CHAPTER 7 ARM Arm CLAVICLE 1 AP — two angled views, page 62 SCAPULA 2. Scapula AP, page 63. 3. Scapula lateral, page 64. SHOULDER JOINT X-rays of the shoulder joint are taken with the patient lying down, unless there is pain 4, Shoulder AP ~ two views taken with different rotation of the arm, page 65. 5. Shoulder AP — actomioclavicular joint, page 66. 6 Shoulder axial, page 67. Patient with the arm in pain (after injury) 7. Shoulder AP, page 68. 8. Shoulder lateral, page 69. HUMERUS X-rays of the humerus are taken with the patient lying down, unless there is pain 9. Humerus AP and lateral — two views taken with different rotation of the arm, page 70. Patient with the arm in pain (afte 10, Humerus AP, page 71 jury) 11, Humerus lateral, page 72. ELBOW 12, Elbow AB, page 73. 13, Elbow lateral, page 74. 14, Elbow semiflexed — after injury, two views to be taken, page 75. FOREARM 15. Forearm PA ~ after injury. page 76. 16. Forearm lateral ~ afier injury, page 77. wrist 17, Wrist PA and additional view in ulnar deviation, page 78. 18, Wrist lateral, page 79. 19, Scaphoid — after injury, page 80. HAND 20. Hand PA and additional two oblique views, page 81. 21. Thumb AP, page 82. 22. Thumb lateral, page 83. 23. Single finger lateral, page 84. THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 61ARM 1 CLAVICLE AP Supine - vertical beam angulated +20° and -20° as shown Two views Cassette speed Cassette with screen-film combination, nominal speed 200/400 in the cassette holder For a CHILD, cassette on the table Cassette size 24x30 cm (10x12 inches) 18x24 cm (8x10 inches) for a child Use a Right or Left marker Exposure | values pg “blue” system | “green” system ae 200 400 Average | 25 2s | Range 20-50 10-25 “blue” system | “green” system isaasS 200 4002250 Average 63 5 BASIC Bring in the patient, put the cassette in the cassette holder or on the table (for a child) Collimate to the format. 2. Angle the tube cassette holder arm. 3. Position the patient. Center and collimate Further, if possible. 4. Expose. 5. Change cassette and angle, expose again. Center point: mid clavicle Xray with angulation as shown X-ray with the opposite angulation 62 ‘THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 2 SCAPULA AP Supine BASIC If the patient is in pain, use ARM 7 Cassette speed 1. Bring in the patient, put che cassette in the Cassette with screen-film combination, cassette holder. Collimate co the format. nominal speed 200/400 in the cassette holder 2, Poalion the patiene, Usew pillow und te For a CHILD, cassette on the table other shoulder. Center and collimate further, Cassette size if possible. 24430 cm (10x12 inches) 3. Expose, 18x24 cm (8x10 inches) for a child Use a Right or Left marker Exposure are values “blue” system | “green” system gts 200 400 Average 25 125 Range 20-50 10-25 I “blue” system | “green” system 200 400/250. Average 63 5 Child 53 kv ‘THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 63ARM 3 SCAPULA LATERAL Sitting erect BASIC Do not use for children under 10 years of age Cassette speed 1, Bring in che patient, put the cassette in the Cassette with screen-film combination, cassette holder. Collimate to the format. nominal speed 200/400 in the cassette holder Position the patient. Unless the patient is in Cassette size pain raise the arm with the hand behind the 24x30 cm (10x12 inches) head. See alternative position with the arm Use a Right or Lefe marker down, when ic is painful. Center and colli- mate further, if possible. Exposure mAs 3. Expose. values rou | “Bless aster | arene sate ‘Average 50 25 Range 40-125 20-64 Alternative position 64 ‘THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 4 SHOULDER AP-two views Supine - vertical beam angled 10° as shown BASIC Cassette speed Cassette with screen-film combination, nominal speed 200/400 in the cassette holder For a CHILD, cassette on the table (one view) Cassette size 2430 em (10x12 inches) 18x24 em (8x10 inches) for a child Use a Right or Left marker Exposure values “blue” system 7OKV ie Average 125 Range 10-25 5125 f “blue” system | “green” system crs 200 400/250 Average 4 32 — Palm of hand facing down 1. Bring in the patient, pur the cassette in the cassette holder or on the table (for a child) Collimate to the format. Position the patient. a. Place a large pillow under the shoulder not to be examined, b. Turn the patient so that the shoulder to be X-rayed lies lat on the table © Rotate the arm outwards so that the palm of the hand faces upwards 3. Center and collimate further, if possible 4, Expose and change cassette 5. Rotate the arm inwards so that the palm of the hand faces downwards. Expose INFANTS and SMALL CHILDREN lie supine oon the cassette on top of the table. Fither view only. Palm of hand facing up THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 65ARM 5 SHOULDER AP Supine ADDITIONAL Upper arm away from body—acromioclavicular joint Cassette speed Cassette with screen-film combination, nominal speed 200/400 in the cassette holder For a CHILD, cassette on the table (one view) Cassette size 1824 cm (8x10 inches) Use a Right or Left marker Eapome pee | mAs (average) wy | “blue® system | “green® sytem 200 200230 Adult 70 | 125 63 child 53 4 32 1. Bring in the patient, put the cassette in che cassette holder or on the table (for a child) Collima to the format 2. Position the patient. Bend the upper arm away from body. 3. Center and collimace farther, if possible. 4, Expose. INFANTS and SMALL CHILDREN lie supine on the cassette on top of the table > 66 ‘THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 6 SHOULDER AXIAL ADDITIONAL Cassette speed Cassette with screen-film combination, nominal speed 100/200 on top of a firm support (12-15 cm high) on the cassette holder. Cassette size 18x24 em (8x10 inches) Use a Right or Left marker Exposure values at “blue” system | “green” system Ba, 200 100/63 [Average 10 25 1. Bring in the patient, put the casserte on top of a firm support (12-15 cm high) on the cas sette holder. Collimace to the format. 2. Position the patient. Bend the upper arm away from body. 3. Center and collimate further, if possible. 4, Expose. ‘THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 67ARM 7 SHOULDER AP Sitting erect. ADDITIONAL After injury Cassette speed Cassette with screen-film combination, nominal speed 200/400 in the cassette holder Cassette size 24x30 em (10x12 inches) Use a Right or Left marker Exposure mas values *plue” system | “green” system rok 200 400 ‘Average 25, 63 Range 10-32 56 Bring in the patient, put the cassette in the cassette holder. Collimate to the format. . Position the patient. The patients forearm should be at right angles to the cassette holder, pointing straight towards the x-ray ube . Center and collimate further, if possible. Expose. 68 “THE WHO MANUAL OF DIAGNOSTIC IMAGING * RADIOGRAPHIC TECHNIQUE AND PROJECTIONSSHOULDER LATERAL - after injury Si Cassette speed Cassette with screen-film combination, nominal speed 200/400 in the cassette holder Cassette size 24,30 em (10x12 inches) Usea Right or Left marker Exposure = values “blue” system | “green” system a 200, 400 ‘Average 32 16 Range 20-50 10-25 ARM 8& ing erect. ADDITIONAL 1. Bring in the patient, pur the cassette in the cassette holder. Collimate to the format. 2. Position the patient. The patients forearm should be close to the cassette holder. 3. Center and collimare further, if possible. 4, Expose, ‘THE WHO MANUAL OF DIAGNOSTIC IMAGING RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 69ARM 9 HUMERUS AP and LATERAL ~no injury Supine BASIC Two views Cassette speed Cassette with screen-film combination, nominal speed 200/400 on the table Cassette size 18x43 cm (7x17 inches) or 20x40 em Use a Right or Left marker Exposure values | bi “blue” system 70 kV ae Average 12.5 Range 816 Palm of hand facing up 1. Bring in the patient, put the cassette on the table. Collimate to the format. Position the patient. Rotate the arm outwards so that the palm of the hand faces upwards. Center and collimate further, if possible. Expose Change cassette, Rorate the arm inwards so that the palm of the hand faces downwards. . Expose Palm of hand facing down 70 THE WHO MANUAL OF DIAGNOSTIC IMAGING » RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 10 HUMERUS AP - after injury _ Sitting erect Cassette speed ie sette with screen-film combination, nominal speed 200/400 in the cassette holder Cassette size 18x43 cm (7x17 inches) or 20x40 cm. Use a Right or Left marker Exposure ae values “blue” system | “green” system yes 200 400 Average 125 63 Range a6 48 ADDITIONAL 1. Bring in the patient, put the cassette in the cassette holder. Collimate co the format Position the patient. The patients forearm should be at right angles to the cassette holder, pointing straight towards the x-ray tube 3. Center and collimate further, if possible 4. Expose. THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONS nARM 11 HUMERUS LATERAL - after injury Cassette speed Cassette with screen-film combination, nominal speed 200/400 in the cassette holder Cassette size 18x43 cm (7x17 inches) or 20x40 cm Use a Right or Left marker Exposure | mAs vas: _| | “blue” system | “green” system FOR ee 200 Average | 25 125 Range | 20-40 10-20 Sitting erect . Position the patient. The p. ADDITIONAL Bring in the patient, put the cassette in the cassette holder. Collimate to the format. jents forearm should be clase to the cassette holder. Center and collimate further, if possible. 72 ‘THE WHO MANUAL OF DIAGNOSTIC IMAGING RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 12 ELBOW AP Sitting, with the arm in supination BASIC Cassette speed 1. Bring in the patient, put the eassette on the Cassette with screen-film combination, cassette holder. Collimate to the format. nominal speed 50/100 on the cassette holder 2. Position the patient. The palm of the patients Cassette size J should be facing up. When x-raying a 18x24 em (8x10 inches) CHILD, if the arm is not long enough for the Half the cassette may be covered by a lead sheet elbow to reach the centre point of the cassette as shown in ARM holder put the cassette on top of a firm sup- Use a Right or Left marker port (10-12 em high) on the cassette holder. 3. Center and collimate further, if possible Exposure | he 4, Expose “plue” system | “green” system sok 50 | 10063 Average 125 10 Range 825 63-20 THE WHO MANUAL OF DIAGNOSTIC IMAGING « RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 2BARM 13 ELBOW LATERAL Cassette speed Cassette with sereen-flm combination, nominal speed 50/100 on the cassecte holder Cassette size 18x24 cm (8x10 inches) Half che cassette may be covered by a lead sheet as shown in ARM 22. Use a Right or Left marker [Expose values "blue oyster sakv | Average | 20 16 Range | 125-25 10-20 Sitting, with the arm in supination BASIC 1. Bring in the patient, put the cassette on the cassette holder. Collimace co the format. 2. Position the patient. The thumb should be facing up. When x-raying a CHILD, if the arm is not long enough for the elbow to reach the centre point of the cassette holder put the cassette on top of a firm support (10-12 cm high) on the cassette holder. 3. Center and collimate further, if possible. 4, Expose. 74 THE WHO MANUAL OF DIAGNOSTIC IMAGING « RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 14 ELBOW AP - after injury Cassette speed Cassette with screen-film combination, nominal speed 50/100 on the cassette holder Cassette size 18x24 cm (8x10 inches) Half the cassette may be covered by a lead sheet as shown in ARM 22. Use a Right or Left marker Exposure values mas “blue” system | "green’ system ak 50 100V63 a ‘Average 20 16 range [2535 os Upper arm parallel to the cassette holder Semiflexed = ADDITIONAL ing, with the arm in supination - two views 1. Bring in the patient, put the cassette on the cassette holder. Collimate to the format. 2. Position the patient. The palm of the patients ¢ facing up. When hand should (if possible) xcraying a CHILD, if the arm is not long enough for the elbow to reach the centre point of the cassette holder put the cassette on top of a firm support (10-12 em high) on the cassette holder. 3. Center and collimate further, if possible 4, Expose 5. Change cassette and take the other view. [ Lower arm parallel to the cassette holder THE WHO MANUAL OF DIAGNOSTIC IMAGING » RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 75ARM 15 FOREARM PA - after injury _ Sitting - with the arm in supination Cassette speed Cassette with sereen-film combination, nominal speed 50/100 on the cassette holder. If the arm is in plaster, nominal speed 200/400, Cassette size 24x30 (10x12 inches) 18x24 cm (8x10 inches) fora child Use a Right or Left marker — ms ‘Average: Rs 10 In plaster | “blue” system | “green” system BASIC n the patient, put the cassette on the cassette holder. Collimate to the format. Position the patient. The palm of the patients hand should be facing down, the elbow bent at right angle as shown and the upper arm parallel ro the cassette holder. Center and collimate further, if possible Expose. 76 THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 16 FOREARM LATERAL - after injury Cassette speed Cassette with screen-film combination, nal speed 50/100 on the cassette holder: Ifthe arm is in plaster, nominal speed 200/400. Cassette size 24x30 (10x12 inches) 1824 cm (8«10 inches) for a child Use a Right or Left marker Exposure mAs values “blue” system | “green” system Sa 50 100/63 Average 125 10 Range 8-20 62-16 In plaster | “blue” system | “green” system | sokv 200 4001320 Average 63 4 Standing or sitting BASIC 1. Bring in the patient, puc the cassette on the cassette holder. Collimate to the forma. 2. Position the patient, Standing or sitting (whichever is more comfortable for the patient). The thumb should be uppermost 3. Center and collimate further, if possible. 4, Expose, THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 7ARM 17 WRIST PA Sitting - with hand turned as shown BASIC Ulnar deviation ADDITIONAL Cassette speed Cassette with screen-film com nominal speed 50/100 on che cassette holder ation, Cassette size 18x24 em (8x10 inches) Half the cassette may he covered by a lead sheet as shown in ARM 22. Use a Right or Left marker 3. Center and collimate furthe Exposure mis values "blue" system | “green” system oa 50 100/63 Average 8 63 Range 516 4125 Ulnar deviation ADDITIONAL Bring in the patient, pur the cassette on the cassette holder. Collimate to the format. Position the patient. The palm of the patients, hand facing down possible, Expose 5. On the request of the doctor, change cassette and position as shown for ulnar deviation and make a new exposure, 78 THE WHO MANUAL OF DIAGNOSTIC IMAGING « RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 18 WRIST LATERAL Standing or sitting Cassette speed Cassette with screen-film combination, nominal speed 50/100 on the cassette holder. Cassette 18x24 em (8x10 inches) Half the cassette may be covered by a lead sheet as shown in ARM 22. Use a it or Left marker Exposure mas values | “blue” system | “green” jue" system | “green” system ae ky 50 100/63 Average | 125 10 Range [63-16 | rt x BASIC 1. Bring in the patient, put the cassette on cassette holder. Collimate to the format. Position the patient. Standing or sitting (whichever is more comfortable for the patient). The thumb uppermost 3. Center and collimate further, if possible. 4. Expose THE WHO MANUAL OF DIAGNOSTIC IMAGING « RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 79ARM 19 SCAPHOID - after injury Sitting ADDITIONAL Two views Cassette speed 1. Bring in the patient, pur the cassette on the Cassette with screen-film combination, cassette holder. Collimate to the format nominal spee Cassette size 18x24 cm (8) as shown in ARM 22. -d 50/100 on the cassette holder Position the patient. The palm of the hand with ulnar deviation, resting on a supporting «10 inches) pad, as shown, Half the cassette may be covered by a lead sheet 3. Center and collimate further, if possible. 4, Expose. Use a Right or Left marker 5. Take the other view. Exposure mAs values “blue” system | “green” system SSiky 50 100/63 Average 10 8 “Range 63-20 5-16 80 THE WHO MANUAL OF DIAGNOSTIC IMAGING * RADIOGRAPHIC TECHNIQUE AND PROJECTIONSHAND PA and OBLIQUES Sitting BASIC (PA) Cassette speed Cassette with screen-film combination, nominal speed 50/100 on the cassette holder Cassette size 18x24 cm (8<10 inches) Half the cassette may be covered by a lead sheet as shown in ARM 22 Use a Right or Lefe marker Exposure values mt “blue” system | “green” system acy 50 100/50 Average 8 8 Range 5125 5125 ARM 20 ADDITIONAL (obliques) he patient, put the cassette on the cassette holder. Collimate to the format. Position the patient. The palm of the patients hand facing down, Cencer and collimate furcher, if possible Expose On the request of the doctor, change cas sette and position as shown for PA and AP obliques and make new exposures THE WHO MANUAL OF DIAGNOSTIC IMAGING « RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 81ARM 21 THUMB AP Cassette speed nominal speed Cassette size 18x24 em (8x1 Standing BASIC 1. Bring in the patient, put the cassette on the Cassette with screen-film combination, cassette holder. Collimate to the format 50/100 on the cassette holder 2. Position the patient. The thumb on the cas (inches) 3. Center and collimate further, if possible Half the cassete for lateral chumb, Protect the other part of the ce can be used for AP, the other A, ase cassette with a lead strip as shown in ARM 22. Use a Right or Left marker = mss ' | assy | “biuez system | “areen® system 4 oe |e Q 82 HO MANUAL OF DIAGNOSTIC IMAGING * RADIOGRAPHIC TECHNIQUE AND PROJECTIONSARM 22 THUMB LATERAL Sitting or standing BASIC Cassette speed 1. Bring in the patient, pur che cassette on the Cassette with screen-film combination, cassette holder. Collimate to the format. nominal speed 50/100 on the casserte holder 2. Position the patient. The palm of the patients Cassette size hand facing down, fin 1824 em (8x10 inches) 3, Center and collimate further, if possible Half the cassette can be used for AP the other closed. 4, Expose, for lateral chumb, Protect the other part of the cassette with a lead strip. Use a Right or Left marker Exposure values mas “blue” system | “green” system a acy, 50 100/50 ‘Average 16 16 Range 125-25 125-25 Cox HO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONS 83ARM 23 SINGLE FINGER LATERAL Sitting or standing BASIC Cassette speed Cassette with screen-film combination, nominal speed 50/100 on the cassette holder Cassette size 18x24 cm (8x10 inches) Half the cassette can be used for each finger. Protect the other part of the cassette with a lead strip. Use a Right or Left marker Exposure | values ee "blue" system | “green system ey 50 100/50 Average 8 8 Range 63-125, 63-125 1. Bring in the patient, put the cassette on the cassette holder, cover half the cassette with a lead sheet. Collimate to the format. . Position the patient. IF possible extend the finger to be examined with a sti Center and collimate farther, F possible. . Expose Hand (ARM 21) is used for AP and obliques. ‘The radiograph below shows separate view of the third finger. 84 THE WHO MANUAL OF DIAGNOSTIC IMAGING + RADIOGRAPHIC TECHNIQUE AND PROJECTIONS.