RAD POSI SUMMARY ALL

AP Projection

• Rotate the leg 3-50 degrees internally until the interepicondylar line is parallel to the image receptor.
• The central ray (CR) is directed 1/2 inch below the apex of the patella.
• The angle of the CR is 5-70 degrees.
• The structure being imaged is the distal femur and proximal leg.

VARIATION- ASIS TO TABLETOP (PA PROJECTION)

• The central ray is directed 50 degrees caudad.
• The central ray is parallel to the tibial plateau because the tibia and fibula are slightly inclined.

Lateral Projection (Mediolateral)

• The patient should turn toward the affected side
• Flex the knee between 20-30 degrees to relax the muscles and show the maximum volume of the joint cavity.
• The central ray is directed 5 - 7 degrees cephalad.

AP Oblique Internal Rotation

• Rotate the leg 45 degrees internally.

AP Weight Bearing (AHLBACK)

• This projection is used to assess Degenerative Joint Disease (DJD), knee joint spaces, varus and valgus deformity and narrowing of the joint space.

AP Oblique Lateral Rotation

• Rotate the leg 45 degrees externally.

PA Projection

• Rotate the heel 5-10 degrees laterally.
• The CR is directed to the midpopliteal depression.

PA Oblique - Medial & Lateral Rotation

• Rotate the knee 45-55 degrees.

Lateral Projection

• Flex the knee no more than 10 degrees to prevent fragment separation in new or unhealed patellar fractures.
• Demonstrates the patella, patellofemoral joint, and tibiofemoral joint.

PA Axial Oblique Projection (Kuchendorf Method)

• The patient should be prone.
• Rotate the knee laterally so the patella and medial condyle both rest on the table (35-40 degrees).
• Flex the knee by 10 degrees to relax the muscles.
• The central ray is directed 25-30 degrees towards the patella.
• This projection demonstrates most of the patella free of superimposition.

Tangential Projection (Hughston Method)

• Also known as Tangential Projection (Merchant Method).
• The patient should be prone with the leg elevated resting on the tube.
• Flex the knee 50-60 degrees.
• The central ray is directed 45 degrees.
• This projection demonstrates the patellofemoral joint and patellar subluxation and femoral condyles.

Tangential Projection (Merchant Method)

• Also known as Mountain View.
• The patient can be sitting or supine with the knee flexed 40 degrees.
• The central ray is directed 30 degrees from horizontal.
• This projection demonstrates patello femoral disorders, patellar subluxation and uses an axial viewer device.

Tangential Projection (Settegast Method)

• The patient should be prone.
• Flex the knee to place the femur at an angle of 45 degrees.
• The central ray is perpendicular to the leg/CR 10 degrees.

PA Proj, Weight Bearing (Rosenberg )

• This projection demonstrates the intercondyloid fossa.

PA Axial Projection (Camp-Coventry Method)

• The patient should be prone with the knee flexed 40-50 degrees.
• The central ray is perpendicular to the long axis of the leg entering the popliteal.
• This projection demonstrates the knee joint space and reveals loose bodies within the joint.

PA Axial Projection (Holmblad Method)

• This projection demonstrates the intercondylar fossa.
• There are 3 positions:
  • Standing with the knee resting on a stool.
  • Standing with the knee on a vertically placed cassette.
  • Kneeling.
• The femur should be 70 degrees to the long axis of the leg.
• The central ray is perpendicular to the long axis of the leg entering the popliteal.

AP Axial Projection (Beclere Method)

• The patient is supine with the image receptor under the popliteal.
• The knee is flexed so the femur forms 60 degrees to the long axis of the leg.
• The central ray is perpendicular to the long axis of the leg entering the knee.

PATELLA

• The patella is the knee cap and the biggest sesamoid bone.

Shoulder AP Neutral

• Hand rotated internally
• Palm of the hand against the hip
• Epicondyles should be perpendicular to IR
• Epicondylar plane is 45 degrees to the plane of the film
• Humerus in true lateral
• To demonstrate lesser tuberosity
• Greater tubercle partially superimposes the humeral head

Shoulder Transthoracic Lateral Projection (Lawrence Method)

• External rotation - insertion site of supraspinatus tendon
• Neutral rotation - profiles small calcific deposit
• Internal rotation - insertion site of subscapularis tendon

Shoulder Inferosuperior Axial / Lawrence

• Supine
• Abduct the arm 90 degrees
• Arm external rotation
• CR: horizontally through the axilla to the AC jt. of 15 degrees

Shoulder Inferosuperior Axial Proj.(Rafert Mod)

• Exaggerated external rotation, thumb pointing downward & posteriorly 45 degrees
• Best for hill sachs
• CR same but medial angulation

Shoulder Inferosuperior Axial Projection / West point

• Reduce magnification & improve recorded detail
• CR ┴ to the midshaft
• SS: entire clavicle with slight superimposition

Shoulder AP Axial Projection

• Lordotic position
• 0-15 degrees if upright
• 15- 30 degrees if supine
• Exact axial image of the clavicle is seen

Shoulder Tangential

• Supine
• IR supported to stand slantedly touching the affected shoulder
• CR: passing bet.Clavicle and chest wall ┴ to IR
• 25-40 degrees from the horizontal
• Note: add 15-25 degrees laterally If medial third is in question

Shoulder PA Axial Projection

• Prone
• 15-30 deg. to the supraclavicular region

Shoulder Tangential Projection (Tarrant)

• Useful in pt. who have multiple injuries and can’t assume the lordotic or recumbent
• CR: 25-35 degrees Anterior & inferior midclavicle

Scapula Procedures

• AP Projection
• Lateral Projection(RAO/LAO)
• PA Oblique Projection (RAO/LAO) (Lorenz and Lilienfield Method)

Scapula Lateral Projection

• (RAO/LAO) affected side in contact
• SS: posterior articulation

Ankle Procedures

• Malleolus
• AP
• Oblique
• Mortise View

Malleolus

• Plantar surface at right angle to IR
• Rotate the leg and foot medially 45 degrees

Ankle AP

• Plantar surface vertically positioned
• CR: ⊥ to ankle joint to a point midway between malleoli
• SS: distal tib.fib.and proximal talus

Ankle Oblique

• AP Projection
• Femorotibial jt
• Patellofemoral jt

Ankle Mortise View

• Plantar surface vertically positioned
• Rotate 3-5 degrees internally until the interepicondylar line is parallel to IR
• ½“ below the apex of the patella
• 5-7 degrees
• SS: distal femur, proximal leg

Knee Radiographic Positioning Procedures

• AP
• Lateral
• AP Oblique Internal Rotation
• AP Oblique Lateral Rotation
• AP Weight Bearing (AHLBACK)
• PA Proj, weight bearing (Rosenberg)
• Intercondyloid Fossa
• PA Axial Projection (Camp-Coventry Method)
• AP Axial Projection (Beclere Method)
• Patella

Knee AP

• Plantar surface vertically positioned
• CR: ⊥ to ankle joint to a point midway between malleoli
• SS: distal tib.fib.and proximal talus

Knee Lateral

• Turn toward the affected side
• Flexion 20-30 degrees relaxes the muscle and show the maximum volume of the joint cavity
• CR 5-7 degrees cephalad

Knee AP Oblique Internal Rotation

• Rotate the leg 45 degrees internally

Knee AP Oblique Lateral Rotation

• Rotate the leg 45 degrees externally

** Knee AP Weight Bearing (AHLBACK)**

• DJD, knee joint spaces, varus and valgus deformity
• Narrowing of the joints space

Knee PA Proj, weight bearing (Rosenberg)

• Flex knee to place the femur at angle of 45 degrees
• dCR:⊥ to leg/CR 100 degrees

Knee Intercondyloid Fossa

• PA Axial Projection (Camp-Coventry Method)
• Intercondyloid fossa
• Prone
• Flex knee 40-50 degrees
• CR: ⊥ to long axis of leg entering popliteal
• To demonstrate the knee joint space and reveal a LOOSE BODY within the joint
• Femur must be 70 degrees to the long axis of leg

Knee AP Axial Projection (Beclere Method)

• Supine, IR under popliteal
• Knee is flexed so that femur forms 60 degrees to the long axis of leg
• CR: ⊥ to long axis of Leg entering knee

Knee Patella

• Knee cap
• Biggest sesamoid bone

Talocalcaneal Joint

• Isherwood method
• Lateromedial Oblique Projection (Medial Rotation Foot)
• AP Axial Oblique Proj.(Medial Rotation Ankle)
• AP Axial Oblique Proj.(Lateral Rotation Ankle)

Talocalcaneal Joint Isherwood method

• Method used to demons. 3 articulation of the talocalcaneal joint separately

Talocalcaneal Joint Lateromedial Oblique Projection (Medial Rotation Foot)

• Plantar flat on IR, then rotate 45 degrees medially
• CR: ⊥ 1 DA to the lateral malleolus
• SS: anterior subtalar joint

Talocalcaneal Joint AP Axial Oblique Proj.(Medial Rotation Ankle)

• From plantar right angle to IR, rotate 30 degrees medially
• CR: 100 1 DA to lateral malleolus
• SS: middle subtalar joint

Talocalcaneal Joint AP Axial Oblique Proj.(Lateral Rotation Ankle)

• From plantar right angle to IR, rotate 30 degrees laterally
• CR: 100 1 D to medial malleolus
• SS: posterior subtalar joint

ASIS to Tabletop PA Projection

• CR: 50 caudad
• Because tibia & fibula are slightly inclined, CR will be parallel to tibial plateau

AP Oblique (Lateral Rotation)

• Used for trauma patients
• Similar to elbow lateral but hands in prone position
• For radial head:
  • Flex elbow 90 degrees
  • Rotate 45 degrees toward the shoulder
• For coronoid process:
  • Flex elbow 80 degrees
  • Rotate 45 degrees away from the shoulder

AP Partial Flexion (distal humerus)

• Used for trauma patients
• Perpendicular to the humerus, traversing the elbow joint

AP Partial Flexion (Proximal Forearm)

• Center ray perpendicular to the forearm

AP Acute Flexion (Jones Method)

• Used for trauma patients
• Two inches superior or distal to the olecranon process

Lateral Projection (Lateromedial Rotation)

• Four position series
• Flex elbow 90 degrees
• Supinate hand and rotate externally
• Place hand in true lateral position (Thumbs up)
• Pronate hand
• Rotate hand internally(Thumbs down)

PA Axial Projection (distal humerus)

• Rest elbow on image receptor with supinated forearm
• Flex elbow 75 degrees
• Center ray perpendicular to the midshaft

PA Axial Projection (olecranon process)

• Flex elbow 45-50 degrees
• Center ray perpendicular to the olecranon process
• Lordotic positioning
  • 0-15 degrees if upright
  • 15-30 degrees if supine
• Exact axial image of the clavicle is seen

Tangential Projection

• Supine position
• Image receptor supported to stand slantingly touching the affected shoulder
• Center ray passing between the clavicle and chest wall perpendicular to the image receptor
• 25-40 degrees from the horizontal
• Add 15-25 degrees laterally if the medial third is in question

PA Axial Projection

• Prone position
• 15-30 degrees to the supraclavicular region
• Center ray perpendicular to the image receptor

Tangential Projection (Tarrant)

• Useful for patients with multiple injuries
• Center ray 25-35 degrees anterior and inferior to the midclavicle

Bony Structure

• Plantar surface vertically positioned
• Rotate leg and foot 45 degrees medially
• Center ray perpendicular midway between the malleoli

Lateral Projection (RAO/LAO)

• Affected side in contact with the image receptor
• Rotate leg and foot 15-20 degrees medially
• Center ray perpendicular to the ankle joint

Lateral (mediolateral)

• Center ray perpendicular to the ankle joint entering the medial malleolus
• Articulation (joint space) between the talus and fibula is not demonstrated

AP stressed studies

• Used to evaluate the joint separation and ligament tear or rupture

Leg

• Tibia: shin bone (anterior crest or border)
• Fibula: calf bone

AP Projection (Leg)

• Center ray perpendicular to the midshaft

Lateral Projection (Leg)

• Center ray perpendicular to the midshaft

AP Oblique (knee)

• Medial rotation: 45 degrees
  • Opens the proximal tibiofibular joint
• Lateral rotation: 45 degrees
  • Superimposes the tibia and fibula
• Center ray perpendicular to the midshaft

Knee joint

• Flex knee to place the femur at an angle of 45 degrees
• Center ray perpendicular to the leg/ 10 degrees

PA Projection, weight bearing (Rosenberg)

• Center ray 10 degrees

PA Axial Projection (Holmblad Method)

• Intercondylar fossa
• Three positions:
  • Standing, knee resting on a stool
  • Standing, knee on a vertically placed cassette
  • Kneeling
• Femur must be 70 degrees to the long axis of the leg
• Center ray perpendicular to the long axis of the leg entering the popliteal

PA Axial Projection (Camp-Coventry Method)

• Intercondyloid Fossa
• Prone positioning
• Flex knee 40-50 degrees
• Center ray perpendicular to the long axis of the leg entering the popliteal
• Demonstrates the knee joint space and reveals loose bodies within the joint.

AP Axial Projection (Beclere Method)

• Supine positioning, with image receptor under the popliteal
• Flex knee so that the femur forms 60 degrees to the long axis of the leg
• Center ray perpendicular to the long axis of the leg entering the knee

Patella

• Kneecap
• Biggest sesamoid bone

PA Projection (Patella)

• Heel rotated 5-10 degrees laterally
• Mid-popliteal depression

Lateral Projection (Patella)

• Flex knee no more than 10 degrees
• Demonstrates the patella, patellofemoral joint and tibio-femoral joint

PA Axial Oblique Projection (Kuchendorf Method)

• Prone positioning
• Rotate the knee laterally so that the patella and medial condyle rest on the table
• Flex knee 10 degrees to relax the muscle
• Center ray 25-30 degrees on the patella

Tangential Projection (Hughston Method)

• Also known as Tangential Projection (Merchant Method)
• Prone positioning
• Leg elevated resting on the tube
• Flex the knee 50-60 degrees
• Center ray 45 degrees
• Demonstrates the patellofemoral joint
• Demonstrates patellar subluxation and femoral condyles

Tangential Projection (Settegast Method)

• Prone positioning

Tangential Projection (Merchant Method)

• Also known as Mountain view
• Sitting or supine positions
• Flex knee 40 degrees
• Center ray 30 degrees from the horizontal
• Demonstrates the patellofemoral disorders
• Uses Axial viewer device.

PA Oblique (Medial and Lateral Rotation)

• Rotate the knee 45-55 degrees
• Demonstrates most of the patella free of superimposition

PA Oblique

• Demonstrates the lateral and medial aspects of the carpal bones
• Utilizes positioning to create an oblique angle with the X-ray beam
• Lateral side view: Trapezium and Scaphoid
• Medial side view: Entire pisiform, Triquetrum, and Hamate

Scaphoid Series (Rafert-Long Method)

• Ulnar deviation with four shots
• PA Axial (Stecher)
  • Cassette inclined
  • CR angulation 0-10-20-30 deg toward elbow
  • Clenched fist
  • Prevents self-superimposition

Carpal Canal - Gaynor-Hart

• Tangential projection (inferosuperior)
• Hyper-extend the wrist
• CR directed 25-30 deg along the long axis of the hand
• Demonstrates fractures of the hamate’s hamulus
• Rules out abnormal calcification in the carpal sulcus
• Detects carpal tunnel syndrome

Carpal Bridge Projection - Tangential

• Also known as the Lentino method
• Utilizes tangential projection, particularly useful for:
  • Fractures of the scaphoid
  • Lunate dislocation
  • Calcification and foreign bodies
  • Chip fractures in the dorsal aspect of carpals
• CR directed 45 deg caudally to the wrist

Clements Nakayama Method

• PA Oblique with Ulnar Flexion
• CR directed 45 degrees distally
• Demonstrates the trapezium and its articulations
• If ulnar flexion is impossible, deviate the long axis of the hand 20 degrees away from the CR's axis

Forearm Radiography

• Two standard views:
  • AP
  • Lateral
• True AP view superimposes the radial head, neck, and tuberosity over the ulna

Elbow Radiography

• Standard views:
  • AP
  • Lateral
  • AP Oblique (Medial Rotation)
  • AP Oblique (Lateral Rotation)
  • AP Partial Flexion (proximal forearm and distal humerus)
  • AP Acute Flexion/Jones method
  • Lateral (Lateromedial rot.) Radial Head
  • Coyle method (coronoid and radial head)

Shoulder Radiography

• AP
  • Lean laterally to reduce strain
  • True AP view superimposes the radial head, neck, and tuberosity over the ulna
• Lateral
  • Griswold technique: Elbow flexed at 90 degrees
    • Demonstrates the lateral epicondyles
    • Demonstrates the olecranon process
    • Demonstrates the fat pads, signifying soft tissue injury
• AP Oblique (Medial Rotation)
  • Hand pronated
  • Demonstrates the coronoid process and elbow joint
  • AP Neutral
  • Palm of the hand against the hip
  • Epicondylar plane is 45 degrees to the plane of the film
  • Greater tubercle partially superimposes the humeral head
• Coyle Method - Axial Lateromedial Projection
  • Hand rotated internally
  • Epicondyles perpendicular to the Image Receptor
  • Humerus placed in true lateral position
  • Demonstrates the lesser tuberosity
• Transthoracic Lateral Projection (Lawrence Method)
  • CR 1 inch inferior to coracoid process
  • External rotation: Demonstrates insertion site of the supraspinatus tendon
  • Neutral rotation: Profiles small calcific deposits
  • Internal rotation: Demonstrates insertion site of the subscapularis tendon

Shoulder - Inferosuperior Axial Projections

• Inferosuperior Axial / Lawrence - Patient supine - Arm abducted 90 degrees - Arm externally rotated - CR directed horizontally through the axilla to the AC joint at 15 degrees
  • Inferosuperior Axial Proj.(Rafert Mod)
    • Exaggerated external rotation
    • Thumb pointing downwards and posteroinferiorly at 45 degrees
    • Best view for Hill-Sachs lesions
    • CR directed medially

Shoulder - Additional Views

• Inferosuperior Axial Projection / West point
• Subacromial & subcoracoid dislocation
• Neer Method - Tangential Projection

Supraspinatus Outlet

• RAO/LAO
  • Affected side in contact with IR
  • Body rotated 45-60 degrees
  • CR 10-15 degrees caudally passing superior margin of humeral head
• SS: coracoacromial arch demonstrating the supraspinatus outlet region

Blacket-Healy Method

• Tangential projection (Fisk Method)
  • Standing
  • Elbow flexed
  • Cassette placed over the supinated forearm
  • Lean forward to place the humerus 10-15 degrees from vertical
  • CR is perpendicular to the head of the humerus
• Teres minor insertion (PA projection)
  • Prone
  • Elbow flexed
  • Forearm resting on back
  • CR perpendicular to the head of the humerus

Glenoid Cavity

• Subscapularis Insertion (AP projection)
  • Two exposures (without and with weights)
  • Equal weights (5-8 lbs)
  • Demonstrates dislocation/separation of joints

Glenoid Cavity - Axial Projection

• AP Oblique Proj.(Alexander Method)
  • Affected side in contact with IR
  • Body rotated 45-60 degrees
  • Arm across chest
  • CR directed 15 degrees superiorly to the coracoid process
• AP Axial Projection (Alexander Method)
  • 15 degrees superiorly to the coracoid process
  • AC joint projected superiorly

Clavicle and Collarbone Radiography

• Standard views include:
  • AP Projection
  • PA Projection
  • AP Axial (Tangential Projection)
  • PA Axial Projection
  • Tangential (Tarrant)

Clavicle - Additional Views

• AP Projection
  • Used to prevent additional injury
  • CR: Midshaft

Hand - PA Oblique

• Demonstrates lateral and medial carpal bones
• Lateral side includes the trapezium and scaphoid
• Medial side includes the entire pisiform, triquetrum, and hamate

Scaphoid series (Rafert-Long Method)

• Ulnar Deviation with four shots
• CR: 0, 10, 20 and 30 degrees towards the elbow
• Cassette is always inclined
• Clenched fist
• Used to prevent self-superimposition

Hand - PA Axial (Stecher)

• Clenched fist
• CR angulation
• Cassette inclined
• Used to prevent self-superimposition

Hand - Gaynor-Hart (Carpal Canal)

• Tangential projection (inferosuperior)
• Wrist is hyperextended
• 250-300 long axis of the hand
• Best view to demonstrate fx of the hamate’s hamulus
• Rule out abnormal calcification
• Carpal tunnel syndrome
• CR: 45 degrees caudally to the wrist

Hand - Tangential Projection (Carpal Bridge)

• Also known as the Lentino method
• Demonstrates fractures of the scaphoid
• Demonstrates lunate dislocation
• Demonstrates calcification and foreign bodies
• Demonstrates chip fractures in the dorsal aspect of the carpals

Hand - Clements Nakayama Method

• PA Oblique with Ulnar Flexion
• CR: 45 degrees distally
• Demonstrates trapezium and its articulations

Forearm (Antebrachium)

• Hand rotated internally
• Epicondyles are perpendicular to IR
• Humerus in true lateral
• Demonstrates lesser tuberosity
• Greater tubercle partially superimposes the humeral head
• Palm of the hand against the hip

Shoulder - AP Neutral

• Epicondylar plane is 45 degrees to the plane of the film
• CR: 1 inch inferior to the coracoid process, enter 1 inch inferior and medial to the coracoid process
• External rotation demonstrates insertion site of supraspinatus tendon
• Neutral rotation demonstrates the profile of small calcific deposits
• Internal rotation demonstrates insertion site of subscapularis tendon

Shoulder - Transthoracic Lateral Projection (Lawrence Method)

• Demonstrates the insertion site of the supraspinatus, infraspinatus and teres minor tendons
• Demonstrates the insertion site of the subscapularis tendon

Shoulder - Inferosuperior Axial (Lawrence Method)

• Supine
• Arm abducted 90 degrees
• Arm externally rotated
• CR: Horizontally through the axilla to the AC joint with 15 degrees cephalic angulation
• Best view to demonstrate a Hill-Sach lesion

Shoulder - Inferosuperior Axial Projection (Rafert Mod)

• Exaggerated external rotation, thumb pointing downwards and posteriorly 45 degrees
• CR is same as Lawrence Method with medial 15 degree angulation
• Best for Hill-Sach lesion

Shoulder - Inferosuperior Axial Projection (West Point)

• Supine
• Arm is slightly abducted
• Forearm is internally rotated
• Dorsum touches the hip
• CR perpendicular to the shoulder joint, entering the coracoid process

Shoulder - Grashey Method

• Rotate the patients body 35 to 45 degrees towards the affected side (when standing)
• Scapula parallel to the IR
• Abduct the arm slightly using internal rotation
• Palm of the hand is placed in the abdomen
• CR: Perpendicular to the shoulder joint, entering the coracoid process

Shoulder - AP Oblique Projection (Apple Method)

• Similar to the Grashey method
• Weighted abduction
• Demonstrates loss of articular cartilage in the shoulder joint

Shoulder - AP Axial Oblique (Garth Method)

• For acute shoulder trauma
• Demonstrates posterior dislocation of shoulder
• Demonstrates Hill-Sach defect
• Apical view
• Rotate body 45 degrees towards affected side
• Flex the elbow and place the arm across the chest
• CR: 45 degrees to the shoulder joint

AC Joint - Bilateral AP Projection (Pearson Method)

• Two exposures without weights and with weights
• Equal weights (5-8 pounds)
• Demonstrates dislocation or separation of AC joint
• Weights make shoulder muscle contract

AC Joint - AP Axial Projection (Alexander Method)

• 15 degrees cephalic to the coracoid process
• AC joint projected superiorly

AC Joint - PA Axial Oblique Projection (RAO/LAO) (Alexander Method)

• Affected side in contact
• Body rotated 45-60 degrees
• Arm across chest
• 15 degrees cephalic to the AC joint

Clavicle / Collar Bone

• AP projection
• PA projection
• AP Axial (Tangential Projection)
• PA Axial Projection
• Tangential (Tarrant)

Clavicle - AP Projection

• Used to prevent further injury
• CR: Midshaft of clavicle

Clavicle - PA Projection

• Flex the knee and position femur at a 45 degree angle
• CR perpendicular to leg or 10 degrees cephalic

Clavicle - PA Projection, Weight Bearing (Rosenberg)

• Used to assess stability of the clavicle with weight bearing

Intercondyloid Fossa

• PA Axial Projection (Camp-Coventry Method)
• Prone, knee flexed 40-50 degrees
• Demonstrates the knee joint space and loose bodies
• CR: Perpendicular to the long axis of the leg, entering the popliteal

Intercondyloid Fossa - PA Axial Projection (Holmblad method)

• Demonstrates the intercondyloid fossa
• Three positions with femur in contact with the table:
  • Standing, knee resting on a stool
  • Standing, knee on a vertically placed cassette
  • Kneeling
• Femur must be 70 degrees to the long axis of the leg
• CR: Perpendicular to the long axis of the leg, entering the popliteal fossa

Intercondyloid Fossa - AP Axial Projection (Beclere Method)

• Supine, IR under the popliteal
• Knee is flexed
• Femur forms 60 degrees to the long axis of the leg
• CR: Perpendicular to the long axis of the leg, entering the knee

Patella

• Knee cap
• Largest sesamoid bone.

Elbow Positioning

• AP
  • Lean the patient laterally for less strain
  • True AP makes the radial head, neck and tuberosity superimposed over the ulna
• Lateral
  • Griswold 90 degrees flexion
  • Lateral epicondyles
  • Demonstrates the olecranon process, fat pads

Elbow Positions

• AP Oblique (Medial Rotation)
  • Hand pronated
  • Demonstrates the coronoid process and elbow joint
• AP Oblique (Lateral Rotation)
  • Hand supinated
  • Demonstrates the radial head and elbow joint
• AP Partial Flexion
  • Demonstrates the proximal forearm and distal humerus
• AP Acute Flexion (Jones method)
  • Demonstrates the olecranon process in a true AP
• Lateral (Lateromedial Rot.) Radial Head
  • Demonstrates the radial head, coronoid process with minimal superimposition of the ulna
• Coyle Method
  • Axial lateromedial
  • Patient lies laterally on the unaffected side
  • Affected arm is abducted at 90 degrees pointing to the ceiling with the forearm horizontal and the CR 5-150 medially
  • Demonstrates the coronoid process and radial head

Additional Elbow Positions

• Inferosuperior Axial Projection
  • Patient prone with arm abducted at 90 degrees and hanging downwards pointing the CR 25 AM towards the elbow
  • Demonstrates the articulation of the proximal and distal humerus
• Superoinferior Axial Projection
  • Extend the shoulder and flex the elbow at 90 degrees
  • CR 5-150 towards the elbow
  • Demonstrates the relationship of the proximal end of the humerus and the glenoid cavity

Clavicle Positioning

• AP Projection
  • CR perpendicular to the midshaft
  • Demonstrates the entire clavicle with slight superimposition
• **AP Axial Projection “Stryker Notch Method” **
  • Patient in lordotic position
  • 0-15 degrees for upright and 15-30 degrees for supine
  • Flex and abduct the arm forwardly beyond 90 degrees and place the hand on top of the head
  • Demonstrates the exact axial image of the clavicle
  • Useful in identifying the cause of shoulder dislocation
• PA Axial Projection
  • Patient prone and 15-30 degrees to the supraclavicular region
  • CR 25-400 from horizontal
  • Demonstrates the entire clavicle
• Tangential Projection
  • Patient supine
  • IR is supported to stand slantedly touching the affected shoulder
  • CR passing between the clavicle and chest wall perpendicular to the IR
  • 25-400 from the horizontal
  • Add 15-250 laterally if the medial third is in question

Scapula Positioning

• AP Projection
  • Demonstrates the scapula
• Lateral Projection (RAO and LAO)
  • Affected side in contact with the IR
  • Heel rotated 5-100 laterally
  • Midpopliteal depression
  • Demonstrates the scapula
• PA Oblique Projection (RAO and LAO)
  • Demonstrates the scapula - Lorenz and Lilienfield method

Knee Positioning

• AP Projection
  • No rotation for distal femur
  • 10-150 internal rotation for proximal femur
  • Demonstrates the entire femur
• Lateral Projection
  • For distal femur, patient lateral with affected side on the IR and draw the unaffected thigh forward
  • For proximal femur, patient supine with body rotated towards affected side and pelvis adjusted 10-150 posteriorly to prevent superimposition
  • Flex affected knee 45 degrees
  • Demonstrates the femur
• PA Axial Oblique Projection (Kuchendorf Method)
  • Patient prone
  • Rotate the knee laterally so that the patella and medial condyle rest on the table (35-400)
  • Flex knee by 10 degrees
  • CR 25-300 patella
  • Demonstrates the patella without superimposition
• Tangential Projection (Hughston Method)
  • Patient prone
  • Leg elevated resting on the tube and knee flexed 50-60 degrees
  • CR 45 degrees
  • Demonstrates the patellofemoral joint
  • Demonstrates patellar subluxation and femoral condyles
• Tangential Projection (Merchant Method)
  • Patient sitting or supine
  • Flex knee 40 degrees
  • CR 30 degrees from horizontal
  • Demonstrates the patellofemoral joint
  • Demonstrates patellofemoral disorders
• Tangential Projection (Settegast Method)
  • Patient prone
  • Acute flexion (greater than 90 degrees)
  • CR perpendicular to the joint space and 15-20 degrees cephalad
  • Demonstrates vertical fractures
• Settegast Method (Inferosuperior)
  • Patient sitting or supine
  • Flex knee 40-45 degrees
  • CR 10-15 degrees from the lower leg
  • Demonstrates the patellofemoral joint

Pelvis Positioning

• AP Projection
  • Demonstrates the entire pelvis

Pelvis Shapes

• Android
• Gynecoid
• Platypelloid
• Anthrapoid
• Iliac crest:*
• Android: Wider flair
• Gynecoid: Narrower
• Coccyx:*
• Android: More straight
• Gynecoid: More curved
• Pubic arch:*
• Android: Greater than 90 degrees
• Gynecoid: Less than 90 degrees

Pelvis Measurements

• Iliopectineal line:
  • Male: 8.5-11.5 cm
  • Female: 8-10.5 cm
• Bischop's line:
  • Male: 6-8 cm
  • Female: 5.5-7 cm
• Baudelocque's diameter:
  • Male: 18-20 cm
  • Female: 18-19 cm
• Sacral promontory to symphysis pubis:
  • Male: 10-12 cm
  • Female: 10-11 cm
• Lateral diameter:
  • Male: 12-14 cm
  • Female: 10-13 cm
• True conjugate:
  • Male: 11-13 cm
  • Female: 11-12.5 cm
• Obstetric conjugate:
  • Male: 9-11 cm
  • Female: 9-11 cm
• Diagonal conjugate:
  • Male: 11.5-13 cm
  • Female: 11.5-13 cm

Test your knowledge on various knee imaging techniques including AP projection, PA projection, and lateral projection. This quiz covers the positioning, central ray directions, and specific angles necessary for effective imaging of the knee joint. Perfect for students in medical imaging or radiography courses.