VERTEBRAL COLUMN

TOPOGRAPHIC LANDMARKS

Cervical Region/Area
• C1 – same level with Mastoid tip
• C2-C3 – approx. at level of Gonion (angle of mandible)
but can vary because of the structure of the face: long, short)
• C3, C4 - Hyoid bone
• C5 - Thyroid cartilage (AKA Adams Apple); C5-most
prominent part of Adams Apple
• C7 - Vertebra prominens (because it has long spinous
process and some individual it is very clearly without bending the
neck; it is also at the level of the body of T1)
 TOPOGRAPHIC LANDMARKS
Thoracic Region/Area
• T1 – located by measuring 2 inches superior to
sternal notch
• T2-T3 – level of manubrial notch/superior
margin of scapula/suprasternal notch
• T4-T5 – same level with sternal angle
• T7 – same level with inferior angles of scapula
(important for chest pa examination; can be palpated
posteriorly; can also be palpated by locating the C7 and
measure 7-8 in. down from that)
• T9-T10 – approx. at the level of xiphoid process
(the end of the sternum)
• T10 – xiphoid tip
 TOPOGRAPHIC LANDMARKS
Lumbar Area
• L3 – Inferior/lower costal margin (easily
palpable for thin patients)
• L3-L4 – Level of umbilicus
• L4 – most superior aspect of iliac crest

Sacrum and Pelvic Area

• S1 - Level of anterior superior iliac spine (ASIS)
– palpate the superior portion of iliac crest and follow the
contour of the bone downward and anteriorly and feel the
bump
• Coccyx –same level with pubic symphysis &
greater trochanter of femur (when doing pelvic
examination there’s no need to palpate symphysis pubis
just locate the level of greater trochanters)
 SPINAL CURVATURES

1) Cervical & Lumbar Curve

• Convex anteriorly & concave posteriorly
• Secondary/compensatory curve:
develop after birth
• Cervical: when baby starts holding the
head
• Lumbar: when baby learns to walk
 SPINAL CURVATURES

2) Thoracic & Pelvic Curve

• Convex posteriorly &
concave anteriorly
• Primary curve: present at
birth
 ABNORMAL CURVATURES

1) Lordosis
• Exaggerated lumbar curvature
• Swayback
• Increase anterior convexity or
posterior concavity
 ABNORMAL CURVATURES

2) Kyphosis
• Exaggerated thoracic curvature
• Humpback or hunchback
• Increase anterior concavity or
posterior convexity
 ABNORMAL CURVATURES

3) Scoliosis
• Lateral curvature
• S-shaped
 ABNORMAL CURVATURES
4) Gibbus
• Posterior angulation of the
spine
 CLINICAL INDICATIONS
1) Clay Shoveler’s Fx
• Avulsion fx of the spinous
process in the lower cervical &
upper thoracic region

2) Compression Fx
• Fx that causes compaction of
bone & a decrease in length or
width
 CLINICAL INDICATIONS
3) Hangman’s Fx
(Traumatic Spondylolisthesis
of Axis)
• Fx of the anterior arch of C2
due to hyperextension

4) Jefferson’s Fx
• Comminuted fx of the ring
of C1
 CLINICAL INDICATIONS
5) Herniated Nucleus
Pulposus
• Rupture or prolapsed of the
nucleus pulposus into the
spinal canal

6) Kyphosis
• Abnormally increased
convexity in the thoracic
curvature
 CLINICAL INDICATIONS
7) Lordosis
• Abnormally increased
concavity of the cervical &
lumbar spine

8) Osteopetrosis
• Increased density of
atypically soft bone

9) Osteoporosis
• Loss of bone density
 CLINICAL INDICATIONS
10) Scheuermann’s Disease
• Adolescent kyphosis
• Kyphosis with onset in
adolescence

11) Scoliosis
• Lateral deviation of the
spine with possible
vertebral rotation

12) Spina Bifida

• Failure of the posterior
encasement of the spinal
cord to close
 CLINICAL INDICATIONS
13) Spondylolisthesis
• Forward displacement of a
vertebra over a lower
vertebra, usually L5-S1

14) Spondylolysis
• Separation of the pars
intercularis

15) Odontoid Fx
• Disruption of the arches of
C1
 CLINICAL INDICATIONS
16) Teardrop Burst Fx
• Comminuted vertebral body with
triangular fragments avulsed from
anteroposterior border caused by
compression with hyperflexion in
the cervical region

17) Transitional Vertebra

• It occurs when the vertebra takes
on a characteristics of the adjacent
region of the spine
 CLINICAL INDICATIONS
18) Chance Fx
• Fx through the vertebral body
caused by the hyperflexion
force

19) Whiplash Injury

• Damage to the ligaments
vertebrae or spinal cord
caused by sudden jerking back
of the head & neck
PROJECTIONS
Atlas & Axis
 ATLAS (C1) & AXIS (C2)
ALBERS-SCHONBERG (1910) &
GEORGE METHOD (1919)
AP “OPEN-MOUTH” PROJECTION

PP: Supine; MSP⟂ ; open mouth as wide as possible;

RP: Midpoint of open mouth
CR: ⟂
Respiration: Instruct the px to keep the mouth wide
open and to phonate “ah” softly during the exposure.
This places the tongue in the floor of the mouth so
that it is not projected on the C1 & C2 and prevents
movement of the mandible.
SS: Atlas & axis
 ATLAS (C1) & AXIS (C2)
ALBERS-SCHONBERG &
GEORGE METHOD
AP “OPEN-MOUTH”
PROJECTION
 ATLAS (C1) & AXIS (C2)
LATERAL PROJECTION

PP: Supine (dorsal decubitus); IR vertical;

MSP // to IR; MSP ⟂ to table; neck slightly
extended (mandibular rami does not
overlap atlas or axis)
RP: 1 in. distal to mastoid tip
CR: ⟂
Respiration: Suspend
SS: Atlas & axis; atlanto-occipital joints-
Pancoast, Pendergrass & Schaeffer
Recommendation: Head rotated slightly
• Rationale: to prevent superimposition
of laminae & atlas.
ALL LATERAL PROJECTIONS OF CERVICAL, THORACIC AND LUMBAR SPINE MSP IS // TO IR
TRUE TO ALL LATERAL PROJECTIONS
 ATLAS (C1) & AXIS (C2)

LATERAL PROJECTION
JUDD METHOD ATLAS (C1) & AXIS (C2)
PA PROJECTION – no longer performed

FUCHS METHOD
AP PROJECTION

PP: Supine; chin extended; chin tip &

mastoid tip⟂ to IR; MSP ⟂ to IR
RP: Distal to chin tip
CR: ⟂
Respiration: Suspend
SS: Dens w/in foramen magnums
ER: Recommended when upper half
of dens is not clearly shown in open-
mouth position
PROJECTIONS
Cervical
 CERVICAL SPINE
AP AXIAL PROJECTION

PP: Supine/upright; chin extended; occlusal plane ⟂ to

IR (prevents superimposition of mandible & midcervical
vertebrae) Upright – big angle of lordotic, Supine – smaller angle
of lordotic
RP: C4, centering the reference line of MSP
CR: 15-20° Cephalad (to make the CR parallel to IV disk
spaces so it will appear open on the radiographs)
Respiration: Suspend
SS: C3-T2
-Interpediculate spaces
-IV disk spaces
-Superimposed transverse & articular processes
ER: Used to demonstrate the presence or absence of
cervical ribs
 CERVICAL SPINE
AP AXIAL PROJECTION
 CERVICAL SPINE
GRANDY METHOD
LATERAL PROJECTION

PP: Supine/upright; patient in true lateral position; shoulder rotated

posteriorly or anteriorly (round shouldered-dapat either posteriorly or anteriorly
roll and depress the shoulder so that it will not superimpose the lower portion of cervical
spine); chin slightly elevated (prevents superimposition of mandibular rami
& spine, clue is the acanthiomeatal line (aml) drawn from acanthio to
ear??); MSP // to IR
RP: C4 (Cervical Spine CR is C4 except open mouth, swimmers, pillars)
CR: Horizontal In C Spine, Z joint is only demonstrated in Lateral
Projection. In Thoracic & Lumbar Spine, same
Respiration: Suspend at the end of full expiration projections (Oblique Projection) will show the Z joint
SS: C1-C7 and IF. Pinagkaiba ng Oblique of T and L spine is body
angle. T Spine – body is rotated 70 degrees from AP
-Articular Pillars and from true lateral is 20) whereas Lumbar is 45
- Zygapophyseal joints (C3-C7) degrees body rotation.
- Spinous processes
Note: If cervical spine trauma is suspected, this projection must be performed first and
“cleared” by the radiologist before additional images are performed.
 CERVICAL SPINE
GRANDY METHOD
LATERAL PROJECTION
 CERVICAL SPINE Must not be attempted until c-spine
pathology or fracture has been ruled
out.
LATERAL PROJECTION
Hyperflexion & Hyperextension
(Special Projection)
PP: Supine/upright; patient in true lateral position; MSP // to IR
• Hyperflexion: head drop forward; draw chin as close as possible to the chest (this
movement will show the anterior movement of c spine)
• Hyperextension: chin elevated as much as possible (shows the posterior movement of c spine)
RP: C4
CR: Horizontal
Respiration: Suspend
SS: IV disks & zygapophyseal joints
SS in Hyperflexion: C1-C7, Elevated & widely separated spinous processes, IV
body will appear closed/dikit dikit/depressed
SS in Hyperextension: C1-C7, Depressed spinous processes; IV body appear
separated
ER: For functional studies (motility) of cervical vertebrae; to demonstrate normal AP
movement/mobility or absence of movement
 CERVICAL SPINE
SID” 60-70” is recommended because
LATERAL PROJECTION of the increase OID. A longer distance
helps show C7.
Hyperflexion & Hyperextension

Note: The radiologist evaluates the

posterior aspect of vertebral bodies
for intersegmental alignment.
 CERVICAL SPINE Ant. Oblique Pos = PA Oblique Projection
Pos. Oblique Pos = AP Oblique Projection

AP AXIAL OBLIQUE PROJECTION

Barsony & Koppenstein: described this projection
PP: Supine/upright (more comfortable); RPO/LPO;
body rotated 45°; chin protruded/elevated
RP: C4
CR: 15-20° Cephalad
Respiration: Suspend
SS: Intervertebral foramina & pedicles (farthest to
IR which means that if we are to perform LPO
position, Right IF is demonstrated)
Boylston Suggestion:
• Functional studies in oblique projection
• Rationale: to demonstrate fx of articular
process dislocation/subluxation
 CERVICAL SPINE
AP AXIAL OBLIQUE PROJECTION
 If we reverse the body position, we also
CERVICAL SPINE reverse the cr direction (from cephalad
to caudad or caudad to cephalad) but
angulation remains the same.

PA AXIAL OBLIQUE PROJECTION

PP: Prone/upright (more comfortable);

RAO/LAO; body rotated 45°; shoulder
rested against IR; chin protruded/elevated;
flex elevated knee and downside is straight
RP: C4
CR: 15-20° Caudad
MNEMONICS to
Respiration: Suspend
remember for this
SS: Intervertebral foramina & pedicles projection is:
(closest to IR) RAO & LPO – demonstrates the AU
Right side IF CAU
LAO & RPO – demonstrates the CLOSE
Left Side IF
 CERVICAL SPINE
PA AXIAL OBLIQUE PROJECTION
 CERVICAL SPINE
OTTONELLO/CHEWING/WAGGING JAW METHOD
AP PROJECTION

PP: Supine; MSP ⟂ to IR and table; chin elevated; upper incisors

& mastoid tips ⟂ to IR; mandible in chewing motion during
exposure (continuously moving of mandible (lower jaw) (use motion artifact to
an advantage)
RP: C4
CR: ⟂
Respiration: Suspend
SS: Entire cervical column with blurred mandible
ER: To blurred the mandibular shadow to demonstrate all cervical
vertebrae
Use longer time of exposure to blur out
mandible, if shorter time sasabay lang yung
motion sa exposure. LONG EXPOSURE TIME
WITH LOW MA
 CERVICAL SPINE
OTTONELLO METHOD
AP PROJECTION
 CERVICAL SPINE & UPPER T SPINE
VERTEBRAL ARCH/PILLARS/
LATERAL MASS PROJECTION
AP AXIAL PROJECTION
(Special Projection)
Originator: Dorland and Radiol
PP: Supine; shoulder depressed; MSP ⟂ to IR; neck hyperextended (if
contraindicated, do not perform this projection)
RP: C7
CR: 25° caudad; 20-30° caudad (range)
Respiration: Suspend
SS: Vertebral arch/pillars structures (specific only in c-spine)
-Superior inferior articular processes (pillars)
-Zygapophyseal joints b/n articular processes
-Upper three of thoracic vertebrae
-Laminae
-Spinous Processes
ER: Useful for demonstrating the cervicothoracic spinous processes in
patients with whiplash injury
 CERVICAL SPINE
VERTEBRAL ARCH/PILLARS/
LATERAL MASS PROJECTION
AP AXIAL PROJECTION
 CERVICAL SPINE & UPPER T SPINE
VERTEBRAL ARCH/PILLARS/
LATERAL MASS PROJECTION
PA AXIAL PROJECTION

PP: Prone; head rested against IR; neck fully

extended; MSP ⟂ to IR;
RP: C7
CR: 25° cephalad; 35-45° cephalad (range)
Respiration: Suspend
SS: Vertebral arch structures;
 CERVICAL SPINE & UPPER T SPINE
VERTEBRAL ARCH/PILLARS/
LATERAL MASS PROJECTION
AP AXIAL OBLIQUE PROJECTION
R & L Head Rotations

PP: Supine; head rotated 45-50 ° ( to see C2-C7

articular processes) or 60-70 ° (C6-T4 articular
processes); turn jaw away from side of interest
RP: C7
CR: 35° caudad; 30-40° caudad (ranges)
Respiration: Suspend
SS: Vertebral arch structures;
ER: Used to demonstrate vertebral arches when the
patient cannot hyperextend head for AP/PA Axial
Projection
 CERVICAL SPINE
VERTEBRAL ARCH/PILLARS/
LATERAL MASS PROJECTION
AP AXIAL OBLIQUE PROJECTION
R & L Head Rotations
 CERVICOTHORACIC REGION
TWINNING & PAWLOW METHOD
PAWLOW METHOD – lateral recumbent
SWIMMER’S TECHNIQUE
TWINNING METHOD – upright position LATERAL PROJECTION

PP: Lateral Recumbent/Upright (seated or standing)

RP: C7-T1 interspace
CR: ⟂ (shoulder well depressed); 3-5° caudad (can’t be
depressed sufficiently)
Respiration: Suspend; if px can cooperate & can be immobilized
a breathing technique can be used to blur lung anatomy
SS: Vertebral arch structures;
ER: Performed when shoulder superimposition obscures C7 on a
lateral cervical spine projection
Monda Recommendation: CR 5-15° cephalad; to better
demonstrate IV disk spaces
 CERVICAL SPINE
TWINNING & PAWLOW METHOD
SWIMMER’S TECHNIQUE
LATERAL PROJECTION

If we are to examine
the Cervicothoracic,
we use Twinning,
Pawlow, Monda,..
Method
PROJECTIONS
Thoracic
Ribs are attached to T-Spine Cathode side of xray tube must be
-If supine, flex knee and hips to reduce positioned to the thicker part of the body so
lordotic curvature of lumbar spine to
straigthten the T spine to reduce its
kyphotic curvature
THORACIC SPINE density will be uniform : Anode Heel Effect

AP (Frontal) PROJECTION

PP: Supine/upright; MSP ⟂ to IR; hips & knees

flexed (to reduce kyphosis); place support under
knees
RP: T7 (b/n jugular notch & xiphoid process)
CR: ⟂
Respiration: The patient may be allowed to take
shallow breaths during the exposure, or respiration
is suspended at the end of full expiration.
SS: T1-T12
-IV disk spaces
-Transverse processes
-Costovertebral articulation
 THORACIC SPINE
LATERAL PROJECTION
PP: Lateral recumbent or upright (Oppenheimer); left side against the
table (places heart closer to IR) MSP // to IR; hips & knees flexed; arms
at right angle to body (to elevate ribs enough); place support under
lower thoracic spine
RP: T7
CR: ⟂ (w/support); 10-15° cephalad (w/o support); 10° (female) or 15°
(male)
Respiration: The exposure can be made with the patient breathing normally to
obliterate or diffuse the vascular marking and ribs or at the end of expiration. When
the breathing technique is used, the patient should be instructed not to move. An
increased exposure time, preferably 2 to 3 seconds (with a corresponding decrease
in mA), can often improve visualization of the thoracic vertebrae by blurring the
vasculature of the lungs.
SS: T1-T12
-IV disk spaces
-Intervertebral foramina
-Lower spinous process
 THORACIC SPINE
LATERAL PROJECTION

Center the posterior half of the thorax to the midline

of the grid and at the level of T7
 THORACIC SPINE
FUCHS METHOD
AP OBLIQUE PROJECTION
(Special Projection)

PP: Supine/upright; RPO/LPO; body rotated 20°

posteriorly; MCP 70° from IR (if px is in true
lateral just rotate 20*)
RP: T7
CR: ⟂
Respiration: Suspend at the end of respiration Mnemonic:
SS: Zygapophyseal/apophyseal joints (farthest PO
Perpen
from IR) Far
Zj
 THORACIC SPINE
OPPENHEIMER METHOD
PA OBLIQUE PROJECTION

PP: Prone/upright; RAO/LAO; body rotated 20°

anteriorly; MCP 70° from IR
RP: T7
CR: ⟂
Respiration: Suspend at the end of respiration
SS: Zygapophyseal/apophyseal joints (closest to IR)

Mnemonic:
AO
Perpen
Close
Zj
 THORACIC SPINE
AP/ PA OBLIQUE PROJECTION
PROJECTIONS
Lumbar
 LUMBAR SPINE
AP PROJECTION
(PA- OPTIONAL recommended because this places IV disk more parallel to
divergent rays so it will appear more open and it also reduces radiation to gonadal area)
PP: Supine/upright; elbow flexed; hands on upper chest
• Hips & knees flexed
-Reduces lumbar lordosis
-Places back in contact w/table
-Reduces distortion of vertebral bodies
-Better delineation of IV disk
RP: L4 (for lumbosacral); L3 (for lumbar spine only)
CR: ⟂
Respiration: Suspend at the end of respiration
SS: Lumbar bodies
-IV disk spaces
-Interpediculate spaces
-Laminae
-Spinous & transverse processes
-Sacrum, coccyx & pelvic bones (larger IR)
Scottie dog is only specific in
Lumbar Spine LUMBAR SPINE
LATERAL PROJECTION

PP: Lateral recumbent or upright; affected side

against IR; hips & knees flexed MCP⟂ to IR; place
support under lower thorax (places spine in true
horizontal position)
RP: L4 (for lumbosacral); L3 (for lumbar spine only)
CR: ⟂ (w/support); 5-8° caudad (w/o support); 5°
(male) or 8° (female) female has large hips so bigger
angle is needed
Respiration: Suspend at the end of respiration
SS: Intervertebral foramina of L1-L4 only; L5
intervertebral foramina (Oblique Projection)
 LUMBAR SPINE

Improving Radiographic Quality

• Close collimation
• A 48-inch (112-cm) or greater SID is
recommended
• A sheet of leaded rubber is placed on
the table behind the patient
PROJECTIONS
Lumbosacral Junction
(L5-S1)
 L5-S1 LUMBOSACRAL JUNCTION
LATERAL PROJECTION

PP: Lateral recumbent or upright; affected side

against IR; hips & knees flexed MCP⟂ to IR;
place support under lower thorax (places spine
in true horizontal position)
RP: 2 in. posterior to ASIS & 1.5 in. inferior to
iliac crest
CR: ⟂ (w/support); 5-8° caudad (w/o support);
5° (male) or 8° (female)
Respiration: Suspend
SS: Lumbosacral junction
L5-S1 LUMBOSACRAL JUNCTION
LATERAL PROJECTION
PROJECTIONS
Lumbar Zygapophyseal Joints
 LUMBAR ZYGAPOPHYSEAL JOINTS
AP OBLIQUE PROJECTION

PP: Semi-supine/upright; RPO/LPO; body

rotated 45° or 60° (L5-S1 zygapophyseal joints
& articular processes)
RP:
Lumbar region: 2 in. medial to elevated ASIS &
Note: A 50° oblique from plane of tabletop
1.5 in. superior to iliac crest (L3) best visualize the zygapophyseal joints at
L1-L2, and 30° for L5-S1
5th zygapophyseal joint: 2 in. medial to
elevated ASIS & midway b/n iliac crest & ASIS
CR: ⟂
Respiration: Suspend at the end of respiration
SS: Lumbosacral junction
 LUMBAR SPINE
AP OBLIQUE PROJECTION
 AO
FAR
Zj
LUMBAR SPINE
PA OBLIQUE PROJECTION
(Recommended for less dose for gonads)
PP: Semi-prone/upright; RAO/LAO; body rotated 45° or
60° (L5-S1 zygapophyseal joints & articular processes)
RP: 1.5 in. superior iliac crest & 2 in. lateral to palpable
spinous process
CR: ⟂
Respiration: Suspend at the end of expiration
SS: Zygapophyseal/apophyseal joints (farthest from IR)
-Scottie dog
 LUMBAR SPINE
PA OBLIQUE PROJECTION

ear
nose
eyes
neck
body
leg
PROJECTIONS
Lumbosacral Junction
&
Sacroiliac Joint
LUMBOSACRAL JUNCTION & SACROILIAC JOINT
FERGUSON METHOD (Cone down technique)
AP AXIAL PROJECTION

PP: Supine; lower limb extended; thigh abducted

RP: 1.5 in. superior to pubic symphysis
CR: 45° cephalad (Ferguson); 30-35° cephalad (Lisbon);
30° (male) or 35° (female has greater sacral curvature) We cannot palpate the pubic
Respiration: Suspend symphysis, but instead we can use
coccyx or greater trochanter of the
SS: Lumbosacral joint; symmetric sacroiliac joints femur
Meese Recommendation:
PP: Prone (places sacroiliac joints nearly // to CR)
RP: 2 in. distal to L5 (level of ASIS)
CR: ⟂
LUMBOSACRAL JUNCTION & SACROILIAC JOINT
FERGUSON METHOD
PA AXIAL PROJECTION

PP: Prone
RP: L4
CR: 35° caudad
Respiration: Suspend
SS: Lumbosacral joint; symmetric sacroiliac
joints
PROJECTIONS
Sacroiliac Joint
 SACROILIAC JOINTS
AP OBLIQUE PROJECTION

PP: Semi-supine; RPO/LPO; body rotated 25-30°;

elevate the side being examined if RPO Left is
seen, if LPO right is seen because side farthest is
examined
RP: 1 in. medial to elevated ASIS
CR: ⟂
Respiration: Suspend
SS: Sacroiliac joint (farthest from IR)
 SACROILIAC JOINTS
AP OBLIQUE PROJECTION
 SACROILIAC JOINTS
Cervical,
PA OBLIQUE PROJECTION Thoracic, SI
(AO CLOSE)
PP: Semi-supine; RAO/LAO; body rotated 25-30°
RP: 1 in. medial to elevated ASIS
CR: ⟂
Respiration: Suspend
SS: Sacroiliac joint (closest to IR)
 SACROILIAC JOINTS
PA OBLIQUE PROJECTION
PROJECTIONS
Pubic Symphysis
 PUBIC SYMPHYSIS
CHAMBERLAIN METHOD
PA PROJECTION

PP: Upright; standing on same size two blocks Chamberlain Recommendations:

First exposure: remove one block; one • For abnormal sacroiliac motion
leg hangs with no muscular resistance • Lateral Projection
Second exposure: replace support under -Upright
foot that was hanging; remove the opposite one; -Centered to lumbosacral junction
second leg hanging free • 2 PA Projections of Pubic bones:
RP: Pubic symphysis -Upright
CR: ⟂ -Weight-bearing on alternate limbs
Respiration: -To demonstrate pubic symphysis
SS: Pubic symphysis reaction by a change in the normal relation of
pubic bones
PROJECTIONS
Sacrum and Coccyx
 SACRUM COCCYX
AP/PA AXIAL PROJECTION AP/PA AXIAL PROJECTION

PP: Supine(AP) or prone (PA) (patient PP: Supine or prone (patient w/painful
w/painful injury/destructive disease) injury/destructive disease)
RP: 2 in. superior to pubic symphysis RP: 2 in. superior to pubic symphysis
(supine); visible sacral curve (prone) (supine); Palpable coccyx (prone)
CR: 15° cephalad (supine); 15° caudad CR: 10° caudad (supine); 10° cephalad
(prone) (prone)
Respiration: Suspend Respiration: Suspend
SS: Sacrum free of foreshortening SS: Coccyx free of superimposition
 SACRUM COCCYX
AP/PA AXIAL PROJECTION AP/PA AXIAL PROJECTION
 SACRUM COCCYX
AP/PA AXIAL PROJECTION AP/PA AXIAL PROJECTION
 SACRUM COCCYX
LATERAL PROJECTION LATERAL PROJECTION

PP: Lateral recumbent; interiliac plane ⟂ to PP: Lateral recumbent; interiliac plane ⟂ to
IR; pelvis & shoulder in true lateral position IR; pelvis & shoulder in true lateral position
RP: 3.5 in posterior to ASIS RP: 3.5 in. posterior & 2 in. inferior to ASIS
CR: ⟂ CR: ⟂
Respiration: Suspend Respiration: Suspend
SS: Sacrum SS: Coccyx
SACRUM COCCYX
LATERAL PROJECTION LATERAL PROJECTION

Use Lead mat to reduce

scatter rays and radiograph
will not appear foggy
SACRUM COCCYX
LATERAL PROJECTION LATERAL PROJECTION
PROJECTIONS
Lumbar Intervertebral Disks
 LUMBAR INTERVERTEBRAL DISKS
WEIGHT-BEARING METHOD
PA PROJECTION
FUNCTIONAL STUDY

PP: Upright; patient bending to right & left;

lean directly lateral as far as possible
RP: L3
CR: 15-20° caudad
Respiration: Suspend
SS: Lower thoracic & lumbar region
ER: Perform for demonstration of the Duncan & Hoen
mobility of intervertebral joints
Duncan & Hoen Recommendation:
• PA projection be used
• Rationale: IV disks more nearly // to CR
 RULES OF OBLIQUE
Anatomy of Interest Projection Position/Degrees Structure Shown Central Ray
CERVICAL AP Oblique LPO - 45° Right IF (side up) 15-20° cephalad
(Intervertebral RPO – 45° Left IF (side up) 15-20° cephalad
Foramina) PA Oblique LAO – 45° Left IF (side down) 15-20° caudad
PO-CEP-FAR IF RAO – 45° Right IF (side down 15-20° caudad
AO-CAU-CLOSE IF
THORACIC AP Oblique LPO – 70° Right ZJ (joints up) ⟂
(Zygapophyseal RPO – 70° Left ZJ (joints up) ⟂
Joints) PA Oblique LAO – 70° Left ZJ (joints down) ⟂
PO-FAR RAO – 70° Right ZJ (joints down ⟂
AO-CLOSE
LUMBAR AP Oblique LPO – 45° Left ZJ (joints down) ⟂
(Zygapophyseal RPO – 45° Right ZJ (joints down) ⟂
Joints) PA Oblique LAO – 45° Right ZJ (joints up) ⟂
RAO – 45° Left ZJ (joints up) ⟂
AP Oblique LPO – 25-30° Right SIJ (joint up) ⟂
SACROILIAC RPO – 25-30° Left SIJ (joint up) ⟂
JOINTS PA Oblique LAO – 25-30° Left SIJ (joint down) ⟂
RAO – 25-30° Right SIJ (joint down ⟂
 RULES OF OBLIQUE

ANATOMY ZYGAPOPHYSEAL INTERVERTEBRAL

JOINTS FORAMINA
Cervical Lateral Oblique – 45°
Thoracic Oblique – 70° Lateral
Lumbar Oblique - 45° Lateral