Master radiography positioning: 126 projections by region.

Skull Lateral

True lateral cranium. SID 40". CR perpendicular to IR.

Trauma patient: this semiprone setup does not apply. A supine horizontal beam lateral is required. Rule out cervical spine fracture, subluxation or dislocation before moving the head or neck.

Skull AP axial (Towne)

AP axial / Towne. Occipital bone, dorsum sellae. SID 40", CR 30° caudad.

Trauma patient: rule out cervical spine fracture, subluxation or dislocation before moving or manipulating the head or neck.

Skull PA axial (Caldwell)

PA axial / Caldwell. Frontal bone, frontal & ethmoid sinuses. CR 15° caudad to OML.

Skull Waters (parietoacanthial)

Waters method. Maxillary sinuses, facial bones. MML perpendicular to IR.

Trauma patient: rule out cervical spine fracture, subluxation or dislocation before moving or manipulating the head or neck.

Skull AP

Trauma AP cranium. SID 40". CR parallel to OML, centered to glabella.

Skull PA

Forehead and nose on IR. OML perpendicular. CR exits glabella or nasion by source.

Trauma patient who cannot be positioned for a PA: use the AP, after ruling out cervical spine injury.

Skull SMV (Cranial Base)

Vertex on IR. IOML parallel to IR. CR perpendicular to IOML.

Trauma patient: rule out cervical spine fracture or subluxation before attempting this projection.

Facial Bones Parietoacanthial (Waters)

Waters method. Maxillary sinuses, facial bones. MML perpendicular to IR.

Trauma patient: rule out cervical spine fracture, subluxation or dislocation before moving or manipulating the head or neck.

Facial Bones Lateral

True lateral facial skeleton. SID 40". CR perpendicular to IR.

Trauma patient: use a supine horizontal beam lateral. Rule out cervical spine fracture, subluxation or dislocation before moving the head or neck.

Facial Bones PA Axial (Caldwell)

Caldwell method. Orbital rims, maxillae, facial bones. CR 15° caudad.

Trauma patient: rule out cervical spine fracture, subluxation or dislocation before moving or manipulating the head or neck.

Nasal Bones Lateral

True lateral nasal bones. SID 40". CR perpendicular to IR.

Trauma patient: rule out cervical spine injury before moving the head or neck.

Mandible PA (Rami)

PA mandible. Body and rami. CR perpendicular to IR.

Trauma patient: this position is best performed supine (Bontrager). Rule out cervical spine injury before moving the head or neck.

Mandible PA Axial (Rami)

PA Axial mandible. Rami and body. CR 20-25° cephalad.

Trauma patient: rule out cervical spine injury before moving the head or neck.

Mandible Axiolateral and Oblique Axiolateral

Axiolateral & oblique axiolateral mandible. Face turned toward the IR by region, CR 25° cephalad.

Trauma patient: use the horizontal beam trauma position with the IR parallel to the mandible, and rule out cervical spine injury before moving the head or neck.

Mandible Submentovertical (SMV)

SMV mandible. Entire mandible. IOML parallel to IR.

Trauma patient: rule out cervical spine fracture or subluxation before attempting this projection.

Off the ARRT outline from March 1, 2027.

TMJ Axiolateral

Axiolateral TMJ (Schuller method). Joint space, condyle. CR 25-30° caudad.

Possible fracture or recent injury: do not open the mouth, because fragments can displace. Trauma patients are examined without stress movement of the mandible.

Off the ARRT outline from March 1, 2027.

TMJ Axiolateral Oblique

Axiolateral oblique TMJ. Joint space clear. CR 15° caudad.

Possible fracture or recent injury: do not open the mouth, because fragments can displace. Trauma patients are examined without stress movement of the mandible.

Sinuses Lateral

Upright lateral. CR horizontal. Demonstrates air-fluid levels.

Sinuses SMV

Upright SMV. Vertex on IR. IOML parallel. Sphenoid + ethmoid sinuses.

Trauma patient: rule out cervical spine fracture or subluxation before attempting this projection.

Off the ARRT outline from March 1, 2027.

Abdomen AP Upright

Erect against vertical Bucky, back straight, arms at sides. SID 40".

Abdomen AP Supine (KUB)

Supine, knees supported, arms at sides. SID 40". Standard KUB position.

Abdomen Lateral Decubitus

Left side down, horizontal CR at 2 inches above iliac crest. SID 40".

AP Odontoid (Open Mouth)

Supine or erect, mouth open wide, CR perpendicular through the open mouth. C1-C2.

Trauma: do not remove the collar or move the head until a physician has cleared the cross-table lateral or CT.

AP Dens (Fuchs)

Supine, chin raised so the MML is near perpendicular, CR parallel to the MML. Alternate dens visualization.

Trauma: do not raise the chin until a physician has cleared the cross-table lateral or CT of the cervical spine.

AP Axial Cervical

Supine or erect, CR 15-20° cephalad through C4. Lower cervical survey.

Lateral Cervical

Erect lateral, CR perpendicular to C4, SID 60-72". Standard survey.

Lateral Cervical (Swimmers)

Erect lateral, arm raised, CR to T1. Twining method.

Trauma: do not remove the collar or move the head or neck until a physician has evaluated the horizontal-beam lateral or CT (Bontrager). Merrill's: do not move the patient's arms without permission from the attending physician and review of the lateral projection, and do not push on the shoulder.

Lateral Cervical (Flexion)

Erect lateral, head flexed forward, CR to C4.

Trauma: never attempt until a physician has reviewed the horizontal-beam lateral or CT (Bontrager). Merrill's: do not attempt until cervical spine pathology or fracture has been ruled out.

Lateral Cervical (Extension)

Erect lateral, head extended backward, CR to C4.

Trauma: never attempt until a physician has reviewed the horizontal-beam lateral or CT (Bontrager). Merrill's: do not attempt until cervical spine pathology or fracture has been ruled out.

AP Thoracic

Supine, arms at sides, CR perpendicular to T7. Grid required.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient (Bontrager). A physician reviews the horizontal-beam lateral before this AP (Bontrager, Merrill's).

Lateral Thoracic

Lateral recumbent, CR perpendicular to T7. Breathing technique.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient (Bontrager). The trauma lateral uses a horizontal beam.

AP Lumbar

Supine, knees flexed, CR perpendicular to the iliac crest (L4-5) on a large IR. Grid required.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient (Bontrager). A physician reviews the horizontal-beam lateral before this AP (Bontrager, Merrill's).

Lateral Lumbar

Lateral recumbent, knees flexed, CR perpendicular to the iliac crest (L4-5) on a large IR.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient (Bontrager). The trauma lateral uses a horizontal beam.

AP Oblique Lumbar Zygapophyseal Joints

45° oblique, RPO or LPO, CR to L3. Facet joints.

L5-S1 Lumbosacral Junction

Lateral recumbent, knees flexed. CR 1.5 in below the iliac crest and 2 in posterior to the ASIS; perpendicular with waist support, otherwise 5 to 8 degrees caudad.

Elbow AP

Seated, arm extended on IR, palm supinated. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Elbow Lateral

Seated, elbow flexed 90 degrees, hand in lateral position. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Elbow AP Oblique (Lateral Rotation)

Arm extended, rotated 45 degrees laterally until 1st/2nd digits touch the table.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Elbow AP Oblique (Medial Rotation)

Arm extended, whole arm internally rotated 45 degrees from true AP.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Elbow Axiolateral, Coyle (Radial Head)

Elbow flexed 90 degrees, palm flat on IR. CR angled 45 degrees toward shoulder.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Elbow Axiolateral, Coyle (Coronoid Process)

Elbow flexed 80 degrees, palm flat on IR. CR angled 45 degrees away from shoulder.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Thumb AP

Seated, hand internally rotated so the dorsal thumb surface lies flat on the IR. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Thumb PA Oblique

Seated, hand pronated, thumb obliqued 45 degrees. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Thumb Lateral

Seated, hand turned slightly medially so the lateral surface of the thumb is on the IR. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Digits 2-5 PA

Seated, hand pronated, palm down on IR. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Digits 2-5 PA Oblique

Seated, hand rotated 45 degrees laterally, radial side raised. The 2nd digit may instead be a 45-degree medial oblique, thumb side down. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Digits 2-5 Lateral

Seated, affected digit in true lateral with adjacent fingers flexed away. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Hand PA

Seated with forearm on table, palm down. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Hand PA Oblique

Seated with hand obliqued 45 degrees, radial side raised. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Hand Lateral

Seated with medial side of hand on IR. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Wrist PA

Seated with forearm on table, wrist pronated. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Wrist PA Oblique

Seated with wrist rotated 45 degrees, radial side raised. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Wrist Lateral

Seated, arm and forearm on the table, wrist lateral. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Wrist PA in Ulnar Deviation

Seated, forearm extended on IR, hand deviated toward ulnar side. SID 40".

WARNING: if wrist trauma is possible, do not attempt this position before a routine wrist series has been completed and evaluated to rule out a distal forearm or wrist fracture (Bontrager).

Wrist PA Axial for Scaphoid

Seated, hand in ulnar deviation. CR angled 10-15° toward elbow.

WARNING: if wrist trauma is possible, do not attempt this position before a routine wrist series has been completed and evaluated to rule out a distal forearm or wrist fracture (Bontrager).

Wrist Tangential (Carpal Canal)

Seated, wrist hyperextended. CR angled 25–30° to long axis of hand.

WARNING: if wrist trauma is possible, do not attempt this position before a routine wrist series has been completed and evaluated to rule out a distal forearm or wrist fracture (Bontrager).

Forearm AP

Seated, forearm extended on IR, palm supinated. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Forearm Lateral

Seated, forearm lateral on IR with thumb up. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Humerus AP

Upright, arm extended at the side with the hand supinated. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Humerus Lateral (Upright)

Upright, arm internally rotated, epicondyles perpendicular to the IR. SID 40".

CONTRAINDICATED if a fracture or dislocation is suspected: do not rotate the arm. Bontrager points to the horizontal beam lateral for the mid-to-distal humerus and the transthoracic lateral for the proximal humerus. Merrill's also shows an upright mediolateral, with the patient facing the IR, for a broken humerus.

Humerus Lateral (Recumbent)

Supine, arm internally rotated, back of the hand against the side. SID 40".

CONTRAINDICATED if a fracture or dislocation is suspected: do not rotate the arm. Bontrager points to the horizontal beam lateral for the mid-to-distal humerus and the transthoracic lateral for the proximal humerus.

Shoulder AP

Erect, arm at side in external or internal rotation; neutral rotation if a fracture or dislocation is suspected. SID 40".

WARNING: do not attempt to rotate the arm if a fracture or dislocation is suspected (Bontrager, Merrill's); Bontrager performs it in neutral rotation, arm as is.

Shoulder AP Oblique, Grashey Method

Body rotated 35-45 degrees toward the affected side. CR perpendicular to IR. SID 40".

WARNING: do not rotate the arm if a fracture or dislocation is suspected (both books print this at the AP shoulder; Bontrager files this oblique under nontrauma).

Shoulder Scapular Y

Erect 45-60 degree anterior oblique, arm hanging at the side. SID 40".

WARNING: do not attempt to rotate the arm if a fracture or dislocation is suspected; leave the affected arm as presented (Bontrager).

Shoulder Transthoracic Lateral

Lateral erect, affected shoulder against IR. Breathing technique. SID 40".

AC Joints AP

Erect, bilateral AC joints. Arms at sides, no weights. SID 72" to fit both joints on one image (Bontrager: 40" minimum, or 72"; Merrill's: 72").

AC Joints AP with Weights

Erect, bilateral AC joints. Equal weights strapped to both wrists (Bontrager: 8 to 10 lb minimum for large adults, less for smaller patients; Merrill's: 5 to 10 lb). SID 72" to fit both joints on one image (Bontrager: 40" minimum, or 72"; Merrill's: 72").

Rule out a fracture first: shoulder or clavicle images, or the non-weighted view checked before the weighted one.

Clavicle AP

Erect or supine, arm at side. CR perpendicular to clavicle midshaft. SID 40". Include entire clavicle.

WARNING: suspected fracture or destructive disease: Merrill's uses the supine position to reduce the possibility of fragment displacement or additional injury. Bontrager allows erect or supine.

Clavicle AP Axial

Erect or supine, CR 15-30 degrees cephalad. Most of the clavicle above the ribs. SID 40".

WARNING: suspected fracture or destructive disease: Merrill's uses the supine position to reduce the possibility of fragment displacement or additional injury.

Scapula AP

Erect, arm abducted 90 degrees. CR perpendicular to midscapula. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Scapula Lateral

Erect anterior or posterior oblique, rotated until the scapular body is lateral. CR perpendicular to IR. SID 40".

WARNING: with shoulder trauma, do not attempt to rotate the arm if a fracture or dislocation is suspected; leave the affected arm as presented (Bontrager). Merrill's: a trauma patient can be done in the LPO or RPO position.

Toes AP

Foot flat on IR, CR 10-15 degrees toward the heel to the MTP joint in question. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Toes Lateral

Affected toe in true lateral on IR, CR perpendicular. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Toes AP Oblique

Foot rotated 30-45 degrees, medially for toes 1-3 and laterally for toes 4-5. CR perpendicular. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Sesamoids Tangential, Lewis Method

Patient prone, toe flexed back on IR. CR perpendicular and tangential. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Off the ARRT outline from March 1, 2027.

Foot AP Axial

Sole flat on IR, CR angled 10° cephalad toward heel. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Foot Medial Oblique

Foot rotated medially 30-40 degrees (Bontrager) or 30 (Merrill's), CR perpendicular. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Calcaneus Axial (Plantodorsal)

Foot dorsiflexed, CR angled 40° cephalad through plantar surface. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Calcaneus Lateral (Mediolateral)

Patient lateral recumbent on affected side, CR perpendicular to calcaneus. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Ankle AP

Supine, leg extended and not rotated, CR perpendicular to the ankle joint. SID 40".

Leave the foot in its natural position; do not force dorsiflexion, which can hurt and add injury.

Ankle Lateral (Mediolateral)

Patient lateral recumbent on affected side, CR perpendicular to ankle. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Ankle Lateral (Lateromedial)

Patient lateral on non-affected side, medial ankle on IR. CR perpendicular. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

AP Medial Oblique Ankle

Supine, ankle internally rotated 45 degrees. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

AP Medial Oblique Mortise Ankle

Supine, leg internally rotated 15-20°. Mortise open. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

AP Weight-Bearing Ankle

Upright on a low platform, heels against the IR, toes forward. SID 40".

AP Leg (Tibia & Fibula)

Supine, leg extended on IR, foot true AP. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Lateral Leg (Tibia & Fibula)

Turned onto the affected side, knee slightly flexed, foot in true lateral. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position. If the patient cannot be turned, take it cross-table with the IR on edge.

AP Knee

Supine, leg fully extended on IR. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Lateral Knee

Lateral recumbent, affected side down, knee flexed 20-30 degrees; horizontal beam if pain or trauma prevents flexing. SID 40".

WARNING: if the patient cannot flex the knee because of pain or trauma, do not flex it: use a horizontal-beam lateromedial with the IR beside the knee and support under the knee (Bontrager). Added flexion may separate patellar fracture fragments.

AP Weight-Bearing Knees

Upright standing, both feet flat, knees extended. SID 40".

PA Axial Intercondylar Fossa Holmblad

Kneeling on the table, affected knee over the IR, leaning forward, knee flexed 60-70 degrees, CR perpendicular to lower leg. SID 40".

PA Axial Intercondylar Fossa Camp-Coventry

Prone, knee flexed 40-50 degrees, CR 40-50 degrees caudad to match. SID 40".

AP Axial Intercondylar Fossa Beclere

Supine, knee flexed 40-45 degrees (Bontrager) or femur 60 degrees to tibia (Merrill's), CR perpendicular to lower leg. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

PA Patella

Prone, leg extended with the patella flat against the IR. SID 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Lateral Patella

Lateral recumbent, affected side down, knee flexed 5-10 degrees; horizontal beam with no flexion for severe trauma. SID 40".

WARNING: with severe trauma, do not flex the knee: use a horizontal-beam lateral with no knee flexion (Bontrager).

Tangential Patella Settegast

Prone, knee flexed to at least 90 degrees (Bontrager) or until the patella is perpendicular to the IR (Merrill's), CR tangential to the patellofemoral joint. SID 40".

WARNING: do not attempt until a patellar fracture has been ruled out by other projections (Bontrager), or a transverse patellar fracture by a lateral image (Merrill's): acute flexion can displace fragments. Merrill's also says not to attempt it if the patient is in pain.

AP Proximal Femur

Supine, leg internally rotated 15-20 degrees (Bontrager) or 10-15 (Merrill's) unless a fracture or dislocation is suspected. Hip joint included.

WARNING: do not rotate the leg if a fracture or dislocation is suspected. With trauma, do not move the injured limb if the leg is externally rotated: take an AP of both hips first (Bontrager).

AP Distal Femur

Supine, leg extended in true AP. Knee joint included.

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.

Lateral Proximal Femur

Lateral recumbent on affected side. Hip joint included.

WARNING: do not use this position if a hip or proximal femur fracture is possible (Bontrager), or with any femoral fracture or possible destructive disease (Merrill's). Use the trauma lateral hip routine or a horizontal-beam lateral.

Lateral Distal Femur

Lateral recumbent on affected side. Knee joint included.

WARNING: do not attempt this position with severe trauma (Bontrager), or with a fracture or possible destructive disease (Merrill's). Use the horizontal-beam lateral, patient supine.

Chest AP supine

Bedside supine or semierect chest. 72" SID if possible; Merrill's sample uses 40".

WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient (Bontrager).

Chest PA

Upright PA chest. SID 72". Inspiration on second breath.

Chest AP

Anteroposterior upright chest projection. SID 72".

Chest Lateral

Left lateral upright chest projection. SID 72".

Chest Lateral Decubitus

Patient on side with horizontal beam. SID 72".

Chest Dorsal Decubitus

Supine chest, horizontal beam across the thorax, giving a lateral image. SID 72".

Lungs AP Axial Lordotic

AP lordotic for pulmonary apices. Patient leans back, shoulders on the IR. SID 72".

Ribs Posterior AP

AP posterior ribs, erect above the diaphragm, supine below. SID 40". Breathing varies by location.

Ribs Anterior PA

PA anterior ribs, erect. SID 40". Full inspiration.

Ribs AP Oblique

AP oblique ribs, 45-degree. SID 40". Breathing varies by location.

Ribs PA Oblique

PA oblique ribs, 45-degree. SID 40". Breathing varies by location.

Sternum PA Oblique RAO

PA oblique sternum (RAO), 15-20 degrees. SID 40". Breathing technique.

Sternum Lateral

Lateral sternum, erect. SID 60-72". Shoulders and arms drawn back.

Sternoclavicular Joints PA

PA sternoclavicular joints. SID 40".

Sternoclavicular Joints PA Oblique

PA oblique SC joints, 10-15 degrees. SID 40".

Hip AP

Supine, affected leg internally rotated 15-20 degrees unless a fracture or dislocation is suspected. SID 40".

WARNING: do not rotate the leg if a fracture or dislocation is suspected. For possible hip or pelvis trauma, complete an AP pelvis including both hips first, without moving the affected leg.

Hip Lateral

Supine frog-leg, non-trauma only, affected femur abducted 45 degrees with hip and knee flexed. SID 40".

CONTRAINDICATED in destructive hip disease or potential hip fracture or dislocation (Bontrager), or any suspected fracture or pathologic condition (Merrill's), because it can displace fracture fragments, and after hip replacement: use the Danelius-Miller axiolateral instead.

Hip Axiolateral

Danelius-Miller. Supine, affected leg extended, opposite leg raised out of the field. Horizontal cross-table CR. SID 40".

Keep the affected leg extended. Do not rotate it if a fracture is possible.

Pelvis AP

Supine, legs internally rotated 15-20 degrees unless a hip fracture or dislocation is suspected. SID 40".

WARNING: do not rotate the legs internally if a hip fracture or dislocation is suspected. Take the image as is, with minimal movement of the affected leg.

Femoral Neck AP Oblique (Modified Cleaves)

Supine, hips and knees flexed about 90 degrees, femora abducted 40-45 degrees, soles together. SID 40".

CONTRAINDICATED in destructive hip disease or potential hip fracture or dislocation (Bontrager), any suspected fracture or other pathologic disease (Merrill's), and after hip replacement (Bontrager): use the Danelius-Miller axiolateral instead.

Sacrum AP Axial

Axial view of sacrum. CR 15° cephalad. SID 40".

Sacrum Lateral

True lateral sacrum. SID 40". CR perpendicular to IR.

Coccyx AP Axial

Axial view of coccyx. CR 10° caudad. SID 40".

Coccyx Lateral

True lateral coccyx. SID 40". CR perpendicular to IR.

Off the ARRT outline from March 1, 2027.

SI Joints AP Axial

AP axial bilateral SI joints. CR 30-35° cephalad. SID 40".

SI Joints AP Oblique (RPO)

AP oblique SI joints, RPO. SID 40". CR perpendicular to IR.