X-Ray Protocols
X-Ray
Skull
PA Skull (Posteroanterior Skull)
Best Visualized
Frontal bone, parietal bones, petrous ridges filling orbits
kVp
80–85
mAs
15–25
SID
100–110 cm
Positioning Notes
Patient positioned posteroanterior, forehead and nose placed against the image receptor. Orbitomeatal line (line from outer eye corner to ear opening) is perpendicular to the image receptor. Central ray directed perpendicular to image receptor.
Lateral Skull
Best Visualized
Entire skull, sella turcica, cranial vault
kVp
80–85
mAs
12–20
SID
100 cm
Positioning Notes
Side of head placed against image receptor. Infraorbitomeatal line (line from infraorbital margin to ear opening) is parallel to the floor. Central ray directed 5 cm above the external auditory meatus (ear canal opening).
Towne’s View (Anteroposterior Axial)
Best Visualized
Occipital bone, foramen magnum, dorsum sellae
kVp
80–90
mAs
20–30
SID
100 cm
Positioning Notes
Patient positioned anteroposterior, chin tucked to chest. Orbitomeatal line is perpendicular to image receptor. Central ray angled 30° caudal (37° if infraorbitomeatal line used) directed through the foramen magnum.
Caldwell View (Posteroanterior Axial)
Best Visualized
Frontal sinuses, orbital rims, ethmoid air cells
kVp
80–85
mAs
15–25
SID
100 cm
Positioning Notes
Patient positioned posteroanterior, orbitomeatal line perpendicular to image receptor. Central ray angled 15° caudal and directed through the nasion (junction of frontal and nasal bones).
Submento-Vertical (SMV)
Best Visualized
Base of skull, sphenoid bone, foramina ovale and spinosum
kVp
80–90
mAs
20–30
SID
100 cm
Positioning Notes
Patient supine or upright, vertex (top of head) against detector. Infraorbitomeatal line parallel to image receptor. Central ray perpendicular to infraorbitomeatal line, entering below mandible.
Face Radiography
Water’s (Occipitomental)
Best Visualized
Maxillary sinuses, orbital floors, zygomatic arches
kVp
80–85
mAs
15–20
SID
100 cm
Positioning Notes
Patient positioned Posteroanterior (PA) with chin extended. Orbitomeatal Line (OML) is adjusted to form a 37° angle with the Image Receptor (IR). Central Ray (CR) is directed perpendicular through the acanthion. This projection best demonstrates the maxillary sinuses and orbital floors.
Caldwell (PA Axial)
Best Visualized
Orbital rims, frontal sinuses, ethmoid air cells
kVp
80–85
mAs
15–20
SID
100 cm
Positioning Notes
Patient positioned Posteroanterior (PA) with forehead and nose resting against the Image Receptor (IR). Orbitomeatal Line (OML) is kept perpendicular to the IR. Central Ray (CR) angled 15° caudally and directed through the nasion. This optimally projects frontal sinuses and orbital margins.
Lateral Face
Best Visualized
Superimposed facial bones, nasal bones, mandible
kVp
80–85
mAs
12–16
SID
100 cm
Positioning Notes
Patient placed in true lateral position with the side of interest closest to the Image Receptor (IR). Interpupillary Line (IPL) is perpendicular to the IR. Infraorbitomeatal Line (IOML) kept parallel to the floor. Central Ray (CR) directed perpendicular and centered midway between the outer canthus and the external auditory meatus (EAM).
Submento-Vertical (SMV) for Zygomatic Arches
Best Visualized
Zygomatic arches free of superimposition
kVp
80–85
mAs
20–25
SID
100 cm
Positioning Notes
Patient positioned supine or upright with the vertex of the skull against the Image Receptor (IR). Neck is hyperextended so that the Infraorbitomeatal Line (IOML) is parallel to the IR. Central Ray (CR) is directed perpendicular to the IOML and centered midway between the zygomatic arches. This view ensures both zygomatic arches are demonstrated without overlap.
Nasal Bones
Nasal Bones - Lateral (both sides)
Best Visualized
Nasal bones & anterior nasal spine
kVp
60–65
mAs
2–4
SID
100 cm
Positioning Notes
Head lateral, Central Ray perpendicular 1.3 cm inferior to nasion
Nasal Bones - Water’s View
Best Visualized
Nasal septum, maxillae, zygoma, orbital floor
kVp
80
mAs
15
SID
100 cm
Positioning Notes
Chin extended, Orbitomeatal Line 37° with Image Receptor
Paranasal Sinuses
Sinus - Water’s (OM)
Best Visualized
Maxillary sinuses, orbital floors
kVp
80–85
mAs
15–20
SID
100 cm
Positioning Notes
Chin extended, Orbitomeatal Line 37° with Image Receptor
Sinus - Caldwell
Best Visualized
Frontal & ethmoid sinuses
kVp
80–85
mAs
15–20
SID
100 cm
Positioning Notes
Orbitomeatal Line 15° to Image Receptor, Central Ray horizontal
Sinus - Lateral
Best Visualized
All sinuses in profile
kVp
80
mAs
12–16
SID
100 cm
Positioning Notes
Head lateral, Central Ray midway between outer canthus & External Auditory Meatus
Sinus - SMV
Best Visualized
Sphenoid & ethmoid sinuses
kVp
80–85
mAs
20–25
SID
100 cm
Positioning Notes
Vertex against Image Receptor, Infraorbitomeatal Line parallel to Image Receptor
Orbits
Orbit - Water’s
Best Visualized
Orbital floors, infraorbital margins
kVp
80–85
mAs
15–20
SID
100 cm
Positioning Notes
Chin extended, Orbitomeatal Line 37° with Image Receptor
Orbit - Caldwell
Best Visualized
Orbital rims, superior orbital fissures
kVp
80–85
mAs
15–20
SID
100 cm
Positioning Notes
Orbitomeatal Line perpendicular to Image Receptor, Central Ray 15° caudal
Orbit - Lateral
Best Visualized
Both orbital roofs, walls, intraorbital foreign bodies
kVp
80–85
mAs
12–16
SID
100 cm
Positioning Notes
Head lateral, Central Ray midway outer canthus–External Auditory Meatus
Mandible
Mandible - PA
Best Visualized
Mandibular body, rami
kVp
80–85
mAs
15–25
SID
100 cm
Positioning Notes
Orbitomeatal Line perpendicular to Image Receptor, Central Ray through lips
Mandible - Oblique Lateral
Best Visualized
Ramus, body of mandible
kVp
80–85
mAs
12–20
SID
100 cm
Positioning Notes
Head rotated 30°, Central Ray tangent to mandible
Mandible - Towne’s (AP Axial)
Best Visualized
Condylar heads, condylar necks
kVp
80–90
mAs
20–30
SID
100 cm
Positioning Notes
Same as skull Towne’s, but Central Ray angled 35° caudal
Mandible - Panoramic (OPG)
Best Visualized
Entire mandible, TMJ
kVp
70–80
mAs
Auto mA (5–10)
SID
Fixed
Positioning Notes
Patient bites on bite-block, panoramic sweep
Cervical Spine
Cervical Spine - AP
Best Visualized
C3–C7 vertebral bodies, intervertebral spaces
kVp
70–80
mAs
5–8
SID
100–110 cm
Positioning Notes
Supine/upright, chin elevated so occlusal plane perpendicular to Image Receptor, Central Ray angled 15–20° cephalad through C4
Cervical Spine - Lateral
Best Visualized
Vertebral alignment, zygapophyseal joints, soft tissue
kVp
70–80
mAs
8–12
SID
180 cm
Positioning Notes
Erect (preferred), shoulders depressed, chin slightly up, Central Ray through C4, expose at expiration
Cervical Spine - Odontoid (Open Mouth)
Best Visualized
Odontoid process (dens), C1–C2 lateral masses
kVp
70–80
mAs
5–8
SID
100 cm
Positioning Notes
Patient opens mouth, Central Ray through center of mouth, align upper incisors and base of skull in one line
Cervical Spine - Oblique (RAO/LAO or RPO/LPO)
Best Visualized
Intervertebral foramina
kVp
70–80
mAs
8–12
SID
180 cm
Positioning Notes
Body rotated 45°, chin extended, Central Ray angled 15° (cephalad for AP, caudal for PA)
Cervical Spine - Swimmer’s
Best Visualized
C7–T1 junction when not visible on lateral
kVp
80–90
mAs
20–40
SID
180 cm
Positioning Notes
One arm raised, opposite depressed, Central Ray to C7–T1, breathing technique optional
Thoracic Spine
Thoracic Spine - AP
Best Visualized
Vertebral bodies, intervertebral spaces
kVp
75–85
mAs
20–30
SID
100–110 cm
Positioning Notes
Supine/upright, Central Ray to T7 (inferior angle of scapulae)
Thoracic Spine - Lateral
Best Visualized
Intervertebral foramina, posterior elements
kVp
75–85
mAs
30–50
SID
110–120 cm
Positioning Notes
Left lateral, arms raised, Central Ray to T7, use breathing technique (low mA, long exposure)
Thoracic Spine - Swimmer’s
Best Visualized
T1–T3 vertebrae
kVp
80–90
mAs
20–40
SID
180 cm
Positioning Notes
Same as cervical swimmer’s positioning
Lumbar Spine
Lumbar Spine - AP
Best Visualized
Lumbar vertebrae, intervertebral spaces, spinous processes
kVp
80–90
mAs
25–40
SID
100–110 cm
Positioning Notes
Supine, knees flexed to reduce lordosis, Central Ray to L3
Lumbar Spine - Lateral
Best Visualized
Intervertebral foramina, vertebral alignment
kVp
85–95
mAs
40–80
SID
110–120 cm
Positioning Notes
Left lateral, knees flexed, Central Ray to L3–L4
Lumbar Spine - Oblique (RPO/LPO)
Best Visualized
Zygapophyseal joints ('Scottie dog')
kVp
80–90
mAs
30–50
SID
100 cm
Positioning Notes
Patient rotated 45°, Central Ray to L3
Lumbar Spine - Lumbosacral Spot (L5–S1 lateral)
Best Visualized
Lumbosacral junction, L5–S1 disc
kVp
90–100
mAs
40–80
SID
100 cm
Positioning Notes
Lateral, Central Ray angled 5–8° caudal if spine not horizontal
Lumbar Spine - AP Axial L5–S1 (Ferguson’s)
Best Visualized
Lumbosacral junction, sacroiliac joints
kVp
80–90
mAs
25–40
SID
100 cm
Positioning Notes
Supine, Central Ray angled 30–35° cephalad, centered at Anterior Superior Iliac Spine
Sacrum & Coccyx
Sacrum - AP (Axial)
Best Visualized
Sacrum, sacroiliac joints
kVp
80–85
mAs
25–40
SID
100 cm
Positioning Notes
Supine, Central Ray angled 15° cephalad, centered midway between symphysis & Anterior Superior Iliac Spine
Sacrum - Lateral
Best Visualized
Sacral vertebrae, curvature
kVp
85–90
mAs
40–60
SID
100 cm
Positioning Notes
True lateral, knees flexed, Central Ray 8 cm posterior to Anterior Superior Iliac Spine
Coccyx - AP (Axial)
Best Visualized
Coccygeal segments, coccyx free of superimposition
kVp
75–80
mAs
20–30
SID
100 cm
Positioning Notes
Supine, Central Ray angled 10° caudal, centered 5 cm inferior to Anterior Superior Iliac Spine
Coccyx - Lateral
Best Visualized
Coccyx in profile
kVp
80–85
mAs
30–50
SID
100 cm
Positioning Notes
Lateral position, Central Ray 5 cm posterior & 5 cm inferior to Anterior Superior Iliac Spine
Routine
PA Chest (Standard)
Best Visualized
Both lungs, heart, mediastinum, costophrenic angles
kVp
110–125
mAs
1–3
SID
180 cm (72")
Positioning Notes
Patient erect, anterior chest against Image Receptor (IR), chin up, shoulders rolled forward, Central Ray (CR) perpendicular to T7, exposure on full inspiration.
AP Chest (Portable)
Best Visualized
Lungs, heart (magnified), mediastinum (bedside cases)
kVp
90–110
mAs
2–5
SID
100–120 cm
Positioning Notes
Patient supine or semi-recumbent, Central Ray (CR) perpendicular to sternum at T7, exposure on full inspiration. Heart appears magnified due to shorter Source-to-Image Distance (SID).
Lateral Chest
Best Visualized
Retrocardiac space, posterior lungs, heart borders
kVp
110–125
mAs
3–6
SID
180 cm
Positioning Notes
Left side against Image Receptor (IR), arms raised above head to avoid superimposition, Central Ray (CR) perpendicular to mid-thorax, exposure on full inspiration.
Special
Lordotic Chest (AP Axial)
Best Visualized
Apices of lungs, TB lesions, calcifications, apical masses
kVp
110–125
mAs
3–5
SID
180 cm
Positioning Notes
Patient stands ~30 cm from Image Receptor (IR), leans backward so shoulders rest on IR. If patient cannot lean, Central Ray (CR) angled 15–20° cephalad, exposure on full inspiration.
Decubitus Chest (Lateral Decubitus)
Best Visualized
Pleural effusion (fluid layering), pneumothorax (air rise)
kVp
110–125
mAs
3–5
SID
180 cm
Positioning Notes
Patient placed in lateral decubitus position. Affected side down for fluid, opposite side down for pneumothorax. Central Ray (CR) horizontal and perpendicular to IR, exposure on full inspiration.
Expiratory Chest
Best Visualized
Pneumothorax, diaphragm movement, air trapping
kVp
110–125
mAs
2–5
SID
180 cm
Positioning Notes
Same as PA/AP chest positioning, but exposure made at end-expiration to demonstrate pneumothorax or trapped air.
Apical Oblique (RAO/LAO Oblique Chest)
Best Visualized
Heart, great vessels, retrocardiac region, lung fields
kVp
110–125
mAs
4–6
SID
180 cm
Positioning Notes
Patient rotated 45°. Right Anterior Oblique (RAO) demonstrates heart and great vessels. Left Anterior Oblique (LAO) demonstrates lungs. Arms raised, exposure on inspiration.
Pediatric
AP/PA Pediatric Chest
Best Visualized
Lungs & mediastinum
kVp
65–80
mAs
1–2
SID
100–120 cm
Positioning Notes
Immobilization devices (e.g., Pigg-O-Stat) often required. Central Ray (CR) perpendicular to mid-thorax. Short exposure time to minimize motion blur. Exposure on inspiration if possible.
Lateral Pediatric Chest
Best Visualized
Heart, retrosternal & retrocardiac regions
kVp
65–80
mAs
2–4
SID
100–120 cm
Positioning Notes
Same as lateral chest. Child held or immobilized. Central Ray (CR) perpendicular to mid-thorax. Exposure on inspiration.
Abdomen Radiography
AP Supine (KUB)
Best Visualized
Kidneys, ureters, bladder, bowel gas pattern
kVp
70–80
mAs
20–40
SID
100–110 cm
Positioning Notes
Patient supine (lying flat on back), arms at side, Central Ray (CR) to iliac crest, include symphysis pubis
AP Erect Abdomen
Best Visualized
Air-fluid levels, free intraperitoneal air, bowel loops
kVp
70–80
mAs
25–50
SID
100–110 cm
Positioning Notes
Patient erect ≥5 min before exposure (to allow air-fluid separation), Central Ray (CR) 5 cm above iliac crest (to include diaphragm), arms away from abdomen
Left Lateral Decubitus
Best Visualized
Free intraperitoneal air (best over liver), air-fluid levels
kVp
70–80
mAs
30–50
SID
100–110 cm
Positioning Notes
Patient in left lateral decubitus (lying on left side) ≥5–10 min, Central Ray (CR) 5 cm above iliac crest, horizontal beam, marker to indicate side up
Dorsal Decubitus (Cross-table lateral)
Best Visualized
Aneurysms, calcifications, foreign bodies
kVp
80–85
mAs
30–60
SID
100–110 cm
Positioning Notes
Patient supine, Central Ray (CR) horizontal to mid-abdomen at iliac crest
Lateral Abdomen
Best Visualized
Soft tissue masses, foreign bodies, Abdominal Aortic Aneurysm (AAA)
kVp
80–85
mAs
40–70
SID
100–110 cm
Positioning Notes
Patient lateral (lying on side), knees flexed, Central Ray (CR) to iliac crest
Pelvis
AP Pelvis
Best Visualized
Entire pelvis, hip joints, proximal femora
kVp
80–90
mAs
20–40
SID
100–110 cm
Positioning Notes
Supine, legs internally rotated 15–20° (unless trauma), CR midway between ASIS & symphysis pubis
AP Inlet (Axial)
Best Visualized
Pelvic ring, pubic symphysis widening, pelvic brim
kVp
80–90
mAs
25–45
SID
100–110 cm
Positioning Notes
Supine, CR angled 40° caudal, centered at ASIS
AP Outlet (Taylor Method)
Best Visualized
Superior/inferior rami, pubic arch, ischium
kVp
80–90
mAs
25–45
SID
100–110 cm
Positioning Notes
Supine, CR angled 20–35° cephalad (men), 30–45° (women), centered 5 cm inferior to ASIS
Judet Views (Oblique Pelvis)
Best Visualized
Acetabulum (anterior & posterior rims)
kVp
80–90
mAs
25–45
SID
100–110 cm
Positioning Notes
Supine, body rotated 45° (RPO/LPO), CR to acetabulum
Hip
AP Hip
Best Visualized
Proximal femur, acetabulum, hip joint space
kVp
80–85
mAs
20–35
SID
100–110 cm
Positioning Notes
Supine, affected leg internally rotated 15–20° (unless fracture), CR 2.5 cm distal to midpoint between ASIS & symphysis
Frog-Leg Lateral (Modified Cleaves)
Best Visualized
Femoral head, neck, greater/lesser trochanter
kVp
80–85
mAs
20–35
SID
100–110 cm
Positioning Notes
Supine, knee flexed, thigh abducted ~45°, CR to mid-femoral neck
Cross-Table Lateral (Danelius-Miller)
Best Visualized
Lateral projection of hip & femoral neck in trauma
kVp
80–90
mAs
40–60
SID
100–110 cm
Positioning Notes
Supine, unaffected leg raised, IR parallel to femoral neck, CR horizontal, perpendicular to femoral neck
Clements–Nakayama
Best Visualized
Lateral hip if patient can’t elevate opposite leg
kVp
80–90
mAs
40–60
SID
100–110 cm
Positioning Notes
Supine, IR tilted back 15°, CR angled 15° posteriorly, perpendicular to femoral neck
Shoulder
AP Shoulder (External rotation)
Best Visualized
Greater tubercle in profile, glenohumeral joint
kVp
70–80
mAs
5–10
SID
100 cm (Source-to-Image Distance)
Positioning Notes
Patient supine or erect, arm externally rotated. CR (Central Ray) directed 2.5 cm inferior to coracoid process.
AP Shoulder (Internal rotation)
Best Visualized
Lesser tubercle in profile medially
kVp
70–80
mAs
5–10
SID
100 cm
Positioning Notes
Arm internally rotated, back of hand placed on thigh. CR (Central Ray) same as external rotation view.
Scapular Y (Lateral)
Best Visualized
Shoulder dislocation, scapula, acromion, coracoid
kVp
70–80
mAs
10–15
SID
100 cm
Positioning Notes
Patient rotated 45–60°. CR (Central Ray) directed through humeral head.
Axillary (Inferosuperior)
Best Visualized
Glenohumeral joint, humeral head, coracoid process
kVp
70–80
mAs
5–10
SID
100 cm
Positioning Notes
Patient supine, arm abducted 90°. IR (Image Receptor) placed at shoulder. CR (Central Ray) horizontal, directed through axilla.
AP Oblique (Grashey Method)
Best Visualized
Glenohumeral joint space, joint integrity
kVp
70–80
mAs
6–12
SID
100 cm
Positioning Notes
Patient rotated 35–45° toward affected side. CR (Central Ray) directed to glenohumeral joint.
Clavicle
AP Clavicle
Best Visualized
Entire clavicle, AC (Acromioclavicular) & SC (Sternoclavicular) joints
kVp
70–80
mAs
5–8
SID
100 cm
Positioning Notes
Patient supine or erect. CR (Central Ray) perpendicular to mid-clavicle.
AP Axial Clavicle
Best Visualized
Clavicle free of rib overlap
kVp
70–80
mAs
5–8
SID
100 cm
Positioning Notes
Patient supine or erect. CR (Central Ray) angled 15–30° cephalad.
Humerus
AP Humerus
Best Visualized
Entire humerus, elbow, and shoulder joints
kVp
70–80
mAs
5–10
SID
100 cm
Positioning Notes
Patient supine or erect, arm abducted, hand supinated. CR (Central Ray) directed to mid-humerus.
Lateral Humerus
Best Visualized
Distal humerus, elbow, humeral shaft
kVp
70–80
mAs
5–10
SID
100 cm
Positioning Notes
Arm flexed 90°, palm on hip. CR (Central Ray) directed to mid-humerus.
Elbow
AP Elbow
Best Visualized
Distal humerus, proximal radius/ulna, joint space
kVp
65–70
mAs
4–6
SID
100 cm
Positioning Notes
Arm extended, hand supinated. CR (Central Ray) directed to mid-elbow joint.
Lateral Elbow
Best Visualized
Olecranon process, joint effusion, fat pads
kVp
65–70
mAs
4–6
SID
100 cm
Positioning Notes
Elbow flexed 90°, thumb up. CR (Central Ray) directed to mid-elbow joint.
AP Oblique (Medial rotation)
Best Visualized
Coronoid process, trochlea, medial epicondyle
kVp
65–70
mAs
4–6
SID
100 cm
Positioning Notes
Arm pronated 45°. CR (Central Ray) directed to mid-elbow joint.
AP Oblique (Lateral rotation)
Best Visualized
Radial head, radial neck, capitulum
kVp
65–70
mAs
4–6
SID
100 cm
Positioning Notes
Arm supinated and rotated 45°. CR (Central Ray) directed to mid-elbow joint.
Forearm
AP Forearm
Best Visualized
Radius & ulna, wrist to elbow
kVp
65–70
mAs
4–6
SID
100 cm
Positioning Notes
Arm extended, hand supinated. CR (Central Ray) directed to mid-forearm.
Lateral Forearm
Best Visualized
Superimposed radius & ulna, distal humerus
kVp
65–70
mAs
4–6
SID
100 cm
Positioning Notes
Elbow flexed 90°, thumb up. CR (Central Ray) directed to mid-forearm.
Wrist
PA Wrist
Best Visualized
Carpals, distal radius/ulna
kVp
60–65
mAs
2–4
SID
100 cm
Positioning Notes
Hand pronated, fingers flexed. CR (Central Ray) directed to mid-carpals.
Oblique Wrist (AP oblique, lateral rotation)
Best Visualized
Trapezium, scaphoid, radial styloid
kVp
60–65
mAs
2–4
SID
100 cm
Positioning Notes
Wrist rotated 45° laterally. CR (Central Ray) directed to mid-carpals.
Lateral Wrist
Best Visualized
Carpal alignment, Colles/Smith fractures
kVp
60–65
mAs
2–4
SID
100 cm
Positioning Notes
Wrist lateral, thumb up. CR (Central Ray) directed to mid-carpals.
Scaphoid View (Ulnar Deviation)
Best Visualized
Scaphoid free of foreshortening
kVp
60–65
mAs
2–4
SID
100 cm
Positioning Notes
Hand PA, wrist ulnar deviated. CR (Central Ray) angled 10–15° proximally toward scaphoid.
Hand
PA Hand
Best Visualized
Phalanges, metacarpals, carpals
kVp
60–65
mAs
2–4
SID
100 cm
Positioning Notes
Hand pronated. CR (Central Ray) directed to 3rd MCP (Metacarpophalangeal joint).
Oblique Hand
Best Visualized
Metacarpal fractures, phalanges
kVp
60–65
mAs
2–4
SID
100 cm
Positioning Notes
Hand rotated 45° laterally. CR (Central Ray) directed to 3rd MCP joint.
Lateral Hand (Fan lateral)
Best Visualized
Phalanges individually, joint spaces
kVp
60–65
mAs
2–4
SID
100 cm
Positioning Notes
Hand lateral, fingers spread. CR (Central Ray) directed to 2nd MCP joint.
Fingers & Thumb
PA Finger
Best Visualized
Phalanx, joint spaces
kVp
55–60
mAs
2–3
SID
100 cm
Positioning Notes
Finger extended flat. CR (Central Ray) directed to PIP (Proximal Interphalangeal joint).
Oblique Finger
Best Visualized
Phalanx, fractures, joints
kVp
55–60
mAs
2–3
SID
100 cm
Positioning Notes
Finger rotated 45°. CR (Central Ray) directed to PIP joint.
Lateral Finger
Best Visualized
Displacement, fractures
kVp
55–60
mAs
2–3
SID
100 cm
Positioning Notes
Finger lateral. CR (Central Ray) directed to PIP joint.
AP Thumb
Best Visualized
Thumb in true AP, MCP & CMC joints
kVp
55–60
mAs
2–3
SID
100 cm
Positioning Notes
Hand internally rotated. CR (Central Ray) directed to 1st MCP joint.
Lateral Thumb
Best Visualized
Thumb fractures, joint integrity
kVp
55–60
mAs
2–3
SID
100 cm
Positioning Notes
Thumb lateral. CR (Central Ray) directed to 1st MCP joint.
Knee Joint
AP Knee
Best Visualized
Distal femur, proximal tibia, and knee joint space
kVp
70–80
mAs
10–15
SID
100–110 cm Positioning: Patient supine with leg fully extended. Central Ray directed 1.5 cm below the apex of the patella. Angle Central Ray 5° cephalad for thin patients or 5° caudad for large patients.
Lateral Knee (Mediolateral)
Best Visualized
Patellofemoral joint, femoral condyles superimposed
kVp
70–80
mAs
10–15
SID
100–110 cm Positioning: Patient in lateral recumbent position with affected knee flexed 20–30°. Central Ray directed 2.5 cm distal to the medial femoral condyle.
AP Oblique Knee (Medial/Lateral Rotation)
Best Visualized
Tibial plateaus, femoral condyles, and joint space
kVp
70–80
mAs
10–15
SID
100–110 cm Positioning: Patient supine. Rotate leg internally or externally by 45°. Central Ray directed to the knee joint.
Intercondylar Fossa (Tunnel / PA Axial / Camp-Coventry / Holmblad)
Best Visualized
Intercondylar notch, tibial spines, and possible loose bodies
kVp
70–80
mAs
10–20
SID
100–110 cm Positioning: For Camp-Coventry: patient prone with knee flexed 40–50°, Central Ray directed caudally. For Holmblad: patient kneeling with knee flexed 60–70°, Central Ray directed perpendicular to the tibia.
Tangential Patella (Sunrise / Skyline / Merchant)
Best Visualized
Patellofemoral joint, vertical fractures, and cartilage evaluation
kVp
70–80
mAs
10–15
SID
100–110 cm Positioning: Patient supine with knee flexed 45°. Central Ray angled 10–15° cephalad through the patellofemoral joint. In Merchant method: knees flexed, both patellae imaged together, Central Ray angled 30° caudad.
Leg
AP Leg
Best Visualized
Entire tibia, fibula, including knee and ankle joints
kVp
65–75
mAs
6–10
SID
100–110 cm Positioning: Patient supine with leg fully extended. Central Ray directed to the mid-shaft of tibia, ensuring both knee and ankle joints are included.
Lateral Leg (Mediolateral)
Best Visualized
Tibia, fibula, ankle, and knee joint in lateral view
kVp
65–75
mAs
6–10
SID
100–110 cm Positioning: Patient lies in lateral recumbent position with opposite leg placed behind. Central Ray directed to mid-shaft of tibia, including both joints.
Ankle Joint
AP Ankle
Best Visualized
Tibia, fibula, talus, and partial ankle mortise
kVp
65–75
mAs
6–10
SID
100–110 cm Positioning: Patient supine, foot dorsiflexed. Central Ray directed midway between medial and lateral malleoli.
AP Mortise Ankle
Best Visualized
Complete ankle mortise with open joint space
kVp
65–75
mAs
6–10
SID
100–110 cm Positioning: Patient supine, leg internally rotated 15–20° until intermalleolar line is parallel to Image Receptor. Central Ray directed midway between malleoli.
Lateral Ankle
Best Visualized
Talus, calcaneus, distal tibia, and fibula
kVp
65–75
mAs
6–10
SID
100–110 cm Positioning: Patient in lateral recumbent position. Central Ray directed to medial malleolus.
Oblique Ankle (Medial/Lateral)
Best Visualized
Distal tibiofibular joint and talus
kVp
65–75
mAs
6–10
SID
100–110 cm Positioning: Patient supine, leg rotated 45° medially or laterally depending on desired view. Central Ray directed midway between malleoli.
Foot
AP Foot
Best Visualized
Phalanges, metatarsals, and tarsals (with some overlap)
kVp
60–65
mAs
4–6
SID
100 cm Positioning: Patient supine with foot flat on Image Receptor. Central Ray angled 10° cephalad, directed to base of 3rd metatarsal.
AP Oblique Foot (Medial Rotation)
Best Visualized
Sinus tarsi, cuboid, and lateral metatarsals
kVp
60–65
mAs
4–6
SID
100 cm Positioning: Patient supine. Rotate foot medially by 30–40°. Central Ray directed to base of 3rd metatarsal.
Lateral Foot
Best Visualized
Calcaneus, talus, and tibiotalar joint
kVp
60–65
mAs
4–6
SID
100 cm Positioning: Patient in lateral recumbent position. Central Ray directed to base of 3rd metatarsal.
Weight-Bearing Foot (AP / Lateral)
Best Visualized
Longitudinal arches and joint alignment under load
kVp
60–65
mAs
4–6
SID
100 cm Positioning: Patient standing on cassette, weight evenly distributed. Central Ray directed to base of 3rd metatarsal.
Toes
AP Toes
Best Visualized
Phalanges, interphalangeal (IP) joints, and metatarsophalangeal (MTP) joints
kVp
55–60
mAs
2–4
SID
100 cm Positioning: Patient supine with foot flat. Central Ray angled 10–15° cephalad, directed to MTP joint of interest.
Oblique Toes
Best Visualized
Digits and joints without overlap
kVp
55–60
mAs
2–4
SID
100 cm Positioning: Patient supine. Rotate foot medially by 30–45°. Central Ray directed to MTP joint of interest.
Lateral Toes
Best Visualized
Individual toe and interphalangeal joints
kVp
55–60
mAs
2–4
SID
100 cm Positioning: Patient in lateral recumbent position. Isolate the toe of interest. Central Ray directed to the proximal interphalangeal (PIP) joint.