Wednesday, January 4, 2012


  • These are special projection taken for pathologic processes of trauma to the area of the radial head and / or the coronoid process of ulna. These are effective projections when patient cannot extend elbow fully for medial or lateral obliques of the elbow.

Pathology Demonstrated:

  • Fractures and dislocations of the elbow, particularly the radial head (part  position 1) and coronoid process (part  position 2), are shown.

Technical Factors:

  • IR size - 18 x 24 cm (8 x 10 inches), crosswise
  • Detail screen, tabletop
  • Digital IR - use lead masking
  • 70 to +- 6kV range (see note)


  • Place lead shield over gonadal area.

Patient Position:

  • Seat patient at the end of the table for erect position or supine on the table for cross imaging.

Part Position:

  • Elbow flexed 90degree if possible; hand pronated
  • CR directed at a 45degree angle toward shoulder, centered to radial head (mid elbow joint)
  • Minimum SID 40 inches (100cm)

Part Position 2 - Coronoid Process

  • Elbow flexed only 80degree from extended position (because more than 80degree may obscure coronoid process) and hand pronated
  • CR angled 45degree from shoulder, into mid elbow joint
  • Minimum SID of 40 inches (100cm)


  • Collimate on four sides to area of interest.


  • Increase exposure factor by 4 to 6 kV from lateral elbow because of angled CR. These projection are effective with or without a splint.

Radiographic Criteria for Specific Anatomy:

For Radial Head:

  • The joint space between radial head and capitulum should be ooen and clear.
  • The radial head, neck, and tuberosity should be in profile and free of superimposition, except for a small part of the coronoid process.
  • The distal humerus and epicondyles appear distorted because of the 45degree angle.

For Coronoid Process:

  • The distal [anterior] portion of the coronoid appears elongated but in profile.
  • The joint space between coronoid process and trochlea should be open and clear.
  • The radial head and neck should be superimposed be ulna.
  • Optimal exposure factors should visualize clearly the coronoid process in profile. Bony margins of superimposed radial head and neck should be visualized faintly through the proximal ulna.

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