Chapter 5: Elbow and forearm; General procedural guidelines and projections

Question 1

What items must be removed on the upper extremity (forearm, elbow, humerus)

Answer 1

watches, rings, bracelets, bras (humerus only)

Question 2

What size cassette should be used for elbow and forearm?

Answer 2

14 x 17

Question 3

What’s the standard SID for elbow and forearm procedures?

Answer 3

40 inches

Question 4

What are the essential projections for the forearm?

Answer 4

AP and Lateral

Question 5

What should the collimation be for AP and lateral forearm images?

Answer 5

2 inches distal to the wrist joint and proximal to the elbow joint.

remember, you want to see the joint spaces in the wrist and elbow

Question 6

What should the patients position be for an AP forearm?

Answer 6

seat the patient close to the table and low enough to place the entire extremity in the same plane?

Question 7

What position should the forearm be in for an AP forearm?

Answer 7

the elbow should be extended with hand supinated

humeral epicondyles should be equidistant from IR

long axis of forearm aligned parallel

Question 8

What should the patients position be for a lateral forearm?

Answer 8

Seat the patient close to the radiographic table with entire upper extremity in same plane with forearm resting on ulnar surface

Question 9

What position should the forearm be in for a lateral forearm?

Answer 9

Elbow flexed 90 degrees, thumb side up, ulnar and radial styloid processes superimposed

long axis aligned parallel with IR

Question 10

Where should the CR enter and where should it be in regards to the IR for a Lateral forearm?

Answer 10

the central ray should be directed perpendicular to the IR

Enters the patient at the midpoint of the forearm

Question 11

What are the essential projections for the elbow?

Answer 11

AP
Lateral
AP oblique medial rotation
AP oblique lateral rotation

Question 12

What should the patients position be like for an AP elbow image?

Answer 12

Seat the patient near the radiographic table

Low enough to place the shoulder joint, humerus, and elbow joint in the same plane.

Question 13

How should the elbow be positioned for an AP elbow image?

Answer 13

Upper extremity in same plane with posterior surface in contact with IR

Elbow extended and hand supinated

Elbow centered to middle of IR

Patient lean laterally until the humeral epicondyles are parallel with the plane of the IR

Question 14

Where should the central ray enter for an AP elbow?

Answer 14

It should enter perpendicular to the elbow joint

Question 15

What should the collimation be for an AP elbow?

Answer 15

3 inches proximal and distal to the elbow joint and 1 inch on the sides

Question 16

How should the elbow be positioned for a lateral elbow image?

Answer 16

elbow flexed 90 degrees and placed in center IR

forearm resting on ulnar surface (thumb side up)

wrist in true lateral

humeral epicondyles perpendicular to IR

Question 17

What’s an acceptable angle for the elbow to be in for a lateral elbow image if there is a soft tissue injury and the patient is unable to achieve a 90 degree angle?

Answer 17

30-35 degrees

Question 18

Where should the CR enter for a lateral elbow image?

Answer 18

it should enter at the elbow joint