Technique 1 Upper limbs 2
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This document provides guidelines for obtaining radiographic images of the arm, elbow, forearm, and humerus. It describes patient positioning, part positioning, image receptor placement, and central ray direction for various projections, including AP, lateral, oblique, and axial views. The goal is to demonstrate anatomical structures clearly while avoiding overlap as much as possible through adjustments to the central ray angle and limb positioning. Proper technique is important for evaluating fractures and other conditions affecting the bones and joints.
Technique 1 Upper limbs 2
- 1. Radiographic Technique 1 September, 2011 Prepared by: Behzad Ommani Bachelor of Radiology Master of Medical Engineering
- 2. Anatomy
- 3. Arm • The arm has one bone called the humerus, which consists of a body and two articular Ends. • The distal end of the humerus is called the humeral condyle and includes two smooth elevations for articulation with the bones of the forearm-the trochlea on the medial side and the capitulum on the lateral side. The medial and lateral epicondyles are superior to the condyle and easily palpated. • On the anterior surface superior to the trochlea, a shallow depression called the corol/oidfossa receives the coronoid process when the elbow is flexed.
- 4. • The olecranon fossa is a deep depression found immediately behind the coronoid fossa on the posterior surface and accommodates the olecranon process when the elbow is extended • The proximal end of the humerus contains the head, which is large, smooth, and rounded and lies in an oblique plane on the superomedial side. Just below the head, lying in the same oblique plane, is the narrow, constricted anatomic neck. • The constriction of the body just below the tubercles is called the surgical neck, which is the site of many fractures Arm
- 5. Arm
- 6. • The lesser Tubercle is situated on the anterior surface of the bone immediately below the anatomic neck. The tendon of the subscapularis muscle inserts at the lesser tubercle. • The greater tubercle is located on the lateral surface of the bone just below the anatomic neck and is separated from the lesser tubercle by a deep depression called the intertubercular groove. Arm
- 8. • AP PROJECTIONS • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 X 30 cm divided • Position at patient : Seat the patient near the radiographic table and low enough to place the shoulder joint, humerus, and elbow joint in the same plane. • Position of part : Extend the elbow, supinate the hand, and center the IR to the elbow joint. • Adjust the IR to make it parallel with the long axis of the part. Elbow
- 9. • Have the patient lean laterally until the humeral epicondyles and anterior surface of the elbow are parallel with the plane of the IR. • Supinatethe handto preventrotationof the bones of the forearm. Central ray: Perpendicular to the elbow joint Elbow
- 10. Elbow
- 11. LATERAL PROJECTIONS • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided • Position at patient : Seat the patient near the radiographic table and low enough to place the shoulder joint, humerus, and elbow joint in the same plane. • Position of part : From the supine position, flex the elbow 90 degrees and place the humerus and forearm in contact with the table. Elbow
- 12. • To obtain a lateral projection of the elbow, adjust the hand in the lateral position and ensure that the humeral epicondyles are perpendicular to the plane of the IR. Central ray : Perpendicular to the elbow joint, regardless of its location on the IR Elbow
- 13. AP OBLIQUE PROJECTIONS (Medial Rotation) • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided • Position at patient : Seat the patient near the radiographic table and low enough to place the shoulder joint, humerus, and elbow joint in the same plane. • Position of part : Extend the limb in position for an AP projection, and center the midpoint of the IR to the elbow joint . Elbow
- 14. • Medially (internally) rotate or pronate the hand, and adjust the elbow to place its anterior surface at an angle of 45 degrees. This degree of obliquity usually clears the coronoid process of the radial head. Central ray : Perpendicular to the elbow joint The image shows an oblique projection of the elbow with the Coronoid Process projected free of superimposition Elbow
- 15. Elbow
- 16. AP OBLIQUE PROJECTIONS (Lateral Rotation) • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided • Position at patient : Seat the patient near the radiographic table and low enough to place the shoulder joint, humerus, and elbow joint in the same plane. • Position of part : Extend the patient's arm in position for an AP projection and center the midpoint of the IR to the elbow joint. Elbow
- 17. • Rotate the hand laterally (externally) to place the posterior surface of the elbow at a 45-degree angle. When proper lateral rotation is achieved, the patient's first and second digits should touch the table. Central ray : Perpendicular to the elbow joint • The image shows an oblique projection of the elbow with the Radial Head and Neck projected free of superimposition of the ulna Elbow
- 18. Elbow
- 19. Distal Humerus AP PROJECTIONS (Partial Flexion) • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided • Position at patient : Seat the patient low enough to place the entire humerus in the same plane. Support the elevated forearm • Position of part : If possible, supinate the hand. Place the IR under the elbow, and center it to the condyloid area of the humerus Elbow
- 20. Central ray : Perpendicular to the humerus, traversing the elbow joint. Depending on the degree of flexion, angle the central ray distally into the joint. This projection shows the distal humerus when the elbow cannot be fully extended Elbow
- 21. Proximal Forearm AP PROJECTIONS (Partial Flexion) • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided • Position at patient : Seat the patient at the end of the radiographic table with the hand supinated. • Position of part : Seat the patient high enough to permit the dorsal surface of the forearm to rest on the table. Elbow
- 22. • If this position is not possible. elevate the limb on a support. adjust the limb in the lateral position. place the IR in the vertical position behind the upper end of the forearm. and direct the central ray horizontally. Central ray : Perpendicular to the elbow joint and long axis of the forearm. Adjust the IR so that the central ray passes to its midpoint. This projection demonstrates the proximal forearm when the elbow cannot be fully extended. Elbow
- 23. Elbow
- 24. Distal Humerus AP PROJECTIONS (Acute Flexion) • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided • Position at patient : Seat the patient at the end of the radiographic table with the elbow fully flexed (unless contraindicated). • Position of part : Center the IR proximal to the epicondylar area of the humerus. The long axis of the arm and forearm should be parallel with the long axis of the IR. • Adjust the arm or the radiographic tube and IR to prevent rotation Elbow
- 25. Central ray : Perpendicular to the humerus approximately 2 inches (5 cm) superior to the olecranon process. This position superimposes the bones of the forearm and arm. The olecranon process should be clearly demonstrated. Elbow
- 26. Proximl Forearm PA PROJECTIONS (Acute Flexion) • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided • Position at patient : Seat the patient at the end of the radiographic table with the elbow fully flexed (unless contraindicated). • Position of part : Center the flexed elbow joint to the center of the JR. The long axis of the superimposed forearm and arm should be parallel with the long axis of the IR. • Move the IR toward the shoulder so that the central ray will pass to the mid point. Elbow
- 27. Central ray : Perpendicular to the flexed forearm, entering approximately 2 inches (5 cm) distal to the olecranon process. Elbow
- 28. Radial Head LATERAL PROJECTION (Lateromedial) Four-position series • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided • Position at patient : Seat the patient low enough to place the entire arm in the same horizontal plane. • Position of part : Flex the elbow 90 degrees, center the joint to the unmasked IR, and place the joint in the lateral position. Elbow
- 29. • Make the first exposure with the hand supinated as much as is possible. • Shift the IR and make the second exposure with the hand in the lateral position, that is, with the thumb surface up. • Shift the IR, and make the third exposure with the hand pronated. • Shift the IR, and make the fourth exposure with the hand in extreme internal rotation, that is, resting on the thumb surface Elbow
- 30. Central ray : Perpendicular to the elbow joint Elbow
- 31. Elbow
- 32. NOTE: Greenspan and Norman' reported that he radial head can be projected more clearly with reduced superimposition by directing the central ray 45 degrees medially (toward the shoulder). Elbow
- 33. PA AXIAL PROJECTION • Image receptor : 8 x 10 inch (18 x 24 cm) for one or two images on one IR • Position at patient : Seat the patient high enough to enable the forearm to rest on the radiographic table with the arm in the vertical position. • The patient must be seated so that the forearm can be adjusted parallel with the long axis of the table. • Position of part : Flex the patient's elbow to place the arm in a nearly vertical position so that the humerus forms an angle of approximately 75 degrees from the forearm Distal Humerus
- 34. • Center a point midway between the epicondyles and the center of the IR Central ray : Perpendicular to the ulnar sulcus entering at a point just medial to the olecranon process Distal Humerus
- 35. Olecranon Process PA AXIAL PROJECTION • Image receptor : 8 x 10 inch (18 x 24 cm) for one or two images on one IR • Position at patient : Seat the patient at the end of the radiographic table. high enough that the forearm can rest flat on the IR. • Position of part : Adjust the arm at an angle of 45 to 50 degrees from the vertical position and ensure that the patient is not leaning anteriorly or posteriorly. • Supinate the hand and have the patient immobilize it with the opposite hand.
- 36. • Center a point midway between the epicondyles and the center of the IR. Central ray : Perpendicular to the olecranon process to demonstrate the dorsum of the olecranon process and at a 20-degree angle toward the wrist to demonstrate the curved extremity and articular margin of the olecranon process. Olecranon Process
- 39. Humerus AP PROJECTION (Upright) • Image receptor : Lengthwise -18 X43 cm; 35 x 43 cm • Position at patient : Place the patient in a seated upright or standing position facing the x-ray tube. • Position of part : Adjust the height of the IR to place its upper margin about 1.5 inches (3.8 cm) above the head of the humerus. • Abduct the arm slightly; and supinate the hand. • A coronal plane passing through the epicondyles should be parallel with the IR plane for the AP (or PA) projection
- 40. • Respiration: Suspend Central ray : Perpendicular to the midportion of the humerus and the center of the IR. Humerus
- 41. Humerus LATERAL PROJECTION (Upright) Latromedial • Image receptor : Lengthwise -18 X43 cm; 35 x 43 cm • Position at patient : Place the patient in a seated upright or standing position facing the x-ray tube. • Position of part : Adjust the height of the IR to place its upper margin about 1.5 inches (3.8 cm) above the head of the humerus. • Unless contraindicated by possible fracture, internally rotate the arm, flex the elbow approximately 90 degrees, and place the patient's anterior hand on the hip.
- 42. • Respiration: Suspend Central ray : Perpendicular to the midportion of the humerus and the center of the IR. Humerus
- 43. Humerus
- 44. Humerus
- 45. LATERAL PROJECTIONS (Recubment) • Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x 30 cm divided When a known or suspected fracture exists, position the patient in the recumbent or lateral recumbent position, place the IR close to the axilla, and center the humerus to the IR's midline, Unless contraindicated, flex the elbow turn the thumb surface of the hand up, and rest the humerus on a suitable support . • Adjust the position of the body to place the lateral surface of the humerus perpendicular to the central ray. Humerus
- 46. • Respiration: Suspend Central ray : Directed to the center of the JR, which exposes only the distal humerus. Humerus