Procedures is the largest section of the ARRT® Radiography exam. It has 66 of the 200 scored questions through February 28, 2027, and 72 from March 1, 2027. The textbooks name many projections, but ARRT publishes the list it draws from, so you can study to that list.
This guide covers the commonly taught setups for chest, extremity, spine, pelvis, skull and trauma. We checked them against Bontrager’s 9th edition and Merrill’s 15th edition, and we say so where the two books differ. Departments vary too, so learn your program’s numbers wherever they differ.
How is the ARRT Procedures section split?
| Category | Through Feb 28, 2027 | From Mar 1, 2027 | What it covers |
|---|---|---|---|
| Extremity | 28 | 30 | Fingers to shoulder, toes to femur, long bone measurement, bone survey |
| Thorax and Abdomen | 20 | 22 | Chest, ribs, sternum, soft tissue neck, SC joints, abdomen, GI and GU studies |
| Head, Spine and Pelvis | 18 | 20 | Skull, facial bones, sinuses, spine, sacrum, SI joints, pelvis and hip |
Note that hip sits under Head, Spine and Pelvis in both outlines, not Extremity. Femur stays with the lower limb.
Across all three, ARRT lists four things it can ask about: positioning, anatomy, adapting the procedure (for body habitus, trauma, pathology, age or limited mobility), and judging the displayed anatomy on the image. Items may also ask you to select an image or watch a short video clip, so practice picturing the result, not only the setup.
What changes in Procedures on March 1, 2027?
If your exam could fall on or after March 1, 2027, study to the new list. Our 2027 changes page covers the whole outline. For Procedures, compare the two PDFs and you find:
Moved
- Clavicle goes to Thorax.
- Bone age goes into Upper Extremities.
Off the list
- IVU leaves GU studies. Retrograde urography stays.
- The axiolateral (modified Schuller) TMJ, the SMV sinus and SMV mandible.
- Tangential sesamoids and the lumbar AP right and left bending views.
New on the list
- Hand: Norgaard (ball catcher’s view).
- Knee: Rosenberg PA axial. Patella now has its own heading.
- Weight-bearing: oblique foot, mortise and AP pelvis.
- Shoulder: superior-inferior axial lateral.
- Spine: AP or PA thoracolumbar.
- Procedures: line placement with a C-arm (such as PICC), nasogastric and orogastric tube placement, foreign body studies, lumbar puncture and epidural injections, and joint injection and aspiration.
What positioning terms do you need first?
Anatomic position: upright, arms down, palms forward. All direction terms start from here, whatever the patient is doing on the table.
Planes:
- Sagittal divides left from right. The midsagittal plane makes equal halves.
- Coronal, also called frontal, divides front from back.
- Transverse, also called axial, divides top from bottom.
Projection, position and view are different words. A projection is the path of the central ray (CR): AP enters the front, and PA enters the back. A position is how the patient is arranged: supine (on the back), prone (face down), erect, or an oblique such as RAO.
Decubitus means lying down with a horizontal beam. Always.
- Left lateral decubitus: lying on the left side.
- Right lateral decubitus: lying on the right side.
- Dorsal decubitus: supine, with the beam crossing side to side.
- Ventral decubitus: prone, with the beam crossing side to side.
The positioning library has a page for more than 120 projections. All but one also have a diagram in the app’s positioning viewer, and most of those need a paid plan.
What are the main chest and thorax projections?
PA chest: erect, 183 cm (72 in) SID, CR horizontal to T7, about 18 to 20 cm (7 to 8 in) below the vertebra prominens. Hands go on the hips, palms out, with shoulders rolled forward to move the scapulae off the lungs. Expose at the end of the second full inspiration. You want at least 10 posterior ribs above the diaphragm, and Bontrager’s notes that many patients show 11.
Lateral chest: left side against the receptor as the routine, arms raised, CR to T7. Merrill’s gives the reason: the heart sits closer to the receptor, so it looks less magnified. Bontrager’s switches to a right lateral for a right-sided complaint if department protocol calls for it.
AP lordotic: the patient leans back with shoulders on the receptor, and the CR stays perpendicular to the midsternum. This throws the clavicles above the apices. If the patient can’t lean back, take it supine with the CR 15 to 20° cephalad.
Lateral decubitus: horizontal beam. Air rises and fluid sinks, so the side of the problem decides which way the patient lies. Merrill’s keeps the patient in position for 5 minutes before the exposure, so fluid can settle and air can rise.
Sternum: RAO 15 to 20°, which moves the sternum off the spine, plus a lateral.
Ribs: inspiration for ribs above the diaphragm, expiration for ribs below. Put the injured area closest to the receptor.
What are the main extremity projections?
Hand: PA, 45° oblique with the thumb side raised, and lateral. Center the PA and oblique to the third MCP joint.
Wrist: PA, 45° oblique and lateral. For a suspected scaphoid fracture, ARRT’s list includes the PA with ulnar deviation and the PA axial (Stecher). The books label these differently. Merrill’s Stecher raises the receptor and wrist 20° with a perpendicular CR, or keeps them flat and angles the CR 20° toward the elbow. Bontrager’s calls the hand raised 20° on a sponge, with ulnar deviation if possible and no CR angle, the modified Stecher. It lists ulnar deviation with the CR 10 to 15° toward the elbow as a separate projection, which is what our scaphoid page shows. Merrill’s ulnar deviation PA keeps the CR perpendicular and adds 10 to 15° only when needed. Take these only after the routine series rules out a fracture of the distal forearm or wrist.
Elbow: AP, lateral with the elbow flexed 90°, and 45° medial and lateral obliques. If the patient can’t straighten the arm, take two AP projections: one with the forearm parallel to the receptor and one with the humerus parallel. Don’t take only one.
Shoulder: AP in internal and external rotation. Don’t rotate if a fracture or dislocation is possible: use neutral. Grashey is a 35 to 45° body rotation toward the affected side, which shows the glenohumeral joint. For trauma, use the scapular Y (45 to 60° anterior oblique) or the transthoracic lateral.
Foot: AP axial with the CR 10° toward the heel, medial oblique, and lateral. Merrill’s sets the oblique at 30°. Bontrager’s gives 30 to 40° and prefers 40°.
Ankle: AP, lateral, medial oblique at 45°, and the mortise at 15 to 20° internal rotation. Bontrager’s keeps the base of the fifth metatarsal, a common fracture site, in the field on the oblique and the mortise.
Knee: AP, lateral with 20 to 30° flexion and the CR 5 to 7° cephalad, and obliques. For the AP, CR angle depends on thickness from ASIS to tabletop: 3 to 5° cephalad over 24 cm, and 3 to 5° caudad under 19 cm. With a new or unhealed patellar fracture, Merrill’s limits lateral knee flexion to 10°.
Intercondylar fossa: the CR stays perpendicular to the lower leg in all three.
- Holmblad: kneeling, or standing with the knee on a stool or against the receptor. Bontrager’s flexes the knee 60 to 70°, and Merrill’s 70°.
- Camp-Coventry: prone, knee flexed 40 to 50°, CR 40 to 50° caudad to match.
- Beclere: supine. Bontrager’s flexes the knee 40 to 45°, which makes the CR about 40 to 45° cephalad. Merrill’s sets the femur at 60° to the tibia and names no tube angle. Bontrager’s adds that this view is not preferred, because of distortion and gonadal dose.
Patella: Settegast is a tangential view with the knee flexed at least 90°. Don’t do it until a transverse patellar fracture is excluded, since acute flexion can cause harm.
Not sure which section is weakest? Try the free practice test.
What are the main spine and pelvis projections?
Cervical spine:
- AP open mouth: CR perpendicular, for C1 and C2.
- AP axial: CR 15 to 20° cephalad, passing through C4.
- Lateral: CR to C4, with exposure on full expiration to help drop the shoulders.
- Obliques at 45°: posterior obliques take a cephalad tube angle and show the upside foramina. Anterior obliques take a caudad angle and show the downside foramina.
Thoracic spine: AP to T7, and lateral, often with a breathing technique. The swimmer’s lateral shows the C7-T1 area.
Lumbar spine: AP and lateral at the iliac crest with a 35 x 43 cm receptor, or at L3 for a smaller receptor, and 45° obliques. A posterior oblique shows the downside zygapophyseal joints, the ones closest to the receptor. The books split on the L5-S1 joint: Bontrager’s rotates less, to 30°, and Merrill’s says up to 60° may be needed.
L5-S1:
- AP axial: CR 30° cephalad for men and 35° cephalad for women, on the midline. The books center it differently. Bontrager’s uses the level of the ASIS. Merrill’s uses 5 to 6.5 cm (2 to 2.5 in) below the ASIS, or about 3.8 cm (1.5 in) above the symphysis.
- Lateral spot: CR perpendicular with enough waist support, otherwise angled caudad to run parallel to the line between the iliac crests. Bontrager’s gives 5 to 8°, and Merrill’s gives 5° for men and 8° for women. Center about 4 cm (1.5 in) below the iliac crest and 5 cm (2 in) posterior to the ASIS.
Sacrum, coccyx and SI joints: the AP axial sacrum is 15° cephalad, the AP axial coccyx is 10° caudad, and the AP axial SI joints are 30 to 35° cephalad.
Pelvis and hip: for the AP, rotate the legs internally 15 to 20°. The femoral neck angles forward by that much, so the rotation brings it into profile. See AP pelvis centering for where the CR goes.
If a hip fracture is possible, don’t rotate the leg and don’t do a frog-leg. Use the cross-table axiolateral (Danelius-Miller).
What are the main skull projections?
Start with the baselines. The OML runs from the outer canthus to the EAM. The IOML runs from the infraorbital margin to the EAM. The GML runs from the glabella to the EAM. The GML sits 7 to 8° above the OML, and the IOML sits 7 to 8° below it (Merrill’s says 8° and 7°). Don’t confuse GML with GAL, the glabelloalveolar line. Bontrager’s runs it from the glabella to the front of the maxilla’s alveolar process, so it doesn’t reach the ear.
| Projection | Setup | What to look for |
|---|---|---|
| AP axial (Towne) | CR 30° caudad to the OML, or 37° to the IOML | Occipital bone, with the dorsum sellae inside the foramen magnum |
| PA axial (Caldwell) | OML perpendicular, CR 15° caudad, exiting the nasion | Petrous ridges in the lower third of the orbits; frontal bone; frontal and anterior ethmoid sinuses |
| Parietoacanthial (Waters) | MML perpendicular, OML at 37°, CR perpendicular, exiting the acanthion | Maxillary sinuses, with petrous ridges just below them |
| SMV (cranium) | IOML parallel to the receptor, CR perpendicular to the IOML | Skull base, with the mandibular condyles anterior to the petrous pyramids. In trauma, rule out cervical injury first |
| Modified Law (TMJ) | Face turned 15° toward the receptor, CR 15° caudad, entering about 4 cm (1.5 in) above the upside EAM | The TMJ closest to the receptor, closed and open mouth |
Sinuses: erect with a horizontal beam and no tube angle, as ARRT tags every sinus projection it lists as horizontal beam. Fluid has to settle into a level, so keep a patient who was lying down upright for at least 5 minutes first (Bontrager’s; Merrill’s says several minutes). A patient who can’t sit up can still show a level with a horizontal beam, since it’s the vertical beam that hides it. If you test from March 2027, note that the sinus SMV leaves ARRT’s list.
Our skull chapter is free, and it goes through each of these with figures.
How do you adapt positioning for trauma?
Bontrager’s sets three trauma principles, and the fourth point here is how it gets there:
- Take two projections as near 90° apart as the patient allows.
- Include the whole structure on the image.
- Keep the patient, staff and public safe.
- Move the tube and the receptor rather than the injured part.
Cervical spine: don’t remove the collar or move the head or neck until a physician has reviewed the horizontal beam lateral or the CT. Many emergency departments now start with CT. Flexion and extension views wait for that review too.
Hip: no rotation, as above.
Humerus: don’t rotate the arm if a fracture or dislocation is possible. Use a trauma horizontal beam lateral, or the transthoracic lateral for the proximal humerus.
Obstructions: if a splint or traction bar stops a true AP and lateral, get two views as close to 90° apart as you can. A single projection is a last resort, and a note explaining why goes in the record or on the requisition.
Which named fractures should you know?
| Name | Where it is |
|---|---|
| Colles | Distal radius, fragment displaced posteriorly |
| Smith | Distal radius, fragment displaced anteriorly (reverse Colles) |
| Bennett | Base of the first metacarpal, into the CMC joint |
| Boxer | Metacarpal neck, most often the fifth |
| Monteggia | Proximal half of the ulna, with radial head dislocation |
| Pott | The books differ. Bontrager’s: distal fibula with major ankle joint injury, often with distal tibia or medial malleolus fracture. Merrill’s: avulsion of the medial malleolus with loss of the mortise |
| Jones | Avulsion fracture at the base of the fifth metatarsal, in Merrill’s. Bontrager’s doesn’t use the name |
| Lisfranc | Injury where a ligament joins the medial cuneiform to the first and second metatarsal bases, which weight-bearing views can reveal |
| Salter-Harris | Fracture involving the growth plate, types I to V |
The scaphoid is the carpal bone fractured most often, which is why the wrist has its own family of scaphoid views.
How should you read a Procedures question?
This is our suggested routine, not an ARRT method:
- What anatomy is being imaged?
- What is the clinical question: fracture, air, fluid, joint space?
- Is this trauma? If so, what must not move?
- Which projection answers that question?
- What are the rotation, CR angle and centering point?
- What would the image look like if it were positioned correctly?
At about 60 seconds per question, this has to become habit. Test it on the questions in our 20 free samples, several of which are Procedures items.
What order should you study Procedures in?
Radtechprepper has 18 Procedures chapters. Our suggested order:
- Positioning foundations, then chest. Every later chapter uses these terms.
- Upper limb, then lower limb, then femur, pelvis and hip.
- Spine, then bony thorax, then skull.
- Abdomen, GI and urinary studies.
- Trauma, pediatrics and pathology, which pull the earlier chapters together.
Then drill by category. The bank has 918 Procedures questions today and 898 from March 1, 2027. Fit this into the rest of your schedule with our 60-day plan. If you are coming back from a failed attempt, use your section scores to decide how much of this you need, as our retake plan explains.
Where can you start for free?
The free tier includes 3 chapters, and all three are Procedures: Skull, Elbow and Shoulder, and Urinary. You also get 50 questions and a full 200-question timed mock, with no card.
Paid plans open soon and can’t be bought yet: Monthly at $39 (renews monthly until you cancel), a 90-Day Pass at $99 once that never renews, or Annual at $199 a year (about $16.58 a month) that renews until you cancel. They add all 28 chapters and the full question bank.