Rad. Positioning 2

RADIOGRAPHIC.
POSITIONING 2
Ms. Cecilia J. Cardoso, RRT, MAEd
Instructor
RADIOGRAPHIC POSITIONING
Radiograph
- is a film or other base material
containing a processed image of an
anatomic part of a patient as produced by
action of x-rays on an IR.
X – ray Film
- specifically refers to physical piece of
material on which a radiographic
image is exposed.
IDENTIFICATION OF RADIOGRAPHS
> Date
> Patient’s age or date of birth
> Time of day
> Name of the rad. Tech or attending
physician
> Right or Left marker
> Position of the patient
Specific Marker placement rules:
1. PA or AP
2. Lateral Projections
3. Oblique
4. Decubitus
Pathologic Conditions That require

Decrease in Technical factors
A. Old age
B. Pneumothorax
C. Emaciation
D. Degenerative arthritis
E. Atrophy
Pathologic Conditions That require

Increase in
Technical Factors:
A. Pleural effusion
B. Hydrocephalus
C. Enlarged heart
D. Edema
E. Ascites
Pre Exposure Instructions
1. Inspiration (Inhalation)*
> depresses diaphragm and abdo.
Viscera
> Lengthens and expands the lung fields
> Elevates the sternum and pushes it ant.
> Elevate the ribs and reduces their
near the spine angle
2. Expiration (Exhalation)*
> Elevates the diaphragm and
abdo. Viscera
> Shortens the lung field
> Depresses the sternum
> Lowers the ribs and increases
their angle near the spine
Anatomical position – a common visual reference point
•A person in the
anatomical position is
standing erect with the
h e a d , e ye s a n d t o e s
pointing forward, feet
together with arms by
the side. The palms of
the hands are also
point forward
Terminology
A plane is a flat surface

passed through the
body or a portion of
the body
Body planes are
divided into:-
 Longitudinal planes
◦ Coronal
◦ Sagittal
 Horizontal plane
◦ Transverse
4 FUNDAMENTAL BODY PLANES
4 FUNDAMENTAL BODY PLANES
 SAGITTAL – divides the entire body or body part into right
or left segments.
 MIDSAGITTAL PLANE – a specific sagittal plane that

passes through the midline of the body and divides it into
right and left halves.
 CORONAL PLANE- divides the entire body or body part

into anterior and posterior segments.
 MID CORONAL PLANE- a specific coronal plane that

passes through the midline of the body, dividing it into
equal anterior and posterior halves (Mid Axillary Plane ).
OBLIQUE PLANE – pass through a body part at an angle
amount these planes.
CR for AP – passes
through the body
part parallel to SP
and perpendicular to
the coronal plane.
SPECIAL PLANES
• INTERILIAC PLANE – interacts the pelvis at
the top of the iliac crests at the level of 4th
lumbar spinous process.
• OCCLUSSAL PLANE – is formed by biting

surfaces of the upper and lower teeth with the
jaws closed.
-it is used in positioning the odontoid
process and some head projection.
Body Position Terms
Describe the overall placement of

the body in the desired position.
Erect "upright"
Position when the Sagittal and
coronal planes of the body are
perpendicular to the horizon
 Recumbent "lying down"

 Position when the transverse
plane of the body
 is perpendicular to the horizon
Recumbent Positions
 Supine
(posterior recumbent
position)
 Lying down on the back
 Prone
(anterior recumbent position)
 Lying face down
 xx lateral recumbent
 lying down on the xx side
Decubitus vs. Recumbent
 general meanings are the same "LYING
DOWN"
 but in radiography, decubitus has a special
meaning
 DECUBITUS
Erect Positions
 Surface of body closest to
the film used to give a
more specific description
 Examples:
Posterior erect -- patient
is standing with the
posterior surface of the
body next to the
cassette
Left lateral erect --
patient is standing with
the left side of the body
next to the cassette
Sim's Position
A near lateral Left anterior oblique ( Left
Sim's ) OR right anterior oblique with the
top leg in front the lower leg.
• Projection
Refers to the path the x-ray
beam takes through part
 Anteroposterior
projection (AP)
Beam enters the front
surface and exits the
back surface of the part
 Posteroanterior
projection (PA) Beam
enters the back and exits
the front of the part
Lateral Projections
 Torso (Trunk) and head
 Right to left lateral projection
 Left to right lateral projection
 Extremities (Limbs)
 Mediolateral projection
 Lateromedial projection
Note:
Normally the positioning Left lateral erect
terminology is position
used rather than projection. R to L lateral projection
X-ray beam
Special Projections
 Right to left lateral

projection
 Left to right lateral
AP axial with 40° caudal angle
projection
X-ray beam
X-ray beam
 Mediolateral projection
 Lateromedial projection
Note:
Normally the positioning
terminology is
used rather than
projection.
Directional Terms
Lateral Vs. Medial
Lateral
• Away from the midline
of the body (On the
outer side of) e.g. the
arms are lateral to the Lateral Medial
chest.
Medial
Near to the midline of the
body
(On the Inner side of) e.g.
the chest is medial to the
arms
Directional Terms
Superior (Vs
cephalic/
Inferiorcranial)
Superior
Towards the head end or

towards the upper part of
a structure( above)
e.g. The head is
Inferior (Caudal)
superior to the chest.
• Away from the head end or Inferior
towards the lower part of a
structure( Below) e.g. the
abdomen is inferior to the
chest.
Directional Terms
Anterior Vs. Posterior
Anterior ( ventral )
Towards or at front of the
body ( in front of)
e.g. The sternum is anterior
to the spine.
Posterior (Dorsal )
Towards or at the back of
the body ( Behind)
e.g. The heart is posterior
to the sternum.
Directional Terms
Proximal Vs. Distal
Proximal
Close to the origin of the body part or
the point of attachment of a limb to
the trunk
e.g. The knee is proximal to the
ankle.
Distal
Farther or away from the origin of the
body part or the attachment of a limb to
the trunk
e.g. The forearm is distal to the arm
Directional Terms
Superficial Vs. Deep
Superficial
Towards or at the body surface
e.g. The skin is superficial to the skeletal
muscles
Deep
Away from the body surface ( more internal)
e.g. The skeletal muscles are deep to the skin
anterior posterior lateral
cephalic
superior
cranial
posterior
anterior
lateral proximal
inferior
caudal medial
distal
1
1
Abduction vs. Adduction
Abduction :
movement away from
the midline of the body
or body part.
Adduction :
Movement toward the
midline of the body or
body part.
12
Flexion vs. Extension
Flexion :
Decrease in the angle of
a joint by bending
Extension:
Increase in the angle of
joint or straightening of a
joint
Note : Hyper flexion is over flexion while hyper 13

extension is extension beyond normal limits
Inversion vs. Eversion
Inversion :
Turning of foot
inward at the ankle
joint.
Eversion:
Turning of the foot
outward at the
ankle joint. 14
Pronation vs. Supination
Pronation :
Turning the hand
so that the palm is
down or onto one's
stomach
Supination:
Turning the hand
so the palm is facing
upward or turning 1
onto one's back. 5
Source to Image Receptor Distance (SID)
Ø is the distance from the anode inside the x-ray tube to the
IR SID is an important technical consideration in the
production of radiographs of optimal quality.
Ø This distance is a critical component of each radiograph

because it directly affects magnification of the body part
and the recorded detail.
Ø The greater the SID, the less the body part is magnified
and the greater the recorded detail will be.
Ø A SID of 40 inches ( 102 cm) traditionally has been used

for most conventional examinations
v In recent years, however, the SID has increased to
48 inches (122 cm) in some departments.
vTechnically, a greater SID requires a longer
exposure time because the x-ray tube is farther
from the IR. This could prompt motion on the image.
vHowever, with the use of faster film-screen
systems and the flexibility of technical factors when
using CR systems, short exposure times are
commonplace with SIDs up to 48 inches ( 1 22 cm).
v A SID must be established for each radiographic
projection, and it also must be indicated on the
technique chart.
üFor sorne radiographic projections an SID
less than 40 inches ( 102 cm) is desirable.\
üFor example, in certain skull examinations

such as that of the paranasal sinuses, a
short SID of 32 to 36 inches (81 to 91 cm)
is used to magnify the opposite side of the
skull, thereby prompting an increase in the
recorded detail of the side being examined.
q Conversely, a longer than standard SID is used
for some radiographic projections. In chest
radiography a 72-inch
(183-cm) SID is the minimum distance, and in
many departments a distance up to 120 inches
(305 cm) is used.
qThese long distances are necessary to ensure

that the lungs fit onto the 35-cm width of the lR
(via reduced magnification of the body part) and,
most importantly, to ensure that the heart is not
technically enlarged for diagnoses of cardiac
enlargement.
Involuntary muscle control
•The primary method of reducing
involuntary motion is to control the
length of exposure time-the Iess
exposure time to the patient, the better.
VOLUNTARY MUSCLES
• The voluntary, or skeletal, muscles are composed
of striated muscular tissue and are controlled by
the central nervous system.
• These muscles perform the movements of the
body initiated by the individual. In radiography the
patient's body must be positioned in such a way
that the skeletal muscles are relaxed. The
patient's comfort level is a good guide to
determine the success of the position.
• Voluntary motion resulting from lack of control is caused
by the following
• : • Nervousness
• •Discomfort
• • Excitability
• • Mental illness
• • Fear
• • Age
• • Breathing Voluntary muscle control
• The radiographer can control voluntary
patient motion by the following:
• • Giving clear instructions
• • Providing patient comfort
• • Adjusting support devices
• • Applying immobilization
• Decreasing the length of exposure time is
the best way to control voluntary motion
that results from mental illness or the age
of the patient.
• Immobilization for limb radiography can
often be obtained for the duration of the
exposure by having the patient phonate an
mmm sound with the mouth closed or an
ahhh sound with the mouth open.
• The radiographer should
always be watching the
patient during the exposure
to ensure that the exposure
is made during suspended
respiration. Sponges and
sandbags are commonly
used as immobilization
devices
Patient Instructions
• When an examination requires preparation such
as in kidney and gastrointestinal examinations,
the radiographer must carefully instruct the
patient
• The radiographer must be sure that the patient
understands not only what to do but also why it
has to be done. A patient is more likely to follow
instruction correctly if the reason for the
inst ruct ions is clear. I f t he inst ru c t i o n a re
complicated, they should be written out and
verbally reviewed with the patient if necessary.
Specific marker placement rules
• Basic marker conventions include the following:
• • The marker should never obscure anatomy
• • The marker should never be placed over the
patient's identification information
• • The marker should always be placed on the
edge of the collimation border
• • The marker should always be placed outside of
any lead shielding
• 1. For AP and PA projections that include both the R and L
sides of the body (head, spine, chest, abdomen, and
pelvis), a R marker is typically used.
• 2. For lateral projections of the head and trunk (head,
spine, chest, abdomen, and pelvis), always mark the side
closest to the IR. For example, if the left side is closest
use a L marker. The marker is typically placed anterior to
the anatomy.
• 3. For oblique projections that include both the R and L
sides of the body (spine, chest, and abdomen) the side
down, or nearest the IR is typically marked. For example,
for a right posterior oblique (RPO) position, mark the R
side.
• 4. For limb projections, use the appropriate R or L
marker. The marker must be placed within the
edge of the collimated x-ray beam.
• 5. For limb prOjections that are done with two
images on one IR. only one of the prOjections
needs to be marked.
• 6. For limb projections where both the R and L
sides are imaged side-by-side on one IR (e.g., R
and L AP knees), both the R and L markers must
be used to clearly identify the two sides
• . 7. For AP. PA or oblique chest projections, the
marker is placed on the upperouter corner so the
thoracic anatomy is not obscured.
• 8. For decubitus positions of the chest and
abdomen, the R or L marker should always be
placed on the side up (oppOSite the side laid on)
and away from the anatomy of interest.
• NOTE: No matter which projection is performed,
and no matter what position the patient is in, if a
R marker is used it must be placed on the "right"
side of the patient's body. If a L marker is used is
must be placed on the "left” side of the patient's
body.
Diagnosis and the Radiographer
• A patient is naturally anxious about examination results
and will ask questions.
• The radiographer should tactfully advise the patient that

the referring physician will receive the report as soon as
the radiographs have been interpreted by the radiologist.
• Referring physicians may also ask the radiographer

questions, and they should be instructed to contact the
interpreting radiologist.
Care of the Radiographic Examining
Room
• The radiographic examining room should be as
scrupulously clean as any other room used for medical
purposes.
• The mechanical parts of the x-ray machine such as the
tableside and the supporting structure and the collimator
should be wiped with a clean, damp (not soaked) cloth
every day.
• The metal part of the machine should be periodically
cleaned with a disinfectant. The overhead system, x-ray
tube, and other parts that conduct electricity should be
cleaned with alcohol or a clean, dry cloth. Water is never
used to clean electrical parts.
• The tabletop should be cleaned after
each examination. Cones, collimators,
com pre ion devices, gonad shields,
and other accessories should be
cleaned daily and after any contact
with a patient.
• Adhesive tape residue left on
cassettes and cassette stands should
be removed and the cassette
disinfected.
• Cassettes should be protected from
patients who are bleeding, and disposable
protective covers should be manipulated so
that they do not come in contact with ulcers
or other discharging lesions.
• Use of stained or damaged cassettes is
inexcusable and does not represent a
professional atmosphere.
• The radiographic room should be prepared for the
examination before the patient arrives. The room
should look clean and organized-not disarranged
from the previous examination.
• Fresh linen should be put on the table and pillow,
and accessories needed during the examination
should be placed nearby.
• Performing these pre examination steps requires
only a few minutes but creates a positive, lasting
i m p r e s s i o n o n t h e p a t i e n t ; h o w e v e r, n o t
performing these steps beforehand leaves a
negative impression.
TOPOGRAPHY
A. CERVICAL REGION
1. C1 – mastoid tip
2. C2, C3 – gonion
3. C5 – thyroid cartilage
4. C7 – vertebra prominens
B. THORACIC REGION
1. T1 – 2” above the sternal notch
2. T2, T3 – level of manubrial notch and
margin of scapula
3. T4, T5 – level of sternal angle
4. T7 – level of inferior angle of scapula
5. T10 – level of xyphoid tip
C. LUMBAR REGION
1. L3 – lower costal margin

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

1. S1 – level of ASIS
2. Coccyx – level of pubic symphesis and
greater trochanter
VERTEBRAL COLUMN
- consists of 33 bones in early life
1. Cervical - 7
2. Thoracic - 12
3. Lumbar - 5
4. Sacral - 5
5. Coccygeal - 4
Spinal Curvatures
1. LORDOTIC
- Cervical
- Lumbar
* Secondary or compensatory curve
2.KYPHOTIC
- Thoracic
- Sacral
* Primary curve
Abnormal Curvatures
1. Lordosis
- lumbar curvatures is exaggerated
- swayback
- increase in anterior convexity or
posterior concavity
2. Kyphosis
- thoracic curvatures is exaggerated
- humpback / hunchback
- increased in anterior concavity or
posterior convexity
3. Scoliosis
- lateral curvature
- S-Shaped
FRACTURES
1. Clay shoveler’s fracture - C6 - T1
2. Compression fracture - lumbar region associated with
osteoporosis
3. Hangman’s - C2 and C3
4. Odontoid fracture - C2
5. Teardrop burst fracture - Compression with flexion in
cervical region
6. Jefferson’s fractures – fracture of the lateral masses of
C1
ATLAS (C1)
- atypical vert.
- thick arch called anterior arch
- has posterior arch
- articulation between C1 and occiput
condyles
* Atlantooccipital articulation
Axis (C2) dens odontoid process
Procedures:
1. AP Projection (Open Mouth)
2. PA Projection (Judd Method)
3. AP Axial Oblique Projection
(Kasabach Method) R or L head
Rotation)
4. AP Projection (Fuchs Method)
C1 AND C2
1. AP Projection (Open Mouth)
- MSP perpendicular
- lower edge of upper incisor is at level of
mastoid tip
* Dens, vert. body of C2, lat. Masses of C1,
Zygapophyseal jts.
2. PA Projection (Judd Method)

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

L head Rotations
- rotate the head away 40–450
- IOML perpendicular
- 10–150
4. AP Fuchs method
- chin and mastoid process same level
- distal to the tip of the chin
Cervical Spine
Procedures:
1. AP Axial Projection
2. Lateral Projection (Grandy Method)
3. Lateral Projection (Hyperflexion &
Hyperextension
4. AP Axial Oblique Projection (RAO and
LPO Position)
5. PA Axial Oblique Projection (RAO and

LAO Positions)
6. AP Projection (Otonello Method)
7. Lateral Projection (Twinning Method or
Swimmer’s View or Pawlow Method)
1. AP Axial Projection
- extend the neck so that the occlussal plane is
perpendicular
- RP thyroid cart. / C4
- CR 15–200
Purpose
- Presence & Absence of cervical ribs
- IV spaces / interpedicute spaces
- C3 T2 or T3 vert. bodies
- Degenerative Disease
2. Lateral Projection (Grandy Method)

- Subluxation
- IV joints, articular pillars, spinous process,
zygapophyseal joint
- 72 SID
3.Lateral Projection (Hyperflexion /

Hypertension)
- functional studies of CV
- Absence of movements resulting from
trauma
- Range of motion of the cervical vertebrae
- Whiplash Injury
* caused by sudden forced movements
in one direction (automobile impact)
4. AP Axial Oblique Projection (RPO / LPO Position)
- rotate the body 450
- farthest IVF are better demons.
- 15–200
5. PA Axial Oblique Projection (LAO / RAO Positions)
- closest IVF and pedicles are demons.
- 15–200
6. AP Projection (Ottonello Method or Chewing or
Wagging Jaw)
- continuous motion
7. Lateral Projection (Twinning, Swimmer’s/ Pawlow

Method)
- demons. cervicothoracic region
- 5–150 caudally
- rotate 50–100
Thoracic Vertebrea
Procedures:
1. AP Projection
2. Lateral Projection
3. AP Oblique Projection (RAO and
LAO Positions)
1. AP Projection
-1½ - 2” above the shoulder
- 2.5 cm./1” below the manubrial notch (3-4”
below”)
- Suspended respiration
- IV spaces, spinous and transverse process,
post-rib, costovertebral articulation
– IVS, foramina, vertebral bodies
* the most metabolic bone disorder
noted in T-S is osteoporosis
3. AP Oblique Projection (RAO and LAO

Position)
- demons. Zygapophyseal joints,
mediastenal structures
- Cervico thoracic spinous processes
Superior Articular Process

Pedicle
Transverse Process
Pars Interarticularis
Inferior Articular Process
Lamina
LUMBAR VERTEBRAE
Procedures:
1. AP Projection
3. AP Oblique Projection (RPO and
LPO Positions)
1. AP Projection
- perpedicular to the I.C
- intervertebral foramina
3. AP Oblique Projection (RPO and LPO

Positions)
- demons. the Scotty dog signs
- pars intercularis
* if L1 and L2 = at least 500
* if L5 and S1 = only 300
- body rotated by 45 deg.
SACRUM
Procedures :
1. AP Projection
1. AP Projection
- 5 cm. / 2” superior to the SP
- 150
- level of the ASIS
COCCYX
Procedures:
1. AP Projection
1. AP Projection
-10-150
- 2” above the SP
2. Lateral
- midway between the PSIS and
sacroccygeal junction
-
STERNUM / BREAST BONE
Procedures:
1. PA Oblique Projection (RAO)
3. PA Oblique Projection (Moore Method)
1. PA Oblique
- rotate the body 15-200
- R.P. 7.5-10 cm / 3-4” lateral to the spine
- shallow breathing
2. Lateral
- Sternal angle (R.P.)
- deep inspiration
- moves the sternum anterior to the ribs
- 150-180 cm / 5-6 ft. / 72 inches
3. PA Oblique Projection (Moore Method)

- bend at the waist, placed the sternum in the
center of the table
- arms above the shoulders
- 250 to the IR
STERNOCLAVICULAR JOINT
Procedures:
1. PA
2. PA Oblique
3. Lateral / Kurzbauer method
1. PA
- erect
- R.P. manubrium sterni
- demonstrate subluxation of SCJ or
pathology of the medial end of the Clavicle
2. PA Oblique Projection (Body Rotation Method) RAO /

LAO
- rotate the body 10-150
- RP T2-T3
3. Lateral / Kurzbauer
- R.P. sternoclavicular joint
- SID 100 cm (5-6ft.) 40 ”
- 150 caudally
RIB CAGE
A. Above the diaphragm

- deep inspiration
* which depresses diaphragm to its
lowest position
- R1 to R10
B. Below the diaphragm

- expiration
* to rise to the level of the 7th or 8th
posterior ribs
- R8 to R12
- body rotated by 450
* to demons. axillary ribs
SCOLIOSIS
Procedures:
1. PA or AP Upright (Ferguson Method)
2. PA or AP with Right and Left Bending
3. Lateral Upright (with or without bending)
4. Lateral Projection (R or L Pos.)
(Hyperflexion and Hyperextension)
1. PA or AP Upright (Ferguson Method)

- lower margin of cassette 1-2” below the iliac
crest
- demons. Degree of curvature
2. PA or AP with Right and Left Bending

- to determine the range of motion


- side of convexity against the film
- lower margin of the cassette is 1-2” below
the iliac crest
- demons. the degree of curvature,
spondylolisthesis or degree of kyphosis or
lordosis
Hyperflexion
- fetal position or bend backward
- level of coastal margin
- determine anterior mobility at the fusion site
or limited motion at the site of the lesion
Hyperextension
- lean the thorax backward and posteriorly
- level of coastal margin
- determine anterior mobility at the fusion site
or limited motion at the site of the lesion
CHEST
Chest Tele
- 72”
- to demons. pulmonary patho. & cardiac size /
shadows
Lungs
- has 3 lobes right
- has 2 lobes left
Pneumothorax
- air or gas pressure in the pleural cavity
Hemothorax
- Accumulation of fluid in the pleural cavity
PARTS of the Lungs

1. Apex
- rounded upper area above the level of the
clavicles
2. Carina
- point of bifurcation
- the lowest margin of the separation of the
trachea into the right & left bronchi
3. Base
- lower concave area of each lung that rests
on the diaphragm
4. Costophrenic angle
- extreme outermost lower corner of each
lung, where the diaphragm meets the ribs
5. Hilum
- Central area of the lungs
CHEST X-RAY
- to demons. Pulmonary patho. & cardiac size and
shadows (Pleural effusions, pneumothorax, atelectasis
and sign of infection)
- Chest teleo 72”
Procedures:
1. PA
2. Lateral
3. RAO or LAO
4. RPO
5. Apico-Lordotic / Lindblom Method
1. PA
- RP at the end of 2nd full inspiration
* to ensure maximum expansion of the lungs
- The lungs will expand:
* Transversely
* Anteriorly
* Vertically
- being the greatest dimension
2. LATERAL
- Left lateral
* to show the heart and left lung
- MSP is parallel
- T7
- lower lobe extends above the level of the
hilum posterioly
- Left Lateral demonstrate the:

* Heart
* Aorta
* Left sided pulmonary lessions
interlobar fissures
- Right lung is 1” shorter than the left lung

* because of the large space occupying liver
located in the right upper abdomen
3. RAO / LAO
- rotate the patient so that the MSP is at 450
- demons. the anterior portion of the right lung,
trachea, left branch of the bronchial tree.
- the best proj. demons. the left atrium
anterior portion of the apex of the left ventricle and right
retrocardiac space
LAO
* ant. Portion of the left lung
* trachea and its bifurcation (the carina)
* right branch of the bronchial tree
- to demons. of the pulmonary disease body
rotated 100-120
* lower lobe
- for standard oblique rotate the body 45-600
4. RPO
- if the px. is to ill
- body rotated 450
5. Apico-Lordotic / Lindblom Method

- demons. Lung apices & sub apical areas
- anterior mediastinum
- interlobar effussions
- 50 towards the head
SKULL RADIOGRAPHY
(8) Cranial Bones
• Key Points
• Pterion, Asterion, Stephanion & Obelion
(14) Facial Bones
MNEMONICS
• Zorro (2) Zygomatic
Bone
• Likes (2) Lacrimal
Bone
• Pricking (2) Palatine
Bone
• My (2) Maxillary
Bone
• Minty (1) Mandible
• Vaginal (1) Vomer
• Nerve (2)
Nasal Bone
• Inside (2) Inferior Nasal
Conchae
Surface Landmarks & Positioning Lines
Skull Morphology
Positioning Considerations
• Erect vs Recumbent
• Patient Comfort
• Hygiene
• Technical Factors
• SID
• Radiation Protection
Five Common Positioning Error
• 1. Rotation
• 2. Tilt
• 3. Excessive Flexion
• 4. Excessive Extension
• 5. Incorrect CR Angle
CRANIUM PROJECTIONS
AP Projection & AP Axial Projection
LATERAL PROJECTION
AP AXIAL PROJECTION:
TOWNE METHOD
PA/PA AXIAL PROJECTION:
15deg (Caldwell) or 25 to 30 deg
SMV PROJECTION
VERTICOSUBMENTO PROJECTION
PA AXIAL ROJECTION: HAAS METHOD
VALDINI METHOD
• Excellent frontal projection of the organs of hearing.
• Head rested on the upper frontal region
• Head require an acutely flexed
• MSP perpendicular
• IOML 50° for the auditory canals and the labyrinths
of the ears
• CR perpendicular 0.5 cm distal to nasion
• OML 50°for the auditory canals and the tympanic
cavities, and the bony part of the Eustachian tubes
• CR perpendicular to the foramen magnum
SELLA TURCICA
PROJECTIONS
1. LATERAL PROJECTIONS
2. AP AXIAL (TOWNES
METHOD)
3. PA AXIAL
(HAAS METHOD)
ORBITS
RHESE METHOD-
PARIETO-ORBITAL PROJECTION
SOM
LOM MOM
OPTIC CANAL & FORAMINA
SPHENOID RIDGE
IOM
RHESE METHOD-
ORBITO-PARIETAL
OPTIC FORAMEN
-PA AXIAL PROJECTION-
Superior Orbital Fissure
LWS
GWS
SOF
PETROUS RIDGE
OPTIC FORAMEN - PA AXIAL
–BERTEL METHOD
Inferior Orbital Fissure
SOM
STYLOID PROCESS
IOF
LATERAL PTERYGOID
NASAL CAVITY LAMINA
MANDIBULAR RAMUS
THE EYE
Orbital Foreign Bodies Localization
•1. Lateral Projection

•2. PA Projection
•3. Water’s Projection
VOGT BONE-FREE PROJECTIONS
lVOGT bone free projections are taken to detect small

or low density foreign particles located in the anterior
segment of the eyeball or in the eyelid.
lMade on standard periapical or occlusal size dental
film.
lEye instructions:
lBone free- eyes looking straight forward
lVertical movement projection 1st looking upward and
2nd looking downward
lHorizontal movement projection 1st looking to right
and 2nd looking to left side
PARALLAX MOTION METHOD
lDetermining whether a foreign body is located within

the eyeball.
lRichards describes consists of making 2 lateral
exposures and 2 PA exposures with the eyeball in
different positions.
lAnteriorly and posteriorly intraocular foreign bodies
move with the eyeball
lCentrally intraocular foreign bodies do not change
position.
lForeign bodies lodged in extrinsic muscles also move
with the eye.
Orbital Foreign Bodies Localization SWEET
METHOD
lThis method of orbital foreign body location

determines the exact location of a foreign body by the
use of geometric calculation.
lRequires a device that contains 2 markers of known
position and relationship, from which measurements
can be made.
lThe apparatus designed comprises of:
l1. Localizer device
l2. 8 x 10 film tunnel of the pedestal type
lThe localizer consists of a small heavy based metal
stand on which is mounted vertically adjustable arm
bearing the essential parts of the device.
PFEIFER-COMBERG METHOD
• A leaded contact lens is placed directly over

the cornea, and intraorbital and intraocular FB
is then localized in relation to the limbus and
the corneoscleral junction.
• The apparatus designed comprises:
• Contact lens localization device
• Pedestal type of film holder
• T h e c o n ta c t l e n s e m b e d d e d a r o u n d t h e
periphery 4 lead markers sp aced at 90°
intervals.
SUMMARY
lVOGT BONE FREE - to detect small or low density
foreign particles located in the anterior segment of
the eyeball or in the eyelid.
lPARALLAX MOTION METHOD - Determining whether
a foreign body is located within the eyeball.
lSWEET METHOD - determines the exact location of a
foreign body by the use of geometric calculation.
lPFEIFER-COMBERG METHOD - A leaded contact lens
is placed directly over the cornea.
FACIAL BONES
PROJECTIONS
1. LATERAL PROJECTION
2. PARIETOACANTHIAL
(WATERS PROJECTION)
3. CALDWELL METHOD
PARIETOACANTHIAL
(WATERS PROJECTION)
Modified Waters Projection
Reverse Water’s Projection
NASAL BONE
PROJECTIONS
1. CALDWELL METHOD
2. WATERS METHOD
3. STL NOSE
4. SUPEROINFERIOR
PROJECTION / TANGENTIAL
PROJECTION
SUPEROINFERIOR PROJECTION / TANGENTIAL
PROJECTION
ZYGOMATIC ARCHES
PROJECTIONS
1.SMV/VSM
2.Townes View
3.Tangential Projection
4.May Method
Tangential Projection
TANGENTIAL PROJECTION – MAY METHOD
MANDIBLE
PROJECTIONS
1. Townes View
2. PA or PA Axial (20-25
cephalad)
3. AP Projection
4. SMV
5. Axiolateral Oblique Projection
6. Panoramic Xray
Axiolateral Oblique Projection
Head in True Lateral 30 degrees rotation 45 degrees rotation

- For mandibular ramus - For mandibular body - For mandibular
symphysis
TEMPOROMANDIBULAR JOINTS
PROJECTIONS
1. Townes View
2. Axiolateral Projections
3. TEMPOROMANDIBULAR
JOINTS- AXIOLATERAL
TRANSCRANIAL
(SHULLER) PROJECTION
4. TMJ-Albers Schonberg Method-
Lateral Transfacial Projection
Axiolateral Projection
CLOSED MOUTH OPEN MOUTH
TEMPOROMANDIBULAR JOINTS- AXIOLATERAL
TRANSCRANIAL
(SHULLER) PROJECTION
• Patient supine or seated

• IPL Perpendicular to IR
• IR is centered to TMJ
• CR 25-30 degrees caudad
• Open and closed mouth.
TMJ-Albers Schonberg Method-
Lateral Transfacial Projection
• Semiprone position
• TMJ centered to cassette
• MSP parallel, IPL perpendicular
• CR 20° cranially
• RP through the lower TMJ
• SS. Lateral of TMJ in open and close mouth
position
PROJECTIONS
2. Caldwell Method
3. Water’s View/Method
4. Water’s Open Mouth
5. SMV
6. PA Projection
MASTOID PROJECTIONS
MASTOID SUMMARY
• Nose & Forehead
intact with the IR
• OML perpendicular
with IR
• 25 degrees cephalad
exiting the nasion
• For visualization of jugular foramina
• SMV Position, OML parallel with the IR, 20 degrees
posterior angle to the mandibular symphysis
• Also for jugular foramina
• Like doing a Kemp – Harper Method but the OML should
be 25 degrees from the plane of the IR.
• For visualizing the
hypoglossal canal (12th
cranial nerve)
• 45 degree rotation of the
head, IOML parallel with
the transverse axis of the
IR
• 12 degrees caudad with
“ah - h – h” phonation
during exposure
• Linear skull fractures are
breaks in the bone that
transverse the full thickness of
the skull from the outer to
inner table.
• They are usually fairly straight
with no bone displacement.
• The common cause of injury is
blunt force trauma where the
impact energy transferred over
a wide area of the skull.
• A depressed skull fracture is a
type of fracture usually
resulting from blunt force
trauma, such as getting struck
with a hammer, rock or getting
kicked in the head.
• Depressed skull fractures may
require surgery to lift the
bones off the brain if they are
pressing on it by making burr
holes on the adjacent normal
skull
Diastatic fracture
• Diastatic fractures occur
when the fracture line
transverses one or more
sutures of the skull causing
a widening of the suture.
• This type of fracture is
usually seen in infants and
young children as the
sutures are not yet fused it
can also occur in adults.
• Linear fractures that
occur in the floor of the
cranial vault (skull base),
which require more force
to cause than other
areas of the
neurocranium.
• They are rare, occurring
as the only fracture in
only 4% of severe head
injury patients.
• is a fracture of one
or more of the
bones surrounding
the eye and is
commonly referred
to as an orbital
floor fracture.
• Contrecoup - Fracture to one side
of a structure caused by trauma to
the other side
• Tripod - Fracture of the zygomatic
arch and orbital floor or rim and
dislocation of the frontozygomatic
suture
- Frontal and Anterior Ethmoidal Sinuses
- PA Axial Projection/ Caldwell Method
- Maxillary Sinuses
Parietoacanthial Projection/ Waters Method
- Maxillary and Ethmoidal Sinuses

Parietoacanthial Transoral Projection/
Open Mouth Waters Method
THANK YOU
and
GOD BLESS!!!

Rad. Positioning 2

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What are the different types of skull fractures mentioned?

What are the different types of skull fractures mentioned?

What are the different planes used to divide the body?

What are the different planes used to divide the body?

RADIOGRAPHIC.

Specific Marker placement rules:

Pathologic Conditions That require

Pathologic Conditions That require

Pre Exposure Instructions

A plane is a flat surface

 MIDSAGITTAL PLANE – a specific sagittal plane that

 CORONAL PLANE- divides the entire body or body part

 MID CORONAL PLANE- a specific coronal plane that

• OCCLUSSAL PLANE – is formed by biting

Describe the overall placement of

 Recumbent "lying down"

 Right to left lateral

Towards the head end or

Note : Hyper flexion is over flexion while hyper 13

Ø This distance is a critical component of each radiograph

Ø A SID of 40 inches ( 102 cm) traditionally has been used

üFor example, in certain skull examinations

qThese long distances are necessary to ensure

• The radiographer should tactfully advise the patient that

• Referring physicians may also ask the radiographer

1. L3 – lower costal margin

D. SACRUM and PELVIC REGION

2. PA Projection (Judd Method)

3. AP Axial Oblique Projection (Kasabach Method) R or

5. PA Axial Oblique Projection (RAO and

2. Lateral Projection (Grandy Method)

3.Lateral Projection (Hyperflexion /

7. Lateral Projection (Twinning, Swimmer’s/ Pawlow

3. AP Oblique Projection (RAO and LAO

Superior Articular Process

3. AP Oblique Projection (RPO and LPO

STERNUM / BREAST BONE

3. PA Oblique Projection (Moore Method)

2. PA Oblique Projection (Body Rotation Method) RAO /

A. Above the diaphragm

B. Below the diaphragm

1. PA or AP Upright (Ferguson Method)

2. PA or AP with Right and Left Bending

3. Lateral Upright (with or without bending)

3. Lateral Upright (with or without bending)

PARTS of the Lungs

- Left Lateral demonstrate the:

- Right lung is 1” shorter than the left lung

5. Apico-Lordotic / Lindblom Method

•1. Lateral Projection

lVOGT bone free projections are taken to detect small

lDetermining whether a foreign body is located within

lThis method of orbital foreign body location

• A leaded contact lens is placed directly over

Head in True Lateral 30 degrees rotation 45 degrees rotation

• Patient supine or seated

- Maxillary and Ethmoidal Sinuses

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