Radiography Forearm Positioning Techniques

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Questions and Answers

What is the recommended hand position to avoid rotation of the radius and ulna during a forearm x-ray?

Neutral

Prone

Pronated

Supinated (correct)

Which of the following is included in the collimation criteria for a forearm x-ray?

The elbow joint only

Both wrist and elbow joints (correct)

Only the proximal wrist joint

Just the distal humerus

What is the appropriate tube angle for a forearm x-ray?

45 degrees lateral

20 degrees cephalad

Straight tube (correct)

30 degrees caudad

What is the required distance for a forearm x-ray?

100-110 cm Signup and view all the answers

Which positioning technique is used for a lateral forearm x-ray?

Flex elbow 90 degrees and place medial aspect on receptor Signup and view all the answers

What characteristic indicates an adequately visualized image density in a forearm x-ray?

Cortical outline and bony trabecular pattern seen Signup and view all the answers

What must be ensured regarding the alignment of the forearm during a forearm x-ray?

Slight superimposition of the radial head over the proximal ulna Signup and view all the answers

What artifact must be removed from the field of view before conducting a forearm x-ray?

Wristwatch and jewelry Signup and view all the answers

What is the tube angle for the Sesamoids Tangential View?

Straight Signup and view all the answers

Where should the central ray be centered for the Foot Dorso-Plantar View?

Base of third metatarsal Signup and view all the answers

Which positioning technique is used for the Sesamoids Tangential View?

Foot positioned with 1st toe flexed Signup and view all the answers

What is the recommended collimation for the Foot Dorso-Plantar View?

Include all required anatomy including skin edges Signup and view all the answers

Which of the following is NOT a criterion for the Sesamoids Tangential View?

Cortical outline and bony trabecular pattern not demonstrated Signup and view all the answers

What is the kVp range specified for both the Sesamoids and Foot Dorso-Plantar Views?

50-55 kVp Signup and view all the answers

In the Foot Dorso-Plantar View, what should be the posture of the patient?

Seated on the table Signup and view all the answers

What is the primary instruction to the patient during the imaging for both views?

Hold still Signup and view all the answers

Which anatomical structures are visible in the lateral profile of the image?

Distal femur, proximal tibia, and fibula Signup and view all the answers

What is the purpose of including side markers in the image?

To determine the orientation and side of the body part Signup and view all the answers

In what settings is this imaging typically requested?

Trauma and post-operative settings Signup and view all the answers

Which of the following describe the visual quality of the image?

Adequate cortical outline and bony trabecular pattern demonstrated Signup and view all the answers

What is the correct label for the described image?

Horizontal Beam Lateral Signup and view all the answers

What is the optimal angle for the tube during Rosenberg imaging?

Approximately 10 degrees caudal Signup and view all the answers

Which criteria is essential for achieving a true lateral view in Horizontal Beam Lateral Knee View imaging?

Femoral condyles are superimposed Signup and view all the answers

What is the recommended kVp for the Horizontal Beam Lateral Knee View?

60 kVp Signup and view all the answers

When performing a PA Rosenberg view, which anatomy must be included in collimation?

Anatomy surrounding the knee joint Signup and view all the answers

What should be the patient’s position for a Horizontal Beam Lateral Knee View?

Supine with extended knees Signup and view all the answers

Which of the following is NOT a requirement for the PA Rosenberg criteria?

Knee flexed at 30 degrees Signup and view all the answers

What is the purpose of the side marker in imaging?

To identify the side being visualized Signup and view all the answers

Which of the following describes the central ray direction for Horizontal Beam Lateral Knee View?

Perpendicular to the long axis Signup and view all the answers

What is the correct angle for the central ray in the axial lateral elbow view?

45 degrees towards the patient Signup and view all the answers

Which of the following should be included in the collimation for the toes (dorso-plantar)?

The toe of interest and adjacent toes Signup and view all the answers

What should be seen in the axial lateral elbow view regarding the anatomy?

Radial head and neck projected away from the ulna Signup and view all the answers

What is the recommended kVp for the toes (dorso-plantar) view?

55 kVp Signup and view all the answers

What is the proper posture for the patient during the axial lateral elbow imaging?

Seated with arm bent at 90 degrees Signup and view all the answers

Which of the following practices should be followed for patient preparation before taking the radiograph?

Remove artifacts in the field of view Signup and view all the answers

In the axial lateral elbow criteria, how should the density of the image be evaluated?

Cortical outline and bony trabecular pattern are demonstrated Signup and view all the answers

What is the recommended distance for the tube during the toe imaging?

100-110 cm Signup and view all the answers

Study Notes

AP Forearm Positioning

Hand supinated to prevent rotation of radius and ulna
Straight tube angle
Central ray perpendicular to mid radius/ulna
Distance: 100-110cm
Collimation: Include all skin edges, both wrist and elbow joints
kVp: 50-60kVp
mAs: 5mAs
Grid: No
Patient preparation: Remove artifacts (watches and jewelry)

AP Forearm Criteria

Collimation: Include all anatomy, skin edges
Alignment: Slight superimposition of radial head, neck and tuberosity over proximal ulna. Partially open elbow joint if the shoulder was placed in the same plane as the forearm.
Anatomy: Entire Forearm, including wrist and distal humerus
Density: Cortical outline and bony trabecular pattern visible
Contrast: Soft tissue and bony interfaces visualized
Markers: Side marker evident
Identification: Appropriate labeling or anonymized

Lateral Forearm Positioning

Patient seated with legs at right angle to table
Entire Arm should be in the same plane
Flex elbow 90 degrees and place medial aspect of forearm on image receptor
Straight tube angle
Central ray perpendicular to mid radius/ulna
Distance: 100-110cm
Collimation: Include all skin edges, both wrist and elbow joints
kVp: 50-60kVp
mAs: 5 mAs
Grid: No
Patient preparation: Remove artifacts (watches and jewelry)

Lateral Forearm Criteria

Collimation: Include all anatomy, skin edges
Alignment: Slight superimposition of radial head, neck and tuberosity over proximal ulna. Partially open elbow joint if the shoulder was placed in the same plane as the forearm.
Anatomy: Entire forearm, including wrist and distal humerus in true lateral position. Superimposition of radius and ulna at distal end.
Markers: Side marker evident
Identification: Appropriate labeling or anonymized

Axial Lateral Elbow (Radial Head Trauma) Positioning

Patient seated with arm bent at 90 degrees
Hand pronated
Elbow flexed at 90 degrees
Hand pronated
Tube angle 45 degrees towards patient
Central Ray 45 degrees angled toward chest at mid elbow joint
Distance: 100-110cm
Collimation: Include skin edges, 5cm distal humerus, proximal forearm
kVp: 55-65kVp
mAs: 4-6 mAs
Grid: No
Patient preparation: Remove artifacts (clothing)

Axial Lateral Elbow (Radial Head Trauma) Criteria

Collimation: Include all anatomy, skin edges
Alignment: Elbow flexed at 90 degrees
Anatomy: Radial head and neck free of superimposition, projected away from ulna. Capitellum seen.
Density: Cortical outline and bony trabecular pattern visible
Contrast: Soft tissue and bony interfaces visualized
Markers: Side marker evident
Identification: Appropriate labeling or anonymized

Toes (Dorso-Plantar) Positioning

Patient seated on table
Knee bent and place foot on image receptor
Tube angle: 15 degrees angled towards heel
Central Ray: perpendicular to third metatarso-phalangeal joint (MTP)
Distance: 100-110cm
Collimation: Include skin edges and adjacent toes.
kVp: 55 kVp
mAs: 3 mAs
Grid: No
Patient preparation: Remove artifacts (shoes, socks)

Toes (Dorso-Plantar) Criteria

Collimation: Include all anatomy, skin edges and adjacent toes.
Alignment: Toes separated without rotation of phalanges, concavity demonstrated on both sides of metatarsal shafts.
Markers: Side marker evident
Identification: Appropriate labeling or anonymized

Sesamoids Tangential View Positioning

Patient lying prone on table or seated
Foot positioned with first toe flexed and ball of foot perpendicular to image plate. Patient can remain seated with foot flexed and tape tensioning the toes back.
Straight angle tube
Central Ray: Centered on second metatarsal
Distance: 100-110cm
Collimation: Include skin edges, metatarsal head and sesamoids
kVp: 50-55kVp
mAs: 2-4 mAs
Grid: No
Patient preparation: Remove artifacts (shoes, socks)

Sesamoids Tangential View Criteria

Collimation: Include all anatomy, skin edges
Alignment: Open joint spaces between sesamoids and first metatarsal
Anatomy: Both sesamoids seen in profile without superimposition
Density: Cortical outline and bony trabecular pattern visible
Contrast: Soft tissue and bony interfaces visualized
Markers: Side marker evident
Identification: Appropriate labeling or anonymized

Foot Dorso-Plantar View Positioning

Patient seated on table
Foot positioned flat on image plate
Tube angle: 10 degrees towards heel
Central Ray: Centered on base of third metatarsal
Distance: 100-110cm
Collimation: Include all anatomy of interest
kVp: 50-55kVp
mAs: 3-4 mAs
Grid: No
Patient preparation: Remove artifacts (shoes, socks)

Foot Dorso-Plantar View Criteria

Collimation: Include all anatomy, skin edges
Alignment: No rotation of foot, long axis of image plate aligned with long axis of foot.
Anatomy: Toes to tarsals included, slight overlap of 2nd-5th metatarsal bases.
Density: Cortical outline and bony trabecular pattern visible
Contrast: Soft tissue and bony interfaces visualized
Markers: Side marker evident
Identification: Appropriate labeling or anonymized

PA Rosenberg Positioning:

Tube angle: Parallel to tibial plateau, appx. 10 degrees caudal angle
Central Ray: Centered to midline of knee at level of joint space
Distance: 100-110cm
Collimation: Include all anatomy of interest
kVp: 60-70kVp
mAs: 12-16 mAs
Grid: Yes
Patient preparation: Comfortable position, quick exposure

PA Rosenberg Criteria

Collimation: Include all anatomy and skin edges
Alignment: No rotation of femur or tibia. Tibial plateau in profile.
Anatomy: Distal femur, proximal tibia and fibula. Open femoro-tibial joint spaces, intercondylar fossa visualized.
Density: Cortical outline and bony trabecular pattern visible
Contrast: Soft tissue and bony interfaces visualized
Markers: Side marker evident, labeled “Wt Bearing Rosenberg”
Identification: Appropriate labeling or anonymized

Horizontal Beam Lateral Knee View Positioning:

Patient supine on bed, knee extended
Performed medio-laterally with image receptor resting between patient’s knees.
Tube angle: Perpendicular to long axis of knee.
Central Ray: Angled appx 5 degrees caudally at distal portion of lateral condyle, superimposing the femoral condyles with medial femoral condyle appearing larger.
Distance: 100-110cm
Collimation: Include all anatomy of interest
kVp: 60
mAs: 12 mAs (adjust based on knee thickness)
Grid: No

Horizontal Beam Lateral Criteria:

Collimation: Include all anatomy, skin edges
Alignment: Superimposed femoral condyles, true lateral. Patella in profile and open femoro-patellar joint space. Tibial plateau in profile.
Anatomy: Distal femur, proximal tibia and fibula in lateral profile.
Density: Cortical outline and bony trabecular pattern visible
Contrast: Soft tissue and bony interfaces visualized
Markers: Side marker evident, labeled “Horizontal Beam Lateral”
Identification: Appropriate labeling or anonymized

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Description

This quiz focuses on the essential positioning techniques and criteria for imaging the forearm in radiography. It covers both AP and lateral views, emphasizing parameters like collimation, alignment, anatomy, and density. Test your knowledge on the crucial factors for successful forearm imaging.