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ulnar nerve entrapment
hi all,
does anyone know of any specialist xray views for ulanr nerve entrapment of the elbow?
i have done an ap, lat and obl today, but for future reference are there anymore?
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Posted:
Sep 10 2008, 7:46 PM EDT by Anonymous
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Obese radiography
Ive just had a placement in a public hospital in Texas and I have seen some massive patients. Some were so big they almost didnt fit on the x-ray table, and you had to be careful that the weight of their pendulous abdomen didnt make them roll off the edge and fall on the floor.
Ive looked for information about positioning of the morbidly obese patient but havent found any in the texts - so I think this page is a great idea.
I have found that the elbow is approximately at the level of the iliac crest if that helps anyone else with their positioning of these patients.
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Posted:
Jan 14 2010, 8:45 AM EST by
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positioning
I agree with you, they were probably referring to what we call "adaption radiography", that is, when you have to adapt your positioning to compensate for a patient's condition. For example, acute flexion AP elbow instead of AP elbow.
Posted:
Feb 4 2011, 5:59 PM EST by
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forearm
I have never done an oblique forearm but i have put some images here http://www.wikiradiography.com/page/Forearm
that might help you, they show the wrist and elbow when positioned with internal and external rotation.
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forearm
(2 replies)
Posted:
Aug 6 2009, 7:46 AM EDT by AndyC
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Scaphoid Series
I have a question regarding the scaphoid series of the wrist (Rafert-Long method) that has become a point of confusion among my students. Merrill's states to use CR angulations of 0, 10, 20, and 30 degrees cephalic. Does "cephalic" in this instance mean angling towards the digits or towards the elbow. I appreciate any help, thanks.
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Posted:
Feb 4 2010, 9:59 AM EST by
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Modified lateral wrist
Hi Michael,
I have noticed that there is a link to an article called about fixation screws impinging on wrist joints. I am hoping you are going to discussed a modified lateral wrist where the elbow is flexed 15 degrees raising the wrist joint from the plate and opening the joint between radius/ulnar and carpals. Perhaps this is still under construction but just wanted to note that I am really keen to see matching images as I have heard this view is done at some of our centres but I haven't seen any images yet. I am going to attempt this view in a lab next week but I suspect our wrist phantoms are not quite accurate enough to acheive the view.
Cheers,
Rachel
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Posted:
Nov 4 2009, 11:25 PM EST by
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for scaphoid angulation varies between 25-40 degrees and should be und
I suspect this refers to the X-ray beam angulation towards the elbow. This angulation makes sense if you consider the position of the scaphoid on the lateral wrist image (google it). The angulation of the beam will potentially image the scaphoid en face without distortion
Posted:
Jan 10 2009, 4:35 AM EST by Anonymous
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Can you use a landscape IR for ribs if the person is too large?
As a PDY I was once shown to do ribs supine, oblique (similarly as you position for a non-NOF # hip, injured side down, arm in down side above head) with 10-25 deg ang cephalic.. straightens trhe ribs beautifully, you use an abdomen type exposure (60-80 kv on 30-50mas). Very helpful in ED/Trauma, After you've done your PA/AP CXR you can your pat in the X-ray table, and it becomes a lot easier for the patient to position. Typically your pat will come hunching over, breathing in spurts, and if you need them to stand and raise the arm you get that look that you get when you tell them they have to try to extend their sore elbow... by lying them downmakes it easier to also "open" the area.. Also ribs are not of a uniform shape, and by looking "up" at them you can imagine you get a more clear view. Ah!! of course, you also need to place an aluminium filter (like a smaller decubitus, or even a foot for people of a slighter build), thinner side in line with sternum(vertically). Either way, I have also tried thies in Erect pats.. and if they are too large for confort, you can even use the automat in your table or erect bucky. By using a man exposure though, with the automats off, your bucky serves as a type of grid...Honestly it works nicely.. most patients wil fit in 1 film portrait. Plus, as Mr. Fuller said in one of his lectures.. you must firstly work out where the injury is, which area.. side, how it happenned, you look at them and their anatomy. that way you include that area in the one cassette, ensuring you include either end of the thoraccic cage for location of the injury in relation to the spine.I have met radiologists who will look forever in the wrong side, or miss them altogether, especially on busy hospitals, and when the the trad. hori ray tends to widen the ribs, and distort them.. also your usual rib exp can make vascular markings look a lot like cracks...
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HOW TO TAKE A SOFT TISSUE X RAY
MY PHYSICIAN ASKED ME TO DO A SOFT TISSUE X RAY OF NECK ,, HOW IS THIS ACCOMPLISHED?
Posted:
Aug 30 2010, 2:31 PM EDT by
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(Image # 4) The lateral projection of the shoulder similarly revealed
Erect or supine?
Most shoulders will be done erect. For the lateral shoulder, get the patient to put the hand of the affected side on their belly and have them stand against the bucky, facing the bucky. You then turn the patient so that their sore shoulder gets closer to the bucky. To determine how much you need to turn them, turn them so that the inferior angle of the scapula and the acromion process are in alignment i.e. a line connecting the two points will be perfectly vertical (use the crosshair lines on the collimation field). This should give you the perfect amount of rotation.
You should also use some tube angulation. For the ipsilateral anterior oblique (or "PA oblique") you should use approximately 15 degrees caudal angulation (angle the tube 15 degrees to the feet).
In this position, the patients humeral shaft will be superimosed over the body of the scapula. To see the scapula body more clearly (vital for ?fracture scapula, less so for shoulder/humerus #/dislocation) you should get the patient to move their elbow, or move their hand more laterally across the stomach. I use an exposure of around 75 kV for 32-35mAs for an average male on CR. This exposure also works well on regular film.
Lateral shoulders can be done on a table aswell if the patient is unable to stand. You are trying to achieve the same thing - align inferior angle of scapula with acromion process such that a straight line between the two will be in perfect alignment with the longitudinal axis of the film. Basically, you are going to roll them AWAY from the affected side (contralateral posterior oblique) and put a radiolucent object (sponge) under their affected side. This view will be magnified and generally requires no angulation. You can adjust for magnification by increasing your FFD but I would assume that the tube would not be able to go to a full 180cm FFD in the vertical direction.
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Posted:
Oct 27 2011, 8:04 PM EDT by
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Can anyone tell me the best way to position for a scapular Y view?
"Personally I dislike the Napoleon view. I agree it is easy to do, but I don't like the humerus being projected over the ribcage. I like it lateral to the ribs where it is supposed to be." Anonymous,
I appreciate that you have a dislike for projecting the humerus over the ribs on the lateral scapula view. The success or legitimacy of a particular technique should be measured by the degree to which it meets your objectives. If one of your objectives is to clearly visualize the proximal third of the humerus on lateral scapula view, this objective should be taken into consideration. There are of course multiple objectives- minimising radiation dose to the patient, reproducibility, easy of positioning, adaptability to different patients and patient abilities etc. The advantage of a website like this (as opposed to a textbook) is that you have the ability to gain an appreciation of what other radiographers are doing and share information and ideas. Radiographers are able to share that pragmatic wisdom that only comes from years of experience.
All radiography textbooks I have read offer alternative techniques to achieve a particular demonstration of anatomy. K.C. Clarke’s "Positioning in Radiography" suggests that the arm position for the lateral scapula should be either "...moved forward across the trunk" or "...moved away from the trunk with slight abduction and flexion of the elbow" (9th ed, p 66)
We all tend to adopt particular radiographic techniques and practices like a favourite recipe. The longer we adhere to a particular technique, the more convinced we become that it is the correct and only way (I am no exception to this phenomenon). Radiographer's assessments of techniques tend to be more experiential than experimental, and I see nothing wrong with that per se.
To return to your comment, I appreciate your effort in making your preference known. I assume that your dislike of the “Napoleon” technique is based on an objective of maximizing the demonstration the proximal humerus on the lateral scapula view.
Cheers,
M.J. Fuller
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Posted:
Jul 30 2008, 9:11 PM EDT by
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