Radiology Positioning Notes

PA Hand

CR at third MCP joint

PA Oblique Hand

CR at third MCP joint, must see trapezium

Lateral (Fan) Hand

CR at second MCP joint, 3 concentric arcs

Wrist Routine

PA, Oblique, Lateral

PA Wrist

CR at midcarpal area, proximal 1/2 of metacarpal to 1/3 of forearm

PA Oblique Wrist

CR at midcarpal area, proximal 1/2 of metacarpal to 1/3 of forearm, must see trapezium

Lateral Wrist

CR at midcarpal area, proximal 1/2 of metacarpal to 1/3 of forearm

Hand and Wrist Exam Non-Routine

May have to take 2 images, try to get area of interest as flat as possible

Forearm Routine

AP, Lateral

AP Forearm

CR at midforearm, metacarpals to 1-2 in of humerus, epicondyles should be parallel

Lateral Forearm

CR at midforearm, metacarpals to light on the back of elbow, elbow flexed 90 degrees and wrist turned lateral

Forearm Non-Routine

Can be done PA if patient is unable to do AP, need joint to joint

Routine Elbow

AP, Medial/Internal Oblique, Lateral/External Oblique, Lateral

AP Elbow

CR at mid elbow, everything on same plane

Internal/Medial Oblique Elbow

CR at mid elbow, everything on same plane and epicondyles 45 degrees, best viewed coronoid process of ulna

External/Lateral Oblique Elbow

CR at mid elbow, everything on same plane and epicondyles 45 degrees, best viewed head neck and tuberosity of radius

Lateral Elbow

CR at crease of elbow, flex 90 degrees, everything on same plane, lateral wrist

Non-Routine Elbow

Two partially flexed AP projections, patient unable to extend arm, CR stays the same

Humerus Routine

AP, Lateral

Humerus Technique

75 kVp, 10 mAs, 10 x 17 field size, 40 SID, hand in anatomic position for AP, posterior hand at side for lateral, CR at mid humerus, hold breathing, 1in of light above shoulder and 1 in below epicondyles

AP Proximal Humerus External Rotation

Epicondyles are parallel, greater tubercle lateral in profile, lesser tubercle anterior, both shoulder and elbow joint

Lateral Proximal Humerus

Epicondyles perpendicular to IR, greater tubercle anterior, lesser tubercle medial in profile, CR mid humerus

Humerus Non-Routine

Joint to joint, can do laying down, neutral view, shield and collimate

Transthoracic Lateral Humerus

IR on affected side, opposite arm out of the way, orthostatic breathing with long exposure time, tech factors 75 @ 50 or 75 for 3 or 4 seconds

Transthoracic Lateral Humerus Demonstrates

Fracture and anterior or posterior displacement, entire humerus without rotation

Routine Shoulder

AP, Lateral

AP and Lateral Shoulder Technical Factors

80 kVp, 15 mAs, 10 x 12 field size, 40 SID, anatomic position for AP, back on hand at side for Lat, CR 1in below corocoid, hold breath, 2 in of light above and skimming light on side

AP Shoulder Best Viewed

Greater tubercle profiled laterally

Lateral AP Best Viewed

Lesser tubercle profiled medially

Non-Routine Shoulder

Transthoracic Lateral, Scap Y

Lateral Scap Y

25-30 degree oblique, humeral head should be in glenoid cavity

On a Properly Positioned AP Forearm, What Should be in Profile?

Humeral epicondyles in profile

What Will be Superimposed on Lateral Elbow?

Epicondyles superimposed

What is the Correct CR for a Routine PA Hand?

Third MCP joint

Non-Routine (Trauma) Positioning for Humerus on Cart

AP Neutral Humerus and a Transthoracic Lateral

What Needs to be Corrected for a Repeat Exposure of PA Oblique Hand?

Decrease the obliquity of the hand

What Anatomy Needs to be Parallel to the IR for a Correctly Positioned AP Elbow?

Epicondyles need to be parallel

What Should be Parallel to the Interepicondylar Plane for a Lateral Elbow?

CR

Non-Routine Positioning for Supine Scapular Y

25-35 degrees (APO Anterior-Posterior Oblique)

What Anatomy Should be Superimposed over the Radius on a Correctly Positioned Lateral Elbow?

Head of the ulna

Correct CR for an AP Shoulder

CR is 1 in below the coracoid