The Elbow 2

Question 1

Supplementary/Additional projections for the elbow joint

Answer 1

a. Antero-posterior projections with partial flexion of the
elbow
b. Axial Projections (Jones method)

Question 2

Elbow projections for head of radius

Answer 2

c. Lateral with palm supinated
d. Lateral with palm facing away from body
e. Lateral with palm facing body
f. Lateral with palm facing down

Question 3

What projection is done when the patient is unable to fully extend the elbow joint.

Answer 3

Antero-posterior projections with partial flexion of the
elbow

Question 4

types of Antero-posterior projections with partial flexion of the
elbow

Answer 4

1. AP with forearm in contact with the IR
2. AP with upper arm in contact with IR .
3. AP with the olecranon resting on the
   image receptor.
4. AP projection Supracondylar fracture with
   elbow joint fully flexed.
5. Lateral projection in Supracondylar fracture.

Question 5

AP with forearm in contact with IR is done when.

Answer 5

if the main area of interest (e.g. fracture
site) is in the proximal end of the radius & ulna.

Question 6

AP with forearm in contact with IR patient positioning.

Answer 6

• The patient is seated alongside the x-ray couch with the affected
  side near the couch
• The posterior part of the forearm placed on the couch and palm in
  supination
• The image receptor is placed under the forearm and centred under
  the elbow joint.
• Adjust the arm so that the medial and lateral epicondyle of humerus are equidistant from the image receptor.

Question 7

AP with forearm in contact with IR centering point.

Answer 7

In the midline of the forearm 2.5 cm distal to the
crease of the elbow

Question 8

AP with forearm in contact with IR direction of CR.

Answer 8

Vertical at 90⁰ to the image receptor

Question 9

Evaluation criteria for AP elbow with forearm in contact
with image receptor

Answer 9

• Evidence of proper collimation
• Proximal radius and ulna without rotation or distortion
• Radial head, neck and tuberosity slightly superimposed over
  the proximal
• Partial open elbow joint
• Foreshortened distal humerus
• Soft tissue and bony trabecular detail

Question 10

AP with upper arm in contact with the
image receptor when is it done.

Answer 10

• Performed when the main area of interest is the distal
  end of the humerus

Question 11

AP with upper arm in contact with the IR patient positioning.

Answer 11

• The posterior aspect of the humerus is placed in contact with
  the couch and hand facing upwards
• The image receptor is placed under the humerus with its centre
  under the elbow joint.
• Adjust the hand so that the medial and lateral epicondyles are equidistant from the ir.

Question 12

Centering point of the Ap with upper arm in contact with IR.

Answer 12

Midway between the epicondyles of the humerus

Question 13

Evaluation criteria for AP elbow with humerus in contact
with image receptor

Answer 13

Evidence of proper collimation
* Distal humerus without rotation or distortion
* Proximal radius superimposed over the ulna
* Closed elbow joint
* Greatly foreshortened proximal forearm
* Trabecular detail on the distal humerus
* Soft tissue and bony trabecular detail

Question 14

AP with the olecranon resting on the
image receptor.

Answer 14

• Performed if the patient is unable to extend the elbow
  to 90⁰ due to pain (presence of supracondyle fracture)

Question 15

AP with the olecranon resting on the image
receptor patient positioning.

Answer 15

• Rest the olecranon on the image receptor
• Support both the forearm and humerus at an angle of 45⁰
  the image receptor

Question 16

AP with olecranon resting on ir centering point.

Answer 16

Vertical beam centre the midline of the
crease of the elbow

Question 17

AP projection Supracondylar fracture with
elbow joint fully flexed centering point and direction of central ray.

Answer 17

From the lateral position, the patient’s upper body is rotated
towards the affected side

• With elbow joint fully flexed: Horizontal central beam is directed at
  90⁰ to the humerus passing through the forearm to a point midway
  between epicondyles of humerus.

Question 18

Lateral projection in Supracondylar fracture

Answer 18

Patient positioning
* The patient sits or stands facing the x-ray tube
* An 18 x 24 cm image receptor is supported between the
patient’s trunk and elbow
* The medial aspect of the elbow is in contact with the image
receptor
* The patient’s trunk is protected from radiation by a lead rubber
sheet positioned between the trunk and back of image receptor

Question 19

Lateral projection in supracondylar fracture centering point.

Answer 19

Angle the beam so that it is perpendicular to the
shaft of the humerus

Direction of central ray: Horizontal 90⁰ to the image receptor
* Note: the image should include the lower end of the humerus
and upper third of radius and ulnar