UPPER LIMB [EXTEREMITY]

Patient positioning

J. W
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2.1 HAND
Anatomy

M.M 2
PA [Dorsi - Palmar] - basic
Technical consideration
Film size – 24 x 30 cm crosswise
No grid, detail cassette if available
50 – 55 Kvp
Collimate to include soft tissue and at
least 1 in of distal radius and ulna; the
rt/lt marker can be included on
opposite projection.

Shielding pt positioning
Gonadal shielding should be used on
all patients, esp. children and adults
of reproductive age

M.M 3
 Con’t
Pt positioning
Assist the pt to a seated position at the end of the
radiographic table.
The pt’s side of interest should be nearest the
table; the arm should be nearest the table with
the elbow flexed approximately 90º.
Part positioning
Pronate the hand and separate the fingers
slightly.
Center the 3rd metacarpophalangeal joint to the
unmasked half of the cassette with the hand and
distal forearm parallel to the long axis of the
unmasked portion of the cassette.
Central ray
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Direct the central ray perpendicular to the 3rd

M.M
Con’t
Image evaluation
The image should demonstrate all the phalanges, including the soft
tissue,
finger tips, the carpal and metacarpals, and the distal end of the
radius and
ulna.
The interphalangeal and metacarpophalangeal and carpometacarpal
joint
should be demonstrated clearly.
No rotation.

M.M
M.M 6
2.6 WRIST JOINT
Two projections are routinely taken, PA and lateral using
18x24cm cassette.
Postero – anterior [basic]
The forearm is placed on the couch with the elbow
flexed and the hand pronated. The wrist and the
hand should be relaxed with the digits slightly
flexed and a non opaque pad placed under the
metacarpophalangeal joints for stability.
Center – Mid way between the radial and ulnar
styloid processes

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M.M
2.7 FOREARM
Two projections (AP &Lateral) are required at right angles
to each other. Include both the wrist and elbow joints.
Anterio – posterior (AP) Basic
The arm is extended at the elbow so that the shoulder,
elbow and wrist are on the same level. Place the dorsum
of the forearm on the cassette. The extended arm is now
in full Supination with the wrist slightly extended. Center
– to the middle of the forearm.

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M.M
Lateral (basic)
The limb is placed in the lateral position with the
elbow flexed; the hand is also in the lateral position
with the ulnar border of the hand and forearm
on the cassette.
Center to the middle of the forearm.
Film size 24x30 cm for both projections.

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M.M
2.8 ELBOW JOINT
Antero-posterior (AP) basic
The arm is extended fully outward to the fully
supinated position with the palm facing the tube.
The shoulder must be well down so that the arm
and the forearm is in one plane and the elbow
joint is in the true anterior position.
Center-through the point between the
epicondyles.

M.M 10
Lateral (basic)
The arm and forearm are placed in lateral position
with the elbow joint flexed to an angle of 900. The
hand and forearm are supported and
immobilized.
Center-to the lateral epicondyles of the
humerus.
Film size 18x24cm for both projection

M.M 11
2.9 HUMERUS
Anterio – posterior (basic)
With the patient supine and facing the tube, the
trunk is rotated towards the affected side and the
opposite shoulder raised on sandbag to bring the
injured arm in contact with the cassette. It can also
be done erect with the pt standing.
The arm is supinated with full extension at the
elbow and slight abduction at the shoulder.
Centre - midway between the shoulder and
elbow joint.

M.M 12
M.M 13
Lateral
From the supine position Abduct the arm to 450,
flex the forearm at the elbow to 900 . and rest
the forearm on the table in the lateral
position with the thumb uppermost.
Center midway between the shoulder and elbow
joint.

M.M 14
2.10 THE SHOULDER
Anterio – posterior Supine or Erect. (basic)
The patient is supine, faces the tube, with the
opposite shoulder raised and the head turned
toward the affected side to bring the shoulder
close to the film. The arm is supinated and slightly
abducted.
Centre over the coracoids process
Film size 24x30 cm

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M.M
2.11 CLAVICIE
Postero – Anterior supine/erect
The patient sits or stand facing an erect cassette
holder
Position the patient so that the middle of the
clavicle is in the center of the cassette.
The patient’s head is turned away from the side
being examined and the unaffected shoulder
rotated slightly forward to allow the affected
clavicle to be brought into close contact with the
Bucky.
Center - to the center of the clavicle.

M.M 16
Anterio – posterior supine
The patient lies supine on the x ray table or stands
on erect position facing the tube.
Center to the middle of the clavicle
Film size 24 x 30cm transverse

M.M 17
 LOWER LIMB
Patient positioning

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 3.1 THE FOOT
ANATOMY
 Bones of the feet are 26 in number which may be
separated into divisions 7 tarsal bones, 5 metatarsals
and 14 phalanges.
 Each tarsal bones are divided into the distal, middle
and proximal except the great toe having only distal
and proximal phalanx.

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 Two projections are obtained dorsi- plantar and
dorsi- plantar oblique using 24x30 cm film size with
50-55 Kvp.

Antero-posterior/Dorsi-plantar (Basic)
 To ensure the tarsal and tarso-metatarsal joints are
demonstrated, the foot is x-rayed with the foot flat on
the cassette and with the x-ray tube angled 15°
cranially or the foot is raised on a 15° non opaque pad
using a vertical x-ray beam. the leg being supported by
the other knee.
 Center - over the cuboid navicular joint.

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21
Lateral
 Used in demonstration of foreign body.
 From The dorsi- plantar position, the leg is rotated
outwards to bring the lateral aspect of the foot in
contact with the cassette.
 A pad is placed under the knee for support
 Adjusted to bring the plantar aspect perpendicular to
the cassette.
 Central - to the navicular cuneiform.

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 3.3 ANKLE JOINT
Antero posterior- basic (Mortice projection)
 The pt is either supine or seating on the x-ray table with
both legs extended.
 The medial and lateral malleoli should be equidistant from
the cassette.
 Center midway between the malleoli.

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Lateral Medio-Lateral (basic) or Latero –
Medial
 The patient turned to the affected side until the
malleoli are superimposed vertically.
 CENTRE- over the medial malleolus

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3.4 LEG
 Comprises of two bones known as the tibia and
fibula.
 The tibia is larger and more medial, it transmits
the weight of the body to the foot.
 The fibula is a long thin bone situated on the
lateral side of the leg. It articulates with the tibia
superiorly and inferiorly.

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Antero - Posterior (Basic)
 The patient should be supine, with the limb
slightly rotated medially and supported in
position.
 Center - to the middle of the film.
 The knee and ankle joints must be included since
the fracture of the distal end of the tibia might
be associated with the fracture of the proximal
end of fibula.

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Lateral (Basic)
 The patient is turned on to the affected side, with
the limb in the true lateral position.
 CENTER to the middle of the film. Film size 30 x
40 cm and 60-65 Kvp

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3.4 KNEE JOINT
Two projections are taken routinely; an AP and
Lateral.
Antero – Posterior (Basic)
 With the patient supine or sitting and both legs
extended on the couch with a back rest, the knee
is relaxed.
 CENTER 2.5 cm below the apex or lower level
of the patella.
 Film size 24 x 30 cm

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Lateral (Basic) prepared by MRT Jimru

 The patient is turned on the affected side with the

limb flexed at the hip and knee joint and with the
sound leg brought forward; the film is raised in
contact with the knee.
 Center - to medial condyle of tibia and Film size
24 x 30cm
 Use horizontal beam in cases of gross injury and
suspected fracture of the patella.

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3.6 FEMUR
 The largest bone in the skeleton it transmits the weight of
the body from the pelvis to tibia.
 composed of the :-
 superiorly -head, neck and trochantors.
 The middle – the shaft or diaphysis
 Inferiorly - condyles and epicondyles.
Antero – Posterior
 The pt lies supine on the x-ray table with both legs
extended.
 The affected limb is rotated to centralize patella over the
femur.
 Place the cassette under the thigh or in the bucky tray.
Lateral
 Rotate the patient to the affected side. The knee is slightly flexed.
 Place the cassette under the thigh or in the bucky tray. 30
31
3.8 HIP JOINT
 A ball and socket joint in which the head of the
femur articulates with the acetabulum of the
pelvis.
Antero – Posterior
 The patient lies supine and symmetrically on the x-
ray table.
 The anterior superior iliac spines should be
equidistant from the table top.
 Center 2.5 cm above the Symphisis pubis and Film
size 24 x 30

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Lateral

 The patient is turned on to the affected side with

the hip joint in the middle of the table and flexion
at hip and knee. with the foot supported
 Centre to the hip joint. And Film size 24 x 30 cm
 Apply gonad shield

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Lateral – both hips (frog’s legs position).
 It is applied in children when osteochondritis is
suspected. It helps to compare both hips on the
same film.
Positioning
 Patient lies supine
 The hips and knees are flexed and the limb
rotated laterally through approximately 60O.
 This movement separates the knee and bring
the platar aspect of the feet in contact with
each other.
 Center in the middle at the level of the femoral
pulse with a proper collimation to the area of
interest. 34
35
3.9 PELVIC GIRDLE
 There is considerable variation b/n the pelvis of the
female patient & that of the male.
 The male pelvis is narrower but has greater
depth where as the female pelvis is wider.
 The pelvis is formed by the two innominate
bones or hip bones (Ilium, Ischium and pubic
bone) and the sacrum.
 The bony prominences in the pelvic region are
important land marks in radiography.
 These are the Symphisis pubis, the posterior
superior iliac spine and the anterior superior
iliac spines.
 For non emergency and accident cases, a clean
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Antero – Posterior (Basic)

 The patient is supine, with the pelvis symmetrical

as for examination of the hip joint.
 The knees are flexed over a small sandbag and a
pressure pad is placed under the heels.
 The feet should be internally rotated to show the
femoral neck.
 Center - in the midline, halfway between the level
of the anterior superior iliac spine and the upper
border of the symphasis pubis
 Film size 30 x 40 or 35 x 43
 Grid should be used

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38
PATIENT POSITIONING FOR CHEST X-RAY

M.M 39
M.M 40
M.M 41
M.M 42
M.M 43
M.M 44
Patient position on abdominal x-ray

M.M 45
M.M 46
M.M 47
M.M 48
M.M 49
Thank you !!!
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