RADIOGRAPHIC

POSITIONING
UPPER LIMB
ANATOMY
PATHOLOGY
POSITIONING
 2 ND – 5 TH DIGITS
PA P
LATERAL I AFFECTED
DIGIT

PA OBLIQUE P
 THUMB -1 STDIGIT
AP 1 ST

M
MAGNIFIED

PA THUMB (NOT
ADVISABLE)

LATERAL C
PA OBLIQUE P
 THUMB -
MODIFICATIONS
*RRL
AP ROBERT 1ST
ARTHRITIC
C CHANGES
M
RAFERT- LONG 15 PROX C
AP DISPLACEMENT

BENNETT’S
FRACTURE
LEWIS 10- 15 PROX 1ST MCP
 THUMB -
MODIFICATIONS
*CLEARER IMAGE
1 ST
MAGNIFIED

AP BURMAN
45 TOWARD
THE ELBOW
C CONCAVOCONVEX
OUTLINE OF CMC

M
TRAPEZIUM IN CONCAVE
BASE OF 1ST METACARPAL
IN CONVEX

C
 1 ST MCP

PA- FOLIO
ULNAR
COLLATERAL

METHOD LIGAMENT/
SKIER’S THUMB
 HAND* 3 RD MCP
PA
AP
PA OBLIQUE FW: (IPJ) /FINGERTIPS (METACARPAL) / INDEX F. (OPEN JOINT)

LATERAL/ FAN LAT. FOREIGN BODIES/ FX

LATERAL(FLEXION) ANTERIOR/ POSTERIOR DISPLACEMENT/ FX OF METACARPAL

AP OBL- NORGAARD RHEUMATOID ARTHRITIS/ FX OF 5TH METACARPAL

REVERSE OBLIQUE SEVERE METACARPAL FX

TANGENTIAL OBL. MC HEAD FX

LEWIS FX OF 5TH METACARPAL

AP AXIAL-BREWERTON 45 BONY EROSION/ EARLY FINDINGS IN RHEUMATOID ARTHRITIS

 WRIST
PA PROJECTION SCAPHOID FAT STRIPE/ CARPAL FX

LATERAL PRONATOR FAT STRIPE

Daffner-Emmerling-Buterbaugh
Recommendation 30 ELONGATED SCAPHITATE

AP PROJECTION CARPAL INTERSPACES (MIDCARPAL

AREA)

LATERAL PROJECTION BARTON’S FX

Lateromedial

BURMAN ET AL. SUGGESTION LATERAL SCAPHOID

LATERAL POSITION IN PALMAR FLEXION

FIOLLE METHOD CARPAL BOSS

LATERAL POSITION IN PALMAR FLEXION

PA OBLIQUE PROJECTION LATERAL CARPALS

Lateral Rotation (SCAPTRAP)
 WRIST/CARPUS
AP OBLIQUE PROJECTION ┴ PISITRIHAM
Medial Rotation

PA PROJECTION ┴ , 10-15 ͦ FX OF SCAPHOID/ NAVICULAR

ULNAR DEVIATION proximally/distally NOT FORESHORTENED
(clear delineation)
PA PROJECTION ┴ MEDIAL CARPALS
RADIAL DEVIATION (TRILUPISIHAM)

Scaphoid ┴ 20- RIGHT ANGLE SCAPHOID

PA AXIAL PROJECTION
STECHER METHOD
Bridgeman(ulnar deviation)
Scaphoid Series 0, 20, and 30 SCAPHOID WITH MINIMAL
PA AND PA AXIAL PROJECTIONS degrees cephalad. SUPERIMPOSITION
RAFERT-LONG METHOD
Ulnar deviation
Trapezium/Greater multangular 45 distally TRAPEZIUM
PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD
HOLLY RECOMMENDATION 30 TRAPEZIUM
Variation of Clements- Nakayama Method
 WRIST/CARPUS
ULNAR SCAPHOID/NAVICULAR
NOT FORESHORTENED
DEVIATION
LATERAL CARPALS

RADIAL MEDIAL CARPALS

DEVIATION
 CARPAL BRIDGE

LENTINO 45 DORSUM WRIST

CALCIFICATIONS/
METHOD
FOREIGN
TANGENTIAL BODIES/ CHIP FX
PROJECTION
 CARPAL CANAL/ TUNNEL

'TANGENTIAL PROJECTION 25- 30

GAYNOR-HART METHOD TO LONG
INFEROSUPERIOR AXIS OF
PROJECTION HAND
CARPAL
'TANGENTIAL PROJECTION 25- 30 TUNNEL/ CANAL
GAYNOR-HART METHOD FROM LONG
SUPEROINFERIOR AXIS OF
PROJECTION HAND

20- 35 Alternative
MARSHALL METHOD FROM LONG position for the
AXIS OF Gaynor-Hart
FOREARM method
 FOREARM

AP HUMERAL EPICONDYLES

CROSSES RADIUS OVER

PA ULNA AT PROX. THIRD

OLECRANON/ FAT STRIPE

LATERAL OF WRIST/ FAT PAD
ELBOW/SUPERIMPOSED
HUMERAL EPI.
 ELBOW
AP (hand supinated)

LATERAL
GRISWOLD 90 ELBOW FAT PADS
(LEAST COMPRESSED)

DISTAL HUMERUS/ AP CANNOT FULLY FLEXED

ELBOW/ TWO AP REQUIRED
PROXIMAL FOREARM/ AP CANNOT FULLY FLEXED
ELBOW/ TWO AP REQUIRED
ACUTE FLEXION/ JONES METHOD OLECRANON PROCESS/ FX
 ELBOW OBLIQUE
M- COLE
AP OBLIQUE/ CORONOID/
MEDIAL ROTATION OLECRANON

L- CARA
AP OBLIQUE/ CAPITULUM
LATERAL RADIAL HEAD
 ELBOW
PROXIMAL FOREARM

RADIAL HEAD ENTIRE CIRCUMFERENCE

OF RADIAL HEAD

GREENSPAN/NORMAN
45 m.
DISTAL HUMERUS/ PA AXIAL RADIOHUMERAL BURSITIS
(TENNIS ELBOW)

OLECRANON/ PA AXIAL /20 OLECRANON PROCESS

(dorsum)
 ELBOW
COYLE METHOD
AXIOLATERAL
80 COATS 90 CARTS
80- ELBOW FLEXION
90- ELBOW FLEXION
COronoid
CApitulum
Away
Radial head
Trochlea
Towards (medially)
SHOULDER
SHOULDER
Cannot fully extend elbow for medial & lateral oblique
Useful in imaging traumatized elbow
 HUMERUS
HUMERAL
EPICONDYLES
AP UPRIGHT GREATER
AP RECUMBENT TUBERCLE

LATERAL UPRIGHT LESSER

LATERAL MEDIOLATERAL TUBERCLE

DISTAL
LATERAL/ LATEROMEDIAL HUMERUS/
RECUMBENT FRACTURE
SHOULDER
ANATOMY
PATHOLOGY
POSITIONING
SHOULDER JOINT – AP- (coracoid process)
NO ExGAP InLeT
HUMERAL EPICONDYLES

Neutral Oblique
45 greater tubercle
(partially)

External GreaterAP
(humeral head in
// profile)

Internal LEsser Tubercle

(true lateral)
 SHOULDER JOINT
Love Like Rosie so WE will CLimb and be Happy Somewhere Anytime

LAWRENCE- (TTL) 10- 15 CEPHALAD TRAUMA/ PROX.

HUMERUS OUTLINE.
LAWRENCE (IS) 15-30 MEDIALLY LESSER TUBERCLE
ANTERIORLY
RAFERT (IS) 15 MEDIALLY HILL SACH

WESTPOINT (IS) 25 A-M BANKART LESION

CLEMENTS (IS) 5-15 MEDIALLY ALTERNATIVE TO ALL IS

HOBBS – PA TRANS OBITO

SUPEROINFERIOR 5-15 TOWARDS END OF HUMERUS TO GH

AXIAL
AP AXIAL 35 CEPHALAD POSTERIOR DISLOCATION
 We Strive Good Rating
West point
Stryker “notch” HILL-
SACHS
Garth DEFECT

Rafert Modification
 PA OBLIQUE- SCAPULAR Y
(scapulohumeral joint)

CorA APo
Anterior/subcoracoid Posterior/subacromial
dislocation dislocation

humeral head humeral head

beneath the coracoid beneath the acromion
process process
 SHOULDER TRAUMA
New York Lawless NeeGa
Neutral rotation/ AP
Y (scapular Y)
Lawrence/ TTL
Neer
Garth/AP Axial
45-60 BODY ROTATION
Alexander
Neer
Your
ScapuLat
 GLENOID CAVITY
G. A. G
Grashey
Glenoid Cavity
(APOL)
Loss of articular
Apple cartilage
(APOL)
Garth (AP 45 CAUDAD SCAPULOHUMERAL
DISLOCATION
Axial Ob) Superiorly- Posterior
Inferiorly Anterior
Dislocations
 PROXIMAL HUMERUS
AP AXIAL- STRYKER NOTCH

POsteroSuperior and
10 CEPHALAD POsteroLateral areas of
the humeral head.

SUPRASPINATUS OUTLET
TANGENTIAL – NEER METHOD

10- 15 CAUDAD Coracoacromial arch

Outlet for supraspinatus outlet
Shoulder Impingement
 INFEROSUPERIOR AXIAL
PROJECTION
Willie Revillame Loves Chix
West point
Rafert mod.
Lawrence
Clements mod.
 INTERTUBURCULAR
GROOVE
TANGENTIAL PROJECTION
FISK MODIFICATION

TANGENTIAL 10-15
POSTERIOR
(supine)
INTERTUBERCULAR
GROOVE
FISK
(upright)
BLACKETT HEALY METHODS
PA Teres Minor AP Subscapularis

Tangential Subscapularis tendon insertion

image of the insertion of
the Teres minor. Lesser tubercle

Lesser tubercle

INFRASPINATUS INSERTION
AP AXIAL
Greater tubercle
25 CAUDAD Infraspinatus tendon
Open subacromial space
 ACROMIOCLAVICULAR
ALEXANDER- AP ALEXANDER - PA
15 CEPHALAD 15 CAUDAD

BILAT-PEARSON- AP UNI- ZANCA- AP AXIAL

10 CEPHALAD

Dislocation Assessment of
Separation acute/chronic unilateral
Function of the ACJ AC joint injury
 CLAVICLE
AP
EXHALATION
PA
AP Axial Lordotic 0- 15 CEPHALAD (upright)

AP Axial INSPIRATION 15- 30 CEPHALAD (supine)

PA Axial 15- 30 CAUDAD

Tangential 25- 40 from HORIZONTAL

Tangential (Medial SUSPEND 15- 25 LATERALLY

Third)
Tarrant Method 25- 35 ANTEROINFERIORLY

Serendipity 40 CEPHALAD
 SCAPULA
AP
LATERAL
LORENZ/ LILIENFELD PA
OBLIQUE
AP AXIAL CORACOID 15- 45 CEPHALAD

Kwak, Espiniella, Kattan 30 CEPHALAD

SCAPULAR SPINE
TANGENTIAL/ Laquerriere-Pierquin 45 CAUDAD
(OBESE/ ROUND SHOULDERED) 35 CAUDAD

TANGENTIAL
-- PRONE 45 CEPHALAD
-- UPRIGHT 45 POSTEROINFERIORLY
 SCAPULA
AP
LATERAL
LORENZ/ LILIENFELD PA
OBLIQUE
AP AXIAL CORACOID 15- 45 CEPHALAD

Kwak, Espiniella, Kattan 30 CEPHALAD

SCAPULAR SPINE
TANGENTIAL/ Laquerriere-Pierquin 45 CAUDAD
(OBESE/ ROUND SHOULDERED) 35 CAUDAD

TANGENTIAL
-- PRONE 45 CEPHALAD
-- UPRIGHT 45 POSTEROINFERIORLY
LOWER LIMB
ANATOMY
PATHOLOGY
POSITIONING
 TOES
AP/ AP AXIAL
/15 P. PHALANGES/ MT/ AXIA/(OPEN IP)

PA IP JOINT
AP OBL/ MEDIAL ROT 2ND- 5TH MTPJ/ 1ST-2ND TOES

AP OBL/ LATERAL ROT 3RD- 5TH MTP

PA OBLIQUE/ MEDIAL ROT OPEN IP (2ND- 5TH)

LATERAL PROJECTION

MEDIOLATERAL 3RD- 5TH

LATEROMEDIAL 1ST- 2ND

 SESAMOID
TANGENTIAL
Tan Loves Having Causton
LEWIS MT HEAD/ FX OF
SESAMOID
(lateral rec.)
MT HEAD/ MORE
COMFORTABLE
HOLLY
(seated)
SESAMOID/
CAUSTON 40 TOWARDS AXIOLATERAL

(prone) HEEL
AP/ DORSOPLANTAR
FOOT
AP AXIAL 10 POSTERIORLY TMT JOINT SPACES
PA OBLIQUE/ MEDIAL/LATERAL 30/ MEDIAL (1ST- 2ND MT)
(GRASHEY) 20/ LATERAL (3RD – 4TH- 5TH MT)

PA OBLIQUE/ MEDIAL ROT CUBOID ARTICULATIONS

LATERAL PROJECTION

MEDIOLATERAL ENTIRE FOOT

LATEROMEDIAL TRUE LATERAL (UNCOMFORTABLE)

LATERAL- WEIGHT BEARING HORIZONTAL LONGITUDINAL ARCH

STRUCTURAL STATUS/ PES PLANUS
BOHLER’S NORMAL (20-40)
40 (NOT UP)
<20 (CALCANEAL FX)
 FOOT OBLIQUE
CuMing
AP OBLIQUE/ CUBOID
MEDIAL ROTATION

LaNa
AP OBLIQUE/ NAVICULAR
LATERAL
 FOOT – WEIGHT
BEARING
AP AXIAL- WEIGHT HALLUX
BEARING VALGUS/
LISFRANC

AP AXIAL- WEIGHT
ENTIRE
BEARING/ COMPOSITE 15 POSTERIORLY
25 ANTERIORLY FOOT
METHOD
 CONGENITAL CLUBFOOT
KI-KI-KA
AP/ KITE 15 POSTERIORLY FOREFOOT ADDUCTION/
CALCANEUS INVERSION

LATERAL/ ANTERIOR TALAR

MEDIOLATERAL/ KITE SUBLUXATION/ PLANTAR
FLEXION

AXIAL PROJECTION/
DORSOPLANTAR/
KANDEL 40 ANTERIORLY AXIAL CLUBFOOT
 CALCANEUS/OS CALCIS
AXIAL/ 40 CEPHALAD MEDIAL/ LATERAL
PLANTODORSAL DISPLACEMENT/TALOCAL
CANEAL JOINT

AXIAL/ 40 CAUDAD MEDIAL/ LATERAL

DORSOPLANTAR DISPLACEMENT
LILIENFELD/ CALCANEOTALAR
WEIGHT BEARING 45 ANTERIORLY SUBLUXATION

LATERAL/ CALCANEAL SPUR

MEDIOLATERAL
LATEROMEDIAL/ STRESS FX OF CALCANEUS
WEIGHT BEARING 45 CAUDAD
 TALOCALCANEAL/ SUBTALAR
PA AXIAL OBLIQUE/ 5 ANTERIOR/ MIDDLE AND POSTERIOR
LATERAL R. 23 CAUDAD ARTICULATIONS

ANTERIOR- 40
10- 20- 30- 40
BRODEN/ AP AXIAL CEPHALAD
POSTERIOR- 10 POSTERIOR
ARTICULATIONS
OBLIQUE/ MEDIAL MIDDLE 20-30

BRODEN/AP AXIAL 15 CEPHALAD POSTERIOR ARTICULATIONS

OBLIQUE/ LATERAL
 ISHERWOOD
FOOT/ ANTERIOR ARTICULATIONS
LATEROMEDIAL/
MEDIAL ROTATION

ANKLE/ AP AXIAL 10 CEPHALAD MIDDLE ARTICULATIONS

OBLIQUE/ MEDIAL R.

ANKLE/ AP AXIAL 10 CEPHALAD POSTERIOR ARTICULATIONS

OBLIQUE/ LATERAL R.
 ANKLE
AP TIBIOTALAR( INFERIORTBF- TRUE)

LATERAL/ MEDIOLAT. TIBIOTALAR JOINT

LATERAL PROJECTION/
LATEROMEDIAL TRUE LATERAL

AP OBLIQUE/ MEDIAL/INTERNAL FX AT TIBIOFIBULAR JOINT

ROTATION

AP OBLIQUE/ MEDIAL OBLIQUE TALOFIBULAR JOINT

ANKLE MORTISE

AP OBLIQUE/ LATERAL FX AT CALCANEAL SULCUS

ROTATION

AP STRESS METHOD INVERSION (LATERAL) EVERSION

(MEDIAL) TEAR

AP WEIGHT BEARING ANKLE JOINT SPACE NARROWING

 LEG
AP FEMORAL CONDYLES //

LATERAL/ DISTAL FIBULA OVER TIBIA

MEDIOLATERAL

AP OBLIQUE/ MEDIAL PROXIMAL/ TIBIOFIBULAR

JOINT
ROTATION

FIBULA SUPERIMPOSED BY
LATERAL TIBIA
 KNEE
AP ASIS
3-5 CAUDAD <19
P- 19-24
3-5 CEPHALAD >24
AP ERECT ARTHRITIC CHANGES

PA 5 CAUDAD
LATERAL/MEDIOLAT 5-7 CEPHALAD
SUPRAPATELLAR EFFUSION
<10 (rotation for new/ unhealed
patellar fx)
AP OBLIQUE/ LATERAL ASIS
ROTATION

AP OBLIQUE/MEDIAL ASIS
ROATION

PA OBLIQUE/ MEDIAL
ROTATION

PA OBLIQUE/LATERAL
ROTATION
 KNEE – WEIGHT
BEARING
BILAT- AP WEIGHT OSTEOARTHRITIS
BEARING VARUM (KNOCK NEE)
VALGUS (BOW LEG)

BILAT- PA/
ALTERNATIVE FOR
ROSENBERG KNEE WEIGHT
BEARING
 INTERCONDYLOID FOSSA
(axial knee)
H- B- C
70 – 60- 40-50
PA AXIAL/ HOLMBLAD 70 Increase in the
(KNEELING) amount of knee flexion

It uses a
AP AXIAL/ BECLERE curved cassette
(SUPINE) 60

PA AXIAL/ CAMP Split/ displaced cartilage/

COVENTRY
40- 50 loose bodies/flattening of
(PRONE) FH/slipped patella
JOINT MICE
 PATELLA

PA

LATERAL/ MEDIOLATERAL

PA OBLIQUE/ MEDIAL/LATERAL

PA AXIAL OBLIQUE/ 25- 30 CAUDAD

KUCHENDORF
LATERAL ROTATION
 PATELLOFEMORAL JOINT
Hu-MESSH
HUGHSTON/ JAROSKY SUBLUXATION/ ASSESSMENT OF FH
45 CEPHALAD
MERCHANT BOTH PATELLA
30 CAUDAD

SETTEGAST VERTICAL FX OF PATELLA

15-20 CEPHALAD

SUNRISE/ SKYLINE 30 FROM NO SPECIAL EQUIPMENT

HORIZONTAL

HOBBS MODIFICATION PATELLOFEMORAL JOINT

(sitting)
 PATELLA AND PATELLOFEMORAL JOINT
TANGENTIAL PROJECTION

HUGHSTON 55

LAURIN 20 (knee flexion) for easier

demonstration of patellar
subluxation

FODOR – MALOTT 45
MERCHANT
 FEMUR
AP 5°(knee/distal femur)
10°-15°internally
(hip/proximal femur)

distal femur (knee)

unaffected limb draw
LATERAL/ forward;10°-15°
Mediolateral posteriorly from the
lateral position.
PELVIC GIRDLE
ANATOMY
PATHOLOGY
POSITIONING
 PELVIS AND UPPER FEMORA

AP PROJECTION GREATER TROCHANTER

LATERAL SUPERIMPOSED HIP BONES

DORSAL DECUBITUS “GULL WING SIGN”

(BERKEBILE) HORIZONTAL

MARTZ TAYLOR LATERAL/SUPERIOR/ANTERIOR

CONGENITAL HIP DISPLACEMENT
DILOCATION /45 CEPHALAD
 FEMORAL NECK

AXIOLATERAL/ORIGINAL CONTRA: FX
CLEAVES METHOD FEMORAL NECK WITHOUT
40 CEPHALAD
SUPERIMPOSITION

AP AXIAL OBLIQUE/ FEMORAL NECK

MODIFIED WITHOUT
CLEAVES METHOD SUPERIMPOSITION
 HIP JOINT TRAUMA
DANELIUS MILLER/ TRAUMA/ SURGERY/ALT. FOR FROG
AXIOLAT/ CROSSTABLE LEG
LATERAL/
HORIZONTAL
SURGICAL/SHOOT THROUGH

CLEMENTS NAKAYAMA/ 15 POSTERIORLY

MODIFIED AXIOLAT. ARTHROPLASTY/ ALT. FOR
DANELIUS

LEONARD GEORGE FH/ NECK

(REVERSE DANELIUS)

PA OBIQUE/ HSIEH POSTERIOR DISLOCATION OF FH

AP OBLIQUE/ URIST POSTERIOR RIM OF ACETABULUM

MEDIOLATERAL/
LILIENFELD ILIUM/ACETABULUM/PROXIMAL
FEMUR
17 ANTERIORLY
COLONNA
 HIP
AP

LAUENSTEIN/ Lateral

HICKEY/ Lateral
20-25 CEPHALAD

FRIEDMAN/AXIOLATERAL 35 CEPHALAD

KISCH 15- 20 CEPHALAD

 PELVIS AND HIP JOINTS
AP AXIAL CHASSARD- LAPINE/ JACK KNIFE

BIISCHIAL DIAMETER IN
PELVIMETRY
 ACETABULUM
TeufelFoveacapitis
PA AXIAL OBLIQUE/
TEUFEL METHOD
PP: Resting on affected side.
Rotation: 38 degrees/RAO/LAO
CR: 12 degrees cephalad
Superoposterior wall of the acetabulum
 ACETABULUM
AP OBLIQUE/RPO/LPO
JUDET METHOD
INTERNAL OBLIQUE EXTERNAL OBLIQUE
(AFFECTED HIP UP) (AFFECTED HIP DOWN)

IPC/ PAR IIC/ AAR

IlioPubicColumn / IlioIschialColumn /
PosteriorAcetabulumRim AnteriorAcetabulumRim
 ACETABULUM- MODIFICATIONS
RAFERT LONG MOD. HORIZONTAL (EXTERNAL)
INTERNAL ( )

DUNLOP/SWANSON/PENNER/ 30 MEDIALLY
SUPEROINFERIOR OBLIQUE
35 (ADULT)
PROJECTION
32 (CHILDREN)
 PELVIC BONES
ANTERIOR PELVIC/PA

MALE: 20- 35 CEPHALAD

TAYLOR AP AXIAL/OUTLET
FEMALE- 30-45 CEPHALAD

BRIDGEMAN/SUPEROINFERIOR
AXIAL/ INLET 40 CAUDAD

LILIENFELD/SUPEROINFERIOE
AXIAL/INLET

PA AXIAL/ STAUNIG/ INLET 35 CEPHALAD

 ILIUM
AP OBLIQUE/ Elevate unaffected side
RPO/LPO 40 degrees to place
affected ilium parallel

Elevate unaffected side

PA OBLIQUE/ 40 degrees to place
LAO/RAO affected ilium
perpendicular
VERTEBRAL

COLUMN
ANATOMY
PATHOLOGY
 INTERVERTEBRAL ZYGAPOPHYSEAL
FORAMINA JOINT
Directed anteriorly at a Forms 90° angle to the
45° angle from the MSP MSP

15° inferior angle to

the horizontal plane of
the body.
POSITIONING
 ATLANTO OCCIPITAL

AP OBLIQUE AO jt/ ALT. for open

mouth

PA
AO jt through maxillary
 DENS
ODONTOID WITHIN FORAMEN
AP/ FUCH METHOD MAGNUM
// TO MML WHEN UPPER HALF IS NOT
SHOWN IN OPEN MOUTH

AP AXIAL/ SMITH- ABEL 35 CAUDAD LAMINAE/ ARTICULAR FACETS

AP AXIAL OBL/KASABACH 10-15 CAUDAD AXIAL DENS/ CONJUNCTION

WITH AP/LATERAL

ATLAS AND DENS

PA/ JUDD METHOD
// TO MML/ PERPENDICULAR
OML: 37
CONTRA: UNHEALED FX/ DEGENERATIVE DISEASE
ATLAS WITHIN FORAMEN MAGNUM
 ATLAS AND AXIS (ODONTOID)
ALBERS- C1-C2
SCHONBERG LOWER MARGIN
AND GEORGE ODONTOID/JEFFERSON’S FX.
“OPEN MOUTH”

LATERAL ATLAS/AXIS/AO

PANCOAST/PENDERGRASS Rot slightly- laminae

SHAEFFER Tilted slightly- arch
 CERVICAL VERTEBRAE
AP AXIAL PROJECTION 15-20 CEPHALAD C3-T2 (presence/absence)
OPEN IV DISK SPACES OF
CERVICAL SPINE

LATERAL PROJECTION ┴ /Horizontal CERVICAL ZJ

GRANDY METHOD

FUNCTIONAL STUDIES/
LATERAL PROJECTION ┴ /Horizontal
MOTILITY
Hyperflexion &
Hyperextension HYPERFLEXION:
ELEVATED/WIDELY SEPARATED
SPINOUS PROCESS

HYPEREXTENSION: DEPRESSED
SPINOUS PROCESS
 CERVICAL IVF
AP AXIAL 15-20 CEPHALAD IVF & pedicles 45o
OBLIQUE (farthest from IR)
PROJECTION
RPO/LPO
Barsony & Koppenstein

PA AXIAL 15-20 CAUDAD IVF & pedicles 45o

OBLIQUE (closest to IR)
PROJECTION
RAO/LAO
Positions

CHEWING/WAGGING BLUR MANDIBULAR SHADOW

TO DEMONSTRATE THE ENTIRE
JAW/OTONELLO METHOD CERVICAL COLUMN
 CERVICOTHORACIC REGION
SWIMMER’S
TECHNIQUE

TWINNING UPRIGHT Perpendicular (shoulder

well depressed)

PAWLOW (SWIMMERS’ RECUMBENT 3- 5 CAUDAD (can’t be

VIEW) depressed sufficiently)

MODIFIED RECUMBENT 5-15 CEPHALAD

PAWLOW/MONDA
 THORACIC VERTEBRAE
┴
AP PROJECTION T1-T12 FUCHS: heel
Costovertebral effect- cathode
articulations. toward feet (more
uniform density of
the thoracic
spine)

LATERAL ┴ Thoracic IVF

PROJECTION MALE: 15
CEPHALAD

FEMALE: 10
CEPHALAD
 THORACIC ZJ
ZJ or apophyseal 70o
AP OBLIQUE joints (farthest
PROJECTION from IR)
RPO/LPO
FUCHS METHOD

ZJ or apophyseal 70o
PA OBLIQUE joints (closest to
PROJECTION IR)
RAO/LAO
OPPENHEIMER
METHOD
 LUMBAR- LUMBOSACRAL
VERTEBRAE
┴ Lumbar bodies
AP/PA PROJECTION
PA PROJECTION
(OPTIONAL)

Lumbar IVF L1-L4

LATERAL ┴
PROJECTION MALE: 5 CAUDAD

FEMALE: 8 CAUDAD
 LUMBAR ZJ
Zygapophyseal/a 45o
AP OBLIQUE pophyseal joints
PROJECTION (closest to IR)
RPO/LPO "Scotty dog"

Zygapophyseal/a 45o
PA OBLIQUE pophyseal joints
PROJECTION (farthest from IR)
RAO/LAO "Scotty dog"
 SCOTTY DOG

Ear: Superior Articular Process

Nose: Transverse Process

Eye: Pedicle

Neck: Pars interarticularis

Body: Lamina

Foot: Inferior Articular Process

 L5-S1 LUMBOSACRAL JUNCTION
LATERAL PROJECTION
R/L/ FRANCIS METHOD
Perpendicular (w/ support)
MALE: 5 CAUDAD
FEMALE: 8 CAUDAD
RP: 2 in. posterior/ 1.5 in inferior to iliac
crest
SS: Lower 2 lumbar vertebrae/ upper sacrum
FRANCIS TECHNIQUE: alternative/ locate
both iliac crest/ cr parallel to interiliac plane
 LUMBOSACRAL AND SACROILIAC
JOINTS
MALE: 30 CEPHALAD
AP AXIAL PROJECTION- FEMALE: 35 CEPHALAD
FERGUSION METHOD
RAO/ LAO

PA AXIAL PROJECTION- 35 CAUDAD MEESE : prone for

FERGUSION METHOD sacroiliac joints- obliquity //
RAO/ LAO 2 in distal to spinous of L5
 INTERVERTEBRAL FORAMEN

PA AXIAL OBLIQUE PROJECTION

KOVACS METHOD
RAO/LAO Position

CR: 15-30 CAUDAD

RP: L5; superior edge of the crest
(entrance)
SS: L5 intervertebral foramina
 SACROILIAC JOINTS
Sacroiliac joint 25-30o
AP OBLIQUE PROJECTION (farthest from IR)
RPO/LPO Position

BROWER & KRANSDORK:

summarized difficulties

PA OBLIQUE PROJECTION Sacroiliac joint (closest 25-30o

RAO/LAO Position to IR)
 SACRUM & COCCYX
SACRUM: COCCYX:
AP/PA AXIAL AP/PA AXIAL

SA/SU/CE15 CYSUCA10

LATERAL LATERAL
3.5’’ posterior to ASIS & 2’’
3.5’’ posterior to ASIS
inferior to ASIS
 PA PROJECTION
CHAMBERLAIN METHOD
FOR ABNORMAL SACROILIAC MOTION/
SACROILIAC SLIPPAGE/RELAXATION

Sacral Vertebral Canal and Sacroiliac Joints

NOLKE METHOD (AXIAL PROJECTION)
Spine sLightly flexed: – Lower sacral vertebral canal
Moderate flexion (bending forward): – Cross section
AcUte flexion (bending forward): – Upper sacral vertebral canal

LUMBAR INTERVERTEBRAL DISK

WEIGHT-BEARING METHOD (PA PROJECTION)
R and L bending
┴/ 15-20 CAUDAD
MOBILITY OF IV JOINTS
 Thoracolumbar Spine Scoliosis
PA (AP) Projection: Scoliosis Series

FRANK ET AL Typical scoliosis study:

PA for scoliosis
• PA (or AP) upright
FRANK & KURTZ • PA (or AP) upright with
Protecting breast during lateral bending
upright • Lateral upright (with or
without bending)
BUTLER ET AL. • PA (or AP) prone or supine
Reduce px exposure during
scoliosis radiography
 LUMBAR SPINE/ SPINAL FUSION

AP Projection: R & L Early scoliosis

Bending Localized HNP
Site of spinal fusion

Whether motion is
present in the area of a
Lateral Projection:
spinal fusion
Hyperflexion &
Hyperextension Localize a herniated
disk.
RULES OF OBLIQUE
RULES OF OBLIQUE
 RULES OF OBLIQUE
SCTao – CRLpo

SCTao CRLpo
Rao/Lao Rpo/Lpo
Sacroiliac joint- 25- 30 Chest – 45
Cervical- 45 Ribs 45
Thoracic Lumbar- 45
MCP- 70
Lateral- 20
BONY THORAX
ANATOMY
PATHOLOGY
POSITIONING
 STERNUM
RESPIRATION:
PA OBLIQUE/ • Expiration
LAO/RAO *15-20* • Slow, shallow breaths
Best projection to
demonstrate sternum

PA OBLIQUE/ 25 TOWARD MSP For ambulatory patients

MOORE with acute pain.
• Alternative for RAO

Best demonstrate the

entire length of sternum
LATERAL
 STERNOCLAVICULAR
ARTICULATIONS
PA STENROCLAVICULAR
ARTICULATIONS
PA OBLIQUE/ BODY ROTATION
RAO/LAO

PA OBLIQUE/ CENTRAL RAY 15 TOWARDS MSP

ANGULATION/ RAO/LAO
 STERNOCLAVICULAR
ARTICULATIONS
AXIOLATERAL PROJECTION
KURZBAUER METHOD CR: 15 CAUDAD
RP: SC joint closest to the IR
SS: Unobstructed
sternoclavicular joint
FULL INSPIRATION

AP AXIAL PROJECTION 40 CEPHALAD

SERENDIPITY STERNOCLAVICULAR
DISLOCATIONS
 RIBS
PA (UPPER ANTERIOR 1st -10th
RIBS) FULL INSPIRATION

Above diaphragm: 1st – 10th

AP (POSTERIOR RIBS) Below diaphragm: 9th - 12th

Respiration:
Ribs above diaphragm : (full
inspiration)
Ribs below diaphragm (full
expiration)
 AXILLARY RIBS
AP OBLIQUE/ RPO/LPO Axilliary ribs closest from IR
Posterior-lateral injury

PA OBLIQUE/RAO/LAO Axilliary ribs farthest from IR

Anterior-lateral injury
THORACIC VISCERA
ANATOMY
PATHOLOGY
POSITIONING
 CHEST
ENTIRE LUNG FIELD/ 10 POSTERIOR RIBS
DIAPHRAGM AT ITS LOWEST/ AIR
PA FLUID/(PNEUMOTHORAX- EXPIRATION)

Magnified heart and great vessels

AP ±5 CAUDAD Short lung field

Engorged pulmonary vessels
Clavicles are projected higher
Ribs assume more horizontal plane

Free basal portions

RESNICK 30 CAUDAD

ER:
Requires the ribs posterior to the vertebral
LATERAL column should superimpose

Hilum of lung field

Pulmonary lesions
 CHEST
PA OBLIQUE PROJECTION Lung closest from IR
RAO/LAO

AP OBLIQUE PROJECTION Lung farthest from IR

RPO/LPO
 PULMONARY APICES
AP AXIAL/LINDBLOM Lung apices inferior to shadow of
clavicles

AP AXIAL LINDBLOM/ Dependent apex and lung of the

affected side
RPO/LPO in its entirety

AP AXIAL 15-20 CEPHALAD Apices lying below the clavicles

PA AXIAL Inspiration (10 to 15 full inspiration (clavicles are elevated)

cephalad) full expiration (clavicles are depressed
Expiration ┴
PA AXIAL/ Axial of the lungs that demonstrates
Fleischner magnified interlobar effusions.

FERGUZON 45 CAUDAD
 LUNGS & PLEURAE
Change in fluid position (pleural
AP OR PA PROJECTION HORIZONTAL effusion)
R or L Reveals any previously obscured
Lateral decubitus positions pulmonary areas
Demonstrate the presence of any free
air (pneumothorax)

EKIMSKY Patient leaning Small pleural effusions

laterally 45

Lateral Projection AIR FLUID LEVELS and reveals

HORIZONTAL
Ventral or Dorsal decubitus pulmonary area that are obscured by
the fluid in standard projections
 TRACHEA
Trachea Air-filled trachea
AP Projection

Foreign body localization

Retrosternal extensions of the
Trachea and thyroid gland
HORIZONTAL
Superior Mediastinum Thymic enlargement in infants (in
the recumbent position)
Lateral Projection Opacified pharynx and upper
esophagus (EISELBERG & SGALITZER)

Trachea and
15 CAUDAD Air-filled trachea/ Apex of the lung
Pulmonary Apex closer to the IR
AXIOLATERAL Respiration:
end of full inspiration (APEX)
PROJECTION during slow inhalation (TRACHEA)
TWINING METHOD
R or L position
ABDOMEN
ANATOMY
POSITIONING
 ABDOMEN
AP/PA
AP Size & shape of liver
Spleen & kidneys
Intraabdominal calcifications
┴ (supine) Evidence of tumor masses
horizontal (upright) “end of expiration”

PA Less desirable kidneys due to increased OID

Greatly reduced the gonadal dose

Patient kept in left lateral position for 10-20 minutes or 5 minutes

before taking radiograph

It allow gas to rise into the area under the right hemidiaphragm
• To demonstrate small amounts of intraperitoneal gas in acute
MILLER abdominal cases (10-20 mins)
• To demonstrate larger amounts free air (5 mins)
 AP Projection: Left Lateral
Decubitus
Horizontal and perpendicular to IR
RP: level of iliac crest or 2 inches above the iliac
crest)
SS:
• valuable for demonstrating air or fluid levels when
an upright abdomen projection cannot be obtained
• best visualizes free intraperitoneal air in the area
of the liver in the right upper abdomen away from
the gastric bubble
“end of expiration”
 ABDOMEN/LATERAL
PROJECTIONS
LATERAL Prevertebral space (occupied
by abdominal aorta)
PROJECTION Localize foreign bodies
R or L Position

Air-fluid levels in the abdomen

Lateral Projection Intraabdominal calcifications
or tumor masses
R/L Dorsal Decubitus Umbilical hernia

Position
SKULL
ANATOMY
POSITIONING
SKULL MORPHOLOGY
MESOCEPHALIC BRACHYCEPHALIC DOLICOCEPHALIC

Average head Petrous pyramid forms Petrous pyramid form

an angle greater than an angle less than 47°
47° (approximately 54°) (approximately 40°) to
Temporal base or to the MSP. the MSP
petrous pyramid forms
an angle of to 47° to the
MSP. The width is 80% or The width is less than
greater than the length 75% of the length.
 CRANIUM
PA PROJECTION
PP: OML ⊥, MSP ⊥
RP: NASION
SS: PACE OF-PEPY Can’t Get FB/FS Don’t Socialize
Posterior Air Cells of Ethmoid
Orbits-Filled
PEtrous PYramid
Crista Galli
Frontal Bone/Sinus
Dorsum Sellae
 CRANIUM
PA AXIAL- CALDWELL
MSP ⊥ OML ⊥ to IR
CR: 15 CAUDAD
RP: exit the nasion
SS: AACE LTO-PEPY Can’t Get FB/FS Don’t Socialize
Anterior Air Cells of Ethmoid
Lower Thirds of the Orbits
PEtrous PYramid
Crista Galli
Frontal Bone/Sinus
Dorsum Sellae

*Alveolar ridge fractures.

 CRANIUM
TRUE CALDWELL/ ORIGINAL
PP: GML ⊥, MSP ⊥
RP: nasion
CR: 23 CAUDAD
SS: SS: AACE LTO-PEPY Can’t Get FB/FS Don’t Socialize
Anterior Air Cells of Ethmoid
Lower Thirds of the Orbits
PEtrous PYramid
Crista Galli
Frontal Bone/Sinus
Dorsum Sellae
MODIFICATIONS OF PA AXIAL OF
SKULL
0°- 5° CAUDAD- Petrous ridges within Orbits

25° CAUDAD– Schuller Method

20°- 25° CAUDAD – Superior Orbital Fissure

25°- 30° CAUDAD- Rotundum Foramina

 CRANIUM

AP NASION PACE OF-PEPY Can’t Get

FB/FS Don’t Socialize
PROJECTION (MAGNIFIED ORBITS)

AP AXIAL AACE LTO-PEPY Can’t Get

PROJECTION 15 CEPHALAD
FB/FS Don’t Socialize
(MAGNIFIED)
 LATERAL PROJECTION
CRANIUM
IOML // to TAIR
MSP //
IPL ⊥
RP: 2 inches (5 cm) superior to EAM or halfway between the glabella and the inion
SS: superimposed GOMET - PADS
Greater wing
Orbital roofs Posterior Clinoid Process
Anterior clinoid Process
Mastoid process Dorsum sellae
Eam Sella trucica
Tmj
 LATERAL PROJECTION
Dorsal decubitus or supine lateral
CROSSTABLE LATERAL

OML- //, MSP //, IPL- ⊥

• CR: Horizontal
• SS: superimposed GOMETS- PADS
Robinson, Meares, and Goree-
Traumatic Sphenoid Sinus Effusion
(Basal skull fracture)
 TRUE LATERAL- CR ⊥
“Faber Castell PENS”
Facial Zygoma
Cranium 2’’ above EAM
PNS ½- 1 ‘’ posterior to outer
canthus
Eyes Outer canthus
Nasal Bones ½ ‘’ distal to nasion
Sella Turcica ¾’’ anterior and
superior to EAM
 AP AXIAL PROJECTION
TOWNE METHOD
ALTSCHUL/GRASHEY/CHAMBERLAIN
OML- ⊥, IOML ⊥ , MSP ⊥
CR: 30° caudad OML, 37° caudad IOML
SS: Do P4 FEJuRo
Dorsum sellae
Posterior clinoid process
Posterior Foramen Magnum
Posterior Parietal Bone
Petrous Pyramid (BILATERAL)
Facial Canal
Ears
Jugular foramina
Rotundum foramina
40- 60° CAUDAD – ENTIRE FORAMEN MAGNUM
 TOWNE
PZT CrystalS (OML ⊥/ IOML ⊥)
Petrous pyramid 2.5 in above 30/ 37
(NASION)
Zygomatic arch 1 in above 30/37
(NASION)
TMJ 3 in above 35/42
(NASION)
Cranium 2.5 in above 30/37
glabella
Sella turcica 2.5-3 in. above 30/37 IOML
glabella 23/30 OML
 PA AXIAL PROJECTION
HAAS METHOD/REVERSE TOWNE/ NUCHOFRONTAL
MSP ⊥ , OML ⊥ ,
CR: 25° CEPHALAD
RP: 1 ½ inches (3.8 cm) below the external occipital protuberance
(inion) and to exit approximately 1 ½ inches (3.8 cm) superior to the
nasion
SS: magnified- Do P4 FEJuRo
For hypersthenic, obese, or other patients who
cannot be adjusted correctly for the AP axial
(Towne) projection
 PA AXIAL PROJECTION
HAAS METHOD/REVERSE TOWNE/ NUCHOFRONTAL
MSP ⊥ , OML ⊥ ,
CR: 25° CEPHALAD
RP: 1 ½ inches (3.8 cm) below the external occipital protuberance
(inion) and to exit approximately 1 ½ inches (3.8 cm) superior to the
nasion
SS: magnified- Do P4 FEJuRo
For hypersthenic, obese, or other patients who
cannot be adjusted correctly for the AP axial
(Towne) projection
 SUBMENTOVERTICAL PROJECTION
SCHULLER’S METHOD/ BASICRANIUM/
IOML NEARLY // , MSP ⊥
RP: ¾ inch (1.9 cm) anterior to the level of the EAM
CR: ⊥ TO IOML
SS: PMMOSE FOSFOZ CACA BOND
Petrosae
Mastoid Process
Mandible (Horseshoe-shaped)
Occiput
Sphenoid and Ethmoid sinus
Foramen Ovale and Spinosum
FOramen magnum Zygomatic arch (Decrease TF)
CArotid CAnal
BOny Nasal septum Dens
 VERTICOSUBMENTAL PROJECTION
SCHULLER METHOD/ PFEIFFER

IOML // , MSP ⊥
RP: ¾ inch (1.9 cm) anterior to the level of the EAM
SS: PMMOSE FOSFOZ CACA BOND (MAGNIFIED)
Useful for the anterior cranial base and
sphenoidal sinuses
 CRANIUM

LYSHOLM/ 30-35 CEPHALAD

For patients who cannot
extend their head enough
AXIOLATERAL for a satisfactory SMV
projection

DILA (IOML 50°)

Dorsum sellae;
Internal Auditory Meatus (IAM);
VALDINI/ LAbyrinth

PA AXIAL ⊥ ETB “EaT Bulaga” (OML 50°)

External auditory meatus;
Tymphanic cavity;
Bony part of Eustachian tube
SELLA TURCICA
¾ anterior & superior to EAM
 LATERAL PROJECTION

SS: superimposed PADS

Posterior Clinoid Process
Anterior clinoid Process
Dorsum sellae
Sella trucica
Best demonstrate the sella turcica and clivus in profile.

REQUIRES CLOSE BEAM RESTRICTION

 LATERAL PROJECTION

SS: superimposed PADS

Posterior Clinoid Process
Anterior clinoid Process
Dorsum sellae
Sella trucica
Best demonstrate the sella turcica and clivus in profile.
 AP AXIAL TOWNE/MODIFIED TOWNE
OML/IOML & MSP ┴
SS: superimposed PADS

IOML 37 & OML 30 (DSPCP-FM)

Dorsum Sellae and PCP within the Foramen Magnum

IOML 30 & OML 23 (DOTA)

DOrsum sellae, Tuberculum sellae, Anterior clinoid
process through the occiput above the foramen
magnum
 PA AXIAL PROJECTION

RP: exiting glabella

CR: 10 CEPHALAD
SS: DOTPA
DOrsum sellae
Tuberculum sellae
Posterior clinoid processes
Anterior clinoid processes through frontal
bone above ethmoidal sinuses
OPTIC CANAL AND
OPTIC FORAMEN
 RHESE METHOD
PARIETO-ORBITAL OBLIQUE
PROJECTION
RP: 1 inch superior and posterior to the upside TEA
SS: Oh Come On Fiona, ILike Q- FES
.
Optic Canal Optic Foramen seen at Infero-Lateral
Quadrant
Frontal Ethmoid Sphenoid

LAteral deviation= incorrect Rotation

Longitudinal deviation = incorrect Angulation of AML

PHAZMA: Prone; Head- 37deg ; Affected orbit;

Zynoch; MSP 53; AML ⊥
 ORBITOPARIETAL OBLIQUE
PROJECTION
REVERSE RHESE METHOD
RP: Inferior and lateral margin of uppermost orbit
SS: Oh Come On Fiona, ILike Q- FES
Optic Canal Optic Foramen seen at Infero-
Lateral Quadrant
Frontal Ethmoid Sphenoid
(increased radiation dose to lens of eye)
SAMA: Supine; Away; MSP 53; AML ⊥
 OPTIC CANAL AND OPTIC FORAMEN

ALEXANDER
METHOD
ORBITO-PARIETAL MSP 40; AML ⊥
OBLIQUE
PROJECTION

MODIFIED
LYSHOLM
METHOD
ECCENTRIC
20 CAUDAD/30 CAUDAD
ANGLE PARIETO-
ORBITAL
OBLIQUE
PROJECTION
SUPERIOR OML 20-25 CAUDAD
ORBITAL
FISSURES
PA AXIAL
PROJECTION
INFERIOR IOML 20-25 CEPHALAD
ORBITAL
FISSURES
BERTEL METHOD
PA AXIAL
PROJECTION
 SPHENOID STRUT
inferior root of lesser wing of sphenoid bone
HOUGH METHOD
PARIETO-ORBITAL OBLIQUE PROJECTION

Head rotation: 20 toward the side of interest;

MSP; 70
CR: 7 CAUDAD
EYES
 EYE- FOREIGN BODY LOCALIZATION
LATERAL OML-MSP // ⊥ Superimposed orbital
roofs

PA AXIAL/ OML ⊥
EXAGGERATED 30 CAUDAD
CALDWELL Petrous pyramids is
located to the inferior
margin of the orbits
MODIFIED WATER’S
PARIETOACANTHIAL OML 50 ⊥
VOGT BONE Taken to detect small or
FREE POSITION 2 Projections: low density foreign
lateral & particles
superoinferior
By Richards/ preliminary
PARALLAX Lateral: 2 check only
exposures Foreign body in eyeball
PA: 2 exposures
SWEET METHOD Lateral: 2 15-25 CEPHALAD
exposures Exact location/geometric
Waters Method: CR horizontal calculations
PFEIFFER-COMBERG Lateral: CR perpendicular
Leaded contact lens
FACIAL BONES
 WATERS METHOD
PARIETO-ACANTHIAL PROJECTION

MSP & MML ⊥ ;OML 37

RP: Acanthion (exit)
CR: ⊥ Best projection for
facial bones
SS: RAZON MF
Rotundum foramina
Petrous ridges
Anterior nasal spine immediately below the
Zygomatic bone and arches maxillary sinuses
Orbital rims (superior & inferior)
Nasal septum (lateral deviation) Tripod Fractures- “free
floating zygoma”
Maxillae (sinuses)
Fractures
 PARIETO-ACANTHIAL PROJECTION
SHALLOW WATERS/ MODIFIED WATERS METHOD

LML; OML 55
ACANTHION
SS: Less axial angulation (RAZON MF)
Petrous ridges seen at the middle or lower third of the antral
floor/inferior margin of the orbits at a point midway through
maxillary sinuses
Orbital floor ⊥ to IR - // to CR
Inferior displacement of orbital floor associated with opacified
maxillary sinus
Best projection for orbital floor (blowout fracture)
 REVERSE WATERS METHOD
ACANTHIO-PARIETAL PROJECTION
AP AXIAL PROJECTION
MML ⊥; OML 37o
SS: MAGNIFIED (RAZON MF)
ER: For trauma patient: CR // to acanthion
 FACIAL BONES
LATERAL Superimposed facial bones
Superimposed mandibular rami &
orbital roofs

PA AXIAL CALDWELL 15/30 CAUDAD Orbital rims, maxillae, zygomatic

bones, nasal septum & anterior nasal
spine
Petrous ridges at lower third of orbits
(15o caudad)

Petrous ridges below the inferior

border or orbits and orbital rim in
particular to the orbital floor (30
caudad)

PA AXIAL Floor & posterior wall of maxillary

sinus (antrum) of side down
OBLIQUE/ LAW METHOD 25- 30 CEPHALAD
NASAL BONE
 NASAL BONES
Nondisplaced linear of nasal bone,
LATERAL frontonasal suture and anterior nasal
spine

TANGENTIAL/ // to GAL Medial/Lateral displacement of

SUPEROINFERIOR fragments in fractures/ displaced
fracture of nasal bone
extraoral (prone)
Intraoral (supine) Contraindications:
Children or adults who have very
short nasal bones, concave face or
protruding upper teeth

WATER’S METHOD
Displacement of bony nasal septum
PARIETOACANTHIAL & depressed fx of nasal wings
 ZYGOMATIC ARCHES
SMV/ JUG HANDLE VIEW
Best demonstrates
IOML // ⊥ to IOML bilateral symmetric
zygomatic arches
MODIFIED TITTERINGTON
PA AXIAL (SUPEROINFERIOR) Well shown zygomatic
MSP ⊥ 23- 38 CAUDAD arches (UNILATERAL)

TANGENTIAL MSP 15 toward ⊥ to IOML

Head tilted 15 away
Useful with patients who
*unilateral* have depressed fractures
or flat cheekbones

MSP 15 away ⊥ to IOML Useful with patients who

MAY METHOD/TANGENTIAL Head tilted 15 away have depressed fractures
*unilateral*
or flat cheekbones

MODIFIED TOWNE/ OML/IOML & MSP ⊥ 30 CAUDAD (OML )

AP AXIAL PROJECTION Bilateral symmetric
37 CAUDAD (IOML ) zygomatic arches free of
superimposition
MANDIBLE
 MANDIBULAR SYMPHYSIS
AP AXIAL
PP: MSP; ┴
CR: 40-45 POSTERIORLY
RP: MIDWAY B/N LIPS
SS: MaMeRosa
Mandibular symphysis
Mental foramen
Roots of canine and incisors of lower teeth
 MANDIBULAR RAMOS

PA PROJECTION

MEDIAL/ LATERAL
DISPLACEMENT OF
OML ⊥ FRAGMENTS IN
FRACTURES OF RAMI

PA AXIAL
20-25 CEPHALAD
PROJECTION
 MANDIBULAR BADY

PA PROJECTION fill the mouth

with air to
obtained better
contrast around
TMJs (Zanelli)
AML ⊥
Best projection
PA AXIAL for subcondylar
30 CEPHALAD fractures
PROJECTION
 MANDIBLE
AXIOLATERAL OBLIQUE PROJECTION
PP: MSP //; IPL ┴ to IR
: HEAD ROTATIONS
MANDIBULAR SYMPHYSIS – 45
MANDIBULAR BODY - 30
MANDIBULAR RAMUS - LATERAL
CR: 25 CEPHALAD
SS: To place the desired portion of the mandible // with the IR
Muscular/Hypersthenic Patients: MSP 15/ CR 10 CEPHALAD
To reduce the possibility of projecting shoulder over the
mandible
 MANDIBLE

SCHULLER
PFEIFFER/SMV
Demonstrate
the HORSE
IOML //
SHOE SHAPED
mandible bone
VSM

PANORAMIC TOMOGRAHY/PANTOMOGRAPHY/ROTATIONAL TOMOGRAPHY

Technique employed to produced tomograms of curved surfaces
Occlusal plane will decline by 10° from posterior to anterior.
TEMPOROMANDIBULAR
JOINT
½ in anterior & inferior to EAM
 TEMPOROMANDIBULAR JOINT
MODIFIED TOWNE
AP AXIAL MSP/OML ⊥ 35 CAUDAD OML
42 CAUDAD IOML

AXIOLATERAL/ AXIAL
TRANSCRANIAL/LAW IOML // IPL ⊥ 25- 30 CAUDAD

INFEROSUPERIOR 30 CEPHALAD
TRANSFACIAL IPL/MSP - 15

ALBERS-SCHONBERG 20 CEPHALAD
IPL ⊥ MSP/IOML //
LATERAL TRANSFACIAL

ZANELLI/ LATERAL OBLIQUE MSP -30 ⊥

TRANSFACIAL
PETROMASTOID
 ORIGINAL LAW METHOD
AXIOLATERAL POSITION
Double tube Angulation Method
Non- grid technique
RP: 2 in. posterior & 2 in. superior to uppermost EAM
CR: 15 CAUDAD & 15 ANTERIOR
Lange Recommendations:
25 CAUDAD & 20 ANTERIOR
Auricles taped forward
SS: MaLPet SAM
Mastoid cells
Lateral Petrous pyramid
Superimposed Acoustic Meatus (IAM/EAM)
 MODIFIED LAW METHOD
AXIOLATERAL POSITION
Single tube Angulation Method
(With Grid)
MSP – 15 (affected side closest)
CR: 15 CAUDAD
Lange Recommendations:
25 CAUDAD & 20 ANTERIOR
Auricles taped forward
SS: MaLPet SAM
Mastoid cells
Lateral Petrous pyramid
Superimposed Acoustic Meatus (IAM/EAM)
 HENSCHEN, SCHULLER, & LYSHOLM METHODS
AXIOLATERAL PROJECTIONS
“Honey Sexy Love”
HENSCHEN/ SCHULLER LYSHOLM
Cushing

15 CAUDAD 25 CAUDAD 35 CAUDAD

MaCAN- AM MaPAN- DAMS MaCAN- CARLAE
Mastoid Cells- ANtrum
Mastoid Cells- ANtrum Mastoid Process CARotid canal
Acoustic Meatus
Antrum LAbyrinthine area
Eam
Useful for acoustic nerve Dural plates Acoustic
tumors. Meatus Runstrom:
Open mouth (petrous
Sinus apex b/n anterior wall of
EAM & mandibular
condyle
 AXIOLATERAL OBLIQUES
Petrous
Pyramid
ARCELIN METHOD/
ANTERIOR PROFILE/ // away 10 CAUDAD
REVERSE STENVERS
METHOD (supine)

STENVERS METHOD/
MSP 45
POSTERIOR PROFILE // closest 12 CEPHALAD
(prone)

MAYER METHOD
(supine)
⊥ closest 45 CAUDAD
 PETROMASTOID
LOW BEER METHOD 10 CEPHALAD SIMILAR IMAGE TO
STENVERS METHOD
33 ANTERIOR

AP AXIAL TOWNE 30 CAUDAD OML PETROSAE ABOVE SKULL

37 CAUDAD IOML BASE

SMV SYMMETRIC PETROSAE

⊥

5 ANTERIORLY PETROSAE POSTERIOR TO

HIRTZ MODIFICATION
MANDIBULAR CONDYLE
STYLOID PROCESS
 STYLOID PROCESS

PA AXIAL/ 25 CEPHALAD UTILIZED TO SHOW

STYLOID PROCESS
CAHOON WITHIN/ ABOVE
METHOD MAXILLARY SINUS

FUCHS METHOD ⊥ / 13 CAUDAD

instead of tilting the STYLOID PROCESS OF
IR. TEMPORAL BONE
WITHIN THE MAXILLARY
SINUS
 STYLOID PROCESS

AP OBLIQUE 8 CEPHALAD Oblique projection of

PROJECTION the styloid process
WIGBY-TAYLOR overlying the soft
METHOD tissue of the neck.

AXIOLATERAL 10 CEPHALAD Lateral image of the

OBLIQUE 10 ANTERIORLY styloid process
PROJECTION projected into the
FUCHS METHOD space superior to
the mandibular
notch.
JUGULAR FORAMINA
 JUGULAR FORAMINA

SMV/ AXIAL OML // JUGULAR FORAMINA

20 POSTERIORLY NEAR/ LEVEL OF
KEMP HARPER Increased central ray 5- 10° ANGLES OF MANDIBLE
METHOD caudad for patient who have
prominent mandible

SMV/ AXIAL OML 25 (not as demanding position as

compared with Kemp Harper
⊥
ERASO MOD. method)
JUGULAR FORAMINA
NEAR/ LEVEL OF
ANGLES OF MANDIBLE
 HYPOGLOSSAL CANAL
AXIOLATERAL OBLIQUE PROJECTION
MILLER METHOD
ANTERIOR PROFILE
Supine; IOML // , MSP 45 away
12 CAUDAD

1 inch directly anterior and ½ inch

inferior to level of EAM.

Phonate “a” to immobilize tongue and

mouth during exposure
Used to delineate the hypoglossal canal
in a patient with a hypoglossal (12th
cranial) nerve tumor.
PARANASAL SINUSES
Frontal Ethmoid Sphenoid Maxillary

Cross & Flecker: pointed out the value of erect

position

To demonstrate presence or absence of fluid

To differentiate between shadows caused by
fluid & those caused by pathology
 PARANASAL SINUSES
“CLOWS PA”
Caldwell/ PA AXIAL MSP/ OML ┴ 15 CAUDAD nasion Frontal sinuses &
anterior ethmoidal
sinuses
Lateral Projection IOML //, IPL ┴ ┴ 0.5-1 in. All FOUR paranasal
posterior to sinuses
outer canthus

Open mouth/ OML 37, MML ┴ acanthion Sphenoidal sinuses

Parietoacanthial Petrous pyramids
inferior to floor of
maxillary sinus
Water’s Method/ OML 37, MML ┴ acanthion Maxillary sinuses
Parietoacanthial
SMV IOML // ┴ to IOML ¾ in. anterior Sphenoidal &
to EAM ethmoidal sinuses
PA Projection MSP ┴/ Nasion (┴) nasion/ glabella Sphenoidal sinuses
OML ┴ Maxillary sinuses
Glabella (10 inferior to cranial
CEPHALAD) base
 PARANASAL SINUSES
VSM MSP ┴ ┴ to IOML ¾ in. anterior Sphenoidal
to EAM sinuses
Posterior
ethmoidal
sinuses
Maxillary
sinuses

Pirie Method/Axial MSP ┴ ┴ to IOML ¾ in. anterior Sphenoidal

transoral to EAM sinuses
Posterior
ethmoidal
sinuses
Maxillary
sinuses
Nasal fossae
ORBITAL CAVITY IS FORMED BY
May Libreng Zumba Fitness Sa PE
Maxillae
Lacrimal
Zygoma
Frontal
Sphenod
Palatine
Ethmoid
 2PT LANDING – OML ┴ prone (forehead & nose)

“Pre Enjoy Mag SawSaw ng Chocolate Chupa Chups Sa Red Horse”

PNS ┴/ 10 CEPHALAD Nasion/glabella

Eyes 30 CAUDAD Inferior margin of orbits
M-RamOs ┴/ 20 – 25 CEPHALAD Acanthion
Schuller 25 CAUDAD Nasion
Sella Turcica 10 CEPHALAD Glabella
Cranium ┴ Nasion
Caldwell 15 CAUDAD Nasion
Cahoon 25 CEPHALAD Nasion
Superior Orbital Fissures 20- 25 CAUDAD Inferior margin of orbits
Rotundum foramina 25-30 CAUDAD Nasion

Haas 25 CEPHALAD 1.5 in below inion

 PETROMASTOID PORTION
“Losing Someone Hurts So Love Her And Say Marry Me”
PROJECTIONS MSP CENTRAL RAY TOPOGRAPHICAL
LINES
Law- O // 15 C/A IOML // TAIR; IPL ⊥
Law- M 15 T 15 C IOML //
SMV ⊥ ⊥ OML //
Henschen // 15 C IOML // TAIR; IPL ⊥
Schuller // 25 C IOML // TAIR; IPL ⊥
Lysholm // 35 C IOML // TAIR; IPL ⊥
Hirtz ⊥ 5A OML //
Arcelin 45 A 10 C IOML ⊥
Stenvers 45 T 12 Sephalad IOML // TAIR
Mayer 45 T 45 C IOML // TAIR
Modified Hickey 55 A 15 C IOML ⊥
Towne ⊥ 30/ 37 C IOML/OML ⊥