An extra-oral imaging apparatus is intended to obtain a cephalmetric image of a portion of a head of a patient. Exemplary apparatus embodiments of cephalometric functionality of such extra-oral imaging apparatus can include a cephalometric sup port mounted to a base of the imaging system that is configured to position a cephalometric sensor about a cephalometric imaging area so that x-rays impinge the cephalometric sensor after radiating the cephalometric imaging area. A cephalometric patient positioning unit mounted to the cephalometric support can be positioned between an x-ray source of the x-rays and the cephalometric sensor. A cephalometric alignment sight can be mounted to patient positioning unit to provide a visual indication of alignment between the x-ray source and the mounted alignment sight/cephaolmetric sensors. Exemplary methods are provided that can use such exemplary cephalometric alignment sights and/or install cephalometric functionality to imaging systems using the same.