Technique 1 Upper limbs 2

Radiographic Technique 1
September, 2011
Prepared by:
Behzad Ommani
Bachelor of Radiology
Master of Medical Engineering

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.

• 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

• 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

• 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

• 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

LATERAL PROJECTIONS
• Image receptor : 8 x 10 inch (18 x 24 cm) single or 24 x
30 cm divided
• Position of part : From the supine position, flex the
elbow 90 degrees and place the humerus and forearm in
contact with the table.
Elbow

• 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

AP OBLIQUE PROJECTIONS (Medial Rotation)
30 cm divided
• Position of part : Extend the limb in position for an AP
projection, and center the midpoint of the IR to the
elbow joint .
Elbow

• 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

AP OBLIQUE PROJECTIONS (Lateral Rotation)
30 cm divided
• 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

• 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.
• The image shows an oblique projection of the elbow with
the Radial Head and Neck projected free of
superimposition of the ulna
Elbow

Distal Humerus
AP PROJECTIONS (Partial Flexion)
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

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

Proximal Forearm
AP PROJECTIONS (Partial Flexion)
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

• 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

Distal Humerus
AP PROJECTIONS (Acute Flexion)
30 cm divided
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

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

Proximl Forearm
PA PROJECTIONS (Acute Flexion)
30 cm divided
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

Central ray : Perpendicular to the flexed forearm, entering
approximately 2 inches (5 cm) distal to the olecranon
process.
Elbow

Radial Head
LATERAL PROJECTION (Lateromedial)
Four-position series
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

• 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

Elbow

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

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

• 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

Olecranon Process
PA AXIAL PROJECTION
• Image receptor : 8 x 10 inch (18 x 24 cm) for one or two
images on one IR
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.

• 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

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

• Respiration: Suspend
Central ray : Perpendicular to the midportion of the
humerus and the center of the IR.
Humerus

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.

LATERAL PROJECTIONS (Recubment)
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

• Respiration: Suspend
Central ray : Directed to the center of the JR, which
exposes only the distal humerus.
Humerus

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