Positioning Review of Upper and Lower Extremities Reference Images in this presentation are from: Merrill’s Atlas of Radiographic Positioning and Procedures. Eugene Frank, Bruce Long, Barbara Smith

Fingers PA Fifth Digit Second Digit Third Digit Fourth Digit CR - PIP

Lateral Fifth Digit Second Digit Third Digit Fourth Digit

Thumb AP CR – MCP

Lateral

Hand AP CR – 3rd MCP

PA Oblique

Lateral Fan Lateral Extension Lateral

Wrist PA CR – Mid Carpal 1. Scaphoid = Navicular 2. Lunate= Semilunar 3. Triquetrum = Triquetral, Triangular 4. Pisiform 5. Trapezium = Greater Multangular 6. Trapezoid = Lesser Multangular 7. Capitate = Os Magnum 8. Hamate = Unciform CR – Mid Carpal

Lateral

PA Oblique

AP Oblique

Ulna Deviation – Ulna Flexion

Stecher Method – Cassette raised

Stecher Method – Tube angled

Carpal Tunnel (Tangential Projection) - Gaynor-Hart Method

Forearm AP

Lateral

Elbow AP Epicondyles are parallel to the IR

Lateral Epicondyles are perpendicular to the IR

Medial (Internal) Rotation Oblique

Lateral (External) Rotation Oblique

Distal Humerus – Partial Flexion AP Patient may be unable to extend elbow due to dislocation or injury. 2 views are needed in this case, one for distal humerus and one for proximal forearm. Distal humerus: humerus is on table in same plane may need to support forearm Supinate hand Proximal Forearm: Patient may be standing or may have to elevate cassette under arm forearm is on cassette CR is perpendicular to elbow jt.

Proximal Forearm – Partial Flexion AP

Humerus AP

Lateral

Transthoracic Lateral

Lower Extremity

Toes AP – Perpendicular CR CR - 3rd MTP

AP Axial

AP Oblique – Medial Rotation

Foot AP Axial CR - Base of 3rd metatarsal

AP Oblique – Medial Rotation

Lateral - Mediolateral

Ankle AP

Lateral - Mediolateral

Medial Rotation (Internal) Oblique for bony structures

15-20 degree Medial Rotation for Ankle Mortise Joint

Lateral (External) Rotation Oblique

Stress Method Inversion Stress Everson Stress For verification of ligament tear Inversion Stress Everson Stress

Calcaneus Axial – Plantodorsal CR - base of 3rd metatarsal

Lateral Calcaneus CR - 1” distal to medial malleoulus

Lower Leg AP

Lateral

Knee AP – Sthenic Patient CR - 1/2” distal to apex of patella

AP - Hypersthenic Patient

AP - Asthenic Patient

Lateral

AP Oblique - Lateral (External) Rotation

AP Oblique – Medial (Internal) Rotation

Bilateral knees – weight- bearing

Patella PA CR - mid patella

Lateral Patella

Settegast Method for Patella “Sunrise or Skyline View” Typical tube angle is 15-20 degrees

Hughston Method for Patella Lower leg forms 50-60 degree angle from table

Intercondylar Fossa - PA Axial Projection (Holmblad Method) Femur is at 20 degree angle “Tunnel” projection

Camp-Coventry Method If knee is flexed 40 degrees, the tube is angled 40

Femur AP Projection (for distal femur)

AP Projection (for proximal femur)

Lateral femur to include knee

Lateral Projection (for proximal femur)