HUMERUS.

HUMERUS AP
Technical Factor:
IR size :
Lengthwise (large enough to include entire humerus)
- Larger Patient: 35 x 43 cm (14 x 17 inches) may be needed to place cassette
diagonally to include both joints.
- Smaller Patient: 30 x 35 cm (11 x 14 inches) Moving or stationary grid (non-
grid, detail screen for smaller patient)
70+- 6 kV range
Minimum SID of 40 inches (100cm)
AP HUMERUS ERECT
Structure Shown:
AP projection of the entire humerus, including the shoulder and elbow joints, is
visible.
Position: Long axis of humerus should be aligned with long axis of IR.
True AP projection is evidenced at proximal humerus by the following:
• Greater tubercle is seen in profile laterally.
• Humeral head is partially seen in profile medially, with minimal
superimposition of the glenoid cavity.
• Distal Humerus: Lateral and medial epicondyles both are visualized in
profile
HUMERUS LATERAL
This projection may be taken Erect AP or PA, or the patient is supine.
Central Ray: CR is perpendicular to midhumerus

Patient Positioning:
Erect (PA) Position:
 Flex elbow into 90 degrees and patient is rotated 15 – 20 degrees from PA or
as needed to bring humerus and shoulder in contact with Image Receptor
holder.
The epicondyle is perpendicular to IR for a true lateral projection.
Erect (AP) Position:
 Rotate the arm medially
 Epicondylar line perpendicular to the film.
 Flex elbow approximately 90° (unless contraindicated) and place palmar
aspect of hand on the hip
 Elbow slightly flexed, arm and wrist rotated for lateral position, this will bring
palm backwards.
The epicondyles is perpendicular to image receptor.
Image receptor is centered to anatomy of interest to include both elbow and
shoulder joints.
A true lateral is confirmed by the superimposed epicondyles.
Best demonstrate the lesser tubercle in profile.
SUPINE:
 Rotate the hand medially (internally) into the lateral position with the thumb
side resting on the table (posterior aspect of the hand against patient side.
HUMERUS/SHOULDER JOINT TRANSTHORACIC LATERAL PROJECTION
LAWRENCE METHOD
Technical Factor:
IR size 35 x 43 cm (14 x 17 inches), lengthwise
75+- 5kV range
Minimum of 2 seconds exposure time with breathing technique (between 2 and 4
seconds is desirable)
Minimum SID of 40 inches (100cm)
Patient Position:
 Perform radiograph with the patient in an erect or supine position. (The erect
position, which also may be more comfortable for patient, is preferred.)
 Place patient in lateral position with side of interest closest to IR.
 With patient supine, place portable grid lines horizontally and center CR to
centerline to prevent grid cutoff (insert).
Part Position:
 Place affected arm at patient's side in neutral rotation; drop shoulder if
possible.
 Raise opposite arm and place hand over top of head; elevated shoulder as
much as possible to prevent superimposition of affected shoulder.
 Superior border of the image receptor should be placed 1 inch (2.5 cm) above
the affected shoulder.
 Ensure that thorax is in a true lateral position or has slight anterior rotation of
unaffected shoulder to minimize superimposition of humerus by thoracic
vertebrae.
Instruct the patient to do shallow breathing to blur out ribs and lung structures
to better visualize the proximal humerus.
Central Ray:
1. Perpendicular to the surgical neck.
2. 10°-15° cephalad if the patient cannot elevate the unaffected shoulder
Structure Shown:
Lateral view of the proximal 2/3 of the humerus seen anteriorly to the thoracic
vertebrae.
Alternative position taken primarily in cases of trauma to the upper arm or
shoulder or when the patient is otherwise unable to rotate or abduct the arm.

SHOULDER JOINT AP PROJECTION

Technical Factors:
IR - size 24 x 30 cm (10 x 12 inches), crosswise (or lengthwise to show more of
humerus if injury includes proximal half of humerus)
Moving or stationary grid
70 +- 5 kV range
Patient Position:
 Perform radiograph with the patient in an erect or supine position. (The erect
position is usually less painful for patient, if condition allows.)
 Rotate body slightly toward affected side if necessary to place shoulder in
contact with IR or tabletop.
NEUTRAL ROTATION
 Rest palm of hand against thigh/hip
 Medial and lateral epicondyles at a 45 degrees angle to plane of cassette IR 2
in. above top of shoulder
CR perpendicular to 1 inch (2.5 cm) inferior to the coracoid process.
Structure Shown:
Greater tubercle partially superimposed the humeral head
Humeral head in partial profile
Best demonstrate the posterior part of the supraspinatus insertion.
Oblique view of the proximal humerus

INTERNAL ROTATION
 Medially (internally) rotate palm of hand (thumb side down).
 Back of the hand against thigh/hip.
 Medial and lateral epicondyles are perpendicular to the plane of the cassette.
CR perpendicular to the coracoid process 1 inch (2.5 cm) inferior to the coracoid
process.
Structure Shown:
Lateral view of proximal humerus and lateral two-thirds of the clavicle and upper
scapula are demonstrated, including the relationship of the humeral head to the
glenoid cavity.
Best demonstrate the lesser tubercle in profile medially.
Profile image of the site of the supraspinatus tendon.
Lateral view of the humerus
EXTERNAL ROTATION
 Laterally (Externally) rotate palm of the hand (extreme supination)
 Medial and lateral epicondyles are parallel to the plane of cassette.
CR perpendicular to the coracoid process 1 inch (2.5 cm) inferior to the coracoid
process
note: The coracoid process may be difficult to palpate directly on most patients,
but it can be approximated; it is about 3/4inch (2cm) inferior to the lateral
portion of the more readily palpated clavicle.
Structure Shown:
 AP projection of proximal humerus and lateral two-thirds of the clavicle and
upper scapula, including relationship of the humeral head to the glenoid
cavity.
Best demonstrate the greater tubercle in profile on the lateral aspect of the
humerus.
Profile image of site of insertion of the supraspinatus tendon.
The true AP projection of the humerus in the anatomic position.
SHOULDER JOINT INFEROSUPERIOR AXIAL PROJECTION LAWRENCE METHOD
Technical Factors:
IR size- 18 x 24 cm (8 x 10 inches), crosswise
Stationary grid (CR to center line of grid, crosswise to prevent grid cutoff caused
by CR angle)
70+- 5 kV range
Patient Position:
 Position patient supine with shoulder raised about 2 inches (5 cm) from table
top by placing support under arm and shoulder to place body part near
center of IR.
Part Position:
 Move patient toward the front edge of tabletop and place a cart or other arm
support against front edge of table to support abducted arm.
 Rotate head towards opposite side, place vertical cassette on table as close to
neck as possible, and support with sandbags.
 Abduct arm 90 degree from body if possible; Keep in external rotation, palm
up, with support under arm and hand.
CENTRAL RAY:
1. Horizontally through the axilla to the acromioclavicular joint.
2. 15°-30° if abduction of arm is less than 90°
Best demonstrate the lesser tubercle in profile directed anteriorly
Demonstrate an inferosuperior axial image of the proximal humerus

SHOULDER JOINT INFEROSUPERIOR AXIAL PROJECTION RAFERT MODIFICATION

 Abduct arm of the affected side 90°
 Humerus in exaggerated external rotation.
 Hand form an angle of 45° oblique.
 Thumb pointing downward.
 Horizontal and angled 15° medially entering the axilla and passing through
the acromioclavicular joint.
Demonstrate an Inferosuperior axial image of the proximal humerus.
Best demonstrate the lesser tubercle in profile directed anteriorly.
Demonstrate Hill-Sachs defect - Compression fracture of the articular surface of
the humeral head with anterior dislocation of the humeral head.

SHOULDER JOINT INFEROSUPERIOR AXIAL PROJECTION WEST POINT METHOD

 Abduct arm of the affected side 90°
 Turn the patient's head away from the side being examined.
 Patient in prone position with approximately 3 inch pad under the shoulder
being examined.
 Place a vertically supported IR against the superior aspect of the shoulder
with the edge of the IR in contact with the neck.
CENTRAL RAY :
25° anteriorly from the horizontal and 25° medially and enters 5 inches (13 cm.)
and 1 ½ medial to the acromial edge and exits the glenoid cavity.
Structure Shown:
• Humeral head projected free of the coracoid process.
• Articular between the head of the humerus and the glenoid cavity.
• Acromion superimposed over the posterior portion of the humeral head.
SHOULDER JOINT INFEROSUPERIOR AXIAL PROJECTION CLEMENTS
MODIFICATION
When the prone or supine is not possible for an inferosuperior projection of the
shoulder joint.
 Patient in lateral recumbent position lying on the unaffected side.
 Abduct the affected arm 90° and point it toward the ceiling.
CENTRAL RAY:
1. CR horizontal to the midcoronal plane passing through the midaxillary
region of the shoulder.
2. 5°-15° medially when the patient cannot abduct the arm for a full 90°.
Lesser tubercle in profile.

SHOULDER JOINT AP AXIAL PROJECTION

• Patient in supine position.
CENTRAL RAY: 35° cephalad to the scapulohumeral joint
Demonstrate the relationship of the humeral head to the glenoid cavity.
Useful in diagnosing cases of posterior dislocation

SHOULDER JOINT SCAPULAR Y PA OBLIQUE PROJECTION

Pathology Demonstrated:
• Fractures and/or dislocations of the proximal humerus and scapula are
demonstrated.
• The humeral head will be demonstrated inferior to the coracoid process with
anterior dislocations,
• For less common posterior dislocations, the humeral head will be
demonstrated inferior to the acromion process.
• Excellent projection to demonstrate profile of coracoid process and scapular
spine.
Technical Factor:
IR size - 24 x 30 cm (10 x 12 inches), lengthwise
Moving or stationary grid
Digital IR - very close collimation required
75 +- 5 kV range
Minimum SID of 40 inches (100 cm)
Patient Position:
• Perform radiograph with the patient in an erect or recumbent position. ( The
erect position is usually more comfortable for the patient.)
Part Position:
• Rotate into an anterior oblique position as for a lateral scapula with patient
facing IR. Average patient will be in 45degree to 60degree anterior oblique
position.
• Palpate scapular borders to determine correct rotation for a true lateral
position of scapula.
• Center scapulohumeral joint to CR and to center of IR.
• Abduct arm slightly if possible so as to not superimposed proximal humerus
 over ribs; do not attempt to rotate arm.
Central Ray:
CR perpendicular to IR, directed to scapulohumeral joint (2 or 2 1/2 inches [ 5 to 6
cm] below top of shoulder)
Alternate view of the shoulder used primarily with trauma patients to
Demonstrate possible shoulder dislocations.
Demonstrate an oblique image of the shoulder.
True lateral view of the scapula, proximal humerus.

GLENOID CAVITY AP OBLIQUE PROJECTION GRASHEY METHOD

Patient may be in an erect or supine position
Part Position:
• Rotate body 35-45 degrees toward affected side
• (Support patient’s hip and shoulder in supine position.)
• Center mid-scapulohumeral joint to CR and IR
• Adjust so top of image receptor is 2 inches above shoulder
• Side of IR is 2 inches from lateral humerus
• Abduct arm slightly with arm in neutral position
CR perpendicular to the glenoid cavity at a point 2 inches (5cm) inferior to the
superolateral border of the shoulder.
Glenoid cavity in profile without superimposition of the humeral head.
The glenoid view is an ideal projection to inspect the glenoid rim, the
glenohumeral joint and the articular surface of the humerus.
The projection is used to assess the integrity of the glenohumeral joint.
Normal AP oblique internal rotation view (Grashey view).
It is also known as a "true AP" view since the view is AP to the scapular instead
of AP to the patient.

SUPRASPINATUS “OUTLET’ TANGENTIAL PROJECTION NEER METHOD

Patient Position and Shielding:
• Take radiograph with the patient in an erect, sitting or recumbent position.
• (The erect position is usually more comfortable for the patient.)
• Shield pelvic area
• With patient facing the IR, rotate the unaffected side away from the IR 45°-
60° anterior oblique position as for lateral scapula.
• Palpate scapular borders to determine correct rotation.
• Abduct arm slightly so as not to superimpose proximal humerus over ribs; do
not attempt to rotate arm.
• Minimum SID of 40 inches (100 cm)
CR 10°-15° caudad entering the superior aspect of the humeral head
• When performing this projection do not attempt to rotate arm if fracture or
dislocation is suspected.
• Fractures and/or dislocations of the proximal humerus and scapula are
visualized.
• Demonstrate tangentially the coracoacromial arch or outlet for the
supraspinatus outlet to diagnose shoulder impingement.
Best demonstrate the supraspinatus outlet of the shoulder.

PROXIMAL HUMERUS AP AXIAL PROJECTION STRYKER NOTCH METHOD

Position of patient:
• The patient should be in a supine position. The patient should suspend
respiration for the exposure.
Position of part:
• The affected arm is flexed for more than 90 degrees and the hand is place on
the top of the head. Make the body of the humerus parallel to the midsagittal
plane.
CR: 10° cephalad entering the coracoid process
Demonstrate the posterosuperior and posterolateral areas of the humeral head
Purpose and Structures Shown:
• This view should demonstrate the bones and soft tissue of the shoulder and
the posterosuperior and posterolateral areas of the humeral head.
• It is sometimes useful in identifying the cause of shoulder dislocation
including dislocations caused by posterior defects.

GLENOID CAVITY AP OBLIQUE PROJECTION APPLE METHOD

Position of patient:
• The position of the patient can be either recumbent or upright.
• Patient’s arm to their side with the back of the shoulder resting on the bucky.
Position of part:
• Turn the body for about 35-45 degrees towards the affected side. The patient
should hold a 1 pound weight using the hand of the affected side in neutral
position.
• Abduct the arm 90° from the midline of the body holding a 1 pound weight
on the affected side.
• The patient should suspend respiration for the exposure.
CR Perpendicular to Level of the Coracoid Process.
Glenoid cavity in profile
Demonstrate loss of articular cartilage in the scapulohumeral joint but uses a
weighted abduction.
Similar to the Grashey method except for the use of the 1 pound weight.

GLENOID CAVITY AP AXIAL OBLIQUE PROJECTION GARTH METHOD

Position of patient:
• The position of the patient can be either recumbent or upright.
• Turn the body about 45 degrees towards the injured side with the back of the
shoulder resting on the bucky.
• Abduct the arm slightly in internal rotation and rest the palm on the
abdomen.
Position of part:
• The posterior surface of the injured side should be closest to the the image
receptor.
Patient Position :
The position of the patient can be either recumbent or upright.
Turn the body about 45 degrees towards the injured side with the back of the
shoulder resting on the bucky.
Abduct the arm slightly in internal rotation and rest the palm on the abdomen.
Position of part:
The posterior surface of the injured side should be closest to the the image
receptor.
CR 45° caudad through the scapulohumeral joint
This view should demonstrate the bones and soft tissue of the shoulder
specifically the Glenoid cavity, scapulohumeral joint, humeral head, coracoid
process, scapular head and neck.
Demonstrate any posterior scapulohumeral dislocations.
• Recommended projection for acute shoulder trauma.
• Anterior dislocation - Humerus projected inferiorly
• Posterior dislocation - Humerus projected superiorly

INTERTUBURCULAR GROOVE TANGENTIAL PROJECTION FISK MODIFICATION

Position of patient:
• Patient in supine, seated or upright position.
• Support the image receptor in a vertical position in contact with the superior
part of the shoulder and as near as possible to the neck and turn the patient’s
head away from the side being examined. The patient should suspend
respiration for the exposure.
• For the Fisk modification, the patient stands at edge of the table leaning over
the image receptor similar to a tangential clavicle view (below) but with a
perpendicular CR.
Part Position:
• The anterior surface of the shoulder is palpated to localize the intertubercular
groove.
• Supinate the hand.
• For the Fisk modification, flex the elbow with the posterior forearm on the
table and adjust the anterior or posterior leaning of the patient to place the
humerus at an angle of 10-15 degrees.
Central ray:should be 10-15 degrees posterior at the intertubercular groove.
For the Fisk modification, the central ray should be perpendicular to the image
receptor at the intertubercular groove and the vertically positioned humerus is
angulated at 10-15 degrees.
Demonstrates the intertubercular groove free of superimposition of the
shoulder.

TERES MINOR INSERTION PA PROJECTION BLACKETT-HEALY METHOD

Position of patient:
• The patient should be prone with arms at the sides of the body and head
resting on the cheek of the injured side.
• The patient should suspend respiration for the exposure.
Position of part:
• Internally rotate the arm and if possible, flex the arm and place hand on the
back of the patient.
• Arm in extreme internal rotation.
Central ray perpendicular to the image receptor at the head of the humerus.
Demonstrate tangential image of the insertion of the teres minor.
Purpose and Structures Shown:
This view should demonstrate bones and soft tissue of the shoulder specifically
the insertion of the teres minor which is projected by rotating the head of the
humerus. It also shows the greater tubercle superimposed by the humeral head,
lesser tubercle pointing medially, and the soft tissue around the humerus with
trabecular detail on the head of the humerus.
Lesser tubercle in profile

SUBSCAPULARIS INSERTION AP PROJECTION BLACKETT-HEALY METHOD

Position of patient:
• The patient should be supine with arms resting on the side of the body.
• The patient should suspend respiration for the exposure.
Position of part:
• Move the arm of the injured side away from the body and then flex the
elbow. Rotate the arm internally pronating the hand. The opposite shoulder
may be elevated for about 15 degrees.
Central ray is perpendicular to the image receptor at the shoulder joint passing
through the coracoid process.
Purpose and Structures Shown:
This view should demonstrate bones and soft tissue of the shoulder, specifically
the insertion of the subscapularis at the lesser tubercle.

AP AXIAL PROJECTION INFRASPINATUS INSERTION

Patient in supine position
• Arm in external rotation - Demonstrate the greater tubercle in profile.
• Arm in neutral position - Demonstrate the insertion of the infraspinatus
tendon.
• Arm in internal rotation - Demonstrate an open subacromial space
CR 25° caudad to the coracoid process

ACROMIOCLAVICULAR ARTICULATIONS AP PROJECTION PEARSON METHOD

Position of patient:
• The position of the patient can be either seated or standing upright with the
back of the patient’s shoulders resting on the image receptor.
• The midline of the patient’s body should be centered at the midline of the
grid.
• The weight of the patient’s body should be equally distributed on both feet to
avoid rotation.
• The patient should suspend respiration for the exposure.
Position of part:
• While the patient’s arms are hanging on the sides, the shoulders should be
positioned on the same horizontal plane.
First Exposure: Patient is standing upright with no weights.
Second Exposure: Patient standing upright with equal weights (5-8 pounds) on
attached with straps on both wrists. Do not make the patient hold the weights
using hand because this contracts the shoulder muscle reducing the small
acromioclavicular separation.
A thyroid collar is usually recommended since the thyroid gland is exposed to the
primary beam.
Central ray:
SID is usually 72 inches or greater. The central ray should be perpendicular to
the image receptor at the midline of the body at the level of the
acromioclavicular joint for a single projection.
This projection is used to demonstrate AC joint disclocation, separation
and function of the joints.

ACROMIOCLAVICULAR ARTICULATIONS AP AXIAL PROJECTION ALEXANDER

METHOD
Position of patient:
• The position of the patient can be either seated or standing upright with the
back of the patient’s shoulders resting on the image receptor.
• The patient should suspend respiration for the exposure.
Position of part:
Center the AC joint to the midline of the grid. Patient’s arms down comfortably.
CR: 15° cephalic to the coracoid process (this angulation projects the AC joint
above the acromion)
Purpose and Structures Shown:
This view should demonstrate bones and soft tissue of the shoulder, specifically
the acromioclavicular joint. Examination of suspected Acromioclavicular
subluxation or dislocation.
Demonstrate the AC Joint projected slightly superiorly compared with an AP
projection.

Learn lllPA AXIAL OBLIQUE PROJECTIONS ALEXANDER METHOD RAO/LAO

POSITION
Position of patient:
• The position of the patient can be either seated or standing upright facing the
image receptor with the hand of the injured side under the other axilla.
• Turn the patient to make the midcoronal plane at an angle of 45-60 degrees
to place the scapula at a right angle to the image receptor.
• The patient should suspend respiration for the exposure.
Position of part:
• Center the acromioclavicular articulation to the midline of the grid.
• Lean the shoulder of the affected side toward the the image receptor stand
and have ptient pull arm firmly across the chest.
• Pulling of the arm draws the scapula laterally and forward and places the joint
as close as possible to the the image receptor.
CR 15° caudad to the AC joint.
Demonstrates the scapula and AC joint in the lateral position.
AC joints in profile

CLAVICLE.
CLAVICLE AP PROJECTION
Technical Factors:
IR size - 24 x 30 cm (10 x 12 inches), crosswise
Moving or stationary grid
Digital IR - requires very close collimation
70 to 5 kV range
Patient Position:
• Perform radiograph with the patient in an erect position with arm at sides,
chin raised, and looking straight ahead. Posterior shoulder should be in
contact with IR or tabletop, without rotation of body.
Part Position:
Center clavicle and IR to CR
AP projection is performed when the patient cannot assume the prone
position.
RADIOGRAPHIC CRITERIA:
Collimation border should be visible with entire clavicle visualized, including
both AC and sternoclavicular joints.
CLAVICLE AP AXIAL PROJECTION LORDOTIC POSITION
Erect position.
Patient lean backward in extreme lordotic position.
CENTRAL RAY: 0°-15° cephalad to midshaft of the clavicle.

CLAVICLE AP AXIAL PROJECTION

Patient in supine position
CENTRAL RAY: 15°-30° cephalad to midshaft of the clavicle
Minimum SID of 40 inches (100 cm)
For thinner patients (asthenic) - 10°-15° cephalad to
midclavicle.
Respiration:
Suspend respiration at end of inhalation (Helps to elevate clavicles).
• Correct angulation of CR will project most of the clavicle above the scapula
and ribs.
• Only the medial portion of the clavicle will be superimposed by the first and
second ribs.
• Optimal exposure will demonstrate the distal clavicle and AC joint without
excessive density.
The bony margins and trabecular markings should appear sharp, indicating no
motion, and the medial clavicle and sternoclavicular joint also should be
visualized through the thorax.
CLAVICLE PA PROJECTION
• Patient in prone or upright position
• Useful when improved detail is desired.
• Clavicle is closer to the IR as compared with AP projection.
• Prone position – for patient who can stand, for improved
detail (reduced OID)
CLAVICLE PA AXIAL PROJECTION
Patient in prone or standing position facing the vertical grid device.
CENTRAL RAY: 15°-30° caudad
• Structures shown same as AP AXIAL PROJECTION

CLAVICLE TANGENTIAL PROJECTION

• Patient in supine position
• The tangential projection is similar to the AP axial projection.
CR 25-40° cephalad to pass between the clavicle and chest wall
CR for medial 3rd - 15°- 25° cephalad

TARRANT METHOD
• Patient in seating position
• Demonstrate the clavicle above the thoracic cage
25°-35° Directed anterior and inferior to the midclavicle.
Requires increased SID because of increased OID

SCAPULA
SCAPULA AP PROJECTION
Technical Factors:
• IR size - 24 x 30 cm (10 x 12 inches), lengthwise
• Moving or stationary grid
• 75 +- 5 kV range
• Minimum of 3 seconds exposure time with breathing technique (3 to 4
seconds is desirable) - Slow breathing to
obliterate lung detail.
• Manual exposure factors (AEC is not recommended)
Patient Position:
• Perform radiograph with the patient in an erect or supine position. (The erect
position may be more comfortable for the patient.)
• Posterior surface of shoulder is in direct contact with tabletop or IR without
of thorax. (Rotation towards affected side would place scapula into a truer
posterior position, but this also would result in greater superimposition of the
rib cage.)
Part Position:
• Position patient so midscapula area is centered to CR.
• Adjust cassette to center to CR. Top of IR should be about 2 inches (5 cm)
above shoulder, and lateral border of IR should be about 2 inches (5 cm)
from lateral margin of rib cage.
• Gently abduct arm 90 degree and supinate hand. (Abduction will move
scapula laterally to clear more of the thoracic structures.)
Central Ray:
CR perpendicular to midscapula, 2 inches (5 cm) inferior to coracoid process, or to
level of axilla, and approximately 2 inches (5 cm) medial from lateral border of
patient.
Minimum SID of 40 inches (100 cm)
Collimation:Collimate on four sides to area of scapula.
Respiration:
Breathing technique is preferred if patient can cooperate. Ask patient to breathe
gently without moving affected shoulder or arm.

RAO OR LAO BODY POSITION LATERAL PROJECTION

• Patient in RAO or LAO, affected scapula center to IR.
• Body rotated 45-60° from the plane of the IR.
• Horizontal fractures of the scapula are demonstrated. Arm placement should
be determined be scapular area of interest.
Acromion and Coracoid Process –elbow flex and hand on posterior thorax.
Body of the Scapula –extend arm upward and rest forearm on the head
CENTRAL RAY : perpendicular to midmedial border of the protruding scapula.

PA OBLIQUE PROJECTION LORENZ AND LILIENFIELD METHODS

LORENZ
• Patient in lateral recumbent or upright lateral
• Arm of the affected side at right angle to the long axis of the body.
Demonstrate an oblique image of the scapula.
CENTRAL RAY : perpendicular to midmedial border of the protruding scapula.

LILIENFIELD
• Patient in lateral recumbent or upright lateral
• Rotate body slightly forward.
• Arm of the affected side extended obliquely upward.
Demonstrate an oblique image of the scapula.
CENTRAL RAY : perpendicular to midmedial border of the protruding scapula.
CORACOID PROCESS AP AXIAL PROJECTION
 Patient in supine
 Abduct arm of affected side slightly and supinate hand
CR :15°-45° cephalad to coracoid process
Demonstrate a slightly elongated inferosuperior image of the coracoid process

SCAPULAR SPINE TANGENTIANL PROJECTION LAQUERRIERE-PIERQUIN METHOD

 Patient in supine position
CENTRAL RAY:
• 45° caudad to the posterosuperior region of the shoulder.
• 35° caudad – for obese and round-shouldered patients.
Demonstrate the spine of the scapula in profile and is free of bony
superimposition except for the lateral end of the clavicle.

TANGENTIAL PROJECTION PRONE POSITION

• Patient in prone position
• Head resting on chin or cheek of the affected side.
CENTRAL RAY :
45° cephalad to scapular spine.
Demonstrate a tangential image of the scapular spine in profile and free of
superimposition of the scapular body.

SCAPULAR SPINE UPRIGHT TANGENTIAL

• Patient sitting with the back against the end of the table.
• IR on a 45° wedge support
Directed through the anterosuperior aspect of the shoulder region at a
posteroinferior angle of 45°
Demonstrate a tangential image of the scapular spine in profile and free of
superimposition of the scapular body.
CHEST
CHEST PA
• The vertebra prominens which corresponds to the level of the apex of the lungs
is the preferred landmark for locating the central ray on a PA chest.
• The vertebra prominens also corresponds to the same level as the T1.
• Use hand spread method for locating T7.
• For female 7 inches below.
• For male 8 inches below.
Central ray level for chest (T7) is same as the inferior angle of the scapula.
CHEST AP
• The easily palpated jugular notch is the recommended location
landmark for location of central ray for chest AP projection.
• The level of T7 is 3-4 inches below jugular notch.

CHEST PA PROJECTION
• Top of image receptor is 1 ½-2 inches above shoulders.
• Chin raised and resting against image receptor.
• Flex arms and back of the hands low on the hips with palms out so that scapula
will move laterally and will not superimpose over the lung fields.
• Depress shoulder to move clavicles below apices and rotated forward
Exposure is made at the end of the 2nd full inspiration to ensure maximum
expansion of the lungs.
• The source-to-image receptor distance (SID) is 72 inches (183 cm) to decrease
magnification of the heart and to increase recorded detail of thoracic structures.
CR perpendicular to level of T7
Horizontal fissure.
• 10 posterior ribs demonstrated above diaphragm.
• To demonstrate pneumothorax and foreign body, radiographs are made at the
end of full inspiration and expiration.
• The expiration chest will clearly demonstrate a pneumothorax.
CHEST LATERAL PROJECTION
• Left lateral position will demonstrate the heart, aorta and left sided pulmonary
lesions.
• Right lateral position will demonstrate right sided pulmonary lesions.
• Hilum in the center of the image.
• Oblique and horizontal fissure fissures.

CHEST PA OBLIQUE PROJECTION RAO AND LAO POSITIONS

• 45 degrees obliquity – Routine position.
• 60 degrees obliquity – studies of the heart (LAO)
• 15-20 degrees – better visualization of various areas of the lungs for possible
pulmonary lesions.
 This position is used to demonstrate the trachea, bronchial tree, heat and aorta
free from superimposition of the vertebral column.
Best demonstrates side farthest from image receptor
LAO
• Maximum area of the right lung.
• Anterior portion of left lung superimposed by the spine.
RAO
• Maximum area of the left lung.
• Anterior portion of right lung superimposed by the spine.
• Best image of the left atrium
CHEST AP OBLIQUE PROJECTION RPO AND LPO POSITIONS
Best demonstrates side nearest to image receptor.
RPO POSITION
• Maximum area of the right lung.
• Left lung appears shorter because of magnification of the diaphragm.
LPO POSITION
• Maximum area of the left lung.
• Right lung appears shorter because of magnification of the diaphragm.

CHEST LATERAL DECUBITUS POSITION

• The patient must remain in this position 5 minutes before exposure to achieved
best visualization so that fluid may settle and air to rise.
Demonstrates air-fluid levels.
• This position is used to demonstrate amounts of fluids in the pleural cavity
which would be demonstrated with the patient lying on the affected side.
• This position is used to demonstrate amounts of air in the pleural cavity
which would be demonstrated with the patient lying on the unaffected side.
PULMONARY APICES LORDOTIC POSITION LINDBLOM METHOD
• Top of the IR 3-4 inches above shoulder.
• Patient standing 1 foot away from the vertical cassette holder (VCH), facing
forward and leaning back with shoulders, neck and back of head against IR.
CR perpendicular to mid sternum
Used to demonstrate right middle lobe pneumothorax
• Preferred apical position for male patient.
• Pulmonary apices below clavicles
PULMONARY APICES AP SEMI-AXIAL PROJECTION
• Patient in upright or supine position.
CR 15°-20° cephalad to mid sternum.
• Alternative projection for patient who are weak and unstable to assume the
lordotic position.
• Used in hypersthenic patients and those patients whose clavicles occupy a
high position.
PULMONARY APICES PA AXIAL PROJECTION
• Patient in standing facing the VCH.
INSPIRATION
10°-15° cephalad to T3
EXPIRATION
Perpendicular to T3
Demonstrate the apices above the clavicles.
PULMONARY APICES FERGUZON METHOD
• Patient position is the same as chest PA.
CR 45 degrees caudad to the Angle of Louis.
• Preferred apical position for female patient.

PULMONARY APICES FELSON METHOD

• Patient is in PA position
• Ask patient to lean forward so that shoulder are in contact with the cassette.
CR horizontally directed to Angle of Louis.
• The leaning forward apical view.

REVERSE LORDOTIC PROJECTION FLEICHNER METHOD

• Ask the patient to lean backward in extreme lordosis so that the abdomen is
against the surface of the cassette.
CR horizontally directed to T4.
• The leaning backward apical view.

PULMONARY APICES AP AXIAL OBLIQUE LORDOTIC PROJECTION

LPO OR RPO POSITION
• Rotate patient’s body 30° away from the position used in AP projection.
• Patient in extreme lordosis.
CR perpendicular to mid sternum.
• This position will demonstrate dependent apex and lung of affected side.
• Pulmonary apices and interlobar effusions.