Region
Fingers
Views
CR
PA
pronate affected
finger in contact with IR
OBL
45 medial rotation for 2nd digit /
PIP Joint
45 lateral rotation for 3rd,4th,5th digit
LAT
mediolateral for 2nd digit /
lateromedial for 3rd,4th,5th digit
PIP Joint
AP- internally rotate hand until post:
surface of thumb contact with IR
PA- rest thumb on sponge so that not
rotate.
1st MCP Joint
AP or PA
Thumb
Positioning
PIP Joint
Thumb
PA OBL
1st MCP Joint
LAT
rotate hand slightly medial until true lat
1st MCP Joint
position of thumb
PA
pronate hand in contact with IR
PA OBL
Hand
abduct thumb slightly with palmar
surface of hand in contact with IR
3rd MCP Joint
Pronate and rotate hand and wrist
laterally 45 degree so all digits // IR
3rd MCP Joint
if metacarpal interest, can be taken with
touching
Hand
LAT Fan Lateral
Rotate hand and wrist into lateral
position with thumb side up. Spread
2nd MCP Joint
fingers and thumb into a “fan” position
Extension-extend fingers and thumb
Lat-Modified directly for true lateral position
Lateral
Flexion- Flex fingers into a natural
extension and flexed position, maintain true lateral
flexion
position
2nd to 5th MCP Joint
Special View AP oblique Supinate hands , place medial part of
midway between 5th
bilateral
both hands together at center of IR and
MCP Joint
norgaard internally rotate hands 45°
method
PA
Wrist
Pronate , arch hand for close contact
with IR
mid carpal area
Wrist
PA obl
Lat
AP
Forearm
LAT
AP
From pronated position, rotate wrist
and hand laterally 45°
mid carpal area
Adjust hand and wrist into a true lateral
position, with fingers comfortably
mid carpal area
extended
Supinate Forearm and Lean laterally as
mid forearm
near AP position as possible , both
joints or one joint included
Palpate the medial and lateral
epicondyles to ensure they are the
same distance from IR
Drop shoulder, flex elbow, rotate hand
and wrist into true lateral position ,
mid forearm
both joints or one joint included
For heavy muscular forearms, place
support under hand and wrist for
placing radius and ulna //IR
Extend elbow, supinate hand, and lean
laterally as necessary for true AP
projection. Palpate humeral epicondyles mid-elbow joint
to ensure that interepicondylar plane //
IR
APPartial
Flexion
Elbow
two AP projections—one with forearm
// IR and one with humerus // IR
mid-elbow joint
Distal humerus:
midway between
forearm acutely flexed and fingertips
epicondyles
resting on shoulder
AP Proximal forearm:
Palpate humeral epicondyles and
acute flexion
(angling CR as
ensure interepicondylar plane is parallel
needed), a point of
to IR for no rotation
2 inches superior to
olecranon process
AP Oblique Supinate hand and rotate laterally the
External
entire arm so that the distal humerus
Rotation
and the anterior surface of the elbow
joint are approximately 45° to IR.
mid-elbow joint
Pronate hand into a natural palm-down
AP Oblique position and rotate arm as needed until
Internal
mid-elbow joint
distal humerus and anterior surface of
Rotation
elbow are rotated 45°
Lat
Drop shoulder so that humerus and
forearm are on same horizontal plane.
mid-elbow joint
Rotate hand and wrist into true lateral
position, thumb side up. Place
interepicondylar plane perpendicular to
AP
humerus
Abduct arm slightly and gently supinate
midpoint of humerus
hand so that epicondyles of elbow are
parallel and equidistant from IR.
Lateromedial;Internally rotate arm as
needed for lateral position, epicondyles
Rotational Lateral
midpoint of humerus
are perpendicular to IR.
Mediolateral: Face patient toward IR.
and oblique as needed to allow close
contact of humerus with IR; flex elbow
90°.
With patient recumbent/placing
TRAUMA support under the arm.
HORIZONTAL Flex elbow if possible, ; projection
BEAM
should be 90° from AP.
LATERAL Gently place image receptor between
arm and thorax (top of IR to axilla).
midpoint of distal
two-thirds of
humerus
AP external Abduct extended arm slightly; externally
1 inch inferior to
rotation
rotate arm (supinate hand) until
coracoid process
non trauma epicondyles of distal humerus are
parallel to IR.
AP internal Abduct extended arm slightly; internally
1 inch inferior to
rotation
rotate arm (pronate hand) until
coracoid process
non trauma epicondyles of distal humerus are
perpendicular to IR.
AP neutral
rotation
trauma
Shoulder
Place patient’s arm at side in “as is”
neutral rotation.
Place affected arm at patient’s side in
neutral rotation.
Raise opposite arm and place hand over
top of head; elevate shoulder as much
Transthoracic as possible to prevent superimposition
Lateral
of affected shoulder.
trauma
Ensure that thorax is in a true lateral
position or has slight anterior rotation
of unaffected shoulder to minimize
superimposition of humerus by thoracic
vertebrae.
Scapula Y
Trauma
mid-scapulohumeral
joint/ 2 cm inferior
and slightly lateral to
coracoid process
surgical neck
Palpate the superior angle of the
scapula and AC joint articulation.
Rotate the patient until an imaginary
line between those two points is
scapulohumeral jointperpendicular to IR.
2inches below AC
amount of body obliquity may range
joint
from 45° to 60°.
Abduct arm slightly if possible so as not
to superimpose proximal humerus over
ribs; do not attempt to rotate arm.
Clavicle
AC Joints
AP and AP
Axial
Position patient erect or sitting,
posterior shoulders against cassette
with equal weight on both
midway between AC
feet with no rotation of shoulders or
joints, 1 inch above
AP
pelvis
jugular notch
* For AC Joint
Two sets of bilateral AC joints are taken Unilateral- 1 inch
separation
in the same position, one without
below affected AC
weights and one stress view with
Joint
weights
AP
Scapula
arms at sides, chin raised, and looking
AP- mid clavicle
straight ahead.
AP Axial - 15 to 30
Posterior shoulder should be in contact
cephalad to
with IR or tabletop
midclavicle
Gently abduct arm 90° and supinate
hand.
midscapula, 2 inches
inferior to coracoid
process
Scapula
Lateral
Have patient reach across front of chest
and grasp opposite shoulder to
demonstrate body of scapula.
Or
Have patient drop affected arm, flex
elbow , let arm hang down at patient’s midvertebral border
side.
of scapula
Palpate superior angle of the scapula
and AC joint articulation.
Rotate the patient until an imaginary
line between the two points is
perpendicular to IR.
Image
anatomy
Criteria
Note
correct CR- Jts open
No rotation- symmetric
concavity
apperance
correct CR- Jts open
medial rotation for
2nd digit- good
definition but must
check patient can do
or not
correct CR- Jts open
mediolateral for 2nd
true lat- concave apperance
digit- good definition
of ant surface of phalange
but must check
shaft
patient can do or not
correct CR- Jts open
No rotation- symmetric
concavity apperance
PA not prefer- poor definition
correct CR- Jts open
correct CR- Jts open
true lat- concave apperance
of anterior surface of
proximal phalanx and 1st
metacarpal
correct CR- Jts open
No rotation- symmetric
concavity apperance
45 oblique -midshafts of
metacarpals should not
excessive overlap of
overlap. Some overlap of
metacarpals _ over
distal heads of 3rd,4th,5th rotation
metacarpals. No overlap of too much separationdistal 2nd ,3rd metacarpals. under rotation
fingers// to IR- equally
separated and in lateral
position, joint spaces open.
True lat position- radius and
ulna superimposed
true lat position
Flexion view is less
Extension- superimposed
painful for Patient.
radius , ulna, phalanges and
fingers and extended
All views are for
Flexion- superimposed
localization of foreign
radius, ulna ,phalanges and
bodies of hand and
fingers and hand flex
fingers.
position
45° oblique position midshafts of 2nd to 5th
metacarpals and base of
phalanges should not
overlap; MCP joints should
be open;
no superimposition of
thumb and 2nd digit should
occur.
True PA_ equal concavity
shapes are on each side of
shafs of metacarpals
early evidence of
rheumatoid arthritis
Modification /Ball
Catcher Position partially fingers flexed distorts the proximal
and distal
interphalangeal joints
but visualizes the MCP
joints equally well
AP-supinate , arch
hand slightly for close
contact with IR
good for visualizing
the carpals ,
intercarpal space if the
patient can assume
this position easily
45 oblique-ulnar head
partially superimposed by
distal radius; proximal third
through fifth metacarpals
(metacarpal bases) should
appear mostly
superimposed
true lat- ulnar head
superimposed over distal
radius; proximal 2nd to 5th
metacarpals appear aligned
and superimposed
no rotation- humeral
epicondyles visualized in
profile, with radial head,
neck, and tuberosity
slightly superimposed by the
ulna.
Wrist and elbow joint
spaces are only partially
open because of beam
divergence.
no rotation- head of ulna
being superimposed over
the radius, and humeral
epicondyles should be
superimposed.
Radial head should
superimpose coronoid
process, with radial
tuberosity demonstrated.
no rotation - bilateral
epicondyles seen in profile /
radial head, neck, and
tubercles separated or only
slightly superimposed by
ulna.
Olecranon process should
be seated in the olecranon
fossa with fully extended
arm
specifically
anteroposterior
fragment
displacements
Structures in elbow
no rotation - epicondyles
joint region
seen in profile / radial head,
are partially obscured
neck, and tubercles
and slightly distorted,
separated or only slightly
depending on amount
superimposed by ulna on
of elbow flexion
forearm parallel projection.
possible.
Distal Humerus- Optimal
exposure - visualize distal
one with CR
humerus and olecranon
perpendicular to the
process through
humerus and one with
superimposed structures.
CR angled so that it is
Proximal Forearm- Optimal
perpendicular to the
exposure -visualizes outlines
forearm.
of proximal ulna and radius
superimposed over
Correct 45° lateral obliquevisualization of radial head,
Best visualizes radial
neck, and tuberosity, free of
head and neck of the
superimposition by ulna.
radius and capitulum
Lateral epicondyle and
of humerus.
capitulum should appear
elongated and in profile
Correct 45° medial oblique coronoid process of the ulna
in profile.
Radial head and neck should
be superimposed and
Best visualizes
centered over the proximal coronoid process of
ulna.
ulna
and trochlea in profile.
True lateral view three concentric arcs of the
trochlear sulcus, double
ridges of the capitulum and
trochlea, and the trochlear
notch of the ulna.
Elevated or displaced
fat pads of the
elbow joint may be
visualized
True AP- greater tubercle is
seen in profile
laterally
True lateral projectionepicondyles are directly
superimposed; lesser
tubercle is shown in profile
medially, partially
superimposed by lower
portion of glenoid cavity.
True lateral projectionepicondyles are directly
superimposed .
Full external rotation greater tubercle visualized
in full profile on lateral
aspect of the proximal
humerus.
Do not attempt to
rotate the arm
if a fracture or
dislocation is
suspected
Do not attempt to
rotate the arm if a
fracture or dislocation
is suspected
Do not attempt to
rotate the arm if a
fracture or dislocation
is suspected
Full internal rotationDo not attempt to
lesser tubercle visualized in
rotate the arm if a
full profile on the medial
fracture or dislocation
aspect of the humeral head.
is suspected
neutral rotation- greater
and lesser tubercles most
often are superimposed by
the humeral
head
If patient is in too
much pain to
drop injured shoulder
Outline of the shaft of the and elevate uninjured
proximal humerus should be arm and shoulder fully
clearly visualized anterior to to prevent
the thoracic vertebrae.
superimposition of
shoulders, angle CR
10° to 15° cephalad.
Patient should be
asked to breathe
gently short, shallow
thin body of the scapula
should be seen on end
If necessary, because
without rib superimposition of the patient’s
.
condition, this PA
Acromion and coracoid
oblique (scapular Y
processes should appear as lateral) may be taken
nearly symmetric Y.
recumbent in the
humeral head should appear opposite AP oblique
superimposed over the base position with injured
of the “Y” if not dislocate. shoulder elevated
AP- without any
foreshortening/
superimposed on the
superior scapular angle
AP axial - most of the
clavicle above the scapula
and second and third ribs.
Shoulder or clavicle
projections should be
completed first to rule
out fracture
Less weight (5 to 8 lb
per limb) may be used
for smaller or asthenic
patients.
No rotation -the symmetric
more weight may be
appearance of the SC joints
used for hypersthenic
on each side of the vertebral
patients.
column.
weights should be
attached to the wrists.
Alternative AP Axial
Projection (Alexander
Method) 15° cephalic
angle centered at the
level of the affected
AC joint. for
suspected AC joint
subluxation or
dislocation.
abducted 90 degrees and
hand supinated - lateral
border of the scapula free of
superimposition.
The position of the
True lateral humerus (down at side
Body of scapula should be in or up across anterior
profile, free of
chest) has an effect
superimposition by ribs.
on the amount of
As much as possible, the
body rotation
humerus should not
required.
superimpose area of
Less rotation is
interest of the scapula.
required with arm up
across anterior chest.
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