ABDOMEN and ACUTE ABDOMINAL SERIES

ROUTINE POSITIONS: AP (K.U.B., Flatplate)

AP Abdomen (K.U.B.)
1. 14 X 17 film
2. Patient supine
3. Cassette is placed so that the pubic bone is at the bottom of the film.
4. Bucky or grid if patient is unable to be moved.
5. 40" SID
6. Central Ray is perpendicular to the film.
7. Expiration

ADDITIONAL VIEWS: Upright, Decubitus, Lateral

Upright Abdomen
1. 14 x 17 film
2. Patient is in an AP ERECT POSITION (allow time for free air to rise).
3. Place top of cassette to the axilla (diaphragms must be demonstrated).
4. Bucky
5. 40" SID
6. Central Ray: horizontal, parallel with the fluid level, even if patient isn't
completely 90 degrees upright.
7. Expiration

Decubitus Abdomen
1. 14 x 17 film
2. Patient is placed in a recumbent left lateral position (allow time for free air to
rise).
3. Place the top of film at axilla (diaphragms must be demonstrated).
4. Upright bucky or grid.
5. 40" SID
6. Central Ray: perpendicular to film.
7. Expiration

Lateral Abdomen
1. 14 x 17 film
2. Patient is placed in a recumbent left lateral position.
3. Bucky
4. 40" SID
5. Central Ray: perpendicular to film.
6. Centering point - level of crest.
7. Expiration

ACUTE ABDOMINAL SERIES (A.A.S.)

ROUTINE POSITIONS: PA chest, AP abdomen, AP upright

PA chest
1. 14 x 17 film
2. Patient upright
3. Patient's chin is extended with their hands on hips and shoulders rolled forward.
4. 72" FFD
5. Central Ray: perpendicular to film.
6. Deep inspiration

AP (K.U.B.)
1. 14 x 17 film
2. Patient supine
3. Cassette is placed so that the pubic bone is at the bottom of the film.
4. Bucky or grid if patient is unable to move.
5. 50" FFD
6. Central Ray: perpendicular to the film.
7. Expiration

Upright
1. 14 x 17 film
2. Patient erect
3. Cassette is placed at the axilla (diaphragms must be demonstrated).
4. Bucky
5. 40" FFD
6. Central Ray: horizontal, parallel with the fluid level, even if the patient isn't completely
90 degrees upright.
7. Expiration
Radiographic Positioning of an ACBE

AIR CONTRAST BARIUM ENEMA (ACBE)

SUPPLIES: Air Contrast Bag with 500 cc of heavy barium (Polibar).

VIEWS:
K.U.B. (Scout) * CHECK WITH RADIOLOGIST BEFORE CONTINUING*
Right Lateral Decubitus
Left Lateral Decubitus
Cross Fire Lateral Recto-Sigmoid Area
PA
AP 30 degree Cephalic
PA 30 degree Caudal
AP
RPO 45 degrees
LPO 45 degrees
Post Evac

ALL FILMS ON 14 X 17, EXCEPT RECTUM VIEWS, 10 X 12 FILMS. ALL FILMS

TAKEN ON EXPIRATION.

Prelim K.U.B.
1. Patient supine
2. Bucky
3. 40" SID
4. Center at crest

Right Lateral Decubitus

1. Patient recumbent in right lateral position.
2. Horizontal beam
3. Grid
4. Center to iliac crest.
5. 40" SID
6. Center beam to grid.

Left Lateral Decubitus

Positioned the same as Right Lateral Decubitus except patient is on left side.

PA
1. Patient prone
2. Bucky
3. 40" SID
4. Center at crest.
AP 30 Degree Cephalic (Up-Shot)
1. Patient supine
2. Central Ray: angled 30 degree cephalic, center to ASIS
3. Bucky
4. 40" SID
5. To demonstrate sigmoid colon.

PA 30 Degree Caudal (Down-Shot)

1. Patient is prone
2. Central Ray: angled 30 degree caudal, center to ASIS
3. Bucky
4. 40" SID
5. To demonstrate sigmoid colon.

AP
1. Patient supine
2. Bucky
3. 40" SID
4. To demonstrate transverse colon and flexures.
5. Center to iliac crest.

RPO
1. Patient recumbent in a 45 degree RPO position.
2. Bucky
3. 40" SID
4. To demonstrate splenic flexure
5. Center at crest

LPO
1. Patient recumbent in a 45 degree LPO position.
2. Bucky
3. 40" SID
4. To demonstrate hepatic flexure.
5. Center at crest

Lateral Rectum Cross-Fire

1. Patient prone
2. Horizontal beam
3. Grid (10 x 12)
4. 40" SID
5. Film to include Recto-Sigmoid area.
6. *Deflate balloon on enema tip before exposure.
7. Center midaxillary plane midway between ASIS and posterior sacrum.

Post Evac
Position the same as Scout.
*110 KVP should always be used on adults.
** 90 KVP should always be used on infants.
***Always check films with Radiologist before patient is allowed t

Radiographic Positioning of the AC-Joints

AC JOINTS (ACROMIOCLAVICULAR JOINTS)

If checking for fracture of AP shoulder to include clavicle must be taken prior to weight
bearing film.

ROUTINE POSITIONS: AP upright without weights and AP upright with weights

FILM SIZE: 14 x 17 crosswise or (2) 10 x 12 films

1. Patient is placed in an AP upright position.

2. Both shoulder joints need to be included.
3. First position made with patient's arms relaxed without weights.
4. Second exposure made with patient holding 10 lb. weights in each hand and bearing
equal weight on both feet.
5. 72" SID
6. Centering point is at suprasternal notch.
7. Suspended respiration.

THE FILMS MUST BE MARKED "WITH" AND "WITHOUT WEIGHT"

Radiographic Positioning: Radiographic Positioning of the Ankle

ANKLE

ROUTINE POSITIONS: AP, Internal oblique, Lateral

AP
1. 10 x 12 extremity cassette (divide in half)
2. Patient supine with foot flexed up.
3. Table top exposure
4. 40" FFD
5. Central Ray: mid ankle joint

Internal Oblique (mortis view)

1. 10 x 12 extremity cassette (divide in half)
2. Patient supine with foot rotated in 5-15 degree to place intermalleolar line parallel to
film with foot flexed.
3. Table top exposure
4. 40" FFD
5. Central Ray: mid-ankle joint

Lateral
1. 8 x 10 extremity cassette
2. Patient lateral turned toward affected side until leg and foot are in a true lateral position
(may need knee support).
3. Table top exposure
4. 40" FFd
5. Central ray: mid-ankle joint

*NOTE: It is very important that the foot be flexed for all views to open up the space
between foot and ankle if patient is able to tolerate it.

STRESS VIEWS

Radiologist is to do ALL stress views.

ROUTINE POSITIONS: Per Radiologists, need comparison views.

RADIOLOGIST WILL APPLY STRESS TO AREA

Radiographic Positioning: Radiographic Positioning of the Appendix

APPENDIX STUDY

SCOUT FILM MUST BE TAKEN

PA ABDOMEN
1. 14 x 17 film
2. Patient prone.
3. Central Ray: perpendicular to film
4. Bucky
5. 40" SID
6. Center at iliac crest
7. Expiration

*NOTE: Patient must be given 6 oz. barium sulfate orally the night prior to exam.

After obtaining scout film, check film with Radiologist.

Radiographic Positioning of a Barium Enema

BARIUM ENEMA

FULL COLUMN

SUPPLIES: Enema bag mixed with room temperature water.

VIEWS:
K.U.B. (Scout)
RPO 45 degree
LPO 45 degree
Left Lateral Abdomen for Flexures
Left Lateral Abdomen for Rectum
PA
PA Sigmoid 30 degree Caudal Tube Angle, (or) due to patient condition
A.P. 30 degree Cephalic.
Post Evac

All films in 14 x 17 except rectum views 10 x 12.

All films taken on expiration.

Scout K.U.B.
1. Patient supine
2. Bucky
3. 40" SID
4. Center at iliac cres
5. Include Symphysis Pubis

RPO 45 degree
1. Patient recumbent, rotated 45 degrees with right side down.
2. Bucky
3. 40" SID
4. To demonstrate splenic flexure
5. Center iliac crest.

L.P.O. 45 degree
1. Patient recumbent, rotated 45 degrees with left side down.
2. Bucky
3. 40" SID
4. To demonstrate splenic flexure
5. Center iliac crest.

Left Lateral for Flexures

1. Patient recumbent in left lateral position.
2. Bucky
3. 40" SID
4. Center to include flexures.
5. Center at iliac crest.

Left Lateral Rectum

1. Patient recumbent in left lateral position.
2. Bucky
3. 40" SID
4. Center to include rectum
5. Deflate tip, midaxillary plane between ASIS and posterior sacrum

PA
1. Patient prone
2. Bucky
3. 40" SID
4. Center to include flexures as well as rectum.
5. Center at iliac crest

PA Sigmoid (Can be done A.P. due to patient condition)

1. 11 x 14 film
2. Patient prone or supine.
3. Bucky
4. 40" SID
5. Center to include sigmoid colon, PA exits ASIS, AP enters ASIS
6. Central Ray: PA 30 degree caudally, AP 30 degree cephalic

Post Evac
Position the same as the scout.

*110 KVP should be used on adults.

**90 KVP should be used on infants.
***Always check films with radiologist before allowing patient to evac.

Radiographic Positioning of Bone Age Survey

BONE SURVEYS

BONE AGE SURVEY

To check stage for maturation at epiphysis.

ROUTINE VIEWS: P.A. Hand and Wrist

1. 10 x 12
2. Have patient place both hands and wrists on film
3. Table top with detail cassette
4. 40" SID
5. Central Ray: perpendicular to film

Radiographic Positioning of Bone Length Study

BONE LENGTH STUDY

To measure the difference in the length of the legs.

ROUTINE POSITIONS:
AP Hips
AP Knees
AP Ankle

1. The lead, numbered ruler, is place under the patient's pelvis so that it extends down
between patient's legs. Secure legs with tape.
2. Patient supine
3. Patient's feet are 7" apart.
4. Using one 14 x 17 film take AP hips, AP knees, AP ankle joints coned down.
5. Bucky
6. 40" SID
7. Central Ray: perpendicular to table.
8. Patient MUST NOT be moved between exposures.

Radiographic Positioning of Cardiovascular Studies

CARDIOVASCULAR STUDIES

I. ECHOCARDIOGRAMS
A. Perform as per corporate protocol. Do 2D, M-mode, doppler, and colorflow on every
patient!
B. Follow guidelines as to where to drop off echoes to be interpreted.
C. For all INPATIENT echoes, make a copy of the worksheet and put in patient's chart.

II. CAROTID DUPLEX SCANS

A. Document transverse images on tape in black and white and with color on tape.
B. Document on tape sagittal views of CCA, bulb, ICA, and ECA.

C. Document on tape and prints systolic velocities from proximal and distal CCA;
systolic and diastolic velocities from proximal and distal ICA; highest systolic velocity
from ECA.
D. Calculate internal/common ratio using highest systolic velocities for common and
internal vessels.
E. Estimate degree of stenosis using specified guidelines.
F. Note on tape and worksheet whether vertebral flow is antegrade or retrograde.
G. Obtain brachial blood pressures.

III. LOWER EXTREMITY ARTERIAL DOPPLERS

A. Document waveforms from DP, PT, POP, SFA, and CFA; also digital to waveforms if
indicated.
B. Do segmental BP on above ankle, below knee, above knee, and high thigh; take above
ankle pressure utilizing DP and PT pulses; do BIG TOE pressure if indicated.
C. Do arm pressures.
D. Do not exercise patient
E. Calculate ABI's for DP, PT, and toe/brachial indices if indicated.

IV. VENOUS DUPLEX - LOWER

Do imaging and doppler compression with augmentation on CFV, SFV, GSV, POPV,
PTV, ATV, peroneal veins and saphenous in the lower leg; do transverse views.

V. VENOUS DUPLEX - UPPER

Do transverse imaging on subclavian, axillary, basilar, brachial, veins, and doppler
augmentation; do radial and ulnar veins.
VI. UPPER EXTREMITY ARTERIAL
A. Document doppler signals from subclavian artery, axillary artery, brachial, radial,
ulnar and palmar arteries; do digital PPG waveforms if indicated.
B. Do upper and lower arm pressures using radial artery signal.
C. Do index finger pressures using PPG.
D. If indicated do thoracic outlet syndrome maneuvers documenting waveforms from
brachial artery.

Radiographic Positioning of the Chest

CHEST

ROUTINE POSITIONS: PA, Lateral

ADDITIONAL POSITIONS: Lordotic, Decubitus, Expiration, 45 degree RAO and LAO

PA
1. 14 x 17 film
2 Patient upright
3. Patient's chin is extended and with their hands on hips have them roll shoulders
forward.
4. 72" SID
5. Central Ray: perpendicular to film.
6. Deep inspiration

LATERAL
1. 14 x 17 film
2. Patient is upright in a true left lateral (right lateral must be specifically ordered).
3. Patient instructed to raise arms over head out of the area of interest.
4. 72" SID
5. Deep inspiration

LORDOTIC
1. 14 x 17 film
2. Patient is place din an upright AP position.
3. Instruct patient to take two (2) steps forward, then lean back so only their shoulders are
touching the cassette.
4. 72" SID
5. Central Ray: perpendicular to film.
6. Deep inspiration

*IF PATIENT IS UNABLE TO LEAN BACKWARD, ANGLE TUBE 15-20 DEGREE

CEPHALIC.
AP DECUBITUS - TO SHOW FLUID IN DEPENDENT SIDE
1. 14 x 17 film
2. Patient is in a recumbent lateral position (side down as ordered).
3. Have patient raise arms out of chest area.
4. 72" SID
5. Central Ray: perpendicular to film.
6. Deep inspiration

EXPIRATION
Patient positioned the same as PA chest except exposure is made on complete expiration.

45 DEGREE LAO AND 45 DEGREE RAO

1. 14 x 17 film
2. Patient placed in 45 degree LAO or 45 degree RAO position.
3. 72" SID
4. Central Ray: perpendicular to film.
5. Deep inspiration

: Radiographic Positioning of an OR Cholangiogram

O.R. CHOLANGIOGRAM WITH C-ARM

1. Position c-arm as soon as PT is positioned on OR table.

2. Position c-arm monitor for physician.
3. Make sure monitor is on "auto" for filming.
4. Have cassettes ready.
5. Mark intensifier with right marker.
6. When ready to film make sure camera is at # 0 image.
7. Once surgeon begins to inject contrast, they will tell you when to "shoot". 1-2 films
will be taken during injection. Films should be brought to the department and run as soon
as possible.
8. Mark films in order of filming sequence.
9. Show films to radiologist for approval. Radiologist will advise the surgeon for
interpretation of films.
10. Films are to be put with patient's jacket and given to the Radiologist for a dictated
report.

Radiographic Positioning of the Clavicle

CLAVICLE

ROUTINE POSITIONS: AP, AP Axial

AP
1. 10 x 12 film crosswise
2. Patient supine
3. Bucky
4. 40" SID
5. Central Ray: perpendicular to film, center mid-clavicle

AP AXIAL
1. 10 x 12 crosswise
2. Position same as AP except tube is angles 10-20 degree cephalad.
3. Bucky
4. 40" SID
5. Central Ray: center to include all of clavicle.

Radiographic Positioning of the Coccyx

COCCYX

ROUTINE VIEWS: AP, Lateral

AP
1. 8 x 10 film
2. Bucky
3. Center midsagittal and 2" above symphysis pubis
4. 40" SID
5. 10 degree caudal tube angle

LATERAL
1. 8 x 10 film
2. Bucky
3. Palpate bottom of coccyx to center
4. 40" SID

Radiographic Positioning of the Cervical Spine

CERVICAL SPINE WITH OBLIQUES (NON-TRAUMA)

ROUTINE POSITIONS:
AP
Open Mouth
Flexion and Extension Laterals
Left Lateral
Obliques (RPO, LPO)

AP
1. 8 x 10 film
2. Patient supine or erect with chin extended.
3. Bucky
4. 40" SID
5. Tube angled 20 degree cephalad
6. Centering Point: thyroid cartilage.

OPEN MOUTH
1. 8 x 10 film
2. Patient supine or erect, adjust head so that the upper occlusal plane is perpendicular to
table, have patient open mouth.
3. Bucky
4. 40" SID
5. Central Ray: perpendicular to film, thru opened mouth

LEFT LATERAL
1. 10 x 12 film
2. Patient sitting or standing at upright film holder with cervical vertebrae centered on
film.
3. 72" SID
4. Central Ray: perpendicular to film
5. Centering point: center to neck with film 2" above E.A.M.
6. Shoulders depressed (hold weights)
7. Must see C-7

LATERAL FLEXION/EXTENSION
Same as left lateral except have patient depress chin to chest (flexion), hyperextend chin
(extension).

OBLIQUES (RPO, LPO)

1. Patient sitting or standing with back against upright film bucky.
2. Rotate patient so that they are 45 degrees away from film for each side.
3. Angle tube 15 degree cephalad.
4. 40" SID

*A swimmer''s view may be utilized to demonstrate C-7. See trauma C-spine for
positioning.
Radiographic Positioning of the Elbow

ELBOW

ROUTINE POSITIONS: AP, External Oblique, Internal Oblique, Lateral

AP
1. 10 x 12 detail film divide in half crosswise.
2. Patient seated with palm up and arm fully extended.
3. Table top
4. 40" SID
5. Central Ray: center to joint

EXTERNAL OBLIQUE
1. 10 x 12 detail film divide in half crosswise.
2. Patient seated with palm up and arm fully extended laterally, rotate entire arm so that
anterior surface of elbow joint is 45 degrees to film.
3. Patient will need to lean over and drop shoulder onto table top.
4. Table top
5. 40" SID
6. Central Ray: center of joint
7. This will demonstrate radial head and neck free of super imposition.

INTERNAL OBLIQUE
1. 10 x 12 detail film divide in half crosswise.
2. Patient seated with palm up and arm fully extended medially, rotate elbow no more
than 45 degrees.
3. Table top
4. 40" SID
5. Central Ray: center to joint
6. This demonstrates the coronoid process of ulna.

LATERAL
1. 10 x 12 detail film divide in half crosswise.
2. Patient seated with elbow flexed 90 degrees. Forearm and Humerus in same place.
Thumb must be up. Wrist and elbow in true lateral position.
3. Table top
4. 40" SID
5. Central Ray: center of joint
6. This demonstrates olecranon process.

*NOTE: THE HUMERUS AND FOREARM MUST BE IN CONTACT WITH CASSETTE

FOR ALL VIEWS.
Radiographic Positioning of the Facial Bones

FACIAL BONES

ROUTINE VIEWS:
PA
Waters
Lateral of Affected Side

BE SURE AND CLEAN TABLE BEFORE PUTTING PATIENT'S FACE ON IT.

PA
1. 8 x 10 film
2. Patient in prone position
3. Position patient' head so that the CML is perpendicular to table (nose and forehead on
table).
4. Bucky
5. 40" SID
6. Central Ray: exits nasion

WATERS
1. Patient in prone position
2. Position head so that chin is resting on table. Be sure to extend chin enough to throw
petrous ridges out of the maxillary sinuses. OML form 37o angle with table.
3. Bucky
4. 40" SID
5. Central Ray: perpendicular to film
6. Exit Point: acanthion

LATERAL
1. 8 x 10 film
2. Patient prone with affected side of face closest to film.
3. Position patient's head so that the intra pupillary line is perpendicular to film.
4. Bucky
5. 40" SID
6. Central Ray: perpendicular to film
6. Centering Point: prominence of cheek

MUST INCLUDE MANDIBLE ON ALL VIEWS

FILMS MAY BE DONE UPRIGHT OR ON THE TABLE

Radiographic Positioning of the Femur

FEMUR

ROUTINE VIEWS:
AP
Lateral

AP
1. 14 x 17 film
2. Patient supine
3. Femur centered on film
4. Table top of bucky
5. Central Ray: mid shaft

LATERAL (DISTAL FEMUR)

1. 14 x 17 film
2. Patient positioned don side with affected side closest to film
3. Opposite leg is pulled up and over affected leg.
4. Table top or bucky
5. 40" SID
6. Central Ray: mid shaft

LATERAL (PROXIMAL FEMUR)

See positioning for Hip

IF FILM DOES NOT INCLUDE BOTH JOINTS, AN ADDITIONAL FILM MUST BE

TAKEN OF SEPARATE JOINT.

Radiographic Positioning of the Foot

FOOT

ROUTINE VIEWS:
AP
Internal Oblique
Lateral
Additional film of toe sometimes needed.

AP
1. 10 x 12 detail film divided lengthwise.
2. Table top
3. Patient's foot plantar surface (sole) of foot resting on film. Angle 10o toward the heel.
4. 40" SID
5. Central Ray: perpendicular to metatarsals

INTERNAL OBLIQUE
1. 10 x 12 detail film divided lengthwise.
2. Table top
3. Rotate foot medially 45o
4. 40" SID
5. Central Ray: centered to base of 3rd metatarsals

LATERAL
1. 10 x 12 detail film or 8 x 10 detail film
2. Table top
3. Turn toward lateral side (true lateral). Support under knee.
4. 40" SID
5. Central Ray: centered to base of 3rd metatarsals

Radiographic Positioning of the Foot

FOREARM (RADIUS AND ULNA)

ROUTINE VIEWS:
AP
Lateral

AP
1. 11 x 14 divided in half extremity cassette
2. Patient seated
3. Affected arm extended with palm facing up.
4. Table top with detail cassette
5. Central Ray: perpendicular to film
6. 40" SID
7. Center midshaft

LATERAL
1. 11 x 14 divided in half extremity cassette
2. Patient seated
3. Affected arm positioned on cassette so that if forms a 90o angle with the Humerus and
hand and wrist in a lateral position.
4. Both the Humerus and forearm should make contact with the cassette.
5. Table top with detail cassette.
6. 40" SID
7. Central Ray: perpendicular to film
8. Center midshaft

MUST INCLUDE BOTH JOINTS ON BOTH VIEWS

Radiographic Positioning of the Hand

HAND

HAVE PATIENT REMOVE RINGS, WATCHES AND BRACELETS.

ROUTINE VIEWS:
PA
External Oblique
Lateral

*FINGERS*
Routine hand films
Coned down view of affected finger in lateral position.

PA HAND
1. 10 x 12 divided
2. Table top extremity cassette
3. 40" SID
4. Palm flat on cassette, fingers straight.
5. Center to third metacarpophalangeal joint.

EXTERNAL OBLIQUE
1. 10 x 12 divided
2. Table top extremity cassette
3. 40" SID
4. Center to third MCP joint.
5. From the PA position externally rotate the hand 45o. Separate the fingers and allow
them to rest against the cassette.

LATERAL
1. 8 x 10 extremity cassette
2. Table top extremity cassette
3. 40" SID
4. Hand in true lateral position and separate fingers.
5. Center to third MCP joint.
Radiographic Positioning of the Non-Trauma Hip

NON-TRAUMA HIP

ROUTINE VIEWS:
AP Pelvis - if no previous or recent one has been taken
AP Hip
Lateral Hip (Frog-Leg)

AP PELVIS
1. 14 x 17 film
2. Patient supine with toes rotated inward.
3. Bucky
4. 40" SID
5. Central Ray: midway between symphsis pubis and iliac crest.

AP HIP
1. 10 x 12 film
2. Patient supine
3. Foot rotated slightly inward 15o
4. 40" SID
5. Central Ray: through femoral neck

LATERAL HIP (FROG-LEG)

1. 10 x 12 crosswise
2. Patient supine
3. Have patient bend knee and allow affected leg to slowly "fall" to side.
4. Bucky
5. 40" SID
5. Central Ray: through femoral neck

BOTH VIEWS TO INCLUDE ENTIRE PIN OR PROSTHESIS.

Radiographic Positioning of the Humerus

NON-TRAUMA HUMERUS

ROUTINE VIEWS:
AP (internal and external)
INCLUDE BOTH JOINTS

AP (INTERNAL AND EXTERNAL)

1. 14 x 17 film
2. Bucky, upright or supine
3. 40" SID
4. Rotate affected arm internal and externally.
5. Central Ray: center to mid Humerus

*DO NOT ATTEMPT THESE PROJECTIONS IF PATIENT IS IN SEVERE PAIN.*

INSTEAD TAKE AP NEUTRAL AND TRANSTHORACIC LATERAL.

Radiographic Positioning of the Knee

KNEE

ROUTINE VIEWS:
AP
Lateral
Tunnel
Tangential

AP
1. Patient supine
2. Knee in true A.P. position.
3. Bucky
4. 40" SID
5. Center to Apex of patella.
6. Angle tube 5-7 degrees cephalad.
7. 10 x 12 film

Lateral
1. Patient in true lateral position with affected side closest to film flex knee slightly if
possible.
2. Bucky
3. 40" SID
4. Angle tube 5-7 degree cephalad.
5. Center medial epicondyle.
6. 10 x 12 film

Tunnel (Homblad)
1. Patient up on knees with femurs forward 20-25 degrees, Central Ray: through bend of
leg.
2. Bucky
3. 40" SID
4. 10 x 12 film

Transgential (Sunrise)
1. Patient sitting on table.
2. Patient's affected leg is placed so that the foot is flat on table.
3. Patient hold 8 x 10 extremity cassette behind knee.
4. Angle tube approximately 45-50 degrees cephalad to project shadow of knee on film.
5. Film is marked medially and laterally.

adiographic Positioning of the Lumbar Spine

LUMBAR SPINE WITH OBLIQUES, NON-TRAUMA

ROUTINE VIEWS:
AP
RPO
LPO
Lateral
L5-S1 Spot

AP
1. 14 x 17 film
2. Patient supine
3. Film placed so that the center of the film is at crest
4. Bucky
5. 40" SID
6. Central Ray: perpendicular to film
7. Bend knees to reduce curvature of spine

RPO-45o
1. 11 x 14 film
2. Patient recumbent rotate left side of body 45o up from table
3. Film is placed so that the center of the film is 1" above crest
4. Bucky
5. 40" SID
6. Central Ray: perpendicular to film
7. Need to visualize right apophysial joints ("scotty dogs").
8. Mark film side down with Rt. marker

LPO 45o
1. 11 x 14 film
2. Patient recumbent rotate right side of body 45o up from table
3. Film is placed so that the center of the film is 1" above crest
4. Bucky
5. 40" SID
6. Central Ray: perpendicular to film
7. Need to visualize left apophysial joints ("scotty dogs").
8. Mark film side down with Lt. marker

Left Lateral
1. 14 x 17 film
2. Patient is on left side in true lateral position
3. Bucky
4. 40" SID
5. Central Ray: centered to iliac crest
6. Disc spaces should be open

L5-S1 SPOT
1. 8 x 10 film
2. Patient is on left in true lateral position
3. Bucky
4. 40" SID
5. Central Ray: angled 5-10o caudal angle
6. Cone down to L5-S1, joint space
7. Center film 11/2 inches below crest

Flexion and Extension Lumbar Spine (Upon Request

1. Patient standing bearing equal weight on both legs.
2. Have patient lean forward for 1 film - lean backward for 1 film.
3. Central Ray: horizontal beam with film centered 1" above crest

Radiographic Positioning of Long Bone Survey

BONE SURVEYS

LONG BONE SURVEY:

To check for diseases such as lead poisoning that manifest in the epiphysis.

1. AP Humerus
2. AP Forearm
3. AP femur
4. AP Lower Leg
*INCLUDE BOTH JOINTS ON ALL FILMS
Radiographic Positioning of the Nasal Bones

NASAL BONES

ROUTINE VIEWS:
Waters
PA
Right and Left Lateral of Nasal Bones

Waters
1. 8 x 10 film
2. Patient prone or upright
3. Patient positioned with chin on table, O.M.L. forms 37o angle with plane of film
4. Bucky
5. 40" SID
6. Central Ray: passes through acanthion
7. This view can demonstrate a deviated nasal septum

PA
1. 8 x 10 film
2. Patient prone
3. Patient positioned with forehead on table, O.M.L. perpendicular to plane of film
4. Angle 15o caudal
5. Central Ray: exits nasion
6. 40" SID
7. Bucky

Right and Left Lateral of Nasal Bones

1. 8 x 10 detail film divided in half for each side
2. Patient prone
3. Head in true lateral position, interpupillary line is perpendicular to the film
4. Table top - detail cassette
5. 40" SID
6. Central Ray: perpendicular to film and centered to bridge of nose
7. Must include to anterior nasal spine
8. Use finger technique

Radiographic Positioning of the Orbits

ORBITS
ROUTINE VIEWS:
Waters
PA
Lateral
Bilateral Rheses' Views

Waters
1. 8 x 10 film
2. Patient prone or upright
3. Patient positioned with chin on table, O.M.L. forms 37o angle with plan of film
4. Bucky
5. 40" SID
6. Central Ray: exits acanthion, mentomeatal is perpendicular to film
7. This view can demonstrate blow out fracture

PA
1. 8 x 10 film
2. Patient prone or upright
3. Position head so that O.M.L. and midsagital plane is perpendicular to table
4. Bucky
5. 40" SID
6. Central Ray: angled 25o caudal exits nasion

Lateral (of affected side)

1. 8 x 10 film
2. Patient in true lateral position, interpapillary line is perpendicular to film
3. Bucky
4. 40" SID
5. Central Ray: perpendicular to film enter bony lateral margin of outer canathus

Bilateral Rheses
1. 8 x 10 film
2. Patient's head rests in 3 point landing (chin, cheek and nose).
3. Patient is rotated 37o from true PA. Center to orbit down.
* Forehead should not touch table
4. Central ray exits at center of orbit nearest table
5. Bucky
6. 40" SID
7. When positioned correctly, optic foramen should be projected in lower, outer quadrant
of orbit examined.

Rhese Suggestions
-If optic foramen is in rim of orbit, patient is positioned too lateral.

-If optic foramen is in middle of orbit, patient is positioned to P.A.

Radiographic Positioning of the Pelvis

PELVIS

ROUTINE VIEWS:
AP

AP Pelvis
1. 14 x 17 film transverse
2. Patient supine
3. Feet internally rotated to project the greater trochanters
4. Central Ray: perpendicular to film
5. Expiration
6. Bucky or grid
7. 40" SID

Radiographic Positioning of the Ribs

RIBS

ROUTINE VIEWS:
*PA Chest to R/O Pneumothorax

POSTERIOR RIB PAIN: AP Upper

AP Lower
LPO
RPO

ANTERIOR RIB PAIN: AP Upper

AP Lower
LAO
RAO
* Can be done supine or upright.

PA Upper
1. 14 x 17 film
2. Affected side centered to film
3. Bucky
4. 40" SID
5. Deep inspiration
PA Lower
1. 10 x 12
2. Affected side centered to film
3. Bucky
4. 40" SID
5. Deep expiration

Posterior and Anterior Obliques

1. 14 x 17 film
2. Patient positioned either for or posterior or anterior rib pain putting affected area
against film.
3. Center over affected side
4. Deep inspiration
5. Bucky
6. 40" SID

* May need to do lower Obliques for better visualization of ribs, especially if this is the
affected area.

Radiographic Positioning of the Sacrum

SACRUM

ROUTINE VIEWS:
AP
Lateral

AP Sacrum
1. 10 x 12 film
2. Patient supine
3. Bucky
4. Center halfway crest and pubis and midline
5. 40" SID
6. Tube angled 15o cephalad
7. Expiration

Lateral
1. 10 x 12 film
2. Bucky
3. Center ASIS and 3" posterior to midaxillary
4. 40" SID
5. Expiration
6. Use lead glove behind patient to absorb scatter
Radiographic Positioning of the Scapula

SCAPULA

ROUTINE POSITIONS:
"Y" view
True AP

"Y" View
1. 10 x 12 lengthwise
2. Patient supine or upright
3. Palpate the borders of the scapula and rotate the patient until the scapula is in true
lateral position.
4. Bucky
5. 40" SID
6. Central Ray: direct to midvertebral border of scapula, film placed 2 inches above
shoulder, raise affeted arm out of the field of view.
7. Used to demonstrate dislocation
8. Expiration

True AP
1. 10 x 12 crosswise
2. Patient supine or upright
3. Rotate body approximately 15o toward side of interest, posterior aspect of arm and
shoulder should be in contact with table.
4. Bucky
5. 40" SID
6. Expiration

Radiographic Positioning of a Scoliosis Study

SCOLIOSIS STUDY

All views done at upright Bucky standing with shoes off. Patient should bear equal
amount of weight on both feet.

ROUTINE POSITIONS:

1. AP thoracic spine to include lower cervical vert. 14 x 17 film.

2. AP lumbar spine centering at 4th-5th lumbar. 14 x 17 film.

*FILM IS TO INCLUDE FEMORAL HEADS*
3. Lateral lumbar spine centering at 4th-5th lumbar vert. 14 x 17 film.
*FILM IS TO INCLUDE FEMORAL HEADS*

If curvature of spine is seen partially on Athoracic film and partially on AP lumbar films,
do Pre AP film to include the entire curvature.

A RADIOLOGIST MUST BE PRESENT!!

CHECK FILMS WITH RADIOLOGIST BEFORE PATIENT LEAVES!

Radiographic Positioning of the Shoulder

NON-TRAUMA SHOULDER

ROUTINE POSITIONS (non-trauma):

AP External
AP Internal Rotation

ADDITIONAL VIEW:
True AP

AP External
1. 10 x 12 crosswise
2. Patient supine or standing
3. Rotate arm externally (palm up)
4. Bucky
5. 40" SID
6. Central Ray: perpendicular to film, centered to coracoid process.
7. Expiration

AP Internal Rotation
Position same as external except have patient rotate arm internally (pronate hand).

ADDITIONAL VIEW
*If joint is not open on AP external or AP internal. Must include this view*

True AP (Glenohumeral Joint Space)

1. 10 x 12 crosswise
2. Patient supine or upright
3. Rotate body approximately 35o toward side of interest, posterior aspect of arm and
shoulder should be in contact with table.
4. Bucky
5. 40" SID
6. Expiration

TRAUMA SHOULDER

ROUTINE POSITIONS (trauma):

"Y" view
True AP
AP Neutral

ADDITIONAL VIEW:
Axillary

"Y" View
1. 10 x 12 lengthwise
2. Patient supine or upright
3. Palpate the borders of the scapula and rotate the patient until the scapula is in true
lateral position.
4. Bucky
5. 40" SID
6. Central Ray: direct to midvertebral border of scapula, film placed 2 inches above
shoulder.
7. Used to demonstrate dislocation
8. Expiration

True AP
1. 10 x 12 crosswise
2. Patient supine or upright
3. Rotate body approximately 35o toward side of interest, posterior aspect of arm and
shoulder should be in contact with table.
4. Bucky
5. 40" SID
6. Expiration

AP Neutral
1. 10 x 12 crosswise
2. Patient supine or standing
3. Do not rotate patient's arm
4. Bucky
5. 40" SID
6. Central Ray: perpendicular to film, center to coracoid process
7. Expiration
ADDITIONAL VIEW
*Done only after routine trauma series completed and checked with ordering physician*

Axillary (transaxillary lateral)

1. 8 x 10 crosswise
2. Patient supine
3. Ordering physician or his designee must abduct patient's arm 90o from body.
Place support under patient's wrist and hand if needed.
4. Rotate patient's head from affected side. Rest film holder on table surface as close to
neck as possible.
5. Table top
6. 40" SID
7. Central Ray: horizontally to axilla

Radiographic Positioning of the SI-Joints

SACROILIAC JOINTS (SI JOINTS)

ROUTINE VIEWS:
AP
RPO
LPO

AP
1. 10 x 12 film
2. Patient supine
3. Bucky
4. 40" SID
5. Central Ray: 15o cephalic angle, enter halfway between A.S.I.S. and symphysis pubis.
6. Suspended respiration

Obliques (RPO and LPO)

1. 10 x 12 film
2. Patient recumbent
3. Patient rotated 30o from AP position
4. Bucky
5. 40" SID
6. Central Ray: enters 1" medial A.S.I.S. of side up.
7. Suspended respiration

Radiographic Positioning of the Sinuses

SINUSES

ROUTINE VIEWS:
PA (Caldwell)
Waters
Open Mouth Waters
Lateral of Affected Side

CLEAN TABLE BEFORE PUTTING PATIENT'S FACE ON IT.

FILMS MUST BE DONE ERECT TO SEE FLUID LEVEL.

PA
1. 8 x 10 film
2. Patient seated or standing with forehead and tip of nose resting on upright Bucky.
3. Central Ray: angled 15o caudally and passes through nasion. The O.M.L. is
perpendicular to table.
4. Bucky
5. 40" SID
6. Central Ray: to exit nasion

Waters
1. 8 x 10 film
2. Patient seated or standing with chin resting on upright Bucky so that the mentomeatal
line is perpendicular to film.
3. Bucky
4. 40" SID
5. Central Ray: to exit acanthion

Open Mouth Waters

Patient positioned same as waters view, but with mouth opened. This view must
DEMONSTRATE SPHENOID SINUS THROUGH THE OPEN MOUTH (Patient's
mouth is placed on table).

Lateral of Affected Side

1. 8 x 10 film
2. Patient sitting or standing
3. Have patient put affected side against Bucky.
4. Bucky
5. 40" SID
6. Head in true lateral with interpupillary line and O.M.L. perpendicular to front edge of
film.
7. Centering Point: outer canthus of eye

Radiographic Positioning of a Skeletal Survey

BONE SURVEY

SKELETAL SURVEY:
A basic total body exam to rule out abuse or disease affecting the bones in general.

1. AP Entire Torso
2. Lateral Skull
3. AP Long Bones

Radiographic Positioning of the Sternum

STERNUM

ROUTINE VIEWS:
RAO
Lateral

RAO
1. 10 x 12 film
2. Patient prone
3. Rotate patient so that they are in a 15-20o anterior oblique position; heavy patients
rotate less and thin patients rotate more.
4. Bucky
5. 30" SID
6. Central Ray: perpendicular to film, enters slightly left of vertebral column and is
centered midway between suprasternal notch and xiphoid process.
7. Breathing technique

Lateral
1. 10 x 12 film
2. Patient in true lateral position
3. Hand pulled behind patient to pull shoulders back
4. Bucky
5. 40" SID
6. Central Ray: perpendicular to film, top of film 11/2 inches above suprasternal notch.
Radiographic Positioning of the Tib Fib

TIB-FIB

ROUTINE VIEWS:
AP
LAT

INCLUDE BOTH JOINTS

AP
1. 14 x 17 film
2. Table top
3. 40" SID
4. Central Ray: center to mid leg

LAT
1. 14 x 17 film
2. Table top
3. 40" SID
4. Central Ray: center to mid leg

Radiographic Positioning of the TMJ-Joints

TEMPERO-MANDIBULAR JOINTS (TMJ'S)

ROUTINE POSITIONS:
Townes (Occipital)
Laws (Bilateral) with open and closed mouth

Townes (Occipital)
1. 8 x 10 crosswise
2. Patient supine
3. Position O.M.L. perpendicular to table
4. Central ray angled 30o caudal enters at glabella
5. Bucky
6. 40" SID

Laws (Bilateral)
1. 8 x 10 crosswise
2. Patient prone with head in true lateral, then rotate face toward table 15o with side of
interest closest to film. Interpupillary line is perpendicular to table.
3. Bucky
4. 40" SID
5. Central Ray exits downside T.M.J. (1 cm anterior to EAM)
6. Need bilateral with open and closed mouth
7. Mark film open or closed

Radiographic Positioning of a Trauma C-spine

CERVICAL SPINE (E.R. OR TRAUMA)

Trauma with collar do lateral, AP, and odontoid, either supine or if on backboard move
patient to table on board and shoot through, then get cleared. Once cleared ER is to
remove c-collar then do the following films:
Neutral Lateral
both Obliques or both Pillars
AP
Odontoid

If E.R./OP trauma (no collar) do:

Neutral Lateral
both Obliques or both pillars
AP
Odontoid
*NO FLEXION AND EXTENSION ARE TO BE DONE UNLESS SPECIFICALLY
ORDERED.

X-FIRE LEFT LATERAL

1. 10 x 12 film L.W.
2. Patient supine with collar ON.
3. 72" SID
4. Central Ray: center to neck with film 2" above EAM.
5. Shoulders depressed
6. Must see C-7

AP
1. 8 x 10
2. Patient supine with collar ON.
3. 40" SID
4. Central Ray: thyroid cartilage
5. Tube angled 20 degree cephalad
ODONTOID (OPEN MOUTH)
1. 8 x 10
2. Patient supine with collar ON, open mouth as wide as possible.
3. 40" SID
4. Central Ray: perpendicular to film, through opened mouth.

After E.R. has cleared films and collar is removed do the following:
Left Lateral
1. 10 x 12 film
2. Patient sitting or standing at upright film holder.
3. 72" SID
4. Central Ray: center to neck with film 2" above EAM.
5. Shoulders depressed (hold weights)
6. Must see C-7

Obliques (RPO, LPO)

1. Patient sitting or standing with back against upright film holder.
2. Rotate patient so that they are 45 degrees away form film for each side.
3. Angle tube 15 degree cephalad.
4. 40" SID
USE MARKERS ACCORDING TO SIDE DOWN.

AP
1. 8 x 10 film
2. Patient supine or erect with chin extended.
3. Bucky
4. 40" SID
5. Tube angled 20 degree cephalad.
6. Center Point: thyroid cartilage

Odontoid (open-mouth)
1. 8 x 10 film
2. Patient supine or erect, adjust head so that upper occlusal plane is perpendicular to
table, have patient open mouth.
3. Bucky
4. 40" SID
5. Central Ray: perpendicular to film, through opened mouth.

-24-
DOCTORS HOSPITAL OF NELSONVILLE Cervical Spine
(E.R. or Trauma)
Page 3

OPTIONAL VIEW:
Swimmers
1. 10 x 12 film
2. Patient supine or on left lateral with one arm extended above head and one at side.
3. X-fire or Bucky
4. 40" SID
5. Central Ray: enters C-4
Radiographic Positioning of a Trauma Hip

TRAUMA HIP

ROUTINE VIEWS:
AP Pelvis
AP Hip
Cross-fire Lateral Hip

AP PELVIS
1. 14 x 17 film
2. Patient supine with toes rotated inward.
3. Bucky
4. 40" SID
5. Central Ray: Midway between symphsis pubis and iliac crest.

AP HIP
1. 10 x 12 film
2. Patient supine
3. Foot rotated slightly inward 15o
4. Bucky
5. 40" SID
6. Central Ray: through femoral neck

CROSS-FIRE LATERAL HIP

1. 10 x 12 grid
2. Patient supine
3. Unaffected leg is up and out of the way.
4. 40" SID
5. Central Ray: Centered through femoral neck
6. Horizontal beam is directed cross table through affected hip.

Radiographic Positioning of a Trauma Humerus

TRAUMA HUMERUS

ROUTINE VIEWS:
AP Neutral
Transthoracic Lateral
AP NEUTRAL
1. 14 x 17 film
2. Bucky or table top
3. 40" SID
4. Upright or supine. Place proximal Humerus in contact with film.
5. Central Ray: surgical neck

TRANSTHORACIC LATERAL
1. 14 x 17 film
2. Bucky
3. 40" SID
4. Patient upright (seated or standing) in lateral position with affected arm in neutral
position. Raise the opposite arm; rest hand on top of head.
5. Central Ray: throughout thorax to surgical neck with 10-15o cephalic angle.

Radiographic Positioning of a Trauma Shoulder

TRAUMA SHOULDER

ROUTINE POSITIONS (trauma):

"Y" view
True AP
AP Neutral

ADDITIONAL VIEW:
Axillary

"Y" View
1. 10 x 12 lengthwise
2. Patient supine or upright
3. Palpate the borders of the scapula and rotate the patient until the scapula is in true
lateral position.
4. Bucky
5. 40" SID
6. Central Ray: direct to midvertebral border of scapula, film placed 2 inches above
shoulder.
7. Used to demonstrate dislocation
8. Expiration

True AP
1. 10 x 12 crosswise
2. Patient supine or upright
3. Rotate body approximately 35o toward side of interest, posterior aspect of arm and
shoulder should be in contact with table.
4. Bucky
5. 40" SID
6. Expiration

AP Neutral
1. 10 x 12 crosswise
2. Patient supine or standing
3. Do not rotate patient's arm
4. Bucky
5. 40" SID
6. Central Ray: perpendicular to film, center to coracoid process
7. Expiration

Radiographic Positioning of the Wrist

WRIST

Have patient remove rings, watches and bracelets.

ROUTINE VIEWS:
PA
RPO
LPO
Lateral

ADDITIONAL VIEW:
Navicular (Scaphoid)

PA
1. 1/2 - 10 x 12 detail cassette
2. Table top
3. 40" SID
4. Curl hand into fist to flatten wrist
5. Center to radioulnar joint

RPO
1. 1/2 - 10 x 12 detail cassette
2. Table top
3. 40" SID
4. Put palm flat on table and rotate wrist up laterally 45o
5. Center to radioulnar joint
LPO
1. 1/2 - 10 x 12 detail cassette
2. Table top
3. 40" SID
4. Put palm flat on table and rotate wrist up medially 45o
5. Center to radioulnar joint

Lateral
1. 1/2 - 10 x 12 detail cassette
2. Table top
3. 40" SID
4. Place hand laterally with fingers straight and thumb pointing up
5. Center to radioulnar joint

ADDITIONAL VIEW:

Navicular
* Radial deviation/ulnar flexion
Position patient with arm straight and fingers deviated out from body. Angle tube 20o
toward the elbow. Central ray enters navicular area.

Radiographic Positioning of the Zygoma

ZYGOMA (ZYGOMATIC-ARCH)

ROUTINE VIEWS:
Waters
SMV
Bilateral Basiliar Obliques

Waters
1. 8 x 10 crosswise
2. Patient prone
3. Position head so that chin is resting on table. Be sure to extend chin enough to throw
petrous ridges out of maxillary sinuses. OML for 37 angle with table.
4. Bucky
5. 40" grid
6. Central Ray: perpendicular to film, exits acanthion

Submentovertex (SMV)
1. 8 x 10 crosswise
2. Patient supine
3. Position patient's head so that Reid's baseline is perpendicular to film. I.O.M.L. parallel
to film. May be necessary to build up shoulders to achieve this.
4. Bucky
5. 40" SID
6. Central Ray enters inferior to chin and exits at vertex

Bilateral Basiliar Obliques (Oblique Axial Position)

1. 8 x 10 crosswise
2. Patient supine
3. Patient's head is positioned so that the I.O.M.L. is parallel to film. Tilt head 15 degrees
toward side to be examined.
4. Bucky
5. 40" SID
6. Central Ray: Skims parietal eminence and body of mandible
7. Both sides are done separately