Procedure radiograph orientation devices and methods of use are provided for stabilization and orientation of a patient's anatomy for a variety of surgical interventions. Additionally, devices of the present invention aid in orienting radiographic imaging devices through the inclusion of radiopaque fiducials so as to optimize radiographic images by providing radiographic reference landmarks.An example of the present invention includes a rostral base plate, a plurality of support slats, and a caudal base plate, these components being adapted to pivot about one another or in certain embodiments, adapted to pivot about a series of spacers. One or more tension wires extend through the slats and base plates, joining the elements. The devices may be secured in various configurations by increasing the tension of the tension cable(s). Visual sighting or aiming devices may also be included in certain embodiments. Certain embodiments may include a rigid base plate having radiopaque fiducials.