IMAGING AND THERAPEUTIC

MODALITIES.

SEPTEMBER 2017.
MAGING AND THERAPEUTIC MODALITIES
(ITM) Module 1..
Module Content Outline
Fundamentals of Radiography;
1. Ethics in Radiographic technology.
2. Terms used in radiographic practice.
3. Preparation for a radiographic procedure.
4. Radiation Protection.
5. Radiographic Imaging
Radiographic Imaging.
6. Upper extremity.
7. Shoulder joint.
8. Lower extremity.
9. Pelvis and Upper femur.
10. Thoracic Cage.
11. Thoracic viscera.
12. Vertebral column.
13. Abdomen.
OBJECTIVES;
• Define the term medical imaging sciences/
radiography.

• Name six branches of medical imaging.

• Define the term radiographer.

• State the role of a radiographer as a member of the

health team.

Definition.
• Imaging and therapeutic modality; science of taking
images of the body for purpose of diagnosis or treatment.

• Radiography; science of applying radiation energy to

the human body either to diagnose or treat diseases.
Imaging is divided into 3 parts;
1) Medical imaging (all 6 specializations).
2) Veterinary imaging. (Animals/cats/dogs horses etc).
3) Industrial imaging (x-ray of pipes lines, aero plane,
tyres industry etc).

Six branches of medical imaging.

Imaging embraces;
1. Conventional imaging (x-rays).
2. Ultra-sonography (sound waves).
3. Computerized tomography (CT) scanning.
4. Magnetic resonance imaging (MRI) uses magnetic
fields.
5. Nuclear medicine (radioisotopes) for diagnosis and
treatment.
6. Radiotherapy (ionizing radiation) treatment of
cancers and tumors.
Conventional Radiography;
Two parts.
1. Plain regional radiography.
2. Special/contrast medium radiography.

Radiographer;
• Is a graduate with a diploma/degree in medical imaging
sciences who uses radiation (energy) either to diagnose or
treat diseases in patient?

Role and duties of a radiographer.

1. Performs all radiographic examination for diagnosis.
2. Care for patient while in the imaging departments.
3. Care for imaging/radiographic equipments.
4. Prepares patient, radiographic equipment and
trays/trolley for examinations.
5. Prepares processing chemicals and processes x-ray
films.
Role cont’
6. Manages imaging department.

7. Maintains departmental hygiene.

8. Gives opinion on pathological findings on radiographs

(x-ray films).

9. Implements radiation protection measures in the

imaging/radiographic department.

10. Educates members of the public on radiation hazards

and protections measures.

11. Treat patient who have diseases such as cancer using

radiation.

12. Complies with the professional code of ethics.

ETHICS IN IMAGING.
1. Professional ethics.
2. Work ethics.

Ethics are DO’s and DON’Ts when one is dealing with a

patient.
They include;
1) No request forms no imaging.

2) Consent signed when required.

3) No operation under influence of intoxicating materials.

4) Do not abuse patient/clients or relatives.

5) Administer radiation protection.

6) Observe privacy.
Ethics cont;.

7. Prior patient preparation.

8. Explain the procedure to the patient.

9. Uphold confidentiality (no public gossip about a

patient).

10. Keep records as required.

11. Integrity (be trustworthy) safekeeping of valuables.

12. Prevent cross-infection.

 References
1) Bontrager, K.L& Lampignano, J. (2010) Textbook of
Radiographic positioning & related Anatomy 7th ed. Mosby.

2) Armstrong, P.Wastie, M.L. & Rockall, A (2005) Diagnostic

imaging. 5th ed. Blackwell.

3) Carroll, Quinn (1993) Evaluating Radiographs 1st ed. Charles C.

Thomas.

4) Clark, K.C. (1991) Positioning in Radiography 12th ed.

Butterworth-Heinemann.

5) Moller, T.B.Reif, E & Stark (1993) Pocket Atlas of

Radiographic Anatomy.

6) Weller B.F. (2005) Bailliere’s Nurses’ Dictionary for nurses &

health care workers 24th ed.Bailliere Tindall.

05/12/2024 9
RADIATION PROTECTION.
• Excessive ionizing radiation can damage body cells.
• Also magnetic waves/ sound waves may be dangerous
to some extent.

There are two fold of effects.

1. Somatic effects.
2. Genetics effect.

SOMATIC EFFECT.
• They effect the individual who has been exposed to the
radiation e.g. radiographer, patient, public or staff.

• They include;
1. Hair loss.
2. Cataracts (black white of the eye becomes whitish).
3. Erythema (skin reddening).
4. Abortion (loss of pregnancies-miscarriage).
Somatic effects cont’
5. Life shortening.
6. Cell death.
7. Leukemia.
8. Nausea.
9. Vomiting.

GENETIC EFFECT.
• These effects will be manifested in the future
generation e.g. deformed babies (born without some
body parts).

RADIATION PROTECTION PRECAUTION

MEASURES.
• Beam collimation.(LBD)
• Green intensifying screens.
• Meticulous techniques.
• Proper instruction the patient.
Protection cont;
• Proper patient identification.

• Short exposure times.

• Inverse square law.

• Use of protection devices (lead rubber gowns, gloves,

gonads shield).

• Close doors and bolt.

• Limit number of room occupancy.

• Do not use faulty equipment.

• Minimize use of ionizing radiation (to yourself, other

staff, patient and the public).
QUALITY OF IMAGES.
• Diagnostic value.
• A good image should have;
1. Good contrasts (should see dark and light parts).
2. High definition.
3. Good demonstration of the area of interest.
4. No motional blur.
5. Good processing technique.
6. Good beam collimation.
7. Exposure on full arrested respiration (CxR).
8. Proper film identifications (name, anatomical
marker, date, institution).
9. Collimation marks (where the image is should have
borders to show how restricted the beam to area of
interest.
 TERMINOLOGIES.
Distal;
• Toward the end or away from point of attachment.
Proximal;
• Close to/near the head. towards the point of attachment.
Anterior;
• Front of the body.
Posterior;
• Back part of the body..
Antero-Posterior (A.P);
• From front to back.
Postero-Anterior (P.A);
• From back to front.
Lateral;
• Away from midline, rotate the body part 900 from
anterior/posterior(to one side).
Oblique;
• 450 Tilt form lateral position.
05/12/2024 14
 TERMINOLOGIES cont’.
Recumbent;
• Semi-lying position.
Ambulant;
• Able to move.
Inversion;
• Sole of foot inwards.
Eversion;
• Sole of foot outwards.
Midline;
• Half body in an anatomical position through
midline plane.
Medial;
• Towards the midline.
Superior;
• Above.
Inferior;
05/12/2024• Below. 15
 TERMINOLOGIES cont’.
Cephalad;
• Towards the head.
Caudad;
• Toward the feet.
Dorsal;
• Related to the back.
Supine;
• Lying facing upwards.
Prone;
• Lying facing downwards.

PATIENT PREPARATION.
Three P’s.
1. Physical.
2. Psychological.
05/12/2024
3. Physiological. 16
PATIENT PREPARATION.
1. Physical.
• Unclothing.
• Clean changing hospital gown.
• Removal of artifacts.
• Shaving.

2. Psychological.
• Brief explanation.
• Proper Instructions.

3. Physiological.
• Bowel preparation.
• Dieting.

What the role of radiographer/imaging technologists ?;

a) Before.
b) During.
05/12/2024 17
c) After examination.
 UPPER LIMBS/EXTREMITY;
• Consists of shoulder girdle having;
1. Scapula (e).
2. Clavicle.

• The arm having the following bones;

1. Humerus (upper arm).
2. Radius and ulna (forearm).
3. Eight (8) carpal bones.
4. Meta-carpals (5).
5. Phalanges (14).

• Joint linking the bones are:

a) Shoulder joint-gleno humeral joint.
b) Elbow joints.
c) Wrist joint, carpo-metacarpal joint.
d) Metacarpo-phalangeal joint.
e) Inter-phalangeal joints.
05/12/2024 18
 UPPER LIMBS;
Different projection to demonstrate the joints and
bones;
• Film projection are taken in two planes;

• Mandatory views/projections.

Basic views;
a) Antero-Posterior AP.
b) Lateral.

Supplementary views/Additional views.

c) Oblique.
d) Tangential.

Alternative views;
e) Postero-Anterior (P.A).
05/12/2024 f) Axial. 19
 IMAGING TECHNIQUES.
THE FINGERS;
•They are formed by 14 phalanges/digits of the hand.
•The thumb has two phalanges and the rest have three.
•When imaging the fingers you do;

1. Dorsipalmar/Postero-anterior (PA) projection.

• Patient sits at the side of the table.
• Hands are in pronation/rests with the palmar surface on
the cassette (24 x18)cm (10x8)in.
• Finger being examined centered to the midline of the
(unmasked half) of the cassette.
• Finger is spread/extended.
•The other fingers abducted.
• FFD – 100cm.
• Centre to the head of proximal phalanx of middle finger.
• Collimate beam to the area of interest.
• Gonad shielded (lead apron).
05/12/2024 20
 IMAGING TECHNIQUES.
THE FINGERS cont;

2. Lateral view.
• Patient sits at the side of the table (legs not under the
table).
• The hand is rotated 900 from pronation.
• 2nd and 3rd finger rest on the cassette with their radial
side.
• 4th and 5th fingers with their ulnar side (finger nails
straight lateral).
• 3rd and 4th finger supported so that the long axis of the
entire finger is parallel to the film).
• Adjacent fingers flexed (use bands if necessary).
• Thumb supported on a foam pad.
• FFD 100cm.
• Centre via medial phalanx of first finger.
• Gonad shielded, collimation, side identification marked.
05/12/2024 21
 IMAGING TECHNIQUES.
THUMB.
a) Postero-anterior (P.A)
b) Lateral.

Postero-anterior (PA).
• Hand in lateral position 900 from pronation or supination.
• Thumb supported on foam pad.
• Centre to meta-carpophalangeal joint.
• FFD 100cm.
• Collimate beam to the middle of a finger.

Lateral.
• Hand in pronation and thumb slightly raised on foam
pad.
• Use (24x18) cm film cassette.
• FFD 100cm.
• Centre over metacarpal joint.
05/12/2024 22
 IMAGING TECHNIQUES cont;
THUMB
Alternative views.
•Antero-posterior view.
•Medio-lateral.

INDEX AND MIDDLE FINGER.

a) Postero-anterior PA view (as the other fingers).
b) Lateral.
• Hand rotated such that the lateral aspects of the two
fingers are in contact with 24x18 cm film cassette.
• FFD 100cm.
• Collimate beam.
• Center to the middle of the finger.

RING AND 5TH FINGER.

a) Postero-anterior (PA) as the other fingers.
b) Lateral.
05/12/2024 23
 IMAGING TECHNIQUES cont;
RING AND 5TH FINGER..
B} Lateral.
• Medial aspects in contact with 24x18cm film cassette.
• The rest of the fingers flexed and on foam pad.
• Collimate the beam.
• Center to middle of the finger.

THE HAND.
• Made of 14 phalanges, 5 metacarpals and 8 carpals.
• For grasping and defense.

Postero-anterior view (PA).

• The hand is in pronation on a (24x18)cm film cassette.
• Fingers are extended and put together.
• Collimate the beam.
• FFD 100cm.
• Centre at the metacarpo-phallangeal joints.
05/12/2024 24
 IMAGING TECHNIQUES cont;

Oblique.
• Fingers 450 from pronation.

• Finger slightly flexed.

• Collimate the beam, side identification marked.

• Center at the metacarpo-phallangeal joint.

05/12/2024 25
Hand PA view.

05/12/2024 26
 PA Oblique

05/12/2024 27
 Lateral.

Fan
Lateral

Extension
Lateral

05/12/2024 28
 WRIST JOINT.
• It is a joint of forearm formed by radius, ulna and
carpals bones.

• The carpals involved are scaphoid, lunate, and

triquetral.

• This articulates with the head of radius to form the

wrist joint.

• Ulna is isolated from the joint by a white fibro-

cartilage.

• Proximal-mediolateral; pisiform, triquetral, lunate,

scaphoid.

• Distal row- lateral medial; trapezium, trapezoid,

05/12/2024 capitates and hamate. 29
 WRIST JOINT.
Slogans; To remember the 8 carpal bones.
• Please;
(Pisiform).
• Talk;
(Triquetral).
• Loudly;
(Lunate).
• So;
(Scaphoid).
• That;
(Trapezium).
• They;
(Trapezoid).
• Can;
(Capitates).
• Hear;
05/12/2024
(Hamate). 30
 WRIST JOINT.
BASIC VIEWS;
1. Postero-Anterior (AP) view.
2. Lateral view.

Postero-anterior (PA).
• Patient sits beside x-ray couch.

• Put the hand in pronation with the wrist in

contact with 24x18cm film cassette.

• Elbow flexed.

• Using FFD 100cm.

• Collimate beam to area of interest.

05/12/2024 • Centre between the styloid processes. 31

 WRIST JOINT.
Lateral view.
• Patient sits beside the x-ray couch.
• The hand is rotated 900 from the pronation.
• The elbow is flexed and wrist joint is moved 50 back.
• Collimate to the area of interest.
• Centre to the radial styloid process.

SCAPHOID VIEW.
Frequently fractured (#).
1. Postero-anterior (PA) done as for normal wrist joint.
2. Lateral; same as for wrist.
3. Postero-Anterior with ulna deviation.
4. Postero-Anterior (PA) obliques 450 Centre between
the styloid processes.
5. Antero-Posterior AP obliques. “ “ “ “ “ .
05/12/2024 32
 Wrist PA view.

05/12/2024 33
Lateral.

05/12/2024 34
 UPPER EXTREMITY Cont;
CARPAL TUNNEL.
• This is a curved depression formed by carpal bones.
• Blood vessels, nerves, ligaments and tendons pass
there.
• Nerve interference may cause carpal tunnel
syndrome.

AXIAL VIEW.
• Patient sits backward with the fingers pressing on
24x18 cm film cassette.

• Patient leans downwards until tunnel is in profile.

• Collimate beam, side anatomical marker.

• Centre through the tunnel.

05/12/2024 35
Carpal Tunnel (Tangential Projection). Gaynor-Hart
Method.

05/12/2024 36
 THE UPPER LIMBS.
THE FOREARM.

ANATOMY.
• The bones of the forearm are the radius and ulna which
articulates with each other at the proximal and distal
radio-ulnar joint.

• They articulate with the humerus at the elbow joint and

with the carpal bones at the wrist joint.

• The head of the radius is at the elbow and the head of

the ulnar is at the wrist joint.

• Supination and pronation involve rotation of the radius

and hand about the ulnar, which remains still.
05/12/2024 37
 THE FOREARM.
ANATOMY cont’.

• On full supination, the radius and the ulnar lies

approximately parallel with one another when the
patient is in the anatomical position.

• On pronation, the distal end of the radius rotates

medially around the anterior surface of the head of the
ulnar, so as to bring the radius obliquely across in front
of the ulnar with the dorsal surface of the radius facing
anteriorly.

• To obtain a true late antero-posterior (A.P) view of the

forearm, the elbow must be extended and the palms face
upwards.
05/12/2024 38
 THE FOREARM.
Basic Views.
1) Antero-posterior AP.
2) Lateral.

1. Antero-Posterior (AP) .
Patient position;
• The patient’s sits beside the x-ray table.

• The elbow is extended and forearm placed in supination

on a long film cassette.

• Usually 15cm x40cm or 18cm x 43cm or 30cm x40 cm

split in two.

• The arm is adjusted to make the humeral epicondyles

equidistant from the film surface and to include both
elbows and wrist joint.
05/12/2024 39
 THE UPPER LIMBS.
The Forearm.
Basic Views.
Antero-Posterior cont’.
• When the site of injury is known, the joint nearest must
be included.

• For immobilization, a sandbag is placed on the fingers.

• Collimate the beam to area of interest.

• Side identification anatomical marker is placed.

Central ray;

• Using a vertical and perpendicular central ray, centre in

the middle of the forearm.
05/12/2024 40
 ANTERO-POSTERIOR VIEW A.P.

05/12/2024 41
 Forearm cont;
Lateral.

• Patient position as above, from the Antero-Posterior

(AP) position.

• The elbow is flexed at right angle and the hand is

placed in the lateral position with thumb uppermost.

• A sandbag is placed against the hand for

immobilization.

• Both joints should be included.

• Collimate the beam and placed anatomical side

marker.
05/12/2024 42
Lateral.

05/12/2024 43
 Special Circumstances.
• When the extension of the elbow is restricted by splint
or plaster of paris fixing the elbow and the wrist joint.

• A lateral view can be obtain by using a horizontal beam

from the trunk aspect.

• Centre to the middle of the forearm.

Foreign bodies in the forearm.

• Both projections must be taken without moving the

limb, for accurate localization of the foreign body (FB),
i.e. lateral with horizontal beam.

Note; Forearm in Plaster of paris (POP); Wet (10 kvp

more), Dry (5 kvp more).
05/12/2024 44
 THE ELBOW JOINT.
Anatomy.
• The articulation at the elbow joint comprises the hinge
joint between the humerus and the forearm (allowing
flexion and extension) and
• The proximal radio-ulnar joint allowing pronation and
supination rolling movement of the radius and hand while
the ulnar remains still.

• The elbow joint is formed by the trochlear of the ulnar

articulating with the trochlear notch of the humerus and
the capitullum articulating with the head of the radius.

• Proximal to the capitullum and trochlear, the humerus

expands to form the medial and lateral epicondyles.

• The medial being more palpable and more prominent

than the lateral.
05/12/2024 45
 THE ELBOW JOINT.
Anatomy.
• The elbow has multiple centers of ossification;
secondary centers appear between the ages of 2 and 12
years.

• Comparatives views of the elbow are often required

in children.

Indications.
1) Dislocation.
2) Fractures e.g. supracondyler #
3) Pathology - osteoarthritis (O.A).
4) F.B localization.

Basic Views.
a) Antero-Posterior.
b) Lateral.
05/12/2024 46
 THE ELBOW JOINT.
Lateral Position.
• This view is taken fast as the position is easier for the
patient.

• The patient sits beside the x-ray table with the elbow flexed
at the right angle and the hand in lateral position.

• The upper arm and forearm must be in the same plane so

either the patient sits on a low stool or the cassette is raised
on a firm support or table is raised until it is in correct
height.

• The epicondyles must be superimposed, a sandbag is

placed on each side of the forearm for immobilization and
support.

Central ray;
• Centre at the lateral epicondyles using a vertical and
05/12/2024 47
 LATERAL VIEW ELBOW JOINT.

05/12/2024 48
 Antero-Posterior View.
• Patient position as above.

• From the lateral position the elbow is extended

and the forearm outstretched with the back of the
hand over the table or resting on a foam pad.

• For immobilization, a sandbag is gently placed on

the forearm.

Central ray;

• The vertical and perpendicular central ray is

centered between and 2.5 cm distal to the
epicondyles.

05/12/2024 49
 ANTERO-POSTERIOR VIEW A.P.

05/12/2024 50
 Supplementary Views.
Lateral (2).
• From the basic lateral position the hand is allowed to
rotate forward until the palm is in contact with the couch,
centre to the lateral epicondyles of the humerus.

Lateral (3).
• From the position of the lateral 2 above.
• The hand is rotated forward until the radial aspect is in
contact with the couch and the palm of the hand faces
away from the trunk and centre as in lateral 2 above.

Note;
• The 3 projections provide an almost complete rotation of
the radial head, a minor injury to the radial head can
therefore be confirmed through these techniques.
05/12/2024 51
 Supplementary views cont;.

I. Antero-posterior 2.

II. Antero-posterior 3.

III. Antero-posterior 4.

1. Antero-Posterior 2.

• Done with the forearm on the film.

• Centre to the midpoint 2.5cm below the crease

of the joint.

05/12/2024 52
 Antero-Posterior 2.
• Done with the forearm on the film centre to the
midpoint 2.5cm below the crease of the joint.

Proximal Forearm – Partial Flexion A.P

05/12/2024 53
 Antero-Posterior 3.
• Done with the humerus on the film centre midway of the
epicondyles.

Distal Humerus – Partial Flexion A.P

05/12/2024 54
 Supplementary views cont;

Antero-Posterior 4.
• Done with the elbow flexed at right angles where
possible and the humerus and the forearm equidistant
from the film surface.

• Centre to the angle of the joint.

HEAD OF THE RADIUS.

Views.
a) Basic lateral of the elbow.
b) Lateral 2.
c) Lateral 3.
d) Antero-posterior 4.
05/12/2024 55
 ULNAR-GROOVE.
Anatomy.
• Is the sulcus at the distal extremity of the humerus which
transmits the ulnar nerves from the upper to the lower arm.

• It is superficial and readily palpable.

• When the groove is projected in profile, the pathological

changes in bones and soft structures may be demonstrated.

Basic Views.
Supero-Inferior/AXIAL VIEW.
• Patient position. The patient sits with his back to the x-
ray table.

• The arm is extended from the shoulder joint with the

elbow and forearm placed on the cassette.
05/12/2024 56
 Basic Views.
Supero-Inferior/AXIAL VIEW cont’.
• The upper arm is adjusted to make and angle of 450 with
the film.

Central ray;
• Centre to the groove immediately lateral to the medial
epicondyle.

Proximal Radio-Ulnar Joint.

• From the general Antero-Posterior (AP) position of the
elbow.

• The arm is rotated slightly outwards to separate the

radius and ulnar in the upper 1/3 of the forearm.

• Centre over the head of the radius.

05/12/2024 57
 Special Circumstances.
• When the patient is unable to extend the elbow due to
injury, pathology or immobilization by POP.

a) Antero-posterior 2.
b) Antero-posterior 3.
c) When the elbow is in extreme flexion.
d) Axial.
e) Infero-Superior.
f) Supero-Inferior.

Inferior-Superior.
• The upper arm is placed on the film and the hand on the
shoulder, the kV is increased by 10 – 15 kV from basic AP
view.

• Centre 5cm (2”inches) to the olecranon process through

the upper arm and forearm.
05/12/2024 58
 Special Circumstances.
Supero-Inferior.
• With patient back against the table, the forearm is placed
on the film cassette.

• Centre just above level of humeral epicondyles with a

straight tube or angled 300 to the elbow joint.

• When the patient must remain supine e.g. in case of

severe illness or multiple injuries.

• Antero-Posterior (AP) view is done by supporting the

film under the elbow at the height at which the upper arm
and forearm are at the same level.

• If the arm is across the chest a lateral views may be

obtained by placing a cassette between the elbow and the
chest, a special attention must be paid to radiation
05/12/2024 59
protection of the gonads.
 Special Circumstances.
Supero-Inferior.
When the elbow is immobilized to the trunk.
• The patient stands/sits with the lateral aspects of the
elbow joint in contact with a vertically supported gridded
cassette or a vertical bucky stand.

• The trunk is slightly rotated forward to separate the

vertebral column from the elbow joint.

Central ray;
• Using a horizontal central ray centre through the trunk
directly over the elbow joint reduce the beam field to
cover only the area of interest.

• Children both joints may be radiograph in Antero-

Posterior (AP) view for comparison.
05/12/2024 60
 HUMERUS.
Anatomy.
• Is the largest bone of the upper limb, the proximal
end is describe under the shoulder girdle and the distal
end in the section of the elbow joint.

• The shaft is cylindrical and about ½ way along it on

the lateral aspect is deltoid tuberosity for attachment
of the deltoid muscles.

• The soft tissues of the upper arm are much thicker at

the proximal end than at the distal end when the arm
is held in a sling following injury.

• Radiography is carried out in this position to avoid

distress or further injury to the patient.
05/12/2024 61
 HUMERUS.
Indications.
1. Fractures #.
2. Pathology e.g. osteogenic sarcoma, osteomylitis.
3. Foreigh Body (FB).

Basic Views.
a) Antero-posterior.
b) Lateral.

Anterior- Posterior View.

Patient position
• Patient faces the x- ray table in the exact /supine position.

• The elbow is extended with the patient with the hand

facing the forward (in the anatomical position) the humeral
epicondyles must be equidistant from the film surface .
05/12/2024 62
 HUMERUS.
Antero-posterior AP cont’

Film position;
• The upper border of the film cassette is placed
25 cm above the top of the shoulder and should
be (large enough to include both the elbows and
the shoulders).

Central ray;
• The perpendicular central ray is centered
midway between the shoulder joint and the elbow
joint.

05/12/2024 63
 HUMERUS...
Humerus A.P.

05/12/2024 64
 Humerus cont’.

Lateral.
• From the above position the arm is abducted and rotated
medially through 900 with the elbow flexed and the hand
placed on the abdomen.

• The film is adjusted to rise 25 cm above the shoulder.

• The epicondyles must be superimposed.

• In the supine position the cassette may be raised on

sandbags or soft pads to bring it into close contact with
the humerus.

Central ray: - Centre midway between the shoulder and

the elbow joint using a perpendicular central ray.
05/12/2024 65
 Lateral.

05/12/2024 66
 Special Circumstances.
1. When the arm is strapped to the side of the trunk;
• The patient may sit /stand and the film cassette may be
placed to the anterior/posterior or lateral aspect of the
humerus with the beam direct through the thoracic when
necessary.

Transthoracic Lateral.

05/12/2024 67
 Exposure factors and other related details.
For all the parts discussed under the upper-limb.

• FFD is 100cm.

• Use of standard screens.

• No grids except in trans-thoracic/trans-

abdominal views.

• Use of fine focus.

• The mA/mAs values and the kV depend on the

particular x-ray generator.

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 Special Circumstances.
Transthoracic lateral.

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 Special circumstances cont;.
2. When the injured arm is suspended freely from the
trunk and cannot be moved without causing
considerable discomfort.

• The patient is examined in the erect/ sitting

position.

• To demonstrate bone alignment / position of

fragment in a mid –shaft fracture.

For the lateral projection.

• The film cassette may be supported on the medial
aspect of the humerus.
a. centre either through the lateral aspect of the
humerus or
b. Through the axilla remote from the film .
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 Special circumstances cont;
3. When the arm is immobilized in abduction
Antero- Posterior View.
• The patient is examined in the supine position.
• The film cassette is placed well-up under the shoulder to
include the shoulder joint and the upper 1/3 of the
humerus.
• Centre over the head of the humerus.

Lateral (Infero-Superior).
• The arm is supported in abduction and the shoulder
slightly raised over a non-opaque pad,
• The head is turned and neck inclined towards the sound
side to allow the vertically supported cassette to be placed
against the neck thus ensuring inclusion of the essential
parts of the shoulder joint.
• Centre towards the axilla and at right angle to the
cassette using a horizontal beam.
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