radiographic techniqes 2 upeer limb projection

The skeleton boneinvestigations ( upper limb) 2

1. FACULTY OF MEDICAL TECHNOLOGY
Radiographic Techniques
UPPER LIMB 2
2024

2. HUMERUS RADIOGRAPH

3. Anatomy of Humerus

4. HumerusAP
•mAs15
•kVp60
•IRSize 35 ×43 cm (14 ×17 inch)
•Central Ray perpendicular beam
directed at the center of humerus
•SID100 cm (40 inches)
•Respirationsuspended
Pathology
fracture and bony lesion of humerus
Collimation
Include the entire humerusincluding the
proximal portion of forearm and elbow
joint.

5. Position:
1.The patient is placed either in a supine position or in an erect position.
2. Place the humerusat the center of the image receptor (IR).
3. Lean the body towards the IRto place the shoulder joint and proximal
portion of the humerustightly on the IR.
4. Supinate the hand and abduct the arm to align lateral epicondyle of
elbow joint and medial epicondyle parallel to the IR.

6. Erect HumerusAP

7. HumerusLateral
•mAs 20
•kVp 65
•IRSize 35 ×43 cm (14 ×17 inch)
•Central Rayperpendicular beam
directed at the center of humerus
•SID100 cm (40 inches)
•Respirationsuspended
Pathology
fracture and bony lesion of humerus
Collimation
Include the entire humerusincluding the
proximal portion of forearm and elbow
joint.

8. 1. The patient is placed either in a supine position or in a erect position.
2. Adjust the posture of the elbow joint of the filming arm to 90°flexion.
3. Attach the humerusand shoulder joint tightly on imagereceptor (IR).
Position:

9. Erect LATHumerus

10. AP SUPINE LATSUPINE

11. SHOULDER RADIOGRAPH

12. Shoulder Anatomy
The shoulder consists of:
Shoulder blade (scapula).
Collarbone (clavicle).
Upper arm bone (humerus).
Thetwojointsthatmakeupyourshoulderjointare:
Glenohumeraljoint
Theglenohumeraljointjoinstheroundedtopofyourupperarmboneintoyour
shoulderblade(glenoidcavityofthescapula).
AcromioclavicularjointTheacromioclavicularjointjoinsthetopofyour
shoulderblade(acromion)andyourcollarbonetogether.

15. Shoulder AP view
fracture of distal humerusand clavicle,dislocation, subluxation and
calcification of shoulder joint
Patient position
Patientispreferablyerect.
Thepatient'sbackisagainsttheimagereceptor.
Glenohumeraljointoftheaffectedsideisatthecenteroftheimagereceptor.
Affectedarmisinaneutralpositionbythepatientside.
Thepatientisslightlyrotated5-10°towardtheaffectedside.Therefore,thebodyof
thescapulaislayingparallelwiththeimagereceptor.
Projections

16. Technicalfactors
Centeringpoint:
o2cminferiortothelateralclavicleattheleveloftheglenohumeraljoint
Collimation:
osuperiortotheskinmargins
oinferiortoincludeone-thirdoftheproximalhumerus
olateraltoincludetheskinmargin
omedialtoincludethesternoclavicularjoint
Detectorsize:
o24cmx30cm
Exposure
o60-70kVp
o10-18mAs
SID:100cm
Grid:yes

17. 1.anatomical neck of
humerus
2.greater tuberosity
3.lesser tuberosity
4.surgical neck of
humerus
5.humeral shaft
6.humeral head
7.glenoid fossa
8.acromion
9.acromioclavicular
joint
10.coracoid process
11.clavicle
12.superior angle of
scapula
13.medial border of
scapula
14.inferior angle of
scapula
15.lateral border of
scapula
16.scapula

20. Shoulder axial view
Theaxialshoulderview(superior-inferior)isanappropriate
projectiontoassesssuspecteddislocations,proximalhumerus
pathology,andglenohumeralarticularsurfaceabnormalities.
Patientposition
Patientseatednexttotheimagereceptor.
Imagereceptoratmidthoracicheight.
Affectedarmisabductedwiththeelbowrestingonthedetector.
Thearmmustbeabductedenoughthattheglenohumeraljointis
centraltotheimagedetector(thepatientmayneedtolean
slightly).
Thepatient'sheadistobetiltedawaytowardstheunaffected
side.

21. Technicalfactors
Centeringpoint:
oglenohumeraljointwitha5-15°degreetowardsthepatient's
elbow
Collimation:
oanterior-posteriortotheskinmargins
olateraltoproximalthirdofthehumerus
omedialtoincludeglenohumeraljoint
Detectorsize:
o18cmx24cm

22. Exposure:
o50-60kVp
o8-15mAs
SID:
o100cm
Grid:
ono
Practicalpoints
•Obtainingthisprojectioncancausegreatdiscomfortevenin
healthypatients.
•Thestandardaxialviewasmaynotbesuitableforpatients
withdislocationsorsignificantglenohumeraltrauma.
•Inthesecases,itmaybebesttoperformamodifiedtrauma
axialprojectionoftheglenohumeraljoint.

26. Modified trauma axial view
Themodifiedtraumaaxialviewisanoptimalprojectionforpossible
scapulohumeraldislocations,glenoidfracturesandHill-Sachsdefects.
Patient position
• The patient lies supine on the X-ray table.
• The arm of the affected side is extended fully and the elbow
then flexed to allow the hand to rest on the patient’s head.
• The line joining the epicondyles of the humerusremains parallel
to the tabletop.
• The centreof the cassette is positioned 2.5 cm superior to the
head of the humerus.

27. Technicalfactors
20
70
24 ×30 cm
beam directed at the
coracoid process with
10˚ cephalic angulation
100 cm (40 inches)
suspended
mAs
kVp
IRSize
Central Ray
SID
Respiration

28. Modified axial view

29. Transthoracic erect lateral view
•Lateralviewofproximalhalfofthehumerusandthe
glenohumeraljointshouldbevisualizedthroughthethorax
withoutsuperimpositionoftheoppositeshoulder.
Patientposition
Patientisinerectposition.
Placepatientinatruelateralposition.
SideofinterestclosesttoIR.
Placeaffectedarmatpatient'ssideinneutralrotation.
Dropaffectedshoulderifpossibleandraiseoppositearmand
placehandovertopofhead.
Elevatenormalshoulderasmuchaspossibletoprevent
superimpositionofaffectedshoulder.

30. Technicalfactors
mAs
kVp
IRSize
Central Ray
SID
Respiration
50
80
24 ×30 cm
perpendicular beam
directed at the surgical
neck of the humerus
100 cm (40 inches)
shallow and rapid
respiration

33. Scapula Projections
Scapula AP
1. The patient is placed either in a supine position or in an
erect position
2. Place the center of the scapula at the center of image
receptor (IR)
3. Abduct the filming arm 90°with supination.

34. Scapula AP supine

35. Shoulder Y view (lateral scapula view)
•Thisviewisarelevantprojectiontoassesssuspecteddislocations,scapula
fractures,anddegenerativechanges.
•Thescapulaisclearlydemonstratedinalateralprofile,givingtheclearappearance
ofa‘Y’.
Patientposition
1. The patient is in an erect position.
2.Rotatethepatienttowardfilmingsidetoadjusttheangleofmidsagittal
plane(MSP)60°totheimagereceptor(IR).
3. Place the filming arm on the back to project the entire structure of scapula.
4. Place the anterior surface of the filming shoulder at the center of IRand
align the flat plane of scapula perpendicular to the IR.

36. Technicalfactors
Centeringpoint
perpendicular beam directed at the center of
the lateral border of the scapula with 0˚ angulation
Collimation
olaterallytoincludetheskinmargin
omediallytocovertheentiretyofthemedialscapula
osuperiortotheskinmargin
oinferiortotheinferiorangleofthescapula
Detectorsize
o24x30cm
Exposure
o60-70kVp
o10-20mAs
SID
o100cm
Grid
oyes

42. Clavicle Projections
Clavicle (AP view)
•TheclavicleAPviewisastandardprojectionpartof
theclavicleseries.
•Theprojectiondemonstratestheshoulderinitsnatural
anatomicalposition.

43. Indications
•TheAPclavicleisoftenindicatedinpatientswith
suspectedclavicularinjuriesfollowingtraumasuch
asfallingontoonesside.
•Itcanberequestedaspartofafocusedradiograph
toassessformetastasisormultiplemyeloma.
•ItisanidealprojectiontoassestheACjoint.
•Itisnotsoidealtoinspectthesternoclavicularjoint

44. Patientposition
Patientispreferablyerect.
Thepatient'sbackisagainsttheimagereceptor.
Theclavicleoftheaffectedsideisatthecenterofthe
imagereceptor.
Affectedarmisinaneutralpositionbythepatientside.

45. Technicalfactors
centeringpoint
omidclavicle
collimation
1.superiortotheskinmargins
2.inferiortoincludemidscapula
3.lateraltoincludetheskinmargin
4.medialtoincludethesternoclavicularjoint

46. detectorsize
o18cmx24cm
exposure
o60-70kVp
o10-18mAs
SID
o100cm
grid
oyes

50. Clavicle AP cephalic view (AXIAL)
•The clavicleAP cephalic angulation viewis a standard
projection part of theclavicle series.
•ItisoftenusedinconjunctionwiththeAPclavicleview.
Indication
•It projects most of the clavicle above the scapula and second
and third rib.
•It can help to determine angulation of fractures and
dislocation.

51. Patientposition
Patientispreferablyerect.
Thepatient'sbackisagainsttheimagereceptor.
Theclavicleoftheaffectedsideisatthecenterofthe
imagereceptor.
Affectedarmisinaneutralposition.

52. Technicalfactors
centeringpoint
ojustbelowmidclavicle
oangledcephalic15-30°
collimation
1.superiortotheskinmargins
2.inferiortoincludemidscapula
3.lateraltoincludetheskinmargin
4.medialtoincludethesternoclavicularjoint

53. detectorsize
o18cmx24cm
exposure
o60-70kVp
o10-18mAs
SID
o100cm
grid
oYes