, midway bet. TMJs, and entering at a point 3”
above nasion
- SD: Condyles of mandible and the mandibular fossae of the
temporal bones
● Axiolateral – R/L
- Semiprone/seated; Mark each cheek at a point ½” ant. to EAM
and 1” inf. to EAM to localize TMJ if needed w/ aff. side closest
to IR; MSP // & IPL ⊥; SR
- After making the exp. w/ px’s mouth closed, change the IR; then,
unless contraindicated, have the px open the mouth wide
- CR: 25o-30o caudad, ½” ant. to EAM
- SD: TMJs when the mouth is open and closed
● Axiolateral Obl – R/L
- Semiprone/seated, make exp. on closed and open(if not CI)
mouths; rot. the head 15o towards the IR; AML // to IR; SR
- CR: 15o caudad and exiting thru the TMJ closest to IR; entering 1
½” sup. to upside EAM
- SD: Relationship of mandibular fossa and condyle; Open mouth:
mandibular fossa and the inf. & ant. excursion of the condyle;
Closed mouth: fx of the neck and condyle of ramus
METHOD
PROJECTION POSITION
CR
SD
o
Semiprone;
TL;
10
cephalad
Albers-Scho
MSP & IOML // to
exiting TMJ
nberg
closest to IR
IR; IPL ⊥ to IR
Lateral
Lateral
recumbent; TL;
⊥ to the
Transfacial
Zanelli
head resting on
parietal region;
MSP 30o to IR
uppermost
gonion
TMJ
PANORAMIC TOMOGRAHY/ PANTOMOGRAPHY/ROTATIONAL
TOMOGRAPHY - technique employed to produced tomograms of curved surfaces
✔
✔
✔
✔
✔
Provides panoramic image of the entire mandible, TMJ, dental arches
Provides distortion-free lateral image of the entire mandible
Patients who sustained severe mandibular or TMJ trauma
Useful for general survey studies of dental abnormalities
Adjuvant for pre-bone marrow transplant
PNS
Cross & Flecker: pointed out the value of erect position
⮚ To demonstrate presence or absence of fluid
⮚ To differentiate between shadows caused by fluid & those caused by pathology
● Lateral – R/L
- Seated (RAO/LAO for TL); MSP & IOML // to IR, IPL ⊥ to IR; SR
- CR: ⊥ entering ½” to 1” pos. to the outer canthus
- SD: All PNS
● SMV
- IOML // to IR, HPE neck; SR
- CR: ⊥ to IOML thru the sella turcica, entering approx. ¾” to the
level of EAM
- SD: Symmetric image of the ant. portion of skull base; SS and
EAC
● PA
- Seated-upright; FN to IR; MSP & OML ⊥ to IR; SR
- CR: ⊥, exiting nasion/ 10o cephalad, exiting glabella/ ⊥, exiting midway bet. infraorbital
margins and the acanthion
- SD: Posterior ethmoid sinuses are projected sup. to ant. ethmoid sinuses (nasion)/
Sphenoidal sinuses through frontal bone (glabella)/ Maxillary sinuses inferior to cranial
base (IOM & AC)
METHOD
Caldwell
Waters
PROJECTION
PA Axial
Parietoacanthial
POSITION
Seated
Angled grid: Tilt
the VCH down to
form a 15° angle;
FN rested on
VCH; MSP &
OML ⊥ to IR; SR
Vertical grid: Ext.
px’s neck; rest
the tip of nose
on the VCH;
OML forms 15°
angle w/ the CR;
place sponge
bet. forehead
and VCH; SR
Seated; HPE the
neck just enough
to place the
dense petrosae
immediately
below the
maxillary sinus
floors; Chin
rests on VCH;
CR
SD
⊥, exiting
nasion
FS & ant. EAC
MS, w/ the petrous ridges lying inf. to the floor
of sinuses;
foramen rotundum; distorted F & EAC
Open-Mouth
Waters
Pirie
Axial Transoral
Rhese
PA Obl
Law
PA Obl
OML forms 37°
and MML ⊥ to
VCH; SR
Same as Waters
+ px slowly open
the mouth wide
open while
holding the pos.
Upright; PNC to
IR; open mouth;
phonate “ah”
during exp.
Seated-upright:
ZNC to IR; AML
⊥ to IR; MSP 53°
Seated-erect;
ZNC to IR; neck
HPE
⊥, exiting
acanthion
⊥, ¾” ant. to EAM
(sella turcica)
SS projected thru the open mouth along with the
MS
SS projected thru the open mouth; MS; Nasal
fossae
⊥ to upper
parietal region
Obl image of post & ant ES; FS & SS; profile
image of optic canal
25°-30° cephalad
to uppermost
gonion
Relationship of MS to teeth
TEMPORAL BONE: MASTOID
METHOD
PROJECTION
Law: Original
Law: MOD
Axiolateral
Obl
POSITION
DT Ang.; TL;
Mastoid closest
to IR; IOML &
MSP //, IPL ⊥ to
IR; Tape auricles
forward; SR
ST. Ang.; Prone;
IOML //, IPL ⊥ to
IR; 15° rot of the
head to the IR;
Tape auricles
forward; SR
Part. Ang; Prone;
Head rests on
cheek; MSP & IPL
CR
15° caudad and
15° ant., 2” post.
& 2” above the
uppermost EAM
15°
caudad,”
⊥, ”
SD
Mastoid cells, lateral portion of
petrous pyramid, superimposed
IAM and EAM, and when present,
mastoid emissary vessel
15° from IR &
vertical; SR
Law: Part Ang.
15° caudad,
exiting EAM
closest to IR
Henschen
Mastoid cells, mastoid antrum,
IAM & EAM
Cushing: demonstrating tumors of
the acoustic nerve
Pneumatic structure of the
mastoid process, mastoid
antrum, IAM & EAM, sinus & dural
plates, and when present, the
mastoid emissary vessel
Mastoid cells, mastoid antrum,
(Runström II) 35°
EAM, labyrinth area and carotid
caudad,”
canal
Runström recom: exp. made w/ mouth open for visualization of the petrous apex bet. the ant. wall of EAM and the mandibular
condyle
Petrosa in the direction of its long
axis demonstrates the EAM,
tympanic cavity & ossicles,
epitympanic recess, aditus, and
mastoid antrum closest to IR
Schüller
Axiolateral
Prone/seated; TL;
IOML & MSP //,
IPL ⊥ to IR; Tape
auricles forward;
SR
25°
caudad,”
Lysholm
Owen mod1: Stated that it is
sometimes advantageous to vary
head rot. and/or CR angulation
Mayer
Axiolateral
Obl
Supine/seated;
Rot. the head 45°
to the IR; Depress
the chin – IOML //
to IR; SR
45°
caudad,”
O1, cited by Pendergrass,
Schaeffer & Hodes: MSP 40° from
the IR; Head rot. 10° caudally; CR
28° caudally
O1, cited by Etter & Cross: MSP of
head 30° to the IR; CR 25°- 30°
caudally
O1, cited by Compere: Head rot.
30°- 45° to the IR; CR 30° caudally
Stenvers: Posterior
Profile
Axiolateral
Obl
Arcelin: Anterior
Profile*exact opposite of
Stenvers
MOD Hickey
AP
Tangential
Towne
AP Axial
SMV*Basilar projection
Hirtz
for petromastoids – project
the long axis of the EAMs,
tympanic cavities &
osseous part of the
auditory tubes immediately
Prone/seated;
FNC w/ side ex.
Petrous ridge, cellular structure
closest to the IR;
12° cephalad,
of the mastoid process, mastoid
IOML // to IR;
entering 3” – 4”
antrum, area of labyrinth, internal
MSP of head 25° post. & ½” inf. to
acoustic canal and the cellular
to IR; DC skull:
upside EAM
structure of the petrous apex
*if correctly positioned, petrous pyramid //
54° = <; BC skull:
to IR
40° = >; SR
Supine; Rot. px’s
face away from
side ex. - 45° w/
10° caudad,
Petrous portion of TB
the IR; IOML // to entering 1” ant. &
farthest from the IR
IR; DC skull: 54° 3/4” sup. to EAM
= <; BC skull: 40°
= >; SR
Supine; face rot.
away from side
on interest; MSP
15° caudad, 1”
Mastoid process free from
35° from the IR/
sup. to tip of
superimposition; projected below
MSP 45° from
mastoid process
the shadow of occipital bone
vertical; IOML ⊥
to IR; IR 15°
caudally
inclined; SR
Supine/seated-upr
Petrosas projected above the skull
ight; MSP &
30° caudad to
base; demonstrates the internal
OML/IOML
OML/ 37° caudad
acoustic canals, arcuate
(cannot flex neck, to IOML; enters 2
eminences, labyrinths, mastoid
compensate w/ 7°
½” above the
antrums, and middle ears;
caudal ang. on
nasion
dorsum sellae w/in the FM
CR) ⊥ to IR; SR
Seated/supine; (1)
adjust the ext. of
5° ant., midway
Mastoid processes, labyrinths,
neck so that OML
bet. 1” ant. to
EAM, tympanic cavities and
is // to IR, (2)
EAMs
acoustic ossicles
behind mandibular
condyles
angle the CR ant.
until ⊥ to IR; SR
● SMV
- Same PJ., Pos & SD for Hirtz
- CR: ⊥ to OML, centered on MSP of the throat at the level of EAMs
METHOD
Valdini
PROJECTION
PA Axial
STYLOID PROCESS
METHOD
PROJECTION
Cahoon PA Axial
JUGULAR FORAMINA
METHOD
PROJECTION
Kemp Harper
Eraso MOD SMV Axial
POSITION
CR
SD
DILA (IOML 50o):
Dorsum sellae; Internal
Auditory Meatus (IAM);
Labyrinth
Recumbent/seated-erect;
upper frontal region of
skull against IR; head
acutely flexed; MSP⊥ to
IR; IOML 50o/OML 50o;
line extending from inion
to 0.5 cm distal to nasion
forming 28o to CR; SR
⊥, entering inion, exiting
0.5 cm distal to nasion
POSITION
CR
SD
Seated-upright/prone; FN
on VCH; Flex neck, OML
& MSP ⊥ to IR; SR
25° cephalad to nasion
Symmetric image of the
styloid processes of the
temporal bones projected
w/in or just above the
maxillary sinuses
POSITION
CR
SD
Supine/seated-upright;
MSP ⊥, OML // to IR; SR
20° posterior, 1” distal
to the mandibular
symphysis
⊥, 2” distal to
mandibular symphysis
Both SMV projections
demonstrate jugular
foramina projected at or
near the level of angles
of the mandible
Similar to KH + 25° OML
from the IR
ETB “EaT Bulaga” (OML
50o): External auditory
meatus; Tymphanic
cavity; Bony part of
Eustachian tube
*When a px with a prominent
mandible is being examined, the
angulation of the CR may be
increased from 5°- 10° caudally;
Eraso mod. Project the JF at ang
angle 5° greater than KH
Strickler mod.: The neck is extended until a line passing thru the infratragal notch and a point 2 cm
distal to the mandibular symphysis is ⊥ to the plane of the film. The CR coincides this line.
HYPOGLOSSAL CANAL
METHOD
PROJECTION
Miller
Axiolateral Obl
POSITION
CR
SD
Supine/seated; Rot. the
MSP of the head 45°
away from the side being
examined, IOML // to IR;
Have the px softly
phonate ah-h-h to
immobilize the mouth
in the open pos/SR
12° caudal, entering 1”
ant., ½” inf. to the level
of EAM farthest from the
IR
Delineate the HC in a px
with hypoglossal nerve
tumor
Mandibular condyle is
projected inf. and ant. to
the canal when the px
can open the mouth wide
enough; because of
normal anatomic
variations, the ideal
image is not always
obtained.
Kirdani, Valvassori and Kirdani recom: Hypoglossal canal be examined by tomographic
sectioning in the SMV, semiaxial AP, and Stenvers positions; These studies also provide
excellent demonstration of the jugular foramina