Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Forearm - AP
Area Covered	Radius, ulna, carpals, distal humerus
Pathology shown	Fractures, dislocations,and pathologic processes such as osteomyelitis or arthritis.
Radiographic Anatomy	Forearm Radiographic Anatomy
IR Size & Orientation	24 x 30 for smaller patients 35 x 43 cm for larger patients Portrait, divided in 2 usually fits two forearm views, use lead masking for unused half
Film / Screen Combination	Regular (CR and DR as recommended by manufacturer)
Bucky / Grid	No
Filter	No
Exposure	54 kVp, 3.2 mAs
FFD / SID	100cm
Central Ray	Directed to mid forearm Perpendicular to IR
Collimation	Centre: Midforearm Shutter A: Including distal humerus to base of the first metacarpal Shutter B: Skin line
Markers	Distal and lateral Marker orientation AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	Not applicable
Positioning	Patient seated close to end of table Elbow fully extended Supinate hand (2nd to 5th metacarpal heads against IR) Entire limb in the same plane Shoulder at table level Align and centre forearm to long axis of IR Supinate hand (2nd to 5th metacarpal heads against IR) Elbow fully extended Check the humeral epicondyles are equidistant from the IR
Critique PACEMAN	Positioning AP positioning of the wrist and hand is demonstrated by: Styloid of radius is in profile No or minimal superimposition of the distal radius and ulna No or minimal super-imposition of the metacarpal bases Humeral epicondyles equidistant to IR is demonstrated by: Ulnar styloid is posterior to the head of the ulna Proximal ulna super-imposes radial head by about half a centimetre Both epicondyles of humerus are demonstrated in profile at the edges of the distal humerus Capitulum-radius joint is party or entirely closed Radial head articulating surface is demonstrated Olecranon process is within the olecranon fossa Coronoid process is demonstrated on end Radial tuberosity in profile medially Long axis of forearm aligned with long axis of IR Radius and ulna are parallel The radial head, neck, and tuberosity slightly superimposed by the ulna Wrist and elbow joints spaces are open only partially because of beam divergence. Area Covered Radius, ulna, carpals, metacarpal bases, humeral epicondyles, olecranon fossa Collimation Centre: Midforearm Shutter A: Including all of the medial epicondyle of the humerus to base of the first metacarpal Shutter B: Skin line Exposure Bony trabecular patterns and cortical outlines are sharly defined Soft tissues are visualised
Special Notes	Position the joint closest to the fracture site in true AP

Reference:

Textbook of Radiographic Postioning and Related Anatomy, Sixth Edition. Authors : Kenneth L. Bontrager, and John P. Lampignano. Copyright 2005 by Mosby, Inc.