Upper Extremity Radiography: Positioning, Anatomy, and Procedures

What are the two long bones that make up the forearm?

Ulna and Radius

Which bone is located on the medial side of the forearm?

Ulna

Which bone is located on the lateral side of the forearm?

Radius

What is the proximal and posterior feature of the ulna?

Olecranon process

What is the distal feature of the ulna?

Styloid process

What are the three joints that comprise the elbow joint proper?

Proximal radioulnar joint, Humeroulnar joint, Humeroradial joint

What is the primary function of the humerus?

It is a long bone in the upper arm that articulates with the scapula to form the shoulder joint.

What is the significance of the surgical neck of the humerus?

It is the site of frequent fractures requiring surgery.

What is the recommended SID (Source to Image Distance) for upper extremity procedures?

40 inches (102 cm)

What should be removed from the anatomy of interest before upper extremity imaging?

Radiopaque artifacts such as watches, rings, bracelets, and bras (for humerus procedures)

What is the general patient position for ambulatory patients during forearm and elbow procedures?

Seated at the end of the x-ray table with the upper limb in the same plane as the shoulder.

What is the importance of using right or left side markers on the IR?

To ensure accurate identification of the side being imaged.

What radiation protection measures should be taken during upper extremity procedures?

Close collimation, optimum technique factors, and use of gonadal shields as per regulations.

What should be explained to the patient before performing upper extremity imaging?

The positions to be performed and the need to hold the position until further instructions.

What is the recommended action for patients during humerus examinations?

Suspend respirations during the exposure.

What anatomical landmark is the proximal feature of the radius?

Radial head

What is the function of the coronoid process in the ulna?

It is a proximal and anterior feature that helps in the articulation of the elbow.

What is the role of the capitulum in the humerus?

It is part of the distal end that articulates with the radius.

What is the olecranon fossa?

A posterior feature of the humerus that accommodates the olecranon process of the ulna.

How does patient size, age, and condition affect imaging procedures?

They require positioning adaptations to maintain diagnostic quality and promote patient safety.

What is the relationship between patient anatomy, positioning, and technical factors?

They influence image quality in diagnostic imaging.

What should be avoided when marking images digitally?

Adding digital annotations after the image has been taken, as it can lead to errors.

What is the purpose of ID markers in radiography?

To indicate the side of the body being imaged and avoid confusion.

What are the routine projections for the forearm?

AP and Lateral

What is the patient position for an AP forearm projection?

Seat the patient close to the radiographic table with the entire arm in contact with the table/IR.

What is the part position for an AP forearm projection?

Elbow extended with hand supinated, humeral epicondyles equidistant from IR, and long axis of forearm aligned parallel.

Where does the central ray enter for an AP forearm projection?

Perpendicular to IR, entering at the midpoint of the forearm.

What is the collimation for an AP forearm projection?

5 cm (2 inches) distal to the wrist joint and proximal to the elbow joint, and 2.5 cm (1 inch) on the sides.

What structures are shown in an AP forearm projection?

Entire forearm, including wrist and distal humerus, slight superimposition of the radial head, neck, and tuberosity over the proximal ulna.

What is the patient position for a lateral forearm projection?

Seat the patient close to the table with the entire upper extremity in the same plane and forearm resting on the ulnar surface.

What is the part position for a lateral forearm projection?

Elbow flexed 90 degrees, thumb side up, with ulnar and radial styloid processes superimposed.

Where does the central ray enter for a lateral forearm projection?

Directed perpendicular to the IR, entering at the midpoint of the forearm.

What structures are shown in a lateral forearm projection?

Entire forearm in true lateral position, superimposition of the radius and ulna at their distal end, and radial head over coronoid process.

What are the routine projections for the elbow?

AP, Lateral, AP Oblique (Medial and Lateral rotation), Partial flexion, and Axiolateral (Coyle method).

What is the patient position for an AP elbow projection?

Seat the patient near the table, ensuring the shoulder joint, humerus, and elbow joint are in the same plane.

What is the part position for an AP elbow projection?

Upper extremity in the same plane with posterior surface in contact with IR, elbow extended and hand supinated.

Where does the central ray enter for an AP elbow projection?

Perpendicular to the elbow joint.

What is the collimation for an AP elbow projection?

8 cm (3 inches) proximal and distal to the elbow joint, and 2.5 cm (1 inch) on the sides.

What structures are shown in an AP elbow projection?

Radial head, neck, and tuberosity slightly superimposed over the proximal ulna, with the elbow joint open and centered.

What is the part position for a lateral elbow projection?

Extremity in the same plane with long axis parallel to IR, elbow flexed 90 degrees.

Where does the central ray enter for a lateral elbow projection?

Perpendicular to the elbow joint.

What structures are shown in a lateral elbow projection?

Elbow joint open and centered, superimposed humeral epicondyles, radial tuberosity facing anteriorly.

What is the part position for an AP oblique elbow projection in medial rotation?

Extremity in the same plane with elbow extended, medially rotate the upper extremity.

What is the required rotation for the humeral epicondyles in an AP oblique elbow projection?

45 degrees from true anatomic position.

What is the central ray (CR) position for the AP Oblique Elbow Medial Rotation?

Perpendicular to the elbow joint.

What is the collimation size for the AP Oblique Elbow projections?

8 cm (3 inches) proximal and distal to the elbow joint and 2.5 cm (1 inch) on the sides.

What structures are shown in the AP Oblique Elbow Medial Rotation?

Elbow joint open and centered, coronoid process in profile, elongated medial humeral epicondyle, ulna superimposed by the radial head and neck, trochlea, olecranon process within the olecranon fossa.

What is the required hand position for the AP Oblique Elbow Lateral Rotation?

Rotate the hand laterally (externally) to place the posterior surface of the elbow at a 45-degree angle.

What structures are evaluated in the AP Oblique Elbow Lateral Rotation?

Elbow joint open and centered, radial head, neck, and tuberosity projected free of the ulna, elongated lateral humeral epicondyle, capitulum.

What is the purpose of the AP Elbow Distal Humerus Partial Flexion Position?

Used when the patient cannot completely extend the elbow joint, commonly for suspected trauma.

What is the central ray (CR) direction for the AP Elbow Distal Humerus Partial Flexion?

Perpendicular to the humerus, passing through the elbow joint.

What structures are shown in the AP Elbow Distal Humerus Partial Flexion?

Distal humerus without rotation or distortion, proximal radius superimposed over the ulna, closed elbow joint.

What is the patient position for the AP Elbow Proximal Forearm Partial Flexion?

Patient seated high enough to permit the dorsal surface of the forearm to rest on the table.

What is the central ray (CR) position for the AP Elbow Proximal Forearm Partial Flexion?

Perpendicular to the elbow joint and long axis of the forearm.

What structures are evaluated in the AP Elbow Proximal Forearm Partial Flexion?

Proximal radius and ulna without rotation or distortion, partially open elbow joint.

What is the purpose of the Axiolateral (Coyle) projection?

Useful in trauma to demonstrate radial head and coronoid process when the elbow cannot be fully extended.

What is the central ray (CR) angle for the Axiolateral (Coyle) projection for the radial head?

Angled 45 degrees toward the shoulder entering the joint at mid-elbow.

What is the central ray (CR) angle for the Axiolateral (Coyle) projection for the coronoid process?

Angled 45 degrees away from the shoulder entering the joint at mid-elbow.

What structures are shown in the Axiolateral (Coyle) projection for the radial head?

Open joint space between radial head and capitulum, radial head, neck, and tuberosity in profile.

What structures are shown in the Axiolateral (Coyle) projection for the coronoid process?

Open joint space between coronoid process and trochlea, coronoid process in profile and elongated.

What are the routine projections for the humerus?

AP, Lateral, Lateral for known or suspected fracture.

What is the patient position for the AP Humerus projection?

Standing, seated, or supine.

What is the central ray (CR) position for the AP Humerus?

Perpendicular to midportion of humerus and centered to IR.

What structures are evaluated in the AP Humerus?

Elbow and shoulder joints, humeral epicondyles without rotation, humeral head and greater tubercle in profile.

What is the part position for the Lateral Humerus non-trauma projection?

Internally rotate humerus, flex elbow 90 degrees, and rest palm of hand on hip.

What is the central ray (CR) position for the Lateral Humerus?

Perpendicular to midportion of humerus and centered to IR.

What structures are evaluated in the Lateral Humerus?

Elbow and shoulder joints visible, superimposed humeral epicondyles, lesser tubercle in profile.