POSITIONING AND

RADIOGRAPHIC IMAGING
OF THE ELBOW
JESSE ANDERSON MAE, BS, R.T. (R)(CT)(ARRT)
ANATOMY OF
THE ELBOW
ANATOMY OF
THE ELBOW
• Elbow consists of
• Distal humerus
• Proximal ulna
• Proximal radius
PROJECTIONS
OF THE
ELBOW
ELBOW SERIES

• Elbow series consists of

• AP
• Oblique
• Medial and lateral
• Lateral

• Raise arm so that the elbow and

shoulder are on the same plane
AP
(ANTERIOR POSTERIOR)

• Clinical Indications
• Fractures
• Dislocations
• Pathologic processes
• Osteomyelitis
• Arthritis
AP

• Anatomy present
• Distal humerus
• Elbow joint space
• Proximal radius and ulna
• Positioning
• Center point- center of elbow
• Elbow extended
• Hand supinated
• Humerus and forearm aligned with IR
• Collimate to area of interest
• Central ray is perpendicular to IR
AP

• Technical factors
• SID: 40”
• IR: 10”x12”
• Grid: none needed
• kVp: equipment dependent
• mAs: equipment dependent
ADDITIONAL VIEWS

• Acute flexion
• Two images taken
• View distal humerus and proximal radius and ulna
• 1st image: CR perpendicular to humerus
• 2nd image: CR is angled to perpendicular to
forearm
OBLIQUE
(EXTERNAL AND MEDIAL ROTATION)

• Clinical Indications
• External rotation
• Radial head and neck
• Fractures
• Dislocations

• Medial rotation
• Coronoid process and Trochlea
• Fractures
• Dislocations
OBLIQUE
(EXTERNAL ROTATION)
• Anatomy Present
• Radial head, neck, tuberosity
• Capitulum of humerus

• Positioning
• Center point- center of elbow joint
• Elbow extended
• Supinate hand and rotate the arm laterally
• Humerus and forearm aligned with IR
• Collimate to area of interest
• CR is perpendicular to IR
 OBLIQUE
(MEDIAL ROTATION)
• Anatomy present
• Trochlea
• Proximal radius
• Proximal ulna
• Coronoid process
• Olecranon process sitting in fossa

• Positioning
• Center point-center of elbow joint
• Elbow extended
• Pronate hand medially
• Humerus and forearm aligned with IR
• Collimate to area of interest
• CR is perpendicular to IR
OBLIQUE
(EXTERNAL AND MEDIAL
ROTATION)
• Technical factors
• SID: 40”
• IR: 10”x12”
• Grid: none needed
• kVp: equipment dependent
• mAs: equipment dependent
ADDITIONAL VIEWS

• Coyle-Trauma axial
• View the radial head and coronoid process
• Two positions
• 1. (radial head) Elbow flexed 90 degrees; hand
pronated
• IR and CR centered to mid elbow joint
• Tube angled 45 degrees toward shoulder
• 2. (coronoid process) elbow flexed 80 degrees
hand pronated
• IR and x-ray tube centered to mid elbow
joint
• CR angled 45 degrees away from shoulder
LATERAL VIEW
(LATEROMEDIAL)
• Clinical indications
• Fractures
• Dislocation
• Pathologic process
• Osteomyelitis
• Arthritis
• Elevated/displaced fat pads
LATERAL VIEW
(LATEROMEDIAL)
• Anatomy present
• Lateral projection of distal humerus
• Proximal forearm
• Olecranon process
• Soft tissues and fat pads of elbow

• Positioning
• Center point-mid elbow joint
• Elbow joint flexed 90 degrees
• Hand is rotated so that the thumb is up, pinky on the receptor
• Long axis of forearm aligned with long axis of IR
• Collimate to area of interest
• CR is perpendicular to IR
LATERAL VIEW
(LATEROMEDIAL)
• Technical factors
• SID: 40”
• IR: 10”x12”
• Grid: none needed
• kVp: equipment dependent
• mAs: equipment dependent
TRAUMA OF
THE ELBOW
IMAGE REFERENCES

• Crosby, N. E., & Greenberg, J. A. (2014). Radiographic Evaluation of the Elbow. The Journal of Hand Surgery, 39(7), 1408–1414.
https://doi.org/10.1016/j.jhsa.2014.04.035

• Elbow in acute flexion proximal forearm. (n.d.). PurposeGames.com. Retrieved June 9, 2021, from
https://www.purposegames.com/es/game/elbow-in-acute-flexion-proximal-forearm

• Jones. (n.d). ELBOW ANATOMY, INJURIES, AND TREATMENT .Retrieved June 6, 2021, from
https://coloradosportsdoctor.com/elbow-anatomy-injuries-and-treatment/

• Layne, S. (2018, October 9). How to beat elbow pain. Surf and Shore PT.
https://www.surfandshorept.com/how-to-beat-elbow-pain/

• Murphy, A. (n.d.). Elbow (Coyle’s view) | Radiology Reference Article | Radiopaedia.org. Radiopaedia. Retrieved June 6, 2021, from
https://radiopaedia.org/articles/elbow-coyles-view?lang=us

• Shetty, A. (n.d.). Elbow series | Radiology Reference Article | Radiopaedia.org. Radiopaedia. Retrieved June 6, 2021, from
https://radiopaedia.org/articles/elbow-series?lang=us

• Thunell, S. (n,d). High school pathology. [PowerPoint]. Health Sciences Department. Northern Michigan University/
REFERENCES

• Lampignano, J. & Kendrick, L. (2018). Bontrager’s Radiographic Positioning and Related

Anatomy (ninth). Elsevier.
• Shetty, A. (n.d.). Elbow series | Radiology Reference Article | Radiopaedia.org. Radiopaedia.
Retrieved June 6, 2021, from https://radiopaedia.org/articles/elbow-series?lang=us