ALL XRAY VIEWS AND POSITIONS

SKULL XRAY VIEWS

1] OCCIPITOFRONTAL VIEW OF SKULL :

Occipitofrontal View of Skull (PA 20°)

Positioning:

Patient lies prone with midline of his body on midline of X-ray table. The chest is raised and rested
on folded arms. Nose and forehead are placed on the midline of table touching it. Head is positioned
such that MSP, and RBL are both at 90° to table-top. Head is immobilised, side is marked and beam is
collimated. Centring: It is done on nasion in the midline. Central beam is directed 20° to vertical in
caudad direction, passing through the occipital bone.

Technique: kVp - 80; mAs-100; FSS - small; FFD-100 cm; With grid; Cassette size - 12" x 10".

Note:AP view of skull is the exact opposite of PA 20° view. Here, patient is lying supine with RBL
perpendicu- lar to table top.

Centring is done on nasion with no tube tilt. PA 20° view is preferred to AP view of skull, as it gives
greater details of all structures.
Lateral View of the Skull

Positioning: Patient lies prone on X-ray table. Only his head is turned to true lateral position,affected
side in contact with table top. Chin is supported by fist of patient. His head is adjusted such that MSP
is parallel to table top as is the RBL.

Cassette is placed transversely in the bucky tray, such that the vertex is completely included in
radiograph. Head is immobilised, side is marked and beam is collimated.

Centring: It is done to temporal region midway between glabella and external occipital
protuberence.

Central beam is directed vertically at 90° to table top through a point (1") 2.5 cm above and infront
of external auditory meatus to centre of cassette.

Technique: kVp80; mAs-60; FSS - small FFD - 100 cm; With grid; Cassette size - 12" x 10".

For nasal bones : kVp-60; mAs-12; FSS - small; FFD - 100 cm; No grid; Cassette size 10" 5 x 8"
split into two halves.
Note:

For lateral view of face, paranasal sinuses or nasal bones, patient's positioning is the same, but
centring varies and exposure techniques also vary. In case of lateral view of face and paranasal
sinuses, centring is over the cheek bones placed on midline of X-ray table. In case of lateral view of
nasal bones, centring is over the nasion (non-grid film).

Towne's View of Skull (Fronto-occipital View/AP 30°)

Positioning: Patient is supine in midline of X-ray table, with chin fully tucked to chest and occiput of
skull in contact with midline of table. Head is adjusted so that, MSP and RBL are perpendicular to
table top. Head is immobilised, side is marked and beam is collimated.

Centring: It is done in midline on forehead (anterior hair line). Central beam is directed 30° caudad
to vertical, so that it enters at glabella and exits through the foramen magnum.
Technique: kVp-85; mAs-120; FSS - small; FFD - 100 cm; With grid; Cassette size - 12" x 10".

Note:

Cassette is displaced suitably downwards in Bucky tray, so that central beam falls on centre of
cassette. This view is used for study of petrous pyramids, internal auditory meati, mastoid air cells of
both sides, dorsum-sella, foramen magnum, temporal bones and parietal bones in profile. This view
is also used to demonstrate rami of mandible, zygomatic arch and TM joints. For dorsum sella, a 35°
tube tilt caudad is needed as in the case of TM joints.

Submentovertical View (Base of Skull View)

Positioning: Patient lies supine on midline of X-ray table. His neck is fully extended and vertex is in
contact with midline of couch. Head is adjusted so that MSP is at right angle and RBL is parallel to
table top. For this purpose, shoulders are to be raised with help of pillows, in order to bring the neck
into full extension. Head is immobilised, side is marked and beam is collimated.

Centring: It is done in midline between angles of mandible. Central beam is directed at 5° cephalad
to vertical. This enters at a point midway between angles of mandible and exits through vertex,
which is at the centre of cassette.
Technique: kVp-90; mAs-160; FSS - small; FFD - 100 cm; With grid; Cassette size - 12" x 10"

Note:

This view is used for studying the structures at the base of the skull, namely the sphenoidal sinuses,
greater wing of the sphenoid, the formen-lacerum, ovale, spinosum, the zygomatic arches, maxillary
sinuses, internal auditory meati, mastoid air cells and foreman magnum.

Occipitomental View for Paranasal Sinuses (Waters' View)

Positioning: Patient lies in prone position, in midline of X-ray table. His hands and arms are rested by
side of body. The nose and chin are placed in contact with table top. Head is positioned so that, MSP
is at right angles to table top and RBL is at 45° to table top. Immobilisation of the head is done, side
is marked and beam is collimated.
Centring: It is done in the middle through vertex to the level of lower orbital margin. Central beam is
directed vertically at 90° to table top.

Technique: kVp - 80; mAs - 120; FSS - small; FFD - 100 cm; With grid; Cassette size - 10" x 8".

PA View of Maindble

Positioning: Patient lies prone on midline of X-ray table, with chest raised and resting on folded fists.
His nose and fore-head are placed in contact with table top. Head is so positioned, so that MSP and
RBL are at right angles to table top. Head is immobilised, side is marked and the beam is collimated.

Centring: It is done in midline, midway between angles of mandible, approximately 7.5 cm (3")
below external occipital protruberence. Central beam is vertical at 90° to cassette.
Technique: kVp-75; mAs-80; FSS-small; FFD-100 cm; With grid; Cassette size - 10"x 8".

Lateral Oblique View of Mandible

Positioning: Patient lies supine on X-ray table, with his head turned towards the side under
examination. The opposite shoulder is supported by sand bag. The arms are rested by side of body.
Head is adjusted until MSP is parallel to table top and is immobilised, side is marked and beam is
collimated.

Centring: It is done 5 cm (2") below angle of mandible, on the side which is upper most. Central
beam is directed 30º cephalad to vertical.

Technique:
(1) kVp-75; mAs - 60; FSS - small; FFD - 100 cm; With grid; Cassette size - 10" x 8";
(2) kVp-60; mAs - 16; FSS - small; FFD - 100 cm; No grid; Cassette size - 10" x 8".

Note:

This view can also be done without grid, using a triangular wooden block on which cassette is kept.
Patient's mandible rests on cassette. The unaffected side mandible is centered to centre of cassette
with head in lateral position. No tube tilt is needed.

Temporomandibular Joint-Lateral Oblique View

Positioning: Patient lies prone in midline of X-ray table, with hands and arms on side of body.
Head is turned to lateral position, with the side of examination in contact with table top in midline.
The opposite shoulder is raised and supported with sand bags. The head is adjusted so that MSP is
parallel and IOL is at right angles to cassette. Head is immobilised, side marked and beam is
collimated using a localising mastoid cone.
Centring: It is done 5 cms (2") above the uppermost TM joint. Central beam is directed 25° caudad to
vertical, to pass through TM joint nearest to cassette.

Technique: kVp-75; mAs-60; FSS-small; FFD-100 cm; With grid; Cassette size 10" x 8".

Note:

Both sides are to be radiographed for comparison. It is better to expose in open mouth position, to
demonstrate any subluxation. TM joints are also clearly seen in Towne's view.

Lateral Oblique View of Mastoids

Positioning: Patient lies in prone position in midline of X-ray table, with head in lateral position. The
side under study is in contact with table top midline. The pinna of ear is folded forwards. The raised
shoulder is supported with sand bag and arms are placed by side of the body. Head is 5 adjusted so
that MSP is parallel and IOL is perpendicular to the table top. Head is immobilised, side is marked
and beam is collimated.

Centring: It is done 5 cm (2") above and 2.5 cm (1") behind the external auditory meatus of upper
most side. The central beam is directed at 25° caudad to vertical.

Technique:

(1) kVp-70; mAs-60; FSS - small; FFD - 100 cm; With grid; Cassette size - 10" x 8"/2; (2) kVp-65; mAs-
45; FSS - large; FFD - 100 cm; No grid; Cassette - 10" x 8"/2

Note: Both sides are to be radiographed for comparison.

Optic Foramen View

Positioning: Patient lies prone in central line of X-ray table. The orbit under study is placed in midline
of table with the forehead, cheek, nose and chin in contact with table top. Head is adjusted so that
MSP and RBL are at an angle of 35° to vertical. Head is immobilised, side is marked and beam is
collimated. Localising cone can be used (mastoid cone).

Centring: It is done through the orbit nearest to film. The central beam is directed vertically at 90° to
film, passing through a point between mastoid and external occipital protruberance of the side
uppermost. Both sides are examined at same time for comparison.
Technique: kVp-80; mAs-60; FSS - small; FFD - 100 cm; With grid; Cassette size - 10" x 8"/2.

RADIOGRAPHY OF THE CHEST

Posteroanterior View of Chest (PA View)

Positioning: Patient stands erect in front of a chest-stand facing it. His neck is extended slightly and
chin is placed on the chin-rest, or on upper border of cassette holder. Back of his hands are placed
on his hips. Shoulders are pressed forwards against cassette. It is ensured that trunk is not rotated.
Patient is asked to remain motionless. Side is marked and X-ray beam is collimated.

Centring: It is done on D-6 vertebra level in the midline of back of chest (at a point midway between
inferior angles of scapulae). The central beam is directed horizontally at 90° to cassette.
Note: Exposure is done during the arrested full inspiration. In cases of suspected pneumothroax,
expiratory films may be done using a slightly less kVp. For a penetrated view of the erect PA view of
chest, higher kVp is required.

Techniques: No grid; FSS - large 1.

1.Adult PA: kVp - 65; mAs-20; FFD – 180 cm; C. size - 15" x 12";

2. Child PA: kVp - 60; mAs - 12; FFD – 180 cm; C. size - 12" x 10";

3. Child AP: kVp - 60; mAs - 10; FFD - 100 cm; C. size - 10" x 8";

4. Adult AP: kVp-65; mAs – 16; FFD - 100 cm; C size - 15" x 12";
5. Penetrated PA: kVp - 80; mAs - 30; FFD - 150 cm; Cassette size - 15" x 12"; FSS - Small.

Lateral View of the Chest

Positioning: Patient stands erect in true lateral position, in front of chest-stand. His shoulders are
moved well back, hands and arms raised above his head. Patient is asked to remain motion-less. Side
is marked, and beam is collimated.

Centring: It is done over mid-axillary line to the centre of cassette, with central beam directed
horizontally at 90° to the cassette.

Technique: kVp-75; mAs-40; FSS- large; FFD - 150 cm; No grid; Cassette size - 12" x 10".

Note:

The same view is done for left lateral view of chest with barium swallow also. Exposure is made in
arrested respiration. Decubitus lateral view can be done, with patient lying supine on X-ray table or
stretcher trolley, with his back of chest raised over pillows and cassette being held vertically by side
of his chest by an attendant, when patient is too ill to stand or sit. For lateral view of chest, centring
is done at the level of sternal angle.

Anterior Oblique View of the Chest

Positioning: Patient is sitting or standing erect in front of chest-stand, facing cassette. For right
anterior oblique view, his right shoulder is placed in contact with cassette and left shoulder is
rotated away until the thorax is at an angle of 60° to cassette. For left anterior oblique view, his left
shoulder is in contact with cassette and right side rotated away till the thorax is at an angle of 60° to
cassette. His arms are raised over his head. Side is marked and beam is collimated.

Technique: kVp-70; mAs-45; FSS-large; FFD-150 cm; No grid; Cassette size - 12" x 10".
Note: The same views are done for RAO and LAO with barium swallows.

Penetrated AP View of the Chest

Positioning: The patient lies supine on the midline of the X-ray table, with the arms abducted. The
upper border of the cassette is placed 2.5 cm (1") above the root of the neck. The back of the chest
shall be in good contact with the table top.

Centring: It is done on midline to the sternal angle for upper ribs, on to xiphi-sternum for lower ribs.
Central beam is directed vertically at 90° to centre of cassette.

Technique: kVp - 70; mAs - 30; FSS - small; FFD - 100 cm; No grid; Cassette size - 12" x 10".

Note:

This view is done for study of ribs and dense intra-thoracic lesions. Decubitus AP view is obtained
with patient lying in lateral position and cassette held at back of his chest vertically to cover the
whole of chest, directing central beam horizontally at 90° to centre of cassette (to demonstrate any
minimal fluid in pleural cavity along the lateral chest wall). Chest is raised on pillows for decubitus
view.

Apical View of the Chest

Positioning: Patient is seated or standing erect, facing cassette in chest-stand. He is asked to lean
back, making an angle of 45° to cassette in chest-stand. He grips the sides of stand, for support and
immobilisation. Side is marked and beam is collimated.

Centring: It is done in midline at D-4 vertebra level. Central beam is directed horizontally at 90° to
centre of cassette.

Technique: kVp-70; mAs-20; FSS - small; FFD-100 cm; No grid; Cassette size - 12" x 12".

Note:

Exposure is done in arrested respiration. This view is useful in demonstrating the apices of lung
fields, free of clavicular shadows and also on cases of any interlobar pleural effusion. Alternatively, a
Lordotic View (Fig. 5.81B), may be done with patient facing X-ray tube directed horizontally, as he
stands in front of chest-stand and leans to it, with his back to the cassette by his shoulders making
an angle of 30° to cassette. Central beam is directed 30° cephalad to horizontal.

Anterior Oblique View of the Sternum

Positioning: Patient lies prone on midline of X-ray table. One side of his trunk is raised, to make 45°
angle with table top. His head and face are turned towards raised side. His raised shoulder is
supported suitably and he is immobilised. It is ensured that sternum is centred to the centre of
cassette. Side is marked and beam is collimated.

Centring: It is done at 10 cm (4") away from spinous process of 5th dorsal vertebra (on the side
remote to cassette). Central beam is directed vertically at 90° to centre of cassette.
Technique: kVp - 65; mAs - 60; FSS - small; FFD - 100 cm; With grid; Cassette size - 12" x 10".

Note:

Exposure is made during quiet respiration, using a low mA and a long exposure time to diffuse rib
shadows (tomographic effect).

RADIOGRAPHY OF ABDOMEN

Supine AP View of Abdomen (KUB)

Positioning: Patient is supine on midline of the X-ray table, with hips slightly flexed and knees resting
on pillows. His hands and arms are above the head. It is ensured that his trunk is straight. The upper
border of cassette is just above xiphi-sternum and the lower border, at a level just 5 below
symphysis pubis. Patient is immobilised, side is marked and beam is collimated.

Centring: It is done in midline to middle of cassette over umbilicus (L-3 level) Central beam is vertical
at 90° to cassette.

Technique: kVp-80; mAs-120; FFS - large; FFD - 100 cm; With grid; Cassette size - 15" x 12".

Note: Exposure is made during arrested inspiration.

Lateral View of Abdomen

Positioning: Patient lies in true lateral position on midline of X-ray table. His arms are raised over the
head. Upper border of cassette is at the level of xiphi-sternum. Patient is immobilised, side is marked
and beam is collimated.

Centring: It is done over mid-axillary line to midline of the cassette. Central beam is directed
vertically at 90° to cassette. Exposure is made in arrested inspiration.

Technique: kVp - 70; mAs - 140; FSS – large; FFD - 100 cm; With grid; Cassette size - 15" x 12".
Erect PA View of the Abdomen

Positioning: Patient stands facing chest-stand, supporting himself by his hands resting on the stand.
Upper border of cassette is at the level of nipples. Patient is immobilised, side is marked and beam is
collimated.

Centring: It is done to L-3 vertebra. Central beam is directed horizontally to centre of cassette at 90°
to it.

Technique: kVp - 70; mAs - 30; FSS – large; FFD – 100 cm; No grid; Cassette size - 15" x 12"

Note:

In very ill patients who cannot stand or sit, this view is modified into a decubitus view. Patient lies in
lateral position on X-ray table, with abdomen raised on pillows
Supine Decubitus View of Abdomen

Positioning: Patient lies supine on midline of X-ray table, with his legs extended. It is ensured that
trunk is not rotated. Cassette is vertically supported in contact with one side of his abdomen. Upper
border of cassette is at the level of nipples and lower border below the level of iliac crest. Beam is
collimated.

Centring: It is done in mid-axillary line to centre of cassette. Central beam is directed horizon- tally to
centre of cassette at 90° to it. Exposure is made in arrested inspiration
Technique: kVp – 70; mAs - 30; FSS – large; FFD – 100 cm; No grid; Cassette size 15" x 12".

Note: This view is an alternative to the erect lateral view of abdomen.

Lateral Decubitus View of Abdomen

Positioning: Patient lies on X-ray table in true lateral position. Hips and knees flexed, and legs
supported in comfortable position. Arms are raised and rested over the head. Cassette is held
vertically in contact with anterior/posterior abdominal wall. Xiphi-sternum and symphysis pubes are
included. Patient is immobilised and beam is collimated.

Centring : It is done over umbilicus (L-3 vertebra) to the centre of cassette. Central beam is directed
horizontally at 90° to the film.

Technic: kVp - 70; mAs-30; FSS-large; FFD-100 cm; No grid; Cassette size - 15" x 12".

Note:

This projection may be needed in trauma cases and in cases of suspected perforation of an
abdominal hallow viscus. Usually left lateral view is taken to avoid confusion between free air in
peritoneal cavity and the air in gastric fundus. Pillows are kept below lateral aspect of patient.

RADIOGRAPHY OF PHARYNX

Lateral View for Postnasal Space

Positioning: Patient sits or stands in a lateral position, in relation to cassette in chest-stand, with his
head in a chin raised position. Upper border of cassette is at the level of glabella and lower border
below the angle of mandible. Patient is immobilised and beam is collimated.

Centring: It is done to lower border of zygoma, with central beam directed horizontally at 90º 16
centre of cassette.

Technique: kVp-60; mAs-15; FSS-small; FFD-100 cm; No grid; Cassette size-10"x8"

Submento-vertical View of Pharynx

Positioning: Patient sits in front of chest-stand facing X-ray tube. His chin is raised so that RBL is
parallel to cassette.

Centring: It is done between the angles of mandible, at right angles to RBL. Central beam is directed
horizontally to cassette at 90° to it.

Technique: kVp-80; mAs-100; FSS-large, FFD-100 cm; No grid; Cassette size - 12" x 10".

Occipito-mental View for Pharynx

Positioning: Patient faces cassette in chest-stand, with his chin raised in contact with cassette, so
that RBL is at 45° to the vertical. Patient's mouth is kept as wide open as possible.

Centring: It is done to a point midway between lower orbital margins to centre of cassette, with a
horizontal central beam.

Technique: kVp-80; mAs-100; FSS-small; FFD-100 cm; No grid; Cassette size-10"x8"

Note:

Same view also demonstrates coronoid process of mandible. It is helpful in visualising any extra
pharyngeal extension of nasopharyngeal tumour .

Lateral View for Larynx

Positioning: Patient is standing or sitting in front of chest-stand, in lateral position with one of his
shoulders against cassette, with head and chin in raised position. Upper border of cassette is at the
level of top of pinna and lower level of cassette at the level of shoulder.
Centring: It is done at 5 cm (2") posterior to front of neck at level of Adam's apple (Laryngeal
prominence). Central beam is directed horizontally at 90° to centre of cassette.

Technique: kVp-65; mAs-20; FSS-small; FFD-100 cm; No grid; Cassette size-10" x 8".
SALIVARY GLANDS RADIOGRAPHY

Lateral View for Parotid Gland

Positioning: Patient lies prone on X-ray table, with his head in lateral position, so that MSP is parallel
to table top.

Centring: It is done to angle of mandible. Central beam is directed vertically at 90° to table and
centre of cassette.

Technique: kVp-70; mAs-25; FSS-small; FFD-100 cm; No grid; Cassette size-10"x8"

AP View for Parotid Glands

Positioning: Patient lies supine on X-ray table in midline. His head is positioned such that RBL is at
right angles to table top and then the head is rotated about 5° to the side opposite to involved side.

Centring: It is done midway between angles of mandible. Central beam is directed vertically at 90° to
centre of cassette.

Technique: kVp-70; mAs-30; FSS-small; FFD-100 cm; No grid; Cassette size-10" x 8".

Lateral Oblique for Parotid Gland

Positioning: Patient lies prone on midline of X-ray table with head in lateral position.
Centring: It is done over the angle of mandible uppermost. Central beam is directed at 15° cephalad
to the vertical.

Technique: kVp-70; mAs-25; FSS-small; FFD-100 cm; No grid; Cassette size-10" x 8"

Lateral View for Submandibular and Sublingual Salivary Glands

Positioning: Patient lies in prone position in midline of X-ray table and his head in lateral position, a
wooden spatula is used to depress the floor of mouth which is held by patient himself, firmly in
position. His chin shall be raised.

Centring: It is done at a point 2.5 cm (1") anterior to angle of mandible upper most. Central beam is
directed vertically at 90° to centre of cassette.

Technique: kVp-70; mAs-25; FSS-small; FFD-100 cm; No grid; Cassette size-10" x 8".

Infero-superior View for Submandibular/Sublingual Gland

Positioning: Patient sits in front of X-ray tube such that, his head is in submento-vertical position in
relation to X-ray tube. An occlusal film is placed well back in the mouth and the patient closes his
teeth gently to steady it.

Centring: Done below angle of mandible. Central beam is directed horizontally at 90° to the film.

Technique: kVp-75; mAs-30; FSS-small; FFD-100 cm; occlusal film.

RADIOGRAPHY OF
THE VERTEBRAL COLUMN CERVICAL SPINE

AP View of Upper Cervical Spine (C1-C3)

Positioning: Patient lies supine in midline of X-ray table with back of his head resting on table top
without any side-ward tilt. The neck is extended until the RB line of the skull is at 20º to the vertical.
Head is immobilised with sand bags. The mouth is kept as wide open as possible to avoid mandibular
shadow from superimposing on the upper cervical vertebrae. Side is marked and beam is collimated.

Centring: It is done to centre of open mouth. Central beam is directed vertically, at 90° to the
cassette and parallel to hard palate.

Technique: kVp-60; mAs-40; FSS-small; FFD-100 cm; With grid; Cassette size - 10" x 8".

AP View of Lower Cervical Spine

Positioning: Patient lies supine on midline of X-ray table. Back of his head rests on table top. His chin
is raised until the lower border of mandible is at 90° to the table top. The head is immobilised. Side is
marked and beam is collimated.

Centring: It is done in the midline, 5 cm (2") above suprasternal notch. Central beam is directed 15°
cephalad to vertical, to reach the centre of cassette.

Technique: kVp-60; mAs-40; FSS - small; FFD - 100 cm; With grid; Cassette size 10" x 8".
Note: This view may be done with patient in erect posture.

Lateral View of the Cervical Spine

Positioning: Patient is seated or standing in front of chest-stand in lateral position. His chin is raised
until angle of mandible clears off cervical vertebrae. Shoulders are depressed as low as possible with
help of sand bags held by both hands. Tip of shoulder is rested on lower border of cassette. Side is
marked and beam is collimated.

Centring: It is done 2.5 cm (1") posterior to angle of mandible. Central beam is directed horizon- tally
at 90° to cassette.

Technique: kVp - 70; mAs -20; FSS-large; FFD - 150 cm; No grid; Cassette size 10" x 8".
Anterior Oblique View of the Cervical Spine

Positioning: Patient is seated or standing facing chest stand with neck placed in centre of cas- sette.
Rotation of patient to left side about 45° from original position is needed for right anterior oblique
view and vice-versa. Chin is depressed slightly and the head is turned until the mid- sagittal plane
(MSP) is parallel to cassette. Side is marked and beam is collimated.

Centring: It is done to middle of neck 2.5 cm (1") below the angle of mandible. Central beam is
directed horizontally and then tilted 15° caudal.

Technique: kVp-65; mAs-30; FSS-large; FFD - 100 cm; No grid; Cassette size - 12" x 10".

Note: Both obliques are taken for comparison of IV foramen.

AP View of Cervico-dorsal Spine

Positioning: Patient lies supine on midline of X-ray table. His chin is raised slightly. It is ensured that
head is not tilted to one side. The region from C-4 to D-4 vertebrae shall be included in the field.
Patient is immobilised, side is marked and beam is collimated.

Centring: It is done on suprasternal notch. Central beam is directed vertically at 90° to cassette.

Technique: kVp-70; mAs-60; FSS - Large; FFD-100 cm; With grid; Cassette size - 12" x 10".

Note: Exposure is made in arrested inspiration.

Lateral View of CD Spine (Swimmer's View)

Positioning: Patient lies on midline of X-ray table in true lateral position. Lower part of arm is rested
by side of the body and upper arm is raised above head. Head is supported by sand bags for
immobilisation. Side is marked and beam is collimated.

Centring: It is done to axilla of opposite side with central beam vertical at 90° to the cassette.

Technique: kVp-70; mAs-70; FSS-large; FFD-100 cm; With grid; Cassette size - 12" x 10".
AP View of Dorsal Spine

Positioning: Patient is lying in supine position on midline of X-ray table with arms and hands by side
of the body. The head is rested on a pillow. Upper border of cassette is placed just above shoulder.
Patient is immobilised, side is marked and beam is collimated.

Centring: It is done in the midline midway between sternal angle and xiphoid process. Central beam
is directed vertically at 90° to cassette.

Technique: kVp-75; mAs - 80; FSS - large; FFD - 100 cm; With grid; Cassette size - 12" x 10".

Note: Exposure is done during arrested inspiration to lower diaphragms maximally. High kV
technique is used for better visualisation of dorsal spine. It is important to include either D-1 or D-12
vertebra in the field so that counting of the affected vertebra is possible.
Lateral View of Dorsal Spine

Positioning: Patient lies in true lateral position on midline of X-ray table with arms raised above the
head which rests on a pillow. Hips and knees are slightly flexed to place legs in a comfortable
position using sandbags. It is ensured that thoracic spine is parallel to table top. Patient is
immobilised and beam is collimated.

Centring: It is to be done 2" (5 cm) anterior to spinous process of 6th dorsal vertebra. Central beam
is directed vertically at 90° to cassette.

Technique: kVp80; mAs80; FSS-large; FFD-100 cm; With grid; Cassette size - 12" x10".

Note: A lead rubber sheet may be placed behind patient on table top to improve quality of image.
Exposure is made during quiet respiration to diffuse the rib shadows, and to get a good image of
vertebrae (tomographic effect). For a cone down view of any specific vertebra, a low mA and a long
exposure time (4 sec) may be used, while focusing of central beam on vertebra of interest.
AP View of Lumbar Spine

Positioning: Patient lies supine in midline of X-ray table with arms by side of the body. Shoulders are
supported by pillows. Knees are flexed and soles of feet rested on table top. It is ensured that trunk
and the pelvis are not rotated. Side is marked and beam is collimated.

Centring: It is done in midline at a level midway between lower costal margin and anterior superior
iliac spine (L-3 level). Central beam is directed 90° to table top. Exposure is done in arrested
respiration.

Technique: kVp-80; mAs - 100; FSS - large; FFD-100 cm; With grid; Cassette size - 12" x10".
Lateral View of Lumbar Spine

Positioning: Patient lies with lumbar spine in lateral position on midline of X-ray table, with arms
raised over his head. Hips and knees are flexed slightly. Using sand bags, patient is immobilised in
this position. Beam is collimated.

Centring: It is done 10 cm (4") anterior to spinous process of L-3 vertebra. Central beam is directed
vertically at 90° to centre of cassette.

Technique: kVp – 90; mAs - 120; FSS - large; FFD - 120; With grid; Cassette size - 12" x 10".
Note: A lead rubber sheet placed behind the patient on table top, improves image quality. FFD is
increased to compensate for the large object film distance. Exposure is done in arrested expiration.

Posterior Oblique View of Lumbar Spine

Position: Patient lies with his lumbar spine in midline of X-ray table in a supine position first. Then he
is rotated 45° to left or right as the case may be. His arm of raised side is above his head and the
other arm by side of his body. His trunk and pelvis are supported with sand bags and legs are kept in
a comfortable position. Side is marked and beam is collimated.

Centring: It is done on midclavicular line at the level of costal margin of raised side.

The central beam is directed vertically at 90° to the centre of the film.
Technique: kVp-90; mAs-120; FSS-large; FFD-120 cm; With grid; Cassette size - 12" x 10".

Note:

Exposure is done in arrested expiration. Both sides' oblique views are to be done for comparison.
This view is indicated to demonstrate the Pars interarticularis of vertebrae.

AP View of Lumbo-sacral Spine

Positioning: Patient lies supine on midline of X-ray table with his arms by side of his body. His knees
are raised and flexed so that soles of feet are resting on table top. This ensures trunk is straightened
and pelvis is not rotated. Side is marked and beam is collimated.

Centring: It is done in midline at the level of anterior superior iliac spines. Central beam is directed
10° cephalad to vertical.

Technique: kVp-80; mAs-100; FSS-large; FFD-100 cm; With grid; Cassette size - 12" x 10".
Note:

Exposure is done in arrested expiration. Degree of tube tilt will depend on the lumbo-sacral angle.
For AP view of Sacrum, centring is done over symphysis pubis, with tube tilt of 20" cephalad to
vertical. For AP view of Coccyx, centring is done in midline at a point 2.5 cm (1") above symphysis
pubis with tube tilt of 15" Caudad to vertical.

Lateral View of Lumbosacral Spine

Positioning: Patient lies with lumbosacral spine in true lateral position on midline of X-ray table with
arms raised above his head, which is supported by pillow. Hips and knees are flexed and legs are
placed in a comfortable position to ensure that lumbar spine is parallel to table-top. Patient is
immobilised in this position with sand bags. Beam is collimated after side marking.

Technique: kVp - 90; mAs - 160; FSS - large; FFD - 120 cm; With grid; Cassette size - 12" x 10".
Sacroiliac Joints-Posterior Oblique View

Positioning: Patient lies supine on the X-ray table midline with legs extended. The patient is rotated
15° to the left side or to right side as the case may be to raise the SI joint under examina- tion. The
raised side leg is crossed over the other leg at the ankle. The patient is immobilised, side marked,
and the beam is collimated.

Centring: It is done 2.5 cm (1") medial to the anterior superior iliac spine on the raised side. The
central beam is directed vertically at 90° to the film.

Technique: kVp - 80; mAs - 120; FSS - large; FFD - 100 cm; With grid; Cassette size - 12" x 10".

Note:
Exposure is done in arrested respiration. Both sides are to be radiographed for comparison. Due to
oblique and irregular surface of sacrum and both iliac bones, this is the only view, which
demonstrates Sl joint spaces individually. This view is indicated, when there is a doubt about
diagnosis of a disease in Sl joints from AP view.

RADIOGRAPHIC VIEWS OF THE UPPER LIMB

Fingers-PA View

Positioning: Patient is seated on a stool along side the X-ray table, placing the palmar surface of
affected finger on the film. The other fingers are kept slightly separated. Thumb or little finger,
whichever is nearer also is to be included in the field of view.
Hand is immobilised with sand bags and a side marker is placed. X-ray beam is collimated for proper
smaller aperture. The unused part of cassette is covered with lead-blocker.

Centring: At the level of proximal interphalangeal joint. The central beam is vertical at 90° to the
cassette. 8½" x

Technique: kVp - 60; mAs - 4; FSS-large; FFD - 100 cm; No grid; Cassette size 6½".
Fingers-Lateral View

Positioning: Patient is seated on a stool along side the X-ray table. Affected hand is rotated medially
and placed on the cassette with involved finger resting by its lateral aspect. The other fingers are
separated slightly from involved finger. This finger is extended and supported with sand bags, while
the other fingers are flexed. The hand is immobilised, side marked and the beam is collimated.

Centring: At the level of proximal interphalangeal joint. The central ray is vertical at 90° to the centre
of the second half of cassette, while the first half is covered with lead blocker.

Technique: kVp60; mAs 4; FSS-large; FFD - 100 cm; No grid; Cassette size - 8%" x 6½".
THE HAND AND WRIST

PA View (Dorsipalmar View) of Hand and Wrist

Positioning: Patient is seated on a stool on the side of X-ray table. The hand, wrist and forearm are
kept extended in a straight line. The palmar aspect of hand including wrist joint is placed on the
cassette. The fingers are extended and separated slightly and spaced evenly. The lower part of
forearm and wrist are immobilised with sand bags. The unused part of the cassette is covered with
lead blocker. Side marked and beam is collimated.

Centring: On the head of the third metacarpal bone. The central beam directed vertically at 90° to
the centre of the film.

Technique: kVp-60; mAs-5; FSS-large; FFD - 100 cm; No grid; Cassette size - 12" x 10".
Oblique View of the Hand and Wrist

Positioning: Patient is seated on a stool on the side of X-ray table. Hand, wrist and forearm are
extended in a straight line. The palmar aspect of the hand including wrist is placed on the cas- sette.
The thumb side is raised until the palm makes about 45° to cassette. The fingers are kept slightly
flexed and also separated from each other. The thumb is rested on a support pad. Fore- arm is
immobilised with a sand bag. The unused half of the cassette is covered by a lead blocker.Side
marked and beam is collimated.

Centring: On the head of fifth metacarpal bone. The central beam directed vertically at 90° to the
centre of the film.

Technique: kVp-60; mAs6; FSS-large; FFD-100 cm; No grid; Cassette size - 2" x 10".

Note:

This view is preferred to the lateral view because, the metacarpals and carpals superimpose on each
other in lateral view. The same is true for proximal phalanges also.
AP Oblique View of Both Hands (Ball Catcher's View)

Positioning: The patient is seated at one end of X-ray table on a stool. The hands are cupped as

if catching a ball, resting on the cassette by their medio-dorsal aspects. Sand bags are used to
immobilise the hands and wrists in this position. Side is marked.

Centring: It is done midway between the hands at the level of the heads of fifth metacarpals.

The central ray is directed vertically at 90° to the film.

Technique: kVp-60; mAs-6; FSS-large; FFD - 100 cm; No grid; Cassette size - 12" x 10".

Note: Metacarpophalangeal joints are better demonstrated in this view.

PA View of the Wrist

Positioning: Patient is seated on the side of X-ray table. The palm, wrist and lower end of forearm
are rested on cassette and are immobilised with sand bag. Side is marked and unused half of
cassette is blocked with lead sheet.

Centring: It is done midway between the radial and ulnar styloid processes. The central ray is

directed vertically at 90° to the film.

Technique: kVp-60; mAs6; FSS-large; FFD - 100 cm; No grid; Cassette size - 10" x 8".
Lateral View of the Wrist

Positioning: The patient is seated on the side of X-ray table. The hand, wrist and forearm are
extended. Forearm is rotated and little finger side is rested on cassette. The back of hand is
supported by sand bag. Side is marked and unused part of cassette is covered by lead blocker.

Centring: It is done on radial styloid process. The central ray is directed vertically at 90° to

cassette.
Technique: kVp-60; mAs-9; FSS-L; FFD-100 cm; No grid; Cassette size - 10" x 8".

PA Oblique View of Wrist with Ulnar Deviation for Scaphoid

Positioning: Patient is seated on the side of X-ray table. Palm, wrist and forearm are rested on
cassette. Hand is rotated laterally for about 45º tilt, and it is kept deviated to the ulnar side. The
hand is immobilised in this position by sand bags under the thumb and fingers. Side is marked and 5
beam is collimated. Unused part of cassette is covered by a lead blocker.

Centring: It is done on ulnar styloid process. The central beam is directed vertically at 90° to the
centre of cassette.

Technique: kVp60; mAs8; FSS-large; FFD-100 cm; No grid; Cassette size 10" x 8".
Superoinferior View of Wrist (Axial) for Carpal Tunnel

Positioning: Patient stands near X-ray table with his arm extended. The elbow and wrist are flexed
with fingers and thumb well-separated. The palm is pressed down on the cassette kept near edge of
the table. It is ensured that carpal tunnel is in profile. Side is marked and the beam is collimated.

Centring: It is done on the mid-carpal region. The central beam is directed vertically at 90° to
cassette.

Technique: kVp - 65; mAs - 6; FSS-large; FFD - 100 cm; No grid; Cassette size - 10" x 8".

Note: This view affords the clear depiction of carpal-tunnel, through which flexor tendons of forearm
pass on to hand.
FOREARM AND ELBOW

AP View of Forearm

Positioning: The patient is seated on the side of X-ray table. The forearm is fully supinated, elbow
extended and placed on the film. Either the wrist or elbow shall positively be included in radiograph.
The hand is immobilised with sand bag, side marked and beam is collimated. The unused part of
cassette is covered with lead blocker.

Centring: It is done on anterior aspect of middle of forearm, midway between wrist and elbow.

The central beam is directed vertically at 90° to the centre of cassette.

Technique: kVp - 60; mAs - 10; FSS – large; FFD - 100 cm; No grid; Cassette - 12" x 10".
Lateral View of Forearm

Positioning Patient is seated on the side of X-ray table, lowering the affected shoulder to the level of
table. The elbow is flexed at 90" and forearm is placed by its medial border on cassette. Either the
wrist or elbow is positively included in the radiograph.

The hand is immobilised by sand bags. Side is marked and beam collimated. Unused part of cassette
is covered with lead blocker.

Centring: It is done on lateral aspect of forearm over radius, midway between wrist and elbow, The
central ray is directed vertically at 90° to centre of cassette.
Technique: kVp-60; mAs-10; FSS-large; FFD-100 cm; No grid; Cassette size-12" x 10"

AP View of Elbow

Positioning: Patient is seated sideways along side the X-ray table, with shoulder at the level of table.
Forearm is fully supinated and elbow extended and is rested on cassette. Side is marked,beam
collimated and unused part of cassette is covered with lead blocker.

Centring: It is done on the midpoint of the anterior aspect of forearm. The central ray is directed
vertically at 90° to the centre of the film.

Technique: kVp-60; mAs-8; FSS-large; FFD-100 cm; No grid; Cassette size - 10" x 8".

Note: For AP view of head of radius, forearm is in mid pronation, with palm of hand resting on the
table. If extension is impossible, then elbow may be kept in flexion.
Lateral View of Elbow

Positioning: Patient is seated sideways alongside X-ray table with shoulder at the level of the table.
Elbow is flexed to 90° and forearm rotated into true lateral position with thumb uppermost. Medial
border of elbow is rested on cassette. Hand and wrist are immobilised with sand bag, side marked,
beam is collimated and unused part of cassette is covered with a lead blocker.

Centring: It is done on lateral epicondyle of humerus, the central beam is directed vertically at 90°
to the film.

Technique: kVp-60; mAs8; FSS-large; FFD-100 cm; No grid; Cassette size-10" x 8".
Note: For lateral view of head of radius, forearm is fully pronated so that radial aspect is resting on
the table. In cases of supracondylar fractures, radiography may have to be done with cassette placed
between chest and elbow with X-ray beam directed horizontally.

Oblique View of Elbow

Positioning: Patient is seated sideways on the side of X-ray table with shoulder at the level of the
table. Elbow is extended and the forearm is fully supinated. The arm is rotated slightly outward to
separate heads of radius and ulna. Elbow is rested on cassette in this position. The hand and wrist
are immobilised with sand bag. Side is marked, beam collimated and unused part of cassette is
covered by lead blocker.

Centring: It is done on head of radius. The central ray is directed vertically at 90° to the cassette.
Technique: kVp-65; mAs-8; FSS-large; FFD-100 cm; No grid; Cassette size 10" x 8"

Note: This view shows the head of radius free from ulna.

Axial View of Elbow

Positioning: Patient is seated on the side of X-ray table, with shoulder at the level of table. Elbow is
flexed such that hand is in contact with shoulder. Elbow is rested on the cassette, so that arm is at
the level of table. Side is marked, beam collimated and unused part of cassette is covered with lead
blocker.
Centring: It is done on back of forearm in midline, 5 cms distal to olecranon process. The central
beam is directed at 90° to the film. Technique: kVp-70; mAs-10; FSS-large; FFD-100 cm; No grid;
Cassette size - 10" x 8",

Note:This view demonstrates a supracondylar fracture, if radiography is to be done with the sling on.

AP View of Elbow for Ulnar Groove

Positioning: Patient sits with his back to X-ray table. Shoulder is extended, the elbow flexed and
forearm is placed on cassette. The arm is adjusted such that it is at an angle of 45° to cassette.

Centring: It is done to the palpable groove on medial part of elbow. Central beam is directed at 90°
to the cassette.
Technique: kVp-70; mAs-10; FSS-large; FFD-100 cm; No grid, Cassette size-10" x 8"

AP View of Humerus

Positioning: Patient is sitting or standing in front of a chest stand facing the X-ray tube directed
horizontally. The trunk is slightly rotated towards affected side, so that humerus lies in its ana-
tomical position resting fully on the cassette, which includes elbow and shoulder. Side marked and
beam is collimated.

Centring. It is done on anterior aspect of arm, midway between shoulder and elbow. The central ray
is directed horizontally at 90° to the centre of cassette.

Technique: kVp-60; mAs-15; FSS-small; FFD-100 cm; No grid, Cassette - 15" x 12"

Note: With patient in supine position, this view is done with central ray directed vertically.
Lateral View of Humerus

Positioning: Patient is sitting or standing, facing the chest-stand. The arm is slightly rotated and
extended with elbow flexed. The trunk is rotated slightly away from affected side, until lateral aspect
of humerus rests on the cassette. The shoulder and elbow are included in the radiograph. Side is
marked and beam is collimated.

Centring: On the medial aspect of humerus, midway between shoulder and elbow. The central beam
is directed horizontally, at 90° to the centre of the cassette.

Technique: kVp-60; mAs-15; FSS-small; FFD-100 cm; No grid; Cassette size: 15" x 12".

AP View for the Neck of Humerus

Positioning: Patient is supine on a stretcher or X-ray table, the arm is fully abducted if possible and is
supported in a comfortable position. Shoulder and only upper portion of the humerus are included.
Side is marked and beam is collimated.

Centring: It is done on head of humerus. Central beam is directed vertically at 90° to the centre of
cassette which is kept below the shoulder joint.
Technique: kVp-60; mAs-10; FSS-small; FFD-100 cm; No grid; Cassette size-12" x 10".

Inferosuperior View of Surgical Neck of Humerus

Positioning: Pully abducted and supported after raising the shoulder on pillows. The cassette held
vertically above shoulder and supported well to include upper humerus. After immobilisation, side is
marked and beam is collimated.

Centring: It is done on head of humerus through axilla. The central beam is directed horizontally at
90° to cassette, as close to chest-wall as possible.

Technique : kVp-60, mAs-16; FSS-small; FFD-100 cm; No grid, Cassette size-12"x10

SHOULDER JOINT

AP View of Shoulder Joint

Positioning. The patient is lying supine on X-ray table. Trunk is rotated 30° towards affected side until
the scapula is parallel to cassette. The arm placed in anatomical position and shoulder is rested on
the cassette. Shoulder is immobilised. Side marked and beam is collimated.

Centring: It is done on anterior aspect of shoulder over the coracoid process of scapula. Central
beam is directed vertically at 90° to the centre of cassette.

Note: To demonstrate glenohumeral joint space, trunk is rotated only 25 towards affected side. The
arm is partially abducted with elbow flexed. Centring is the same as above. To demonstrate muscle
calcifications, AP views are done with full internal rotation and external rotation of humerus,
centring on coracoid process.

Technique: kVp-60; mAs-15; FSS-small; FFD-100 cm; No grid; Cassette size-0"x8" or With grid:

kVp-60; mAs-40; FSS-small; FFD-100 cm; Cassette size-10" x 8".

Axial View of Shoulder (Superoinferior View)

Positioning: Patient is seated on a stool on the side of X-ray table, leaning slightly towards the table.
The arm is abducted and elbow is flexed at 90°, resting the forearm and hand on table. Shoulder is
positioned over the cassette to include Gleno-humeral joint. Side marked and the beam is
collimated.

Centring: It is done over head of humerus. Central ray is directed vertically at 90° to centre of
cassette. If necessary, tube may be tilted 10º laterally.

Technique: kVp65; mAs-15; FSS-small; FFD-100 cm; No grid; Cassette size-10" x 8"

Note: Film is exposed in arrested respiration.

THE SCAPULA

AP View of Scapula

Positioning: Patient is seated in front of a chest stand facing X-ray tube, with trunk rotated about 30°
towards affected side, until scapula is parallel to cassette. Arm is placed in anatomical position.
Scapula is rested on the cassette. Side is marked and the beam is collimated.

Centring: It is done to the head of the humerus with the central beam directed horizontally at 90° to
the cassette.

Technique: kVp-65; mAs-15; FSS-small; FFD-100 cm; No grid; Cassette size - 10" x 8".
Lateral View of Scapula

Positioning: Patient stands in front of the chest stand facing it. Humerus is slightly abducted and
extended with elbow flexed. The trunk is rotated until blade of scapula is at 90° to the film. Shoulder
is rested on cassette. Side is marked and the beam is collimated.

Centring: It is done on the head of humerus through the medial border of scapula on 4th dorsal
vertebra level. Central beam is directed horizontally at 90° to cassette.

Technique: kVp70; mAs-20; FFS-small; FFD-100 cm; No grid; Cassette size 10" x 8"

Or kVp75; mAs80; FFS-small; FFD-100 cm; With grid; Cassette size 10" x 8".

Note: This projection may be used to show dislocation of head of humerus.

AP View of Both Acromioclavicular Joints

Positioning: Patient is stands or sits in front of chest stand facing the x-ray tube. Both arms are in
anatomical position. Both shoulders are rested against the cassette placed in chest stand. Patient
holds sand bag in each hand. Side is marked and beam is collimated.

Centring: It is done on each acromio-clavicular joint separately in turns. Central ray is directed
horizontally at 90° to centre of the cassette

Technique: kVp-60; mAs-15; FSS-small; FFD-100 cm; No grid; Cassette size 10" x 8".

Note: Expose each side separately in arrested respiration, using lead blocker.

CLAVICLE
AP View of the Clavicle

Positioning: Patient is seated in front of chest stand facing the X-ray tube. Shoulder is rested against
the cassette with arm resting by side of the body. The whole of clavicle is included in the cassette.
Side is marked and beam is collimated.

Centring: It is done on the middle of clavicle. The central beam is directed horizontally at 90° to the
cassette.

Technique: kVp-60; mAs-15; FSS-small; FFD-100 cm; No grid; Cassette size-10"x8".

Note: This view may also be taken with patient in supine position by vertical beam.

Inferosuperior View of Clavicle

Positioning: Patient lies supine on X-ray table with affected arm by the side of trunk. Head is turned
away from affected side. The cassette is placed at 45° angle to the table, such that it is in contact
with posterior aspect of shoulder using a sandbag. Side is marked and beam is collimated.
Centring: It is done 2.5 cm (1 inch) from sternal end of clavicle. The central beam is directed at 35° to
the vertical towards the shoulder and 15 lateral wards.

Technique: kVp-60; mAs-15: FSS-small; FFD-100 cm; No grid; Cassette size-12" x 10".

Note: Exposure is made in arrested respiration.

Sternoclavicular Joint-PA View

Positioning: Patient lies prone on X-ray table with his/her sternoclavicular joint in contact with the
centre of cassette. Arms are placed by the side of his body. The side is marked and beam is
collimated.

Centring: It is done on suprasternal-notch (D4 level). Central beam is directed vertically over one
shoulder first and also angled 15" inwards towards midline.
Technique: kVp-65; mAs-20; FSS-small; FFD-100 cm; No grid; Cassette size-12" x 10".

Note: The exposure is made on arrested respiration.

Anterior Oblique View of Sternoclavicular Joint

Positioning: Patient lies prone on X-ray table. Trunk is rotated to 45° to side of interest and
supported with stand bags. Raised-side arm is kept above the head, while the other arm is by side of
patient. Side is marked and beam is collimated.

Centring: It is done on a point 10 cm from midline on the raised side of the chest at D4 vertebra
level. Central beam is directed vertically at 90° to centre of the cassette.
Technique: kVp-70; mAs-30; FSS-small; FFD-100 cm; With grid; Cassette size - 12" x 10".

Note : Each side is exposed separately. To diffuse rib shadows, the exposure is made during quiet
respiration. A lower mA and longer exposure time are used.

RADIOGRAPHY OF THE LOWER LIMB

AP Views of the Toes

Positioning: Patient is seated on X-ray table with knees flexed. The plantar aspect of foot (involved)
rests on cassette. Foot is immobilised with sand bags. Side is marked and beam is collimated. Unused
part of cassette is covered with lead blocker.
Centring: It is done on head of 3rd metatarsal bone of the foot under study. Central beam is directed
vertically at 90° to centre of cassette half.

Technique: kVp-55; mAs-4; FSS-large; FFD-100 cm; No grid; Cassette size 10" x 8".

Lateral View of Toes

Positioning: Patient lies on X-ray table on affected side with hip and knee flexed. The unaffected leg
is rested comfortably. The foot is placed in true lateral position on cassette. The foot is immobilised.
Side is marked and beam is collimated. Unused part of cassette is covered with lead blocker.

Centring: On head of first metatarsal bone. Central beam is directed vertically at 90° to film.

Technique: kVp-55; mAs-4; FSS-large; FFD-100 cm; No grid; Cassette size - 10" x 8"
Note: If lateral view of individual toe is required, a dental film can be placed under the toe
concerned. The other toes are slightly pulled aside by flexion and centring is done on affected toe.
For lateral oblique view of great toe, the medial aspect of affected side great toe is placed at 45° to
the film. Centring is done on head of 1 metatarsal bone.

AP View of the Foot

Positioning: Patient is seated on X-ray table with knees flexed. The affected foot is placed on the
cassette, with affected limb immobilised by sand bags. Side is marked and beam is collimated.
Unused part of cassette is covered with lead blocker.

Centring: It is done on the dorsum of foot over navicular-cuboid junction. Central beam is directed
vertically at 90° to cassette.

Technique: kVp-55; mAs-4; FSS-small; FFD-100 cm; No grid, Cassette size-12" x 10".
Oblique (AP) View of the Foot

Positioning: Patient is seated on X-ray table with knees flexed. Affected foot is placed on cas sette,
and its lateral border is raised on a pad, so that dorsum of foot is parallel to the cassette. Affected
limb is supported by the knee of other side for immobilisation. Side is marked and beam is
collimated. Unused part of cassette is covered with lead blocker. the cuboid-navicular junction.
Central beam is directed

Centring: It is done on dorsum of foot at vertically at 90° to the centre of cassette.

Technique: kVp-60; mAs-6; FSS-large; FFD-100 cm; No grid, Cassette size 12"x10"
Note: To show joint spaces of tarsal bones, X-ray tube may be angled 15" towards ankle.

Lateral View of the Foot

Positioning: Patient is lying on X-ray table on his affected side with flexed hip and knee joints. The
other leg is rested comfortably. A sand bag is placed below affected side knee, for the foot to be
placed on cassette in true lateral position. Foot is immobilised, side is marked and beam is
collimated. Unused part of cassette is covered with lead blocker.
Centring: It is done on medial aspect of foot over cuboid-naviular junction. Central beam is directed
vertically at 90° to the centre of cassette.

Technique: kVp-65; mAs-6; FSS-large; FFD-100 cm; No grid; Cassette size-12" x 10".

Note: As bones of foot superimpose on each other in lateral view, this view is done only for
localisation of foreign bodies and to assess any displacement/fractured metatarsals or calcaneum.
Radiographs of lateral views of both calcanel may be done at same time or separately in which case,
centring is done in between two calcanel or upon the individual calcaneum when exposed one after
the other.

Translateral View of Foot (For Evaluation of Arch of Foot)

Positioning: Patient is standing over a block of wood on X-ray table with cassette supported vertically
on lateral aspect of foot close to edge of wooden block. The unaffected leg is held in comfortable
position in front or behind affected one, with an equal distribution of body weight on both feet. Side
is marked, beam is collimated and unused part of cassette is covered with lead blocker.
Centring: It is done on medial aspect of foot at cuboid-navicular joint and central beam is directed
horizontally at 90° to centre of cassette.

Technique: kVp-70; mAs-6; FSS-small; FFD-100 cm; No grid; Cassette size-12" x 10".

Note: Both feet are to be examined under similar conditions one for comparison.

Axial View of Calcaneum

Positioning: The patient is seated on X-ray table with legs extended. Affected side ankle is dorsi-
flexed placing the heel on cassette. The patient is asked to hold the ankle in complete dorsiflexion by
help of a bandage cloth-sling over sole of foot. Lower leg is immobilised with sand bags. Side is
marked and beam is collimated. Unused part of cassette is covered with lead blocker.

Centring: It is done on middle of sole of foot. Central beam is directed vertically at 90° to cassette.

Technique: kVp-70; mAs-10; FSS-small; FFD-100 cm; No grid; Cassette size-10" x 8".

Note: Both feet are to be examined under similar conditions for comparison sake.

AP View of Ankle Joint

Positioning: Patient is seated on X-ray table with affected leg extended. Unaffected hip and leg
abducted. Affected ankle is placed on cassette such that the foot is making an angle of 90° with leg.
Foot is internally rotated so as to bring both malleoli equidistant to table-top. Foot is immobilised
with sand bag, side is marked and beam is collimated. Unused part of the film is covered with lead
blocker.

Centring: It is done midway between malleoli of ankle. Central beam is directed vertically at 90 to
the film.

Technique: kVp-70; mAs-10; FSS-large; FFD-100 cm; No grid, Cassette size-10"x8".

Lateral View of Ankle Joint

Positioning: Patient lies on the affected side with hip and knee flexed. Unaffected leg is rested
comfortably, Affected leg is raised on a sand bag, so as to place lateral aspect of affected ankle on
the cassette, such that malleoli are superimposed on each other. The leg is immobilised, side is
marked and beam is collimated. Unused part of the film is covered with lead blocker.

Centring: It is done over medial malleolus. Central beam is directed vertically at 90° to centre of
cassette.

Technique: kVp-70; mAs-10; FSS-large; FFD-100 cm; No grid; Cassette size-10" x 8".

Note: To demonstrate subtalar joint, foot is kept in true lateral position. To show 'Sulcus-tarsi' the
foot is rotated 60" internally from AP position and centring is done 2.5 cm (1") distal to lateral
malleolus, with X-ray tube angled 15 cephalad from vertical. To show posterior part of ankle joint,
foot is rotated 60" externally and centring is done 1" distal to medial malleolus.

View of the Leg AP

Positioning: Patient lies supine with affected leg on cassette with knee extended. Unaffected leg is
abducted. In adults, as leg is longer than the length of the cassette, it may be possible to examine
only upper or lower 2/3d of leg including the nearest joint. Leg is immobilised with sand bags on the
foot. Side is marked, beam is collimated and unused part of cassette is covered with lead blocker.

Centring: It is done on anterior aspect of leg to middle of the cassette. Central beam is directed
vertically at 90° to cassette.

Technique: kVp-65; mAs-12; FSS-large; FFD-100 cm; No grid; Cassette size-15" x 12";

Note: Take another radiograph of the part which was not included in the first.
Lateral View of the Leg

Positioning: Patient lies laterally with affected side on X-ray table, with his hips and knee slightly
flexed. Unaffected leg is rested comfortably. Lateral aspect of affected leg is placed on cassette with
sand bags under knee and toes. The nearest joint (knee or ankle) is included. Side is marked and
beam is collimated. Unused part of the film is covered with lead blocker.

Centring: Is done on medial aspect of leg at middle of the cassette. Central ray is directed vertically
at 90° to the centre of cassette.

Technique: kVp-65; mAs-12; FSS-large; FFD-100 cm; No grid; Cassette size 15" x 12".

Note: As it is not always possible to include the whole of the leg in the first radiograph, it is
important to take the second radiograph for the part not included in the first.
AP View of the Knee (with Patella)

Positioning: Patient lies supine on X-ray table, with affected side knee on cassette with that side hip
and knee flexed slightly. Unaffected leg is rested comfortably by the side of affected leg. Leg and
ankle are immobilised with sand bags. It is ensured that patella is in the centre of cassette. Side is
marked, beam is collimated. Unused part of cassette is covered with lead blocker.

Centring: It is done 2.5 cm (1") below the apex of patella. Central beam is directed vertically at 90°
to cassette.

Technique: kVp-60; mAs-15; FSS-large; FFD-100 cm; No grid; Cassette size-12" x 10".

Note: Alternatively, a translateral view may be done, with horizontal beam.

Lateral View of the Knee (with Patella)

Positioning: Patient lies laterally on X-ray table with his legs extended. Unaffected leg is ab- ducted.
Affected knee is placed on the cassette and leg is rotated properly until patella is in profile Leg is
immobilised with sand bags, side is marked, beam is collimated and unused part of cassette is
covered with lead blocker.

Centring: It is done on anterior aspect of medial condyle of tibia. Central beam is directed vertically
at 90 to cassette.

Technique: kVp-60; mAs-15, FSS-large; FFD-100 cm; No grid; Cassette size-12"x10

Note: To show superior tibio-fibular joint, patient is rotated to prone position. Affected knee is
turned such that it rests on its lateral aspect.
Oblique View of the Knee (For Superior Tibiofibular Joint)

Positioning: Patient is seated on X-ray table with his legs extended. Unaffected leg is abducted.
Affected knee is placed on cassette and leg is rotated medially until fibula is in profile. Leg is
immobilised with sand bags, side is marked, beam is collimated and unused part of cassette is
covered with lead blocker.

Centring: It is done on superior tibiofibular joint. Central beam is directed vertically at 90° to
cassette,

Technique: kVp-60; mAs-15; FSS-large; FFD-100 cm; No grid; Cassette size - 12" x 10".
Axial (Inferosuperior) View of Patella

Positioning: Patient is in prone position on X-ray table. The unaffected leg is rested comfortably
while affected knee is flexed. The foot is extended and held with a looped bandage around it, so that
the flexed knee is immobilised in that position, by patient himself.

Centring: It is done behind the apex of patella. Central beam is directed at 15° cephalad to the
vertical.

Technique: kVp-65; mAs-15; FSS-large; FFD-100 cm; No grid; Cassette size - 12" x 10".
AP View of Thigh The lower 2/3rd

Positioning: Patient lies supine on X-ray table with both legs extended. Unaffected leg is ab- ducted
and held in comfortable position behind affected leg. Knee joint of affected side is in- cluded in
cassette. Lower leg is immobilised with sand bags. Side is marked and beam is colli- mated. Unused
part of cassette is covered with lead blocker.

Centring: It is done on anterior aspect of thigh to centre of cassette. Central beam is directed
vertically at 90° to cassette.
Technique: kVp-65; mAs-20; FSS-large; FFD-100 cm; No grid; Cassette size-15"x12".

Lateral View of Thigh (Upper 2/3)

Positioning: Patient lies laterally on X-ray table, with affected side hip and knee slightly flexed.
Unaffected leg is comfortably rested behind affected limb. The lateral aspect of affected thigh is
placed on cassette. Limb is immobilised with sand bags under the ankle. Knee joint is included in the
cassette. Side is marked and beam is collimated. Unused part of cassette is covered with lead
blocker.

Centring: It is done on medial aspect of thigh. Central beam is directed vertically at 90° to centre of
cassette.

Technique: kVp-65; mAs-20; FSS-large; FFD-100 cm; No grid; Cassette size-15" x 12".

Note: Upper 1/3 of thigh is to be included in radiograph of hip joint lateral view.
HIP JOINT AND UPPER FEMUR

AP View of Hip Joint Upper Femur

Positioning: Patient lies supine, with hip under study placed on midline of X-ray table. Both legs are
extended, the knees flexed slightly and rested on sand bags. Both legs are rotated medially and great
toes are brought together. The side is marked and beam is collimated.

Centring: It is done on a point, midway between anterior superior iliac spine and symphysis pubis of
concerned side. Central beam is directed vertically at 90° to centre of cassette.

Technique: kVp-70; mAs-60; FSS-large; FFD-100 cm; No grid; Cassette size-12" x 10".
Lateral View of Hip Joint with Upper 1/3rd of Femur

Positioning: Patient lies laterally on affected side with involved hip in midline of X-ray table and he is
slightly turned into supine oblique position with affected hip and knee slightly flexed. Unaf- fected
leg is rested comfortably behind affected one, with help of sand bags support. Side is marked and
beam is collimated.

Centring: It is done on hip joint below groin crease in midline on the thigh. Central beam is directed
vertically at 90° to cassette.

Technique: kVp-75; mAs-40; FSS-large; FFD-100 cm; No grid; Cassette size 12" x 10".

Note: Cassette is placed oblique, so that long axis of cassette is in line with the long axis of upper
femur of affected side.
AP View of Pelvis (Including Both Hip Joints)

Positioning: Patient lies supine in midline of X-ray table. His thighs are extended and knees are
slightly flexed and supported by sand bags. Both thighs are rotated medially and great toes are
placed together. Side is marked and beam is collimated.

Centring: It is done on midline at a point 5 cm (2") above symphysis pubis, to include both iliac crests
in transversely placed cassette. Central beam is directed vertically at 90° to the centre of cassette.

Technique: kVp-70; mAs-80; FSS-large; FFD-100 cm; With grid; Cassette size - 15" x 12
Lateral View of Hip (Neck of Femur)

Positioning: Patient lies supine with pelvis raised on pillows. Injured limb is extended and foot is
rotated medially. Other knee is flexed and its foot is placed on a stool. Cassette is supported
vertically, against the injured hip pushed against waist and adjusted so that it is parallel with neck of
femur.

Centring: X-ray tube with long cone (preferably) is directed horizontally at 90° to centre of cassette,
which is centred to the groin.
Technique: kVp-65; mAs-40; FSS-large; FFD-100 cm; No grid; Cassette size-12" x 10".

AP View of Hip for Acetabulae (Von Rosen's View)

Positioning: Child lies supine, with both thighs and legs abducted making an angle of about 90° to
each other at the groin. Both legs are rotated internally and held firmly by two attendants.

Centring: It is done on midpoint of a line joining both femoral pulses. Central ray is directed vertically
at 90° to centre of film.

Technique: kVp-60, mAs-40; FSS-small; FFD-100 cm; With grid; Cassette size-10"x 8".
The view is done for children suffering from congenital dislocations of hips (CHD). Remember to use
groin shield .

AP View of the Hip for Femoral Epiphyses (Frog View)

Positioning: Child lies supine, with knees flexed and hips abducted. The soles of feet are placed
together and hips externally rotated. The thighs rest symmetrically on pillows. Sand bags ard used to
immobilise the feet.

Centring: It is done in midline at the level of femoral pulses. Central beam is directed vertically at 90°
to the centre of cassette.

Technique: kVp-60; mAs-40; FSS-Small, FFD-100 cm; With grid; Cassette size-10" x 8" .