Forearm, Elbow, Humerus Positioning

AP forearm

position

projection

CR

position: hand supinated (digits top of image), elbow and arm extended, shoulder down on same plane (armpit on table), epicondyles parallel to IR

projection AP

CR: mid shaft

AP forearm

collimation
kV

radiographic criteria

65-75 kV

collimate to include forearm, both wrist and elbow joints

radiographic criteria (4):

-epicondyles parallel to IR

-radial head slightly superimposed on ulna

-both joints seen

-shafts not superimposed

lateral forearm

position

projection

CR

position: LATERAL, hand and wrist in lateral position, digits top of image, elbow flexed 90 degrees, shoulder down

projection: lateromedial

CR: mid shaft

lateral forearm

collimation

kV

radiographic criteria (4)

65-75 kV

collimate to forearm, include both wrist and elbow joints

criteria:

- epicondyles perpendicular to IR, superimposed

-radial head and coronoid process superimposed

-elbow flexed 90 degrees

distal radius and ulna superimposed

AP elbow

position

projection

CR

position: hand supinated, digits bottom of image, arm and elbow extended, shoulder down, epicondyles parallel to IR

projection: AP

CR: mid elbow joint, 3/4" distal to epicondyles

AP elbow

collimation

kV

radiographic criteria (2)

collimate to include proximal radius and ulna, and distal humerus

65-75 kV

criteria:

epicondyles in profile, parallel to IR

radial head, neck , and tuberosity slightly superimposed with ulna

AP elbow - trauma 2V partial flexion

position

projection

CR

position: hand supinated, digits bottom of image, arm in partial flexion

projection: AP

first view: arm in partial flexion, xr of proximal forearm parallel to iR

second view: arm in partial flexion, xr of distal humerus parallel to IR

CR: mid elbow joint, 3/4 inches distal to epicondyles

AP elbow - trauma 2V partial flexion

collimation

kV

radiographic criteria

collimate to include proximal radius and ulna, and distal humerus

65-75 kV

criteria (2):

-epicondyles in profile, parallel to IR

-proximal radius partially superimposed with ulna

trauma - 2 view AP elbow jone's method for acute flexion

position

projection

CR

position: shoulder down, arm in acute flexion

projection: AP

CR 1st view (distal humerus) = perpendicular to humerus between the epicondyles

CR 2nd view (proximal forearm) = perpendicular to forearm, 2" above olecranon process

internal oblique elbow

position

projection

CR

position: internal oblique elbow, hand pronated, digits at bottom of image, arm and elbow extended, shoulder down, epicondyles at 45 degrees to IR

projection: AP

CR: mid elbow joint

internal oblique elbow

kV

criteria

65-75 kV

criteria (4)

coronoid process in profile

medial epicondyle and trochlea elongated

olecranon process seated in olecranon fossa of the humerus

trochlear notch partially open

*radial head, neck, and tuberosity superimposed with ulna (crossing of radius and ulna indicates the position)

external oblique elbow

position

projection

cr

position: external oblique; hand supinated with pinky up, arm and elbow extended and rotated externally, shoulder down, epicondyles 45 degrees to IR

projection: AP

CR: mid elbow joint

external oblique elbow

kV

criteria (3)

65-75 kV

epicondyles 45 degrees to IR

radial head, neck, and tuberosity free of superimposition from ulna

Lateral epicondyle and capitulum elongated

what anatomy is best demonstrated in a lateral elbow xr?

olecranon process

what anatomy indicates a true lateral position?

superimposition of the 3 concentric arcs

trochlear notch

trochlear sulcus

outer ridges of the capitulum and trochlea

ap humerus

bucky grid or tabletop

position

projection

cr

bucky/grid bc >10cm

position: palm up, digits bottom of image, arm extended, epicondyles parallel to IR, can be upright or dorsal recumbent

projection: AP

CR: mid humerus

SUSPEND RESPIRATION + GOWN

ap humerus

kV

collimation

criteria (3)

70-85kV

collimate to include both shoulder and elbow joints

criteria (3)

epicondyles in profile (parallel with IR)

greater tubercle in profile

humerus and glenoid fossa overlap (superimposed)

lateral humerus - lateromedial

position

projection

cr

position - lateral, can be upright or recumbent, arm internally rotated, digits bottom of image, epicondyles perpendicular to IR

projection- lateromedial

cr mid humerus

SUSPEND RESPIRATION + GOWN

lateral humerus lateromedial

kV

collimation

radiographic criteria (2)

70-85kV

collimate to include both shoulder and elbow joints

criteria (2)

epicondules superimposed (perpendicular to IR)

lesser tubercle projected medially

lateral humerus - mediolateral

position

projection

cr

position: lateral, upright preferred, patient faces IR and is rotated 20-30 degrees, elbow flexed 90 degrees, epicondyles perpendicular to IR

projection mediolateral

cr mid humerus

SUSPEND RESPIRATION + GOWN

lateral humerus mediolateral

collimation

kV

radiographic criteria (2)

70-85kV

collimate to include both shoulder and elbow joints

criteria (2)

epicondyles superimposed (perpendicular to IR)

lesser tubercle projected medially

trauma - horizontal beam lateral humerus

position

projection

cr

demonstrates distal 2/3 of humerus

position: lateral, dorsal recumbent, elbow flexed 90 degrees, IR btwn thorax and arm (as high up the armpit as you can get), horizontal beam, bolster under arm to not clip anatomy

projection: lateromedial

cr: midpoint of distal 2/3 of humerus

SUSPEND RESPIRATION + GOWN

trauma horozintal beam lateral humerus

kV

criteria

70-85 kV

lateral 2/3 of distal humerus and elbow joint included

trauma transthoracic lateral humerus

position

projection

cr

position lateral upright, affected arm on IR, lower shoulder of affected arm, unaffected arm is raised and shoulder elevated

projection transthoracic lateral

cr mid humerus

exposure 4-5 seconds, short shallow breaths

trauma transthoracic

kV

criteria (4)

75-90kV

lateral view of entire humerus visualized thru the thorax

no superimposition of opposite humerus

glenohumeral joint demonstrated

rib and lung markings blurred

hand pronated: radius and ulna?

radius and ulna shafts crossed

hand supinated: radius and ulna?

shafts free from superimposition

lateral elbow

position

projection

cr

position: lateral; arm and elbow in lateral position with thumb up, elbow flexed 90 degrees, epicondyles perpendicular to IR, shoulder down

projection: lateromedial

cr mid elbow joint 3/4" distal to epicondyles

lateral elbow

kV

collimation

criteria (4)

collimate to include distal humerus and proximal radius and ulna

65-75kV

half of radial head superimposed by coronoid process

olecranon process in profile

concentric arcs superimposed (trochlear notch, trochlear sulcus, outer ridges of the capitulum and trochlea)

epicondyles perpendicular to IR (superimposed)