Positioning Review of Positioning Review of Upper and LowerUpper and Lower

ExtremitiesExtremities

ReferenceReferenceImages in this presentation are from:Images in this presentation are from:

Merrill’s Atlas of Radiographic Positioning and Merrill’s Atlas of Radiographic Positioning and Procedures.Procedures.

Eugene Frank, Bruce Long, Barbara SmithEugene Frank, Bruce Long, Barbara Smith

FingersFingersPAPA

Third Digit

Fifth Digit

Fourth Digit

Second Digit

CR - PIP

LateralLateral

Third DigitSecond Digit

Fourth Digit

Fifth Digit

ThumbThumbAPAP

CR – MCP

LateralLateral

HandHandAPAP

CR – 3rd MCP

PA ObliquePA Oblique

LateralLateral

Extension Lateral

Fan Lateral

WristWrist PA PA

CR – Mid Carpal

1. Scaphoid = Navicular 2. Lunate= Semilunar3. Triquetrum = Triquetral, Triangular4. Pisiform

5. Trapezium = Greater

Multangular6. Trapezoid = Lesser Multangular7. Capitate = Os Magnum8. Hamate = Unciform

LateralLateral

PA ObliquePA Oblique

AP ObliqueAP Oblique

Ulna Deviation – Ulna Ulna Deviation – Ulna FlexionFlexion

Stecher Method – Cassette Stecher Method – Cassette raised raised

Stecher Method – Tube Stecher Method – Tube angledangled

Carpal Tunnel (Tangential Carpal Tunnel (Tangential Projection) - Gaynor-Hart Projection) - Gaynor-Hart

MethodMethod

ForearmForearmAPAP

Lateral Lateral

ElbowElbowAP AP

Epicondyles are parallel to the IR

LateralLateral

Epicondyles are perpendicular to the IR

Medial (Internal) Rotation Medial (Internal) Rotation ObliqueOblique

Lateral (External) Rotation Lateral (External) Rotation ObliqueOblique

Distal Humerus – Partial Distal Humerus – Partial FlexionFlexion

APAP

Proximal Forearm – Partial Proximal Forearm – Partial FlexionFlexion

APAP

HumerusHumerusAPAP

LateralLateral

Transthoracic LateralTransthoracic Lateral

Lower ExtremityLower Extremity

ToesToes AP – Perpendicular CR AP – Perpendicular CR

CR - 3rd MTP

AP AxialAP Axial

AP Oblique – Medial AP Oblique – Medial RotationRotation

FootFoot AP AxialAP Axial

CR - Base of 3rd metatarsal

AP Oblique – Medial AP Oblique – Medial RotationRotation

Lateral - MediolateralLateral - Mediolateral

AnkleAnkleAPAP

Lateral - MediolateralLateral - Mediolateral

Medial Rotation (Internal) Medial Rotation (Internal) ObliqueOblique

for bony structuresfor bony structures

15-20 degree Medial Rotation 15-20 degree Medial Rotation for Ankle Mortise Jointfor Ankle Mortise Joint

Lateral (External) Rotation Lateral (External) Rotation ObliqueOblique

Stress MethodStress Method

Inversion StressEverson Stress

For verification of ligament tear

CalcaneusCalcaneus Axial – PlantodorsalAxial – Plantodorsal

CR - base of 3rd metatarsal

Lateral CalcaneusLateral Calcaneus

CR - 1” distal to medial malleoulus

Lower LegLower Leg AP AP

LateralLateral

KneeKneeAP – Sthenic PatientAP – Sthenic Patient

CR - 1/2” distal to apex of patella

AP - Hypersthenic PatientAP - Hypersthenic Patient

AP - Asthenic PatientAP - Asthenic Patient

LateralLateral

AP Oblique - Lateral (External) AP Oblique - Lateral (External) RotationRotation

AP Oblique – Medial (Internal) AP Oblique – Medial (Internal) Rotation Rotation

Bilateral knees – weight- Bilateral knees – weight- bearingbearing

Patella Patella PAPA

CR - mid patella

Lateral PatellaLateral Patella

Settegast Method for PatellaSettegast Method for Patella“Sunrise or Skyline View”“Sunrise or Skyline View”

Typical tube angle is 15-20 degrees

Hughston Method for PatellaHughston Method for Patella

Lower leg forms 50-60 degree angle from table

Intercondylar Fossa - PA Axial Intercondylar Fossa - PA Axial Projection (Holmblad Method)Projection (Holmblad Method)

Femur is at 20 degree angle

“Tunnel” projection

Camp-Coventry MethodCamp-Coventry Method

If knee is flexed 40 degrees, the tube is angled 40

FemurFemur

AP Projection (for distal femur)AP Projection (for distal femur)

AP Projection (for proximal femur)AP Projection (for proximal femur)

Lateral femur to include kneeLateral femur to include knee

Lateral Projection (for proximal Lateral Projection (for proximal femur)femur)