Forearm Radiographic Examination Technique in Patient with Fracture in

X-Ray Department of Semoga-Sembuh Hospital

Erio Fabian Mustofa
Radiodiagnostic and Radioteraphy Department of Semarang Health Polytechnics

ABSTRACT
AP projection and lateral should be performed in radiographic examination of forearm
in fracture cases, but different techniques were performed in Radiology
Department of Semoga-Sembuh Hospital. This case report aims to know the forearm
radiographic examination technique of patient with fracture in Radiology Department
of Antah-Berantah Hospital.

Data were colected by observation and indepth interview to the three radiographers,
patient, radiologist, and requesting physician on June 2017

Forearm Radiographic Examination in patient with fracture in Semoga-Sembuh Hospital

was performed using AP projection in supine position and lateral projection. AP
projection in seat the patient close to the radiographic table was not performed in this
hospital.

Forearm Radiographic Examination in patient with fracture in Semoga-Sembuh Hospital

was different to the theory. Lateral projection and AP projection should be done to get
accurate diagnosis. Intensive communication can increase patients motivation to fight
the pain, so the optimum positioning can be performed.

INTRODUCTION

Positioning technique is a factor that greatly affect the diagnosis accuracy of

radiographic image, including in fracture case. AP projection should be performed in
cases of fracture to visualize the elbow joint, the radius and ulna, and the proximal row
of slightly distorted carpal bones(Ballinger, 1999). Lateral projection should be to
visualize an AP projection of elbow joint, distal arm, and proximal forearm is
presented(Laudicina, 1989).

Practically, these technique are not performed in every radiology departments,

including Semoga-Sembuh hospital. Forearm radiographic examination in fracture
patient performed using AP and Lateral projection in supine position.

The aim of this case report is to know/ describe the forearm radiographic examination
procedure in patient with fracture in Radiology Departement of Semoga-Sembuh
Hospital.

CASE PRESENTATION

Based on document study, Mr.X felt pain on his left forearm since December 2014. He
was diagnosed suffering fracture on his left forearm. Radiographic examination was
performed to support that diagnosis.

There were no special patient preparations. The equipments used are general purpose
X-ray unit, 24x30 cm X-ray Cassettes and Films, X-ray marker, and soft-bag.

The first performed projection was AP in supine position. Patient’s forearm were
positioned in supinated the hand, extend the elbow, and center the unmasked half of
the IR to the forearm. Adjust the IR so that the long axis is parallel with the forearm.
The beam was centered on perpendicular to the midpoint forearm. The Source to
Image Distance (SID) was 100 cm. Exposure factors were 48 kVp and 6 mAs.

The second projection was lateral in same position. Flex the elbow 90 degrees, and
centre the forearm over the unmasked half of the IR and parallel with the long axis of
the forearm. Make sure that the entire joint of the interest is included. Adjust the limb
in a true lateral position. The thumb side of the hand must be up. The beam was
centered on perpendicular to the midpoint of the forearm. The Source to Image
Distance (SID) was 100 cm. Exposure factors was 48 kVp and 6 mAs.

AP and Lateral images are shown in figure below

AP projection in seat the patient close to the radiographic table was not performed was
not performed due to patient condition that felt severe pain when seat.

DISCUSSION

Gregg and Siber (2001) recommend radiographic examination of forearm in fracture

case is performed using Antero Posterior and Lateral, patient sit on the seat the patient
close to the radiographic table. Contrasting to the recommendation, forearm
radiographic technique used in Radiology Departments of Semoga-Sembuh Hospital
was only performed on affected side. It could not produce accurate diagnosis. The
Lateral projection should be done both in left forearm.

Anteroposterior projection should be performed using AP on supine position. It can

visualize bones in it natural position, so the fracture is obvious. Patient incomfortability
can be reduced by intensive communication and motivation. Patient should be
motivated to fight the pain to reach accurate examination result.

CONCLUSSION

Forearm Radiographic Examination in patient with fracture in Semoga-Sembuh Hospital

was performed using AP projection in supine position and lateral projection, only on
affected forearm. AP projection in seat the patient close to the radiographic table was
not performed due to patient condition. Lateral projection on supine position should be
done to get accurate diagnosis. Intensive communication can increase patients
motivation to fight the pain, so the optimum positioning can be performed.

REFFERENCE

Ballinger, P. W. 2011. Merril’s Atlas of Radiographic Positions and Radiologic

Procedures, Volume One, Twelfth Edition. St. Louis: CV. Mosby Company.
Bontrager, K. L. 2014. Textbook of Positioning and Related Anatomy, Eighth Edition. St.
Louis: CV. Mosby Company.
Frank, P. W. 2012. Merril’s Atlas of Radiographic Positions and Radiologic
Procedures, Volume One, Twelve Edition. St. Louis: Elsevier.