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Radiographic Positioning I
UPPER LIMB
Note: the patient is often seated on a stool/chair which is placed at the end of the
radiographic table; place a lead shield on the patient’s lap (60 years and younger) in order
to shield the gonadal area.
ANATOMY: Pgs. 93-100
Volume I Chapter 4 Merrill’s Atlas
DIGIT: (2-5) Pgs. 102-107
PA
45 degree oblique
Lateral—lateromedial or mediolateral
Field Size:
8 x 10
kVp: 60 Table top preferred
SID: 40 inches
CR: perpendicular to the PIP joint
Evaluation Criteria for PA:
Evaluation Criteria for oblique:
Evaluation Criteria for Lateral:
HAND: Pgs. 116-123
PA
45 degree oblique—with fingers extended
Lateral*--lateromedial
Field Size: 8 x 10
kVp:
60 Table top preferred
SID:
40 inches
CR:
PA & Obl: perpendicular to the 3rd metacarpophalangeal joint
Lat: perpendicular to the 2nd metacarpophalangeal joint
*3 methods for Lateral 1)Pg. 120-1 Fingers “fanned” for better demonstration of
individual fingers
2)Pg. 120-1 Hand in extension—for foreign bodies
3)Pg. 122 Hand in flexion—for demonstration of
anterior/posterior displacement in fxs of
metacarpals
(Note—most dept protocols require # 1 lateral method)
Evaluation Criteria for PA:
Evaluation Criteria for oblique:
Evaluation Criteria for Lateral:
FIRST DIGIT (THUMB): Pgs. 108-11
PA or AP
Lateral--mediolateral
Oblique
Must include entire first metacarpal on all views
Field size:
8 x 10
kVp: 60—Table top preferred
SID: 40 inches
CR: perpendicular to the metacarpophalangeal joint
Evaluation Criteria for PA:
Evaluation Criteria for oblique:
Evaluation Criteria for Lateral:
WRIST: Pgs. 124, 126-8, 132
Or
PA
45 degree oblique
Lateral--lateromedial
PA Axial—Stecher method pg. 132
PA Axial—Bridgman method pg. 132
Field size: 8 x 10
kVp:
60 Table top preferred
SID:
40 inches
CR:
PA & Oblique: perpendicular to midcarpal area
Lateral: perpendicular to the wrist joint
Stecher: angled 20 degrees toward the elbow, entering at the
scaphoid
or Bridgman: also angled 20 degrees toward the elbow, entering at the
scaphoid with the wrist in ulnar deviation
Evaluation Criteria for PA:
Evaluation Criteria for oblique:
Evaluation Criteria for Lateral:
Evaluation Criteria for Stecher:
Evaluation Criteria for Bridgman:
FOREARM: Pgs. 140-142
AP
Lateral--lateromedial
Field Size: 7 x 17
kVp: 60—Table top preferred
SID: 40 inches
CR: perpendicular to the midpoint of the forearm
Must include both the wrist and elbow joints on each projection.
Evaluation Criteria for AP:
Evaluation Criteria for Lateral:
ELBOW: Pgs. 143-147
AP
Lateral--lateromedial
Obliques—in lateral rotation & medial rotation
Field size: 8 x 10
kVp: 60—Table top preferred
SID: 40 inches, table top
CR: perpendicular to the elbow joint
Note: some depts.. will also include an Oblique in medial rotation
Evaluation Criteria for AP:
Evaluation Criteria for oblique:
Evaluation Criteria for Lateral:
SPECIAL ELBOW PROJECTIONS:
A. ELBOW IN ACUTE FLEXION
Jones method: for elbow in acute flexion
Pgs. 150-1
Field Size: 8 x 10
kVp:
60-65—Table top preferred
SID:
40 inches
CR:
For AP distal humerus: Perpendicular to the humerus 2 inches
superior to olecranon
For AP Proximal Radius/Ulna: Perpendicular to forearm 2 inches
distal to olecranon
also take a lateral in acute flexion—8 x 10 60 kVp
B. ELBOW IN PARTIAL FLEXION
Pgs. 148-9
AP of distal humerus
AP of proximal forearm
Field size: 8 x 10
kVp: 60—Table top preferred
SID: 40 inches
CR: AP of distal humerus—perpendicular to humerus to joint
AP of proximal forearm—perpendicular to long axis of forearm to joint
--angle either views as needed
also take a lateral in partial flexion
HUMERUS Pgs. 161-2
AP (external rotation)—supinate
Lateral (internal rotation)—place posterior side of hand against the hip
Field size: 7 x 17
kVp: 60—Table top preferred
SID: 40 inches
CR: perpendicular to the midpoint of the humerus
Must include both the elbow and shoulder joints
Respiration: suspended
Evaluation Criteria for AP:
Evaluation Criteria for Lateral:
Proximal Humerus: Transthoracic Lateral Projection—Lawrence method
This method is used when trauma exists and the humerus cannot be rotated or abducted.
This will demonstrate the proximal humerus in a 90 degree projection from the AP
Pgs. 180-1
Position the patient either recumbent or upright with affected
humerus adjacent to the IR
Elevate the non-injured arm & shoulder as much as
possible and rest the arm on the patient’s head
No attempt should be made to rotate or move the injured
humerus.
Field size: 10 x 12
kVp:
75—bucky or grid
SID:
40 inches
CR: through the thorax, perpendicular* to the cassette at the level of the surgical
neck of the humerus (*may angle 10-15 degrees cranial, as needed)
Respiration: Full inspiration in order to improve the contrast & decrease exposure
or quiet breathing technique in order to blur the ribs & lung markings
Remember to elevate the opposite arm!
Lateral—Distal Humerus Pg. 163
Field size: 10 x 12 --placed under the humerus with patient either recumbent or lateral
recumbent
SID: 40 inches
kVp: 60—Table top
CR: perpendicular to midpoint of IR
-----------------------------------------------------------------------------------------------------------Evaluation criteria for transthoracic humerus:
Evaluation criteria for lateral distal humerus: