Elbow and humerus

daughterduckUrban and Civil

Nov 15, 2013 (3 years and 8 months ago)

66 views

Elbow and humerus

24. AP PROJECTION: ELBOW

ELBOW FULLY EXTENDED


Pathology demonstrated


Fx

or dislocation of elbow


Osteoarthritis and
osteomyelitis


Technical factors:


IR size: 24 X 30 cm (10 X 12
inches)


Division in half, crosswise


Detail screen, tabletop


Digital IR (use lead masking)


60
±

6 kV range


Technique and dose (see the
table)

Part thickness
(cm)

kVp

mAs

Patient dose (mrad)

Skin

ML.

Gonadal

7

64

6

25

17

M


Null

F


< 0.1

30

24

R


Shielding:
place lead shield over patient’s lap


Patient position:
seat pt at end of table, with
elbow fully extended, if possible


Part position:


Extend elbow, supinate hand, and align arm and
forearm to long axis of portion of IR being exposed


Center elbow joint to center portion of IR being
exposed


Ask pt to lean laterally as necessary for true AP
projection (palpate epicondyles to ensure that they
are // to the IR)


Support hand as needed to prevent motion


CR


CR


to IR directed to midelbow joint, which is
approximately 2 cm (3/4 inch) distal to midpoint of a
line b/w epicondyles


Minimum SID of 100 cm (40 inches)


Collimation:
collimate on 4 sides to area of interest

AP PROJECTION: ELBOW

ELBOW FULLY EXTENDED

AP PROJECTION: ELBOW

ELBOW FULLY EXTENDED


Radiographic criteria

25.

AP PROJECTION: ELBOW

WHEN ELBOW CANNOT BE FULLY EXTENDED


Pathology demonstrated


Fx

or dislocation of elbow


Osteoarthritis and
osteomyelitis


Technical factors:


IR size: 24 X 30 cm (10 X 12 inches)


Division in half, crosswise


Detail screen, tabletop


Digital IR (use lead masking)


64
±

6 kV range, exposure increased
4
-
6 kV because of increased part
thickness due to partial flexion


Technique and dose (see the table)

Part thickness
(cm)

kVp

mAs

Patient dose (mrad)

Skin

ML.

Gonadal

7

64

6

25

17

M


Null

F


< 0.1

30

24

R

R

AP PROJECTION: ELBOW

WHEN ELBOW CANNOT BE FULLY EXTENDED


Shielding:
place lead shield over patient’s lap


Patient position:
seat pt at end of table, with
elbow partially flexed


Part position:


Obtain
2
AP projections


one with forearm // to
IR and one with humerus // to IR


Place support under wrist and forearm for
projection with humerus // to IR, if needed to
prevent motion


CR


CR


to IR directed to
midelbow

joint, which is
approximately
2
cm (
3
/
4
inch) distal to midpoint
of a line b/w epicondyles


Minimum SID of
100
cm (
40
inches)


Collimation:
collimate on
4
sides to area of
interest


Note:

if patient cannot partially extend elbow and
elbow remains flexed near
90
o
, take the
2
AP
projections as described, but angle the CR
10
o

to
15
o

into elbow joint, or if flexed more than
90
o
, use the Jones method (see projection #
29
)

AP PROJECTION: ELBOW

WHEN ELBOW CANNOT BE FULLY EXTENDED


Radiographic criteria

26. AP OBLIQUE PROJECTION


LATERAL
(EXTERNAL) ROTATION: ELBOW


Pathology demonstrated


Fx

or dislocation of elbow (radial
head and neck)


Osteoarthritis and
osteomyelitis

External oblique: best visualizes radial
head and neck and
capitulum

of
humerus


Technical factors:


IR size:
24
X
30
cm (
10
X
12
inches)


Division in half, crosswise


Detail screen, tabletop


Digital IR (use lead masking)


60
±

6
kV range


Technique and dose (see the table)

Part thickness
(cm)

kVp

mAs

Patient dose (mrad)

Skin

ML.

Gonadal

7

64

6

25

17

M


Null

F


< 0.1

30

24

R

AP OBLIQUE PROJECTION


LATERAL (EXTERNAL)
ROTATION: ELBOW


Shielding:
place lead shield over patient’s lap


Patient position:
seat pt at end of table, with arm
fully extended and shoulder and elbow on same
horizontal plane (lower shoulder as needed)


Part position:


Align arm and forearm to long axis of IR being
exposed


Center elbow joint to center portion of IR being
exposed


Supinate hand and rotate laterally the entire arm so
that the distal humerus and the anterior surface of
the elbow joint are approximately 45
o

to cassette (pt
must lean laterally for sufficient lateral rotation).
Palpate epicondyles to determine approximately 45
o

rotation of distal humerus


CR


CR


to IR directed to midelbow joint, which is
approximately 2 cm (3/4 inch) distal to midpoint of a
line b/w epicondyles


Minimum SID of 100 cm (40 inches)


Collimation:
collimate on 4 sides to area of interest

AP OBLIQUE PROJECTION


LATERAL (EXTERNAL)
ROTATION: ELBOW


Radiographic criteria

27. AP OBLIQUE PROJECTION


MEDIAL (INTERNAL)
ROTATION: ELBOW


Pathology demonstrated


Fx

or dislocation of elbow (coronoid
process of ulna)


Osteoarthritis and
osteomyelitis

Internal oblique: best visualizes
coronoid process of ulna and
trochlea

of humerus in profile


Technical factors:


IR size: 24 X 30 cm (10 X 12 inches)


Division in half, crosswise


Detail screen, tabletop


Digital IR (use lead masking)


60
±

6 kV range


Technique and dose (see the table)

Part thickness
(cm)

kVp

mAs

Patient dose (mrad)

Skin

ML.

Gonadal

7

64

6

25

17

M


Null

F


< 0.1

30

24

R


Shielding:
place lead shield over patient’s lap


Patient position:
seat pt at end of table, with arm
fully extended and shoulder and elbow on same
horizontal plane


Part position:


Align arm and forearm to long axis of IR being
exposed


Center elbow joint to center portion of IR being
exposed


Pronate hand into a natural palm
-
down position and
rotate arm as needed until distal humerus and the
anterior surface of the elbow are approximately
45
o

to cassette (palpate epicondyles to determine
approximately
45
o

rotation of distal humerus)


CR


CR


to IR directed to midelbow joint, which is
approximately
2
cm (
3
/
4
inch) distal to midpoint of a
line b/w epicondyles


Minimum SID of
100
cm (
40
inches)


Collimation:
collimate on
4
sides to area of interest

AP OBLIQUE PROJECTION


MEDIAL (INTERNAL)
ROTATION: ELBOW

AP OBLIQUE PROJECTION


MEDIAL (INTERNAL)
ROTATION: ELBOW


Radiographic criteria

28. LATERAL


LATEROMEDIAL PROJECTION:
ELBOW


Pathology demonstrated


Fx

or dislocation of elbow


Osteoarthritis and
osteomyelitis


Elevated or displaced fat pads


Technical factors:


IR size:
18
X
24
cm (
8
X
10
inches), crosswise


Detail screen, tabletop


60
±

6
kV range


Technique and dose (see the
table)

Part thickness
(cm)

kVp

mAs

Patient dose (mrad)

Skin

ML.

Gonadal

7

64

6

25

17

M


Null

F


< 0.1

24

18

R


Shielding:
place lead shield over patient’s lap


Patient position:
seat pt at end of table, with elbow flexed
90
o


Part position:


Align forearm to long axis of cassette


Center elbow joint to center portion of IR


Drop shoulder so that humerus and forearm on same
horizontal plane


Rotate hand and wrist into true lateral position, thumb side
up


Place support under hand and wrist to elevate hand and distal
forearm as needed for heavy muscular forearm so that
forearm is // to IR for true lateral elbow


CR


CR


to IR directed to
midelbow

joint (a point approximately
4 cm (1 ½ inches) medial to easily palpated posterior surface
of
olecranon

process


Minimum SID of 100 cm (40 inches)


Collimation:
collimate on 4 sides to area of interest


Note:

diagnosis of certain important joint pathologic processes
(such as possible visualization of the posterior fat pad)
depends on 90
o

flexion of the elbow joint

Exception:

certain ST diagnoses require less flexion (only 30
o

to
35
o
), but these views should be taken only when
specifically indicated


LATERAL


LATEROMEDIAL PROJECTION: ELBOW

LATERAL


LATEROMEDIAL PROJECTION: ELBOW


Radiographic criteria

29. ACUTE FLEXION PROJECTIONS: ELBOW

JONES METHOD (AP PROJECTIONS OF ELBOW IN ACUTE
FLEXION)


Pathology demonstrated


Fx

and moderate dislocation of elbow

Note:

to visualize both the distal humerus
and the proximal radius and ulna,
2
projections are required


one with
the CR
┴ to the humerus and one
with the CR angled so that it is ┴
to the forearm


Technical factors:


IR size:
18
X
24
cm (
8
X
10
inches),
lengthwise (or divide in half, crosswise,
for
2
projections)


Detail screen, tabletop


64
±

6
kV range (increase
4
-
6
kV for
proximal forearm)


Technique and dose (see the table)

Part thickness
(cm)

kVp

mAs

Patient dose (mrad)

Skin

ML.

Gonadal

7

64

6

25

17

M


Null

F


< 0.1

18

24

R

24

18

R

R

ACUTE FLEXION PROJECTIONS: ELBOW

JONES METHOD (AP PROJECTIONS OF ELBOW IN ACUTE
FLEXION)


Shielding:
place lead shield over patient’s lap


Patient position:
seat pt at end of table, with
elbow flexed
90
o


Part position:


Align humerus to long axis of IR, with forearm
acutely flexed and fingertips resting on shoulder


Adjust cassette to center elbow joint to center
portion of IR


Palpate epicondyles and ensure that they are equal
distances from cassette for no rotation


CR


Distal humerus:

CR


to IR and humerus, directed to
a point midway b/w epicondyles


Proximal forearm:

CR


to forearm (aligning CR as
needed), directed to point approximately
2
inches (
5
cm) proximal or superior to olecranon process


Minimum SID of
100
cm (
40
inches)


Collimation:
collimate on
4
sides to area of interest