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Questions and Answers
What is the most commonly fractured carpal bone?
What degree of obliquity is required for the AP medial oblique projection of the elbow?
In positioning the long axis of a radiographic part, how should it be aligned in relation to the IR?
When a patient cannot fully extend their arm for the elbow projection, how should the forearm be positioned?
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What is the central ray (CR) location for an AP forearm projection?
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Which landmarks are palpated for positioning an AP elbow projection?
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What is the central ray (CR) location for the AP forearm projection?
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Which projection best showcases potential subacromial spurs?
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What is the required medial CR angle for the inferosuperior axial shoulder (Lawrence Method)?
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In the inferosuperior axial projection, where is the acromion positioned relative to the humerus?
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What is the common term for idiopathic chronic adhesive capsulitis?
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Which hand position is correct for the AP projection of the shoulder and proximal humerus in neutral rotation?
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Which projection of the shoulder demonstrates the lesser tubercle in profile medially?
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What positioning error is indicated if the midaspect of the fourth and fifth metacarpals is superimposed in a PA oblique of the hand?
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What additional maneuver is required in the Lawrence Method to visualize a Hill-Sachs defect?
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What adjustment should be made if the clavicle is not positioned within the midaspect of the lung apices in an AP axial projection?
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Which projection is suitable for trauma assessment of the shoulder for possible fracture or dislocation?
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Which statement about the most common dislocation of the shoulder is correct?
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In a lateral elbow projection, what is the correct interpretation if half of the radial head is superimposed by the coronoid process?
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What projection of the elbow shows the radius directly superimposed over the ulna?
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What correction is necessary if the PA projection of the hand does not include all the carpals?
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Which routine rays should be obtained for a possible Bennett's fracture?
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What is the imaging criteria for the AP Axial view of the thumb?
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What is the correct degree of obliquity for a PA oblique hand projection?
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If a PA projection shows the radius and ulna but cuts off the carpals, how should the imaging technique be adjusted?
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Study Notes
Projection Techniques
- AP Scapula requires orthostatic breathing for optimal visualization.
- AP Clavicle demands suspension of respiration at the end of inhalation to enhance clarity.
- Scapular Y projection also requires respiratory suspension for accurate positioning.
Carpal Bones
- The Scaphoid is the most commonly fractured carpal bone.
- There are a total of 8 carpal bones in the wrist.
Positioning Principles
- The long axis of the body part must be positioned parallel to the long axis of the image receptor (IR) for accurate imaging.
Elbow Projections
- For an AP medial oblique projection of the elbow, the humeral epicondyles need to be angled at 45°.
- Palpation of the humeral epicondyles is essential for accurate elbow positioning.
- Lateral forearm and AP forearm views are necessary for lateromedial positioning with medial internal rotation.
- For a patient unable to fully extend their arm, use:
- Flexed elbow: Forearm parallel to the IR.
- Extended elbow: Humerus parallel to the IR for accurate imaging.
Imaging Criteria
- Standard positioning for AP elbow includes clear visibility of key anatomical landmarks.
- AP forearm requires CR to be located at mid forearm.
- For an AP thumb, CR should be centered at the 1st MCP joint.
- Frozen shoulder, or idiopathic chronic adhesive capsulitis, indicates chronic inflammation around the shoulder joint.
- The AP shoulder with internal rotation shows the lesser tubercle in profile medially.
AC Joint
- For AC joint weight-bearing views, weights of 8-10 lbs should be applied to the patient's wrists to help relax the hands and assess joint separation.
Shoulder Dislocations
- Anterior dislocation is the most common type for the shoulder.
- Effective imaging methods for the shoulder joint include sonography (ultrasound).
Clavicle Imaging
- An AP Axial of the clavicle shows the clavicle within the mid-aspect of the lung apices; adjustments may require a cephalic CR angle increase on a repeat exposure.
Relationships in Elbow Imaging
- In an AP humerus view, the humeral epicondyles are aligned parallel to the IR.
- For assessing a fractured left proximal humerus, the AP horizontal beam and transthoracic lateral shoulder projection are used.
Fat Pad Sign
- An elevated or visible posterior fat pad is characteristic of a lateral elbow radiograph.
Forearm and Shoulder Projections
- For the AP forearm, the CR must be directed to mid forearm.
- In PA Hand, the CR targets the 3rd MCP joint.
- DA Finger positioning has the CR at the proximal PIP joint.
Shoulder Projections
- Suspected subacromial spurs can be confirmed via:
- Apical AP Axial projection or Tangential Projection of the intertubercular sulcus (Fisk view).
- Inferosuperior axial projection (Lawrence method) allows visualization of the acromion superimposed over the humerus.
Radiation Safety
- The use of a grid for shoulder x-rays increases the radiation dose to the patient.
Additional Techniques
- To view the Hill-Sachs defect in inferosuperior projections, perform exaggerated external rotation of the affected limb.
- A medial CR angle of 25° - 30° is needed for the inferosuperior axial shoulder projection.
Trauma Imaging
- An AP Apical oblique axial (Garth method) projection is effective for evaluating potential fractures or dislocations.
Hand Positioning
- For an AP projection of the shoulder, the hand should be in an anatomical position with the thumb facing palmarly.
Humerus Rotation
- Internal rotation of the humerus allows for the lateral positioning of the proximal humerus, with epicondyles facing downward to the IR.
Positioning Errors
- In PA oblique hand views, excessive rotation yields mid-aspect superimposition of the fourth and fifth metacarpals.
- Distal radius and ulna must be fully captured in PA views; adjust to include about 1 inch of these structures.
Bennet Fracture
- For a suspected Bennett fracture, the AP Axial view using the modified Roberts method is recommended.
Imaging Criteria for Thumb Views
- In the AP Axial (Modified Roberts) view, the thumb and 1st CMC joint must be visible without superimposition.
- The PA oblique view of the hand needs a precise 45° degree obliquity for correct representation.
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Description
Test your knowledge on various projection techniques in radiography, including the specifics of AP scapula and elbow projections. Learn about the carpal bones and key positioning principles that are essential for accurate imaging. This quiz covers critical concepts for students studying radiographic technology.
