Anatomy

Projection

Positioning

Centering

Angle

Proximal
Femur

AP

1. Place patient supine, arms across their

chest
2. Rotate affected leg internally 15o to
place femoral neck in profile

Perpendicular

Mediolateral
lateral

1. Patient supine first, ask patient to move

to far side of table
2. Ask patient to roll slightly towards
affected leg & place a sponge behind
them
3. Unaffected leg straight, bend affect leg
1. Patient supine, affected leg furthest
away from x-ray tube
2. Place cassette & grid in the crease
above the iliac crest at 45o
3. Place the x-ray tube perpendicular to
the cassette
4. Ask patient to flex the unaffected leg
and elevate until 90o and support with
chair
1. Patient supine, arms across their chest
2. Rotate affected leg slightly internally to
place patella in true AP

Collimate to 35
x43cm, place ASIS
at the top of
cassette/ Center
2.5cm below pubic
symphysis/greater
trochanter
Collimate to 35
x43cm, place ASIS
at the top of
cassette

Horizontal
beam
axiolateral

Distal
Femur

AP

Mediolateral
lateral

1. Patient supine first, ask patient to move

to far side of table
2. Ask patient to roll slightly towards
affected leg & place a sponge behind
them
3. Unaffected leg straight, bend affect leg

Perpendicular

Exposure
Factors
Grid
70kVp,
25mAs

Grid
75kVp,
20mAs

Center at the
Perpendicular
crease of leg
between inside top
of leg and pelvis
(inguinal crease)

Grid
80-120kVp,
64-80mAs

Place bottom of
cassette 5cm
below knee joint

Perpendicular

Place bottom of
cassette 5cm
below knee joint

Perpendicular

Grid: 66kVp,
20-25mAs
Non-grid:
60kVp, 1620mAs
Grid: 66kVp,
20-25mAs
Non-grid:
60kVp, 1620mAs

Pelvis

Horizontal
beam lateral

1. Patient supine, place affected leg closest Place bottom of

to x-ray tube
cassette 5cm
2. Place cassette against medial side of leg below knee joint

Perpendicular

AP

1. Patient supine, arms across chest, legs

extended
2. Patient to separate heels 20cm and
rotate legs internally until big toes touch

Perpendicular

Pelvic Inlet

1. Patient supine, legs extended, arms

across chest
1. Patient supine, legs extended, arms
across chest

Center midway
between the ASIS
and superior
border of the
symphysis pubis
Collimate to 35
x43cm cassette
and place the top
of the iliac crest at
the top of
collimation
Center at the ASIS
Center 5cm below
greater trochanter

Angle 30o
cephalad for
male
Angle 40o
cephalad for
female
Perpendicular

Pelvic Outlet

Hip

Unilateral AP

1. Patient supine, arms across chest, leg

extended
2. Patient to internally rotate affected leg
15o

Lateral Oblique
(same as
mediolateral
lateral of
proximal
femur)

1. Patient supine first, ask patient to move

to far side of table
2. Ask patient to roll slightly towards
affected leg & place a sponge behind
them
3. Unaffected leg straight, bend affect leg

Find the ASIS and

the pubic
symphysis, find
the point midway
and center 2.5cm
below this point
Place ASIS at the
top of cassette or
center at the
inguinal crease

Angle 40o caudal

Perpendicular

Grid: 66kVp,
20-25mAs
Non-grid:
60kVp, 1620mAs
Grid
66-70kVp,
25-32mAs

Grid: 70kVp,
16mAs
Grid: 70kVp,
16mAs

Grid
66-70kVp,
25-32mAs

Grid
75kVp,
20mAs

Judets
downside
(anterior rim)
Judets upside
(posterior rim)
Sacroiliac AP Axial SI
Joints
joints

1. Patient supine, patient to roll towards

their affected side and place sponge
behind patients back
2. Ask patient to roll back onto the sponge
1. Patient supine, patient to roll towards
their unaffected side and place sponge
behind patients back
2. Ask patient to roll back onto the sponge
1. Patient supine, legs extended, arms
across chest

Posterior
Oblique

1. Patient supine, arms across their chest

2. Elevate patient with affected side up 2530o with sponge

Sacrum

AP (Axial)

1. Patient supine, arms across their chest,

legs extended
2. Patient to hold their breath

Coccyx

AP (Axial)

1. Patient supine, arms across their chest,

legs extended
2. Patient to hold their breath

Sacrum
& Coccyx

Lateral
(Sacrum &
Coccyx)

1. Patient to roll onto their left side

2. Place support between knees
3. Place a sponge at between patients
waist and table to ensure that the spine
is straight

Center 5cm medial Perpendicular

and 5cm distal to
the ASIS

Grid
75kVp,
20mAs

Center 5cm distal

to the ASIS

Perpendicular

Grid
75kVp,
20mAs

Center between
level of pubic
symphysis and
ASIS in the midline
Center over the
elevated (affected)
side, 2.5cm medial
to upside ASIS
Center 5cm
superior to pubic
symphysis
Or center midway
between the ASIS
and pubic
symphysis
Center 5cm above
pubic symphysis/
5cm below the
ASIS
Or center midway
between the ASIS
and pubic
symphysis
Collimate to
24x30cm cassette
and have the top
of the collimation
at the iliac crest
and center in line

Angle 15o
cephalad

Grid
75kVp,
20mAs

Perpendicular

Grid
75kVp,
20mAs

Angle 15o
cephalad

Grid
70kVp,
32mAs

Angle 10o caudal

Grid
65kVp,
20mAs

Perpendicular

Grid
75kVp,
40mAs

Lumbar
Spine

AP supine

1. Patient supine with legs flexed, arms

across the chest
2. Patient to breathe in, breathe out and
hold

AP erect

1. Patient to stand with their back against

the bucky in the middle with weight
evenly distributed between their feet

Lateral

1. Patient lying in recumbent position,

place sponge between the knees
2. Patient to breathe in, breathe out and
hold

Lateral erect

1. Patient left side against the bucky in

true lateral position
2. Ask patient to place arms on top of their
head
3. Patient to breathe in, breathe out and
hold

Lateral flexion

1. Patient left side against the bucky, ask

patient to place arms on their head
2. Patient to lean forward as much as
possible using their lower back
3. Patient to breathe in, breathe out and
hold
1. Patient left side against the bucky, arms
on their head
2. Patient to lean back as much as possible
using their lower back

Lateral
extension

with the high point

of the iliac crest
Center at the
lower costal
margin in the
midline, collimate
to include SI joints
Collimate to
35x43cm cassette,
place the bottom
of the bucky 7.5cm
below the iliac
crest
Center to level of
lower costal
margin- this is
where L3 is (same
for HBL lateral Lspine)
Center at the level
of the iliac crest,
ensure the bucky
is 5-7cm below the
iliac crest, center
in the midcoronal
plane
Center at the level
of the iliac crest,
ensure that bucky
is 5-7cm below the
iliac crest
Center at the level
of the iliac crest

Perpendicular

Grid
70kVp,
32mAs

Perpendicular

Grid
70kVp,
32mAs

Perpendicular
OR if L-spine is
not straight,
angle 8o
cephalad male,
12o cephalad
female
Perpendicular

Grid
80kVp, 4060mAs

Perpendicular

Perpendicular

3. Patient to breathe in, breathe out and

hold
1. Patient semisupine 45o with sponge for
support
2. Ask patient to place elevated arm over
their opposite shoulder
1. Patient supine with arms across chest,
knees flexed
2. Patient breathe in and stop

Center at the level

of the lower costal
margin in the mid
auxiliary line
Center at the level
of ASIS

Lateral L5/S1

1. Patient lying in recumbent position,

place sponge between the knees
2. Patient to breathe in, breathe out and
hold

AP Supine

1. Patient supine with arms by their side

2. Patient to flex hips and knees to place
thighs vertical (reduces kyphosis)
3. Raise patients chin slightly to avoid
superimposition
4. Ask patient to hold their breath

AP erect

1. Patient standing with their back against

the bucky in the middle
2. Ask patient to breathe in, breathe out
and hold

Center at the
perpendicular
intersects of the
point of the
highest point of
the iliac crest
laterally &
posterior superior
iliac spine
Find xiphoid
sternum & sternal
notch, center half
way between
these points
Collimate to
35x43cm and
place top of
cassette above
patients shoulder,
center at T7
Place detector at
the top of the
shoulders
Center at T7

Oblique

L5/S1

Thoracic
Spine

AP Axial

Perpendicular

Grid
75kVp,
40mAs

Angle 30o
cephalad male,
35o cephalad
female
Perpendicular
OR 0-3o caudal
with spine nearsufficient
support
OR 5-8o caudal
with less support

Grid
75kVp,
35mAs

Perpendicular

Grid
70kVp,
25mAs

Perpendicular

Grid
85kVp, 50100mAs

AP erect lateral
bending
scoliosis

Lateral

Lateral erect

Cervical
Spine

1. Patient standing with their back against

the bucky in the middle
2. Ask patient to lean to their side keeping
their hips still
3. Patient to breathe in, breathe out and
hold
1. Patient lying on their left side in true
lateral position, place a sponge between
patients knees
2. Place lead mat behind collimated area
on table
3. Patient to breathe gently
1. Patient standing with their left side
against the bucky
2. Ask patient to place their arms on top of
their head

Center in the
Perpendicular
middle between
xiphoid and sternal
notch
Turn the beam
diaphgram
Top of collimation
Perpendicular
(35x43cm
cassette) at the
shoulder level
Center below T7

Grid
73kVp,
40mAs

Collimate to
35x43cm cassette
Center at the
midcoronal plane
and below T7
1. Patient standing with back of head
Centered in the
against the bucky
middle of the
2. Ask patient to open their mouth by
mouth, collimate
dropping their lower jaw as wide as they to the edge of the
can, align the base of skull (occiput) with height
the inferior border of the front incisors

Perpendicular

Perpendicular

Grid: 70kVp,
16mAs
Non-grid:
65kVp,
6mAs

AP (Axial)

1. Patient standing with back of head

against the bucky
2. Patient to slightly lift chin up
3. Patient to stop breathing and dont
swallow

Center at lower
thyroid cartilage

Angle 15o-20o
cephalad

Lateral

1. Patient standing or sitting with left side

against the IR (no grid)
2. Patient to place hands behind their back
and pull down onto their shoulders
3. Patient to breathe in, breathe out and
relax their shoulders and dont swallow

Center at lower
thyroid cartilage
and collimate to
include top of ear
to AC joint

Perpendicular
SID: 180cm (air
gap)

Grid: 6070kVp,
16mAs
Non-grid:
65kVp,
6mAs
No grid
66kVp,
16mAs

AP Odontoid

Lateral
(Swimmers)

1. Patient standing with left side against

the bucky
2. Ask patient to place their left arm up
and rest their arm on their head and
keep the right arm down and patient to
lean against the bucky

Lateral Flexion

1. Patient standing or sitting with left side

against the bucky
2. Ask patient to tuck their chin into their
chest as much as they can

Lateral
Extension

1. Patient standing or sitting with left side

against the bucky
2. Ask patient to raise their chin as high as
they can

Anterior
Obliques

1. Patient to face the bucky, patient turned

so shoulder touches the bucky at 45o
2. Ensure patients head is in lateral
position
1.
Patient head against the bucky, patient
turned so shoulder touches the bucky at
45o
2. Ensure patients head is in lateral
position
1. Patient supine with neck hyperextended,
arms by their side

Posterior
Obliques

AP AxialVertebral Arch
Facial
Bones

OM (Waters)

1. Position chair close to the board, ask

patient to sit on the chair facing the
board
2. Ask patient to rest their chin on the
board and relax shoulders forward
3. Adjust the patients head so MML

Center just above

the AC joint on the
right side (T1)2.5cm above the
jugular notch
Collimate to
include the area
that was missed in
the lateral
Center at the level
of the thyroid
cartilage
Collimate to
include tip of ear
Center at the level
of thyroid cartilage
Collimate to
include the tip of
the ear
Center above the
thyroid cartilage
Collimate to top of
ear
Center below the
thyroid cartilage
Collimate to top of
ear

Perpendicular
SID: 100cm
(reduced)

Center to lower
margin of thyroid
cartilage
Adjust the bucky
so the centering
will be at the
acanthion
Collimate to
patients face-

Angle 20-30o
caudal

Grid
80kVp,
80mAs

Perpendicular

Perpendicular

Angled 15o
caudal

Grid
70kVp,
20mAs

Angled 15o
cephalad

Grid
70kVp,
20mAs

Perpendicular
If OMBL is not 37
degrees, angle
tube accordingly
so patient angle
& tube angle is

Grid
63kVp,
40mAs

OM 30
MO - Trauma

1. Patient will be supine

2. Raise patients chin to bring OMBL
(orbitomeatal baseline) 37O to IR, if
patient cannot raise chin up, angle the
CR cephalad to the amount equal to the
difference between OMBL angle and the
required 37O

Lateral

1. Patient erect, rotate the patients

shoulder and ask them to stand up close
to the bucky so the side of their face is
touching the bucky in true lateral
position
2. If the patient cannot move their neck,
stand in true lateral position with their
shoulders touching the bucky (this will
increase OID so increase SID to
compensate)
1. Patient seated erect facing the bucky or
prone on the table
2. Ask patient to rest their forehead (and
nose) on the bucky
3. Adjust patients head to place OML
(orbitomeatal line) parallel to the ground
1. Patient in same position as Lateral facial
bones
1. Patient sitting or lying supine against
the bucky

PA Axial
(Modified
Caldwell)
OF 15

Zygoma

(Mento-mandible line) parallel to the

ground, OMBL is at 37 degrees
4. Ensure that there is no rotation of the
patients head
5. Ask patient to suspend respiration
1. Same positioning as OM (waters)- above

Lateral Nasal
Bones
AP 30O (Slit
Townes)

include the top of

the frontal sinuses
to the patients
mandible

37O

Center to top of
skull, beam should
exit at acanthion

Angle 20-30o
caudal

Center midway
between EAM and
canthus (outer
canvas of the eye)

Angle CR
cephalad to the
amount equal to
the difference
between OMBL
angle & 37O if
patient cannot
raise chin high
enough
Perpendicular

Center at the back

of head so the exit
point is at the
nasion (below the
glabella)

Angle 15O caudal

Center 1.25cm
inferior to nasion
Center 2.5cm
superior to

Perpendicular
Out of bucky
Angle CR 35-40O
caudal

Grid
63kVp,
40mAs

Grid: 65kVp,
16mAs
Non-grid:
60kVp,
12mAs

No grid
66kVp,

Zygomatic
arches

Mandible

2. Ask patient to look down to the ground

and adjust patients head so the
radiographic baseline (OML) is parallel
to the ground
3. Suspend respiration
PA Mandible
1. Patient sitting facing the bucky with
forehead resting on the bucky
2. Patient can support their head by
placing both hands on the side to
stabilize
3. Adjust patients head so OML (EAM to
outer canvas of eye) is parallel to the
floor
AP Axial
1. Have patient sitting or supine with back
(Townes)
of head against the bucky
Mandible
2. Ask patient to look down to the ground
and adjust patients head so the
radiographic baseline (OML) is parallel
to the ground
3. Suspend respiration
Oblique
1. Patient sitting with their shoulders
(Axiolateral)
rotated and face on the bucky
Mandible
2. Ask patient to rest the side of their
Lazy lateral
forehead on the board (head tilted ~25o)
(general survey 3. Ask patient to suspend respiration
of mandible)

Protocols
Facial Bones:
OM
OM 30
Lateral

glabella to pass
midway between
EAMs and angle of
mandible

20mAs

Center at the
junction of lips
Collimate to
18x24cm & have
top of collimate to
top of ears

Perpendicular
OR Angle 225O
cephalad & have
CR exit at
acanthion

Center at galbella,
pass midway
between EAMs

Angle 35-40O
caudal

Center mid body

head tilt 15
Center so the exit
beam is at the
mandibular region
of interest
(mandible closest
to IR)

Angle 10O
cephalad
(As patient
cannot head tilt
25O)

Grid
75kVp,
20mAs
Grid
70-80kVp,
12mAs

70-80kVp,
5mAs

Sinuses:
OM
Lateral
PA (Modified Caldwell view)