NAME: NISHI-LHEN D.

MACALLING DATE: 01/ 28 /2023

TOPIC: AXIAL RADIOGRAPHIC POSITIONING

processes, such as osteoporosis and

FINGERS osteoarthritis
CR: CR perpendicular to IR, directed to PIP
ROUTINE joint
SS: Lateral views of distal, middle, and
 PA proximal phalanges; distal metacarpal; and
 PA oblique associated joints are visible.
 Lateral

PA PROJECTION: FINGERS THUMB

CI: Fractures and dislocations of the distal, ROUTINE

middle, and proximal phalanges; distal
metacarpal; and associated joints. Pathologic  AP
processes, such as osteoporosis and  PA oblique
osteoarthritis  Lateral
CR: CR perpendicular to IR, directed to PIP
joint SPECIAL
SS: Distal, middle, and proximal phalanges;
distal metacarpal; and associated joints.  AP, Modified Robert’s method
 PA stress (Folio method)
PA OBLIQUE PROJECTION— projection
MEDIAL OR LATERAL ROTATION:
FINGERS

CI: Fractures and dislocations of the distal, AP PROJECTION: THUMB

middle, and proximal phalanges; distal
metacarpal; and associated joints. Pathologic CI: Fractures and dislocations of the distal
processes, such as osteoporosis and and proximal phalanges, distal metacarpal,
osteoarthritis and associated joints. Pathologic processes,
CR: CR perpendicular to IR, directed to PIP such as osteoporosis and osteoarthritis
joint CR: CR perpendicular to IR, to first MCP
SS: 45° oblique view of distal, middle, and joint
proximal phalanges; distal metacarpal; and SS: Distal and proximal phalanges, first
associated joints. metacarpal, trapezium, and associated joints
are visible. Interphalangeal and
LATERAL—LATEROMEDIAL OR metacarpophalangeal joints should appear
MEDIOLATERAL PROJECTIONS: open.
FINGERS
PA OBLIQUE PROJECTION—MEDIAL
ROTATION: THUMB
CI: Fractures and dislocations of the distal,
middle, and proximal phalanges; distal CI: Fractures and dislocations of the distal
metacarpal; and associated joints. Pathologic and proximal phalanges, distal metacarpal,
and associated joints. Pathologic processes, CR: CR perpendicular to IR directed to
such as osteoporosis and osteoarthritis midway between MCP joint
CR: CR perpendicular to IR, to first MCP SS: Entire thumbs from first metacarpals to
joint distal phalanges. Demonstrates
SS: Distal and proximal phalanges, first metacarpophalangeal angles and joint spaces
metacarpal, trapezium, and associated joints at MCP joints.
are visualized in a 45° oblique position.
HAND

LATERAL POSITION: THUMB ROUTINE

CI: Fractures and dislocations of the distal  PA

and proximal phalanges, distal metacarpal,  PA oblique
and associated joints. Pathologic processes,  Lateral (fan)
such as osteoporosis and osteoarthritis  Lateral (extension and flexion)
CR: CR perpendicular to IR, to first MCP
joint SPECIAL
SS: Distal and proximal phalanges, first
metacarpal, trapezium (superimposed), and  AP oblique bilateral (Norgaard
associated joints are visualized in the lateral method)
position.

SPECIAL
PA PROJECTION: HAND
AP AXIAL PROJECTION (MODIFIED
CI: Fractures, dislocations, or foreign bodies
ROBERT’S METHOD) THUMB
of the phalanges, metacarpals, and all joints
of the hand. Pathologic processes such as
CI: Base of first metacarpal is demonstrated
osteoporosis and osteoarthritis.
for ruling out Bennett’s fracture. Pathologic
CR: CR perpendicular to IR, directed to
processes such as osteoarthritis. This special
third MCP joint
projection demonstrates fractures or
SS: PA projection of entire hand and wrist
dislocations of the first CMC joint.
and about 2.5 cm (1 inch) of distal forearm
CR: CR directed 15° proximally (toward
are visible. PA projection of hand
wrist), entering at the first CMC joint
demonstrates oblique view of the thumb.
SS: An AP projection of the thumb and first
CMC joint are visible without
superimposition. Base of first metacarpal
PA OBLIQUE PROJECTION: HAND
and trapezium should be well visualized.
CI: Fractures, dislocations, or foreign bodies
PA STRESS THUMB PROJECTION
of the phalanges, metacarpals, and all joints
FOLIO METHOD
of the hand. Pathologic processes such as
osteoporosis and osteoarthritis.
CI: Sprain or tearing of ulnar collateral
CR: CR perpendicular to IR, directed to
ligament of thumb at MCP joint as a result
third MCP joint
of acute hyperextension of thumb; also
referred to as a “skier’s thumb” injury.
SS: Oblique projection of the entire hand CI:  Performed commonly to evaluate for
and wrist and about 2.4 cm (1 inch) of distal early evidence of rheumatoid arthritis at the
forearm are visible. second through fifth proximal phalanges and
MCP joints. May demonstrate fractures of
“FAN” LATERAL—LATEROMEDIAL the base of the fifth metacarpal Both hands
PROJECTION: HAND generally are taken with one exposure for
bony structure comparison of both hands. A
CI:  Fractures and dislocations of the common term for this projection is the “ball-
phalanges, anterior/posterior displaced catcher’s position
fractures, and dislocations of the CR: CR perpendicular, directed to midpoint
metacarpals. Pathologic processes, such as between both hands at level of fifth MCP
osteoporosis and osteoarthritis especially in joints.
the phalanges SS: Both hands from the carpal area to the
CR: CR perpendicular to IR, directed to tips of digits in 45° oblique position are
second MCP joint visible.
SS: Entire hand and wrist and about 2.5 cm
(1 inch) of distal forearm are visible. Fingers WRIST
appears equally separated, with phalanges in
the lateral position and joint spaces open. ROUTINE

LATERAL IN EXTENSION AND  PA (AP)

FLEXION—LATEROMEDIAL  PA oblique
PROJECTIONS: HAND  Lateral
ALTERNATIVES TO FAN LATERAL
SPECIAL
CI:  The lateral in either extension or flexion
is an alternative to the fan lateral for  Scaphoid views
localization of foreign bodies of the hand  CR angle, ulnar deviation
and fingers; it also demonstrates anterior or
 Modified Stecher method
posterior displaced fractures of the
 Radial deviation
metacarpals. The lateral in a natural flexed
position may be less painful for the patient.  Carpal canal (inferosuperior)
CR: CR perpendicular to IR, directed to the  Carpal bridge
second to fifth MCP joints
SS: Entire hand and wrist and about 2.5 cm
(1 inch) of distal forearm are visible. Thumb PA (AP) PROJECTION: WRIST
should appear in slightly oblique position
and free of superimposition with joint spaces CI: Fractures of distal radius or ulna,
open. isolated fractures of radial or ulnar styloid
processes, and fractures of individual carpal
SPECIAL bones. Pathologic processes, such as
osteomyelitis and arthritis
AP OBLIQUE BILATERAL CR: CR perpendicular to IR, directed to
PROJECTION: HAND NORGAARD midcarpal area
METHOD SS: Midmetacarpals and proximal
metacarpals; carpals; distal radius, ulna, and
associated joints; and pertinent soft tissues
of the wrist joint, such as fat pads and fat scaphoid at a point 2 cm [3/4 inch] distal and
stripes, are visible. All the intercarpal spaces medial to radial styloid process.)
do not appear open because of irregular SS: Distal radius and ulna, carpals, and
shapes that result in overlapping. proximal metacarpals are visible. Scaphoid
should be demonstrated clearly without
PA OBLIQUE PROJECTION— foreshortening, with adjacent carpal
LATERAL ROTATION: WRIST interspaces open (evidence of CR angle).
CI:  Fractures of distal radius or ulna,
isolated fractures of radial or ulnar styloid
processes, and fractures of individual carpal PA SCAPHOID—HAND ELEVATED
bones. Pathologic processes, such as AND ULNAR DEVIATION: WRIST
osteomyelitis and arthritis. MODIFIED STECHER METHOD
CR: CR perpendicular to IR, directed to
midcarpal area CI: Possible fractures of the scaphoid This is
SS: Distal radius, ulna, carpals, and at least an alternative projection to the CR angle
to Midmetacarpal area are visible. • ulnar deviation method demonstrated on the
Trapezium and scaphoid should be well preceding page.
visualized, with only slight superimposition CR: Center CR perpendicular to IR and
of other carpals on their medial aspects. directed to scaphoid. (Locate scaphoid at a
point 2 cm [3/4 inch] distal and medial to
LATERAL—LATEROMEDIAL radial styloid process.)
PROJECTION: WRIST SS: Distal radius and ulna, carpals, and
proximal metacarpals are visible. Carpals
CI: Fractures or dislocations of the distal are visible, with adjacent interspaces more
radius or ulna, specifically anteroposterior open on the lateral (radial) side of the wrist.
dislocations of Barton’s, Colles’, or Smith’s Scaphoid is shown, without foreshortening
fractures. Osteoarthritis also may be or superimposition of adjoining carpals
demonstrated primarily in the trapezium and
first CMC joint PA PROJECTION—RADIAL
CR: CR perpendicular to IR, directed to DEVIATION: WRIST
midcarpal area
SS: Distal radius and ulna, carpals, and at CI: Possible fractures of the carpal bones on
least the midmetacarpal area are visible. the ulnar side of the wrist, especially the
lunate, triquetrum, pisiform, and hamate
PA AND PA AXIAL SCAPHOID— CR: CR perpendicular to IR, directed to
WITH ULNAR DEVIATION: WRIST midcarpal area.
SS: Distal radius and ulna, carpals, and
CI: Possible fractures of the scaphoid proximal metacarpals are visible. Carpals
Nondisplaced fractures may require are visible, with adjacent interspaces more
additional projections or CT scan of the open on the medial (ulnar) side of the wrist.
wrist
CR: Angle CR 10° to 15° proximally, along CARPAL CANAL (TUNNEL)—
long axis of forearm and toward elbow. (CR TANGENTIAL, INFEROSUPERIOR
angle should be perpendicular to long axis of PROJECTION: WRIST GAYNOR-
scaphoid.) Center CR to scaphoid. (Locate HART METHOD
CI: Rule out abnormal calcification and SS: AP projection of the entire radius and
bony changes in the carpal sulcus that may ulna is shown, with a minimum of proximal
impinge on the median nerve, as with carpal row carpals and distal humerus and pertinent
tunnel syndrome. Possible fractures of the soft tissues, such as fat pads and stripes of
hamulus process of the hamate, pisiform, the wrist and elbow joints.
and trapezium
CR: Angle CR 25° to 30° to the long axis of
the hand. (The total CR angle in relationship
to the IR must be increased if patient cannot
hyperextend wrist as far as indicated.)
Direct CR to a point 2 to 3 cm (1 inch) distal LATERAL—LATEROMEDIAL
to the base of third metacarpal (center of PROJECTION: FOREARM
palm of hand
SS: The carpals are demonstrated in a CI: Fractures and dislocations of the radius
tunnel-like, arched arrangement. or ulna. Pathologic processes such as
osteomyelitis or arthritis
CARPAL BRIDGE—TANGENTIAL CR: CR perpendicular to IR, directed to
PROJECTION: WRIST mid-forearm
SS: Lateral projection of entire radius and
CI: Calcification or other pathology of the ulna, proximal row of carpal bones, elbow,
dorsal (posterior) aspect of the carpal bones. and distal end of the humerus are visible as
CR: Angle CR 45° to the long axis of the well as pertinent soft tissue, such as fat pads
forearm. Direct CR to a midpoint of the and stripes of the wrist and elbow joints.
distal forearm about 4 cm (11/2 inches)
proximal to wrist joint.
SS: Tangential view of the dorsal aspect of ELBOW
the scaphoid, lunate, and triquetrum is
visible. ROUTINE
Outline of the capitate and trapezium
superimposed is visible.  AP

FOREARM o Fully extended

o Partially flexed
ROUTINE
 AP obliques
 AP  Lateral (external) rotation
 Lateral  Medial (internal) rotation
 Lateral
AP PROJECTION: FOREARM
SPECIAL
CI: Fractures and dislocations of the radius
or ulna. Pathologic processes such as  Acute flexion (Jones method)
osteomyelitis or arthritis
 Trauma axial laterals (Coyle
CR: CR perpendicular to IR, directed to
method)
mid-forearm
 Radial head laterals
 SS: Oblique projection of distal humerus
AP PROJECTION: ELBOW (ELBOW and proximal radius and ulna is visible.
FULLY EXTENDED)
CI: Fractures and dislocations of the elbow • AP OBLIQUE PROJECTION—
Pathologic processes, such as osteomyelitis MEDIAL (INTERNAL) ROTATION:
and arthritis ELBOW
CR: CR perpendicular to IR, directed to
mid-elbow joint, which is approximately 2 CI: Fractures and dislocations of the elbow,
cm (3 /4 inch) distal to midpoint of a line primarily the coronoid process. Certain
between epicondyles pathologic processes, such as osteoporosis
SS: Distal humerus, elbow joint space, and and arthritis
proximal radius and ulna are visible. CR: CR perpendicular to IR, directed to
mid-elbow joint, which is approximately 2
AP PROJECTION: ELBOW WHEN cm (3 /4 inch) distal to midpoint of a line
(ELBOW CANNOT BE FULLY between epicondyles
EXTENDED) SS: Oblique projection of distal humerus
CI: Fractures and dislocations of the elbow • and proximal radius and ulna is visible.
Pathologic processes, such as osteomyelitis
and arthritis LATERAL—LATEROMEDIAL
CR: CR perpendicular to IR, directed to PROJECTION: ELBOW
mid-elbow joint, which is approximately 2
cm (3 /4 inch) distal to midpoint of a line CI: Fractures and dislocations of the elbow.
between epicondyles Certain bony pathologic processes, such as
SS: Distal humerus is best visualized on osteomyelitis and arthritis. Elevated or
“humerus parallel” projection, and proximal displaced fat pads of the elbow joint may be
radius and ulna are best visualized on visualized
“forearm parallel” projection. CR: CR perpendicular to IR, directed to
Note: Structures in elbow joint region are mid-elbow joint (a point approximately 4 cm
partially obscured and slightly distorted, [11/ 2 inches] medial to easily palpated
depending on amount of elbow flexion posterior surface of olecranon process
possible SS: Lateral projection of distal humerus and
proximal forearm, olecranon process, and
AP OBLIQUE PROJECTION— soft tissues and fat pads of the elbow joint
LATERAL (EXTERNAL) ROTATION: are visible.
ELBOW
CI: Fractures and dislocations of the elbow, ACUTE FLEXION PROJECTIONS:
primarily the radial head and neck. Certain ELBOW AP PROJECTIONS OF
pathologic processes, such as osteomyelitis ELBOW IN ACUTE FLEXION
and arthritis. Lateral (external rotation)
oblique Best visualizes radial head and neck CI: Fractures and moderate dislocations of
of the radius and capitulum of humerus. the elbow in acute flexion
CR: CR perpendicular to IR, directed to  NOTE: To visualize both the distal
mid-elbow joint, which is approximately 2 humerus and the proximal radius and
cm (3 /4 inch) distal to midpoint of a line ulna, two projections are required
between epicondyles one with CR perpendicular to the
 humerus and one with CR angled so elongated but in profile. Joint space between
that it is perpendicular to the forearm coronoid process and trochlea should be
CR: Distal humerus: CR perpendicular to open and clear. Radial head and neck
IR and humerus, directed to a point midway should be superimposed by ulna. Bony
between epicondyles. margins of superimposed radial head and
Proximal forearm: CR perpendicular to neck should be visualized faintly through
forearm (angling CR as needed), directed to proximal ulna.
a point approximately 2 inches (5 cm)
proximal or superior to olecranon process
SS: Proximal Humerus: Forearm and
humerus should be directly superimposed.
Medial and lateral epicondyles and parts of RADIAL HEAD LATERALS—
trochlea, capitulum, and olecranon process LATEROMEDIAL PROJECTIONS:
all should be seen in profile. Optimal ELBOW
exposure should visualize distal humerus
and olecranon process through CI: Occult fractures of the radial head or
superimposed structures. Soft tissue detail is neck.
not readily visible on either projection. CR: CR perpendicular to IR, directed to
Distal Forearm: Proximal ulna and radius, radial head (approximately 2 to 3 cm [1
including outline of radial head and neck, inch] distal to lateral epicondyle)
should be visible through superimposed SS: Direct superimposition of epicondyles.
distal humerus. Optimal exposure visualizes Radial head and neck should be partially
outlines of proximal ulna and radius superimposed by ulna but completely
superimposed over humerus. visualized in profile in various projections.
Radial tuberosity should be visualized.
TRAUMA AXIAL LATERALS—AXIAL
LATEROMEDIAL PROJECTIONS:
ELBOW COYLE METHOD

CI: Fractures and dislocations of the elbow,

particularly the radial head and coronoid
process.
CR: Radial Head: CR directed at 45° angle
toward shoulder, centered to radial head
(mid elbow joint), Coronoid Process: CR
angled 45° from shoulder, into mid elbow
joint.
SS: For Radial Head: Joint space between
radial head and capitulum should be open
and clear. Radial head, neck, and tuberosity
should be in profile and free of
superimposition except for a small part of
the coronoid process. Distal humerus and
epicondyles appear distorted because of 45°
angle. For Coronoid Process: Distal
(anterior) portion of the coronoid appears