Positioning Review of Upper and Lower Extremities Reference Images in this presentation are from: Merrill’s Atlas of Radiographic Positioning and Procedures.

Eugene Frank, Bruce Long, Barbara Smith

Fingers

PA Second Digit Third Digit Fourth Digit Fifth Digit CR - PIP

Lateral Second Digit Third Digit Fourth Digit Fifth Digit

CR – MCP

Thumb

AP

Lateral

Hand

AP CR – 3 rd MCP

PA Oblique

Extension Lateral

Lateral

Fan Lateral

Wrist

PA 1. Scaphoid = Navicular 2. Lunate= Semilunar 3. Triquetrum = Triquetral, Triangular 4. Pisiform 5. Trapezium = Greater Multangular 6. Trapezoid = Lesser Multangular 7. Capitate = Os Magnum 8. Hamate = Unciform CR – Mid Carpal

Lateral

PA Oblique

AP Oblique

Ulna Deviation – Ulna Flexion

Stecher Method – Cassette raised

Stecher Method – Tube angled

Carpal Tunnel (Tangential Projection) - Gaynor-Hart Method

Forearm

AP

Lateral

Elbow

AP Epicondyles are parallel to the IR

Lateral Epicondyles are perpendicular to the IR

Medial (Internal) Rotation Oblique

Lateral (External) Rotation Oblique

Distal Humerus – Partial Flexion AP

Proximal Forearm – Partial Flexion AP

Humerus

AP

Lateral

Transthoracic Lateral

Lower Extremity

Toes

AP – Perpendicular CR CR - 3 rd MTP

AP Axial

AP Oblique – Medial Rotation

CR - Base of 3 rd metatarsal

Foot

AP Axial

AP Oblique – Medial Rotation

Lateral - Mediolateral

Ankle

AP

Lateral - Mediolateral

Medial Rotation (Internal) Oblique for bony structures

15-20 degree Medial Rotation for Ankle Mortise Joint

Lateral (External) Rotation Oblique

Stress Method Everson Stress For verification of ligament tear Inversion Stress

Calcaneus

Axial – Plantodorsal CR - base of 3 rd metatarsal

Lateral Calcaneus CR - 1” distal to medial malleoulus

Lower Leg

AP

Lateral

Knee

AP – Sthenic Patient CR - 1/2” distal to apex of patella

AP - Hypersthenic Patient

AP - Asthenic Patient

Lateral

AP Oblique - Lateral (External) Rotation

AP Oblique – Medial (Internal) Rotation

Bilateral knees – weight- bearing

CR - mid patella

Patella

PA

Lateral Patella

Settegast Method for Patella “Sunrise or Skyline View” Typical tube angle is 15-20 degrees

Hughston Method for Patella Lower leg forms 50-60 degree angle from table

Intercondylar Fossa - PA Axial Projection (Holmblad Method) Femur is at 20 degree angle “Tunnel” projection

Camp-Coventry Method If knee is flexed 40 degrees, the tube is angled 40

Femur

AP Projection (for distal femur)

AP Projection (for proximal femur)

Lateral femur to include knee

Lateral Projection (for proximal femur)