---

X-Ray Imaging Criteria — Complete Body Region Guide

Universal / General Criteria (Apply to ALL X-rays)

---

1. 🫁 Chest X-ray (CXR)

Projections: PA Erect (routine) + Left Lateral

• SID: 72 inches (reduces cardiac magnification)
• Position: Patient erect, posterior chest against detector, chin raised, hands on hips, shoulders rolled forward
• Respiration: Full inspiration — 10 posterior ribs visible above diaphragm
• Central Ray (CR): T7 vertebra level
• Criteria for acceptability:
  • Both lung fields fully included (apices to costophrenic angles)
  • Medial borders of scapulae outside lung fields
  • Trachea midline, carina visible
  • Vertebral column visible through cardiac shadow
  • No rotation — medial clavicular ends equidistant from spine
  • Sharp vascular markings to periphery
  • Diaphragm and costophrenic angles sharp and visible

• Left side closest to detector
• Arms raised above head
• CR at T7
• Criteria: Both hemidiaphragms visible, posterior ribs superimposed, sternum in true lateral

• Patient lies on side; CR horizontal
• Labeled "Right/Left Lateral Decubitus"
• Arms above head, chin up
• CR at T7

---

2. 🔲 Skull X-ray

Projections: AP, PA Caldwell, Towne's, Lateral (R & L), Submentovertex (SMV)

• CR: Nasion, angled 15–23° caudally
• Criteria: Petrous ridges projected into lower 1/3 of orbits; no rotation; equal distance from lateral skull to lateral orbital margins bilaterally

• Patient supine, IOML perpendicular to detector
• CR: 30° caudal through foramen magnum
• Criteria: Petrous pyramids symmetric; dorsum sellae & posterior clinoids in foramen magnum; entire calvarium visible

• Patient lateral, interpupillary line perpendicular to detector
• Criteria: Sella turcica in true lateral; orbital roofs superimposed; mandibular rami superimposed; no rotation

• Neck fully extended, IOML parallel to detector
• CR: Perpendicular through sella
• All positions must be upright when possible

---

3. 🦴 Sinuses

Projections: PA Caldwell, Waters (Open & Closed Mouth), Lateral — ALL UPRIGHT

• Chin extended, tip of nose and chin touching detector
• CR: Through mid-sinuses at acanthion
• Criteria: Petrous ridges below maxillary sinuses; orbits fully visible; no rotation

• Forehead and nose on detector, OML perpendicular
• CR: ~15° caudal at nasion
• Criteria: Frontal and ethmoid sinuses visible above petrous ridges

All sinus films must be upright to demonstrate air-fluid levels

---

4. 🦷 Mandible / TMJ

• 35–42° caudal for mandible
• Criteria: Condylar processes symmetric; rami visible bilaterally

• Exaggerated Towne's + Schuller's projections
• Both open and closed mouth positions
• CR: 25–30° caudal in true lateral position

---

5. 🦴 Cervical Spine (C-Spine)

Projections: AP, Lateral, Obliques (RPO/LPO), Open-Mouth Odontoid

• CR: C4, directed 15–20° cephalad
• Criteria: C3–T1 visible; no rotation; spinous processes midline

• Mouth open wide; OML perpendicular
• CR: Through open mouth
• Criteria: Dens fully visible between lateral masses of C1; upper incisors superimpose base of skull

• Patient erect, true lateral
• Shoulders depressed (hold sandbags if needed)
• CR: C4
• Criteria: All 7 cervical vertebrae and C7-T1 junction visible; anterior and posterior cortical margins sharp; soft tissue of posterior pharynx visible

• Criteria: Intervertebral foramina open on the side away from the tube

• One arm extended alongside ear, opposite shoulder depressed
• CR: T1-T2 at midaxillary plane
• kVp: 80–90; mAs: 80–120

---

6. 🦴 Thoracic Spine (T-Spine)

Projections: AP, Lateral

• CR: T7
• Criteria: T1–T12 visible; spinous processes midline; ribs symmetric

• Patient lateral, arms raised
• CR: T7
• Criteria: Vertebral bodies, intervertebral disc spaces visible; posterior elements superimposed

---

7. 🦴 Lumbar Spine (L-Spine)

Projections: AP, Lateral, Obliques (for facet joints)

• CR: L3 (iliac crest level)
• Knees/hips flexed to reduce lordosis
• Criteria: L1–L5 + sacrum visible; disc spaces open; spinous processes midline; SI joints visible

• True lateral; hips & knees flexed slightly
• CR: L3
• Criteria: Disc spaces open; posterior spinous processes superimposed; L5-S1 junction included

• Demonstrates "Scottie Dog" sign for pars interarticularis

---

8. 🫀 Sternum

Projections: RAO (Right Anterior Oblique), Right Lateral

• Rotated to project sternum over cardiac shadow (for contrast)
• CR: Manubrium
• Criteria: Entire sternum visible without rib superimposition; cardiac shadow provides contrast

• Patient standing at chest board if possible
• Criteria: Sternum in true lateral, both surfaces visible

---

9. 🫁 Ribs

Projections: PA Chest, AP Upper Ribs (inspiration), AP Lower Ribs (expiration), Oblique Ribs

• Oblique ribs of affected side included
• Criteria: Entire affected rib cage visualized; costophrenic angles included for lower ribs

---

10. 🫃 Abdomen / KUB

Projections: AP Supine, AP Erect (or Left Lateral Decubitus if unable to stand)

• CR: Iliac crests / L3
• Criteria: Both kidneys, ureters, bladder (symphysis pubis to diaphragm); spine aligned to midline; no rotation

• Annotation "ERECT" or "UPRIGHT" required
• Criteria: Both hemidiaphragms included (to detect free air under diaphragm); symphysis pubis to diaphragm

• Patient lies on left side, CR horizontal
• Criteria: Free air rises to right side above liver; both diaphragms and full abdomen visible

---

11. 🦴 Pelvis & Hips

• CR: Iliac crest or ASIS midpoint
• Feet internally rotated 15° (to project femoral necks)
• Criteria: Both iliac wings symmetric; femoral necks fully visible; lesser trochanters minimally visible; symphysis pubis and sacroiliac joints included

• AP + Frog-leg lateral of affected side
• Criteria: Femoral head, neck, acetabulum, and proximal femur on each view

• Pelvis + frog-leg laterals (done separately for adults)

---

12. 🦴 Upper Extremity X-rays

Shoulder

• AP: True AP — glenohumeral joint space open; greater tuberosity in profile (external rotation)
• Axillary / Lateral: Glenoid profile; coracoid and acromion visible

Humerus

• AP + Lateral: Entire humerus including both joints; oriented diagonally if too long for receptor

Elbow

• AP + Lateral + Obliques:
  • AP: Arm fully extended, CR at joint space; radial head/capitellum visible
  • Lateral: 90° flexion; trochlea and olecranon fossa visible; anterior fat pad sign evaluable

Forearm

• AP + Lateral: Entire radius + ulna including wrist and elbow joints on both views

Wrist

• PA, Lateral, PA Oblique, ± Navicular/Scaphoid view (coned)
• PA: Carpal bones distinct; radiocarpal joint open
• Navicular view: Ulnar deviation to open scaphoid

Hand

• PA, Oblique (45°), Lateral
• PA Hands: Distal part uppermost on image
• Oblique: Fingers slightly spread; metacarpals separated

Thumb

• PA Hand + Lateral + AP Thumb

---

13. 🦴 Lower Extremity X-rays

Femur

• AP + Lateral: Both hip and knee joints included; oriented diagonally if needed

Knee

• AP + Lateral + Obliques (± Tunnel/Merchant views)
• AP Standing: Patella midline; joint space open; distal femur and proximal tibia symmetric
• Lateral: 90° flexion or 20–30°; patella in lateral projection

Tibia/Fibula

• AP + Lateral: Entire tibia and fibula with both joints

Ankle

• AP Standing, Mortise (15–20° internal rotation), Lateral Standing
• Mortise view: Tibiofibular clear space and ankle mortise open equally on all three sides
• Lateral: Fibula posterior to tibia; tibiotalar joint open

Foot

• AP, Oblique, Lateral
• AP: Tarsals, metatarsals to toes; slight 10° cephalad angulation to open tarsometatarsal joints

Calcaneus (Os Calcis)

• Axial (plantodorsal) + Lateral
• Axial: Subtalar joint and calcaneal body visible

Toes

• AP Foot + Oblique + Lateral of affected toes

---

Quick Reference Summary Table

---