Title: Upper Extremity Imaging
1Upper Extremity Imaging
- Critical Thinking Activity
2Case Study
- A patient with tennis elbow is scheduled for a
routine elbow series. - The patient is a 22 y/o male who has normal arm
mobility - Patient walks into the Medical Imaging Department
at 200pm
3Physicians Order
- Elbow routine series
- Routine projections are.
- History
- Patient complains of pain in the right elbow x10
days - R/O
- Fracture
- Tendonitis
4Elbow Projections
- Select the projection you would complete now?
- AP Elbow
- Medial Oblique Elbow
- Lateral Oblique Elbow
- Lateral Elbow
5AP Elbow
- What is your
- Image receptor choice?
- Arm position?
- CR entrance point?
6AP Elbow
7You produced the following image.
- Anatomy included
- Centering
- IR (type, size, orientation)
- Collimation
- Rotation - 0º
- Arm Extension
- Correct labeling
- Exposure factors Next Position
8AP Elbow Evaluation
- Anatomy distal humerus and proximal radius and
ulna - Centered well elbow joint
- 8x10 LW Extremity IR used
- Collimation to include the soft tissue
- Back to image
9AP Elbow Evaluation
- Rotation - 0º
- Too much superimposition of the radius and ulna
- Olecranon process not symmetrical or rotated
cobra - This indicates
- Medial rotation
- Lateral rotation
- Back to image
10 Medial Rotation is correct
11Medial Rotation is correct
- How would you correct your positioning error?
- Rotate the arm laterally or toward the AP
position until the epicondyles are parallel to
the IR
Back to image
12Do you think Lateral Rotation is the correct
answer? Yes or No
13AP Elbow Evaluation
- Lateral rotation is not the correct answer go
back! - Back to rotation
14AP Elbow Evaluation
- Arm Extension
- Arm fully extended olecranon process in the
olecranon fossa - Labeling
- Marker missing add R marker
- Exposure factors
- Correct soft tissue and boney trabecular
markings are visualized - Back to image
- Next Position
15Medial Oblique Elbow
- What is your
- Image receptor choice?
- Arm position?
- CR entrance point?
16Medial Oblique Elbow
17You produce the following image
- Anatomy included
- Centering
- IR (type, size, orientation)
- Collimation
- Rotation - 45º
- Arm Extension
- Correct labeling
- Exposure factors
- Next Position
18Medical Oblique Elbow Evaluation
- Anatomy distal humerus and proximal radius and
ulna - Centered well elbow joint
- 8x10 LW Extremity IR used
- Collimation to include the soft tissue
- Back to image
19Medial Oblique Elbow Evaluation
- Rotation 45
- Too much superimposition of radius and ulna
- Radial head super imposes the coronoid process
- This indicates
- Excessive medial rotation
- Insufficient medial rotation
20Excessive Medial Rotation is correct
21Excessive Medial Rotation is correct
- How would you correct your positioning error?
- Rotate the arm laterally or toward the AP
position until the epicondyles are 45 to the IR - Back to image
22Do you think Insufficient Medial Rotation is
correct? Yes or No
23Medical Oblique Elbow Evaluation
- Insufficient medial rotation is not the correct
answer go back to the original image. - Back to rotation
24Medial Oblique Elbow Evaluation
- Arm Extension
- Arm fully extended olecranon process in the
olecranon fossa - Labeling
- Marker missing add R marker
- Exposure factors
- Correct soft tissue and boney trabecular
markings are visualized - Back to image
- Next Position
25Lateral Oblique Elbow
- What is your
- Image receptor choice?
- Arm position?
- CR entrance point?
26Lateral Oblique Elbow
27You produce the following image
- Anatomy included
- Centering
- IR (type, size, orientation)
- Collimation
- Rotation - 45º
- Arm Extension
- Correct labeling
- Exposure factors
- Next Position
28Lateral Oblique Elbow Evaluation
- Anatomy distal humerus and proximal radius and
ulna - Centered well elbow joint
- 8x10 LW Extremity IR used
- Collimation to include the soft tissue could be
opened superiorly and inferiorly - Back to image
29Lateral Oblique Elbow Evaluation
- Rotation 45
- The radius and ulna are not separated enough so
the Radial head, neck, and tuberosity are not
clearly seen - This indicates
- Excessive lateral rotation
- Insufficient lateral rotation
30Do you think . . . Excessive Lateral Rotation is
the correct answer? Yes or No
31Lateral Oblique Elbow Evaluation
- Excessive lateral rotation is not the correct
answer, go back! - Back to rotation
32Insufficient Lateral Rotation is correct
33Insufficient Lateral Rotation is correct
- How would you correct your positioning error?
- Rotate the arm laterally until the epicondyles
are 45 to the IR - Back to image
34Lateral Oblique Elbow Evaluation
- Arm Extension
- Arm fully extended olecranon process in the
olecranon fossa - Labeling
- Marker missing add R marker
- Exposure factors
- Correct soft tissue and boney trabecular
markings are visualized - Back to image
- Next Position
35Lateral Elbow
- What is your
- Image receptor choice?
- Arm position?
- CR entrance point?
36Lateral Elbow
37You produce the following image
- Anatomy included
- Centering
- IR (type, size, orientation)
- Collimation
- Total Extremity Position
- 90º flexion
- Correct labeling
- Exposure factors
- Next Position
38Lateral Elbow Evaluation
- Anatomy distal humerus and proximal radius and
ulna - Centered well elbow joint
- 8x10 LW Extremity IR used
- Collimation to include the soft tissue
- Back to image
39Lateral Elbow Evaluation
- Total Extremity Position
- The 3 concentric arcs are not superimposed
- The trochlear notch is closed inferiorly
- This indicates
- Humerus elevation
- Forearm elevation
40Humerus Elevation is correct
41Humerus Elevation is correct
- How would you correct your positioning error?
- Lower the shoulder or raise the arm until both
humerus and forearm are in the same plane of
reference - (parallel to the IR)
- Back to image
42Do you think Forearm Elevation is the correct
answer? Yes or No
43Lateral Elbow Evaluation
- Forearm elevation is not the correct answer go
back! - Total extremity positioning
44Lateral Elbow Evaluation
- 90º flexion
- Arm flexed 90º olecranon process seen in profile
without superimposition - Labeling
- Marker missing add R marker
- Exposure factors
- Correct soft tissue and boney trabecular
markings are visualized - Back to image
- Next Position
45Congratulations
- You have just completed another procedure
- getting the patient
- Producing images
- to taking your completed images to the
radiologist for interpretation!!