Radiographic Protocols & Positioning

A guide for routine and special series along with their positioning.

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    Head & Neck

    Facial Bones

    Additional / Special Views

    Occipitomental (OM) Waters 20 Down Performed routinely at some select sites only

    Nasal Bones

    Routine Series

    Nasal Bone Lateral (R & L) Perform both right and left nasal bone lateral views

    Skull

    Routine Series

    PA Skull Sometimes performed AP

    Additional / Special Views

    PA Caldwell Performed routinely at some select sites only
    Submentovertex (SMV) Performed when requested by referrer or radiologist

    Mandible

    Routine Series

    PA Caldwell Collimated to mandible
    Lateral Mandible Affected side close to the detector
    Oblique / Lazy Lateral (R & L) Perform with both right and left sides

    Additional / Special Views

    Orthopantomogram (OPG) Performed when requested by referrer or radiologist

    Temporomandibular Joints (TMJ)

    Soft Tissue Neck

    Routine Series

    Soft Tissue Neck Lateral Either performed erect or supine HBL depending on site and patient presentation. Ask radiologist.

    Cervical Spine

    Routine Series

    PA Obliques (R & L) Should not be performed in a trauma setting

    Additional / Special Views

    AP Obliques (R & L) Can replace PA Obliques, although less common
    Swimmer's View Performed to visualise the C7/T1 junction if not visible on Lateral C-Spine
    Flexion & Extension Lateral Performed when requested by referrer to assess for spinal stability
    Fuchs View Should not be used in a trauma setting. Used to visualise C1 and C2

    Chest

    Routine Series

    Paediatric Series (0-4 years)

    AP Supine/Sitting Chest Sitting is preferred but depends on presentation

    Paediatric Series (5-15 years)

    Ribs

    Routine Series

    Lateral Chest Performed with affected side closest to detector
    AP/PA Unilateral Ribs Performed AP if posterior rib pain and PA if anterior rib pain
    AP/PA Unilateral Oblique Ribs Performed AP if posterior rib pain and PA if anterior rib pain

    Sternum

    Routine Series

    PA Oblique Sternum (R & L) RAO is more common than LAO due to visiblity

    SC Joints

    Routine Series

    PA Oblique SC Joint (R & L) Perform with both right and left sides

    Thoracic Spine

    Routine Series

    Additional / Special Views

    Flexion & Extension Lateral Performed when requested by referrer.

    Abdomen

    Paediatric Abdomen Series

    Additional / Special Views

    Lateral Decubitus Abdomen Alternative to PA Erect Abdomen to assess for free gas
    Dorsal Decubitus HBL Abdomen Performed when requested
    Kidney-Ureters-Bladder (KUB) Performed when requested

    Pelvis

    Routine Series

    AP Pelvis Performed Erect or Supine depending on site and referrer

    Peadiatric Series

    Additional / Special Views

    Orthopaedic View (Higgs View) Performed when patient has hip prothesis not entirely visualised in AP Pelvis
    Inlet View Evaluation of posterior displacement of both main pelvic ring and fractures of pubic symphysis
    Outlet View Evaluation of suspected cephalic shift of hemipelvis
    Flamingo View Evaluation of suspected pubic symphysis instability

    Lumbar Spine

    Routine Series

    Additional / Special Views

    Lateral L5/S1 Performed to visualise L5/S1 joint if not visible on routine views on Lateral
    Oblique L-Spine (L & R) Performed when requested. Visualise articular facets and pars interarticularis
    Flexion & Extension Lateral L-Spine Performed when requested by referrer

    Sacrum

    Routine Series

    SI Joints

    Routine Series

    Oblique SI Joint (R & L) Perform with both right and left sides

    Coccyx

    Arm (Upper Extremity)

    Clavicle

    Shoulder

    Additional / Special Views

    Axial Shoulder Performed routinely at some select sites.

    Scapula

    Acromioclavicular Joints

    Additional / Special Views

    AP Clavicle W/ Weight Bearing Performed when requested or to rule out suspected displacement.
    AP Comparison Clavicle Performed when requested or to rule out suspected displacement.

    Humerus

    Routine Series

    Elbow

    Additional / Special Views

    Radial Head Lateral Performed when hard to visualise radial head or suspected radial head fracture

    Forearm

    Routine Series

    Hand

    Bone Age

    DP Hand X-ray of the less dominant hand

    Additional / Special Views

    Ball Catchers Performed when suspected Rheumatoid arthritis or bilateral joint pain

    Wrist

    Additional / Special Views

    Scaphoid View Performed when suspected scaphoid fracture or pain at anatomical snuff box.
    Scaphoid Oblique View Performed when suspected scaphoid fracture or pain at anatomical snuff box.

    Fingers

    Hip

    Routine Series

    AP Pelvis Performed Erect or Supine depending on site and referrer

    Additional / Special Views

    HBL Shoot Through Hip Performed if Lateral Hip cannot be done due to immoblity
    Modified Axiolateral Hip Performed if HBL Shoot Through Hip cannot be done due to immoblity
    Judets View Performed when requested by referrer to visualize the acetabulum

    Femur

    Additional / Special Views

    HBL Distal Femur Performed if Lateral Distal Femur cannot be done due to immoblity
    HBL Proximal Femur Performed if Lateral Proximal Femur cannot be done due to immoblity

    Knee

    Routine Series

    AP Knee Weigth bearing preferred unless patient is unable
    Rosenberg View Not performed if history of knee replacement

    Major Trauma Series

    Additional / Special Views

    Patella Obliques (Internal & External) Performed if requested or if suspected patellar fracture.
    Intercondylar View Performed if requested or if suspected tibial plateau fracture.
    Comparison Lateral Knee Performed when suspected Osgood Schlatter disease.

    Tibia and Fibula

    Ankle

    Routine Series

    AP Ankle Performed weight bearing when requested.
    Mortise Ankle Performed when requested to assess for suspected ankle fractures or ligamentous injuries.
    Lateral Ankle Performed when requested to assess for suspected ankle fractures or ligamentous injuries.

    Additional / Special Views

    Saltzmann View Performed when requested to assess hindfoot alignment

    Foot

    Routine Series

    DP Foot Performed weight bearing when requested or suspected flat foot, bunions or Lisfranc injuries.
    Oblique Foot Performed when requested to assess foot alignment or suspected fractures.
    Lateral Foot Performed when requested to assess foot alignment or suspected fractures.

    Toes

    Calcaneus

    Region