Shoulder complex | A-P, external rotation | The patient is supine or erect, preferably erect, and slightly oblique, so the scapula is near parallel to the film. The forearm is supinated with a slight abduction of the shoulder for external rotation, and the elbow is slightly flexed. Central ray perpendicular to the coracoid process | Anatomic position of the shoulder girdle with the greater tuberosity seen in profile, laterally. The glenohumeral and acromioclavicular joints, proximal humerus, clavicle, and portions of scapula can all be viewed in this position |
| A-P, internal rotation | The patient is positioned as for external rotation except that the back of the hand rests on the hip. Central ray is perpendicular to the coracoid process | Provides approximately 90-degree opposing view to anteroposterior, external rotation including a true lateral of the humerus with the lesser tuberosity seen in profile, medially |
| Axillary | Has many variations but essentially consists of the X-ray beam passing through the axilla from inferior to superior. The West Point axillary view is obtained with the patient prone and the tube angled 25 degrees cranially and medial to the midline of the glenohumeral joint. The Stryker notch view is taken with the patient supine and the arm flexed (without abduction), and the cassette beneath the shoulder. The central ray is directed 10 degrees cranially | The glenohumeral joint, coracoid process, and the acromion process can be seen in addition to the humeral head position with respect to glenoid fossa West Point view maximizes visualization of the anterior inferior glenoid rim, enhancing the detection of bony Bankart lesions Stryker notch view: maximizes the visualization of the humeral head and Hill-Sachs lesions |
| A-P, lateral scapula | | Useful in identifying fractures of scapula |
| Transscapular or Y view | | Entire scapula; best view for comminuted and displaced fractures of the scapula |
Acromioclavicular joints | A-P | The patient is erect with the arms hanging at the sides. The central ray is 15 degrees cranially at the level of the coracoid process. | A bilateral frontal projection of the AC joint |
| Stress | As above except with 10–20-lb weight strapped (if the patient holds the weight, the resulting muscle contraction may produce a false-negative) to the patient's wrist | Helps differentiate incomplete from complete injuries |
Sternoclavicular | P-A | The patient is positioned in prone. The central ray is perpendicular to the midpoint of the body at the level of the sternoclavicular joints | A frontal view of the sternoclavicular joints and medial aspects of the clavicles. |
| Serendipity | The patient is supine or erect, facing the tube. A 40-degree cranial tilt of the central ray. | Allows for evaluation of anterior and posterior dislocation |
Elbow | A-P | The elbow is extended with the forearm supinated and the patient leaning laterally until the anterior surface of the elbow is parallel with the plain X-ray cassette of the film. Central ray is perpendicular to the elbow joint | An A-P projection of the elbow joint including the distal end of the humerus, the humeroulnar and humeroradial joints, and the proximal end of the forearm |
| Lateral | The elbow is flexed 90 degrees and the hand is in a lateral position. Central ray is perpendicular to the elbow joint | Integrity of olecranon articulation with olecranon fossa; look for fat pad signs |
| Epicondylar groove (cubital tunnel) | This view is an axial view, modified by 15 degrees of external rotation | Used to determine whether there is bony encroachment on the cubital tunnel, contributing to ulnar nerve entrapment |
| Radial head-capitellum | Obtained in the same position as a lateral view with the primary beam angled 45 degrees toward the shoulder and centered on the radial head | Best view of radial head, capitellum, and coronoid process |
Forearm | A-P, lateral | Both views include the elbow and the wrist, and both views are centered on the midshaft of the forearm bones | Entire radius and ulna, wrist, elbow |
Wrist | P-A | Forearm and hand on X-ray cassette with palmar surface down; the hand is slightly arched, placing the wrist in close contact with the film. Central ray perpendicular to the midcarpus | P-A projection of all carpals, the distal end of the radius and ulna, and the proximal ends of the metacarpals, carpal alignment |
| Lateral | Elbow flexed 90 degrees, the forearm and arm on the X-ray cassette are ulnar side down. Central ray perpendicular to the carpus | Lateral view of the carpus, the proximal end of the metacarpals and the distal end of the radius and ulna highlighting posterior (dorsal)/volar relationships |
| Posterior oblique | From the lateral position, the forearm is pronated until the wrist forms an angle of approximately 45 degrees with the plane of the film. The central ray is perpendicular to the scaphoid | Demonstrates the carpal bones on the lateral side of the wrist, in particular the scaphoid. In addition the first metacarpal, thumb carpometacarpal joint, and trapezium can be viewed |
Hand | P-A | Forearm and hand on X-ray cassette with palmar surface down. Central ray perpendicular to the third metacarpophalangeal joint | P-A view of the carpals, metacarpals and phalanges (except the thumb), and the distal ends of the radius and ulna. This position yields an oblique view of the thumb. A true anterior–posterior projection of the thumb is obtained by turning the hand into a position of extreme internal rotation and holding the extended fingers back with the opposite hand, with the posterior (dorsal) surface of the thumb resting on the X-ray cassette |
| Lateral | Forearm and hand on X-ray cassette, ulnar side down with fingers superimposed. Central ray perpendicular to the MCP joints | Lateral view of the bony and soft tissue structures highlighting the posterior (dorsal)/volar relationships so that anterior and posterior displacement of fracture fragments can be seen |
| Posterior oblique | Forearm and hand on X-ray cassette, ulnar side down with the forearm pronated so that the fingers, which are slightly flexed, touch the cassette and the MCP joints form an angle of approximately 45 degrees. Central ray perpendicular to the third MCP joint. | Oblique view of the bone and soft tissue of the hand. With a slight adjustment of this position, a true lateral of the thumb can be obtained. |
Hip | A-P pelvis | Patient supine with the feet internally rotated 15 degrees (to eliminate overlay of the greater trochanter). Central ray perpendicular to the midpoint of the film | Frontal projection of the entire pelvis, both hips and proximal femurs |
| Lateral-oblique (frog leg) | The patient is turned to a near lateral position and toward the affected side with the hip and knee flexed. A straight tube is centered on the femoral head | Extremely valuable for examining the femoral head and neck, especially to exclude fractures and to assess the apophysis and femoral capital epiphysis in the immature patient |
Knee | A-P | Patient supine with the knee extended. Central ray 5–7 degrees cranial to the knee joint | Frontal view of the tibiofemoral joint space and articular surfaces; distal femur; proximal tibia |
| Lateral | Lateral with the affected side down and the knee flexed approximately 30 degrees. The central ray is 5 degrees cranial | Lateral view of the patellar position, distal femur; proximal tibia and fibula |
| Sunrise axial | The patient is positioned in prone and the knee is flexed more than 90 degrees. The beam is angled perpendicular to the X-ray cassette | Patellofemoral joint and medial/lateral positioning of patellar; intercondylar groove |
| Intercondylar | The patient is positioned kneeling on the table with the knee flexed to 70 degrees and the beam centered on the inferior pole of the patella. | Intercondylar fossa, notch of popliteal tendon, tibial spines, intercondylar eminence, posterior aspects of the distal femur and proximal tibia, intercondylar eminence of tibia |
| Merchant | The patient is supine and the knees are flexed over the end of the X-ray cassette. The beam is directed toward the feet and the film cassette is held on the shins | Patellar, femoral condyles. Preferred view of articular surface of the patellar, subtle dissertations |
Ankle | A-P | The patient is positioned in supine with the foot vertical. The central ray perpendicular to a point midway between the malleoli | Frontal projection of the ankle joint, the distal end of the tibia and fibula, and the proximal portion of the talus. Neither the syndesmosis nor the inferior portion of the lateral malleoli is well demonstrated in this projection |
| Mortise | Supine with the leg and foot rotated internally approximately 15 degrees. The central ray perpendicular to the ankle joint | The syndesmosis is well seen without overlap of the anterior process of the distal tibia; best view of mortise and distal aspect of the lateral malleolus |
| Lateral | Lateral side of the ankle down; the patient is supine and turned toward the affected side. The central ray is perpendicular to the lateral malleolus | A lateral view of the distal third of the tibia and fibula, the ankle joint, talus, calcaneus, and the hind foot |
| Impingement | The ankle is positioned in extreme plantar flexion to detect posterior impingement, and weight-bearing and maximum dorsiflexion to detect and anterior impingement | To assess bony contribution to posterior or anterior impingement |
| Oblique tarsal | The ankle is positioned to provide an oblique view of the foot | Best view to detect a fracture of the anterior process of the calcaneus, but can also demonstrate fractures of the base of the fifth metatarsal |
| Inversion stress | Best performed with a calibrated standardized device needed to position and stress the ankle | Check for lateral instability |
| Eversion stress | Best performed with a calibrated standardized device needed to position and stress the ankle | Check for medial instability |
Foot | Dorsoplantar | Patient supine with the knee flexed and the sole of the foot resting on the X-ray cassette. Central ray is perpendicular to the base of the third metatarsal | A frontal projection of the tarsals, metatarsals, and phalanges; tarsometatarsal, metatarsophalangeal, and interphalangeal joints. |
| Lateral | Lateral side down with the patient supine. The central ray is perpendicular to the midfoot | A true lateral projection of the talocrural, subtalar, transverse, and tarsometatarsal joint; hind foot, midfoot, and forefoot relationships |
| Medial oblique | Supine with the knee flexed and the leg rotated medially until the sole of the foot forms an angle of 30 degrees to the plane of the film. The central ray is perpendicular to the midfoot | The calcaneocuboid, cuboid-fourth and fifth metatarsal, cuboid cuneiform, and talonavicular articulations Less overlap of tarsals than anteroposterior Good view of sinus tarsi |
| Harris Beath (axial) view of the hind foot | The patient is positioned in sitting on the X-ray table, leg extended, and the heel resting on the cassette. The ankle is extended and held in this position by the patient applying traction to the forefoot with a bandage or strap. A 45 degrees cranial tube angle is used with the primary beam entering the sole of the foot at the level of the base of the fifth metatarsal | Best shows the articular surfaces of both the posterior and medial subtalar joints, coalition at the medial facet, and avulsions fractures at the medial or lateral aspects of the calcaneal tuberosity |
Cervical spine | A-P | The patient is placed either supine or erect. The central ray is 15–20 degrees cranial at the most prominent point of the thyroid cartilage | A frontal view of the C3–C7 vertebral bodies, and the upper two or three thoracic bodies, the interpedicular spaces, the superimposed transverse and articular processes, the uncinate processes, and the intervertebral disk spaces |
| Lateral | The patient is lateral to the X-ray cassette, either seated or standing. The central ray is perpendicular to the midneck | A lateral view of the C1–C7 vertebral bodies, disk spaces, the articular pillars, spinous processes, and the lower five facet joints. Depending on how well the shoulders can be depressed, the seven cervical vertebrae and sometimes the upper one or two thoracic vertebrae can be seen; all seven cervical vertebrae, particularly in trauma cases, must be seen |
| A-P Obliques | Obtained by rotating the entire patient 45 degrees one way and then the other, obtaining images in each position. | Provides information on the neural foramen and posterior elements of the cervical spine. Best view for detecting osteoarthritic encroachment of the intervertebral foramina |
| A-P open mouth | The patient's head is positioned in slight extension to prevent the front teeth from being superimposed over the odontoid | Anteroposterior view of C1–C2 articulation. Fractures of C1 and arthritic changes at the C1–C2 facets may also be identified. |
| Flexion/extension laterals | Obtained by asking the patient to flexed and then extend the neck, obtaining images in each position | Stress films to check for instability that may not be detected on routine neutral views |
| Pillar | An A-P view taken with 20–30 degrees of caudal tube angulation, with a pad under the upper thoracic spine to elevate the shoulders and to allow extension of the cervical spine | Shows the articular pillars or lateral masses to advantage as the central beam is angulated parallel to their sloping course, caudad in the A-P projection, and cranial in the P-A projection. Occult fractures may be detected with this view |
| Swimmers view | Obtained by positioning the patient so that one arm is raised above their head and the other is by their side like a freestyle swimmer | Best view of C7–T2, prevents obstruction by shoulders. Proximal humerus, lateral clavicle, AC joint, superior lateral aspect of the scapula |
Thoracic spine | A-P | Obtained with the patient in the supine position, arms by the side and shoulders at the same level. The knees are slightly flexed to reduce the dorsal kyphosis and, using a straight to, the beam is sent to 10 cm below the sternal notch | T1–T12 vertebral end plates, pedicles, and spinous processes; intervertebral disk spaces; costovertebral joints; medial aspect posterior ribs |
| Lateral | The patient is positioned standing side-on, with the shoulder just touching the Bucky for support. The arms are extended and the patient's balance is stabilized. The film is centered on T7 | T1–T12 vertebral end plates, pedicles, spinous processes; intervertebral disk spaces and foramina |
| Posterior oblique | The patient is positioned with their back against the bucky, and then rotated posteriorly so they are angled 45 degrees with the affected side touching the bucky. The arm on the affected side is positioned so that it is away from the area of interest (either out to the side, or over the patient's head) | Facet joints, pedicles, and the pars interarticularis |
| Anterior oblique | The patient is positioned with their back against the bucky, and then rotated anteriorly so they are angled 45 degrees with the affected side touching the bucky. The arm on the affected side is positioned so that it is away from the area of interest (either out to the side, or over the patient's head) | Sternum, axillary portion of the ribs |
Lumbar spine | A-P or posteroanterior | Either frontal projection is adequate and can be taken with the patient supine or erect with patient comfort dictating the position. If the patient is supine, the knees and hips should be flexed. The central ray is perpendicular to L3 | A frontal view of the L1–L5 vertebral bodies, pedicles, disk spaces, the lamina, and the spinous and transverse processes. The Ferguson view in an A-P view with a cranial angulation, which essentially compensates for the normal lordosis of the lumbosacral region, and allows one to see the junction clearly |
| Lateral | Supine or erect. If supine, the left side is down with the hips and knees flexed to a comfortable position. The central ray is perpendicular to L3 | A lateral view of the lumbar vertebral bodies and their disk spaces, the spinous processes, the lumbosacral junction, sacrum and coccyx, the intervertebral foramina, and the pedicles |
| Obliques | The patient is positioned in supine with their body angled 30 to 45 degrees | Not only shows the neural foramina but also demonstrates the pars interarticularis to aid in the detection of spondylolysis; best view of facet joints |
| L5–S1 (coned down lateral) spot view | The patient is positioned standing in a lateral position with the arms across the chest | Lateral of L4–S1 vertebral bodies and disk spaces |
| Flexion–extension | The patient is positioned standing side-on and is asked to flex and extend the lumbar spine. An image is taken at each position | Many enhance spondylolisthesis or retrolisthesis or demonstrate pivotal motion at a given disk |
Sacroiliac joint | A-P axial, obliques | The patient is positioned in standing, with the affected side rotated 20–30 degrees away from the film. | A-P images bilateral sacroiliac joints; obliques image unilateral sacroiliac joint |
Pelvis | A-P | Supine with the feet internally rotated approximately 15 degrees. Central ray perpendicular to the midpoint of the pubic symphysis | A frontal view of the pelvic girdle and proximal third of both femora |
| Oblique | Also called the bilateral “frog leg” position, and the patient is positioned accordingly for a bilateral view | Detection of acetabular and pubic rami fractures |
| Inlet | Patient supine and the beam angled 10 degrees cranially | |
| Outlet | Patient supine and the beam angled 15 degrees caudad | |
| Judet | Patient positioned so that the injured side is rotated 45 degrees internally and externally | Internally rotated: an anterior oblique view or obturator oblique view is obtained which demonstrates the iliopubic (anterior) column and the posterior lip of the acetabulum Externally rotated: a posterior oblique view or iliac oblique view is obtained which shows the ilioischial (posterior) and the anterior acetabular rim |