Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Upper limb
Similar to Upper limb (20)
Recently uploaded
Recently uploaded (20)
Upper limb
- 1. By: Dr Kushagra V Garg
- 13. Prone or upright Ant aspect towards the cassette Arm should be in neutral position Perpendicular to midclavicle According to the size of the patient tailor-made angulation can be given
- 18. forward-angulation of the cassette of 15 degrees towards the shoulder Unaffected side is slightly raised CR is given 30 degree angulation to throw the clavicle away from the bony thorax Clavicle should be horizontal
- 20. Patient is supine A NRO sponge supports the arm under investigation The cassette is given 20-25 degree angulation and tube is given 45 degree of cranial angulation Centering is at the mid of clavicle
- 23. Both SC jts are included
- 26. Supine or erect Affected scapula towards the IR Forearm semi flexed IR should be 5 cms above the shoulder CR centered at the mid of the film with centering at the head of humerus
- 28. supine or upright Post surface of the body towards plate Affected arm in neutral position Turn the patient 30 degree away Central rays perpendicular to gh Possible dislocation of head of humerus
- 31. Upright with arms on the sides B/L image with and without stress Central ray perpendicular to midpoint B/W the two ac joints Rotation should be checked by sc joints To demonstrate dislocations and subluxation
- 34. supine or upright Post surface of the body towards plate Affected arm on patients side CR perpendicular to coracoid process #,dis.,tendon and lig dam.,cyst and tumors
- 36. supine or upright Post surface of the body towards plate Affected arm on patients side IC line Parallel to image receptor CR perpendicular to coracoid process greater tubercle on the lateral aspect
- 38. supine or upright Post surface of the body towards plate Affected arm on patients side IC line Perpendicular to image receptor CR perpendicular to coracoid process Lesser tubercle on the medial aspect
- 40. Supine IR Perpendicular to table Abduct the affected arm by 90 Neck away Non opaque sponge under the shoulder CR horizontal towards the axilla exit at AC joint LT superiorly GH should be clear
- 42. Supine IR Perpendicular to table Abduct the affected arm by 90 Neck away Non opaque sponge under the shoulder CR 25 degree up and medial to horizontal towards the axilla exit at AC joint LT superiorly Coracoid process should not be over the humeral head GH should be clearly demonstrated
- 45. Supine or upright Affected arm resting on the side Hand supinated CR 30 degree cephalad and directed towards coracoid process coracoid process elongated and superimposed on clavicle slightly
- 47. Supine or upright Forearm resting on the chest 35 to 45 degree turn on the affected side Scapula parallel to IR LPO for left side and vice a versa CR perpendicular to gh Dislocation of head of humerus Superimposition of humeral head should not be there
- 49. Supine or upright Fully extend the elbow Hand rest on the side IC line should be parallel to the IR
- 51. supine or upright Flex the elbow and medially rotate the arm IC perpendicular to IR Include both shoulder and elbow joint CR perpendicular to midshaft of humerus Epicondyles should be overlapping each other LT on the medial aspect
- 53. Upright and affected Affected arm in neutral position IR should be above the shoulder CR horizontal and perpendicular to the midshaft of affected humerus NOTE :patient should breath normally Proximal 2/3rd of humerus and GH should be demonstrated
- 55. Clarks radiographic positioning Radiographic positioning by greathouse Radiopedia Learning radiology Valuable inputs by my seniors and professors
- 56. On public demand torticollis Thank You
Editor's Notes
- Position of patient and cassette• The patient sits or stands facing an erect cassette holder.• The patient’s position is adjusted so that the middle of theclavicle is in the centre of the cassette.• The patient’s head is turned away from the side being examinedand the affected shoulder rotated slightly forward toallow the affected clavicle to be brought into close contactwith the Bucky.Direction and centring of the X-ray beam• The horizontal central ray is directed to the centre of the clavicleand the centre of the image, with the beam collimated tothe clavicle
- Position of patient and cassette• The patient is supine on the X-ray table.• A small sandbag is placed under the opposite shoulder torotate the patient slightly towards the affected side to makesure that the medial end of the clavicle is not superimposedon the vertebral column.• The arm of the side being examined is in a relaxed positionby the side of the trunk.• A 24 30-cm cassette is placed transversely behind thepatient’s shoulder and adjusted so that the clavicle is in themiddle.Direction and centring of the X-ray beam• The vertical central ray is directed to the middle of the clavicle.Essential image characteristics• The entire length of the clavicle should be included on theimage.• The lateral end of the clavicle will be demonstrated clear ofthe thoracic cage.• There should be no foreshortening of the clavicle.• The exposure should demonstrate both the medial and thelateral ends of the clavicle
- Position of patient and cassette• The patient lies supine on the table, with the shoulder of theside being examined raised on a non-opaque pad and withthe arm relaxed by the side.• The patient’s head is turned away from the affected side.• The cassette is tilted back about 20 degrees from the verticaland is supported by sandbags against the upper border of theshoulder and pressed into the side of the neck.Direction and centring of the X-ray beam• The central ray is angled 45 degrees cranially and centred tothe centre of the clavicle.Essential image characteristics• The image should demonstrate the entire length of the clavicle,including the sternoclavicular and acromioclavicular joints.• The entire length of the clavicle, with the exception of theproximal end, should be projected clear of the thoracic cage.• The clavicle should be horizontal.NoteIf the cassette cannot be pressed well into the side of the neck,then the medial end of the clavicle might not be included on thecassette. In this case, with the central ray again angled 45 degreescranially, the central ray is first centred to the sternoclavicularjoint of the affected side and then the tube is rotated until thecentral ray is directed to the centre of the clavicle.
- Position of patient and cassette• The patient stands facing the Bucky.• The patient is then rotated through 45 degrees so that themedian sagittal plane of the body is at 45 degrees to thecassette with the sternoclavicular joint being examinednearer the cassette and centred to it.• The patient holds the vertical stand to help immobilizationand continues to breathe during the exposure.Direction and centring of the X-ray beam• The horizontal central ray is centred at the level of the fourththoracic vertebra to a point 10 cm away from the midline onthe side away from the cassette.Essential image characteristics• The sternoclavicular joint should be demonstrated clearly inprofile away from the vertebral column.NoteSuperimposed lung detail may be reduced by asking the patientto breathe gently during the exposure.Semi-prone (alternate)
- Alternatively, the patient may be examined in the semi-proneposition. Starting with the patient prone, the side not beingexamined is raised from the table until the median sagittal planeis at 45 degrees to the table, with the joint being examined in themidline of the table. The centring point is to the raised side,10 cm from the midline at the level of the fourth thoracic vertebra.Radiological considerations• These joints are difficult to demonstrate, even with good technique.Alternatives include ultrasound, CT (especially withthree-dimensional or multiplanar reconstructions) and MRI.
- NoteA long exposure time may be chosen and the patient allowed tocontinue quiet breathing during the exposure, so that images ofoverlying lung and rib are blurred in cases of non-trauma.