Tutorial 4 AHMI 1323 by Soo Foon Moey

A. 1st rib
B. Scapular notch
C. Acromial extremity
D. Acromioclavicular joint
E. Acromion process

Question 3 (AP Elbow)
A. Olecranon process
B. Lateral epicondyle
C. Humeroradial joint
D. Head of radius
E. Neck of radius
F. Body of radius
G. Body of ulna
H. Radial tuberosity
I. Coronoid tubercle
J. Trochlea
K. Medial epicondyle
L. Coronoid fossa
M. Body (shaft) of humerus

Question 4.
AP vs PA thumb

a) Object to Image Receptor Distance (OID)
AP: Smaller
PA: Larger

b) Magnification
AP: Lower
PA: Higher

c) Resolution
AP: High resolution
PA: Low resolution

Question 5.
AP Shoulder (Neutral Rotation)

a)
i) Patient preparation
- Ask LMP for female patient
- Ask the patient to remove necklace, bra and other radiopaque material from region of interest.
- Ask patient to change to hospital gown.
- Shield radiosensitive tissue outside region of interest.

ii) Patient position
- Patient in erect position
- Rotate patient's body slightly towards the left side of shoulder to bring shoulder and proximal humerus close to IR.

iii) Part positioning.
- Position patient to center scapulohumeral joint to center of IR.
- Place patient's arm in neutral position. (Epicondyle 45 degree to plane of IR).

iv) Tube positioning.
- CR perpendicular to IR, directed to scapulohumeral joint.
- Collimation:
-Superior: Soft tissue margin & upper scapula.
-Inferior: Proximal 1/3 humerus.
-Lateral: Soft tissue margin and lateral 2/3 of clavicle.

v) Technical factors:
- Kv: 70-80
- mAs: 6-12
- SID: 100cm
- Size of IR: 10x12 in
- Orientation: Crosswise
- Grid: Use grid

b) Transthoracic Lateral Projection.

c)
i) Patient positioning
- Patient in upright position.
- Place patient in lateral position with left side against IR.

ii) Part positioning
- Place left arm at patient's side in neutral rotation. Drop shoulder if possible.
- Raise right arm and place hand over top of head; elevate shoulder as much as possible to prevent superimposition of left shoulder.
- Center surgical neck and center of IR to CR as projected through thorax.
- Ensure that thorax is in a true lateral position or has slight anterior rotation of right shoulder to minimize superimposition of humerus by thoracic vertebrae.

iii) Tube positioning
- CR is perpendicular to IR, directed through thorax to surgical neck.
- Collimation:
Superior: Clavicle
Inferior: Proximal humerus
Lateral: Soft tissue of humerus and ribs.

iv) Technical factors
- kV : 80-90
- mAs : 6-12
- FFD : 100cm
- size of IR : 24x30 cm (10x12 in)
- Orientation : Lenghtwise
- Grid : with grid

Question 6.
Position radius and ulna (elbow)

E: Radial Styloid Process

H: Ulna Styloid Process

L: Hamulus of Hamate

M: Metacarpals

Q2 ( AC Joint AP Projection)

D: Acromioclavicular Joint

E: Acromion

Q3 ( AP projection of the elbow)

A: Olecranon Process

B: Lateral Epicondyle

C: Humeroradial joint

I: Coronoid Tubercle

K: Medial Epicondyle

M: Humerus

Q4: Differentiate the radiographic image of the thumb if the radiographer is to undertake the PA projection instead of the AP projection;

(i) Patient preparation
-Ask the last menstrual period (LMP) of the patient
-Patient must remove her bra if she can tolerate
-Place gonad shielding on her waist to shield the gonads

(ii) Patient positioning
-Patient's left arm is not being rotate due to the fracture.
- Patient is in erect position.

(iii) Part positioning
-The affected side of patient is being rotated slightly toward the image receptor to bring shoulder and proximal humerus in contact with image receptor
-The scapulohumeral joint is centred to the center of image receptor
-If possible, patient's arm has to be in neutral rotation

(iv) Tube Positioning
-The x-ray tube must be perpendicular to image receptor directed 1 inch inferior to coracoid process

(v) Technical factors used (kV, mAs, FFD, size of IR and orientation, grid or without grid)
-kVp: 65 -75 kVp
-mAs: 6-12 mAs
-SID: 100 cm
-Size of image receptor: 24 cm x 30 cm in crosswise with grid

b) Projection to demonstrate dislocation of the scapula-humeral joint:
- Transthoracic lateral projection

c) Describe that projection ;

(i) Patient positioning
- Place patient in an erect position
-Place patient in lateral position with left side closest to image receptor

(ii) Part positioning
-Place left (affected) arm at patient's side in neutral rotation and drop the shoulder
- Raise opposite arm over the top of head and elevate the shoulder to prevent superimposition of affected shoulder
-Center mid-diaphysis of the left (affected) humerus and center of image receptor to central ray as projected through thorax
- Ensure that thorax is in a true lateral position

(iii) Tube Positioning
- Central ray perpendicular to image receptor directed through thorax to mid-diaphysis
-Horizontal beam

(iv) Technical factors used (kV, mAs, FFD, size of IR and orientation, grid or without grid)
kVp: 70-80 kVp
mAs: 25-35 mAs
Size of image receptor: 14 x 17 inches
Orientation: Lengthwise
Grid: Using grid

Q6: Differentiate the position of the radius and ulna as well as the proximal radio-ulnar joint (if indicated), if radiography of the elbow is undertaken.

v- Technical Factors
kvp- 70-80
mAs- 6-12
SID- 100cm
Size IR- 10' x 12 ' (crosswise)
Grid- yes