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Radiography With Richie X-Ray Positioning Radiography With Richie

Designed to empower emerging imaging professionals with the absolute safest, clearest, and most confident path to mastering basic diagnostic X‑rays in clinical settings.

Our goal is simple: to provide the safest, easiest, and least intimidating path to learning X‑ray positioning and terminology.

Who This Site Is For

This educational resource is designed for the modern clinical professional tasked with delivering high-quality diagnostic imaging in a fast-paced environment. Whether you are providing support in an outpatient setting, an urgent care clinic, or are in the early stages of your medical imaging journey, this platform offers a practical, clear, and stress-free approach to mastering radiographic fundamentals. If your clinical responsibilities include patient x-ray positioning, equipment alignment, or producing diagnostic views under medical supervision, these guides were built to help you perform your role with total confidence and a safety-first mindset.

What You Will Learn Here

This site focuses on foundational, practical knowledge, including:

  • Basic X‑ray terminology
  • Patient x-ray positioning explained in plain language
  • Central ray (CR) placement and SID guidance
  • Common x-ray positioning mistakes and how to avoid them
  • Safety‑first imaging principles

Each imaging position is broken down into clear, repeatable steps so learners understand what to do and why it works.

How This Site Is Different

Many educational resources assume prior x-ray positioning experience or use complex technical language. This site does not. What sets this project apart:

  • ✅ Designed for clinical clarity and immediate application
  • ✅ No physics overload or unnecessary jargon
  • ✅ Step‑by‑step instructions that build confidence
  • ✅ Focused on patient safety and image quality
  • ✅ Structured like a hands‑on training guide, not a textbook

Learning X‑ray positioning should not be overwhelming — and here, it isn’t.

Scope & Safety First

This site is educational in nature. It does not replace formal radiology education, regulatory requirements, or employer policies.

All instruction emphasizes:

  • Radiation safety principles
  • Proper patient communication
  • Limiting repeats through correct x-ray positioning
  • Performing imaging only within the scope permitted by local and facility policy
Always follow: Your employer’s x-ray positioning protocols, physician orders, and state/facility regulations.
How to Use This Site
  • Start with the Radiology Training section
  • Review x-ray positioning by body region
  • Practice concepts alongside supervised clinical imaging
  • Return as a reference when needed

The site is designed to be:

  • Used during orientation
  • Referenced during training
  • Accessed quickly in a clinical environment
Built by a Radiology Educator

This site was developed by a radiology professional with extensive experience in clinical imaging and staff training, with a focus on bridging the gap between theory and the clinical floor.

Ready to Begin X-Ray Positioning?

Start with the X-Ray Positioning Guide section and click the Terminology Hub if a term is unfamiliar. Begin learning X‑ray positioning the right way — safely, clearly, and without intimidation!

Clinical X-Ray Positioning Guides

How to Use This Guide: Click any anatomical category below to open the menu, then select your specific view. Use the Setup bullet points on the left for instant baseline protocols (Centering, Position, and Technical factors), and click the Reference Image on the right to open a full-screen x-ray positioning visual.

PA Axial Caldwell Setup
  • Position: Rest forehead and nose against the board so the OML orbitomeatal line (corner of eye to center of the ear) is perfectly perpendicular to the IR.
  • Centering: Angle the tube 15° caudad (toward the feet) to exit at the Nasion, the top part of nose at the inner corners of the eyes.
  • Collimation: Crop the light to closely frame the outer borders of the skull skull.
  • Exposure: Use 72 kVp @ 32 mAs as a baseline setting.
  • Tube Setup: Set a 40-inch SID with a 15° downward (caudad) angle.
PA Caldwell X-ray
Waters Projection Setup
  • Position: Rest the chin on the center of the bucky (IR) and tilt the head back so the orbitomeatal line OML (eye-to-ear line) is at a 37° angle.
  • Centering: Aim the central ray at the back of the patient's head to exit at the acanthion (the groove right at the base of the nose, above the upper lip).
  • Collimation: Crop the light to frame the facial bones, including the full skull margin from the top of the head and bottom of the chin, and ear to ear.
  • Exposure: Use 70-80 kVp with a Grid to clearly display the air-filled sinus cavities.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
Waters View X-ray
AP Towne's Setup
  • Position: Tuck the chin to bring the OML orbitomeatal line perfectly perpendicular to the IR.
  • Centering: Aim the central beam to enter 2.5 inches above the between the eyebrows at the glabella (near the hairline) and exit the foramen magnum, where the cervical spine articulates with the base of the skull.
  • Collimation: Crop the light to closely frame the outer margins of the skull.
  • Exposure: Use 75-85 kVp with a Grid to punch through the thick occipital bone.
  • Tube Setup: Set a 40-inch SID. Angle the tube 30° downward (caudad) to the orbitomeatal line OML.
AP Towne's X-ray
PA Projection Setup
  • Position: Rest forehead and nose against the board so the orbitomeatal line OML (eye-to-ear line) is perfectly perpendicular to the bucky (IR) .
  • Centering: Aim the central ray crosshairs to exit at the glabella (the smooth flat area between the eyebrows).
  • Collimation: Crop the light square to closely frame the outer edges of the entire head and jaw.
  • Exposure: Use 70-80 kVp with a Grid to punch through the thick bone safely and clearly.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
PA Skull X-ray
Lateral Skull Setup
  • Position: Turn the head completely sideways against the board so the IPL (pupil-to-pupil line) is straight up and down.
  • Centering: Aim the beam 2 inches above the EAM (the ear hole opening).
  • Collimation: Open the light to cover the entire front, back, and top rounded edges of the skull.
  • Exposure: Use 75-85 kVp with a Grid to push through the dense sides of the brain case.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
Lateral Skull X-ray
Lateral Projection Setup
  • Position: Rest the affected side of the face against the board so the IPL (pupil-to-pupil line) is perfectly perpendicular to the bucky (IR).
  • Centering: Aim the central ray crosshairs directly at the cheek bone zygoma, halfway between eye and ear).
  • Collimation: Crop the light to include the front of the face to the ear so the temporomandibular joint is included. Also include the forehead halfway to the hairline, and lower jawline.
  • Exposure: Use 65-75 kVp, dropping the power slightly since facial bones are thinner than the skull.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
Lateral Facial Bones X-ray
Nasal Bones Setup
  • Views Required: Waters View, Right Lateral, and Left Lateral.
  • Why Both Laterals? Nasal bones are thin and superimpose easily. Taking both right and left profiles ensures a unilateral fracture isn't hidden by the opposite side, and it provides an uninjured side for comparison.
Nasal Bones X-ray
PA Chest Setup
  • Position: Stand facing the board, rolling shoulders forward to move shoulder blades off the lungs.
  • Centering: Aim the central beam at T7 (align with the bottom tips of the shoulder blades).
  • Collimation: Open the light to frame from just above the shoulders to the lower rib cage.
  • Exposure: Use 110-120 kVp to penetrate the heart and visualize delicate lung tissue clearly.
  • Tube Setup: Set a 72-inch SID (tube distance) with a 0° straight beam (no angle).
  • Breathing: Instruct the patient to "Take in a deep breath. Blow it all the way out. Take in another deep breath and hold it."
PA Chest X-ray
Lateral Chest Setup
  • Position: Stand with the left side flat against the board, raising both arms high above the head.
  • Centering: Aim the beam at T7, entering the mid-coronal plane (directly beneath the armpit).
  • Collimation: Crop the light to include the front of the chest to the back edge of the spine.
  • Exposure: Use 110-120 kVp, increasing mAs slightly to punch through the thicker side profile.
  • Tube Setup: Set a 72-inch SID (tube distance) with a 0° straight beam (no angle).
  • Breathing: Instruct the patient to "Take in a deep breath. Blow it all the way out. Take in another deep breath and hold it."
Lateral Chest X-ray
Supine Abdomen Setup
  • Position: Lie flat on the back with arms comfortably out of the way of the stomach area.
  • Centering: Aim the central beam directly at the iliac crests (the top curves of the hip bones).
  • Collimation: Open the light to cover the upper abdomen entirely down to the pubic bone.
  • Exposure: Use 75-85 kVp with a Grid to cleanly penetrate the dense abdominal soft tissues.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
  • Breathing: Instruct the patient to "Take in a deep breath. Blow it all the way out. Hold it out there."
AP Supine Abdomen KUB
Upright Abdomen Setup
  • Position: Stand straight with the back flat against the board, distributing weight evenly.
  • Centering: Aim the beam 2 inches above the iliac crests to ensure the diaphragm is included.
  • Collimation: Crop the light to frame the upper abdomen, ensuring you catch any free air under the lungs.
  • Exposure: Use 75-85 kVp with a Grid to clearly visualize bowel gas patterns and soft tissue.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
  • Breathing: Instruct the patient to "Take in a deep breath. Blow it all the way out. Hold it out there."
AP Upright Abdomen Xray
AP/PA Ribs (Upper & Lower) Setup
  • Position: For a posterior Rib injury (Patient's back):Stand the patient with their back against the bucky or have them lie supine on the table (on their back). If the patient has an anterior rib injury (Patient's Chest), stand the patient with their chest against the bucky(IR) or prone on the table (on their stomach).The injured or affected side should be closer to the IR (Bucky).
  • Centering (Upper Ribs): Aim the central beam at the center of the chest/back on the patients affected side (injured side). Level of T7, about 3-4 inches below the jugular notch.
  • Centering (Lower Ribs): Lower the x-ray tube so the the central ray (CR) crosshairs are halfway between the lower tip of the breastbone (xiphoid process) and the bottom edge of the flank ribs. Be sure to include the very lower border of the upper Ribs x-ray on the this lower Ribs x-ray image so no anatomy is missed or left out.
  • Exposure: Use 70-75 kVp for upper ribs to catch bone detail over the air-filled lungs; use 75-85 kVp with a Grid for lower ribs to punch through thick abdomen tissues.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
  • Breathing (Upper Ribs): "Take a deep breath IN and hold it." (Pushes the diaphragm down out of the way).
  • Breathing (Lower Ribs): "Blow your breath OUT and hold it." (Lets the diaphragm rise up out of the way).
AP Ribs X-ray
AP/PA Oblique Ribs Setup
  • Position: For a posterior or back Ribs injury, have the patient stand with their back against the bucky or lie them supine on their back on the table (IR). Rotate the patient's non-injured side 45° away from the bucky (IR). If the patient has an anterior Ribs injury, have the patient positioned with their chest against the IR (bucky) or lie them prone on their belly on the table. Rotate the patient's non-injured side 45° away from the bucky (IR) The injured side will always be the side touching the IR (Bucky). Pro-Tip: If the patient has an anterior injury (chest), do PA Oblique Ribs X-ray positioning. If the patient has a posterior injury do AP Oblique Ribs X-ray positioning.
  • Centering: Aim the beam halfway between the spine and the Lateral (outer side) of the patient chest/back on the affected side (injured side).
  • Exposure: Use 70-80 kVp with a Grid to account for the rotated thickness of the body profile.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
  • Breathing: Take a deep breath IN and hold it." (Pushes the diaphragm down out of the way).
Oblique Ribs X-ray
AP Cervical Spine Setup
  • Position: Stand or lie flat, lifting the chin slightly to line up the upper teeth with the base of the skull.
  • Centering: The central ray is angled 15-20 degrees cephalad, toward the head, at C4 (Adam's Apple). Generally, this will be halfway between the sternal notch and the tip of the slightly elevated chin.
  • Collimation: Crop the light to include the base of the skull down to the top of the shoulders. Pro Tip: The light field should include the top of the ears and the sternal notch.
  • Exposure: Use 70-80 kVp to see the delicate cervical vertebrae structures clearly through the soft tissue.
  • Tube Setup: Set a 40-inch SID with the tube angled 15° to 20° upward (cephalad).
AP Cervical Spine Xray
AP Open Mouth Setup
  • Position: Have the patient open their mouth wide and align the lower edge of the upper teeth to the mastoid tips (lowest part of the back of the skull) perfectly perpendicular to the IR.
  • Pro Tip: Politely ask the patient if they have any removeable dental work (False Teeth) that can be taken out. Dental work will obscure anatomy. Have them take out removeable dental work out prior to imaging
  • Centering: Aim the central beam directly through the center of the open mouth. The laser crosshairs will form a plus sign from the tip of the patient's nose to the chin and the corners of their mouth.
  • Collimation: Crop tightly to a 5x5 inch square catching only the lips and mouth opening. The bones you are imaging are only behind the jaw
  • Exposure: Use 70-80 kVp to penetrate the teeth and base of the skull.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam (no angle).
AP Open Mouth X-ray
Lateral Cervical Setup
  • Position: Stand in a true lateral profile, dropping the shoulders down as far as possible to clear the lower neck. Have larger patients hold weighted bags in each hand to help lower thick shoulders.
  • Centering: Aim the central ray perpendicular at C4 (Adam's apple).
  • Collimation: Open the light to include the top of the ear down to the jugular notch.
  • Exposure: Use 70-85 kVp to penetrate the lateral neck tissue clearly.
  • Tube Setup: Set a 72-inch SID to reduce magnification, using a 0° straight beam.
Lateral Cervical Spine
Oblique Cervical Setup
  • Position: Rotate the entire body 45° from an AP position to open the intervertebral foramina.
  • Centering: The central ray is angled 15-20 degrees cephalad, toward the head, at C4 (Adam's Apple).
  • Collimation: Crop the light to include the base of the skull to the top of the shoulders.
  • Exposure: Use 70-80 kVp.
  • Tube Setup: Set a 72-inch SID with the tube angled 15° to 20° upward (cephalad).
Oblique Cervical Spine
Swimmer's View Setup
  • Position: True lateral. Raise the arm closest to the IR (bucky) straight up and supported by lying over the top of the patients head for comfort and stability. By raising the arm and shoulder up, this position will drop the other shoulder lower to better visualize the C7-T1 junction.
  • Centering: Aim the central ray perpendicular at C7-T1 (the prominent posterior bump at the base of the neck).
  • Collimation: Crop the light to frame the lower neck and upper mid-chest.
  • Exposure: Use 75-85 kVp to punch through the dense shoulder joint overlay.
  • Tube Setup: Set a 40-inch SID. Use a 3° to 5° downward (caudad) angle if the shoulders cannot separate fully.
Swimmer's View X-ray
AP Fuchs Method Setup
  • Position: Supine or erect, elevate chin until tip of chin and mastoid tips are vertical.
  • Centering: Central ray directed perpendicular to midpoint of mandible (inferior tip of chin).
  • Collimation: Collimated to a 5x5 inch field centered over C1-C2 region.
  • Exposure: 75–80 kVp, adjust mAs for dense bone visualization.
  • Tube Setup: 40" (100 cm) SID, grid recommended.
Fuch's View X-ray
AP Thoracic Spine Setup
  • Position: Lie flat on the back (supine) and flex the knees to reduce the natural curve of the spine.
  • Centering: Aim the central beam at T7 (align with the inferior angle of the scapulae).
  • Collimation: Crop narrowly side-to-side, from the jugular notch down to the xiphoid process.
  • Exposure: Use 80-90 kVp with a Grid to manage scatter from the chest cavity.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam (no angle).
AP Thoracic Spine X-ray
Lateral Thoracic Spine Setup
  • Position: Lie in a true lateral profile, flexing the knees for stability and bringing the arms straight forward.
  • Centering: Aim the central beam at T7 (align with the inferior angle of the scapulae).
  • Collimation: Crop to include the lower neck down to the lower ribs.
  • Exposure: Use 80-90 kVp. Utilize a breathing technique (low mA, 2-3 second exposure) to blur the ribs out of the way.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam. Support the waist to keep the spine parallel to the table.
Lateral Thoracic Spine Xray
AP Lumbar Spine Setup
  • Position: Lie flat on the back, flex the knees, and plant feet flat on the table to flatten the lower back against the IR. If the patient is unable to lie down due to pain or injury, position them standing with their back against the upright bucky (IR).
  • Centering: Aim the central ray directly at the iliac crests (L4 level).
  • Collimation: Open the light to frame from the lower ribs down to the mid-pelvis.
  • Exposure: Use 80-90 kVp with a Grid to penetrate the dense abdominal structures cleanly.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam (no angle).
AP Lumbar Spine
Lateral Lumbar Spine Setup
  • Position: Lie in a true lateral profile with knees flexed. Place a sponge under the waist to keep the spine perfectly parallel to the table. If the patient is unable to lie down due to pain or injury, position them standing with their left side against the upright bucky (IR).
  • Centering: Aim the central beam at the iliac crests (L4 level).
  • Collimation: Crop to include the lower ribs down to the sacrum.
  • Exposure: Use 85-95 kVp with a Grid, utilizing high power for the thickest part of the torso.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam. Angle 5° to 8° downward (caudad) only if the waist sags and cannot be supported.
Lateral Lumbar Spine X-ray
L5-S1 Spot Setup
  • Position: Maintain the true lateral recumbent position used for the Lateral L-Spine view.
  • Centering: Aim the beam 1.5 inches inferior to the iliac crest and 2 inches posterior to the ASIS (front hip bone).
  • Collimation: Crop tightly to an 8x10 or 5x5 inch square focused directly on the lumbosacral joint.
  • Exposure: Use 90-100 kVp with a Grid, increasing power to punch through the dense pelvis.
  • Tube Setup: Set a 40-inch SID. Use a 5° to 8° downward (caudad) angle if the hips are wide and the spine sags.
L5-S1 Spot View X-ray
Oblique L-Spine (RPO) Setup
  • Position: Roll the body 45° from a supine position onto the right side to visualize the right-side zygapophyseal joints (Scottie Dogs). If the patient is unable to lie down due to pain or injury, position them standing in an AP oblique position at the upright bucky (IR). Their back to the bucky with their body turned on a 45 degree angle to the patient's right side.
  • Centering: Aim the beam 1.5 inches above the iliac crest and 2 inches medial to the elevated (left) ASIS (L-3).
  • Collimation: Open the light to frame from the lower ribs to the SI joints.
  • Exposure: Use 80-90 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Oblique Lumbar Spine X-ray
Oblique L-Spine (LPO) Setup
  • Position: Roll the body 45° from a supine position onto the left side to visualize the left-side zygapophyseal joints (Scottie Dogs). If the patient is unable to lie down due to pain or injury, position them standing in an AP oblique position at the upright bucky (IR). Their back to the bucky with their body turned on a 45 degree angle to the patient's left side.
  • Centering: Aim the beam 1.5 inches above the iliac crest and 2 inches medial to the elevated (right) ASIS.
  • Collimation: Open the light to frame from the lower ribs to the SI joints.
  • Exposure: Use 80-90 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Oblique Lumbar Spine X-ray
AP Sacrum Setup
  • IR Size: 10x12 Lengthwise
  • SID: 40 inches
  • Patient Position: Supine, legs extended
  • Central Ray (CR): Angled 15° cephalad (toward the head), entering 2 inches superior to the pubic symphysis (generally mid-pelvis).
  • Respiration: Suspend respiration
AP Sacrum X-ray
AP Coccyx Setup
  • IR Size: 10x12 Lengthwise
  • SID: 40 inches
  • Patient Position: Supine, legs extended
  • Central Ray (CR): Angled 10° caudad (toward the feet), entering 2 inches superior to the pubic symphysis, generally mid-pelvis.
  • Respiration: Suspend respiration
AP Coccyx X-ray
Lateral Sacrum & Coccyx Setup
  • IR Size: 10x12 Lengthwise
  • SID: 40 inches
  • Patient Position: True lateral recumbent, hips and knees flexed for stability
  • Central Ray (CR): Perpendicular, entering 3-4 inches posterior and two inches below the Iliac crest (ASIS). Plainly said, aim for the middle of the buttock.
  • Respiration: Suspend respiration
Lateral Sacrum/Coccyx X-ray
PA Finger Setup
  • Position: Extend the affected finger flat on the IR with the palm facing down against the IR (Image receptor). Gently separate adjacent fingers to avoid overlap.
  • Centering: Direct the central ray perpendicular to the Proximal Interphalangeal (PIP) joint of the affected digit (Second joint space from the tip of the finger).
  • Collimation: Include from the middle of the metacarpal (middle of back of hand) to the tip of the affected finger, assuring that all anatomy is included.
  • Exposure: 50–55 kVp.
  • Tube Setup: 40-inch SID, 0° beam angle, tabletop (no grid).
AP Finger X-ray
PA Oblique Finger Setup
  • Position: Rotate the hand and affected digit 45° laterally from the PA position (do the 'C' method also used for an oblique hand. Support the finger on a 45° foam wedge if needed to maintain parallel placement to the IR.
  • Centering: Direct the central ray perpendicular (straight) to the PIP (2nd) joint of the affected digit.
  • Collimation: Include from the fingertip down through the distal half of the metacarpal (palm of hand).
  • Exposure: 50–55 kVp.
  • Tube Setup: 40-inch SID, 0° beam angle, tabletop (no grid).
PA Oblique Finger X-ray
Lateral Finger Setup
  • Position: Rotate the finger into a true 90° lateral position. Rotate palm laterally for index and middle finger. Rotate palm internally for ring finger and pinky. Curl unaffected digits away to prevent superimposition.
  • Centering: Direct the central ray perpendicular (Straight) to the PIP joint of the affected digit.
  • Collimation: Include from the distal tip through the distal metacarpal and MCP joint space.
  • Exposure: 50–55 kVp.
  • Tube Setup: 40-inch SID, 0° beam angle, tabletop (no grid).
Lateral Finger X-ray
AP Thumb Setup
  • Position: Rotate the palm laterally to place the posterior (Back) surface of the thumb flat against the IR.
  • Centering: Aim the central ray perpendicular to the 1st Metacarpophalangeal (MCP) joint (Thumb meets palm).
  • Collimation: Include from the distal tip of thumb through the entire 1st metacarpal and trapezium (wrist).
  • Exposure: Use 50–55 kVp for optimal joint visualization.
  • Tube Setup: 40-inch SID with a 0° straight beam. No grid required.
AP Thumb X-ray
PA Oblique Thumb Setup
  • Position: Abduct the thumb slightly and place the palmar surface flat on the IR; the thumb naturally rests in a 45° oblique position.
  • Centering: Direct the central ray perpendicular to the 1st MCP joint.
  • Collimation: Include from the distal phalanx through the 1st metacarpal and trapezium.
  • Exposure: 50–55 kVp.
  • Tube Setup: 40-inch SID, 0° beam angle, tabletop (no grid).
PA Oblique Thumb X-ray
Lateral Thumb Setup
  • Position: Flex the fingers into a light fist while resting the hand on the IR, rotating until the lateral surface of the thumb rests directly against the IR in a true 90° lateral position.
  • Centering: Direct the central ray perpendicular to the 1st MCP joint.
  • Collimation: Include from the distal phalanx through the 1st metacarpal and trapezium.
  • Exposure: 50–55 kVp.
  • Tube Setup: 40-inch SID, 0° beam angle, tabletop (no grid).
Lateral Thumb X-ray
PA Hand Setup
  • Position: Pronate the hand flat on the IR with fingers slightly separated to prevent soft tissue overlap.
  • Centering: Aim the central beam directly at the 3rd MCP joint (the middle knuckle).
  • Collimation: Crop the light to include the tips of the fingers down to the distal ends of the radius and ulna.
  • Exposure: Use 55-60 kVp to cleanly display the delicate phalanges and joint spaces.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam. No grid is required.
PA Hand X-ray
Oblique Hand Setup
  • Position: Rotate the hand 45° laterally from a prone position. Use a step sponge to support the fingers and keep joints open.
  • Centering: Aim the central beam at the 3rd MCP joint.
  • Collimation: Crop to include all fingers to the distal radius and ulna.
  • Exposure: Use 55-60 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Oblique Hand X-ray
Lateral Hand Setup
  • Position: Place the hand in a true lateral (karate chop) position with fingers extended into a stacked or "fan" profile.
  • Centering: Aim the central beam at the 2nd MCP joint.
  • Collimation: Frame from the fingertips to the distal radius and ulna.
  • Exposure: Use 60-65 kVp, increasing slightly for the thicker stacked profile.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Hand X-ray
PA Wrist Setup
  • Position: Pronate the hand flat, arching it slightly (curling the fingers under) to place the carpal bones in direct contact with the IR.
  • Centering: Aim the central beam at the mid-carpal area.
  • Collimation: Crop to include the distal radius/ulna and the proximal half of the metacarpals.
  • Exposure: Use 55-60 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Oblique Wrist Setup
  • Position: Rotate the wrist 45° laterally from a prone baseline.
  • Centering: Aim the central beam perpendicular to the mid-carpal area.
  • Collimation: Frame the distal forearm through the proximal metacarpals.
  • Exposure: Use 55-60 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Oblique Wrist X-ray
Lateral Wrist Setup
  • Position: Rotate 90° into a true lateral position with the elbow flexed 90° and resting flat on the table.
  • Centering: Aim the central beam at the mid-carpal zone.
  • Collimation: Crop tightly around the carpal bones, distal forearm, and proximal metacarpals.
  • Exposure: Use 60-65 kVp to push through the stacked radius and ulna.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Wrist X-ray
AP Forearm Setup
  • Position: Supinate the hand (palm up) and extend the arm fully flat against the IR.
  • Centering: Aim the central beam at the mid-forearm.
  • Collimation: Open the light to include both the wrist and elbow joints completely.
  • Exposure: Use 60-65 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Forearm X-ray
Lateral Forearm Setup
  • Position: Flex the elbow exactly 90° and place the arm in a true lateral alignment (thumb up).
  • Centering: Aim the central beam at the mid-forearm.
  • Collimation: Ensure both the wrist and elbow joints are included in the field.
  • Exposure: Use 60-65 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Forearm X-ray
AP Elbow Setup
  • Position: Extend the joint completely and supinate the hand so the arm is flat.
  • Centering: Aim the central beam directly at the mid-elbow joint.
  • Collimation: Crop to include about 3 inches of the distal humerus and 3 inches of the proximal forearm.
  • Exposure: Use 60-65 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Elbow X-ray
Lateral Elbow Setup
  • Position: Flex the elbow exactly 90° and rotate the hand thumb up for a true lateral.
  • Centering: Aim the central beam at the mid-elbow joint.
  • Collimation: Frame the joint space, catching the distal humerus and proximal forearm.
  • Exposure: Use 60-65 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Elbow Xray
Internal Oblique Elbow Setup
  • Position: Extend the elbow, pronate the hand flat, and internally rotate the entire arm 45° to clear the coronoid process.
  • Centering: Aim the central beam at the mid-elbow joint.
  • Collimation: Frame the joint space as in the AP view.
  • Exposure: Use 60-65 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Internal Oblique Elbow X-ray
AP Humerus Setup
  • Position: Supinate the hand to place the epicondyles parallel to the IR.
  • Centering: Aim the central beam at the mid-humerus.
  • Collimation: Open the light to include the shoulder joint above and the elbow joint below.
  • Exposure: Use 70-80 kVp (use a grid if the part is thick enough).
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Humerus X-ray
Lateral Humerus Setup
  • Position: Flex the elbow 90° and place the hand on the abdomen to track the epicondyles perpendicular to the IR.
  • Centering: Aim the central beam at the mid-humerus.
  • Collimation: Include both the shoulder and elbow joints.
  • Exposure: Use 70-80 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Humerus X-ray
AP Shoulder (External) Setup
  • Position: Rotate the arm externally (supinated) until epicondyles are parallel. This puts the greater tubercle in profile laterally.
  • Centering: Aim the central beam 1 inch inferior to the coracoid process.
  • Collimation: Frame from above the clavicle to the proximal humerus, including the lateral skin line.
  • Exposure: Use 70-80 kVp with a Grid to manage scatter.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Shoulder External Rotation
AP Shoulder (Internal) Setup
  • Position: Rotate the arm internally (pronated) until epicondyles are perpendicular to the IR. This puts the lesser tubercle in profile medially.
  • Centering: Aim the central beam 1 inch inferior to the coracoid process.
  • Collimation: Frame the shoulder joint as in the external rotation view.
  • Exposure: Use 70-80 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Shoulder Internal Rotation
Scapular Y View Setup
  • Position: Rotate the patient 45° to 60° anteriorly against the IR. Ensure the flat scapular body is perpendicular to the IR plane.
  • Centering: Aim the central beam at the scapulohumeral joint boundary.
  • Collimation: Crop to frame the entire scapula and proximal humerus.
  • Exposure: Use 75-85 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Scapula Y X-ray
AP Clavicle Setup
  • Position: Patient can be upright or supine, arms down by their sides.
  • Centering: Aim the central beam perpendicular to the mid-clavicle body.
  • Collimation: Crop tightly top-to-bottom to frame the collarbone, but leave it wide enough to catch both the AC and SC joints.
  • Exposure: Use 70-80 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Clavicle
AP Axial Clavicle Setup
  • Position: Patient upright or supine, arms down.
  • Centering: Aim the central beam at the mid-clavicle.
  • Collimation: Frame the clavicle to include both the AC and SC joints.
  • Exposure: Use 70-80 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID. Angle the Central Ray 15° to 30° Cephalad to clear the rib cage overlay (use closer to 30° for thinner patients).
Axial Clavicle
AP Pelvis Setup
  • Position: Lie completely flat on your back (supine) down the center of the table. Pigeon-toe both feet internally 15° to 20° to roll the femoral necks into a perfect, true profile view.
  • Centering: Aim the central beam directly down the midline, about 2 inches lower than the ASIS (the hard, bony bumps on the front of the hips). This positions the beam perfectly midway between the hip crests and the pubic bone.
  • Collimation: Open the light wide enough horizontally to include the outer soft tissue skin lines of both hips, and vertically to capture from the lower lumbar spine down to the upper thighs.
  • Exposure: Use 75-85 kVp with a Grid to cleanly penetrate the dense pelvic bone structures and abdominal tissues.
  • Tube Setup: Set a 40-inch SID (tube distance) with a 0° straight beam (no angle).
  • Breathing: Instruct the patient to "Take in a deep breath. Blow it all the way out. Hold it out there."
AP Pelvis X-ray
AP Axial Foot Setup
  • Position: Rest the plantar surface (bottom) of the foot flat on the IR.
  • Centering: Aim the central beam at the base of the 3rd metatarsal.
  • Collimation: Frame from the tips of the toes to the back of the heel, clearing the side skin margins.
  • Exposure: Use 55-60 kVp to clearly visualize the small bones.
  • Tube Setup: Set a 40-inch SID with the tube angled 10° toward the heel (cephalad).
AP Axial Foot X-ray
Medial Oblique Foot Setup
  • Position: Rotate the foot and leg medially (inward) 30° to 40°.
  • Centering: Aim the central beam directly at the base of the 3rd metatarsal.
  • Collimation: Include the entire foot from toes to heel.
  • Exposure: Use 55-60 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Oblique Foot X-ray
Lateral Foot Setup
  • Position: Roll into a true lateral profile resting on the outside edge of the foot. Dorsiflex the foot 90°.
  • Centering: Aim the central beam at the base of the 3rd metatarsal (mid-cuneiform area).
  • Collimation: Frame the entire foot and about an inch of the distal lower leg.
  • Exposure: Use 60-65 kVp to penetrate the stacked metatarsals.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Foot X-ray
AP Ankle Setup
  • Position: Keep the leg straight in a true AP alignment. Dorsiflex the foot to 90°.
  • Centering: Aim the central beam perpendicular to a point midway between the malleoli.
  • Collimation: Crop to include the ankle joint, distal tib/fib, and proximal talus.
  • Exposure: Use 60-65 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Ankle X-ray
Ankle Mortise Setup
  • Position: Rotate the entire leg and foot internally 15° to 20° until the intermalleolar line is perfectly parallel to the IR.
  • Centering: Aim the central beam midway between the malleoli.
  • Collimation: Frame the entire joint space closely.
  • Exposure: Use 60-65 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Mortise Oblique Ankle X-ray
Lateral Ankle Setup
  • Position: Roll into a true lateral alignment resting on the outside of the ankle. Dorsiflex the foot 90°.
  • Centering: Aim the central beam at the medial malleolus.
  • Collimation: Include the distal tib/fib down through the heel and base of the 5th metatarsal.
  • Exposure: Use 60-65 kVp.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Ankle X-ray
AP Tibia & Fibula Setup
  • Position: Extend the leg straight. Ensure the femoral condyles at the knee are parallel to the IR.
  • Centering: Aim the central beam at the midpoint of the lower leg.
  • Collimation: Open the light to capture both the knee and ankle joints completely (turn IR corner-to-corner if needed).
  • Exposure: Use 70-80 kVp.
  • Tube Setup: Set a 40-inch (up to 48-inch if needed) SID with a 0° straight beam.
AP Tibia & Fibula X-ray
Lateral Tibia & Fibula Setup
  • Position: Roll the patient onto the affected side into a true lateral configuration.
  • Centering: Aim the central beam perpendicular to the midpoint of the lower leg.
  • Collimation: Ensure both the knee and ankle joints are visible in the frame.
  • Exposure: Use 70-80 kVp.
  • Tube Setup: Set a 40-inch (up to 48-inch) SID with a 0° straight beam.
Lateral Tibia & Fibula X-ray
AP Knee Setup
  • Position: Extend the leg and rotate it internally 3° to 5° for a true AP alignment.
  • Centering: Aim the central beam 1/2 inch below the apex (bottom point) of the patella.
  • Collimation: Frame the joint, capturing the distal femur and proximal tib/fib.
  • Exposure: Use 70-80 kVp.
  • Tube Setup: Set a 40-inch SID. Apply ASIS thickness rules (<19cm: 5° caudad, 19-24cm: 0°, >24cm: 5° cephalad).
AP Knee X-ray
Lateral Knee Setup
  • Position: Roll into a true lateral recumbent position, flexing the knee 20° to 30°.
  • Centering: Aim the central beam 1 inch distal to the medial epicondyle.
  • Collimation: Tightly frame the knee joint space and patella profile.
  • Exposure: Use 70-80 kVp.
  • Tube Setup: Set a 40-inch SID. Angle the CR 5° to 7° Cephalad to prevent the medial condyle from obscuring the joint space.
Lateral Knee X-ray
Oblique Knee (Medial) Setup
  • Position: Rotate the entire leg internally 45° to fully display an open proximal tibiofibular joint.
  • Centering: Aim the central beam 1/2 inch below the patellar apex.
  • Collimation: Frame the joint identically to the AP view.
  • Exposure: Use 70-80 kVp.
  • Tube Setup: Set a 40-inch SID. Maintain the same ASIS tube angle used for the AP projection.
Oblique Knee X-ray
Sunrise View Setup
  • Position: Flex the knee (degree of flexion varies by specific technique, generally ~40° to 90°).
  • Centering: Aim the central beam tangentially, tracking directly through the patellofemoral joint space.
  • Collimation: Crop tightly around the patella and the anterior femoral condyles.
  • Exposure: Use 65-75 kVp.
  • Tube Setup: Set a 40-inch SID. Angle the tube to match the degree of flexion so it cleanly skims the joint gap.
Sunrise View X-ray
AP Unilateral Hip Setup
  • Position: Lie flat and rotate the affected leg internally 15° to 20° to place the femoral neck parallel to the IR.
  • Centering: Aim the central beam perpendicular to the femoral neck.
  • Collimation: Frame from the ASIS down past the lesser trochanter.
  • Exposure: Use 75-85 kVp with a Grid to manage pelvic scatter.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Unilateral Hip X-ray
Frog Lateral Hip Setup
  • Position: Flex the hip and knee, then abduct the femur 40° to 45° outward from vertical.
  • Centering: Aim the central beam directly at the femoral neck.
  • Collimation: Include the acetabulum down to the proximal femur shaft.
  • Exposure: Use 75-85 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Frog Lateral Hip X-ray
AP Femur (Upper) Setup
  • Position: Lie flat and rotate the leg internally 15° to 20° to match the AP hip profile.
  • Centering: Aim the central beam at the mid-upper femur.
  • Collimation: Open the light to ensure the proximal margin line of the hip joint space is fully included.
  • Exposure: Use 75-85 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Femur (Upper) X-ray
AP Femur (Lower) Setup
  • Position: Lie flat and rotate the leg internally 3° to 5° to match the AP knee profile.
  • Centering: Aim the central beam at the mid-lower femur.
  • Collimation: Ensure a minimum of 2 inches below the distal knee joint is included.
  • Exposure: Use 75-85 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
AP Femur (Lower) X-ray
Lateral Femur (Upper) Setup
  • Position: Roll onto the affected side. Roll the pelvis posteriorly 10° to 15° to clear the opposite leg structure out of the field.
  • Centering: Aim the central beam at the mid-upper femur.
  • Collimation: Ensure the entire hip joint is visible within the frame.
  • Exposure: Use 75-85 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Femur (Upper) X-ray
Lateral Femur (Lower) Setup
  • Position: Roll into a true lateral position with epicondyles perpendicular. Flex the knee 45° and move the unaffected limb out of the way.
  • Centering: Aim the central beam at the mid-lower femur.
  • Collimation: Include the knee joint and about 2 inches below it.
  • Exposure: Use 75-85 kVp with a Grid.
  • Tube Setup: Set a 40-inch SID with a 0° straight beam.
Lateral Femur (Lower) X-ray

Anatomy & Orientation

Surface landmarks, anatomical planes, and orientation lines to aid in proper clinical X-ray positioning.

Master Skeletal Anatomy

Primary structural bones and reference landmarks.

Skeleton Anatomy
AGlabella
BAcanthion
CExternal Auditory Meatus (EAM)
DOrbit
EZygomatic Arch
FUpper Alveolar Process
GC-3 Vertebrae
HJugular Notch
IAcromion Process
JHumeral Head
KXiphoid Process of Sternum
LRibs
MIliac Crest
NFemoral Head
OGreater Trochanter
PPubic Symphysis
QLesser Trochanter
RFemur
SPatella (Kneecap)
TKnee Joint
UFibula
VTibia
WAnkle
XFoot
  • A: Glabella
  • B: Acanthion
  • C: External Auditory Meatus (EAM)
  • D: Orbit
  • E: Zygomatic Arch
  • F: Upper Alveolar Process (Upper Teeth)
  • G: C-3 Vertebrae
  • H: Jugular Notch
  • I: Acromion Process
  • J: Humeral Head
  • K: Xiphoid Process of Sternum
  • L: Ribs
  • M: Iliac Crest
  • N: Femoral head
  • O: Greater Trochanter
  • P: Pubic Symphysis
  • Q: Lesser Trochanter
  • R: Femur
  • S: Patella (kneecap)
  • T: Knee Joint
  • U: Fibula
  • V: Tibia
  • W: Ankle
  • X: Foot
Skull & Facial Baselines

Reference lines used to ensure precise angulation for headwork.

Skull Line Orientations
  • GML: Glabellomeatal line
  • OML: Orbitomeatal line
  • IOML: Infraorbitomeatal line
  • AML: Acanthiomeatal line
  • LML: Lipsmeatal line
  • MML: Mentomeatal line
  • EAM: External acoustic meatus
Facial Landmarks

Palpable points on the face used for precise CR centering.

Facial Landmark Features
  • MSP: Midsagittal plane
  • Glabella
  • SOG: Supraorbital groove
  • Nasion
  • IPL: Interpupillary line
  • Acanthion
  • IOM: Infraorbital margin
  • Mental point
  • EAM: External acoustic meatus
Boney Thorax / Chest

Structural anatomy of the chest used for X-ray positioning.

Boney Chest Anatomy
  • Scapula: Acromion, Coracoid process, Glenoid cavity
  • Clavicle: SC joint, AC joint
  • Sternum: Manubrium, Sternal angle, Body, Xiphoid process
  • Ribs 1-12: Costal cartilage, False ribs, Floating ribs
Diagnostic vs. Non-Diagnostic Chest X-Rays

Examples of optimal and suboptimal image quality.

Optimal vs Suboptimal Chest X-Rays

Optimal

  • A: Optimal quality chest X-ray

Suboptimal (B–I)

  • B: Non-inclusion of lung apices and costophrenic angles
  • C: Low lung volume / inadequate inspiration
  • D: Under-exposure
  • E: Over-exposure
  • F: Chin overlying the lung fields
  • G: Patient rotation
  • H: Foreign body (necklace) overlying the lung field
  • I: Artifact obscuring part of the left costophrenic angle
Bony Pelvis Landmarks

Palpable surface parts used for centering the CR.

Bony Pelvis Anatomy
  • A: Iliac Crest (ASIS)
  • B: L5-S1 Joint Space
  • C: SI Joints (Sacroiliac Joints)
  • D: Ilium
  • E: Sacrum
  • F: Acetabulum
  • G: Pubic Symphysis
  • H: Greater Trochanter
  • I: Pubic Ramus (Rami)
  • J: Lesser Trochanter

Terminology Hub

Instant searchable index of core X-ray positioning terms, planar structures, and physics rules.

1. General Anatomical & X-Ray Positioning Terms

AP (Anteroposterior)The x-ray beam enters the anterior (front) surface and exits the posterior (back) surface.
PA (Posteroanterior)The x-ray beam enters the posterior (back) surface and exits the anterior (front) surface.
LateralA side view tracking perpendicular to the coronal plane; names the surface nearest the image receptor.
ObliqueAn angled or rotated setup that is neither AP, PA, nor true lateral. Typically rotated 45°.
AxialA projection where the x-ray tube is angled rather than tracking completely perpendicular to the IR plane.
TangentialA projection where the central ray merely skims the outer border profile of a surface or structure.
Coronal PlaneA vertical plane dividing the body into front (anterior) and back (posterior) halves.
Sagittal PlaneA vertical plane dividing the body into left and right halves.
Transverse PlaneA horizontal plane dividing the body into upper (superior) and lower (inferior) sections.
Midsagittal Plane (MSP)The exact vertical structural line dividing the patient anatomy evenly into left and right sides.
Midcoronal Plane (MCP)The vertical line passing sideways through the body, separating front anterior fields from back posterior structures.
DistalSituated away from the center of the body or from the point of attachment.
ProximalSituated nearer to the center of the body or the point of attachment.
MedialSituated near the median plane of the body or the midline of an organ.
SuperiorSituated above or higher than another part of the body.
InferiorSituated below or lower than another part of the body.
CephaladRefers to an angulation of the central ray directed upward toward the head of the patient.
CaudadRefers to an angulation of the central ray directed downward toward the feet of the patient.
Plantar SurfaceThe sole or absolute bottom weight-bearing skin surface layer of the human foot structure.
Dorsal SurfaceThe top aspect of the foot (dorsum pedis) or the backward-facing posterior aspect of the hand structure.
PronationA rotational track movement of the forearm that spins the palm of the hand flatly downward or backward.
SupinationRotational adjustment turning the palm upward; standard default position for all baseline AP forearm/elbow tracking.
Joint SpaceThe anatomical gap between two articulating bones; appears radiolucent on an x-ray due to the presence of cartilage and synovial fluid.
Types of JointsCategorized by movement: Synovial (freely movable), Cartilaginous (slightly movable), and Fibrous (immovable).
Long BoneHard, dense bones that provide strength, structure, and mobility (e.g., femur, humerus), possessing a long shaft (diaphysis) and two ends (epiphyses).

2. X-Ray Positioning Lines & Baselines

GML (Glabellomeatal Line)An x-ray positioning line between the glabella and the EAM.
AML (Acanthiomeatal Line)An x-ray positioning line between the acanthion and the EAM.
LML (Lipsmeatal Line)An x-ray positioning line between the junction of the lips and the EAM.
MML (Mentomeatal Line)An x-ray positioning line between the mental point (chin) and the EAM.
OML (Orbitomeatal Line)Critical skull landmark line stretching from the outer canthus of the eye to the external auditory meatus.
IOML (Infraorbitomeatal Line)Skull baseline line traveling from the lower bony rim of the eye socket to the external opening of the ear.
IPL (Interpupillary Line)A straight line passing through both pupils, utilized to prevent tilt on true lateral head projections.

3. Specialized Anatomical Landmarks

C1 (Atlas) & C2 (Axis)The first two cervical vertebrae; C2 contains the Dens (Odontoid Process), the pivot for rotation.
Thyroid CartilageExternal landmark at C4 used for cervical spine centering.
Jugular NotchThe dip at the top of the sternum (T2-T3 level) used for chest and T-spine centering.
Iliac CrestThe upper border of the pelvic bone (L4 level); the primary landmark for abdominal and lumbar imaging.
Costophrenic AnglesThe extreme lower corners of the lungs; essential to capture on chest films to check for fluid.
Pubic SymphysisThe bottom-most landmark of the abdomen; must be included on a KUB.
"The Scottie Dog"The unique silhouette seen on an Oblique L-Spine (Pedicle = eye, Pars = neck).
EAM (External Auditory Meatus)The opening of the ear canal.
ASIS (Anterior Superior Iliac Spine)A prominent bony landmark on the anterior aspect of the pelvis.
NasionThe depression at the root of the nose.
GlabellaThe smooth area between the eyebrows just above the nose.
AcanthionThe point at the base of the anterior nasal spine.
ZygomaThe cheekbone.
CondyleA rounded protuberance at the end of some bones, forming an articulation with another bone.

4. Technical Imaging & Physics

GridA device used to absorb scatter radiation before it reaches the image receptor, improving image contrast.
BuckyA device containing a moving grid, located beneath the exam table or in the wall stand, which holds the image receptor.
IR (Image Receptor)The device that captures the radiographic image (e.g., cassette, digital detector).
CollimationManual or automatic adjustment restriction of the useful beam width, lowering patient entry dose parameters.
Central Ray (CR)The core center axis point of the primary beam, directed squarely to anatomical structures to avoid elongation distortions.
SID (Source-to-Image Distance)The complete distance tracking from the focal spot on the x-ray anode directly down to the image capture medium.
AttenuationThe reduction of beam intensity as it passes through the body (high in bone, low in air).
Radiolucent vs. RadiopaqueRadiolucent (black) allows X-rays through; Radiopaque (white) absorbs them.
Anode Heel EffectBeam intensity is stronger on the cathode side; use the "Head to Anode" rule for T-spine.
OID (Object-to-Image Distance)Patient-to-IR distance. Minimizing OID reduces magnification.
Air-Gap TechniqueUsing a large OID to naturally reduce scatter reaching the IR.

5. Quality & Exposure Factors

kVp (Kilovoltage Peak)The maximum peak potential voltage applied across the tube gap; rules photon penetration power level attributes.
mAs (Milliampere-seconds)The mathematical product of tube current and exposure duration; dictates primary quantitative beam volume density.
Spatial ResolutionThe ability to see small, fine details clearly (sharpness).
Quantum MottleA grainy appearance caused by low mAs (insufficient photons).
Exposure Index (EI)The numerical value indicating the actual radiation that reached the IR.
ArtifactAny unwanted mark on an image (jewelry, zippers, or Tongue Shadows).

6. Clinical & Pathological Indicators

Air-Fluid LevelsHorizontal lines between gas and liquid, seen only on upright or decubitus views.
Free Air (Pneumoperitoneum)Air outside the bowel, typically under the diaphragm; a surgical emergency.
PatencyThe state of being open or unobstructed (e.g., neural foramina).
SpondylolysisA stress fracture of the pars interarticularis (the "collar" on the Scottie Dog).
PneumothoraxA collapsed lung, requiring specific technical factors to demonstrate.

7. Legal & Ethical Standards

ALARAAs Low As Reasonably Achievable (Time, Distance, Shielding).
Informed ConsentEnsuring the patient understands risks/benefits before a procedure.
Medical NegligenceA breach of duty (e.g., failing to shield or imaging the wrong patient).
Scope of PracticeLegal limits of a tech's role (e.g., no diagnosing).
HIPAAFederal law protecting patient privacy and data.
Image Wisely & GentlyNational initiatives for adult and pediatric radiation safety.
No matching core radiography terms found.

Technical Reference Guide

Simple rules and setting baselines for setting up perfect x-ray exposures every time.

☢️ Comprehensive Technique Chart

Average (medium) adult profile baselines. Adjust up or down based on patient pathology and size.

  • Skull AP 77 kVp @ 18 mAs
  • Skull Lateral 73 kVp @ 15 mAs
  • Waters 77 kVp @ 40 mAs
  • Caldwell 72 kVp @ 32 mAs
  • C-Spine AP/Obl/Odon 75 kVp @ 15 mAs
  • C-Spine Lateral 80 kVp @ 30 mAs
  • T-Spine AP/Obl 77 kVp @ 65 mAs
  • T-Spine Lateral 60 kVp @ 120 mAs
  • L-Spine AP/Obl 76 kVp @ 80 mAs
  • L-Spine Lat/Spot 75 kVp @ 120 mAs
  • Chest PA (72") 105 kVp @ 6 mAs
  • Chest Lateral (72") 110 kVp @ 7.5 mAs
  • KUB / Abdomen 70 kVp @ 55 mAs
  • Ribs Upper 73 kVp @ 15 mAs
  • Ribs Lower 72 kVp @ 55 mAs
  • Shoulder 60 kVp @ 40 mAs
  • Humerus 65 kVp @ 7.5 mAs
  • Elbow 56 kVp @ 1.7 mAs
  • Forearm 55 kVp @ 1.7 mAs
  • Hand / Wrist 55 kVp @ 1.7 mAs
  • Finger 52 kVp @ 1.7 mAs
  • Pelvis 80 kVp @ 66 mAs
  • Hip 77 kVp @ 65 mAs
  • Femur 75 kVp @ 20 mAs
  • Knee 55 kVp @ 7.5 mAs
  • Tibia / Fibula 60 kVp @ 2 mAs
  • Ankle / Foot 55 kVp @ 2 mAs
🎨 The 15% Rule (Contrast Styler) IMAGE LOOKS

Think of kVp as your beam's punching power (penetration) and mAs as the total volume of x-rays. The 15% rule allows you to change the contrast (the shades of gray) of your image without changing the overall brightness.

Desired Image Style The 15% Adjustment When & Why to Use It
Bold Black & White
High Contrast / Short Scale		 ↓ Turn kVp DOWN 15%
↑ Double mAs (x2)		 When: Extremities, ribs, and orthopedics.
Why: Lowering the energy causes more x-rays to be completely absorbed by bone, leaving bright white bone against dark backgrounds for sharp structural borders.
Smooth & Detailed Grays
Low Contrast / Long Scale		 ↑ Turn kVp UP 15%
↓ Cut mAs in Half (-50%)		 When: Chest, abdomen, and soft tissue.
Why: Higher energy easily punches through varying tissue densities, painting the plate with many subtle shades of gray to reveal delicate structures like lung markings.
💡 The Water Hose Analogy: If you turn up the pressure on a water hose (kVp), the water shoots much faster—so you only need to spray it for half the time (mAs) to fill the exact same bucket!
⚖️ Body Size Adjustment Rules Habitus Guide

The technique chart assumes an average-sized adult. When your patient is significantly larger or smaller, use these simple mAs (x-ray amount) math tricks to keep your image quality perfect.

Patient Size (Habitus) The Adjustment Rule Why It Works
Thin / Frail
Asthenic / Hyposthenic		 Cut mAs in Half (-50%) Less tissue to push through means you need fewer x-rays to reach the plate.
Average / Normal
Sthenic		 Use Chart Baseline Standard baseline settings are built specifically for this body type.
Large / Muscular
Hypersthenic		 Double the mAs (x2) Dense muscle and deep tissue absorb a lot of x-rays. You need twice as many to get a clear picture.
📏 The 4 Centimeter Rule: As a general clinical trick, for every 4 to 5 cm of extra body thickness your patient has compared to average, you must double your mAs to maintain the same image brightness.

Clinical Quiz

Test your knowledge of X-ray positioning, orientation, and exposure techniques.

Radiography Positioning And Exposure

You’ve put in the hard work and studied the materials—now let’s see how it all comes together. This quiz is designed to build your confidence and reinforce the key imaging principles you've learned. Take your time, focus on the details, and remember: precision in positioning is the key to diagnostic excellence.


About & Mission

The philosophy, scope, and purpose behind Radiography with Richie.

About the Instructor & Program

My name is Richie Shivers, RT(R)(CT)(ARRT). I am a registered radiologic technologist with experience in diagnostic radiography, computed tomography, and clinical radiology training. Over the course of my career, I have worked closely with imaging teams across the full spectrum of clinical care, from Level 1 Trauma Centers to specialized outpatient clinics.

Through that experience, I recognized a consistent opportunity to better support the field: Imaging team members are often tasked with performing high-quality radiography in high-pressure environments, where straightforward, practical, and accessible training resources are at a premium.

While formal academic programs provide the essential scientific foundation, many fast-paced clinical settings benefit from clear, safe, and foundational refreshers. There is a vital need for instruction that focuses on the practical “how-to” of x-ray positioning and the clinical “why” behind it—bridging the gap between complex theory and daily patient care.

That gap is why this site exists.

Program Focus

Radiography with Richie is an educational resource designed to support healthcare professionals in mastering the technical fundamentals of diagnostic x-ray positioning and patient safety. This program focuses on:

  • Preparation
  • Performance
  • Perspective
  • Presence
  • Protocol
  • Purpose

Every section is written in plain, clinical language, with step‑by‑step breakdowns that emphasize what to do, why it works, and how to avoid common mistakes.

This is not a physics course. It is not intended to replace formal radiologic education. It is a training support resource built to reduce confusion, anxiety, and unnecessary repeat imaging.
Educational Philosophy

This program is guided by a few core principles:

  • Clarity over complexity
  • Safety first, always
  • Confidence is built through understanding, not memorization
  • Good x-ray positioning prevents repeat exposure

Radiology should not feel mysterious or intimidating. When practitioners understand the reasoning behind x-ray positioning, they perform more confidently, patients feel more comfortable, and image quality improves.

Intended Audience & Scope

This site is intended for multidisciplinary imaging teams, clinical support professionals, students learning basic imaging concepts, and frontline healthcare imaging providers.

The information presented is for educational and training support purposes only. It does not grant licensure or certification, replace employer training programs, or supersede facility protocols.

Always follow: Physician orders, facility policies, and applicable state laws and scope‑of‑practice requirements.

Why This Site Was Created

This program exists to make X‑ray education less intimidating, more accessible, clinically useful, and patient‑focused.

If this site helps even one member of the team feel more confident with x-ray positioning a patient safely and correctly, it has achieved its purpose.

“The goal of radiologic imaging is to produce the highest quality diagnostic image with the least possible radiation exposure to the patient.”
— Stewart C. Bushong, ScD, Medical Physicist

Privacy Policy

Transparency regarding how your information is collected, used, and protected.

Radiography With Richie (“we,” “us,” or “our”) respects your privacy and is committed to transparency about how information is collected, used, and protected when you visit our website (the “Site”). This Privacy Policy explains our practices. By using the Site, you agree to the terms described below.

Information We Collect

Information You Provide: If you voluntarily submit information through contact forms, comments, email subscriptions, or any other interactive feature, we may collect your name, email address, and any other information you choose to provide. We do not require you to create an account to access educational content on this Site.

Information Collected Automatically: When you visit the Site, certain information may be collected automatically, including your IP address, browser type, operating system, referring URLs, pages viewed, time spent on pages, and the date and time of your visit. This information is collected through standard web server logs, cookies, and similar technologies.

How We Use Your Information

We may use the information we collect to: respond to inquiries and communications you send us; deliver email updates or newsletters if you have opted in; improve the content, functionality, and user experience of the Site; monitor and analyze Site usage and trends; and comply with applicable legal obligations. We do NOT sell, rent, or trade your personal information to third parties for marketing purposes.

Cookies and Tracking Technologies

This Site may use cookies and similar tracking technologies to enhance your browsing experience, analyze traffic, and understand how visitors interact with the Site. Cookies are small data files stored on your device. You can control cookie preferences through your browser settings. Disabling cookies may affect certain features of the Site. Third-party services integrated with this Site (such as analytics providers or embedded content platforms) may also set their own cookies subject to their respective privacy policies.

Third-Party Services

This Site is hosted on WordPress and may use third-party tools and services including but not limited to analytics platforms (e.g., Google Analytics, Jetpack), embedded video platforms (e.g., YouTube), social media plugins, and email subscription services. These third-party services may collect information about your use of the Site in accordance with their own privacy policies. We encourage you to review the privacy policies of any third-party services you interact with through this Site. We are not responsible for the privacy practices of third-party services.

Data Sharing and Disclosure

We do not sell your personal information. We may share your information only in the following limited circumstances: with service providers who assist in operating the Site (subject to confidentiality obligations); when required by law, regulation, legal process, or enforceable government request; to protect the rights, property, or safety of Radiography With Richie, our users, or the public; or with your explicit consent.

Data Security

We take reasonable measures to protect the information collected through this Site from unauthorized access, alteration, disclosure, or destruction. However, no method of electronic transmission or storage is 100% secure. While we strive to protect your personal information, we cannot guarantee its absolute security. You use this Site and transmit information at your own risk.

Children’s Privacy

This Site is not directed to children under the age of 13, and we do not knowingly collect personal information from children under 13. If we become aware that we have inadvertently collected personal information from a child under 13, we will take steps to delete that information promptly. If you believe a child has provided us with personal information, please contact us immediately.

Your Rights and Choices

Depending on your jurisdiction, you may have certain rights regarding your personal information, including the right to access, correct, delete, or restrict the processing of your data. If you have subscribed to email communications, you may opt out at any time by using the unsubscribe link provided in each email or by contacting us directly. To exercise any of your rights, please contact us using the information provided below.

External Links

This Site may contain links to external websites or resources that are not operated by us. We are not responsible for the content, privacy practices, or policies of any third-party websites. We encourage you to review the privacy policy of every site you visit. Inclusion of any link does not imply endorsement by Radiography With Richie.

Changes to This Privacy Policy

We reserve the right to update or modify this Privacy Policy at any time. Any changes will be posted on this page with an updated “Last Updated” date. Your continued use of the Site after any changes constitutes your acceptance of the revised Privacy Policy. We encourage you to review this page periodically.

Contact

If you have any questions or concerns about this Privacy Policy, please contact us through the Radiography With Richie website.

Tools & Downloads

Helpful resources, guides, and PDF downloads for clinical practice.

ID Badge Technique Chart Preview

ID Badge Technique Chart

A quick-reference technique chart designed to fit behind your clinical ID badge. Keep standard kVp and mAs settings easily accessible for quick adjustments on the floor.

Download PDF
Blank X-ray Positioning Flash Cards Preview

X-Ray Positioning Flash Cards

Blank, structured flash cards with detailed sections for central ray placement, SID, patient x-ray positioning, and evaluation criteria. Print these out for active studying and clinical review.

Download PDF
Standard Required Views Preview

Standard Required Views

A quick-reference badge card outlining the standard required views for common diagnostic exams. Perfect for confirming baseline protocols before positioning the patient.

Download PDF
Image Critique Checklist Preview

Image Critique Checklist

A rapid, 10-point self-evaluation checklist tailored for an ID badge. Run through these core criteria to verify x-ray positioning, collimation, and technique before sending an image to the provider.

Download PDF
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