UCSD Musculoskeletal Radiology

Head to toe radiographic projections. Click on the hyperlinks for technique. Use the back arrow to return to the images.

II. All requests will need to be evaluated by the Neuroradiologist. Study of choice is usually CT/MRI.

CRANIUM

Exams/Views

Image receptor size and orientation

Patient position relative to image receptor

Central ray (CR) direction

SKULL SERIES

4. PA - zero (0) tube angle

10x12 LW

OML perpendicular, MSP perpendicular

CR perpendicular to image receptor, exits at glabella

5. PA Caldwell- 23º tube angle

10x12 LW

OML perpendicular, MSP perpendicular

CR 23°caudad, exits at nasion

6. AP axial (Townes)

10x12 LW

OML perpendicular, MSP perpendicular

CR 30° caudad, exits inion

7. Submentovertex (SMV)

10x12 LW

IOML parallel, MSP perpendicular. Project mandible beyond the nasal septum and ethmoid air cells.

CR perpendicular to IOML, enters midway between gonion

8. Lateral - affected side

10x12 CW

IOML perpendicular to front edge of image receptor, MSP parallel, IPL perpendicular

CR perpendicular to 2" (5cm) superior to EAM

FACIAL BONES SERIES

1. Parietoacanthial projection (Waters)

10x12 LW

OML forms an angle of 37º to image receptor, MSP perpendicular

CR perpendicular, exits at the acanthion

2. PA Caldwell

10x12 LW

OML perpendicular, MSP perpendicular

CR 23° caudal, exits at nasion

3. Lateral

10x12 LW

IOML perpendicular to front edge of image receptor, MSP parallel, IPL perpendicular, affected side to image receptor

CR perpendicular to outer canthus

4. Submentovertex

(SMV)

10x12 LW

IOML parallel to image receptor (neck hyperextended),

MSP perpendicular

CR perpendicular to IOML, enter midway between gonion

MANDIBLE

1. PA mandible

8x10 CW

OML perpendicular, MSP perpendicular

CR perpendicular, enters at the level of the gonion to exit at lips

2. AP axial (Townes) open mouth

8x10 LW

OML perpendicular, MSP perpendicular, patient to have mouth open, if possible

CR 35° caudad, enters 3" above nasion, passes through TMJ's.

3. Right lateral oblique

8x10 CW

MSP forms 15° angle to image receptor, chin extended anterior to cervical spine. (Total angle of tube + patient = 35.)

CR 20° cephalic, enters midway between gonion

4. Left lateral oblique

8x10 CW

MSP forms 15° angle to image receptor, chin extended anterior to cervical spine. (Total angle of tube + patient = 35.)

CR 20° cephalic, enters midway between gonion

NASAL BONES - Always image both laterals.

1. Parietoacanthial projection (Waters)

8x10 LW

OML forms an angle of 37°, MSP perpendicular. Collimate to 5" by 5".

CR perpendicular, exits at acanthion

2. Right lateral

8x10LW

IOML perpendicular to front edge of image receptor, MSP parallel, IPL perpendicular

CR perpendicular, 1" (2cm) above nasion

3. Left lateral

8x10LW

IOML perpendicular to front edge of image receptor, MSP parallel, IPL perpendicular

CR perpendicular, 1" (2cm) above nasion

ORBITS (Study of choice is CT. Refer all requests to Neuroradiologist for protocol.)

1. PA Caldwell

8x10 LW

OML perpendicular, MSP perpendicular

CR angled 23° caudad, exits at nasion

2. Lateral

8x10 LW

IOML perpendicular to front edge of image receptor, MSP parallel, IPL perpendicular

CR perpendicular to outer canthus

ORBITS - FOREIGN BODY (MRI screening)

1. Modified Parieto-

acanthial (Waters)

EYES LOOKING UP

8x10 LW

OML forms angle of 55° with image receptor, MSP perpendicular

CR perpendicular, exits at acanthion

2. Modified Parieto-

acanthial (Waters)

EYES LOOKING DOWN

8x10 LW

OML forms angle of 55° with image receptor, MSP perpendicular

CR perpendicular, exits at acanthion

Write time of exam on all bone films. Films taken in surgery, portables, trauma, E.D. often have multiple studies; times are needed to sort films. For acute injuries, follow trauma protocol or other methods as directed by Radiologist.

If patient has internal fixators/prosthesis, always include the entire length of the fixator/prosthesis.

UPPER EXTREMITIES
Exams/Views to be done	Cassette size, type and orientation	Patient position relative to film	Central ray (CR) direction
FINGERS (For acute injuries, film the PA hand and oblique/lateral of the affected digit.) For thumb series, see next entry.
1. PA Hand	_½ of 10x12 LW, LFC, tabletop	Pronate hand onto extremity cassette, include all digits on radiograph. Flatten hand in cassette whenever possible.	CR perpendicular to base of third (3rd) metacarpal
2. Oblique of digit	¹/₄ of 10x12 LW	Rotate hand laterally 45E, separate fingers	CR perpendicular to proximal PIP
3. Lateral of digit	¹/₄ of 10x12 LW	Rotate hand into lateral position, separate affected finger and place closest to film	CR perpendicular to proximal PIP
THUMB	Follow protocol above. PA hand position shows the thumb in oblique position. Series will include: 1. PA hand 2. Lateral Thumb 3. AP thumb

HAND (Include the wrist on hand films.)
1. PA hand	_½ of 10x12 CW	Pronate hand onto extremity cassette. Flatten hand whenever possible and include wrist in collimation.	CR perpendicular to the base of third (3rd) metacarpal
2. Oblique hand	_½ of 10x12 CW	Rotate hand laterally 45E, separate fingers	CR perpendicular to third metacarpal
3. Lateral hand	8x10 LW	Rotate hand 90E, thumb parallel to film, fingers "fanned" to avoid superimposition	CR perpendicular to second metacarpal
WRIST (Non-trauma)
1. PA	_½ of 8x10 CW	Pronate hand, flex fingers to position wrist closer to film.	CR perpendicular to midcarpal
2. Lateral	_½ of 8x10 CW	Rotate hand and wrist 90E, elbow flexed 90E	CR perpendicular to midcarpal
WRIST - (Acute injuries)
1. PA	_½ of 8x10 CW	Same as described above for chronic conditions.	Same as described above.
2. Lateral	_½ of 8x10 CW	Same as described above for chronic conditions.	Same as described above.
3. Ulnar oblique	_½ of 8x10 CW	Rotate hand and wrist laterally 45E, elbow flexed 90E	CR perpendicular to midcarpal
WRIST - (Acute injuries)
4. Radial oblique	_½ of 8x10 CW	Pronate hand, have patient move hand laterally as much as possible without lifting or rotating forearm	CR angled 20E toward elbow, centered to scaphoid
5. Navicular view

FOREARM
1. AP (Include BOTH joints on each film.)	_½ of 11x14 LW	Supinate hand and forearm.	CR perpendicular to mid-forearm
2. Lateral - flex elbow 90E	_½ of 11x14 LW	Flex elbow 90E, rotate hand and wrist to lateral position; have hand, elbow and humerus in the same plane.	CR perpendicular to mid-forearm
ELBOW (Non-trauma, chronic injuries)
1. AP	_½ of 10x12 CW	Supinate forearm, fully extended	CR perpendicular to elbow joint
2. Lateral	_½ of 10x12 CW	Flex elbow 90E, have forearm and humerus in the same plane, wrist and elbow in true lateral	CR perpendicular to elbow joint

ELBOW (Trauma, acute injuries)
1. AP	_½ of 10x12 CW	Same as described above for chronic conditions.	Same as described above.
2. Lateral	_½ of 10x12 CW	Same as described above for chronic conditions.	Same as described above.
3. Lateral oblique (radial)	_½ of 10x12 CW	Forearm fully extended, supinate hand and laterally rotate arm to form an angle of 45E off film	CR perpendicular to elbow joint
4. Medial oblique (ulnar)	_½ of 10x12 CW	Forearm fully extended, pronate hand	CR perpendicular to elbow joint
5. Radial head view	8x10 LW	Elbow in true lateral, flexed 90E, humerus and wrist in same plane	CR angled 45E towards humerus, enters at radial head

SHOULDER (Non trauma, chronic pain)
1. AP - internal rotation	10x12 CW	Patient supine or upright, rotate arm internally until epicondyles of humerus are perpendicular to film	CR perpendicular to glenoid fossa
2. AP - external rotation	10x12 CW	Patient supine or upright, rotate arm externally to place epicondyles parallel to film	CR perpendicular to glenoid fossa
SHOULDER (Trauma, acute injuries - perform the following procedures)
1. AP - neutral position	10x12 CW	Patient supine or upright, do not rotate arm.	CR perpendicular to glenoid fossa
2. Lateral "Y" view - patient placed PA	10x12 LW	Patient PA , rotate patient's non-affected side away from film until scapula is perpendicular to film, the affected shoulder usually forms angle of 60E with film	CR perpendicular to mid vertebral border of scapula
SHOULDER - ADDITIONAL VIEWS (As directed by radiologist.)
1. Axillary view	8x10 CW	Abduct arm 90E away from body, supinate hand, rotate head away, place cassette firmly against shoulder and neck	CR perpendicular to glenoid fossa
3. Supraspinatus view (Bigliani method)	8x10 LW	Follow positioning protocol for Lateral "Y" view	CR angled 15E caudad, enters at coracoid process

CLAVICLES
1. AP - 0 tube angle	10x12 CW	Patient supine or upright with no rotation	CR perpendicular to mid-clavicle
2. AP - axial view	10x12 CW	Patient supine or upright with no rotation	CR angled 20E cephalic
ACROMIOCLAVICULAR JOINTS (AC)
1. AP - non-weight bearing (Use 72" SID)	14x17 CW to include both joints or two 8x10 CW for each AC joint	Patient upright in AP position, equal weight on both feet, no rotation, arms relaxed at sides. patient to suspend respiration during exposure. Always include both joints bilaterally.	CR perpendicular to AC joints
2. AP - weight bearing		Follow non-weight bearing protocol, add 10 pound weights to each hand. Always include both joints bilaterally. Strap weights to wrist for optimum films.	CR perpendicular to AC joints
SCAPULA
1. AP	10x12 LW	Patient supine or upright, rotate patients body until scapula rests on table, abduct affected arm 90E away from trunk, flex elbow for patient comfort	CR perpendicular to mid-scapula
2. Lateral	10x12 LW	Patient PA, recumbent or erect, rotate patient's non-affected side away from Bucky until the scapula is lateral, angle of affected shoulder and film will be approximately 60E	CR perpendicular to mid-scapula

LOWER EXTREMITIES
TOES (AP view of foot to be done with acute injuries, otherwise AP of affected toe only.)
1. AP foot	_½ of 10x12 LW	Place sole of foot flatly on cassette in dorsal plantar position	CR angled 5E-10E to base of third (3rd) metatarsal
2. Medial oblique of affected toe(s)	¹/₄ of 10x12 LW	From AP position, internally rotate foot 45E	CR perpendicular to proximal PIP joint
3. Lateral of toe(s)	¹/₄ of 10x12 LW	Rotate foot towards affected side, until foot is in lateral position	CR perpendicular to proximal PIP joint
FOOT
1. AP (Dorsoplantar)	_½ of 10x12 LW	Plantar surface of foot against film, with no rotation	CR angled 5E-10E to base of third (3rd) metatarsal
2. Medial Oblique	_½ of 10x12 LW	Rotate foot medially 45E	CR perpendicular to base of third (3rd) metatarsal
3. Medial-Lateral Lateral	_½ of 10x12 LW	Rotate foot laterally until foot is in lateral position	CR perpendicular to base of third (3rd) metatarsal

FOOT (WEIGHT- BEARING)
1. AP	_½ of 10x12 LW	Patient upright, follow positioning protocol above	CR angled 5E-10E to base of third (3rd) metatarsal
2. Lateral	_½ of 10x12 LW	Patient upright, follow positioning protocol above	Horizontal CR perpendicular to base of third (3rd) metatarsal
3. Oblique	_½ of 10x12 LW	Patient upright, foot in Dorsoplantar position	CR angled 45E medially to base of third (3rd) metatarsal
OS CALCIS
1. Lateral calcaneus	_½ of 8x10 CW	Place foot in mediolateral position	CR perpendicular to mid-calcaneus
2. Axial plantodorsal	_½ of 8x10 CW	Place plantar surface perpendicular to film	CR angled 40E with long axis of the foot, to base of 3rd metatarsal
ANKLE
1. AP	_½ of 10x12 CW	Place foot so that plantar surface of foot is perpendicular to film	CR perpendicular to ankle joint
2. Mortise	_½ of 10x12 CW	From AP position, rotate leg medially 10E -15E until intermalleolar line is parallel to film	CR perpendicular to ankle joint
3. Mediolateral lateral	8x10 LW	From AP position, rotate leg, foot and ankle towards affected side until foot is in lateral position	CR perpendicular to medial malleolus
TIBULA FIBULA
1. AP	14x17 on diagonal	Patient supine, leg fully extended, no rotation on pelvis or leg	CR perpendicular to mid-tibia
2. Mediolateral lateral	14x17 on diagonal	Patient to lie on affected side, ensure affected leg is in lateral position with the unaffected side anterior to part	CR perpendicular to mid-tibia

KNEE - Non -trauma, chronic injury

1. AP	10x12 LW	Patient supine, leg extended, femoral epicondyles parallel to table. Perform erect if standing films ordered.	CR perpendicular to 1cm inferior to patellar apex
2. Mediolateral lateral	10x12 LW	Patient to lie on affected side, unaffected leg anterior to part, knee flexed about 45E	CR angled 5E cephalic, to a point 1cm distal to epicondyle
KNEE - Trauma, acute injury
1. AP	10x12 LW	Same as described above.	Same as described above.
2. Mediolateral lateral	10x12 LW	Same as described above.	Same as described above.
3. Lateromedial Cross table lateral	10x12 CW	Patient supine, part raised above tabletop, do not flex knee for cross-table lateral.	Horizontal CR perpendicular to knee joint

PATELLA
1. PA	8x10 LW	Patient supine or upright, femoral epicondyles parallel to film, leg fully extended	CR perpendicular to mid-patella
2. Mediolateral Lateral	8x10 LW	Patient to lie on affected side, with unaffected leg anterior, knee flexed 5E	CR perpendicular to mid-patella
3. Merchants View - bilateral patellar view	11x14 CW	Patient supine with legs flexed over Merchant board 30E-45E, knees close together, film to lie on distal tibias	CR angled caudal parallel to patella, enters at joint space
4. Axial projection (Sunrise method)	8x10 LW	Patient prone, knee flexed to maximum patient ability	CR angled cephalic so that there is a 45E with tibia

FEMUR - Include both joints on films if possible
1. AP - to include knee and distal femur	14x17 LW	Patient supine, leg fully extended, femoral epicondyles parallel to film	CR perpendicular centered to include knee joint
2. AP - to include hip and proximal femur	11x14 LW	Position patient and part exactly as above if performing two exposures.	CR perpendicular to include hip joint
3. Mediolateral Lateral - to include knee	14x17 LW	Patient to lie on affected side, unaffected leg anterior to part, flex knee 45E	CR perpendicular to include knee joint
4. Lateral frog-leg hip	11x14 LW	Patient supine, flex knee and fully abduct leg	CR perpendicular to femoral neck

HIPS - Non-trauma, chronic injury

1. AP Pelvis

14x17 CW

Patient supine, legs fully extended and internally rotated 15E

CR perpendicular to MSP 2" inferior to ASIS

2. Frog-leg lateral of

affected hip

10x12 LW or

11x14 LW to include prothesis

Patient supine with knee flexed and knee fully abducted. For older patients, you may oblique body slightly toward side of interest.

CR perpendicular to femoral neck

HIPS - Trauma, acute injury
1. AP Pelvis	14x17 CW	Follow positioning protocol above for AP pelvis.	Same as above AP pelvis
2. Translateral lateral of affected hip	10x12 CW or 11x14 CW	Flex and elevate unaffected leg, place cassette vertically on table lateral to affected hip. Place cassette high enough to include femoral head.	Horizontal CR perpendicular to femoral neck
SACROILIAC JOINTS
1. AP Pelvis	14x17 CW	Follow positioning protocol above for AP pelvis.	Same as above AP pelvis
2. AP axial	10x12 LW	Patient in AP position.	CR angled 20E cephalic to mid sacrum

ACETABULUM (JUDET VIEWS) - include iliac crest to ischial tuberosities, collimate to affected side only
1. AP Pelvis - if not taken previously for current injury	14x17 CW	Follow filming protocol for AP pelvis above
2. Right Posterior Oblique	11x14 LW	Rotate body into 45E RPO, include iliac crest and ishial tuberosities on film	CR perpendicular to affected hip joint
3. Left Posterior Oblique (LPO)	11x14 LW	Rotate body into 45E LPO, include iliac crest and ishial tuberosities on film	CR perpendicular to affected hip joint

PELVIS - include Inlet/Outlet views only if requested
1. AP Pelvis	14X17 LW	Follow AP pelvis protocol above
2. AP axial outlet view	14x17 LW	Patient supine in AP pelvis position, include iliac crest and ischial tuberosities on film	Male: CR angled 20E-30E cephalic to 2 cm superior to symphysis pubis Female: CR angled 30E to 45E cephalic
3. AP axial inlet view	14x17 LW	Patient supine in AP pelvis position, include iliac crest and ischial tuberosities on film	Male: CR angled 20E-30E caudal to ASIS Female: CR angled 30E to 45E caudal

MISCELLANEOUS BONE STUDIES
SCAN-O-GRAM: Place and tape scanogram ruler under patient before positioning. Must include ruler markings from iliac crest to ankle! Use two (2) 14x17 cassettes. DO NOT MOVE PATIENT ON THE RULER ONCE YOU HAVE BEGUN FILMING! Show both right and left joint spaces. In some cases, the joint spaces may not be in the same transverse plane. In these cases, center between the two joints.
1. AP - wing of pelvis	_½ of 14x17 CW			Patient supine, legs fully extended in AP position	CR perpendicular to iliac crest
2. AP - hip joint	_½ of 14x17 CW			Same as above	CR perpendicular to hip joint
3. AP - knee joints		_½ of 14x17 CW	Same as above			CR perpendicular to knees
4. AP - ankle joints	_½ of 14x17 CW			Same as above	CR perpendicular to ankles

LEG ALIGNMENT - include joints from hip to ankle
AP only (72" SID)	14x56 LW	Patient supine or upright, equal weight in each foot	CR perpendicular to include hip to ankle joints
ARTHRITIS JOINT SURVEY - Review each request with Bone radiologist for filming. See previous sections for positioning criteria.
1. AP/Lateral C-spine	2. AP/Lateral T-spine	3. AP/Lateral L-spine	4. AP bilateral shoulders	5. AP/Lateral bilateral knees
5. AP/Lateral bilateral knees	6. AP pelvis	6. AP/Lateral bilateral ankles (include heel on lateral views)	7. AP/Oblique/Lateral bilateral hands (to include wrists)	8. AP/Oblique bilateral feet

METASTATIC BONE SURVEY - Review each request with Bone radiologist for filming.

1. Left lateral skull

3. AP/Lateral

C-spine

5. AP/Lateral L-spine

7. AP/Lateral bilateral

humerus (to include

shoulders)

9. AP/Lateral bilateral

forearms

2. AP ribs, bilaterally

4. AP/Lateral

T-spine

6. AP pelvis

8. AP/Lateral bilateral

femurs

10. AP/Lateral bilateral

tibia/fibulas

BONY THORAX
Exams/Views to be done	Cassette size, type and orientation	Patient position relative to film	Central ray (CR) direction
STERNUM
1. Right anterior oblique	10x12 LW	Patient prone in 15E - 20E RAO to superimpose sternum on heart shadow, breathing technique	CR perpendicular to mid-sternum
2. Lateral	10x12 LW	Patient upright in lateral position if possible, filmed on inspiration	CR perpendicular to mid-sternum
STERNO-CLAVICULAR JOINTS - Study of choice is CT. Consult Radiology Bone Fellow for protocol

RIBS: Trauma, acute injury (PA chest film usually done to evaluate for pneumothorax. Review each request with chest radiologist.)

1. AP or PA.

Above diaphragm: 11x14LW or 14x17LW

Below diaphragm:

14x17 CW

Patient erect if possible, place patient to have affected side toward film (anterior vs posterior). Above diaphragm, film taken on inspiration; below diaphragm, film taken on expiration

Above and below diaphragm: CR perpendicular to affected rib(s)

2. Oblique

As stated above

From AP, rotate body 45E toward the site of injury.

From PA, rotate body 45E away from site of injury

Same as above. The distance between the spine and lateral rib margin on the affected side should be two times larger than the unaffected side.

RIBS - Non-trauma, chronic injury or to evaluate metastases (Usually done after bone scan of affected area.)
1. AP - above and below diaphragm	Same as above.	Follow positioning above.		Follow above protocol.
2. Oblique - above and below diaphragm	Same as above.	Follow positioning above.		Follow above protocol.
CERVICAL SPINE - always include all views on new patients or following new injury.
1. AP	10x12 LW		Patient supine or upright, neck slightly extended with no rotation. Mastoid tip should be superimposed on the gonion.	CR angled 10E cephalic to C-4
2. Lateral (Use 72" SID whenever possible)	10x12 LW		Patient supine or upright, film taken on expiration, shoulders relaxed to lower humeral heads	CR perpendicular to C4, include C1- T1 on film
3. AP odontoid (open mouth)	8x10 LW		Patient supine or upright, open mouth, flex neck to have line from upper teeth to skull base perpendicular to table	CR parallel to the line from the teeth to skull base
4. Swimmer's view - to visualize C7-T1	10x12 LW		Patient supine or upright, place left side against film, vertically raise left arm and relax right arm to side of the body.	CR perpendicular to C4 (An angle of 5E caudal may be needed to separate shoulders)

CERVICAL SPINE - Additional views - to be done on approval of bone radiologist
1. Right anterior oblique	10x12 LW	Place patient into 45E RAO	CR angled 10E -15E caudal to C-4
2. Left anterior oblique	10x12 LW	Place patient into 45E LAO	CR angled 10E -15E caudal to C-4
3. X-table Lateral. Show film to radiologist prior to moving patient	10x12 CW	Follow positioning protocol above.	Horizontal CR perpendicular to C4.
THORACIC SPINE
1. AP	14x17 LW	Patient supine or upright, film taken on inspiration	CR perpendicular to T7, 3"(7.5cm) below sternal angle
2. Lateral	14x17 LW	Patient in left lateral, erect or recumbent, breathing technique preferred, otherwise on inspiration.	CR perpendicular to T7
THORACIC SPINE - additional views
1. Swimmer's (If area of interest is T1-T4.)	10x12 LW	Follow positioning protocol for Swimmers described in cervical spine section	Follow protocol for cervical swimmers view EXCEPT central ray to C7..
2. Right Posterior Oblique	14x17 LW	From AP position, rotate right side up from film 70E	CR perpendicular to T7
3. Left Posterior Oblique	14x17 LW	From AP position, rotate left side up from film 70E	CR perpendicular to T7

LUMBAR SPINE - Include AP pelvis if patient has not had a pelvis within the last three months. Schedule and bill patient for single view pelvis.
1. AP pelvis	14x17 CW	Follow positioning protocol for AP pelvis previously described	Follow protocol previously described
2. AP L-spine	11x14 LW	Patient supine with hips and knees flexed	CR perpendicular to L2, 3 cm superior to iliac crest
3. Lateral L-spine	11x14 LW	Patient in left lateral position, knees flexed, use supports to place spine parallel to table	CR perpendicular to iliac crest
LUMBAR SPINE - additional views
1. Right Posterior Oblique L-spine	11x14 LW	From AP position, rotate body to the right 45E	CR perpendicular to iliac crest, 2" (5cm) medial to ASIS
2. Left Posterior Oblique L-spine	11x14 LW	From AP position, rotate body to the left 45E	CR perpendicular to iliac crest, 2" (5cm) medial to ASIS
3. Flexion Lateral L-spine	11x14 LW	Patient in lateral position, maximum patient flexion	CR perpendicular to iliac crest
4. Extension Lateral L-spine	11x14 LW	Patient in lateral position, maximum patient extension	CR perpendicular to iliac crest
5. L5-S1 Lateral	10x12 LW	Patient in lateral position	CR perpendicular to L5-S1 3cm inferior to iliac crest

SACRUM
1. AP	10x12 LW	Patient supine, hips and knees flexed	CR angled 20E cephalic to MSP midway between ASIS and symphysis pubis
2. Lateral	10x12 LW	Patient in left lateral position, knees flexed	CR perpendicular to ASIS and mid-sacrum
COCCYX
1. AP	8x10 LW	Patient supine with hips and knees flexed	CR angled 10E caudal to 2" (5cm) superior to symphysis pubis
2. Lateral	8x10 LW	Patient in left lateral position	CR perpendicular to _½" (1cm) superior to coccyx tip
SCOLIOSIS - Use compensating filter and breast shields when possible, refer to patent's personal technique reference card. Include C7-S1.
1. PA (Use 72" SID)	14x36 LW	Patient erect or prone	CR perpendicular to include C7-S1 on film
2. Lateral (Use 72" SID)	14x36 LW	Patient in left lateral position, elevate both arms to right angles to trunk	CR perpendicular to include C7-S1 on film
3. AP best bend, right	14x36 LW	Patient supine or upright with maximum spine flexion laterally to the right	CR perpendicular to include C7-S1
4. AP best bend, left	14x36 LW	Patient supine or upright with maximum spine flexion laterally to the left	CR perpendicular to include C7-S1

KNEE ADDITIONAL VIEWS - upon radiologist's approval
4. Medial oblique	10x12 LW	From AP position, rotate knee medially 45E	CR perpendicular to 1 cm inferior to patellar apex
5. Lateral oblique	10x12 LW	From AP position, rotate knee laterally 45E	CR perpendicular to 1 cm inferior to patellar apex