Summary of Radiographic Upper Extremity Positioning

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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.

Notable Quotes

— 06:29 — « I don't know about you but I don't like to do math so if I just click on the MAS it will show me my MA times my time. If I click off on the seconds I know it'll show me the time in seconds but that's just too much math for me. »
— 16:35 — « With the fan lateral we're still going to be taking our x-rays at the third metacarpal phalangeal joint and make sure that the patient brings their hand out like an okay sign and you want to be able to see between all of the phalanges. »
— 23:33 — « If you can slip the grid out then you can keep your radiographic technique down into 55 to 65 range but if you're going to be taking this AP humerus NHS chamber with a grid then you want to go all the way up to 70 kVp and make your radiographic parameters change based upon that. »
— 24:03 — « You can put a karate chop on the elbow, a karate chop at the top of the humerus and then just bisect those two areas and that's where you want to center to the mid humerus. »

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Educational

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