Specialty Views

Elbow internal oblique

Medically rotate elbow & adjust so anterior surface is 45 degrees CR= perpendicular to the elbow joint

Soft Tissue Neck

AP and lateral c-spine

L-spine Anterior Oblique

-Prone -40" SID 14x17 Length -Rotate body 45 degrees -Patient turns semi prone-support body on knee and forearm; turn away from the side of interest approx. 45 degrees to show the z-joint farthest from the IR -CR = perpendicular to enter the elevated side approx. 2 inches lateral to palpable spinous process and 1-1.5 inches above the iliac crest

Rhese Method (Parieorbital Oblique)

-Prone -x-ray beam is directed PA at 40 degrees to MSP -Nose, Chin, and zygoma should touch IR -MSP 53 degrees to IR

Sesamoids (toes)

-Prone (Lewis), Sitting (Holly) -Rest the great toe and ball of foot in dorsiflexion -Center= to 1st MTP joint -Collimate to 3x3 -Prone (lewis)= 10x12 crosswise -Sitting (Holly) = 10x12 lengthwise

Dorsoplantar Calcaneus

-Prone (on stomach) -Elevate ankle on sandbags -Adjust height and position of sandbags under the ankle so the patient can dorsiflex the ankle enough to place the long axis of the foot perpendicular to the tabletop -Place IR on plantar surface of foot -40 degree caudal angle -Center at achilles - Shows: the calcaneus, calcaneocuboid joint, & sustentaculum tali

PA Axial (Camp-Coventry)

-Prone position -Flex knee 40-50 degrees and place femoral portion of knee on IR and rest foot on support Center upper half of IR to knee joint -CR= Angled 40 degrees when the knee is flexed 40 degrees and 50 with 50 perpendicular to long axis of lower leg entering popliteal fossa and exiting patellar apex -Shows the intercondylar fossa and posterior inferior articulate surfaces of the condyles of the femur, medial and later intercondylar tubercles of the intercondylar eminence and tibial plateaus in profile

Coyle Method Trauma

-Radial head angle 45 degrees toward radial head -Coronoid process angle 45 degrees caudal to the coronoid process

AP Oblique Tib/Fib (internal and external oblique)

-Rotate limb medially or laterally 45 degrees Medial= elevate affected hip enough to rest medial side of foot and ankle against a 45 degree wedge and place a support under greater trochanter CR= mid point of tib-fib perpendicular to IR Shown: an oblique projection of the bones and soft tissues of the leg and adjacent joints

Coyle Method (Coronoid Process)

-Seated: -Flex elbow 80 degrees -CR is directed away from the shoulder at an angle of 45 degrees toward coronoid process -Supine (Trauma): Horizontal CR is directed caudal at an angle of 45 degrees to the coronoid process

AP L-Spine R or L Bending (spinal fusion)

-Supine or Upright -First image with max right bending, and make the 2nd with max left bending -If patient is supine cross legs to show equal bending force (ex. Right bending = left leg to be crossed over the right)...move heels toward the side that is flexed and immobilize with sandbags) CR- center perpendicular to L3 = 1-1.5 inches above crest -Usually done 6 months after fusion procedure; early scoliosis, localize herniated disk

L Spine Flexion and Extension

-Upright or lateral recumbent -Center IR to spinal fusion or level of L3 (1-1.5 inches above crest) -Flexion= bend forward as much as possible -Extension= bend backward as much as possible -Shown: determine whether motion is present in the area of a spinal fusion, indicating nonunion, or to localize a herniated disk due to limitation in motion

PA/PA Axial Mandible

-patient seated toward vertical bucky -forehead and nose on IR -Center exiting the Acanthion (For PA Axial angle 20-25 degrees cephalic)

SMV Mandible

-seated -Neck fully extended, rest the head on the vertex and adjust head so MSP is vertical -Center= midway between the angles of the mandible

Axiolateral oblique Mandible - BODY

-seated -mouth closed -extend neck -Angle tube 25 degrees cephalic -Rotate head 30 degrees toward IR

Axiolateral Oblique Mandible- SYMPHYSIS

-seated, mouth closed, extend neck -Angle tube 25 degrees cephalic -Rotate head towards IR 45 degrees

Axiolateral Oblique Mandible- RAMUS

-seated, mouth closed, extend neck -Angle tube 25 degrees cephalic -Keep head in true lateral position

Lateral ankle (lateromedial)

-supine -Medial Lateral -Patella perpendicular to horizontal plane -Center= 1⁄2 inch superior to lateral malleolus -Shown: lower third of tib fib, ankle joint, and the tarsal

PA Scaphoid with Ulnar Deviation Wrist

Elbow flexed 90 degrees CR= perpendicular to scaphoid

Carpal Canal Tangential (Gaynor-Hart Method)

Forearm adjust to low parallel with the long axis of the table Hyperextend the wrist Center IR to the joint at the level of the radial styloid process Rotate hand slightly to the radial side CR= directed to palm of the hand at the level 1 inch distal I base of third metacarpal and angled 25-30 degrees

PA Knee

Patient prone with toes on the table or sandbags under the ankle Center a point of 1/2 inch below patellar apex to center of IR; femoral condyles are parallel with tabletop CR= perpendicular for patients w large thighs or dorsiflexed foot

PA Axial Scaphoid (Stecher Method)

Place IR & wrist horizontal and angle CR 20 degrees towards the elbow.

PA Axial Scaphoid (Stecher Method)

Place one end of IR on support & adjust IR so that the finger end is elevated 20 degrees. Adjust wrist for a PA projection of the wrist.

Rhese Method

Prone CR= perpendicular to downsize of orbit MSP is 53 degrees to IR & AML is perpendicular to IR

SC joints oblique (CR angulation method)

Prone Center grid to level of SC joints From the opposite side of what's being examined, angle CR 15 degrees towards MSP to the midpoint of the IR CR should enter at level of T2-3 and 1-2 inches lateral to MSP If CR enters left side, right side is being shown.

Settagast method

Prone or supine Flex knee until patella is perpendicular to the IR IR= transversely under knee and center Ir to the joint space between the patella and the femoral condyles CR= perpendicular to the joint space between the patella and the femoral condyles when the joint is perpendicular. When the joint isn't perpendicular the degree of the CR angulation depends on the flexion of the knee. The angle is typically 15-20 degrees She's the articulating surfaces of the patellofemoral joint; can see vertical fractures Shouldn't be attempted until a transverse fracture of the patella has been ruled out

Hughston Method

Prone position Place IR under the femoral portion of the knee; flex tibia and fibula to form a 50-60 degree angle from the table Rest foot against collimator CR= 45 degree cephalic and directed to patellofemoral joint Shows the subluxation of the patella and patella fractures and allows radiologic assessment of the femoral condyles

Judet Method (outlet)

RPO or LPO with affected side down Align the body and center the hip being examined to the middle of the IR Elevate unaffected side so that MCP forms a 45 degree angle from table CR= perpendicular to the IR and entering at the pubic symphysis Shows the acetabular rim

Judet Method (internal)

RPO or LPO with affected side up Align the body and center the hip being examined to the middle of the IR Elevate the affected side so the MCP of the body forms a 45 degree angle from the table CR=perpendicular to the IR entering 2 inches inferior to the ASIS of the affected side Shows posterior rim of acetabulum

AP Oblique Foot (Lateral Rotation)

Rotate leg laterally until plantar surface of foot forms angle of 30 degrees to IR. CR= is perpendicular to base of third metatarsal. -Shows: 1st and 2nd metatarsal bases free of superimposition

AP Stress Views Ankle

Same as AP ankle but physician turns foot into extreme stress and holds or straps it in position Patient can hold it with a strip of bandage looped around the ball of the foot Done after an inversion or eversion injury to verify the presence of a ligamentous tear Rupture shown by widening the joint space on the side of the injury without moving or rotating the leg

AP L5-S1 (Ferguson Method)

Supine CR- 35 degrees cephalic for females 30 for males Center - 1.5 inches superior to pubic symphysis or 2-5 inches inferior to ASIS Shown: lumbosacral joint and a symmetric image of both SI joints free of superimposition

Pelvis Inlet & Outlet View

Supine CR= 30-45 degrees cephalic (outlet) caudal (inlet) and enters midline 2 inches inferior to the superior border of the pubic symphysis (outlet) ASIS (inlet) Outlet shows superior and inferior rami without the foreshortening seen in a PA/AP projection due to CR being more perpendicular to the rami Inlet shows an axial projection of the pelvic ring or inlet in its entirety

Lateral oblique knee

Supine May need to elevate hip of unaffected side enough to rotate the affected extremity Center IR 1/2 inch below patella Externally rotate limb 45 degrees CR angle: under 19 cm is 3-5 caudal, 19-24 cm is 0 & over 24 cm is 3-5 cephalic Shows the femoral condyles laterally rotated, the patella, tibial condyles, and the head of the fibula

AP Axial (Beclere Method)

Supine position Flex affected knee so long axis of femur is at an angle of 60 degrees to long axis of tibia Support the knees with sandbags; immobilize foot with sandbags Place IR under the knee and position IR so the center point coincides with the CR CR= perpendicular to long axis of the lower leg went wrong the joint 1/2 inch below patellar apex Shows the intercondylar fossa, intercondylar eminence, & knee joint

Clements-Nakayama Method

Supine with affected side near the edge of the table Do not rotate leg internally, external rotation Support a grid IR on the Bucky tray so that it's lower margin is below the patient Adjust to grid parallel to the axis of the femoral neck and tilt the top back 15 degrees CR= directed 15 degrees posteriorly and aligned perpendicular to the femoral neck and the grid of the IR; 30-40 degrees mediolateral Shows the acetabulum and proximal femur including the head, neck, and trochanter in lateral profile

PA Axial Holmblad

Tibial portion of knee is in contact with the IR and the patients upper body is stabilized with an appropriate support Place IR against anterior surface of the patients knee, center IR to the apex of the patella Flex knee 70 degrees from full extension CR= perpendicular to lower leg, enter ring the superior aspect of the popliteal fossa and exiting at the level of the patellar apex Shows the widened joint space between the femur and tibia and gives an improved image of the joint & surfaces of the tibia & femur

Lawrence Method

Upright Raise unaffected arm above head Elevate shoulder as much as possible Center IR to surgical neck of affected humerus CR= perpendicular to IR entering the mid coronal plane If patient can't elevate shoulder, angle CR 15-20 degrees Full inspiration or breathing technique required Shows relationship between proximal humerus & the scapula

SC joints

Upright Center IR at level of spinous process of third thoracic vertebrae (posterior to jugular notch) Palms to the side facing forward If bilateral, rest patients head on the chin Unilateral, turn head to face affected side CR= perpendicular to center of IR entering T3 Side pens at the end of expiration

Bilateral standing knees

Upright Center knees to IR toes straight ahead Knees fully extended and weight equally distributed Center IR 1/2 inch below spices of patella Shows the joint spaces of the knee, varus, & valgus deformities

Scoliosis series Ferguson method

Upright PA 72 inch SID Center 1 inch above iliac crest First radiograph patient standing normal and relax arms Second radiograph elevate patients hip or foot on the convex side 3-4 inches Shows T and L vertebrae for comparison to distinguish the deforming or primary curve from scoliosis

Coyle Method (radial head)

seated: - flex elbow 90 degrees -angle toward the shoulder 45 degrees - center at joint and mid elbow Supine (trauma): -Horizontal CR is directed cephalic at an angle of 45 degrees toward radial head