Procedures

Master Positioning Guide

Complete exams, eponyms, positioning, CR angles, centering, and exposure techniques. Adult DR technique ranges are approximate and vary by habitus, equipment, and protocol.

Upper Extremity & Shoulder Girdle

Anatomy & View	Eponym / Method	Part Position	CR Angle	Centering Point	kVp / mAs	SID
Finger PA	—	Palmar surface on IR; digit fully extended and isolated.	Perpendicular	PIP joint of affected digit	50–55 / 1–2	40"
Finger oblique	—	45° rotation; digit parallel to IR.	Perpendicular	PIP joint	50–55 / 1–2	40"
Finger lateral	—	True lateral; affected digit isolated, others flexed.	Perpendicular	PIP joint	50–55 / 1–2	40"
Thumb AP	Roberts	Internally rotate hand; posterior thumb on IR.	Perpendicular (Roberts: 15° proximal, centered to 1st CMC)	1st MCP joint	50–55 / 1–2	40"
Thumb PA / lateral	—	PA with hand in lateral; true lateral of thumb.	Perpendicular	1st MCP joint	50–55 / 1–2	40"
Hand PA	—	Palm flat; fingers slightly spread.	Perpendicular	3rd MCP joint	55–60 / 2–3	40"
Hand oblique	—	45° external rotation from PA; digits parallel to IR.	Perpendicular	3rd MCP joint	55–60 / 2–3	40"
Hand lateral	Fan lateral	Lateromedial (ulnar side down); digits fanned and parallel to IR.	Perpendicular	2nd MCP joint	55–60 / 2–4	40"
Wrist PA	—	Elbow 90°; hand pronated; fingers slightly flexed.	Perpendicular	Midcarpal area	55–60 / 2–3	40"
Wrist oblique	—	45° external rotation from PA.	Perpendicular	Midcarpal area	55–60 / 2–3	40"
Wrist lateral	—	Elbow 90°; true lateral; ulna down.	Perpendicular	Wrist joint	60–65 / 3–4	40"
Scaphoid PA	Ulnar deviation	PA wrist with ulnar deviation to elongate scaphoid.	Perpendicular (or 10–15° toward elbow)	Scaphoid (anatomic snuffbox)	55–60 / 2–3	40"
Scaphoid PA axial	Stecher	PA wrist; IR or fist elevated 20°, or CR angled.	20° toward elbow if IR is flat	Scaphoid	55–60 / 2–3	40"
Carpal tunnel	Gaynor-Hart	Hyperextend wrist; rotate hand 10° internally.	25–30° to long axis of the hand	1" distal to base of 3rd metacarpal	60–65 / 3–5	40"
Forearm AP	—	Arm extended; epicondyles parallel to IR; include both joints.	Perpendicular	Mid-forearm	60–65 / 3–4	40"
Forearm lateral	—	Elbow 90°; epicondyles perpendicular; thumb up.	Perpendicular	Mid-forearm	60–65 / 3–4	40"
Elbow AP	—	Arm fully extended; epicondyles parallel to IR.	Perpendicular	Mid-elbow joint	60–65 / 3–5	40"
Elbow lateral	—	Elbow 90°; humerus and forearm on same plane.	Perpendicular	Mid-elbow joint	60–65 / 3–5	40"
Elbow external oblique	—	45° external rotation; radial head free of ulna.	Perpendicular	Mid-elbow joint	60–65 / 3–5	40"
Elbow internal oblique	—	45° internal rotation; coronoid in profile.	Perpendicular	Mid-elbow joint	60–65 / 3–5	40"
Radial head axiolateral	Coyle	Elbow 90°; hand pronated.	45° toward the shoulder	Radial head	65–70 / 4–6	40"
Coronoid axiolateral	Coyle	Elbow 80°; hand pronated.	45° away from the shoulder	Coronoid process	65–70 / 4–6	40"
Humerus AP	—	Arm abducted slightly; epicondyles parallel; include both joints.	Perpendicular	Mid-humerus	70–75 / 6–10	40"
Humerus lateral	—	Internally rotate arm; epicondyles perpendicular.	Perpendicular	Mid-humerus	70–75 / 6–10	40"
Transthoracic humerus	Lawrence	Affected arm against IR; opposite arm raised; breathing technique.	Perpendicular (10–15° cephalad if needed)	Surgical neck	75–85 / 20–40	40"
Shoulder AP external	—	Erect or supine; arm externally rotated; epicondyles parallel.	Perpendicular	1" inferior to coracoid	70–80 / 8–16	40"
Shoulder AP internal / neutral	—	Internal rotation (epicondyles perp) or as-presented trauma neutral.	Perpendicular	1" inferior to coracoid	70–80 / 8–16	40"
Glenoid AP oblique	Grashey	35–45° posterior oblique; scapular body parallel to IR.	Perpendicular	2" inferior and 2" medial to superolateral border of shoulder	70–80 / 10–16	40"
Scapular Y	—	45–60° anterior oblique; affected side against IR.	Perpendicular	Scapulohumeral joint	70–80 / 12–20	40"
Inferosuperior axial shoulder	Lawrence	Arm abducted 90°; external rotation if tolerated.	25–30° medially	Axilla / glenohumeral joint	70–75 / 8–12	40"
Outlet / coracoacromial arch	Neer	45–60° anterior oblique (Y position).	10–15° caudad	Superior margin of humeral head	70–80 / 12–20	40"
Bicipital groove	Fisk	Patient leaning forward; humerus 10–15° to IR, or supine tangential.	Perpendicular to groove / 10–15° posterior	Bicipital groove	65–75 / 6–10	40"
Clavicle AP	—	Erect preferred; arms at sides; chin raised.	Perpendicular	Mid-clavicle	70 / 8–12	40"
Clavicle AP axial	—	Erect; shoulders relaxed.	15–30° cephalad	Mid-clavicle	70–75 / 8–12	40"
AC joints AP	Pearson	Erect; with and without weights; both joints on one IR if possible.	Perpendicular	MSP at level of AC joints	65–75 / 8–12	72"
Scapula AP	—	Arm abducted 90°; elbow flexed (stop-sign).	Perpendicular	2" inferior to coracoid, 2" medial to lateral border	75–80 / 10–16	40"
Scapula lateral	—	45–60° anterior oblique; arm across chest or behind back for body vs acromion.	Perpendicular	Mid-vertebral border of scapula	75–80 / 12–20	40"

Lower Extremity

Anatomy & View	Eponym / Method	Part Position	CR Angle	Centering Point	kVp / mAs	SID
Toe AP	—	Plantar surface on IR; toes extended.	10–15° toward the calcaneus	MTP of affected toe	50–55 / 1–2	40"
Toe oblique / lateral	—	30–45° rotation; true lateral of affected digit.	Perpendicular	MTP (oblique) or PIP/IP (lateral)	50–55 / 1–2	40"
Foot AP	Dorsoplantar	Plantar surface on IR; knee flexed.	10° toward the heel	Base of 3rd metatarsal	55–65 / 2–4	40"
Foot medial oblique	—	30–40° medial rotation.	Perpendicular	Base of 3rd metatarsal	55–65 / 2–4	40"
Foot lateral	Mediolateral	Lateral recumbent; plantar surface perpendicular to IR.	Perpendicular	Medial cuneiform / base of 3rd MT	60–65 / 3–4	40"
Calcaneus axial	Plantodorsal	Supine; dorsiflex foot; toes toward ceiling.	40° cephalad	Base of 3rd metatarsal	70–75 / 6–10	40"
Calcaneus lateral	—	True lateral; plantar surface perpendicular.	Perpendicular	1" inferior to medial malleolus	60–70 / 4–6	40"
Ankle AP	—	Leg extended; foot dorsiflexed; toes straight up.	Perpendicular	Midway between malleoli	60–65 / 3–5	40"
Ankle mortise	—	15–20° internal rotation until intermalleolar plane is parallel.	Perpendicular	Midway between malleoli	60–65 / 3–5	40"
Ankle oblique	—	45° internal rotation.	Perpendicular	Midway between malleoli	60–65 / 3–5	40"
Ankle lateral	Mediolateral	True lateral; dorsiflex foot; fibula posterior to tibia.	Perpendicular	Medial malleolus	60–65 / 3–5	40"
Tib/fib AP	—	Leg extended; femoral condyles parallel; include both joints.	Perpendicular	Mid-shaft	65–70 / 4–8	40–44"
Tib/fib lateral	—	True lateral; femoral condyles superimposed; include both joints.	Perpendicular	Mid-shaft	65–70 / 4–8	40–44"
Knee AP	—	Leg extended; 3–5° internal rotation; epicondyles parallel.	By ASIS–table: <19 cm 3–5° caudad; 19–24 cm perp.; >24 cm 3–5° cephalad	½" inferior to patellar apex	70–75 / 8–12	40"
Knee lateral	Mediolateral	Affected side down; knee flexed 20–30°.	5–7° cephalad	1" distal to medial epicondyle	70–75 / 8–12	40"
Knee medial / lateral oblique	—	45° internal or external rotation.	Perpendicular	½" inferior to patellar apex	70–75 / 8–12	40"
Intercondylar fossa PA axial	Camp-Coventry	Prone; knee flexed 40–50°.	40–50° caudad (match flexion)	Popliteal crease	70–75 / 8–12	40"
Intercondylar fossa PA	Holmblad	Kneeling; femur 70° from IR (20° from vertical).	Perpendicular to lower leg	Popliteal crease	70–75 / 8–12	40"
Intercondylar fossa AP axial	Béclère	Supine; knee flexed 40–45°.	40–45° cephalad, perp. to lower leg	½" inferior to patellar apex	70–75 / 8–12	40"
Patella PA	—	Prone; heel rotated 5–10° laterally (anterior knee ~5° internal).	Perpendicular	Mid-patella	70–75 / 6–10	40"
Patella tangential	Settegast / sunrise	Knee flexed ≥90°; prone or seated.	15–20° cephalad to patellofemoral joint	Patellofemoral joint	65–75 / 6–10	40"
Patella axial	Merchant	Seated; knees flexed 40° over IR edge.	30° caudad from horizontal	Patellofemoral joint, midway between knees	65–75 / 8–12	48–72"
Femur AP	—	Leg internally rotated 15–20°; include hip or knee.	Perpendicular	Mid-femur	75–80 / 10–20	40"
Femur lateral	—	True lateral of distal femur; do not frog a suspected proximal fracture.	Perpendicular	Mid-femur	75–80 / 10–20	40"
Hip AP	—	Supine; 15–20° internal rotation unless fracture is suspected.	Perpendicular	Femoral neck (1–2" medial and 3–4" distal to ASIS)	80–85 / 15–40	40"
Hip frog-leg	Modified Cleaves	Hip abducted 40–45°; contraindicated in trauma.	Perpendicular	Femoral neck	80–85 / 15–40	40"
Axiolateral hip	Danelius-Miller	Unaffected leg flexed and elevated; IR in crease above iliac crest.	Horizontal, perpendicular to femoral neck	Femoral neck	80–90 / 32–80	40"
Modified axiolateral hip	Clements-Nakayama	Bilateral hip injury; IR tilted 15°; grid parallel to neck.	15° posteriorly from horizontal	Femoral neck	80–90 / 32–80	40"

Spine, Sacrum & Pelvis

Anatomy & View	Eponym / Method	Part Position	CR Angle	Centering Point	kVp / mAs	SID
C-spine AP axial	—	Erect preferred; occlusal plane perp. to IR; chin elevated.	15–20° cephalad	C4	75–80 / 8–12	40"
AP open-mouth	Odontoid	Occlusal plane perpendicular to IR; mouth open.	Perpendicular	Center of open mouth	75–80 / 10–16	40"
AP dens	Fuchs	MML perpendicular to IR; chin elevated.	Parallel to MML	Just distal to chin tip	75–85 / 12–20	40"
C-spine lateral	Grandy	Erect; shoulders depressed; 72" SID; expiration.	Perpendicular (horizontal beam for trauma)	C4	75–85 / 16–32	72"
C-spine posterior oblique	—	45° RPO/LPO; upside intervertebral foramina.	15–20° cephalad	C4	75–80 / 10–16	40–72"
Cervicothoracic lateral	Swimmer / Twining	Arm nearest IR up; opposite arm down and slightly posterior.	Perpendicular (3–5° caudad if needed)	C7–T1	80–90 / 32–64	40–72"
T-spine AP	—	Supine or erect; anode toward head (heel effect); flex knees.	Perpendicular	T7 (3–4" below jugular notch)	80–85 / 12–25	40"
T-spine lateral	—	Left lateral; arms forward; breathing technique.	Perpendicular (or 10–15° cephalad if not supported)	T7	80–90 / 25–50	40–48"
L-spine AP	—	Supine; knees flexed; MSP to midline.	Perpendicular	Iliac crest (L4–L5)	80–90 / 20–40	40"
L-spine oblique	Scottie dog	45° RPO/LPO; downside zygapophyseal joints.	Perpendicular	1.5" above crest, 2" medial to upside ASIS	80–90 / 20–40	40"
L-spine lateral	—	True lateral; knees stacked; sponge under waist if needed.	Perpendicular (5–8° caudad if waist unsupported)	Iliac crest	85–95 / 40–80	40"
L5–S1 spot lateral	—	True lateral lumbar position, collimated to lumbosacral junction.	Perpendicular (5–8° caudad if waist unsupported)	1.5" inferior to iliac crest, 2" posterior to ASIS	90–100 / 40–80	40"
Scoliosis PA/AP (whole spine)	—	Standing, weight even on both feet, MSP to long IR; PA preferred (less breast/thyroid dose).	Perpendicular, horizontal beam	MSP; C7 through iliac crests included (about T10–T12)	85–95 / 15–30	60–72"
Scoliosis lateral (whole spine)	—	Standing lateral, convex side to IR; arms raised or crossed to clear the spine.	Perpendicular, horizontal beam	Midcoronal plane; C7 through sacrum included	90–100 / 40–80	60–72"
Scoliosis block / bending views	Ferguson; R & L lateral bending	Ferguson: 3–4" block under the foot (or hip) on the convex side. Bending: PA or AP, maximum lateral bend to each side, pelvis still.	Perpendicular	Same as the scoliosis PA/AP	85–95 / 15–30	60–72"
Sacrum AP axial	—	Supine; knees flexed slightly.	15° cephalad	2" superior to pubic symphysis	80–90 / 16–32	40"
Coccyx AP axial	—	Supine; bladder empty if possible.	10° caudad	2" superior to pubic symphysis	75–85 / 12–20	40"
Sacrum / coccyx lateral	—	True lateral; hips stacked.	Perpendicular	3–4" posterior to ASIS (sacrum) or 2" distal (coccyx)	85–95 / 40–80	40"
SI joints AP axial	—	Supine.	30–35° cephalad	2" below ASIS, MSP	80–90 / 16–32	40"
SI joints oblique	—	25–30° RPO/LPO; upside joint (LPO shows right SI).	Perpendicular	1" medial to upside ASIS	80–90 / 16–32	40"
Pelvis AP	—	Supine; 15–20° internal rotation of feet unless trauma.	Perpendicular	Midway between ASIS and pubic symphysis	80–85 / 20–40	40"
Pelvic inlet	—	Supine.	40° caudad	ASIS, MSP	80–90 / 20–40	40"
Pelvic outlet	Taylor	Supine.	20–35° cephalad (♂) or 30–45° cephalad (♀)	1–2" distal to pubic symphysis, MSP	80–90 / 20–40	40"
Acetabulum posterior oblique	Judet	45° posterior oblique; downside = anterior rim / posterior column.	Perpendicular	2" distal and 2" medial to downside ASIS (or 2" distal to upside ASIS)	80–85 / 16–40	40"

Chest, Bony Thorax & Ribs

Anatomy & View	Eponym / Method	Part Position	CR Angle	Centering Point	kVp / mAs	SID
PA chest	—	Erect, facing IR; shoulders rolled forward; 2nd full inspiration.	Perpendicular	T7 (inferior scapular angle)	110–125 / 2–8	72"
Lateral chest	—	Left lateral erect; arms raised; MCP to midline.	Perpendicular	T7, MCP	110–125 / 4–16	72"
AP lordotic chest	Lindblom	Patient 1 ft from IR, leaned back; or erect AP with CR angle.	Perpendicular if lordotic, or 15–20° cephalad	Mid-sternum / T7	110–125 / 4–12	72"
Lateral decubitus chest	—	Affected side down for fluid, up for air; 5 minutes if possible.	Horizontal beam, perpendicular to IR	T7	110–125 / 4–12	40–72"
AP stretcher / portable chest	—	As erect as tolerated; cassette behind back.	Caudad to be perp. to sternum (≈5°)	3" below jugular notch (T7)	90–120 / 2–8	40–72"
Soft-tissue neck lateral	—	Erect; slow inspiration through nose.	Perpendicular	C4–C6 (laryngeal prominence)	70–80 / 8–12	72"
Sternum RAO	—	15–20° RAO; breathing technique or expiration.	Perpendicular	Center of sternum (1" left of MSP, midsternum)	70–80 / 20–40 (breathing)	40"
Sternum lateral	—	Erect; shoulders back; inspiration.	Perpendicular	Mid-sternum	75–85 / 16–32	40–72"
SC joints PA / RAO-LAO	—	PA then 10–15° anterior oblique; head turned from side of interest.	Perpendicular	T2–T3 (3" distal to vertebra prominens)	70–75 / 8–12	40"
Upper ribs AP/PA	—	Erect preferred; inspiration; arms abducted.	Perpendicular	T7	70–80 / 10–20	40"
Lower ribs AP	—	Recumbent preferred; expiration.	Perpendicular	Midway between xiphoid and lower rib margin	75–85 / 12–25	40"
Axillary ribs oblique	—	45° RPO/LPO (posterior pain) or RAO/LAO (anterior pain); affected side elongated.	Perpendicular	T7 (upper) or midway xiphoid–lower ribs (lower)	70–80 / 12–25	40"

Skull, Facial Bones & Orbits

Anatomy & View	Eponym / Method	Part Position	CR Angle	Centering Point	kVp / mAs	SID
Skull PA axial	Caldwell	OML perpendicular to IR; forehead and nose on IR.	15° caudad	Nasion	75–85 / 12–20	40"
Skull AP axial	Towne	OML perp. (or IOML perp. with 37° angle).	30° caudad to OML (37° to IOML)	2.5" above glabella	80–85 / 16–25	40"
Skull lateral	—	True lateral; IPL perp.; IOML parallel to long axis of IR.	Perpendicular	2" superior to EAM	75–85 / 10–16	40"
Skull SMV	Schüller	IOML parallel to IR; vertex on IR.	Perpendicular to IOML	1.5" inferior to mandibular symphysis	80–90 / 20–32	40"
Facial bones parietoacanthial	Waters	MML perpendicular; OML 37° to IR.	Perpendicular	Acanthion	75–85 / 12–20	40"
Modified Waters	—	LML perpendicular; OML ≈55° to IR (less extension).	Perpendicular	Acanthion	75–85 / 12–20	40"
Facial bones lateral	—	True lateral; affected side against IR.	Perpendicular	Zygoma (midway EAM and outer canthus)	70–80 / 8–12	40"
Nasal bones lateral	—	True lateral; both sides usually obtained.	Perpendicular	½" inferior to nasion	50–60 / 1–3	40"
Zygomatic arches SMV	—	IOML parallel to IR; reduce exposure vs skull SMV.	Perpendicular to IOML	1.5" inferior to mandibular symphysis	70–80 / 8–12	40"
Zygomatic arch tangential	May	SMV base; rotate head 15° toward side; tilt chin 15° toward side.	Perpendicular to IOML	Zygomatic arch of interest	70–80 / 6–10	40"
Mandible PA	—	Forehead and nose on IR, OML perp. (rami); nose only, AML perp. (body).	Perpendicular (or 20–25° cephalad for rami)	Junction of lips (body) or acanthion (rami)	75–80 / 10–16	40"
Mandible axiolateral oblique	—	Head in true lateral; rotate toward IR 0° (ramus), 30° (body), 45° (mentum); 10–15° survey.	25° cephalad (or 25° head tilt)	Downside mandible	75–80 / 8–12	40"
Mandible AP axial	Towne	OML perp.	35–42° caudad	Glabella	80–85 / 16–25	40"
TMJ AP axial	Modified Towne	OML perp.; open- and closed-mouth.	35° caudad	3" above nasion	75–85 / 12–20	40"
TMJ axiolateral	Schüller	True lateral skull; open- and closed-mouth.	25–30° caudad	½" anterior and 2" superior to upside EAM	75–85 / 10–16	40"
TMJ axiolateral oblique	Law	Rotate face 15° toward IR.	15° caudad	1.5" superior to upside EAM	75–85 / 10–16	40"
Orbits parieto-orbital oblique	Rhese	Three-point landing (chin, cheek, nose); AML perp.; 37° from PA / 53° from lateral.	Perpendicular	Downside orbit	75–80 / 10–16	40"
Sinuses PA axial	Caldwell	Erect; OML 15° to CR (horizontal beam).	Horizontal, exit nasion	Nasion	75–85 / 12–20	40"
Sinuses parietoacanthial	Waters	Erect; MML perp.; horizontal beam.	Horizontal, exit acanthion	Acanthion	75–85 / 12–20	40"
Sinuses open-mouth Waters	Pirie	Waters position with mouth open for sphenoid.	Horizontal, exit acanthion	Acanthion	75–85 / 12–20	40"
Sinuses lateral	—	Erect true lateral; horizontal beam.	Horizontal, perpendicular	½–1" posterior to outer canthus	70–80 / 8–12	40"