,
,
, MERRILL’S ATLAS OF
RADIOGRAPHIC
POSITIONING
& PROCEDURES
,This page intentionally left blank
,THIRTEENTH EDITION VOLUME TWO
MERRILL’S ATLAS OF
RADIOGRAPHIC
POSITIONING
& PROCEDURES
Bruce W. Long, MS, RT(R)(CV), FASRT, FAEIRS
Director and Associate Professor
Radiologic Imaging and Sciences Programs
Indiana University School of Medicine
Indianapolis, Indiana
Jeannean Hall Rollins, MRC, BSRT(R)(CV)
Associate Professor
Medical Imaging and Radiation Sciences Department
Arkansas State University
Jonesboro, Arkansas
Barbara J. Smith, MS, RT(R)(QM), FASRT, FAEIRS
Instructor, Radiologic Technology
Medical Imaging Department
Portland Community College
Portland, Oregon
,3251 Riverport Lane
St. Louis, Missouri 63043
MERRILL’S ATLAS OF RADIOGRAPHIC POSITIONING ISBN: 978-0-323-26342-9 (vol 1)
& PROCEDURES, THIRTEENTH EDITION ISBN: 978-0-323-26343-6 (vol 2)
ISBN: 978-0-323-26344-3 (vol 3)
ISBN: 978-0-323-26341-2 (set)
Copyright © 2016, 2012, 2007, 2003, 1999, 1995, 1991, 1986, 1982, 1975, 1967, 1959, 1949 by Mosby,
Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies, and our arrangements with organizations such as the
Copyright Center and the Copyright Licensing Agency, can be found on our website: www.elsevier.com/
permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment may
become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods, they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge
of their patients, to make diagnoses, to determine dosages and the best treatment for each individual
patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume
any liability for any injury and/or damage to persons or property as a matter of product liability,
negligence, or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
The Publisher
Previous editions copyrighted 2012, 2007, 2003, 1999, 1995, 1991, 1986, 1982, 1975, 1967, 1959, 1949
International Standard Book Numbers:
978-0-323-26342-9 (vol 1)
978-0-323-26343-6 (vol 2)
978-0-323-26344-3 (vol 3)
978-0-323-26341-2 (set)
Executive Content Strategist: Sonya Seigafuse
Content Development Manager: Billie Sharp
Content Development Specialist: Betsy McCormac
Publishing Services Manager: Julie Eddy
Senior Project Manager: Richard Barber
Designer: Margaret Reid
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
, PREVIOUS AUTHORS
Vinita Merrill Philip W. Ballinger, PhD, RT(R), Eugene D. Frank, MA, RT(R), FASRT,
1905-1977 FASRT, FAEIRS, became the author of FAEIRS, began working with Phil
Vinita Merrill was born in Oklahoma in Merrill’s Atlas in its fifth edition, which Ballinger on the eighth edition of Merrill’s
1905 and died in New York City in 1977. published in 1982. He served as author Atlas in 1995. He became the coauthor in
Vinita began compilation of Merrill’s in through the tenth edition, helping to launch its ninth and 50th-anniversary edition,
1936, while she worked as Technical successful careers for thousands of stu- published in 1999. He served as lead
Director and Chief Technologist in the dents who have learned radiographic po- author for the eleventh and twelfth edi-
Department of Radiology, and Instructor sitioning from Merrill’s. Phil currently tions and mentored three coauthors. Gene
in the School of Radiography at the New serves as Professor Emeritus in the Radio- retired from the Mayo Clinic/Foundation
York Hospital. In 1949, while employed logic Sciences and Therapy, Division of in Rochester, Minnesota, in 2001, after 31
as Director of the Educational Department the School of Health and Rehabilitation years of employment. He was Associate
of Picker X-ray Corporation, she wrote Sciences, at The Ohio State University. In Professor of Radiology in the College of
the first edition of the Atlas of Roentgeno- 1995, he retired after a 25-year career as Medicine and Director of the Radiography
graphic Positions. She completed three Radiography Program Director and, after Program. He also served as Director of
more editions from 1959 to 1975. Sixty- ably guiding Merrill’s Atlas through six the Radiography Program at Riverland
six years later, Vinita’s work lives on in editions, he retired as Merrill’s author. Community College, Austin, Minnesota,
the thirteenth edition of Merrill’s Atlas of Phil continues to be involved in profes- for 6 years before fully retiring in 2007.
Radiographic Positioning & Procedures. sional activities, such as speaking engage- He is a Fellow of the ASRT and AEIRS.
ments at state, national, and international In addition to Merrill’s, he is the coauthor
meetings. of two radiography textbooks, Quality
Control in Diagnostic Imaging and Radi-
ography Essentials for Limited Practice.
He now works in hospice through Chris-
tian Hospice Care and helps design and
equip x-ray departments in underdevel-
oped countries.
, THE MERRILL’S TEAM
Bruce W. Long, MS, RT(R)(CV), FASRT, Barbara J. Smith, MS, RT(R)(QM),
FAEIRS, is Director and Associate Profes- FASRT, FAEIRS, is an instructor in the
sor of the Indiana University Radiologic Radiologic Technology program at Port-
and Imaging Sciences Programs, where he land Community College, where she has
has taught for 29 years. A Life Member of taught for 30 years. The Oregon Society of
the Indiana Society of Radiologic Tech- Radiologic Technologists inducted her as a
nologists, he frequently presents at state Life Member in 2003. She presents at state,
and national professional meetings. His regional, national, and international meet-
publication activities include 28 articles in ings, is a trustee with the ARRT, and is
national professional journals and two involved in professional activities at these
books, Orthopaedic Radiography and Radiography Essentials levels. Her publication activities include articles, book reviews,
for Limited Practice, in addition to being coauthor of the Atlas. and chapter contributions. As coauthor, her primary role on the
The thirteenth edition is Bruce’s third on the Merrill’s team and Merrill’s team is working with the contributing authors and
first as lead author. editing Volume 3. The thirteenth edition is Barb’s third on the
Merrill’s team.
Jeannean Hall Rollins, MRC, BSRT(R) Tammy Curtis, PhD, RT(R)(CT)(CHES),
(CV), is an Associate Professor in the is an associate professor at Northwestern
Medical Imaging and Radiation Sciences State University, where she has taught for
department at Arkansas State University, 14 years. She presents on state, regional,
where she has taught for 22 years. She is and national levels and is involved in pro-
involved in the imaging profession at local, fessional activities on state level. Her pub-
state, and national levels. Her publication lication activities include articles, book
activities include articles, book reviews, reviews, and book contributions. Previ-
and chapter contributions. Jeannean’s first ously, Tammy served on the advisory board
contribution to Merrill’s Atlas was on the and contributed the updated photo for
tenth edition as coauthor of the trauma radiography chapter. The Vinita Merrill, as well as other projects submitted to the Atlas.
thirteenth edition is Jeannean’s third on the Merrill’s team and Her primary role on the Merrill’s team is writing the workbook.
first as a coauthor. Her previous role was writing the workbook, The thirteenth edition is Tammy’s first on the Merrill’s team.
Mosby’s Radiography Online, and the Instructor Resources that
accompany Merrill’s Atlas.
vi
, ADVISORY BOARD
This edition of Merrill’s Atlas benefits from the expertise of a special advisory board. The following board members have provided
professional input and advice and have helped the authors make decisions about Atlas content throughout the preparation of the
thirteenth edition:
Andrea J. Cornuelle, MS, RT(R) Joe A. Garza, MS, RT(R)
Professor, Radiologic Technology Associate Professor, Radiography Program
Director, Health Science Program Lone Star College—Montgomery
Northern Kentucky University Conroe, Texas
Highland Heights, Kentucky
Patricia J. (Finocchiaro) Duffy, MPS, Parsha Y. Hobson, MPA, RT(R)
RT(R)(CT) Associate Professor, Radiography
Clinical Education Coordinator/Assistant Passaic County Community College
Professor Paterson, New Jersey
Medical Imaging Sciences Department
College of Health Professions
SUNY Upstate Medical University
Syracuse, New York
Lynn M. Foss, RT(R), ACR, DipEd, BHS Robin J. Jones, MS, RT(R)
Instructor, Saint John School of Radiological Associate Professor and Clinical Coordinator
Technology Radiologic Sciences Program
Horizon Health Network Indiana University Northwest
Saint John, New Brunswick, Canada Gary, Indiana
,
, MERRILL’S ATLAS OF
RADIOGRAPHIC
POSITIONING
& PROCEDURES
,This page intentionally left blank
,THIRTEENTH EDITION VOLUME TWO
MERRILL’S ATLAS OF
RADIOGRAPHIC
POSITIONING
& PROCEDURES
Bruce W. Long, MS, RT(R)(CV), FASRT, FAEIRS
Director and Associate Professor
Radiologic Imaging and Sciences Programs
Indiana University School of Medicine
Indianapolis, Indiana
Jeannean Hall Rollins, MRC, BSRT(R)(CV)
Associate Professor
Medical Imaging and Radiation Sciences Department
Arkansas State University
Jonesboro, Arkansas
Barbara J. Smith, MS, RT(R)(QM), FASRT, FAEIRS
Instructor, Radiologic Technology
Medical Imaging Department
Portland Community College
Portland, Oregon
,3251 Riverport Lane
St. Louis, Missouri 63043
MERRILL’S ATLAS OF RADIOGRAPHIC POSITIONING ISBN: 978-0-323-26342-9 (vol 1)
& PROCEDURES, THIRTEENTH EDITION ISBN: 978-0-323-26343-6 (vol 2)
ISBN: 978-0-323-26344-3 (vol 3)
ISBN: 978-0-323-26341-2 (set)
Copyright © 2016, 2012, 2007, 2003, 1999, 1995, 1991, 1986, 1982, 1975, 1967, 1959, 1949 by Mosby,
Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies, and our arrangements with organizations such as the
Copyright Center and the Copyright Licensing Agency, can be found on our website: www.elsevier.com/
permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment may
become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods, they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge
of their patients, to make diagnoses, to determine dosages and the best treatment for each individual
patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume
any liability for any injury and/or damage to persons or property as a matter of product liability,
negligence, or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
The Publisher
Previous editions copyrighted 2012, 2007, 2003, 1999, 1995, 1991, 1986, 1982, 1975, 1967, 1959, 1949
International Standard Book Numbers:
978-0-323-26342-9 (vol 1)
978-0-323-26343-6 (vol 2)
978-0-323-26344-3 (vol 3)
978-0-323-26341-2 (set)
Executive Content Strategist: Sonya Seigafuse
Content Development Manager: Billie Sharp
Content Development Specialist: Betsy McCormac
Publishing Services Manager: Julie Eddy
Senior Project Manager: Richard Barber
Designer: Margaret Reid
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
, PREVIOUS AUTHORS
Vinita Merrill Philip W. Ballinger, PhD, RT(R), Eugene D. Frank, MA, RT(R), FASRT,
1905-1977 FASRT, FAEIRS, became the author of FAEIRS, began working with Phil
Vinita Merrill was born in Oklahoma in Merrill’s Atlas in its fifth edition, which Ballinger on the eighth edition of Merrill’s
1905 and died in New York City in 1977. published in 1982. He served as author Atlas in 1995. He became the coauthor in
Vinita began compilation of Merrill’s in through the tenth edition, helping to launch its ninth and 50th-anniversary edition,
1936, while she worked as Technical successful careers for thousands of stu- published in 1999. He served as lead
Director and Chief Technologist in the dents who have learned radiographic po- author for the eleventh and twelfth edi-
Department of Radiology, and Instructor sitioning from Merrill’s. Phil currently tions and mentored three coauthors. Gene
in the School of Radiography at the New serves as Professor Emeritus in the Radio- retired from the Mayo Clinic/Foundation
York Hospital. In 1949, while employed logic Sciences and Therapy, Division of in Rochester, Minnesota, in 2001, after 31
as Director of the Educational Department the School of Health and Rehabilitation years of employment. He was Associate
of Picker X-ray Corporation, she wrote Sciences, at The Ohio State University. In Professor of Radiology in the College of
the first edition of the Atlas of Roentgeno- 1995, he retired after a 25-year career as Medicine and Director of the Radiography
graphic Positions. She completed three Radiography Program Director and, after Program. He also served as Director of
more editions from 1959 to 1975. Sixty- ably guiding Merrill’s Atlas through six the Radiography Program at Riverland
six years later, Vinita’s work lives on in editions, he retired as Merrill’s author. Community College, Austin, Minnesota,
the thirteenth edition of Merrill’s Atlas of Phil continues to be involved in profes- for 6 years before fully retiring in 2007.
Radiographic Positioning & Procedures. sional activities, such as speaking engage- He is a Fellow of the ASRT and AEIRS.
ments at state, national, and international In addition to Merrill’s, he is the coauthor
meetings. of two radiography textbooks, Quality
Control in Diagnostic Imaging and Radi-
ography Essentials for Limited Practice.
He now works in hospice through Chris-
tian Hospice Care and helps design and
equip x-ray departments in underdevel-
oped countries.
, THE MERRILL’S TEAM
Bruce W. Long, MS, RT(R)(CV), FASRT, Barbara J. Smith, MS, RT(R)(QM),
FAEIRS, is Director and Associate Profes- FASRT, FAEIRS, is an instructor in the
sor of the Indiana University Radiologic Radiologic Technology program at Port-
and Imaging Sciences Programs, where he land Community College, where she has
has taught for 29 years. A Life Member of taught for 30 years. The Oregon Society of
the Indiana Society of Radiologic Tech- Radiologic Technologists inducted her as a
nologists, he frequently presents at state Life Member in 2003. She presents at state,
and national professional meetings. His regional, national, and international meet-
publication activities include 28 articles in ings, is a trustee with the ARRT, and is
national professional journals and two involved in professional activities at these
books, Orthopaedic Radiography and Radiography Essentials levels. Her publication activities include articles, book reviews,
for Limited Practice, in addition to being coauthor of the Atlas. and chapter contributions. As coauthor, her primary role on the
The thirteenth edition is Bruce’s third on the Merrill’s team and Merrill’s team is working with the contributing authors and
first as lead author. editing Volume 3. The thirteenth edition is Barb’s third on the
Merrill’s team.
Jeannean Hall Rollins, MRC, BSRT(R) Tammy Curtis, PhD, RT(R)(CT)(CHES),
(CV), is an Associate Professor in the is an associate professor at Northwestern
Medical Imaging and Radiation Sciences State University, where she has taught for
department at Arkansas State University, 14 years. She presents on state, regional,
where she has taught for 22 years. She is and national levels and is involved in pro-
involved in the imaging profession at local, fessional activities on state level. Her pub-
state, and national levels. Her publication lication activities include articles, book
activities include articles, book reviews, reviews, and book contributions. Previ-
and chapter contributions. Jeannean’s first ously, Tammy served on the advisory board
contribution to Merrill’s Atlas was on the and contributed the updated photo for
tenth edition as coauthor of the trauma radiography chapter. The Vinita Merrill, as well as other projects submitted to the Atlas.
thirteenth edition is Jeannean’s third on the Merrill’s team and Her primary role on the Merrill’s team is writing the workbook.
first as a coauthor. Her previous role was writing the workbook, The thirteenth edition is Tammy’s first on the Merrill’s team.
Mosby’s Radiography Online, and the Instructor Resources that
accompany Merrill’s Atlas.
vi
, ADVISORY BOARD
This edition of Merrill’s Atlas benefits from the expertise of a special advisory board. The following board members have provided
professional input and advice and have helped the authors make decisions about Atlas content throughout the preparation of the
thirteenth edition:
Andrea J. Cornuelle, MS, RT(R) Joe A. Garza, MS, RT(R)
Professor, Radiologic Technology Associate Professor, Radiography Program
Director, Health Science Program Lone Star College—Montgomery
Northern Kentucky University Conroe, Texas
Highland Heights, Kentucky
Patricia J. (Finocchiaro) Duffy, MPS, Parsha Y. Hobson, MPA, RT(R)
RT(R)(CT) Associate Professor, Radiography
Clinical Education Coordinator/Assistant Passaic County Community College
Professor Paterson, New Jersey
Medical Imaging Sciences Department
College of Health Professions
SUNY Upstate Medical University
Syracuse, New York
Lynn M. Foss, RT(R), ACR, DipEd, BHS Robin J. Jones, MS, RT(R)
Instructor, Saint John School of Radiological Associate Professor and Clinical Coordinator
Technology Radiologic Sciences Program
Horizon Health Network Indiana University Northwest
Saint John, New Brunswick, Canada Gary, Indiana
