Summary of "Radiographic Upper Extremity Positioning"

This instructional video by Tammy McLeish provides a comprehensive guide to radiographic positioning and technique for upper extremity imaging, emphasizing proper preparation, patient positioning, technical settings, and image critique.

Main Ideas and Concepts

Requisition and Coding Verification
- Confirm the requisition has the correct CPT (Current Procedural Terminology) code for the specific exam (e.g., right-hand 3-view).
- Match the requisition to the patient's script, ensuring the diagnostic code aligns with the exam (e.g., rheumatoid arthritis for a hand x-ray).
- Verify the accession number corresponds to the specific procedure.
General Setup and Equipment Preparation
- Source-to-image distance (SID) should be 40 inches for upper extremity x-rays (72 inches mainly for chest or cervical spine).
- Use a ruler from the collimator to the image receptor to confirm the 40-inch SID.
- Center the patient on the image receptor, especially when using detail cassettes.
- Collimate appropriately (e.g., 8x10 for hand x-rays).
- Place correct right or left markers before imaging.
- Position the patient’s chair to allow easy access and proper limb positioning.
Radiographic Technique Settings
- Use kVp between 55-65 for adults; lower to ~45 kVp for infants or small children.
- Select a small focal spot for better image detail.
- Start with a fixed mA and adjust exposure time (milliseconds or seconds) based on patient size.
- Digital imaging allows for lower mAs compared to film.
Patient Positioning and Anatomical Orientation
- Anatomical position: palms forward, toes forward, face forward.
- For PA views, place the palm down so the anterior surface faces the image receptor.
- Ensure hand, forearm, and humerus are on the same plane for optimal imaging.
- Centering and collimation vary by digit and exam type.
Specific Upper Extremity Views and Positioning
- Fingers (2nd to 5th digits)
  - PA view: Center at proximal interphalangeal joint, hand flat.
  - Oblique (OBE) view: Rotate fingers medially or laterally depending on digit.
  - Lateral view: Fingers straight, rotated medially or laterally depending on digit.
  - Avoid overlap of fingers.
- Thumb (1st digit)
  - AP view: Palm up, fingers out of the way, center at metacarpophalangeal joint.
  - PA oblique: Palm down, center at metacarpophalangeal joint.
  - Lateral: Thumb on its side, center at metacarpophalangeal joint.
- Hand
  - PA: Patient seated, elbow bent, hand flat, center at 3rd metacarpophalangeal joint.
  - Oblique: Rotate hand 45 degrees, use wedge or sponge for support.
  - Lateral: Fan lateral (fingers spread like “OK” sign) preferred over extension lateral.
- Wrist
  - PA: Patient seated, loose fist to bring wrist closer to receptor, center at midcarpal bones.
  - Oblique: Rotate wrist 45 degrees to better visualize scaphoid/navicular.
  - Lateral: Wrist and forearm on the same plane, center at midcarpal bones.
  - Navicular (scaphoid) view: Ulnar deviation with 10-15 degree angled central ray or modified view with hand elevated 20 degrees.
- Forearm
  - AP: Patient seated, arm extended, center at midpoint of forearm, all segments on same plane.
  - Lateral: Elbow bent, forearm lateral, center at midpoint.
- Elbow
  - AP: Arm extended, palm up, center at mid-elbow.
  - Alternative views if patient cannot extend elbow: two images with central ray perpendicular to forearm and humerus.
  - Oblique: External rotation (45 degrees) preferred to separate radius and ulna.
  - Lateral: Elbow bent 90 degrees, center at mid-elbow.
- Humerus
  - AP: Patient standing or supine, center at mid-humerus, palm up, shoulder rotated away.
  - Lateral: Various positions (patient facing receptor, back against receptor, supine).
  - Ensure both elbow and shoulder joints are included.
  - Use appropriate kVp and grids depending on thickness.
Additional Tips
- Use tape to secure fingers for pediatric patients or when needed.
- Collimate before exposure to include only the area of interest.
- Properly mark images with side markers and digit numbers.
- Digital imaging allows for post-processing.