Final 141 Part 2

PA wrist positioning

Flex the digits to place the wrist in close contact with the IR and to decreases OID to image receptor Shoulder, elbow, and wrist joints should be in the same plane Collimate 2.5" proximal and distal to wrist joint and 1" on sides.

Lateral Forearm

Flex the elbow 90° CR: 0° = Perpendicular to midpoint of the forearm Humerus, elbow, and shoulder are in same plane CR: 0° to the midpoint of the forearm Position the wrist in true lateral

PA Oblique Wrist x-ray

45 rotation of anatomy slight overlap of the distal radius and ulna Carpals on the lateral side of the wrist trapezium and the distal half of the scaphoid and scaphotrapezial joint space. Trapezium and Scaphoid are seen in profile

Wrist Routine

PA, PA oblique, lateral

AP Humerus

CR: 0° to mid-portion of the humerus and the center of the IR Upper margin of the IR is 1.5" above the head of the humerus Plane passing through epicondyles should be parallel with IR Respiration: Suspend

PA Oblique Wrist

CR: 0° = Perpendicular to mid carpal area IR: 10 x 12" Lengthwise SID: 40 kVp: 55 and mAs 3

PA Wrist Technical factors

CR: 0° = Perpendicular to mid carpal area IR: 10 x 12" Lengthwise SID: 40 kVp: 55 and mAs 3

Lateral Wrist

CR: 0° = Perpendicular to mid carpal area IR: 10 x 12" Lengthwise SID: 40 kVp: 55 and mAs 3 Place hand in true lateral Have the patient flex the elbow in 90 degrees.

AP Forearm

CR: 0° = Perpendicular to mid point of the forearm IR: 14 x 17" Lengthwise Epicondyles parallel to IR SID: 40 kVp: 55 and mAs 3 Do not do PA because radius and ulna cross each other

Fan Lateral hand

CR: 0° to 2nd MCP kVp 55 and mAS 2 IR: 10 x 12" Portrait SID: 40" Fingers equally separated

PA Hand

CR: 0° to 3rd MCP kVp 55 and mAS 2 IR: 10 x 12" Collimate 1" on all sides of the hand including 1" proximal to ulnar styloid.

PA Oblique Hand

CR: 0° to 3rd MCP kVp 55 and mAS 2 IR: 10 x 12" Portrait Hand on the sponge show joint spaces Hand on the IR show metacarpals

AP Thumb

CR: 0° to MCP of thumb kVp 40 and mAS 1 IR: 10 x 12" Collimate 1" on all sides of the digit including 1" proximal to CMC. Place hand in extreme internal rotation.

PA Axial Scaphoid

Ulnar Deviation with CR 10° to 15° Angle

PA Finger

CR: PIP joint SID: 40 kVp 40 and mAS 1 IR: 10 x 12" -Open IP & MCP joints -Entire digit from fingertip to distal portion of metacarpal

Ball Catchers/ Norgaard Method

CR: Perpendicular to the midpoint between the hands at the level of the MCP joints kVp 55 and mAS 2 IR: 10 x 12" Portrait SID: 40" Is done for diagnosis of Rheumatoid arthritis.

Lateral Humerus Positioning

CR: parallel Internally rotate hand, placing back of hand against thigh. Epicondyles perpendicular to cassette, arm slightly abducted. kVp 65 and 5 mAs

AP Forearm x- ray

Collimate to include both joint.

Radial Deviation X- ray

Distal radius and ulna, Hamulus of hamate, pisiform , triquetrum and lunate.

AP ELBOW

IR: 10 x 12" Lengthwise SID: 40 kVp: 55 and mAs 3 • CR perpendicular to IR directed to the mid elbow joint (3/4" distal to the midpoint of the line between humeral epicondyles) • SID 40 inches • Lead apron over patients lap • 4 borders of collimation

Styloid process of ulna

Is distal

coronoid process of ulna

Is proximal and anterior

olecranon process of ulna

Is proximal and posterior

Fan Lateral x-ray

Metacarpals, carpals, radius and ulna are superimposed

Hand Routine

PA Oblique "Fan" Lateral

PA Oblique Hand X- ray

Partial superimposition of the third, fourth and fifth metacarpal bases and head

Carpal bones from lateral to medial:

Proximal Row: Scaphoid, lunate, triquetrum, pisiform Distal Row: trapezium, trapezoid, capitate, hamate

PA Wrist x-ray

Shows open radioulnar space

Lateral wrist x-ray

Superimposed distal radius and ulna Superimposed metacarpals Lunate is in profile No rotation

PA Scaphoid/Modified Stretcher Method

Two ways to do it: 1-Hand elevated 20° (no ulnar deviation) 2-Hand elevated 20° (with ulnar deviation) No CR angulation The scaphoid is in profile Ulnar Deviation to see fractures of the scaphoid Elongate the scaphoid

Lateral Humerus X-ray

Ø Lateral of entire humerus Ø Shoulder and elbow joints Ø Epicondyles directly superimposed Ø Lesser tubercle in profile medially Ø 2 inches of the proximal forearm Ø Surgical neck demonstrated

AP Humerus X-ray

ØAP of entire Humerus Ø Soft tissue structures Ø Anatomical and Surgical necks Ø Glenoid fossa Ø 2 inches of proximal forearm Ø Shoulder and Elbow joints Ø Greater Tubercle in profile laterally Ø Humeral head in profile medially

PA Oblique elbow

• 45 degree oblique of elbow joint • Distal humerus • Proximal radius and ulna • Coronoid process of ulna in profile

AP Elbow X-ray

• AP of elbow joint space • Distal humerus • Proximal radius and ulna • Space between radial head and capitulum visualized • Medial and lateral epicondyles • Radial head and neck

Lateral Elbow

• Elbow flexed 90 degrees • Shoulder lowered to the same horizontal plane • Long axis of the humerus to long axis of IR center elbow joint to the IR • Rotate hand and wrist into true lateral support if needed • CR perpendicular to IR directed to midelbow (1 ½ inches medial to posterior surface of olecranon process) • SID 40 inches

PA Oblique ( medial rotation ) elbow

• Elbow fully extended • Entire UE on same horizontal plane • Center/align elbow joint to long axis of IR • Pronate hand (palm down) • Rotate arm until distal humerus and anterior surface of elbow joint are 45 degrees to IR • CR perpendicular to IR • CR directed to mid elbow joint • SID 40 inches

AP oblique Lateral Rotation of the elbow

• Radial head, neck and tuberosity free of superimposition by ulna

Hand and Wrist: 27 Bones

•14 Phalanges •5 Metacarpals •8 Carpal Bones

Radial Deviation

•CR to midcarpals •CR perpendicular

AP oblique Lateral Rotation of the elbow

•Elbow fully extended • Entire UE on same horizontal plane • Center/align elbow joint to long axis of IR • Supinate hand (palm up) • Rotate arm entire arm laterally so distal humerus and anterior surface of elbow joint are 45 degrees to IR

Thumb X-ray

•Entire thumb demonstrated (including first CMC joint) •Center field at first MCP joint

Lateral Forearm X-ray

•Head of ulna superimposed over radius •Carpals and distal humerus included Epicondyles are superimposed.

Lateral Elbow X-ray

•Lateral of distal humerus • Lateral of the proximal forearm • Olecranon process in profile • Soft tissue (fat pad) • Elbow joint

Elbow joint 3 joints enclosed in a common capsule

•Proximal radioulnar joint •Humeroulnar joint •Humeroradial joint

•Radial anatomy

•Radial head is proximal •Radial tuberosity is proximal

PA Axial Scaphoid X-ray

•Scaphoid clearly seen without superimposition •Scaphoid not foreshortened The scaphoid is in profile Ulnar Deviation to see fractures of the scaphoid Elongate the scaphoid

Wrist movements

•Ulnar deviation •Scaphoid in projection •Radial deviation •Lunate, triquetrum, pisiform, and hamate in profile