upper extremities

Question 1

AP projection of the fingers

Answer 1

patient postion: siting upright 
Direction of the tube: perpendicular 
Central Ray: to proximal interphalangeal joint 
IR size: 8x10 
table top 
Crosswise 
SID: 40"
Bony Markings: the entire phalange requested, distal phalanx, middle phalanx, proximal phalanx

Question 2

Lateral finger

Answer 2

patient position: 4&5 hand in lateral position resting on ulnar surface; for fingers 2 & 3 hand in lateral position resting on radial surface; finger in question is extended with other fingers flexed
Direction of tube: perpendicular to IR
center ray: to proximal interphalanageal joint
IR: 8x10
table top
IR postion: crosswise
SID: 40”
Boney markings: enter finger requested should be on the IR

Question 3

Medial or Lateral oblique of fingers

Answer 3

Patient postion: finger is oblique 45 degrees; other fingers should be positioned so as not to overlap the finger in question
Direction of tube: perpendicular to IR
Central Ray: próximal interphalangeal joint
IR size: 8x10
Table top
IR probation: crosswise
SID: 40”
Bony Markings: an oblique view of the entire finger

Question 4

AP of Thumb

Answer 4

Patient position: thumbs should be supinated on IR
Direction of tube: perpendicular
Central Ray: to the first metacarpal joint
IR size: 8x10
table top
IR: crosswise
SID: 40”
Bony Markings: entert frontal view of the thumb; three articulations should be demonstrated (inrephalangeal, metacarpophalangeal, and carpometacarpal joints)

Question 5

oblique of thumb

Answer 5

Patient positon: place the hand in the prone position; when the hand is pronated the thumb is in the oblique position
Direction of tube: Perpindicular
Central Ray: to metacarpophalangeal joint
IR size: 8x10
Table top
IR: crosswise
SID: 40”
Bony markings: oblique view of the enter thumb three articulations should be demonstrated. (CMC,MP & IP joint)

Question 6

lateral of thumb

Answer 6

patient position: fingers elevated enough to place the lateral surface of the thumb adjacent to IR 
Direction of the tube: Perpendicular 
center ray: to metacarpal joint 
IR size: 8x10
Table top 
IR position: crosswise 
SID: 40" 
Bony Markings: lateral view of the entire thumb; to include  three articulations (CMC, MP,& IP joints)

Question 7

PA of hand

Answer 7

patient position: sitting, forearm resting on table, hand in pronation
Direction of tube: perpendicular
Center Ray: central ray to 3rd meracarpaphalangeal joint
IR size: 10x12
Table Top
crosswise
SID 40”
Bony markings: all the digits and the wrist bones, All phalanges, metacarpals and carpals. Fingers should be separated enough so that the soft tissue of fingers does not overlap

Question 8

Oblique of hand

Answer 8

patient positon: sitting hand obliqued 45 degrees.
Direction of tube: perpendicular
central Ray: central ray to 3rd metacarpaphalageal joint
IR size: 10x12
table top
crosswise
SID: 40”
Bony Markings: oblique view of all the digits and the carpal bones; 1st and 2nd metacarpals should not overlap. slight overlap of the heads of 3,4, and 5 metacarpals. MC &m IP joints should be clearly seen.

Question 9

Lateral view of hand

Answer 9

patient position: hand in lat. position; hand resting on ulnar surface. natural flection- For fracture, Lateral in extension- foreign bodies
Direction of tube: perpendicular
Central Ray: to metacarpaphalaneal joint
IR size: 10x 12
table top
IR: crosswise
SID: 40”
bony markings: metacarpals 2-5 and phalanges are superimposed; thumb should be seen in PA positon

Question 10

Carpal Bones

Answer 10

scaphoid
lunate
triquetrum
pisiform
trapezium 
trapezoid 
capitate 
hamate

Question 11

PA of wrist

Answer 11

Patient position: sitting hand resting on IR in pronated, fingers flexed to allow wrist to be flat
Direction of tube: perpendicular
Central Ray: the ray is centered at mid area of carpals
IR size: 10x12
table top
crosswise
SID: 40”
Bony Markings: Carpal bones, distal radius and ulna and proximal metacarpals, good view for ulnar styloid process

Question 12

oblique view of wrist

Answer 12

patient position: sitting; wrist resting on ulnar surface while and hand and fingers are slightly flexed. Oblique 45 degrees 
direction of tube: perpendicular 
Central Ray: mid-carpal area 
IR size: 10x12 
table top 
crosswise
SID:40"
Bony markings: demonstrate carpals on the lat. side of wrist.

Question 13

Lateral view of the wrist

Answer 13

P.P: sitting; wrist resting on ulnar surface
direction of tube: perpendicular
central ray: the ray is center to midcarpal area
IR size: 10x12
Table top
crosswise
SID: 40”
Bony markings: entire view of the carpal bones, distal radius and ulnar superimposed

Question 14

PA of scaphoid (Navicular)

Answer 14

PP: sitting: forearm resting on the table; wrist resting on its anterior surface; hand is in ulnar deviation
Direction of tube: CR ample 10 to 15 degrees towards Elbow
center ray: to the scaphoid (navicular)
IR: size 10x12
table top
crosswise or lateral
SID:40”
bony markings: scaphoid (navicular) projected clear with only minimum overlap at either end; Scaphoid (navicular) should not appear foreshortened.

Question 15

AP of forearm (ulna and Radius)

Answer 15

P.P: siting down; hand supinated with entire hand resting on table.
Direction of tube: perpendicular
Central ray: the ray is centered at the mid-shaft of the ulna and radius
IR size: 10x12
Table Top
length wise
SID: 40”
bony markings: frontal view of entire ulna and radius; to include the wrist and elbow joints

Question 16

lateral view of the forearm

Answer 16

PP: siitng on stool at end of X-ray table; extremity resting on IR with the elbow flexed 90 degrees; hand in true lat. pos; forearm resting on ulnar side
Direction of tube: perpendicular
center ray: the ray is centered at the mid-shaft of the ulna and radius
IR size: 10x12
table top
length wise
SID: 40”
bony markings: lateral view of the entire ulna and radius; the ulnar head superimposed on radius, epicondyles superimposed. radial head superimposed on coronoid process

Question 17

AP of elbow

Answer 17

PP: sitting on stool with the am fully extended on X-ray table 
Direction of tube: perpendicular 
center ray: at the elbow joint 
IR size: 10x12
table top 
length wise or crosswise 
SID: 40"
bony markings: frontal view of elbow joint to include the distal part of humerus and proximal radius and ulna elbow space between the radial head and capitulum should be clearly seen. redial head, neck and radial tubercle are slightly superimposed on proximal ulna.

Question 18

lateral view of Elbow

Answer 18

PP: sitting; the elbow is flexed at a 90 degree angle; hand resting on ulnar surface; 
direction of the tube: perpendicular 
center ray; at the joint of the elbow
10x 12
table top 
length wise or crosswise 
SID: 40" 
bony markings: lateral view of elbow which includes the proximal part of Radius & ulna,  and distal part of Humerus; good view of oleacrnon process. About 1/3 of radial head superimposed by coronoid.

Question 19

AP Oblique of elbow (medial oblique)

Answer 19

PP: extend elbow and supinate the hand then from this position have patient pronate the hand 
Direction of tube: perpendicular
Central Ray: elbow joint 
IR size: 10x12
table top 
Crosswise 
SID: 40"
bony markings: coronoid process projected free of superimposition

Question 20

AP oblique of elbow (lateral oblique)

Answer 20

PP: First extend elbow and supinate hand then from this position rotate forearm and hand 45 degrees externally 
Direction of tube: perpendicular 
Central Ray: to elbow joint 
IR size: 10x12
table top
IR position: crosswise 
SID: 40"
Bony markings: capitulum and Radial head are well demonstrated

Question 21

Humerus AP

Answer 21

AP supine or erect; hand is supine (coronal plane between the epicondyles is parallel to IR)
Direction of tube: perpendicular
Center ray: to the shaft of the humerus
IR size: 14x17
Bucky, but can be table top for a small patient
IR: length wise
IR distance: 40”
bony markings: the entire humerus; the greater tubercle should be projected laterally and demonstrated in profile

Question 22

lateral view of humerus

Answer 22

PP: supine, hand should be turned internally util the coronal plane between the epicondyles is perpendicular to IR
Direction of tube: perpendicular
center ray: the ray is centered to the shaft of the humerus
IR size: 14x17
Bucky however, can be table top for small patients
IR: length wise
SID: 40”
bony markings: the entier humerus; lesser tubercle should be projected medially; humeral condyles should be superimposed

Question 23

AP shoulder

Answer 23

PP: Mid coronal plane of epicondyles is parallel with IR; Done in the supine position o erect; elbow fully extended, hand is in supination
direction of tube: perpendicular
Central Ray: one inch inferior to the coracoid process (Coracoid is about 3/4 of an inch inferior to the lateral portion of the clavicle)
IR size 10x12
Bucky
IR positon: crosswise
IR distance: 40”
bony markings: scapula, clavicle, proximal humerus and glenoid fossa; profile view of greater tubercle

Question 24

shoulder (internal rotation)

Answer 24

PP: supine, arm rotated internally with the hand in extreme pronation
- coronal plane of epicondyles is perpendicular to the IR
Direction of tube: perpendicular
CR: one inch inferior to Coracoid process: (coracoid is about 3/4 inch inferior to the lateral portion of the clavicle)
IR size 10x12
Bucky
IR position: crosswise
SID: 40”
bony markings: the lesser tuberosity projected medially:; scapula proximal humerus are also demented

Question 25

transthoraic view of humerus (Lawrence position)

Answer 25

PP: can be done erect o supine; side of interest against IR; opposte extremity is elevated above the patient's head. Direction of tube: perpendicular Central Ray: the ray is centered at the mid-point of the IR IR size: 10x12 Bucky IR position length wise SID: 40" Boney markings: lateral view of humerus projected through the thorax. (might use breathing technique to blur out other organs) humeral head must be included on IR

Question 26

Axial view of the shoulder (Lawrence Position) inferior superior projection

Answer 26

PP: supine; the extremity being examined is abducted to form 90m degree angle to long axis of boy. keep hand supinated. Direction of tube: perpendicular central ray: the ray is centered to the axilla to the region of the acromioclavicular joint. IR: 10x12 Grid IR position: crosswise SID 40" Bony markings: upper end of humerus, glenoid fossa, lateral portion of coracoid pointing anteriorly, and acromioclavicular articulation.

Question 27

Clavicle; AP projection

Answer 27

``` PP: supine ro prone Direction of tube: 90 degree angle central ray: center to the mid-point of clavicle IR size: 10x12 Bucky IR postion: crosswise SID: 40" Bony markings: clavicle, scapula, and humerus ```

Question 28

Axial view of clavicle

Answer 28

PP: supine; AP projection Direction of tube: 15 to 30 degrees cephalad ( towards the head), degree of angle depends on size of patients central ray: the ray is center to mid-shaft of the clavicle IR size: 10x12 Bucky IR position; cross-wise SID: 40" bony markings: Axial view of clavicle: most of the clavicle is projected above the ribs and scapula

Question 29

AC joints (Acromioclavicular joint AP)

Answer 29

``` PP: upright tube: perpendicular Central ray: the C.R is centered 1 Inch above jugular notch Digital IR: 14x17 Bucky IR position: crosswise SID: 72" bony markings: clavicle, humerus, and scapula; and both AC joints should be included ```

Question 30

AP scapula

Answer 30

PP: PT. supine; arm is abducted; to form a 90 degree plane with long axis of body Direction of tube: 90 C.R.: mid scapula IR size: 10x12 bucky IR position: lengthwise SID: 40" Bony markings: entire scapula; acromion process, coracoid process, and gleniod fossa clearly visible

Question 31

lateral projection of scapula

Answer 31

PP: patient is positioned in RAO/LAO; adjust the body (rotate body) to place the scapula perpendicular to the plane of the IR. To demonstrate the body of scapula rest forearm of effect side on head. to demonstrate the acromion and coracoid process better, have the patent flex elbow and place in back at level of their waist. Direction of tube perpendicular to the IR central ray: to the mid-point of the vertebral (medial) border of the scapula IR size: 10x12 Bucky IR position: length wise SID: 40" bony markings: A lateral view of the scapula: the axillary (lateral) and vertebral (medial) borders of the scapula are superimposed)