Transthoracic Lateral Projection

1. Stand the patient in the lateral position;
2. Rest the forearm, flex the elbow 90º with the hand on the abdomen;
3. The contralateral limb flexed over the head.

Central ray perpendicular entering at the level of the surgical neck.

Respiration: Suspended at the end of Full inspiration.

Evaluation criteria:

• Visualization of the proximal humerus;
• Scapula, clavicle and humerus seen through the lung field;
• Scapula superimposed over the thoracic spine;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Humerus Projection

AP Projection

1.  Patient in standing position;
2. Upper limb in extension and slight abduction;
3. Hand in supination.

Central ray perpendicular to the midportion of the humerus.

Respiration suspended.

Evaluation criteria:

• Visualization of the elbow and shoulder joints;
• Epicondyles without rotation;
• Humeral head and greater tubercle in profile;
• Outline of the lesser tubercle located between the humeral head and the grater tubercle;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1.  Patient in standing position;
2. Flex the elbow 90º and place the anterior hand on the hip.

Central ray perpendicular to the midportion of the humerus.

Respiration suspended.

Evaluation criteria:

• Visualization of the elbow and shoulder joints;
• Superimposed epicondyles;
• Lesser tubercle in profile;
• Greater tubercle superimposed over the humeral head;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Elbow Study

AP Projection

1. Seat the patient near the table and low enough to place the shoulder join, humerus, and elbow joint in the same plane;
2. Extended the elbow;
3. Supinate the hand (prevent rotation of the bones of the forearm).

Central ray perpendicular to the elbow joint.

Evaluation criteria:

• Radial head, neck and tuberosity slightly superimposed over the proximal ulna;
• Elbow joint open and centered to the central ray;
• No rotation of the humeral epicondyles;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral projection

1. Seat the patient at the end of the table low enough to place the humerus and elbow joint in the same plane;
2. Flex the elbow 90º;
3. Adjust the hand in the lateral position and ensure that the humeral epicondyles are perpendicular to the plane of the IP.

Central ray perpendicular to the elbow joint.

Evaluation criteria:

• Open elbow joint centered to the central ray;
• Elbow flex 90º;
• Superimposed humeral epicondyles;
• Radial head partially superimposing the coronoid process;
• Olecranon process seen in profile;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Forearm Study

AP Projection

1. Seat the patient close to the table and low enough to place the entire limb in the same plane;
2. Supinate the hand and extend the elbow.

Central ray perpendicular to the midpoint of the forearm.

Evaluation criteria:

• Visualization of the wrist and elbow joints;
• Slight superimposition of the radial head, neck, tuberosity over the proximal ulna;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1. Seat the patient close to the table and low enough that the humerus, shoulder joint and elbow lie in the same plane;
2. Flex the elbow 90º.

Central ray perpendicular to the midpoint of the forearm.

Evaluation criteria:

• Superimposition of the radius and ulna at their distal end;
• Radial tuberosity facing anteriorly;
• Superimposed humeral epicondyles;
• Elbow flexed 90º;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

 

Pisiform Study

AP Oblique Projection

1. Seat the patient at the end of the table;
2. Rest the forearm on the table in the supine position;
3. Rotate the wrist with the plantar surface until it forms an angle of approximately 60º.

Central ray perpendicular to the ulnar styloid apophysis.

Evaluation criteria:

• Carpals on medial side of the wrist;
• Triquetrum, hamate and pisiform free of superimposition and in profile;
• Visualization of distal radius and ulna, carpals and proximal half of metacarpals;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).


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