This document provides positioning guidelines for radiographic imaging of the cervical spine, thoracic spine, lumbar spine, lumbo-sacral spine, and sacrum. It describes the standard views, patient preparation, positioning, tube and cassette centering, and exposure settings for each anatomical region. Proper patient positioning and radiographic technique are important to obtain diagnostic images while minimizing radiation dose.

1. V.Deepak Prasath, B.Sc RIT.
K.G.Hospital & Post Graduate Medical Institute,
Coimbatore.

2. POSITIONING TERMINOLOGY
• Radiographic positioning refers to the study of
patient positioning performed for radiographic
demonstration or visualization of specific body
parts on image receptors.
• Each person who plans to work as a radiologic
technologist must clearly understand the
correct use of positioning terminology.

3. Cervical Spine
Indications
• Trauma,Fracture,Dislocation,Bone disease,
cervical spondylities, Inflammation,
Degeneration, & Osteomylitis.
Views
Anteroposterior,
Lateral,
Oblique,
Open Mouth,
Trans-Lateral.

4. Cervical Spine-Open Mouth
Patient Preperation
• Ask the patient to remove the all metals
plastic retainer & earing also.
Position
• Make the patient to lie on the x-ray table or sit.
• Mid saggital plane should be center to the
center of the table.
• The patient should face towards the tube.
• The chin is extented.
• Ensure the mouth is wide open & there is no
rotation of head & neck.
• Radiation Production given to the patient.

5. Tube Centering
• Middle of the mouth open using vertical view.
Cassette centering
• The cassette is placed behind the neck.
• The upper border of the cassette two inch above the EAM.
Warning
• Do not attend any head or neck movement, if cervical trauma
is visible. Female patient care.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 60 60-80 NO 8"X10"

7. Cervical Spine-Anteroposterior
Patient Preperation
• Ask the patient to remove the all metals plastic retainer &
earing also.
Position
• Make the patient to lie on the x-ray table.
• Mid saggital plane should be center to the center of the
table.
• The patient should face towards the tube.
• The chin is raised, so that the mandible is superimposedon
the occipital.(The line from the tip of the mandible to the base
of the skull should be parallel to the center.)
• Ensure there is no rotation of the head.
• Radiation Production given to the patient.

8. Tube Centering
• Center to the mid line joint of the angle of mandible or at the
level of C3-C4.
• Tube angulation is 5° to 15° Cephalad.
Cassette centering
• The cassette is placed behind the neck.
• The upper border of the cassette one inch above the EAM.
Warning
• Do not attend any head or neck movement, if cervical trauma
is visible.Female patient care.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 60 48-60
5° to 15°
Cephalad
8"X10"

10. Cervical Spine-Lateral
Patient Preperation
• Ask the patient to remove the all metals plastic retainer &
earing also.
Position
• Make the patient to stand in front of the x-ray table in true
lateral position.
• Mid saggital plane should be parallel to the center of the
table.
• Depressed the shoulder as much as possible.Ask the patient
to lowered there shoulder as much as possible so as to avoid
overlapping.
• To pull out the patient shoulder more with help of weight
bearing(sand bag) on both hands.
• The chin is raised, so that angle of mandible dose not come in
way to upper c-spine.
• Ensure there is no rotation of the head.

11. Tube Centering
• Center to the angle of mandible or at the level C4 or at the
level of the upper border of thyroid cardilage.
Cassette centering
• The upper border of the cassette one inch above the EAM.
Warning
• Do not attend any head or neck movement, if cervical trauma
is visible.Female patient care.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
5 Feet Large No 55 24-32 No 8"X10"

15. Tube Centering
• Center to the angle of mandible or at the level C4 or at the
level of the upper border of thyroid cardilage.
Cassette centering
• The upper border of the cassette one inch above the EAM.
Warning
• Do not attend any head or neck movement, if cervical trauma
is visible.Female patient care.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
5 Feet Large No 55 24-32 No 8"X10"

17. Cervical Spine-RAO & LAO
Patient Preperation
• Ask the patient to remove the all metals plastic retainer &
earing also.
Position
• Make the patient to lie on prone position or PA standing
position on x-ray table.
• Mid saggital plane should be center to the center of the table.
• From this position the left side or right side of the body along
with head & neck is rotated 45° away from the table.
• Extend the chin to prevent mandible to super imposed to the
vertebra.
• Hands are kept in the side of the body.
• Foam pads are kept for immobilisation.
• Ensure there is no rotation of the head.
• Radiation Production given to the patient.

18. Tube Centering
• Center to the level of C4.
• Tube angulation of 15° caudal.
Cassette centering
• The upper border of the cassette one inch above the EAM.
Warning
• Do not attend any head or neck movement, if cervical trauma
is visible.Female patient care.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
5 Feet Large No 55 to 60 24-32 15° Caudal 8"X10"

20. Cervical Spine-RPO & LPO
Patient Preperation
• Ask the patient to remove the all metals plastic retainer &
earing also.
Position
• Make the patient to lie on supine position or AP standing
position on x-ray table.
• Mid saggital plane should be center to the center of the table.
• From this position the left side or right side of the body along
with head & neck is rotated 45° away from the table.
• Extend the chin to prevent mandible to super imposed to the
vertebra.
• Hands are kept in the side of the body.
• Foam pads are kept for immobilisation.
• Ensure there is no rotation of the head.
• Radiation Production given to the patient.

21. Tube Centering
• Center to the level of C4.
• Tube angulation of 15° caudal.
Cassette centering
• The upper border of the cassette one inch above the EAM.
Anatomical Structure
• Intervertebral foramen, pedicle.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
5 Feet Large No 55 to 60 24-32 15° Caudal 8"X10"

23. Cervical Spine-Trans-Lateral
Patient Preperation
• Ask the patient to remove the all metals plastic retainer & earing
also.
Position
• Make the patient to lie on the x-ray table in supine position.
• Hands are kept at side of the body.
• Ensure there is no rotation of the head & neck without much
pressure to the injury neck & foam pads are kept for immobilization.
• Radiation Production given to the patient.

24. Tube Centering
• Center to the horizontal beam to the cassette at level of C4.
Cassette centering
• Cassette is kept at side of the shoulder of one inch above
the pinna.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
5 Feet Large No 55 24-32 No 8"X10"

26. Swimmers View

27. Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
5 Feet Large No 55 24-32 No 8"X10"

28. Thoracic Spine
Indications
• Trauma,Fracture,Dislocation,Bone disease,
Inflammation, Degeneration, & Kyphosis,
skoliosis.
Views
Anteroposterior,
Lateral.

29. Thoracic Spine-Anteroposterior
Patient Preperation
• Ask the patient to remove the all metals plastic retainer.
Position
• Make the patient to lie on the x-ray table in supine position.
• Mid saggital plane should be center to the center of the table.
• The patient should face towards the tube.
• Knees are flexed, small pillows are kept between for comfort.
• Large cassette size is used.
• Radiation Production given to the patient.

30. Tube Centering
• Direct the central ray at right-angles to the cassette and
towards a point 2.5 cm below the sternal angle.
• Collimate tightly to the spine.
Cassette centering
• The upper border of the cassette is kept above spinoces
process of the 7th c-spine vertebra.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 65-70 80-120 0° 12"X15"

32. Thoracic Spine-Lateral
Patient Preperation
• Ask the patient to remove the all metals plastic retainer.
Position
• Make the patient to lie or stand in front of the x-ray table in
lateral position.
• Mid saggital plane should be parallel to the center of the
table.
• Arm should be raised well above the head.
• The head can be supported by pillow & pads may be placed
between the knee for the patients comfort.
• Radiation Production given to the patient.

33. Tube Centering
• The tube center at the level of 1" below the axila T7 & T8.
Cassette centering
• The upper border of the cassette is kept 3 to 4 cm above the
spinous process of the C7.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 65-70 100-120 0° 12"X15"

35. Lumbar Spine
Indications
• Trauma,Fracture,Dislocation,Bone disease,
Inflammation, Degeneration, & Kyphosis,
skoliosis.
Views
Anteroposterior,
Lateral,
Oblique.

37. Lumbar Spine-Anteroposterior
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on the x-ray table in supine position.
• Mid saggital plane should be center to the center of the table.
• The patient should face towards the tube.
• Both hands are kept by the side of the body.
• Knees are flexed, small pillows are kept between for comfort.
• Large cassette size is used.
• Radiation Production given to the patient.

38. Tube Centering
• Direct the central ray towards the midline at the level of the
lower costal margin (L3).
Cassette centering
• The lower border of the cassette 2 inch below the ASIS.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 65-75 100-120 0°
10"x12"
12"x15"

39. Lumbar Spine-Lateral
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on the x-ray table in lateral position.
• Mid saggital plane should be parallel to the center of the
table.
• Hands are fold & kept on the head & knees are flex & small
foam pads are kept to avoid movement.
• Small foam pad are kept under the lumbar spine to reduce the
lumbar arch & lumbar lordorsis.
• Radiation Production given to the patient.

40. Tube Centering
• Center to the level of lower costal margin at the level of L2 &
L3 level.
Cassette centering
• The lower border of the cassette 2 inch below the ASIS.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 70-75 120-160 0° 12"x15"

41. Lumbar Spine-RAO & LAO
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on prone positionon x-ray table.
• Mid saggital plane should be center to the center of the table.
• From this position the left side or right side of the body is
rotated 45° away from the table.
• One hand is kept over the head & another hand flexed in
comfortable position & legs are flexed .
• Foam pads are kept for immobilisation.
• Radiation Production given to the patient.

42. Tube Centering
• Center to the level of lower costal margin at the level of L2 &
L3 level.
Cassette centering
• The lower border of the cassette 2 inch below the ASIS.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 70-75 120-160 0° 17"x14"

43. Lumbar Spine-RPO & LPO
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on supine position on x-ray table.
• Mid saggital plane should be center to the center of the table.
• From this position the left side or right side of the body is
rotated 45° away from the table.
• One hand is kept over the head & another hand flexed in
comfortable position & legs are flexed .
• Foam pads are kept for immobilisation.
• Ensure there is no rotation of the head.
• Radiation Production given to the patient.

44. Tube Centering
• Center to the level of lower costal margin at the level of L2 &
L3 level.
Cassette centering
• The lower border of the cassette 2 inch below the ASIS.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 70-75 120-160 0° 17"x14"

46. Lumbo Sacral Spine-Anteroposterior
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on the x-ray table in supine position.
• Mid saggital plane should be center to the center of the table.
• The patient should face towards the tube.
• Both hands are kept by the side of the body.
• Knees are flexed, small pillows are kept between for comfort.
• Large cassette size is used.
• Radiation Production given to the patient.

47. Tube Centering
• central ray directed to the at the level of L5.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 70-75 100-120 0°
10"x12"
12"x15"

48. Lumbo Sacral Spine-Lateral
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on the x-ray table in lateral position.
• Mid saggital plane should be parallel to the center of the
table.
• Radiation Production given to the patient.

49. Tube Centering
• Central ray directed to the at the level of L5.
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 75-85 120-160 0° 12"x15"

50. Sacrum-Anteroposterior
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on the x-ray table in supine position.
• Mid saggital plane should be center to the center of the table.
• The patient should face towards the tube.
• Both hands are kept by the side of the body.
• Knees are flexed, small pillows are kept between for comfort.
• Radiation Production given to the patient.

51. Tube Centering
• Centered to the mid line 2 inch below the ASIS with the tube
angulation of 10° to 15° cephalad for male & 20° to 25° for
Female.
Cassette centering
Upper border of the cassette placed at the level of illiac creast
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 70-75 80-100
10° to 15°
for male
20° to 25°
for Female
cephalad
10"x12"

52. Sacrum-Lateral
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on the x-ray table in lateral position.
• Mid saggital plane should be parallel to the center of the
table.
• Knees are flexed, small pillows are kept between for comfort.
• Radiation Production given to the patient.

53. Tube Centering
• Centered to the mid line 2 inch below the ASIS with the tube
angulation of 10° to 15° cephalad for male & 20° to 25° for
Female.
Cassette centering
Upper border of the cassette placed at the level of illiac creast
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 75-85 120-160
0°
10"x12"

54. Coccyx-Anteroposterior
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on the x-ray table in supine position.
• Mid saggital plane should be center to the center of the table.
• The patient should face towards the tube.
• Both hands are kept by the side of the body.
• Knees are flexed, small pillows are kept between for comfort.
• Radiation Production given to the patient.

55. Tube Centering
• Centered to the mid line 2 inch below the ASIS with the tube
angulation of 10° to 15° cephalad for male & 20° to 25° for
Female.
Cassette centering
Upper border of the cassette placed at the level of illiac creast
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 70-75 80-100
10° to 15°
for male
20° to 25°
for Female
cephalad
10"x12"

56. Coccyx-Lateral
Patient Preperation
• Ask the patient to remove the all metals.
Position
• Make the patient to lie on the x-ray table in lateral position.
• Mid saggital plane should be parallel to the center of the
table.
• Knees are flexed, small pillows are kept between for comfort.
• Radiation Production given to the patient.

57. Tube Centering
• Centered to the mid line 2 inch below the ASIS with the tube
angulation of 10° to 15° cephalad for male & 20° to 25° for
Female.
Cassette centering
Upper border of the cassette placed at the level of illiac creast
Exposure Settings
Distance Focal Spot Grid kV mAs
Tube
Angulation
Cassette
Size
100 cm Large Yes 75-85 120-160
0°
10"x12"