Elbow & Forearm Trauma ASRT @ RSNA


Elbow CT: Positioning - WRONG WAY
Anatomy CT Scout
Technical
FOPH
BBFF
Monteggia
Galeazzi NEVER scan patients with their
Essex-Lop. elbow laying on their abdomen
Fat Pads Elbow moves with
Peds Elbow patient breathing
Supracond. We don’t scan patients with Makes it impossible
Lat. condyle their elbow down at their side to get good reformats
Med. epicon. Excess radiation across torso Instead get terrible
4  X-ray scatter decreases res.
www.schreibman.info
images like this 
© 2013 Ken L Schreibman, PhD/MD 18 of 99
Elbow & Forearm Trauma ASRT @ RSNA
Elbow CT: Positioning - RIGHT WAY
Anatomy Elbow over head! Optimal Position
Technical
FOPH Avoids torso radiation Elbow straight
BBFF Avoids scatter from torso Head bent out of field
Monteggia
Galeazzi
Essex-Lop.
Fat Pads
Peds Elbow
Supracond.
Lat. condyle
Med. epicon.
4
www.schreibman.info
Supine = OK Prone/Decubitus = OK
However the patient is most comfortable
© 2013 Ken L Schreibman, PhD/MD 19 of 99
Elbow & Forearm Trauma ASRT @ RSNA
Elbow CT: Positioning - BEST WAY
Anatomy Straight arm & elbow
Technical
FOPH Perpendicular to
BBFF CT scanning plane
Monteggia Coronoid
Galeazzi Easier reformatting Fracture
Essex-Lop. Yields highest
Fat Pads resolution reformats
Peds Elbow
Supracond.
Lat. condyle
Med. epicon.
4 CT Scout
www.schreibman.info S,Y 30yoM
Sagittal
Reformat
© 2013 Ken L Schreibman, PhD/MD 20 of 99
Elbow & Forearm Trauma ASRT @ RSNA
Elbow CT: Positioning - With a cast…
Anatomy This is the position to avoid!
Technical
FOPH with arm parallel to CT scanning plane
BBFF
Monteggia Streak artifacts
Galeazzi from scanning
Essex-Lop. length of forearm
Fat Pads limits resolution
Peds Elbow
Supracond. Sagittal
Lat. condyle Reformat
Med. epicon.
4 CT Scout
www.schreibman.info T,B 65yoF
© 2013 Ken L Schreibman, PhD/MD 21 of 99
Elbow & Forearm Trauma ASRT @ RSNA
Elbow CT: Positioning - With a cast…
Anatomy This is a better position
Technical
FOPH with arm oblique to CT scanning plane
BBFF
Monteggia Minimizes forearm
Galeazzi streak artifacts Coronoid
Essex-Lop. Minimizes radiation Fracture
Fat Pads to patient’s head
Peds Elbow
Supracond.
Lat. condyle
Med. epicon.
Sagittal
4 CT Scout
www.schreibman.info R,A 27yoF
Reformat

© 2013 Ken L Schreibman, PhD/MD 22 of 99

Elbow & Forearm Trauma ASRT @ RSNA
Elbow CT: UW 2-page Protocol Sheets
Anatomy Reformat in 6 planes
Technical
FOPH
3 planes relative to distal humerus
BBFF
3 planes relative to proximal forearm
Monteggia  Off Sagittal reference image:
Galeazzi
Positioning 1) Axial to Humerus
Essex-Lop. Reformatting 2) Axial to Forearm
3) Coronal to Radius
Fat Pads 4) Coronal to Ulna
Peds Elbow
Supracond.  Off Axial Humerus reference:
5) Parallel to Inter-Epicondyle Line
Lat. condyle 6) Perpendicular to Epicondyle Line
Med. epicon.
4
www.schreibman.info
If elbow is straight, only need 3!
www.radiology.wisc.edu
© 2013 Ken L Schreibman, PhD/MD 23 of 99