Revision 2 for 'Elbow (inferosuperior view)'

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Elbow (inferosuperior view)

The inferior-superior elbow view is a modified elbow projection for patients in acute flexion greater than 90 degrees, it is also an additional projection to better demonstrate the olecranon process.It is comprised of two views demonstrating the distal humerus and proximal forearm structures

Patient position

Distal humerus projection
  • patient is seated alongside the table
  • with the arm still in full flexion, the humerus is placed onto the IR
Proximal forearm projection
  • patient is seated alongside the table
  • with the arm still in full flexion, the humerus is placed onto the IR

Technical factors

  • inferosuperior projection
  • centering point
    • distal humerus projection
      • perpendicular the humerus, superior to the olecranon process
    • proximal forearm projection
      • the central beam is angled to be perpendicular to the forearm
  • collimation
    • superior to the distal third of the humerus
    • inferior to include one-third of the proximal radius and ulna
    • lateral to include the skin margin 
    • medial to include medial skin margin 
  • orientation  
    • portrait
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60 kVp
    • 5-7 mAs
  • SID
    • 100 cm
  • grid
    • no 

Image technical evaluation

  • distal humerus projection
    • the olecranon process is seen free from superimposition on the inferior portion of the image
    • the humeral epicondyles are also free from superimposition 
    • central structures of the distal humerus are superimposed by the forearm in flexion 
  • proximal forearm projection
    • the proximal forearm structures including the ulna, radial tubercle and radial head are free from distortion (due to CR angle to the forearm), however, superimposed over the distal humerus 

Practical points

This projection should only be performed when requested specifically or in the even of high patient pain leading to an inability to straighten the arm. The projection requires little movement by the patient, this is a good thing and something one should share with them before the beginning of the examination.

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