Upper Extremities Radiology Positioning

Radiographic positioning techniques for upper limb imaging.

Shoulder and Proximal Humerus

Overview of radiographic views for shoulder imaging.

AP View

Anterior-posterior projection, arm in neutral position.

Lateral Scapular View

True lateral of scapula, with beam perpendicular to mid-scapular line.

Axillary View

Axillary projection, arm abducted 90 degrees, useful for glenohumeral joint.

Y-View

For assessing shoulder dislocation, resembles a 'Y' shape of scapula bones.

Elbow

Standard positioning for elbow radiography.

AP View

Elbow extended, hand supinated.

Lateral View

Elbow flexed at 90 degrees, thumb up.

Oblique Views

Medial and lateral rotation of the arm to visualize joint spaces.

Forearm

Imaging the radius and ulna.

AP View

Elbow extended, palm up.

Lateral View

Elbow flexed at 90 degrees, hand in lateral position.

Wrist

Essential angles for carpal area imaging.

PA View

Wrist in pronation, fingers flexed.

Lateral View

Hand in lateral position, wrist in profile.

Oblique View

45-degree rotation of wrist, palm down.

Hand and Fingers

Detailing digits and associated structures.

PA View

Hand flat, fingers extended.

Oblique View

Hand rotated 45 degrees, little finger side down.

Lateral View

Hand on its side, thumb pointing up.

Patient Preparation

Ensure patient understanding and consent for the procedure.
Remove any garments or jewelry that might interfere with the X-ray image.
Position patient to maximize comfort, especially if immobilization is required.

Exposure Settings

Set the appropriate kVp and mAs based on body part thickness and the required image contrast.
Use Automatic Exposure Control (AEC) if available, to adjust for patient size and tissue density.

Anatomical Landmarks

Identify and mark landmarks such as the iliac crest, anterior superior iliac spine (ASIS), or pubic symphysis, to aid in positioning.

Safety Considerations

Apply shielding to protect patient’s gonads and other sensitive areas when feasible.
Minimize repeats by ensuring proper position before taking the initial image.

PA (Posteroanterior) Position

Patient stands facing the image receptor with hands on hips, shoulders rolled forward.
Arrange for a deep breath and hold during exposure to expand the lungs.

Lateral Chest Position

Patient stands sideways against image receptor, with arms raised.
Ensure no rotation by aligning shoulders and hips perpendicular to the image receptor.

Exposure Considerations

High kVp settings typically used to penetrate the mediastinum and show lung detail.
Short exposure time to minimize motion blur from heartbeat and breathing.

Anatomical Landmarks

Mid-sagittal plane centered to the image receptor.
T7 (seventh thoracic vertebra) is generally the central ray location.

Supine Position

Patient lies on their back with arms at their sides.
Gentle immobilization used as needed to maintain position.

Upright Position

Patient stands or sits upright, depending on ability.
Demonstrates free air under the diaphragm and levels of fluid.

Exposure Considerations

Medium kVp settings to achieve a balance between bony structures and soft tissue visibility.

Anatomical Landmarks

Include diaphragm, pubic symphysis to include all abdominal contents.
Iliac crests aligned horizontally for the transverse plane.

Limb Positioning

Position the extremity in both AP (anteroposterior) and lateral views for comparison.
Ensure the limb is in a true lateral or AP position by aligning anatomical structures.

Immobilization

Use foam blocks, tape, or sandbags to maintain a stable position without patient strain.

Exposure Considerations

Lower kVp settings than for trunk imaging, to enhance contrast between soft tissue and bone.

Anatomical Landmarks

Include joints above and below the area of interest.
Make sure limb is centered and parallel to the image receptor.

Cervical Spine

Collimate to the area of interest, aligning the central ray with C4.
Flex the patient’s knees to reduce lordosis in lateral views.

Thoracic Spine

Patient is usually positioned prone or upright for PA projection.
Ensure scapulae are clear of the vertebral column in the lateral projection.

Lumbar Spine

Align the central ray with the L3 vertebra.
Use a lead mat behind patient to reduce scatter if needed.

Crosstable Lateral

Ideally suited for trauma patients who cannot be positioned upright or prone.
Central ray crosses the table horizontally to capture the lateral aspect.

Skull Positioning

PA, lateral, and Waters projections commonly used.
Ensure no rotation by keeping midsagittal plane perpendicular to image receptor.

Sinuses

Position patient erect with chin raised for Waters view.
Ensure occipital bone is flush with image receptor.

Exposure Considerations

Lower kVp and variety of mas settings based on the projection and patient size.

Anatomical Landmarks

For lateral view, inter-pupillary line perpendicular to the cassette.
For PA, the CR (Central Ray) exits at the nasion.

This cheat sheet provides a starting point for technique considerations in radiography. It includes general patient prep and safety tips as well as position-specific guidelines. It's designed to be a quick reference for radiologic technologists and professionals in training.

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