Chapter 4 positioning exam RAD114

Describe the projections you will perform for the patient who presents with severe elbow trauma?

2 partially flexed AP elbows, angle CR 10-15 degrees into elbow joint.

Describe the projection you will perform if the patient presents with a request for Nørgaard method.

Hands supine, rotated inward to 45 degrees, side by side, relaxed. CR aimed between the 5th MCPs. CR perpendicular to IR. Nørgaard projection for rheumatoid arthritis.

you used a 60 kvp on a PA projection of the wrist post reduction and application of a fiberglass cast. How would you adjust the technique for the fiberglass cast?

increase kV by 3 or 4.

Describe a projection of the elbow which demonstrates the radius directly superimposed over the ulna.

AP medial oblique

how will you correct the positioning for your lateral elbow projection which reveals about half of the radial head is superimposed over the coronoid process?

nothing needs correcting. a lateral elbow is supposed to have the radial head superimposing over the coronoid process.

Describe the 2 projections of the elbow which you may perform if the patient presents with a possible non-displaced fracture of the coronoid process.

1) oblique medial rotation of elbow 2) Coyle method for coronoid— elbow flexed 80 degrees and CR angled 45 degrees from shoulder aimed at mid elbow joint.

what is the "Jone's Method"?

Acute flexion of the elbow- when elbow cannot be extended at all. 2 projections— 1) CR perpendicular to forearm 2) CR perpendicular to humerus

Describe the projection that you will perform with a patient who presents with possible fractures of coronoid process.

Coyle projection for coronoid— CR angled 45 degrees coming from shoulder, directed at mid elbow joint.

Describe the positioning of the elbow using the Trauma mediolateral (medial) Coyle method.

Elbow flexed 80 degrees, hand prone, CR directed to mid elbow joint at 45 degrees coming from shoulder. This Coyle projection shows fractures and dislocations of the coronoid process.

Describe the position of the elbow using the Trauma Lateral Coyle Method.

Elbow flexed 90 degrees, hand pronated, CR at 45 degrees-directed towards shoulder, aimed at mid elbow joint. This Coyle projection is for best demonstrating fractures of the radial head.

describe a special projection you will perform on a patient who presents with a possible tear of the ulnar collateral ligament of the wrist.

Folio method— both hands pronated, in 45 degree oblique position, thumbs PA. place spacer between proximal thumbs, CR perpendicular to IR, directed between 1st MCP joints. rubber band around thumbs, ask patient to pull thumbs apart. work quickly because this is often painful for the patient.

Describe the projection that you will perform with a patient who presents with a history of calcifications in the carpal sulcus.

Gaynor heart method—wrist and hand prone, patient flexes fingers back and holds with tape. CR is 25-35 degrees aimed at mid palm.

describe a project of the elbow which best demonstrates the olecranon process in profile.

Lateral- elbow flexed 90 degrees, CR perpendicular to IR, directed at elbow joint.

Describe the radiographic imaging procedure which will best identify a Bennett's fracture.

Modified Robert's AP projection Bennett's fracture is a fracture at the base of the 1st MCP.

Describe a projection which demonstrates the carpal joints on the ulnar side of the wrist.

Radial deviation

Describe the radiographic imaging projection which is best suited for a patient unable to perform the ulnar deviation position.

Use the modified Stetcher method, hand elevated 20 degrees on a radiolucent sponge. CR perpendicular to IR, directed at navicular

Describe the imaging PROCEDURE which will best demonstrate a Smith fracture.

Wrist and forearm (Smith fracture is a fracture of the distal radius, where the displaced fragment is more anterior.)

describe the positions of the elbow that will best demonstrate an elevated or visible fat pad.

a true 90 degree lateral.

How will you correct the position for your PA scaphoid projection which reveals superimposition of the carpal bones located on the radial aspect?

deviate towards ulnar side to open carpal bones up— "ulnar deviation"

How will you correct the positioning for your PA projection of the hand where the carpals and distal forearm have been cut off?

repeat image to include all carpals and 1" of distal forearm

How will you correct the positioning of your PA oblique hand which reveals superimposition of the 4th and 5th metacarpals?

you've rotated hand too much laterally— so you will need to rotate hand back medially until you've achieved a 45 degree oblique.

How will you correct the positioning for your AP projection of the elbow which reveals complete separation of the ulna and proximal radius?

you've rotated the arm too far laterally, so you will need to rotate arm back medially to a true PA position where the epicondyle plane is parallel to the plane of the IR.

How will you correct your AP Medial oblique projection of the elbow which reveals the radial head is superimposed over coronoid process?

you've rotated too much, need to rotate back for a 45 degree oblique.