Final answer:
The 37° AP axial of the skull will produce the greatest distortion due to the significant angle between the x-ray beam and the skull.
Step-by-step explanation:
The AP projection of the skull with a 37° axial tilt will produce the greatest distortion.
Distortion is created when the angle of the x-ray beam is not perpendicular to the object being imaged. In this case, the 37° axial tilt creates a significant angle between the x-ray beam and the skull. This will result in a distorted image of the skull.
On the other hand, the PA projection of the skull and the 20° AP axial of the skull have less distortion because the x-ray beam is more perpendicular to the skull in those projections.