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134
CHAPTER 5
|
IMAGING PROCEDURES
• Superimposition of the greater and lesser trochan-
ters with greater trochanter mostly superimposed by
femoral neck
• No evidence of elongation or foreshortening
• Optimal exposure
Demonstrates
• Lateral view of the proximal femur to midshaft of femur
• Anterior/posterior displacement of proximal femur to
midfemur
• Detection and evaluation of fractures and/or bone
lesions
Lateral Femur: Midfemur to Distal Femur
Positioning Criteria
• Routine mediolateral
• Patient slightly rotated to affected side with leg bent
at 45 degrees with lateral aspect of femur in contact
with table; gonadal region shielded
• Support foot of affected leg with a sponge; bend unaf-
fected knee and keep behind affected leg to prevent
overrotation
• Place top of 10⬙ ⫻ 12⬙ (25 ⫻ 30 cm) or 14⬙ ⫻ 17⬙ (35 ⫻
42.5 cm) IR adjacent to the distal aspect of the proxi-
mal lateral femur image in table Bucky or tabletop
depending on part size to include knee joint (lower
margin of IR should be 2⬙ [5 cm] below knee joint)
• Direct central ray perpendicular and to the midpoint
of the IR
• Collimate to four sides to include all pertinent anatomy
• Place appropriate side marker within light field on
lateral aspect of image
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True lateral of distal two-thirds of distal femur, in-
cluding knee joint
• Knee joint is not open, and distal margins of femoral
condyles will not be superimposed due to divergent
x-ray beam
• Anterior and posterior margins of medial and lateral
femoral condyles superimposed and aligned with
open femoropatellar joint space
• Optimal exposure
Demonstrates
• True lateral of distal two-thirds of distal femur,
including knee joint
• Anterior/posterior displacement of midfemur to
distal femur
• Detection and evaluation of fractures and/or bone lesions
• Ensure internal rotation of the affected leg is main-
tained at 5 degrees
• Direct central ray perpendicular and to the midpoint
of the IR
• Collimate to four sides to include all pertinent
anatomy
• Place appropriate side marker within light field on
lateral aspect of image
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• Midfemur to distal shaft of femur demonstrated in the
AP position adjacent to the proximal femur image
• Knee joint included
• No rotation evident
Demonstrates
• An AP view of the midfemur to distal femur adjacent
to proximal femur image
• Medial/lateral displacement of the midfemur to distal
femur
• Detection and evaluation of fractures and/or bone
lesions
Lateral Nontrauma Projections: Femur
Lateral Femur: Proximal Femur to Midfemur
Positioning Criteria
• Routine mediolateral
• Patient slightly rotated to affected side with leg bent
at 45 degrees with lateral aspect of femur in contact
with table and aligned to table midline; gonadal re-
gion shielded
• Support foot of affected leg with a sponge; extend and
support unaffected leg behind unaffected knee and
allow patient to roll posteriorly about 15 degrees to pre-
vent superimposition of proximal femur and hip joint
• Place 10⬙ ⫻ 12⬙ (25 ⫻ 30 cm) or 14⬙ ⫻ 17⬙ (35 ⫻ 42.5 cm)
IR in table Bucky with top of IR at ASIS and include hip
joint
• Direct central ray perpendicular and to the midpoint
of the IR
• Collimate to four sides to include all pertinent anatomy
• Place appropriate side marker within light field on
lateral aspect of image
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• Proximal one-half to two-thirds of proximal femur,
including hip joint
• No superimposition by opposite limb
• True lateral of the proximal femur to midfemur
135
CHAPTER 5
|
IMAGING PROCEDURES
Mediolateral Proximal Femur:
Sanderson Method
Positioning Criteria
• Patient supine with support placed under affected hip
on stretcher or bed; oblique 20 degrees to 30 degrees
from supine
• Align IR so that it is parallel to long axis of foot; place
gridded 14⬙ ⫻ 17⬙ (35 ⫻ 42.5 cm) IR against and par-
tially under affected thigh to be near perpendicular
to central ray
• Angle central ray mediolaterally to be near perpen-
dicular to long axis of foot
• Employ 10-degree to 20-degree cephalad angle of tube
to better visualize the neck and head
• AMOUNT OF CENTRAL RAY CROSS-ANGLE WILL
VARY DEPENDING ON EXTERNAL ROTATION OF
AFFECTED LEG
• Collimate to four sides to include all pertinent anatomy
• Place appropriate side marker within light field on
lateral aspect of image
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True lateral view of hip and proximal femur with mini-
mal distortion
• Entire hip prosthesis or pin visualized in its entirety
Demonstrates
• Lateral of proximal femur and hip for patients with
limited bilateral lower limb movement due to trauma
or arthroplasty
• Alignment of hip prosthesis or pin postoperatively
seen with minimal distortion
• Anterior/posterior dislocation or displacement of
proximal femur and hip
Posteroanterior Finger
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR crosswise on table
• Pronate hand and extend fingers
• Direct central ray perpendicular to IR and proximal
interphalangeal joint
• Finger of interest should be separated from other fin-
gers and aligned to long axis of IR
• Collimate to four sides to include all pertinent
anatomy
• Place appropriate side marker within light field on
lateral aspect of image
• Minimum SID: 40⬙ (100 cm)
Lateral Trauma Projections: Femur
Lateral Femur: Midfemur to Distal Femur
(Trauma)
Positioning Criteria
Mediolateral
• Patient is supine/dorsal decubitus with affected leg
elevated with support of radiolucent sponges or pads
• Place 14⬙ ⫻ 17⬙ (35 ⫻ 42.5 cm) IR on the lateral aspect
of the affected leg to include midfemur to distal femur
and knee joint
• Raise unaffected leg and support with leg lift or step
stool to prevent superimposition of soft tissue
• Direct central ray horizontal and perpendicular to
midpoint of IR
• Collimate to four sides to include all pertinent anatomy
• Place appropriate side marker within light field on
lateral aspect of image
• Minimum SID: 40⬙ (100 cm)
Lateromedial
• Patient supine/dorsal decubitus with affected leg ele-
vated with the support of radiolucent sponges or pads
• Place 14⬙ ⫻ 17⬙ (35 ⫻ 42.5 cm) IR on the medial aspect
(between patient’s legs) of the affected leg to include
midfemur to distal femur and knee joint
• Direct central ray horizontal and perpendicular to
midpoint of IR
• Collimate to four sides to include all pertinent anatomy
• Place appropriate side marker within light field on
lateral aspect of image
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True lateral of distal two-thirds of distal femur, in-
cluding knee joint
• Knee joint is not open and distal margins of femoral
condyles will not be superimposed due to divergent
x-ray beam
• Anterior and posterior margins of medial and lateral
femoral condyles superimposed and aligned with
open femoropatellar joint space
• Optimal exposure
Demonstrates
• True lateral of distal two-thirds of distal femur,
including knee joint
• Anterior/posterior displacement of midfemur to dis-
tal femur
• Detection and evaluation of fractures and/or bone
lesions
136
CHAPTER 5
|
IMAGING PROCEDURES
Lateral Finger
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR crosswise on table
• Hand extended in true lateral
• Phalanx of interest parallel with long axis of IR
• Direct central ray perpendicular to IR and proximal
interphalangeal joint
• Sponge, pencil eraser, or tape may be necessary to
extend phalanx of interest and avoid superimposition
of adjacent anatomy
• Collimate to four sides
• Place appropriate side marker
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True lateral of entire phalanx of interest
• Interphalangeal and metacarpophalangeal joint spaces
should be open
• Concave appearance of anterior aspect of the phalanges
• No superimposition of adjacent digits
Demonstrates
• True lateral of metacarpophalangeal joint, proxi-
mal phalanx, proximal interphalangeal joint, middle
phalanx, distal interphalangeal joint, and distal phalanx
• Fractures and dislocations to phalanx of interest
• Pathologic conditions of bone
Anteroposterior Thumb
Positioning Criteria
• Patient seated facing the radiographic table
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR crosswise on table
• Rotate entire arm in order to place the posterior aspect of
the thumb against the IR and parallel to long axis of the IR
• A PA thumb allows for easier positioning for the
patient at the expense of increased OID and should
only be performed if necessary
• Digits 2 to 5 should be pulled back in order to avoid
superimposition over the 1st digit
• Direct central ray perpendicular to IR and the 1st
metacarpophalangeal joint
• Collimate to four sides
• Place appropriate side marker
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• AP projection of the thumb
• Interphalangeal and metacarpophalangeal joints
should be open
Evaluation Criteria
• True PA projection of the digit of interest
• No overlapping of adjacent digits
• Symmetry to soft tissue should be evident
• Interphalangeal joints should be open if hand is truly
extended
• Optimal exposure factors, demonstrating short-scale
contrast
Demonstrates
• Metacarpal phalangeal joint, proximal phalanx, proxi-
mal phalangeal joint, middle phalanx, distal interpha-
langeal joint, and distal phalanx
• Pathologic conditions of the bone
Posteroanterior Oblique Finger
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR crosswise on table
• Pronate hand and extend fingers along a 45-degree
wedge, placing digit of interest in a lateral oblique
and parallel to IR
• Collimate from mentum to approximately 1⬙ (2.5 cm)
below the jugular notch and to the soft tissue margins
laterally
• Alternate medial oblique may be performed for the
2nd digit only in order to reduce OID
• Direct central ray perpendicular to IR and proximal
interphalangeal joint
• Finger of interest should be separated from adjacent
fingers and aligned with long axis of IR
• Collimate to four sides
• Place appropriate side marker to lateral aspect of
image
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• 45-degree oblique of finger of interest
• Interphalangeal and metacarpophalangeal joints
should appear open
• Optimal exposure factors demonstrating short-scale
contrast
• No overlapping of adjacent anatomy
Demonstrates
• 45-degree oblique of metacarpal phalangeal joint,
proximal phalangeal joint, proximal phalanx, distal
interphalangeal joint, and distal phalanx
• Fractures and dislocations of phalanx of interest
• Pathologic conditions of the bone
137
CHAPTER 5
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IMAGING PROCEDURES
• No superimposition of digits 2 to 5
• No rotation; equal amount of soft tissue present
Demonstrates
• True AP of 1st digit, including the trapezium, entire
1st metacarpal, metacarpophalangeal joint, proximal
phalanx, interphalangeal joint, and distal phalanx
• Optimal image demonstrating short-scale contrast
Oblique Thumb
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) crosswise on table
• Hand pronated; thumb and hand extended
• Digits 2 to 5 spread apart from the thumb
• Long axis of thumb aligned to long axis of IR
• Central ray perpendicular to IR and directed to the
1st metacarpophalangeal joint
• Collimate to four sides
• Place appropriate side marker
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• 45-degree oblique projection of the thumb
• Interphalangeal and metacarpophalangeal joints should
be open
• No superimposition of digits 2 to 5
• No rotation; equal amount of soft tissue present
Demonstrates
• Oblique of 1st digit, including the trapezium, entire
1st metacarpal, metacarpophalangeal joint, proximal
phalanx, interphalangeal joint, and distal phalanx
• Fracture, anterior/posterior dislocation
• Pathologic conditions of the bone
• Optimal image demonstrating short-scale contrast
Lateral Thumb
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR crosswise on table
• From a PA hand position, internally rotate the thumb
slightly in order to place it 90 degrees and parallel to
the IR
• Keep digits 2 to 5 away from thumb in order to pre-
vent superimposition
• Direct the central ray perpendicular to the IR and to
the 1st metacarpophalangeal joint
• Collimate to four sides
• Place appropriate side marker to lateral aspect of image
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True lateral of 1st digit
• Interphalangeal and metacarpophalangeal joints
should be open
• No superimposition of anatomy
• Concave appearance of anterior aspect of the phalanges
Demonstrates
• True lateral of 1st digit, including the trapezium, en-
tire 1st metacarpal, metacarpophalangeal joint, proxi-
mal phalanx, interphalangeal joint, and distal phalanx
• Anterior/posterior displacement or fracture of the thumb
• Pathologic conditions of the bone
• Optimal image demonstrating short-scale contrast
Posteroanterior Hand
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 10⬙ ⫻ 12⬙ (25 ⫻ 30 cm) IR crosswise on table; use
half of the IR and cover the other half with lead
• Hand extended and pronated; fingers slightly spread
apart
• Long axis of hand and wrist parallel to long axis of IR
• Central ray perpendicular to IR and directed to the
3rd metacarpophalangeal joint
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• Digits 2 to 5 in PA projection; thumb is obliqued in
this view
• Distal phalanges, distal interphalangeal joints, middle
phalanges, proximal interphalangeal joint, proximal
phalanges, 5 metacarpals, carpals, and 1⬙ (2.5 cm) of
the distal radius and ulna
• Interphalangeal and metacarpophalangeal joints
should be open
• No superimposition of digits
• No rotation; equal amount of soft tissue present
Demonstrates
• Entire hand, including distal phalanges, distal inter-
phalangeal joints, middle phalanges, proximal inter-
phalangeal joints, proximal phalanges, 5 metacarpals,
carpals, and 1⬙ (2.5 cm) of the distal radius and ulna
• The base of the 3rd to 5th metacarpals are free of
superimposition
• Fracture, anterior/posterior dislocation
• Pathologic conditions of the bone
• Optimal image demonstrating short-scale contrast
138
CHAPTER 5
|
IMAGING PROCEDURES
• Rotate hand laterally 45 degrees using a sponge to
hold hand in place
• All digits should be separated and parallel to IR un-
less only the metacarpals are of interest, in which
case the digits may be slightly bent
• Central ray perpendicular to IR and directed to the
3rd metacarpophalangeal joint
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True 45-degree oblique of hand
• Interphalangeal and metacarpophalangeal joints should
be open unless the digits are not parallel to IR
• No superimposition of digits
• The bases of metacarpals 1 and 2 are free of super-
imposition, and the bases of metacarpals 3 to 5 are
superimposed
• Equal amount of soft tissue present
Demonstrates
• Entire hand, including distal phalanges, distal in-
terphalangeal joints, middle phalanges, proximal
interphalangeal joints, proximal phalanges, 5 meta-
carpals, carpals, and 1⬙ (2.5 cm) of the distal radius
and ulna
• Fracture, anterior/posterior dislocation
• Pathologic conditions of the bone
• Optimal image demonstrating short-scale contrast
FIGURE 5-39
FIGURE 5-40
Posteroanterior Oblique Hand
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 10⬙ ⫻ 12⬙ (25 ⫻ 30 cm) IR crosswise on table; use
half of the IR and cover the other half with lead
139
CHAPTER 5
|
IMAGING PROCEDURES
Fan Lateral, Extended Lateral, and Lateral
in Partial Flexion
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR lengthwise on table
• Patient’s hand and wrist should be placed in a true
lateral, 5th digit down
• Fingers should then be fanned out in order to avoid
superimposition of the digits and placed on step
wedge sponge
• Digits should be parallel to the IR; metacarpals are in
a true lateral
• The central ray is perpendicular to the IR and directed
to the 2nd metacarpophalangeal joint
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• Fan lateral of hand
• Interphalangeal joints should be free of superimposi-
tion; however, metacarpals should be superimposed
• Distal 1⬙ (2.5 cm) of radius and ulna should be super-
imposed
• Digits should have equal amount of distance between
them
• Equal amount of soft tissue present
Demonstrates
• Lateral of entire hand, including distal phalanges, dis-
tal interphalangeal joints, middle phalanges, proximal
interphalangeal joints, proximal phalanges, 5 meta-
carpals, carpals, the thumb in a slight oblique, and 1⬙
(2.5 cm) of the distal radius and ulna
• Fracture and dislocations of the phalanges
• Anterior/posterior dislocation of the metacarpals
• Pathologic conditions of the bone
• Optimal image demonstrating short-scale contrast
Extension Lateral/Partial Flexion Lateral
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR lengthwise on table
• Patient’s hand and wrist should be placed in a true
lateral, 5th digit down
• Fingers and metacarpals should be superimposed and
extended, directed parallel to the long axis of the IR
• The partial flexion lateral is used for patients unable
to extend hand because of pain, fracture, or surgery
• The central ray is perpendicular to the IR and directed
to the 2nd metacarpophalangeal joint
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria for Extension Lateral
of Hand
• Superimposition of entire hand and wrist, including
phalanges, metacarpals, and carpals
• Distal 1⬙ (2.5 cm) of radius and ulna should be super-
imposed
Demonstrates
• Foreign bodies to hand
• Anterior/posterior dislocation of the metacarpals
FIGURE 5-41
• Pathologic conditions of the bone
• Optimal image demonstrating short-scale contrast
Posteroanterior Wrist
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 10⬙ ⫻ 12⬙ (25 ⫻ 30 cm) IR crosswise on table;
use half of the IR and cover the other half with lead
140
CHAPTER 5
|
IMAGING PROCEDURES
• Hand pronated and fingers clenched, making a fist
and bringing the carpals closer to the IR
• The central ray is perpendicular to the IR and di-
rected to the midcarpal area
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True PA of the wrist
• Equal distance evident between the carpals
• Separation of the radius and ulna
Demonstrates
• Metacarpals, carpals, and distal one-third of radius
and ulna
• Scaphoid, capitate, hamate free of superimposition
• An AP wrist with a slight arch may be done to place
carpals in close contact with the IR to better dem-
onstrate intercarpal spaces and rule out ligament
disruption
• Fractures of the carpals, distal radius, ulna, and radial
or ulna styloid
• Pathologic conditions of the bone
Posteroanterior Oblique Wrist
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 10⬙ ⫻ 12⬙ (25 ⫻ 30 cm) IR crosswise on table; use
half of the IR and cover the other half with lead
• Hand pronated, fingers extended and rotated 45 de-
grees externally, parallel with the long axis of the IR
• The central ray is perpendicular to the IR and di-
rected to the midcarpal area
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• 45-degree oblique of the wrist
• Separation of the radius and ulna
FIGURE 5-42
141
CHAPTER 5
|
IMAGING PROCEDURES
Demonstrates
• Metacarpals, carpals, and distal one-third of radius
and ulna
• Trapezium, scaphoid, and trapezoid are best demon-
strated
• Ulnar head is superimposed over the distal radius
• Fractures of the carpals, distal radius, ulna, and radial
or ulna styloid
• Pathologic conditions of the bone
Anteroposterior Oblique Wrist
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 10⬙ ⫻ 12⬙ (25 ⫻ 30 cm) IR crosswise on table; use
half of the IR and cover the other half with lead
• Hand supinated, fingers extended and rotated 45 de-
grees medially, parallel with the long axis of the IR
• The central ray is perpendicular to the IR and di-
rected to the midcarpal area
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• 45-degree oblique of the wrist
• Separation of the radius and ulna
Demonstrates
• Metacarpals, carpals, and distal one-third of radius
and ulna
• Triquetrum and pisiform are best demonstrated, free
of superimposition
• Ulnar head is superimposed over the distal radius
• Fractures of the carpals, distal radius, ulna, and radial
or ulna styloid
• Pathologic conditions of the bone
Lateral Wrist
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR lengthwise on table
• Hand and wrist extended in a true lateral, ulnar side down
• Hand and wrist parallel with the long axis of the IR
• The central ray is perpendicular to the IR and directed
to the midcarpal area
• Collimate to four sides
• Place appropriate side marker
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True lateral of wrist
• Centered to IR
• Four-sided collimation
FIGURE 5-43
142
CHAPTER 5
|
IMAGING PROCEDURES
FIGURE 5-44
• Scaphoid centered to IR
• Four-sided collimation evident
Demonstrates
• Scaphoid is best demonstrated without superimposi-
tion or foreshortening
• Distal radius and ulna
• Lateral carpals and interspaces open
• Best demonstrates fracture of the scaphoid
Posteroanterior Stecher
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR lengthwise on table
• Hand and wrist placed PA and deviated toward ulna
• Central ray is angled 15 degrees to 20 degrees proxi-
mally and directed to the scaphoid, or snuff box, lo-
cated (2 cm, or ¾ inch, proximal and 2 cm, or ¾ inch
lateral to first carpometacarpal joint)
1
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• PA scaphoid demonstrated without superimposition
of adjacent carpals
• Scaphoid centered to IR
• Four-sided collimation evident
Demonstrates
• Scaphoid is best demonstrated without superimposi-
tion or foreshortening
• Distal radius and ulna
• Lateral carpals and interspaces open
• Best demonstrates fracture of the scaphoid
Carpal Canal
Positioning Criteria
• Patient seated facing the radiographic table; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR crosswise on table
• Instruct patient to hyperextend fingers in order to
bring metacarpals and digits as vertical as possible,
while leaving the carpals and forearm on IR
• Patient may use opposite hand to hold the dorsi-
flexed fingers of the affected hand in position
• Rotate hand and wrist 10 degrees toward thumb
• Angle central ray 25 degrees to 30 degrees to the long
axis of the hand, more if dorsiflexion is minimal, and
1⬙ (2.5 cm) distal to the base of the 3rd metacarpal
• Collimate to four sides
• Place appropriate side marker on lateral aspect
Demonstrates
• Metacarpals, carpals, and distal one-third of radius
and ulna superimposed
• Pronator fat pad demonstrated ½⬙ (1 cm) anteriorly
to radius
• Barton, Colles, and Smith fractures
• Anterior/posterior displacement and fractures of the
carpals, distal radius, and ulna
• Pathologic conditions of the bone
Posteroanterior Scaphoid
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Place 8⬙ ⫻ 10⬙ (20 ⫻ 25 cm) IR lengthwise on table
• Hand and wrist placed PA and deviated toward ulna
• Lateral hand and wrist elevated 20 degrees on a sponge
• Central ray is perpendicular to the IR and directed to
the scaphoid, or snuff box, located (2 cm, or ¾ inch,
proximal and 2 cm, or ¾ inch lateral to first carpo-
metacarpal joint)
1
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• PA scaphoid demonstrated without superimposition
of adjacent carpals
143
CHAPTER 5
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IMAGING PROCEDURES
Evaluation Criteria
• Carpals appear arched
• Collimation visible on four sides
• 10-degree internal rotation evident by hamulus and
pisiform free of superimposition
Demonstrates
• Pisiform and hamulus demonstrated in profile
• Demonstrates abnormal calcifications and bony
changes in carpal sulcus, causing impingement on
median nerve
• Capitate, scaphoid, and trapezium also well demon-
strated
Forearm
FOR FOREARM PROJECTIONS, TAKE INTO CONSIDE-
RATION ANODE HEEL EFFECT AND PLACE WRIST
UNDER ANODE ASPECT OF X-RAY BEAM.
Positioning Criteria
• Patient seated facing the table and elbow extended;
full shield
• Place 14⬙ ⫻ 17⬙ (35 ⫻ 42.5 cm) IR
• Entire forearm to humerus parallel to IR
• Central ray perpendicular to IR and midway between
elbow and wrist
• Collimate to lateral margins of forearm and vertically
if possible
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True AP of forearm
• No superimposition of distal radius and ulna
• Collimation evident
Demonstrates
• AP of radius and ulna
• The distal row of carpal bones
• Superimposition of radial tuberosity over proximal
ulna
• Pathology of radius and ulna
• Fractures
Lateral Forearm
Positioning Criteria
• Patient seated and elbow flexed 90 degrees; full shield
• Hand in extension lateral
• Place 10⬙ ⫻ 12⬙ (25 ⫻ 30 cm) IR
• The central ray is perpendicular to the IR and di-
rected to the midshaft of radius and ulna
• Collimate to four sides
• Place appropriate side marker on lateral aspect
• Minimum SID: 40⬙ (100 cm)
Evaluation Criteria
• True lateral of forearm
• Collimation evident
Demonstrates
• Superimposition of carpals, distal radius, and ulna
• Epicondyles of the humerus should be superimposed
and perpendicular to the table
• The radial head will slightly superimpose over the
ulna
• Pathologies of the forearm
Elbow
FOR ELBOW PROJECTIONS, TAKE INTO CONSIDERATION
ANODE HEEL EFFECT AND PLACE WRIST UNDER ANODE
ASPECT OF X-RAY BEAM.
FIGURE 5-45