Radiographic Positioning: (Reinforcement)

RADIOGRAPHIC POSITIONING
(REINFORCEMENT)
By:
Dean LORENZO A. REVELDEZ JR.

RRT, RN, MAN, MAEd, PhDc
Common Positioning Terms
1. Projection
2. Axial
3. Position
 Lateral
 Oblique
 Decubitus
 Lordotic
4. Method
5. Tangential
6. View
General Body Position
1. Upright
2. Seated
3. Recumbent
4. Supine
5. Prone
6. Trendelenburg
7. Fowlers
8. Sims
9. Lithotomy
Positioning Terms
 Supine
 Prone
 Trendelenburg
 Lat. (RLR/LLR)
 Oblique
 RAO/LAO
 RPO/LPO
 Decubitus
 Ventral
 Dorsal
 Lat.
HAND
Procedures:
1. PA
2. PA Obl.
3. Lateral
A. Fan Knife Lateral
B. Lateral Extension
C. Lateral Flexion
4. Ball Catcher / Norgaard / Brewerton
Routine:
1. Bony injuries
- PA, PA Oblique, Lateral
2. Bony Pathology
- PA, PA Oblique
3. FB Localization
- PA and Lateral
1. PA
2. PA oblique
PA Oblique
 demons. Bones and soft tissues
 Investigating fractures and
pathologic conditions.
3. Lateral
- extended or partially flexed
A. Lateral Extension
 FB & MTC Fracture displacement
 Ulnar side closest
B. Fan Knife Lateral
 Distal radius and ulnar directly superimposed
 Metacarpals directly superimposed
C. Lateral Flexion
 Anterior and Posterior displacement of fractures
of the MTC
4. Ball Catcher / Norgaard / Brewerton

- rheumatoid arthritis / arthritides
WRIST
Procedures:
1. PA
2. Lateral
3. PA Oblique
4. AP Oblique
5. PA Ulnar Flexion
6. PA Radial Flexion
7. PA Axial (Stetcher’s Method)
8. Gaynor Hart / Templeton & Zim
9. Carpal Bridge
10. PA Axial Ulnar Deviation ( Rafert Long Method)
11. AP
12. Lateral with Palmar Flexion
 Injury or Pathologic conditions

1. PA
2. PA obl.
3. Lateral
1. PA
- Arch hand slightly
NB.
- to demons. The scaphoid CR 30° towards
the elbow to elongates the scaphoid &
capitate
- 30° towards the finger tips to elongate the

capitate only.
2. Lateral / Lateromedial
- assess the relationship
of capitate, lunate and
distal radius
- Barton’s, Colles, Smith
- Ant. & Post. Fxs.
3. PA Oblique
- Trapezeum & Scaphoid
- Distal Radius and Ulna
- Rotate laterally
- Anatomic snuff box
4. PA with Ulnar Flexion

- to open spaces between adjacent carpals
- C.R. 10-150 proximally or distally
- correct for shortening of the scaphoid
5. PA with Radial Flexion

- open spaces between carpal and medial
side of the wrist
6. PA Axial (Stetcher)
- Ulnar deviation / Radial flexion
- Scaphoid
- 25-300 towards the elbow
- Hammate, pisiform and triquetrum
 to show a fracture line that angles
superiorly, the CR towards the digits
Inclined PA / PA Axial
 IR 20° angle
 CR perpen.
7. Gaynor Hart / Templeton & Zim

- wrist about 4” (10 cm.) above the table
- 250-300 long axis of the hand
- best view to demons. a suspected fracture in the
hook of the Hammate
- to rule out abnormal calcification in the carpal sulcus
- compression of the median nerve
- to prevent superimposition of the pisiform hammete
rotate int. 10°
8. Carpal Bridge
- shows tangential image of the carpus
- fractures of the scaphoid
- lunate dislocation
- calcification & FB in the dorsum of the wrist
- chip fractures in dorsal aspect of the carpal
bone
- 450 to the long axis of the forearm
9. AP
- carpal interspaces
- distal radius & ulna
10. AP Oblique
- Pisiform, Triquetrum and Hammate
- rotate medially 450
11. PA Axial Ulnar Deviation ( Rafert Long

Method)
- Scaphoid
- 0-10, 20-300 degrees cephalad
12. Lateral with Palmar Flexion

- demons. Carpal boss or carpe bossu
 a small bony growth occurring on the
dorsal surface of the third CMC joint.
ELBOW
Procedures:
1. AP
2. Lateral
3. AP Flexed (Partial Flexion)
4. AP Oblique (Medial Rotation)
5. AP Oblique (Lateral Rotation)
6. AP Partial Flexed (Proximal Forearm)
7. AP Acute Flexion / Jones method
8. Lateral (Lateromedial) Radial Head
9. Axial Lateromedial
1. AP
- 2.5 cm / 1 inch below the midpoint
epicondyle
- olecranon & coronoid fossae are super
imposed
- Humeral epicondyles and Ant. Surface of
the elbow are parallel with the IR
2. Lateral
- lateral epicondyle
- Olecranon Process
- Fat Pads
- 30-350 soft tissue
injury flexion
3. AP Oblique (Medial Rotation)

- hand pronated 450
- coronoid process and elbow joint

- Supinate hand and rotate laterally
- rotate 450
- radial head, neck, tuberosity and capitulum
5. AP Partial Flexion (Trauma)

- perpen.
- demons. elbow joint space proximal
radius/ ulna and distal humerus
6. AP Partial Flexion (Proximal Forearm)

7. AP Acute Flexion (Jones Method)

- Epicondyle parallel
- Olecranon process
- to obtain visualization of the soft tissue
outside the olecranon process
- 2’ superior or distal to the OP
- funny bone or crazy bone
8. Lateral Projection (Lateromedial)

- 4 positions series
- Flex the elbow 900
* supinate hand and rotate externally
* hand in true lateral position (Thumbs up)
* hand pronate
* rotate hand internally (Thumbs down)
- Radial head is projected
supinate hand and rotate externally

hand in true lateral position (Thumbs up)

hand pronate
rotate hand internally (Thumbs down)

9. Axial Lateral Medial Proj. (Coyle Method)

- Elbow 900 hand in pronation
- 450 towards the shoulder
 Radial head
- 45° away from shoulder
 Coronoid process
- demons. A fracture of the radial head in cases of
trauma
SHOULDER / PECTORAL GIRDLE
1. Clavicle
- S-shaped
- Long bone
- last bone to completely ossify at the age 21
- most commonly fractured bone
- located over the upper anterior rib cage
2. Scapula
- shaped like an inverted triangle
- upper margin of the scapula
* 2nd posterior rib
- lower margin of the scapula
* t7 of the posterior rib
- Flat bone
SHOULDER JOINTS
Procedures:
1. AP Neutral
2. AP Internal Rotation
3. AP External Rotation
4. Transthoracic Lateral /
Lawrence Method
5. Inferosuperior / Axial Projection
6. Inferosuperior / West Point
7. Inferosuperior / Axial Projection (Clements

Modification)
8. Superoinferior / Axial Projection
9. Grashey / AP Obl.
10. PA Oblique (RAO&LAO) (Scapular Y)
11. AP Apical Oblique Axial Projection (RPO&LPO)
(Garth Method)
12. Apple Method / AP Obl.
13. Hobbs Modification / PA Transaxillary
14. Tangential / Fisk Method
SHOULDER (Non-Trauma)
Procedures:
1. AP internal Rotation & External Rotation
2. Inferosuperior Axial Projection
3. Grashey
4. Tangential / Fisk method
* Intertubecular Groove
SHOULDER (Trauma)
Procedures:
1. AP Neutral
2. Transthoracic
3. Scapular Y
4. Apical / Garth Method
1. AP Neutral
- palm of the hand against the hip (inward)
- coracoid process
- demons. scapulohumeral joints
- oblique humerus
- distal humerus 450 to the film
- post. Part of the supraspinatus insertion
2. AP Internal Rotation
- hand rotated internally
- rotate the body 15-20°
- lateral of the humerus
- Epicondyles of the distal humerus perpen.
- to demonstrate lesser tubercle / tuberosity
- site of insertion of the subscapular tendon
3. AP External Rotation
- hand is abducted and supinated
- epicondyles are parallel
- rotate the body 15-200
- frontal view of the humerus
- to demonstrate greater tubercle/ tuberosity
- site of insertion of the supraspinatus tendon
4. Transthoracic Lateral Projection (Lawrence

Method)
5. Inferosuperior / Lawrence
- supine
- head, shoulder and thorax is elevated 3”-4”
- abduct the arm
- C.R. horizontally through the axilla to the AC jt.
- Hill-Sachs defect (Anterior dislocation of the
humeral head)
 if 900 abduction the CR is 30-350
 if 600 abduction the CR is 200
- Glenohumeral joint
6. Inferosuperior Axial Projection (Rafert

Method)
- Thumb pointing downward
- 150 horizontally
- demons. fx of the humeral
head
7. Inferosuperior Axial Projection / West point

- prone
- abducted at 900
- C.R. 250 ant. from the horizontal and
250 medially
- demonstrate bony abnormalities in px.
with instability of the shoulder
8. Inferosuperior Axial Projection (Clements

Modification)
- lateral recumbent on the unaffected side
- abduct the affected arm @ 900 pointing
the ceiling
- horizontally to the midcoronal
- CR 5-150 medially
9. Superoinferior / Axial Projection

- extend the shoulder
- flex the elbow 900
- 5-150 towards the elbow
- relationship of the proximal end of the
humerus and glenoid cavity
10. AP Axial Projection

- supine
- 350 cephalad
- post. dislocation of the
shoulder
11. Tangential Projection (Fisk Method)

- supine or standing
- rotate the head away
- flex the elbow and lean forward to place the
humerus 10-150 from vertical
- CR ┴
12. PA Oblique / Scapular Y (RAO or LAO)

- rotate the px., midcoronal plane angle of
45-600
- CR horizontally to the vert. border to the
glenohumeral jt.
- suspended respiration
- demonstrate the joint dislocations
- relationship of the humeral head to glenoid
cavity
13. AP Apical Oblique (RPO&LPO) (Garth

Method)
- demons. of acute shoulder trauma

- identifying posterior scapulohumeral
dislocations
- glenoid fractures
- Hill-Sach lessions
- soft tissue calcification
- rotate the body 450 towards

- flex the elbow and place arm across the
chest
- CR 450
14. AP oblique Projection (RPO&LPO)

(Grashey Method)
- rotate the body 35-45° towards the affected
side (if supine)
- scapula is parallel to the IR
- abduct the arm with internal rotation
- Glenoid cavity
Recumbent
- palm of the hand in the abdomen
* to demonstrate the space between
the humeral head and the glenoid
cavity
- 45-60°
15. Tangential Projection (RAO&LAO) (Neer

Method)
- useful to demonstrate to coracoacromial
arch or outlet to diagnose shoulder
impingement
- rotate the body 45-600
* entering the superior aspect of the
humeral head
16. AP Axial Projection (Stryker “Notch” Method)

- useful in identifying the cause of the
shoulder dislocation
- flex the arm slightly and place the hand on
top of the head
- CR 100 cephalad
- coracoid process
17. AP Oblique Projection (RPO/LPO) (Apple

Method)
- uses weight abduction for demons. a loss of
articular cartilage in the scapulohumeral joint.
- rotate 35-40° towards
- abduct @ 90° 1lb. weight each hand
- RP coracoid process
- demons. Scapulohumeral joint, Glenoid cavity
18. Hobbs modification / PA Transaxillary

proj.
- pt. erect facing the VCH
- slightly rotate 5-10° ant. obl.
- raised affected arm supriorly
- demons. Lateral view of proximal
humerus in relation to the glemohumeral
joint
Coracoid Process
AP Axial Proj.
- Supine
- Shoulders same transverse plane
- Hand Supination
- CR 15-45° cephalad or depends on the shape
of pts. back round shoulder greater angulation
 Kwak, espiniella and Kattan 30° cephalad
- CR 25° caudad
 Demons. Greater tuberosity
site of insertion of the infraspinatus tendon
open up subacromial space
 are neutral position
 To evaluate humeral Head
• Complete internal rotation
ACROMIOCLAVICULAR ARTICULATIONS
Procedures:
1. AP Projection (Bilateral) (Pearson
Method)
2. AP Axial Projection (Alexander
Method)
3. PA Axial Oblique Projection
(RAO/LAO) (Alexander Method)
1. AP Projection (Bilateral) (Pearson Method)

- equal weights 10-15 lbs.
* make the shoulder muscle contract
- demons. dislocation, separation and
function of the joints
2. AP Axial Projection (Alexander Method)

- 150 cephalad
 AC jt. Projects
above the acromion
- coracoid process
- suspected AC jt.
subluxation or dislocation
- AC jt. Seen slightly
superiorly
3. PA Axial Oblique Projection (RAO/LAO)

(Alexander Method)
- body rotated 45-600
- 150 caudally
FOOT
Hindfoot – calcaneous and Talus

Midfoot – cuboid, Navicular and Cunieforms
Forefoot – metatarsals and phalanges
Joints of the Digits

- IP joints
- DIP joints
- PIP joints
Metatarsals = MP joints
= Tarsometatarsal joint
Tarsal Bones
1. Come – largest tarsals / anterior cuboid
2. To – superior to the calcenous with navicular
3. Colorado
4. Next – laterally with the cuboid oval in shape
5. 3 Christmasses – wedge-shaped
Longitudinal Arch
- provides a strong, shock absorbing type of
support for the weight of the body
Stress fx
- most common to metatarsals
CONGENTIAL CLUBFOOT
- Talipes equino varus
Shows 3 deviations:
1. Plantar flexion and inversion of the calcaneous or
EQUINUS
2. Medial displacement of the forefoot or
ADDUCTION
3. Elevation of the medial border of the foot or
SUPINATION
- demonstration the anatomy of the foot and

bones or ossification centers of the tarsal
and their relation to one another.
Procedures:
1. Kite Methods
A. AP Projection
B. Lateral Projection
2. Kandel Method
A. Axial Projection (Dorsoplantar)
1. Kite Method (Dorsoplantar and Lateral)
A. AP Projection
- demonstrate the degree of adduction
of the foot and the degree of inversion
of the calcaneous
- 150 posterior angle
B. Lateral Projection (Mediolateral)

- demonstrate anterior talar subluxation
and the degree of plantar flexion
2. Kandel Method
A. Axial Projection / Dorsoplantar /
Suroplantar
- bending forward
- 400 anterior angulation
- through the lower leg
CALCANEOUS / OS Calsis
Procedures:
1. Axial Projection (Plantodorsal)
2. Axial Projection (Dorsoplantar)
3. Axial Projection (Weight Bearing)
(Coalition Method)
4. Lateral Projection (Mediolateral)
5. Lateromedial Oblique / Weight
Bearing Method
1. Axial Projection (Plantodorsal)

- plantar surface at right angles
- acute flexion / dorsiflex the foot
- 400 cephalad
- RP base of the 3rd metatarsals
* tuberosity and sustentaculum tali
2. Axial Projection (Dorsoplantar)

- prone
- 1” (2.5cm) inferior to the medial malleolus
- 400 caudally
*demonstrate calcaneous,sustentaculum
tali and trochler process
- Subtalar
3. Axial Projection (Coalition Weight Bearing)

- demonstrate calcaneotalar
- 450 anteriorly to the posterior Surface
- known as Harris-beath method or skiers
position
4. Lateromedial Oblique / Weight Bearing Method

- pt. standing position
- affected heel centered to the lateral boarder of
the IR
- CR 150 directed medially entered the lateral
malleolus
* demonstrates:
- calcaneal tuberosity, stress fx. of the
calcaneous, sinus tarsi, cuboid
TALOCALCANEAL / SUBTALAR JOINT

Procedures:
A. Broden method
1. AP Axial Oblique Projection
(Medial Rotation)
(Lateral Rotation)
Subtalar Joint
- consist of two articulations between
calcaneous and Talus
a. Anterior articulations
* Talocalcaneonavicular jt.
b. Posterior articulations
* Talocalcaneal art.
A. AP Axial Oblique Projection (Mediolateral

Rotation)
- dorsiflex the foot
- rotate the leg and the foot medially 450
- 15° cephalad
- demons. post. articulation
- 2cm distal and 2cm anterior to the lateral
malleolus
– 10° post. Portion of Talus and

sustentaculum tali
– 20° Ant. Portion of the Ant. Articulation
– 30° post. Portion of the Post. Articulation
– 40° ant. Portion of the Post. Facet
B. AP Axial Oblique Projection

(Lateromedial Rotation)
- rotate the leg and foot 450 laterally
- 150 cephalad
- 2cm below and 2cm anterior to the
medial malleolus
* to determine the presence of joint
involvement in case of comminuted
fx.
B. Isherwood Method
1. Lateromedial Oblique Proj.
(Medial Rotation Foot)
(Medial Rotation Ankle)
(Lateral Rotation Ankle)
B. Isherwood method
- a method of the 3 separates articulation of
the talo calcaneal
1. Latero Medial Oblique Projection (Medial

Rotation Foot) / Feist-mankin method
- demons. the anterior talar articular surface
- obl. Proj. of the Tarsals
- 1” distal and 1” anterior to the lateral
malleolus
- 45° rotation
2. AP Axial Oblique Projection (Medial Rotation

Ankle)
- rotate the leg and foot 300 medially
- C.R.100
- 1” distal and 1” anterior to the lateral malleolus
- shows middle articulation of the subtalar joint and
“end-on” projection of the sinus tarsi
3. AP Axial Oblique Projection (Lateral Rotation

Ankle)
- rotate the leg and foot 300 laterally
- 10 cephalad
- shows post. articulation of the subtalar joint
- RP 1” distal to the medial mallelous
ANKLE
Procedures:
1. AP
2. Oblique
3. Lateral
4. AP Stressed / Forced inversion
6. AP Projection (Weight Bearing)
1. AP
- rotate the leg and foot for 50
- malleoli are equidistant
* distal tib.fib. and proximal of Talus
- inferior portion of the lateral mallelous
- Tibiotalar jt.
- Talotibial
2. Oblique
A. Bony Structure / Survey
- rotation is 450
- R.P. midway between the malleoli
- Talotibial joint
* demonstrate lateral malleolus
and the space between the
talus and malleolus
- Tibiofibular joint
B. Mortise / AP Oblique (Medial Rotation)

- inferior portion of the Tib-fib from a deep
socket or 3 sided opening
- rotate 150 to 200
- intermalleolar line is parallel to film
- common to open reduction
- Talofibular jt.
- Plantar surface at right angle to the film
3. Lateral
- R.P. 2 cm proximal to the tip of the
medial malleolus
- lower third of Tib. Fib. / Talus
- Tibiotalar, Subtalar jts.
- Talotibial
- 5th Metatarsal to check Jones fx
4. AP stressed / forced inversion

- to evaluate the joint separation and
ligament tear or rupture

- rotate the leg and the foot laterally 450
- to determine fxs & demons. Superior
aspect of the calcaneous
6. AP Projection (Weight Bearing Method)

- demons. side to side comparison of
the joint
- identify narrowing of the ankle joint
space
- cassette at the back of the ankle
- relationship of the distal Tib. Fib.
KNEE
Procedures:
1. AP Projection
2. Lateral Projection
3. AP Internal Oblique
4. AP Projection (Weight Bearing Method)
5. PA Projection (Rosenberg Method)
6. AP Oblique Lateral Rotation
7. PA Axial Projection (Homblad Method) /

Tunnel View
8. PA Axial Projection (Camp-Coventry
Method)
9. AP Axial Projection (Beclere Method)
1. AP Projection
- rotate 5 deg. until the interepicondylar line is parallel
to the film
- 1.25 cm / ½“ below the apex of the patella
- 5-70
Thin Pelvis - 3-50 less than 19cm
Large Pelvis - 3-50 more than 24cm
- Femoral Condyle Symmetric
- Femorotibial joint space
- flexion 20-300 relaxes the muscle and show the
maximum volume of the joint cavity
- CR 5-70 cephalad
- 2.5 cm./ 1” below 2.5 cm./1” behind the lower
border of the Patella
- Suprapatellar knee effusion
- Femoral condyles Superimposed
3. AP Oblique Internal / Medial /

Anteromedial Rotation
- rotate the leg 450 internally
- 50 cephalad
- proximal tibiofibular and femoro tibial knee jt.
- posterior tibia
- Tibial Plateau
- lateral condyles of the femur and Tibia
- Tibial condyles
4. AP Obl. (Lateral Rotation) / Anterolateral

- External rotate 45°
- ½’ below the apex
- demons. Tibial condyles, head of fibula, patella
- medial femoral and Tibial condyles
- Tibial plateaus
- Fibula Superimposed over the lateral half of the
Tibia
5. AP Projection (Weight Bearing)

- degenerative joint disease, knee joint spaces, varus
and valgus deformity, narrowing of the joints space
- arthritic knees
- 1/2’ below the apex
- this aids in pre & postoperative evaluation of knees
undergoing osteotomy
- Permits more accurate estimation of the degree of
LE varus and valgus deformity
6. PA Projection (Rosenberg Method)

- flex knee to place the femur at angle of 450
- CR horizontally or 100 sometimes used
- RP ½ “ below the apex of the patella
- demons: narrowing of the jt. space, articular
cartilage disease
6. PA Axial Projection (Homblad Method)

- intercondylar fossa
- medial & lateral intercondylar eminence, tubercle
- kneeling 700
- lean forward 20-300
- femur is 600 in relation to the table top
- popletial depression
- widens the jt. Space between the femur and tibia
- posteroinferior surface of the femoral condyles
8. PA Axial Projection (Camp-Coventry Method)

- intercondyloid fossa
* prone, femur close in contact, flex knee
40-500, popletial depression, 40-500
- to demons. the knee joint space
- reveal a loose body within the joint,
- medial and lateral intercondylar tubercle
9. AP Axial Projection (Beclare Method)

- intercondylar fossa
- eminence, medial and lateral condyles
- knee is flexed 60°
- Posteroinferior surface of the femoral condyles
- tibial spine
- distal femur and proximal tibia
PATELLA
- knee cap
- biggest sesamoid bone of the body and
most constant
- develops in the tendon of quadriceps
femoris bet 3-5 yrs of age
Procedures:
1. PA Projection
3. PA Axial Oblique Proj. (Kuchendorf Method)
4. Tangential Projection (Houghston Method)
5. Tangential Projection (Merchant Method)
6. Tangential Projection (Settegast Method)
1. PA Projection
- heel rotated 5-100 laterally/outward
- midpopletial depression / crease
- provides sharper recorded detail
2. Lateral Projection / Mediolateral

- flex not more than 5-100
* to prevent fragments separation in
new or unhealed patellar fractures.
- demons. patella, patello femoral joint,
tibiofemoral joint
- increasing flexion
* reduces the patellofemoral jt. space
3. PA Axial Oblique Projection (Kuchendorf

Method)
- elevate the hip by 2” or 3”
- flex knee by 100 to relax the muscle
- rotate the knee laterally 35-400
- CR 25-300
4. Tangential Projection (Hughston Method)

- the leg resting the tube
- flexed the knee 50-600
* patellar fxs.
* assessment of the femoral trochlea and condyles
- flexed 20° demons. Patellar subluxation
- CR 450
- patellofemoral joint
- demons. subluxation of the patella and patellar fracture and
assessment of the femoral trochlea and condyles
5. Tangential Projection (Merchant Method)

- sitting/supine
- flex knee 400
- 30-900 Normally
- CR 300 if the knee flexion is 400
* demons. patellafemoral disorders
* intercondylar sulcus (trochlear
groove) patella
6. Tangential Projection (Settegast Method)

- prone
- acute flexion (900)
- 15-200
* vertical fracture and to investigate the
articulating surfaces of the fermoropatellar
articulation.
- transverse fracture
7. Tangential Projection (Sunrise / Mountain

View / Skyline)
- sitting / supine
- flex knee 40-450
- CR 15-200 cephalad
* joint space between patella and the
femoral condyles
PELVIS
- is a base for the trunk
- a girdle fro the attachment of the lower limbs
- consist of four bones;
1. 2 hip bones
2. sacrum
3. coccyx
Hip Bone / Os Coxae / Innominate bone

1. Ilium
2. Pubis
3. Ischium
- these three joined together to form acetabulum.
Legg- Calve Perthes

- head of femur / pelvis
MALE
 Appears narrower and deeper

 Less than 900 in pubic arch / acute angle
 Shape of the inlet is not broad or rounded
oval or heart shaped on some males
FEMALE
 Wider more shallow, more flared

 Obtuse angle or greater than 900
 More round
PELVIS
1. AP
- Rotate medially 15-20° to place femoral necks
parallel with the IR
- Heels be placed 8-10 inch. apart
- Midway between ASIS and SP
- Superior border 1 1/2” above the crest
- Demons. Iliac crest, ASIS, Sacroiliac Jt., Greater
Trochanter, Obturator foramen, Ischial Spine
A. - recumbent position.
- MAP midline of the table
- Vert. column parallel with the table top
- ASIS lying in the same vertical plane
B. Cross-table lat. / dorsal decubitus
- demons; Gull wing Sign,, in cases of fx.
dislocation of the acetabular rim and post
dislocation of the femoral head
C. Erect Pos.
- if the extremeties are of unequal length
*place a support of suitable height
under the foot of the short side
- RP 2” above the greater trochanter
3. Axial Proj. / Chassard-Lapine

- measuring the transverse, or bi ischial diameter
in pelvimetry
- determine relationship of the femoral head to the
acetabulum
- demons. of the opacified recto sigmoid
- lean / tilt forward by 45°
- CR perpendicular to the coronal plane of the SP
- demons. the relationship bet. The femoral heads
and the acetabula pelvic bones
FEMORAL NECKS
1. AP Obl. / modified cleaves

- bilateral frogleg
- flex. The elbows and rest the hands on the upper
chest
- abduct the thighs 45° from the vertical plane to
place the long axis of the femoral necks parallel
with the IR
- 1” Superior to the SP
- lesser trochanter acetabulum femoral
head and neck
2. Axiolateral / original cleaves

- abduct 45°
- femoral neck angles approx. 15-20°
superior to the femoral bodies
Anterior Pelvic bones
1. PA
- demons. SP and ischia including obturator
foramen
2. AP axial Outlet / Taylor Method

- Supine
- CR men > 20-35° ↑
women > 30-45° ↑
- demons. Pubic and ischial rami /
Superior and inferior rami
3. Superioinferior Axial inlet / Bridgeman

method
- Supine
- Pelvis and ASIS are equidistant
- CR 40°↓ level of the ASIS
- Axial proj. of the pelvic ring or inlet
- Anterior pelvic bones
4. Superoinferior Proj.
* Dunlap
* Swanson
* Penner method
- Sit erect with thighs together
- cross the arms over the chest
- CR 30° to the crest of the ilium
- plane of acetabulum is 35° with the sagittal plane
on the average adult
- Children 30°
- demons. acetabula
ILIUM
1. AP
2. PA Oblique (RAO & LAO)

- elevate the unaffected side 40° to
place the broad surface of the wing
parallel with the plane of the IR.
- ASIS same transverse plane
- Shows ilium & femoral head within the
acetabulum
3. AP Oblique
- Shows an unobstructed proj. of the ala
and sciatic notches
- broad surface of the iliac wing without
rotation
SACRO-ILIAC JOINTS
Procedures:
2. AP Oblique Projection (RPO or LPO
Position)
3. PA Oblique Projection (RAO or LAO
Position
- 30-450
- 1 ½ - 2“ superior to the pubic symphysis
* assess fracture and joint
dislocation
Male -300
Female - 350
2. AP Oblique Projection (RPO/LPO Position)

-rotate the body 25-300 side of interest
elevated
- 1” medial to the ASIS
- CR 15 - 200 demons. distal portion of the
joint
* to correct foreshortening and thus
open the lower portion better
3. PA Oblique Projection (RAO/LAO Position)

- rotate the body towards the affected side
25-300
- 1’ lat. to the vert. process
TOPOGRAPHY
A. CERVICAL REGION
1. C1 – mastoid tip
2. C2, C3 – gonion
3. C5 – thyroid cartilage
4. C7 – vertebra prominens
B. THORACIC REGION
1. T1 – 2” above the sternal notch
2. T2, T3 – level of manubrial notch and
margin of scapula
3. T4, T5 – level of sternal angle
4. T7 – level of inferior angle of scapula
5. T10 – level of xyphoid tip
C. LUMBAR REGION
1. L3 – lower costal margin

2. L3, L4 – level of umbilicus
3. L4 – level of most superior aspect of iliac
crest
D. SACRUM and PELVIC REGION

1. S1 – level of ASIS
2. Coccyx – level of pubic symphesis and
greater trochanter
3 Regions consist vertebral segment
- free or movable vert.
- consist of 24 vert. segments
2 Regions Vertebrate
- false or fixed vert. because of change
they undergo in adults.
VERTEBREA
- consist of 33 bones that compose of spinal
column
1. Cervical - 7
2. Thoracic - 12
3. Lumbar - 5
4. Sacral - 5
5. Coccygeal - 4
Spinal Curvatures
1. Convex curves (hollow)
- Cervical
- Lumbar
* Secondary or compensatory curve
2. Concave curves (arched)
- Thoracic
- Sacral
* Primary curve
Abnormal Curvatures
1. Lordosis
- lumbar curvatures is exaggerated
- swayback
- increase in anterior convexity or
posterior concavity
2. Kyphosis
- thoracic curvatures is exaggerated
- humpback / hunchback
- increased in anterior concavity or
posterior convexity
3. Scoliosis
- lateral curvature
- S-Shaped
4. Gibbus
- posterior angulation of the spine
FRACTURES
1. Clay shoveler’s Fx. - C6 - T1
2. Compression fracture - Fx that causes compaction of
bone and a decrease in length or
width
3. Hangman’s - C2 and C3 / anterior subluxation
4. Odontoid fracture - C2
5. Teardrop burst fracture - Compression with flexion in cervical
region
6. Jefferson’s fractures – fracture of the lateral masses of C1
Vertebral Bodies are Separate by Intervertebral

Disks
1. Nucleous Pulposus
- central mass of soft pulpy semigelatenous
materials.
2. Anulus Fibrosus
- an outer fibro cartilagenous disk
Congenital Defect
A. Spina Bifida
- failure f the lamina to unite posterioly at the
midline spinal cord to close.
B. Ankylosing Spondylitis
- rheumatoid arthritis involving SI jts & spine
C. Spondylolisthesis
- forward displacement of a vert. over a lower
vertebra
D. Spondylolysis
- breaking down of the vert
- bony defect occur in the parts interarticularis
in the lamina bet. the two articular process.
ATLAS (C1)
- a typical vert.
- thick arch called anterior arch
- has posterior arch
- articulation between C1 and occiput
condyles
* Atlantooccipital articulation
Axis (C2) dens odontoid process
Rib Articulations
1.Costovertebral Joints (11 to 12th ribs)

- two partial facets called demifacets
2. Costotransverse
- articulates from 1st to 10th ribs
C1 AND C2
Procedures:
1. AP Projection (Open Mouth)
2. PA Projection (Judd Method)
(Kasabach Method) R or L head
Rotations
5. AP Projection (Fuchs Method)
1. AP Projection (Open Mouth)

- MSP perpendicular
- 2.5 cm. below the upper lip
- lower edge of upper incisor is at level of
mastoid tip
* Dens, vert. body of C2, lat. Masses of C1,
Zygopophyseal jts.
2. PA Projection (Judd Method)

- waters/occiput
- chin & mastoid are vertical / OML 370
- MSP perpendicular
3. AP Axial Projection (Kasabach Method) R or

L head Rotations
- rotate the head away 40–450
- IOML perpendicular
- 10–150
- 1” distal to the tip of mastoid process
5. AP Fuchs method
- chin and mastoid process same level
- distal to the tip of the chin
- odontoid seen through the foramen
magnum
Vertebral Arch (Pillars)

1. AP Axial / Pillar or Lateral mass
- show the posterior elements of the CV
- the upper 3 or 4 TV
- articular processes and their facets
- laminae & spinous processes
- RP C7
- CR 20-30↓
* greater angle if the curve is accentuated
* lesser angel if curve is diminished
2. AP Axial Oblique (R and L rotation)

- shows vertebral arches of pillars when px
cannot hyperextend the head
- rotate head 45-50° away
* show articular process of C2-7 and T1
- rotate head 60-70°
* show the process of C6 and T1-4
Cervical Spine
Procedures:
2. Lateral Projection (Grandy Method)
3. Lateral Projection (Hyperflexion &
Hyperextension
4. AP Axial Oblique Projection (RAO and
LPO Position)
5. PA Axial Oblique Projection (RAO and

LAO Positions)
6. AP Projection (Otonello Method)
7. Lateral Projection (Twinning Method or
Swimmer’s View or Pawlow Method)
Unique Characteristics of the Cervical Spine

- has 3 foramina
* left and right transverse foramina
* Single large vertebral foramen
- extend the neck so that the occlussal plane
is perpendicular
- RP thyroid cart. / C4
- CR 15–200
Purpose
- Presence & Absence of cervical ribs
- IV spaces / interpedicute spaces
- C3-C7 / T1-T3 vert. bodies
- Degenerative Disease
2. Lateral Projection (Grandy Method)

- Subluxation
- IV joints, articular pillars / lat. masses,
spinous process, zygopophyseal joint,
(C2-C7)
- 5-10 lbs. each arm
- 72” SID
3. Lateral Projection (Hyperflexion /

Hypertension)
- functional studies of CV
- Absence of movements resulting from
trauma
- Range of motion of the cervical vertebrae
- Whiplash Injury
* caused by sudden forced movements
in one direction (automobile impact)
- shows fxs. Of the articular processes
4. AP Axial Oblique Projection (RPO / LPO

Position)
- rotate the body 450
- farthest IVF are better demons.
- 15–200
5. PA Axial Oblique Projection (LAO / RAO

Positions)
- rotate the body 450
- closest IVF and pedicles are demons.
- 15–200
6. AP Projection (Ottonello Method or Chewing

or Wagging Jaw)
- continuous motion
- mandibular shadow / Blurring
7. Lateral Projection (Twinning, Swimmer’s/

Pawlow Method)
- demons. cervicothoracic region
- 5–150 caudally
- rotate 50–100
- C4-T3
Thoracic Vertebrea
Procedures:
1. AP Projection
2. AP Oblique Projection (RPO and
LPO Positions)
1. AP Projection
- RP T6 (T7 optimal)
- 1½ - 2” above the shoulder
- 2.5 cm./1” below the manubrial notch (3-4”
below”) / T6
- Suspended respiration
- Fat cat
- IV spaces, spinous and transverse process,
post-rib, costovertebral articulation
2. AP Oblique Projection (RPO and LPO

Position)
- rotate the body 200 from true lat. to form
700
- T6 or (T7 optimal) 2” below the ST
- demons. Zygapophyseal joints,
mediastenal structures, T1-T12
- Cervico thoracic spinous processes
- IV foramina, transfers processes, T1-T10
- CR 3-50 cephalad
- breathing technique, RP T6
- demons: Intervertebral foramina (Best T11&
T12)
- 2 transverse processes
LUMBAR VERTEBRAE
Procedures:
1. AP Projection
3. AP Oblique Projection (RPO and
LPO Positions)
1. AP Projection
- lower costal margin
- knee & hips flexed
Demons; Lumbar vert. bodies, IV jts.,

spinous & transverse processes, laminae, SI
jts & Sacrum
2. Lateral Projections
- lower costal margin
- first 4 intervertebral foramina
- L5-S1, IV joint, Vertebral bodies
- CR 2-50 caudally
- spondylolisthesis
- convexity closest to the film to open up
intervertebral spaces
3. AP Oblique Projection (RPO and LPO

Positions)
- demons. the Scotty dog signs
- pars interarticularis – spondylolysis
* if L1 and L2 = at least 500
* if L5 and S1 = only 300
- body rotated by 45 deg.
- zygapophyseal joint
RIB CAGE
A. Above the diaphragm

- deep inspiration
* which depresses diaphragm to its
lowest position
- R1 to R10
- low kVp, if injury over the heart – high kVp
* to obtain high scale contrast
B. Below the diaphragm (Recumbent)

- expiration
* to rise to the level of the 7th or 8th
posterior ribs
- R8 to R12
- body rotated by 450
* to demons. axillary ribs
CHEST
Chest Teleo
- 72”
- to demons. pulmonary patho. & cardiac
size / shadows
Lungs
- has 3 lobes right
- has 2 lobes left
Pneumothorax
- air or gas pressure in the pleural cavity
Hemothorax
- Accumulation of fluid in the pleural cavity
PARTS of the Lungs

1. Apex
- rounded upper area above the level of the
clavicles
2. Carina
- point of bifurcation
- the lowest margin of the separation of the
trachea into the right & left bronchi
3. Base
- lower concave area of each lung that rests
on the diaphragm
4. Costophrenic angle
- extreme outermost lower corner of each
lung, where the diaphragm meets the ribs
5. Hilum
- Central area of the lungs
CHEST X-RAY
- to demons. Pulmonary patho. & cardiac size
and shadows (Pleural effusions, pneumothorax,
atelectasis and sign of infection)
- Chest teleo 72”
Parts of Respi
1. Larynx
2. Trachea
3. Right and left bronchi
4. Lungs
Structures located in the mediastinum:

1. Thymus gland
2. Heart & great vessels
3. Trachea
4. Esophagus
Reasons of Erect CXR

1. To allow the diaphragm to move
down farther:
- causes liver & other abdo.
organs to drop.
- allowing the lungs to fully
aerate
2. To show possible air & fluid levels in

the chest.
3. To prevent engorgement &
hyperemia of pulmonary vessels.
Engorgement = distended or swollen
with fluid.
Hyperemia = excess of blood
Procedures:
1. PA Erect
2. Lateral Erect
3. AP Lordotic / Lindbloom Method
4. Lateral Decubitus
5. LAO / RPO
6. RAO / LPO
7. AP Supine
8. Ventral or Dorsal Decubitus
1. PA Erect
- RP at the end of 2nd full inspiration
* to ensure maximum expansion of the
lungs
- The lungs will expand:
* Transversely
* Anteriorly
* Vertically
- being the greatest dimension
2. LATERAL Erect
- Left lateral
* to show the heart and left lung
- Left side against the film
- MSP / Sagittal planes are parallel
- Coronal plane perpendicular
- T7
- lower lobe extends above the level of the
hilum posterioly
- Left Lateral demonstrate the:

* Heart and great vessels
* Aorta
* Left sided pulmonary lessions
interlobar fissures
* Trachea, Bony thorax
- Right lung is 1” shorter than the left lung
* because of the large space occupying liver
located in the right upper abdomen
3. Apico-Lordotic / Lindblom Method

- demons. Lung apices & sub apical areas
- anterior mediastinum
- interlobar effussions
- vascular markings of the lungs
- masses beneath the clavicles
- CR 15-200 towards the head
- RP midsternum
- for fluid or pleural effusion suspected side
down.
- for air (pneumothorax) affected side up.
- elevate 5-8cm / 2-3inches
- 5 minutes before the exposure
5. LAO / RPO
-right lung, trachea, bony thorax, with heart
aorta infront of the vert. column.
- 450 rotation
* ant. Portion of the left lung
* trachea and its bifurcation (the carina)
* right branch of the bronchial tree
- to demons. of the pulmonary disease
- if cardiac series examination 600 rotation
6. RAO / LPO
- best image of the left atrium
- Left lung, trachea, bony thorax with
heart and aorta infront of the vert. column.
- body rotated 450
* for possible pulmonary disease body
rotation is only 15-200.
7. AP Supine
- + 50 Caudally
* to prevent clavicles from
obscuring the apices.
- if too ill to turned to the prone position
- heart & great vessels are magnified
8. Ventral or Dorsal Decubitus

- elevate 2-3 inches
- shows a change of pos. of fluids and reveals
pulmonary areas that are obscured by the
fluid in standard projection.
ABDOMEN
Procedures:
1. AP Projection (KUB) / Flat Plate
2. AP Upright Projection
4. Dorsal Decubitus
3 Ways or AAS
1. AP Supine
2. AP
3. CXR
- to detect free air that may
accumulate under the
diaphragm.
1. AP Projection (KUB) / Flat Plate

- RP iliac crest
- include SP
- demon. size and shape of the liver, spleen
and kidney
- intra. Abdominal calcification
- tumor masses
2. AP Upright Projection
- 2” above the iliac crest
- UB is included
- diaphragm is included
- is used in most cases
- demons. air/fluid level or free intraperitonial
air in cases of bowel obstruction or
perforated viscus.
Right Lateral Decubitus

- maybe required when the patient cannot lie
on the left side.
4. Dorsal Decubitus
- when cannot stand or lie on the side
- CR
- 2” above the level of the iliac crest
- demons. air fluid levels of abdo.
- RP 2” above the level of iliac crest
- demons. prevertebral space occupied
by the abdo. aorta or intra. abdo.
calcifications.
SPECIAL PROCEDURE w/o
CONTRAST
SKULL - A bony framework of the head

CONTRAST
CONTRAST
Divided into 2 parts
1. CRANIUM
2. FACIAL BONES
CONTRAST
1. Cranium (Skull cap)

8 bones & houses the brain
1 Frontal
1 Ethmoid
2 Parietal
1 Sphenoid
2 Temporal
1 Occipital
CONTRAST
a. Skull cap / calvaria

1 Frontal
2 Parietal
1 Occipital
b. Floor
1 Ethmoid
1 Sphenoid
2 Temporal
CONTRAST
2. Facial bones (Protective housing of the upper

ends of the respiratory & digestive )
14 bones irregular shaped
2 Nasal
2 Lacrimal
2 Palatine
2 Inferior nasal conchae
2 Maxillae
2 Zygomatic bones
1 Vomer- plowshare
1 Mandible
CONTRAST
CONTRAST
CONTRAST
Cranial Bones
-are rigidly joined together by fibrous
joints or sutures.
CONTRAST
Average or Normal Cranium

- Oval in shape
- Wider in back than in front
- measures:
6 inches (15 cm.)widest point from
side to side
7 inches(17.8 cm)longest point from
front to back
9 inches(22 cm)deepest point from
vertex to submental region.
CONTRAST
4 Funda lines
- OML/ RBL
- GML
- IOML/Reids BL or anthropological
base line.
- Acanthiomeatal line
CONTRAST
TYPES OF THE SKULL
1. MESOCEPHALIC
- Normal type of the skull
- Petrous pyramid project anteriorly and
medially
- MSP forms an angle of 47 degrees
- Superior border of the structures are
situated in the base of the cranium.
- the length is bet. 75 to 80%
CONTRAST
2. Brachycephalic
- broad type of skull / Short
- petrous pyramid & MSP form 540
- internal structures are higher with reference
to the IOML.
- greater 80% in length
3. Dolicocephalic
- internal structures are lower w/ reference to the
IOML
- long/ elongated, front, narrow, deep from V to B
- Petrous pyramid & MSP form 400
- less than 75% in length
CONTRAST
SKULL TOPOGRAPHY
1. MSP
2. Interpupillary or Interorbital line
3. Orbitomeatal line/Radiographic base line
4. Infraorbitomeatal line/Reid’s BL or
Anthro-pological baseline
5. Acanthiomeatal line
6. Mentomeatal line
7. Glabellomeatal line
8. EAM
CONTRAST
CONTRAST
CONTRAST
FONTANEL’S
1. Anterior Fontanel / Bregma

- soft spots
- largest fontanel that closes until 18
mos. of age
2. Posterior Fontanel / Lambda
CONTRAST
CONTRAST
3. Sphenoid fontanel / Pterion

- Right sphenoid
- Left sphenoid
4. Mastoid Fontanel / Asterion

- Right mastoid
- Left mastoid
CONTRAST
Major Sutures of the Skull
1. Sagittal
- located on top of the head that
separates the two parietal bones
2. Coronal
- found bet. Frontal and parietal bones.
CONTRAST
3. Lambdoidal
- Parietal and occipital
4. Squammosal
- Temporal & parietal
CONTRAST
Skull
- To demons. fracture, bony pathology and
intracranial calcification
1. Fracture
*disruption in the continuity of a bone
A. Linear Fracture
- fracture of the skull that may
appear as jagged or irregular
lucent line with sharp borders.
CONTRAST
B. Depressed Fracture
- sometimes called pingpong
fracture
- fragment of bone that is
separated and depressed into
the cranial cavity
2. Gunshot wounds
CONTRAST
Procedures:
1. AP
2. PA
3. Lateral
4. SMV/ Full Basal
5. AP Axial/ Townes/ Chamberlaine
6. PA Axial/ HAAS
CONTRAST
1. AP Projection
- OML perpendicular
- Orbits are magnified or increased OID
- the lateral margin of the orbit and lateral
margin of the temporal bone measures
less in AP than in PA.
- crista galli
- posterior portion of the cranial vault
CONTRAST
CONTRAST
2. PA
- when frontal bone is of primary interest
- CR perpendicular, eixt the nasion
 orbits are filled by he margins of the
petrous pyramids.
 post. Ethmoidal air cells
 Symmetric petrous ridges
 Entire cranial perimeter showing three
distinct tables of squamous bone.
CONTRAST
CONTRAST
CONTRAST
- for Gen-Survey / Caldwell

150 to nasion
 petrous ridges projected into the
lower third of the orbit
 ant. Ethmoidal air cells
- for SO fissures
20-250 to mid orbits
CONTRAST
- Foramina rotundum
25-300 to nasion
*to demons; art. ethmoidal air cells,
CONTRAST
3. Lateral
- IOML perpendicular
- MSP parallel to the film
- IPL is perpendicular
- 5 cm ( 2” ) above the EAM
- superimposed, orbital roofs & greater wing of the sphenoid
& mastoid regions and
EAM
- IOML parallel to the film
- all sinuses
- nasal bones
CONTRAST
- sella turcica
- ant. Clinoid processes
- dorsum sellae
- post. Clinoid processes
- superimposed TMJ
CONTRAST
In case of injury to the frontal bone:

- cross table or horizontal
- to demons. the presence of air in the cranial cavity.
4. Lateral Projection / Dorsal decub / Cross table

lateral
- show traumatic sphenoid sinus effusion
- Supine
- elevate the head
- 2” superior to the EAM
CONTRAST
CONTRAST
5. AP Axial/ Townes/ Chamberlaine

- AP Semiaxial / halfaxial
- MSP / OML perpendicular/ IOML
* 300 caudad to the OML sella turcica &
anterior clinoid process above the
foramen magnum
* 370 caudad to the IOML dorsum
sella & post. Clinoid within the
foramen magnum
CONTRAST
CONTRAST
-2 ½” above the glabella

- entire foramin magnum
- CR 400 -600 to the OML
- Occipital bone
- Mastoid air cells
- Grashey method
- Petrous pyramid
- Dorsum sellae
- Posterior clinoid process
CONTRAST
CONTRAST
- sphenoid bone
- cranial foramina
- jugular and rotundum foramina.
CONTRAST
6. SMV/ Full Basal / Basilar Proj.
- IOML is parallel
- Zygomatic arches
- CR from gonion to vertex
- sphenoidal sinuses
- petrosae
- full basal projection
- inferosuperior projection
- Tangential projection
- basilar proj.
*Basal foramina, Foramen ovale, foramen
spinosum, foramen lacerum cranial base.
CONTRAST
CONTRAST
7. VSM
- anterior cranial base
- sphenoid sinuses
CONTRAST
CONTRAST
CONTRAST
8. PA Axial/ HAAS
- Prone
- opposite of Towne’s
- Forehead & nose touching the table
- OML ┴
- C.R. 250 / 1 1/2 “ below the inion & exit 1
½ “ superior to the nasion
*demons. the occipital region, petrous
pyramids, dorsum sella and posterior
clinoid processes w/in the FM.
CONTRAST
CONTRAST
CONTRAST
- occipital bone
- dorsum sellae and post clinoid process
with in the foramen
- Nuchofrontal proj.
- PA axial opposite of AP axial
CONTRAST
Sella turcica
- saddle type / horse shoe / clivus
Procedure:
1. Lateral
2. Towne’s
CONTRAST
1. Lateral (Hest Proj.)

- ¾” anterior & superior
- MSP parallel, IPL ┴ ,
IOML parallel
- Superimposed the
anterior and posterior
clinoid processes
- dorsum sellae
CONTRAST
2. Towne’s
-3” above the bridge
of the nose
- IOML ┴
- MSP ┴
* demons. Pituitary adenomas
petrous pyramid
dorsum sellae
CONTRAST
- CR 370 to projects the dorsum sellae &

posterior clinoid processes w/ in the
foramen magnum
- CR 300 to the IOML
* Dorsum and tuberculum sellae
* the anterior clinoid process
demons. The sellar region and petrous
pyramids
CONTRAST
OPTIC CANAL (Foramen)
- to demons. size of the optic foramina

- blow out fx. in the floor of the orbit
Procedures:
1. Parieto-orbital Oblique / Rhese /
3 point landing
2. Orbito-parietal/Alexander Method
CONTRAST
1. Parieto- orbital obl./ Rhese/ 3 points

landing
- semi-prone
- cheek, nose & chin
• optic foramen lying in the inferior &
lat. Quadrant of the orbit
- MSP is 530
- Acanthiomeatal ┴
- C.R ┴
CONTRAST
- Outer canthus / 1” superior & posterior to

the TEA
 Optic foramen, orbital margins
 ethmoidal, sphenoidal & frontal sinuses
 Optic canal lying in the inferior and lat.
quadrant of the orbital shadow
 Optical canal inface in the end of the
sphenoid ridge
 Entire orbital shadow
CONTRAST
- Lateral deviation of optic foramen

* incorrect rotation of the head
- longitudinal deviation of optic foramen
* incorrect angulation of AML
- lower outer quadrant
- cross section of the optic foramen
CONTRAST
CONTRAST
2. Orbito - parietal/ Alexander method

- supine
- rotate head away
- MSP 400 to the
plane of the film
- A canthiomeatal ┴
- RP inferior & lat.
margin of the upper
most orbit
CONTRAST
3. PA axial / modified lysholm

- CR 200
• demons. Optic canal and
anterior clinoid process
- CR 300
• Superior orbital fissure

CONTRAST
CONTRAST
CONTRAST
SUPERIOR ORBITAL FISSURES
- is the cleft between the greater and lesser

wings of the sphenoid bone.
Procedure:
1. PA Axial proj.
CONTRAST
1. PA axial proj.
- prone
- OML ┴
- MSP ┴
- CR 20-250
- forehead & nose touching
- level of inferior margin of the orbit.
CONTRAST
- Petrous portions of the temporal bone in

projected below the inferior margin of the
orbits
- orbital fissures seen in the medial side of the

orbits between the greater and lesser wing.
- Petrous ridges should be projected

below the superior orbital fissures.
CONTRAST
CONTRAST
CONTRAST
Inferior Orbital Fissures

- is a narrow cleft extending from the lower
anterolateral aspect of the sphenoid body
1. PA axial Proj. (Bertel Method)
- Prone
- forehead & nose are touching
- MSP ┴
- IOML ┴
- CR 20-250 exiting the nasion enters
3” below the external occipital
prutuberance
CONTRAST
- inferior orbital fissures is seen between

the shadows of the lateral pterygoid
lamina of sphenoid bone & condylar
process of the mandible
- anterior image of the orbital floor

CONTRAST
CONTRAST
CONTRAST
Sphenoid Strut
- inferior root of the lesser wing of the
sphenoid bone
Procedures:
1. Parieto-orbital Oblique/Hough Method
CONTRAST
1. Parieto- orbital obl./ Hough method

- prone
- supercillary ridge resting the table
- IOML ┴
- Head rotated toward
- MSP 200
- C.R. 70
- erosion of bone caused by a lesion
involving the adjacent cavernous sinus.
CONTRAST
CONTRAST
CONTRAST
- superior root of the lesser wing of the

sphenoid bone.
- forming the roof of the optic canal
- visualized between optic canal and

superior orbital fissure
CONTRAST
FACIAL BONES
Procedures:
1. Parieto-Acanthial / Waters
2. PA Axial / Caldwell
3. Lateral
4. Modified Parietoacanthial / Modified
Waters.
5. Acanthioparietal / Reverse Waters
CONTRAST
1. Parieto- Acanthial/ Waters

- petrous ridges seen below the auxillary sinuses
- best projections for facial bones
- OML 370 angle
- MSP ┴
- Mentomeatal ┴ tip of the nose is 3/4 inch from the
table top
- demons. blowout fx., orbit, maxillae, zygomatic
arches, tripod, Le forte fracture
CONTRAST
CONTRAST
- prone
- forehead and nose touching the
table
- MSP ┴
- OML ┴
- nasion
CONTRAST
If for Gen survey

- 150 exit at the nasion
* to projects petrous ridges into the
lower third of the orbit (orbital
rink, orbital floor)
Orbital Rim
- 300 below the inferior margin of
orbit (known as exaggerated
caldwell)
CONTRAST
Demonstrates: Fractures of the facial bones

Alveolar ridge fractures
Orbital rim
Nasal Septum and
Mandibular Condyles
Zygomatic bones
CONTRAST
CONTRAST
CONTRAST
Tripod Fracture / free floating zygomatic bone

- fracture caused by a blow to the cheek, resulting a
fracture in the zygoma in three places
* Orbital process
* Maxillary process
* Zygomatic arch
Le Forte fracture
- severe bilateral horizontal fractures of the
maxillae resulting in an unstable detached fragments
Le Fort Fracture
CONTRAST
3. Lateral
- Prone head true lateral
- MSP parallel
- IPL ┴
- IOML parallel
- CR ┴ between the
outer canthus and EAM
* demons. lateral image of
the bones of the face
CONTRAST
Demonstrates :
- Depressed fractures of the frontal
sinuses
- Orbital roof
- Sella turcica
- Mandible
CONTRAST
CONTRAST
4. Modified Parietoacanthial / Modified

Waters / Shallow Waters
- increase OML angulation by 550
- petrous ridges are projected below
the inferior border of the orbits at a
level midway through the maxillary
sinuses.
- demons. Blowout fx
- Orbital floor ┴ to the IR
CONTRAST
CONTRAST
5. Acanthioparietal / Reverse Waters

- when the px cannot be placed in prone
position
- chin up, OML 370
- MML ┴
- demons. superior facial bones, petrous
ridges projected below maxillary
sinuses.
- for trauma patient
CONTRAST
NASAL BONES
- demons. fxs. and degree of displacement of
the nasal bones, septum & soft tissues
fractures of the nose.
Procedures:
1. Lateral
2. Tangential/Supero-inferior
3. Parieto-Acanthial (waters)
CONTRAST
1. Lateral
- prone, head is true lateral
- IPL ┴
- IOML parallel with the transverse
axis of the IR
- MSP parallel with the table top
- R.P ½” distal to the nasion or
bridge of the nose
CONTRAST
CONTRAST
2. Tangential / Supero- Inferior

- MSP ┴
- Maybe done using occlussal film
*shows medial or lateral
displacement
- Best for linear fracture of the nasal bone
CONTRAST
CONTRAST
CONTRAST
3. PARIETO-ACANTHIAL (Waters)
- MSP is perpendicular
- OML is 37 degrees angle to the IR
- Acanthion
- demonstrates: displacement of
bony nasal septum and depressed
fractures of the nasal wings.
CONTRAST
CONTRAST
ZYGOMATIC ARCHES
Procedures:
1. Tangential/SMV/Full Basal
2. Tangential / May Method
3. AP Axial Proj. (Townes/Grashey)
4. PA Axial (Superoinferior)
CONTRAST
1. Tangential/ SMV/ Full basal

CONTRAST
CONTRAST
2. Tangential / May Method

- prone
- nose & chin touching
- MSP 150 away
- C.R ┴ to the IOML
- RP ½” posterior to the outer canthus
* demons. zygomatic arch free of
superimposition & those who have
depressed fracture or flat cheek bone
CONTRAST
CONTRAST
CONTRAST
CONTRAST
3. AP axial / modified town
- seated-erect / supine
- MSP ┴ to the midline of the grid
- OML ┴ to the plane of the film
- CR 300
- RP 1” above the nasion
- demons. zygomatic arches free of

superimposition
- if unable to flex the neck IOML ┴ with the IR, CR
370
CONTRAST
4. PA axial (Superoinferior) / modified

Titterington
- Prone position
- Nose and chin are touching
- MSP ┴ to the film
- CR 23-380
 enters the vertex midway between
the zygomatic arches
CONTRAST
CONTRAST
MANDIBLE
Procedures:
1. PA
2. Axio-Lateral oblique proj.
3. AP AXIAL PROJECTION
CONTRAST
1. PA
- forehead & nose touching
- MSP ┴
- OML ┴
* If for Gen. Survey
- C.R ┴
- demons. mandibular body and rami
– to show medial & lat. displacement
of fragments in fxs. of the rami
CONTRAST
CONTRAST
CONTRAST
CONTRAST
2. Axio-lateral oblique projection

- prone
- MSP parallel
- IPL ┴
- C.R. 250 to 35 degrees cephalad
* If the ramus
- head in true lateral position
CONTRAST
CONTRAST
If the body
- head rotated until MSP form 300 towards.
CONTRAST
If symphesis
- head rotated 450 towards
CONTRAST
4. Intraoral Projection
- Superioinferior
- Hard palate
- roof of the mouth
- palatine process of the maxillae
- horizontal plates of the palatine bone
- entire dental arch
- occlusal film
- perpendicular to the film
CONTRAST
5.Intraoral Projection
- Anterior portion of the hard palate
- alveolar process
- upper incisors
- MSP is vertical
- Occlusal plane is perpendicular to the
table
- 60-650 caudad
CONTRAST
6. Intraoral Projection
- Inferosuperior (SMV)
- Mandible
- Floor of the mouth
- lower dental arch (entire)
- medial and lateral displacement of fracture
- submaxillary and sublingual salivary glands
CONTRAST
7. Extraoral
- superoinferior axial position
- mandibular symphesis
- mental foramina
- roots of the lower incisors
- canines
- 40-450 posteriorly if upright
- 40-450 caudad if recumbent
CONTRAST
MANDIBULAR RAMI
PA Axial
- prone, forehead and nose touching
- OML ┴ to the IR
- MSP ┴ to the IR
- CR 20-250 RP Acanthion
- Demons. Mandibular body and rami
Medial and lat. Displacement of
fragments in fx.
CONTRAST
MANDIBULAR BODY
PA
- nose and chin touching
- AML nearly ┴ to the IR
- MSP ┴ to IR
- CR ┴ to the level of the lips
PA axial
- CR 300 , midway between TMJ
CONTRAST
CONTRAST
CONTRAST
SMV
- demons. The coronoid and condyloid
processes of the rami
condyles the mandible
anterior to the pars petrosa
- IOML parallel
- CR ┴ to the IOML
- RP midway between the angles of
mandible
CONTRAST
Panorex / Panoramic Tomo. / Pantomography

Rotational Tomo.
- demonstrates fractures of the mandibles,

TMJ pathology and dental arches
- entire mandible
- the rotation time is 10-20 secs.
CONTRAST
CONTRAST
TMJ
Procedures:
1. AP axial/ Townes
2. Lateral Oblique / Axiolateral/
Axial Transcanial
3. Obl. Transfacial / Zanelli method
4. Lateral Transcanial
5. Inferosuperior Transfacial
6. Lat. Transfacial / Albers-schonberg
CONTRAST
1. AP axial / Townes
- supine
- MSP & OML ┴
- C.R. 350 from the OML or 420 from IOML
- 3” above the nasion
- demons. Condylesof the mandible &
mandibular fossae
CONTRAST
CONTRAST
2. Lateral Oblique / Axiolateral/ Axial

Transcanial
- prone, head lateral pos.
- MSP parallel
- IPL┴
- 5 cm / 2” superior to the EAM / ½” anterior
- C.R. 25-300
- TMJ is lying ant. To the EAM
CONTRAST
If Mouth is open:
- condyle lying inferior in the articular tubercle.
- condyle and TMJ below pars petrosa
- demonstrates the mandibular fossa & the
inferior & ant. excursion of the condyle
If Mouth is closed:
- condyle lying in mandibular fossa.
- petrosa superimpose on the condyle
- demons. fxs. of the neck & condyle of the
ramus, Disloc. or small fx. Of the cortex
CONTRAST
CONTRAST
3. Obl. Transfacial / Zanelli method

- rest the cheek against the IR
- rotate the head towards the IR until the
MSP forms 30 degrees angle
- AML is parallel
- CR ┴ to the mandibular angle
- demons. Axiolateral image of the
mandibular jts. in the open and
close mouth
CONTRAST
CONTRAST
4. Lateral Transcanial
- semi prone, head true lat.
- MSP 150 towards the film
- AML parallel with the transverse
axis of the film
- CR 150 , entering TMJ
- close and open mouth
CONTRAST
CONTRAST
CONTRAST
5. Inferosuperior Transfacial
- semi prone head true lat.
- IPL forms 10-150 from the ┴
- MSP 150 from the plane of the
film
- CR 300 enters to the inferior
angle of the mandible
- shows the oblique lateral image of the
TMJ
CONTRAST
CONTRAST
CONTRAST
6. Lat. Transfacial / Albers-schonberg

- semi prone head true lat.
- MSP parallel, IPL ┴, IOML parallel to
the transverse axis of the film
- CR 200
- demons. Lat. Image of the TMJ
- close and open mouth
CONTRAST
CONTRAST
CONTRAST
CONTRAST
Eye
- demonstrates the presence of radiopaque FB in
the orbital cavity
CONTRAST
Procedures:
1. Lateral
2. Occipito-mental
Lateral Preliminary
- prone, head lat
-1 exposure eye looking straigth
CONTRAST
1. Lateral
- prone, head lat
- 2 exposure are made
* 1 eye raised
* 1 eye down
- C.R. ┴
- RP outer canthus
CONTRAST
CONTRAST
CONTRAST
2. Occipito- Mental / Parietoacanthial /

Modified Waters
- prone
- nose & chin touching
- OML 500
- MSP ┴
- eyes closed, petrous pyramids
seen below the orbital shadows.
CONTRAST
CONTRAST
CONTRAST
VOGT- BONE FREE POSITION

- used to detect small or low density
foreign particles
2 Movements
1. Vertical movement
2. Horizontal movement
CONTRAST
Parallax Method
- deep localization/ fluoroscopic guided
Sweet Method
-orbital FB localization using geometric
calculation
Pfeiffer – Comberg Method

- using leaded contact lense placed
directly over the cornea
CONTRAST
Function of PNS
- serves as resonating chamber for
the voice
- Decrease the weight of the skull by
containing air
- Help to warm and moisten inhaled air
- act as shock absorber in trauma
- possibly control the immune system
CONTRAST
1. Maxillary Sinuses
- the oldest term Antrum (Antrum of
Highmore)
- exhibit a definite cavity at birth
- largest
CONTRAST
2. Frontal Sinuses
- begin to be visible on radiographs @ 6 or
7 y/o
- second largest
- measures 2 to 2.5 cm in the vertical or
lateral dimension
- posterior to the Glabella
CONTRAST
3. Ethmoid sinuses
- located within in the lateral masses of
the labyrinths of the ethmoid bone
- develop last
4. Sphenoid Sinuses
- lies in the body of the sphenoid bone
directly below the sella turcica
CONTRAST
CONTRAST
CONTRAST
SINUSES
- demonstrates Pathology of the accessory
nasal sinuses.
- To demonstrate the presence or absence of

fluid levels and other pathologic conditions.
*Should be taken in erect or upright position

CONTRAST
Procedures:
1. Parieto-acanthial / Waters /
occipitomental
2. PA axial
3. Lateral
4. Oblique
5. OM w/ Open Mouth / Water’s w/
open mouth
CONTRAST
1. Parieto- Acanthial/ Waters/ Occipitomental

- prone
- OML 370
- C.R. ┴
- R.P acanthion
- MML / MSP ┴
- frontal & ethmoidal cells are
distorted
- demons. Maxillary sinuses, foramen rotundum
CONTRAST
- Mahoney’s
- Blow out fractures
- facial bones
- orbit, maxilla and zygomatic arches
- nose 2-3cm from the table
- Hyperextend the neck to place the
dense petrosae below the maxillary
sinus floors
CONTRAST
If OML is less than 370

- petrousal shadows into the lower
antra
If OML is more than 370
- foreshortened antra
CONTRAST
Demonstrates:
- Sinusitis of the maxillary sinuses
- Retention cysts and nasal deviation
- Petrous ridges lying inferior to the
floor of the sinuses.
* seen in the inferior to medial
aspect of the orbital floor superior to the
roof of the maxillary sinuses.
CONTRAST
CONTRAST
CONTRAST
- demons. Frontal & ant. ethmoid sinuses
Frontal sinus lying above the
frontonasal suture and the
anterior ethmoidal air cells
lying above the petrous ridges
- forehead & nose
- MSP & OML┴
- C.R. 150 to nasion original 230 to glabella
CONTRAST
CONTRAST
CONTRAST
3. Lateral
- demons. all sinuses
- prone, head in lateral
- MSP parallel
- IPL ┴
- IOML parallel
- RP ½ inch. posterior to the outer canthus
of the eye.
- thickness of the outer table of the frontal
bone
CONTRAST
CONTRAST
CONTRAST
4. Oblique
- demons. posterior ethmoid sinuses
- prone
- forehead & check resting
- MSP 400
- OML 300
CONTRAST
CONTRAST
CONTRAST
5. OM with Open mouth/ Water’s with open

mouth
- demons. Sphenoidal sinuses along with maxillary
sinuses
- head in prone
- chin resting
- MSP ┴
- IOML parallel
- OML 370
- CR perpendicular
CONTRAST
CONTRAST
CONTRAST
6. SMV
- basal proj. of sphenoid & ethmoid
sinuses.
- anterior portion of the base of the skull
- IOML nearly parallel
- MSP┴
CONTRAST
7. Axial Transoral Proj. (Pirie method)

- Prone or erect
- Nose and Chin are touching
- Mouth is open, MSP is Perpendicular
- CR 30 degrees caudally
- demonstrate: Sphenoid sinuses
Maxillary sinuses and
Nasal fossae
CONTRAST
CONTRAST
CONTRAST
8. Granger 23 pos.
- prone
- forehead touching the table
- C.R. 230
- R.P level of Infra orbital margin
*demons. Frontals
- anterior
- Ethmoid & Antra
CONTRAST
8. Granger 107
- prone
- forehead touching
- C.R. 170
- level of IOM
*demonstrates – Sphenoid
-post ethmoid
-Antra
CONTRAST
Ethmoidal, Fronal and Sphenoidal

PA Obl. / Rhese method
- prone
- zygoma, nose and chin touching
- AML parallel with the transverse of
the film
- MSP 530
- RP enters at the upper parietal region
- demons. Optic canal
CONTRAST
MASTOID
- demonstrate the air cells
1.350 Fronto occipital

2. Lat. oblique/ Schuller
3. Law
CONTRAST
1. Towne’s
- Supine
- OML & IOML ┴ & MSP
- C.R. 300 to the OML or
370 to the IOML
- R.P. 2” above the glabella on at the
level of Mastoid on EAM / 2 ½ inches
above the nasion.
CONTRAST
Demonstrates:
- Internal auditory canals
- Petrous portion of the temporal bone
- Labyrinths
- Mastoid antrum
- Middle ears
- Dorsum sellae (seen w/in the FM)
- foramen magnum
- post-clinoid process
CONTRAST
CONTRAST
2. Schuller/Axiolateral
- Semi prone, Head true lat.
- MSP parallel
- IOML parallel, IPL perpendicular
- C.R. 25-300 caudally
- R.P. 1 ½” superior & posterior to the EAM
*Pneumatic structure of the mastoid,
Mastoid antrum, Dural plates, Int. & Ext.
meatuses.
CONTRAST
CONTRAST
3. Modified Law method / Axiolateral Oblique

(Single-Tube angulation)
- prone, head lateral
- IOML parallel IPL┴
- rotate the head toward until MSP will form 150
- CR 150
- RP 1” posterior to the EAM and 2 “ superior to
the uppermost EAM
* demons. mastoid cells, lateral portion of
the petrous pyramids, superimposed IAM
& EAM,
CONTRAST
CONTRAST
4. Low Beer Pos. / Parieto-temporal

- Mastoid
- Semi-prone, Head true lat.
- IOML parallel
- CR 10 cephalad
- Similar & Stenvers
- RP 1 1/2” below the EAM.
CONTRAST
CONTRAST
CONTRAST
CONTRAST
5. AP Tangential / Modified Hickey

- Supine
- rotate the head away, MSP 550
- IOML ┴ to the film
- CR 150 enters the interior border of the mastoid
process
- mastoid process is projected below the
shadow of the occipital bone
- auricle of the ear should not superimposed the
mastoid
CONTRAST
CONTRAST
CONTRAST
CONTRAST
6. PA Tangential
- seated erect / prone
- IOML ┴, MSP 550 to plane of the film, 350
from the vertical
- CR 150 , RP posterior border of the
mastoid process
CONTRAST
CONTRAST
CONTRAST
CONTRAST
Petrous Temporal Bone
1. Stenvers / Axiolateral Obl.

2. Arcelin / Axiolateral Obl.
3. Henchen / Axiolateral Obl.
4. Mayer / Axiolateral Obl.
CONTRAST
1. Stenvers / Axiolateral oblique

- prone
- forehead, nose & zygoma
- IOML parallel if neck is flex
- MSP is 450 towards the side of interest
CONTRAST
- petrous pyramid or petrousa parallel to the film

- C.R. 120
- 3-4” post. & ½” inferior to the EAM.
* demons. petromastoid portion, petrous ridge
mastoid antrum, tympanic cavity, mastoid process, IAM
& EAM, tumors of the acoustic nerve.
CONTRAST
CONTRAST
3. Arcelin (Reverse of Stenvers) / Axiolateral Obl.

- Supine
- Rotate the head away 450
Brachy - 540 with the MSP
Dolico - 400 with the MSP
- IOML ┴
- CR 100
- R.P. 1” ant. & ¾” Superior to the EAM
* demonstrate the Petrous portion of
the temporal bone, mastoid process
CONTRAST
CONTRAST
4. Henschen / Axiolateral Obl.
- MSP / IOML parallel
- IPL┴
- Prone, Head true lat.
- C.R. 150
- R.P. 2”/ 5 cm. above the EAM
* demonstrate mastoid cells, mastoid
antrum, IAM & EAM
* Tumors of the acoustic nerve
CONTRAST
CONTRAST
5. Mayer / Axiolateral Oblique

- Supine, OML ┴, IOML parallel
- Head is rotated 450 towards
- CR 450
- R.P. 3” above the Supercillary ridges
- attic-aditus antrum areas
- TMJ Anterior to the EAM
- EAM anterior to the petrosa
* demons. tympanic cavity and ossicles, epitympanic
recess, aditus and mastoid antrum, petrosa, EAM
CONTRAST
CONTRAST
6. Lysholm method / Axiolateral oblique

- prone
- head in true lateral
- MSP / IOML parallel to transverse axis of
the cassette
- CR 30-350
- referred to as Runstrom II method with
open mouth to visualize petrous apex
* demons. Mastoid cells, mastoid
antrum, Labyrinth, carotid canal
CONTRAST
CONTRAST
TEMPORAL BONE
PA / Transorbital method
- Prone
- Forehead and nose are touching
- MSP ┴, OML ┴
- CR ┴, RP nasion or either 50 or 50
- demons. Internal acoustic canals through
the shadows of the orbit
petrous ridges should be projected inferior to
the superior margin of the orbits
CONTRAST
CONTRAST
CONTRAST
CONTRAST
Valdini / PA axial
- prone
- IOML 500
*demons. The labyrinths and the
internal acoustic canal

- OML 500
*demons. External acoustic tymphanic
cavities and eustachian tube

- excellent image of vestibulocochlear organ
- most of the foramen magnum should be seen
CONTRAST
CONTRAST
CONTRAST
SMV / Hirtz Modification

- Basilar projection of petrousmatoid portion
- Supine
- Rest head on the vertex
- MSP ┴
- OML parallel
- CR is ┴ to the OML / 50
* demons. Tympanic cavities
* mastoid processes, labyrinths,
EAM, and acoustics ossicles.
CONTRAST
CONTRAST
CONTRAST
CONTRAST
Styloid Process
Cahoon Method / PA Axial Projection
- prone
- forehead & nose
- MSP / OML ┴
- CR 250 cephalad
- RP nasion
* demons. Symmetric image of the styloid process
temporal bone above the maxillary sinuses
CONTRAST
CONTRAST
CONTRAST
CONTRAST
Jugular Foramina
SMV / Axial Projection (KEMP HARPER
METHOD)
- supine
- head on the vertex
- OML parallel
- MSP ┴
- CR 200 posterior angle
- RP 1” distal to the mandibular symphesis
CONTRAST
CONTRAST
CONTRAST
ERASO MODIFICATION
- position similar to KEMP HARPER
- OML 250
- MSP ┴
- RP 2” distal to the mandibular symphesis
* demons. Jugular foramina
- CR perpendicular
increased by 50-100 in Kemp
CONTRAST
Hypoglossal Canal
Axiolateral Oblique / Miller Method
* to delineate hypoglossal canal
- supine
- MSP 450 away
- OML parallel
- Open mouth as possible
- CR 120
- RP 1” anterior & ½ inferior to the EAM
CONTRAST
CONTRAST
CONTRAST
CONTRAST
Fetography
- to determine the age, position and
presentation of fetus
- multiple pregnancy such as
* Distal anomalies
* Fetal death
* Hydraminous
CONTRAST
Procedures:
1. AP
2. Lateral
CONTRAST
Type of Pelvis
1. Gynecoid
- transverse diameter
- oval shape
2. Anthropoid
- one whose anteroposterior diameter equals
or exceeds the transverse
CONTRAST
3. Platypelloid
- a pelvis having an inlet with a transverse
diameter that exceeds the anteroposterior
diameter, the inlet thus appearing as a flat oval.
4. Android
- Heart shaped
CONTRAST
Pelvimetry
- demons. the size of the fetal head
with the maternal bony pelvic outlet.
Colcher – Sussman method

1. AP
2. Lateral
CONTRAST
2. Thoms method
- Torpin – Thoms pelvimeter
1. AP
2. Lat.
3. Ball Method
- no special apparatus
CONTRAST
3. Rice / Rise Wangestein Tech.

- in perforated anus
- upside down
Procedures:
1. AP
2. Lateral
* done with in 24 hrs. after birth so that the
stomach be filled with air using rectal
thermometer
CONTRAST
Breast Positioning
Base
- portion near the chest wall
Apex
- near the nipple
CONTRAST
MAMMOGRAPHY
Breast Cancer
- is the leading cause of Ca death
bet. ages 15 to 54 yrs
- most women who developed breast
Ca have no family history of the disease.
- the most treatable Ca, when
detected early.
CONTRAST
GOAL
- to detect breast Ca before it is palpable
Radical Mastectomy was introduced by

Halstead in 1898
EGAN & GROS

- who popularized mammo. for diagnosing
and evaluating breast Ca 1950’s
CONTRAST
Women age 50 should undergo annual

mammo.
Women ages between 40-49 should

undergo mammo every year or every
other year.
Baseline before the onset of menopause.

CONTRAST
Screening Mammo
- is a procedure performed on
asymptomatic patient or a patient who
presents without any known breast
problems.
CONTRAST
Criteria:
1. Must be simple
2. Must be acceptable
3. Must demons. high sensitivity
4. Must demons. high specificity
5. Must be reproducible
6. Must be cost effective
7. Must have a low risk vs benefit ratio
CONTRAST
Mammography
- is simple it takes only about 15 mins. To
complete
- cannot detect all cancerous lesions
- will return for subsequent mammo
3 or 6 mos.
- Breast Ca can only be diagnosed by
tissue extracted from the lesion
CONTRAST
Risk Factors:
1. Gender
2. Age - incidence increase w/ age
3. Hormonal History
- Breast tissue is more sensitive to
carcinogens during menarche
- Early menses women before age
12 or after age 52
* first birth after age 30 & multiparity
4. Family History
CONTRAST
Breast / Mammary gland

- are lobulated glandular structures located within
the superficial fascia of the anterolateral surface of the
thorax of both males & females.
Involution
- when the lobules tend to decrease in size with
increasing age and particularly after pregnancy.
* Mammo unit was introduced in 1967

CONTRAST
Methods of Examination
- remove any deodorant and powder form
the axilla regime
* because it will resemble
calcifications on the resultant image.
- complete hx is taken
- careful physical assessment
- noting all biopsy scars
- palpable masses
CONTRAST
- suspicious thickenings
- skin abnormalities
- nipple alterations
Routine:
- CC / craniocaudad
- MLO / mediolateral oblique
CONTRAST
Compression
- to produce uniform breast thickness
from the nipple to the most posterior aspect
of the breast
CC
- elevate the inframmary fold to its
maximum.
CONTRAST
1. Craniocaudad (CC)
- elevate the inframmary fold to its maximum
height.
- pull gently the breast into the casette holder
- lean the patient toward the machine
- bring compression paddle into the contact
with the breast
- CR ┴ to the base of the breast
CONTRAST
* demons. the central, subareolas and fibrograndular

breast tissue
* only 30% of the pectoral is demonstrated
CONTRAST
2. Mediolateral oblique / MLO projection

- erect
- rotate the body 30-60 until the long edge of the
cassette is parallel to the upper one third of the
pectoral muscle of the affected side.
- CR ┴
* demons. all the breast tissue with
emphasis on the lateral aspect and
axillary tail.
CONTRAST
CONTRAST
Magnification Technique
- magnifies the area with improved
detail and determine the characteristics of
microcalcifications and margin of suspected
lesions.
CONTRAST
Magnification Technique
CONTRAST
Spot Compression Technique

- resolves superimposed structures
seen on only one projection.
- visualizes small lesions located in
the extreme post-breast.
CONTRAST
Spot Compression Technique

CONTRAST
90 Degree Mediolateral Projection

- shows lesions on the lateral aspect of the
breast in the superior or inferior aspect.
- shows air-fluid and fat-fluid levels in breast
structures and in pneumocystography.
CONTRAST
90 Degree Mediolateral Projection

CONTRAST
90 Degree Latero-Medial
- shows lesions on the medial aspect of the
breast in the superior or inferior aspects.
- shows air-fluid and fat-fluid levels in breast

structures and in pneumocystography.
CONTRAST
90 Degree Latero-Medial
CONTRAST
Exaggerated Craniocaudal (XCCL)
- shows a superoinferior projection of the

lateral fibroglandular breast tissue and post.
Aspect of the pectoral muscle.
- shows lateral orientation of a lateral lesion

located in AT of the breast.
CONTRAST
Exaggerated Craniocaudal (XCCL)

CONTRAST
Craniocaudal Projection for Cleavage (CV)

- shows lesions located in the deep
posteromedil aspect of the breast.
CONTRAST
Craniocaudal Projection for Cleavage (CV)

CONTRAST
Tangential Projection
- shows superficial lesions close to the skin
surface with minimal parenchymal
overlapping.
- shows skin calcifications or palpable lesions

projected over subcutaneous fat.
CONTRAST
Tangential Projection
CONTRAST
Capture Lesion Or Coat-Hanger Projection

- very useful when imaging a palpable lesion
located in the extreme posterior breast
tissue.
- captures and isolates the palpable lump for
imaging.
CONTRAST
Capture Lesion Or Coat-Hanger Projection
CONTRAST
Cleopatra Position
- demons. The lateral aspect of the breast
including the detail.
- useful only if a significant amount of breast
tissue is present in the tail region.
* seating position
* lean backward and laterally
* with the breast support at her side
CONTRAST
Methods used in Augmented Breast
1. Eklund Method
- the implant is pushed posteriorly against
the chest wall so that it is excluded from the
image and the breast tissue surrounding the
implant is pulled anteriorly and compressed.
CONTRAST
Complications
1. Fibrosis (increased fibrous tissue
surrounding the implant).
2. Shrinking
3. Hardening
4. Leakage
5. Pain
CONTRAST
1. Craniocaudal Projection w/ Implant

Displaced
- shows the implant displaced
posteriorly.
- anterior and central breast tissue is seen
projected free of superimposition with
uniform compression and improved tissue
differentiation.
CONTRAST
Craniocaudal Projection w/ Implant Displaced
CONTRAST
2. CC with Full Implant

- show the entire implant and surrounding
posterior breast tissue with suboptimal
compression of the anterior fibroglandular
breast tissue.
CONTRAST
Complications:
1. Fibrosis (Increased Fibrous Tissue
surrounding the implant )
2. Shrinking
3. Hardening
4. Leakage
5. Pain
CONTRAST
1. Modified radical mastectomy

2. Radiation System Therapy
- when tumor is located near the chest
wall
Survival rate: 97% survive 5 yrs
CONTRAST
Projection
1. CC / Caudocranial
2. MLO / Lateromedial (LMO)
Cleavage View
- a double breast compression view
* demons. breast tissue, anterior to the
sternum and medial aspect of both breast
CONTRAST
Male Breast
- develop breast Ca are 60 yrs older
- male breast Ca are primary tumors
* because less breast tissue
* smaller breast lesions
Symptoms
- nipple, retraction
- crusting
- discharge
- ulceration
CONTRAST
Gynecomastia
- a benign excessive dev’t of the male
mammary gland
Cause:
* hormonal imbalance
* Increasing age
* Positive family history
* Klinefelter’s syndrome
THANK YOU VERY MUCH
and
GOD BLESS!!!

Radiographic Positioning: (Reinforcement)

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RADIOGRAPHIC POSITIONING

Dean LORENZO A. REVELDEZ JR.

Common Positioning Terms

General Body Position

4. Ball Catcher / Norgaard / Brewerton

 Injury or Pathologic conditions

- 30° towards the finger tips to elongate the

4. PA with Ulnar Flexion

5. PA with Radial Flexion

7. Gaynor Hart / Templeton & Zim

11. PA Axial Ulnar Deviation ( Rafert Long

12. Lateral with Palmar Flexion

3. AP Oblique (Medial Rotation)

4. AP Oblique (Lateral Rotation)

5. AP Partial Flexion (Trauma)

6. AP Partial Flexion (Proximal Forearm)

7. AP Acute Flexion (Jones Method)

8. Lateral Projection (Lateromedial)

supinate hand and rotate externally

hand in true lateral position (Thumbs up)

rotate hand internally (Thumbs down)

9. Axial Lateral Medial Proj. (Coyle Method)

SHOULDER / PECTORAL GIRDLE

7. Inferosuperior / Axial Projection (Clements

4. Transthoracic Lateral Projection (Lawrence

 if 600 abduction the CR is 200

6. Inferosuperior Axial Projection (Rafert

7. Inferosuperior Axial Projection / West point

8. Inferosuperior Axial Projection (Clements

9. Superoinferior / Axial Projection

10. AP Axial Projection

11. Tangential Projection (Fisk Method)

12. PA Oblique / Scapular Y (RAO or LAO)

13. AP Apical Oblique (RPO&LPO) (Garth

- demons. of acute shoulder trauma

- rotate the body 450 towards

14. AP oblique Projection (RPO&LPO)

15. Tangential Projection (RAO&LAO) (Neer

16. AP Axial Projection (Stryker “Notch” Method)

17. AP Oblique Projection (RPO/LPO) (Apple

18. Hobbs modification / PA Transaxillary

1. AP Projection (Bilateral) (Pearson Method)

2. AP Axial Projection (Alexander Method)

3. PA Axial Oblique Projection (RAO/LAO)

Hindfoot – calcaneous and Talus

Joints of the Digits

- demonstration the anatomy of the foot and

1. Kite Method (Dorsoplantar and Lateral)

B. Lateral Projection (Mediolateral)

1. Axial Projection (Plantodorsal)

2. Axial Projection (Dorsoplantar)

3. Axial Projection (Coalition Weight Bearing)

4. Lateromedial Oblique / Weight Bearing Method

TALOCALCANEAL / SUBTALAR JOINT

A. AP Axial Oblique Projection (Mediolateral

– 10° post. Portion of Talus and

B. AP Axial Oblique Projection