Unit 1 Procedures - Special Projection of Elbow, Routine Humerus, and AC Joints

Coyle Method Radial Head

Flex elbow 90 degrees Pronate hand Angle tube 45 degrees towards the elbow Center to the elbow joint Radial head is free of superimposition of the ulna

Coyle method- Coronoid process

Flex elbow only 80 degrees Pronate hand Angle tube 45 degrees away from the shoulder towards the elbow joint

Partial Flexion - AP elbow of proximal humerus

Forearm is parallel to the film CR perpendicular to elbow joint True AP of forearm

What does an AP humerus best demonstrate?

Greater tubercle in profile

Proximal Forearm PA Projection Acute Flexion

Humerus is placed on IR Acute flexion Epicondyles parallel to IR CR is angled perpendicular to the forearm (not a set angle due to the differences in individual acute flexion) Center 2 inches inferior to the olecranon process Open joint space between the radius and humerus PA projection of the radius and ulna

Distal Humerus AP Projection (Acute Flexion)

Humerus is placed parallel to IR Arm is acutely flexed Epicondyles are parallel CR is perpendicular to IR Center 2 inches superior to the olecranon

Lateral Humerus

14x17 erect or supine top of IR is 1.5 inches above the humeral head Place back of hand on thigh (internally rotates humerus) Epicondyles are perpendicular Slightly abduct arm

AP Humerus

14x17 cassette Can do supine or erect (typically erect) Do not rotate the patient's arm if there is a possible fracture Place top of IR 1.5 inches above the humeral head Epicondyles are parallel to IR Supinate hand Slightly abduct the arm (do not want breast tissue to superimpose the humerus) CR is perpendicular Center to mid-humerus Elbow and shoulder joint must be included

Radial head special projection

4 projections Need to see the entire circumference of the radial head Same positioning as a lateral elbow, but the positioning of the hand is different for each projection Lateral hand Supinate hand (as much as possible) Pronate hand Internally rotate hand (each movement provides a slightly different view of the radial head)

What x-rays are going to be done if there is suspected humeral fracture?

AP Humerus without moving arm Transthoracic lateral

AC Joints (Pearson Method)

Erect 72 inch SID (reduces magnification) 14x17 crosswise 2 projections (one with 5-10 pound weights and one without) MSP vertical Equal weight distribution Both shoulders against board (true AP) CR is perpendicular Center down MSP at level of AC joint Trying to demonstrate separation/dislocation of AC joints May have to do 4 images if have broad shoulders (use 10x12 crosswise, center to AC joint)

Why do we do the coyle method?

Need to do a medial and oblique elbow, but the patient cannot extend their arm

Why do we do partial flexion AP elbow?

Patient cannot extend arm to get an AP elbow (in order to get a true AP of the forearm and the humerus, need to do two projections)

Partial Flexion - AP elbow of distal humerus

Place humerus down on table/cassette CR perpendicular to elbow True AP of humerus

What does a lateral humerus best demonstrate?

The lesser tuberosity in profile

What does a distal humerus AP with acute flexion best demonstrate?

The olecranon process