Merrill’s Pocket Guide to Radiography

14th Edition Edition Bruce Long

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The Following Abbreviations Are Used Throughout the Pocket Guiders
o okAbbreviation Definition
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Abbreviation
b
Definition
AC Acromioclavicular
e / e
MCP Metacarpophalangeal
AML
AP
: / /
Anteroposterior .
Acanthomeatal line
t m MTP
OID
Metatarsophalangeal

: /
Object–to–image-receptor distance / t .
ASIS
C h ttps
Anterior superior iliac spine(s)
Cervical spine
OML
PA
Orbitomeatal line
Posteroanterior ht tps
cm Centimeters PIP Proximal interphalangeal
EAM External acoustic meatus RAO Right anterior oblique

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in Inches RPO
er s
Right posterior oblique

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IOML Infraorbitomeatal line RUQ Right upper quadrant
kVp Kilovolt (peak)
/ e bo S Sacrum
L Lumbar spine

t . me SID Source–to–image-receptor distance

t .
LAO
: / /
Left anterior oblique T Thoracic spine
: / /
ttps tps
LPO Left posterior oblique TMJ Temporomandibular joint

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M E R R I L L’ S s
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Pocket Guide
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M E R R I L L’ S s
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Pocket Guide
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Fourteenth Edition
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3251 Riverport Lane
St. Louis, Missouri 63043

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MERRILL’S POCKET GUIDE TO RADIOGRAPHY ISBN: 978-0-323-59703-6 Library of Congress Control Number: 2018959059

Copyright © 2019 Elsevier, Inc. All rights reserved.

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Previous editions copyrighted 2016, 2012, 2007, 2003, 1999 and 1995. Content Strategist: Sonya Seigafuse
Content Development Manager: Lisa Newton

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No part of this publication may be reproduced or transmitted in any form or by Content Development Specialist: Betsy McCormac
any means, electronic or mechanical, including photocopying, recording, or any Publishing Services Manager: Shereen Jameel

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information storage and retrieval system, without permission in writing from the Project Manager: Nadhiya Sekar

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publisher. Details on how to seek permission, further information about the Publisher’s
permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
Designer: Brian Salisbury

Printed in United States of America

This book and the individual contributions contained in it are protected under copyright Last digit is the print number: 9 8 7 6 5 4 3 2 1
by the Publisher (other than as may be noted herein).

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Notices

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Practitioners and researchers must always rely on their own experience and knowledge

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in evaluating and using any information, methods, compounds or experiments described
herein. Because of rapid advances in the medical sciences, in particular, independent

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verifi cation of diagnoses and drug dosages should be made. To the fullest extent
of the law, no responsibility is assumed by Elsevier, authors, editors or contributors

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for any injury and/or damage to persons or property as a matter of products liability,

/
negligence or otherwise, or from any use or operation of any methods, products,

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instructions, or ideas contained in the material herein.

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Merrill’s Pocket Guide to Radiography concisely pres-
e rs
• Footnote that references information in the 14th edition

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ents essential positioning information for the most
frequently requested projections in a format designed for
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of Merrill’s Atlas
• Exposure technique chart with space for writing manual

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quick reference. This edition offers step-by-step explana-
e and automatic exposure control (AEC) technical factors

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tions of methods to position the patient and body part for (a sample of this chart with instructions for completion

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more than 150 of the most commonly requested radiog-
: / may be found on the next page after the contents)
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raphy projections, including mobile. • Competency check-off for students—blank lines are

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Its format makes the Pocket Guide particularly easy to present on each projection page for the instructor to
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use, with each projection presented in a broadside, two-
page spread. Each projection presentation includes the
sign and date after the student has demonstrated com-
petency for that projection
following information: • Specific collimation sizing for use with DR systems
• Patient position Features designed to enhance the utility of the Pocket
• Part position Guide include section dividers with tabs, which make

e rs
• Central ray angulation
r s
finding the beginning of each section easier, and abbre-
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• Collimation viations and external landmarks printed on the inside of
• kVp
• Photograph of properly positioned patient
/ e bo the covers for quick reference.

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Introduction
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 How to Use the Technical Factors Chart

e rs
Part Thickness mA kVp Time
e rs CR, DR Exposure HF, 1Ø, or 3Ø

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A given technique
always depends on
Set an mA that
enables use of the
The kVp should be set

b
to penetrate the body
o ok
Time always varies
with part thickness
Indicator
Indicate the
Always indicate the
generator phase. A
the thickness of the
body part.
small focal spot
whenever possible.
e/ e
part, ensure optimum
image quality at the
and respiration
considerations.
exposure index,
S number, or REX
3Ø 12p requires 50%
less mAs than a 1Ø

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lowest dose. number.

: / / t
50% more mAs than
.
2p. A 1Ø 2p requires

ttps tps
a 3Ø 12p.*

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Manual Factors

e rs Part
Thickness
Image
Receptor
er s CR, DR
Exposure HF 1 ,

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(cm) mA kVp Time mAs SID Size Indicator Grid or 3

21 200 80 0.30

/ e bo 60 40 14 17 400 12:1 3 12p

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AEC Factors

o Part
Thickness AEC Density
/ e b o CR, DR
Exposure HF 1Ø
(cm) mA kVp

t . m e
Detector Comp. SID IR Size Indicator Grid or 3Ø

t .
21 200 80

: / / 0 48 14 17 400 12:1 3

:
12p
/ /
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Detectors Density Compensation Digital Indicator
Shade in the detector or detectors Indicate if a 1 or 2 or a 1 or The exposure index for the system

e rs
used for the body part. 2 compensation is required for
r s
in use and projection should be

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the exposure. entered here.

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Example of the way technical factors would be entered for an AP projection of

technical factors.
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the pelvis in two different rooms. One room uses AEC, and the other uses manual

t .
: / / *See imaging textbooks for other 1Ø and 3Ø variables.
: / /
h ttps ht tps ix
 This page intentionally left blank

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 e rs
Second Through Fifth Digits: Carpal Canal:
e rs
Shoulder:

o ok PA, 2
Lateral, 4
Tangential; GAYNOR-HART
METHOD, 30
b o ok AP, 52
Shoulder Joint:
PA oblique (lateral rotation), 6 Forearm:
e/ e AP oblique; GRASHEY METHOD, 54

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First Digit (Thumb): AP, 32 Shoulder:
AP, 8

: / / t Lateral, 34
/
Inferosuperior axial; LAWRENCE

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Lateral, 10 Elbow: METHOD, 56

ht
PA oblique, 12 AP, 36 Scapular Y: PA oblique, 58
Hand:
PA, 14 h
PA oblique (lateral rotation), 16
Lateral, 38
AP oblique (medial rotation), 40
AP oblique (lateral rotation), 42
Acromioclavicular Articulations:
AP; PEARSON METHOD, 60
Clavicle:
Lateral, 18 AP partial flexion, 44 AP, 62
Wrist: Humerus: AP axial, 64

e rsPA, 20 AP, 46
er s
Scapula:

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Lateral, 22 Lateral, 48 AP, 66
PA oblique (lateral rotation), 24
PA: ulnar deviation, 26
/ e bo
Proximal Humerus/Shoulder:
Transthoracic lateral; LAWRENCE
Lateral, 68

PA axial; STECHER METHOD, 28

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METHOD, 50

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: / / : / /
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 Second Through Fifth Digits
PA

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
e/ e
• Place extended digit of interest with palmar surface of hand down
on the IR.

: / / t .m
• Separate digits slightly, and center the digit under examination to the
: / / t .
ttps tps
center of the IR.
• Shield gonads.
Central Ray h
• Perpendicular, entering PIP joint of digit being examined
ht
Collimation:

e s
1 inch (2.5 cm) all sides of digit, including 1 inch (2.5 cm) proximal
r
to MCP joint. Place side marker in the collimated exposure field.
er s
ook / e bo ok 5 3

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: / / : / /
ttps tps
kVp: 63 Reference: 14th edition ATLAS p. 1:154.

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ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

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_______________________________________________________________________________        Instructor: ___________________

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: / / : / /
Upper Extremity
h ttps ht tps 3
 Second Through Fifth Digits
Lateral

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
e/ e
• Demonstrate position for patient. Ask patient to extend digit

: / t .m
of interest and to close rest of digits into a fist.
/
• Adjust digit of interest parallel to IR plane.
: / / t .
ttps tps
• Rest digit on lateral or medial surface as needed to obtain

h
smallest possible OID.
• Immobilize extended digit. (Use cotton swab or tape.)
• Shield gonads.
ht
Central Ray
• Perpendicular, entering PIP joint

e rs
Collimation:
er s
ook ok
1 inch (2.5 cm) all sides of digit, including 1 inch (2.5 cm) proximal

bo
to MCP joint. Place side marker in the collimated exposure field.

/ e
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: / / : / /
ttps tps
kVp: 63 Reference: 14th edition ATLAS p. 1:156.

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 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

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: / / : / /
Upper Extremity
h ttps ht tps 5
 Second Through Fifth Digits
PA oblique (lateral rotation)

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
e/ e
• Place patient’s hand in lateral position, ulnar side down and centered
to IR area.

: / / t .m
• Rotate palm 45 degrees toward IR until digits are resting on sponge
: / / t .
ttps tps
support.

h
• Immobilize separated digits.
• Shield gonads.
Central Ray
ht
• Perpendicular, entering PIP joint

e s
Collimation:
r
1 inch (2.5 cm) on all sides of digit, including 1 inch (2.5 cm) proxi-
er s
ook ok
mal to MCP joint. Place side marker in the collimated exposure field.

/ e bo
t . me 3

t .
: / / : / /
ttps tps
kVp: 63 Reference: 14th edition ATLAS p. 1:158.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 7
 First Digit (Thumb)
AP

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
e/ e
• Place affected hand in extreme internal rotation, with first digit cen-
tered to IR area.

: / / t .m
• Adjust position of hand to ensure true AP projection of first digit.
: / / t .
ttps tps
• Extend and secure digits two through five to eliminate superimposi-

h
tion over first digit.
• Shield gonads.
Central ray
ht
• Perpendicular, entering MCP joint of first digit

e s
Collimation:
r
1 inch (2.5 cm) on all sides of digit, including 1 inch (2.5 cm) proxi-
er s
ook ok
mal to CMC joint. Place side marker in the collimated exposure field.

/ e bo
t . me t .
: / / : / /
ttps tps
kVp: 63  Reference: 14th edition ATLAS p. 1:160.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 9
 First Digit (Thumb)
Lateral

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
• Have patient rest palmar surface of hand on IR.
e/ e
achieved.
: / t .m
• Adjust arching of hand until true lateral position of first digit is
/ : / / t .
ttps tps
• Shield gonads.
Central Ray
h
• Perpendicular, entering MCP joint of first digit ht
Collimation:
1 inch (2.5 cm) on all sides of digit, including 1 inch (2.5 cm) proxi-

e rs
mal to CMC joint. Place side marker in the collimated exposure field.

er s
ook / e bo ok
t . me t .
: / / : / /
ttps tps
kVp: 63 Reference: 14th edition ATLAS p. 1:160.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 11
 First Digit (Thumb)
PA oblique

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
• Abduct first digit.
e/ e
to oblique position.
: / t .m
• Place palmar surface of hand firmly against IR, and adjust first digit
/ : / / t .
ttps tps
• Shield gonads.
Central Ray
h
• Perpendicular, entering MCP joint of first digit ht
Collimation:
1 inch (2.5 cm) on all sides of digit, including 1 inch (2.5 cm) proxi-

e rs
mal to CMC joint. Place side marker in the collimated exposure field.

er s
ook / e bo ok
t . me t .
: / / : / /
ttps tps
kVp: 63 Reference: 14th edition ATLAS p. 1:160.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 13
 Hand
PA

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
e/ e
• Rest forearm on table with palmar surface of hand against IR.
• Spread digits slightly.
• Shield gonads.
: / / t .m : / / t .
Central Ray
h ttps
• Perpendicular to third MCP joint
Collimation:
ht tps
1 inch (2.5 cm) all sides of hand including 1 inch (2.5 cm) proximal
to ulnar styloid. Place side marker in the collimated exposure field.

e rs er s
ook / e bo ok
t . me t .
: / / : / /
ttps tps
kVp: 66 Reference: 14th edition ATLAS p. 1:168.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 15
 Hand
PA oblique (lateral rotation)

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
e/ e
• Rest forearm on table with palmar surface of hand against IR.

: / t .m
• Rotate hand laterally (externally), and place digits on 45-degree
/
radiolucent support to show interphalangeal joints. Adjust digits
: / / t .
ttps tps
parallel with IR.

h
• When metacarpals are area of primary interest, rotate hand laterally
so that fingertips touch IR.
• Shield gonads.
ht
Central Ray
• Perpendicular to third MCP joint

e rs
Collimation:
er s
ook ok
1 inch (2.5 cm) on all sides of hand including 1 inch (2.5 cm)

exposure field.
/ e bo
proximal to ulnar styloid. Place side marker in the collimated

t . me t .
: / / : / /
ttps tps
kVp: 66 Reference: 14th edition ATLAS p. 1:170.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 17
 Hand
Lateral

e rs
Patient Position
e rs
o ok
• Seat patient at end of radiographic table.

b o ok
Part Position
e/ e
• Rest ulnar surface of forearm on table with hand in true lateral
position.

: / / t .m
• Extend digits with first digit (thumb) placed at right angles to palm
: / / t .
ttps tps
of hand. As an option, have patient “fan” fingers and place on posi-

h
tioning sponge to reduce superimposition of phalanges (as illus-
trated).
• Center MCP joints to IR, and adjust palmar surface of hand perpen-
ht
dicular to IR.
• Shield gonads.

e rs
Central Ray
er s
ook ok
• Perpendicular to second MCP joint
Collimation:

/ e bo
1 inch (2.5 cm) on all sides of shadow of hand and thumb, including

t . e
1 inch (2.5 cm) proximal to ulnar styloid. Place side marker in the
m t .
collimated exposure field.
: / / : / /
kVp: 70
h ttps Reference: 14th edition ATLAS p. 1:172.
https
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 19
 Wrist
PA

e rs
Patient Position
e rs
o ok
• Seat patient at end of table with axilla in contact with table.

b o ok
Part Position
• Have patient rest forearm on table.
e/ e
• Center wrist to IR area.

: / / t .m
• Flex digits slightly to place wrist in contact with IR.
: / / t .
ttps tps
• Shield gonads.
Central Ray
h
• Perpendicular to midcarpal area ht
Collimation:
2.5 inches (6 cm) proximal and distal to wrist joint and 1 inch (2.5 cm)

e rs
on the sides. Place side marker in the collimated exposure field.

er s
ook / e bo ok
t . me t .
: / / : / /
ttps tps
kVp: 66 Reference: 14th edition ATLAS p. 1:176.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 21
 Wrist
Lateral

e rs
Patient Position
e rs
o ok
• Seat patient at end of table with axilla in contact with table.

b o ok
Part Position
e/ e
• Flex elbow 90 degrees, with forearm and arm in contact with table.

position.
: / t .m
• Center carpals to IR, and adjust hand so that wrist is in true lateral
/ : / / t .
ttps tps
• Shield gonads.
Central Ray
h
• Perpendicular to wrist joint ht
Collimation:
2.5 inches (6 cm) proximal and distal to wrist joint and 1 inch (2.5 cm)

e s
on palmar and dorsal surfaces. Place side marker in the collimated
r
exposure field.
er s
ook / e bo ok
t . me t .
: / / : / /
ttps tps
kVp: 70 Reference: 14th edition ATLAS p. 1:178.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 23
 Wrist
PA oblique (lateral rotation)

e rs
Patient Position
e rs
o ok
• Seat patient at end of table with axilla in contact with table.

b o ok
Part Position
• Rest anterior surface of wrist on IR.
e/ e
• Center wrist to IR area.

: / / t .m
• Rotate wrist approximately 45 degrees laterally (externally) and
: / / t .
ttps tps
support on sponge.
• Shield gonads.
Central Ray h
• Perpendicular to IR, entering midcarpal area just distal to radius
ht
Collimation:

e s
2.5 inches (6 cm) proximal and distal to wrist joint and 1 inch (2.5 cm)
r
on sides. Place side marker in the collimated exposure field.
er s
ook / e bo ok
t . me t .
: / / : / /
ttps tps
kVp: 66 Reference: 14th edition ATLAS p. 1:180.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 25
 Wrist
PA: ulnar deviation

e rs
Patient Position
e rs
o ok
• Seat patient at end of table with axilla in contact with table.

b o ok
Part Position
e/ e
• Flex elbow 90 degrees, with forearm and arm in contact with table.
• Center wrist to IR area.

: / / t .m
• Without moving the forearm, turn the hand outward until wrist is in
: / / t .
ttps tps
extreme ulnar deviation.
• Shield gonads.
Central Ray h
• Perpendicular to scaphoid
ht
NOTE: If necessary to delineate fracture, angle central ray 10 to
15 degrees proximally (toward elbow) or distally.

e rs
Collimation:
er s
ook ok
2.5 inches (6 cm) proximal and distal to wrist joint and 1 inch

bo
(2.5 cm) on sides. Place side marker in the collimated exposure field.

/ e
t . me t .
: / / : / /
ttps tps
kVp: 66 Reference: 14th edition ATLAS p. 1:182.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________      Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 27
 Wrist
PA axial STECHER METHOD

e rs
Patient Position
e rs
o ok
• Seat patient with arm and axilla in contact with table.

b o ok
Part Position
e/ e
• Place one end of IR on a support, and adjust so that finger end is
elevated 20 degrees.

: / / t .m
• Adjust the wrist for a PA projection, and center wrist to IR.
: / / t .
ttps tps
• Shield gonads. 20°
Central Ray
h
• Perpendicular to table, and position to enter scaphoid ht
Collimation:
2½ inches (6 cm) proximal and distal to wrist joint and 1 inch (2.5 cm)

e rs
on sides. Place side marker in the collimated exposure field.

er s
ook / e bo ok
t . me t .
: / / : / /
ttps tps
kVp: 66 Reference: 14th edition ATLAS p. 1:184.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 29
 Carpal Canal
Tangential GAYNOR-HART METHOD

e rs
Patient Position
k k e rs 25°–30°

oo• Seat patient with forearm parallel with long axis of table.

b o o
e/e
Part Position
• Hyperextend wrist, and center it to center of IR.

if needed.
: / t .m
• Place ¾-inch radiolucent pad under lower forearm for support,
/ : / / t .
ttps tps
• Adjust hand position to make long axis of hand as vertical as
possible.
h
• Have patient grasp digits with opposite hand to hold in extended
position, or pull with a band (as shown).
ht
• Shield gonads.
Central Ray
rs
• Direct to palm of hand 1 inch (2.5 cm) distal to base of third
e er s
ook ok
metacarpal at 25- to 30-degree angle
Collimation:

/ e bo
1 inch (2.5 cm) on the three sides of shadow of wrist. Place side
marker in the collimated exposure field.

t . me t .
: / / : / /
ttps tps
kVp: 70 Reference: 14th edition ATLAS p. 1:190.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 31
 Forearm
AP

e rs
Patient Position
e rs
o ok
• Seat patient at end of table with arm extended and entire extremity
in same plane.
b o ok
Part Position
e/ e
interest.
: / t .m
• Supinate hand, and center forearm to IR to include joint or joints of
/ : / / t .
ttps tps
• Adjust rotation to place humeral epicondyles equidistant from IR.
• Shield gonads.
Central Ray h
• Perpendicular to midpoint of forearm
ht
Collimation:

e s
2 inches (5 cm) distal to wrist joint and proximal to elbow joint, and
r
1 inch (2.5 cm) on sides. Place side marker in the collimated exposure
er s
ook ok
field.

/ e bo
t . me t .
: / / : / /
ttps tps
kVp: 70 Reference: 14th edition ATLAS p. 1:192.

h ht
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 33
 Forearm
Lateral

e rs
Patient Position
e rs
o ok
• Seat patient at end of table with humerus and forearm in contact
with table.
b o ok
Part Position
e/ e
: / t .m
• Have patient flex elbow, and position entire extremity in same plane.
/
• Flex elbow 90 degrees, and adjust hand to lateral position (thumb
: / / t .
ttps tps
up).

h
• Center forearm to IR to include joint or joints of interest.
• Shield gonads.
Central Ray
ht
• Perpendicular to midpoint of forearm

e s
Collimation:
r
2 inches (5 cm) distal to wrist joint and proximal to elbow joint, and
er s
ook ok
1 inch (2.5 cm) on sides. Place side marker in the collimated exposure
field.

/ e bo
t . me t .
kVp: 70
: / / Reference: 14th edition ATLAS p. 1:194.
: / /
h ttps https
 e rs e rs
ok ok
Manual Factors

o Part

e b o Image CR, DR

e/
Thickness Receptor Exposure HF, 1Ø
(cm) mA kVp Time mAs SID Size Indicator Grid or 3Ø

: / / t .m : / / t .
h ttps ht tps

e rs er s
ook / e bo ok
Notes: _________________________________________________________________________ Competency: _________/____/____

t . e
_______________________________________________________________________________        Instructor: ___________________

m t .
: / / : / /
Upper Extremity
h ttps ht tps 35
 Elbow
AP

e rs
Patient Position
e rs
o ok
• Seat patient at end of table with arm extended and entire extremity
in same plane.
b o ok
Part Position
e/ e
: / t .m
• Extend elbow, supinate hand, and center elbow joint to IR.
/
• Adjust humeral epicondyles to be equidistant from IR.
: / / t .
ttps tps
• Have patient lean slightly laterally if necessary to ensure
AP alignment.
• Shield gonads.
Central Ray
h ht
• Perpendicular to elbow joint

e s
Collimation:
r
3 inches (8 cm) proximal and distal to elbow joint and 1 inch (2.5 cm)
er s
ook ok
on sides. Place side marker in the collimated exposure field.

/ e bo
t . me t .
: / / : / /
ttps tps
kVp: 70 Reference: 14th edition ATLAS p. 1:195.

h ht
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