Transcript CT Elbow Presentation

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
images like this 
 X-ray scatter decreases res.

www.schreibman.info
© 2013 Ken L Schreibman, PhD/MD
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Elbow & Forearm Trauma
ASRT @ RSNA
Elbow CT: Positioning - RIGHT WAY
Anatomy
Elbow
over
head!
Technical
Avoids torso radiation
FOPH
Avoids scatter from torso
BBFF
Monteggia
Galeazzi
Essex-Lop.
Fat Pads
Peds Elbow
Supracond.
Lat. condyle
Med. epicon.
4
Supine = OK

www.schreibman.info
© 2013 Ken L Schreibman, PhD/MD
Optimal Position
Elbow straight
Head bent out of field
Prone/Decubitus = OK
However the patient is most comfortable
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Elbow & Forearm Trauma
ASRT @ RSNA
Elbow CT: Positioning - BEST WAY
Anatomy
Straight
arm
&
elbow
Technical
Perpendicular to
FOPH
BBFF
CT
scanning
plane
Monteggia
Easier reformatting
Galeazzi
Essex-Lop.
Yields highest
Fat Pads
resolution reformats
Peds Elbow
Supracond.
Lat. condyle
Med. epicon.
4
CT Scout

www.schreibman.info
© 2013 Ken L Schreibman, PhD/MD
S,Y 30yoM
Coronoid
Fracture
Sagittal
Reformat
20 of 99
Elbow & Forearm Trauma
ASRT @ RSNA
Elbow CT: Positioning - With a cast…
Anatomy
This
is
the
position
to
avoid!
Technical
with arm parallel to CT scanning plane
FOPH
BBFF
Monteggia Streak artifacts
from scanning
Galeazzi
Essex-Lop. length of forearm
limits resolution
Fat Pads
Peds Elbow
Sagittal
Supracond.
Reformat
Lat. condyle
Med. epicon.
4
CT Scout

www.schreibman.info
© 2013 Ken L Schreibman, PhD/MD
T,B 65yoF
21 of 99
Elbow & Forearm Trauma
ASRT @ RSNA
Elbow CT: Positioning - With a cast…
Anatomy
This
is
a
better
position
Technical
with arm oblique to CT scanning plane
FOPH
BBFF
Monteggia Minimizes forearm
streak artifacts
Galeazzi
Coronoid
Fracture
Essex-Lop. Minimizes radiation
to patient’s head
Fat Pads
Peds Elbow
Supracond.
Lat. condyle
Sagittal
Med. epicon.
Reformat
4
CT Scout

www.schreibman.info
© 2013 Ken L Schreibman, PhD/MD
R,A 27yoF
22 of 99
Elbow & Forearm Trauma
ASRT @ RSNA
Elbow CT: UW 2-page Protocol Sheets
Anatomy
Technical
FOPH
BBFF
Monteggia
Positioning
Galeazzi
Essex-Lop. Reformatting
Fat Pads
Peds Elbow
Supracond.
Lat. condyle
Med. epicon.
4

www.schreibman.info
© 2013 Ken L Schreibman, PhD/MD
Reformat in 6 planes
3 planes relative to distal humerus
3 planes relative to proximal forearm
 Off Sagittal reference image:
1) Axial to Humerus
2) Axial to Forearm
3) Coronal to Radius
4) Coronal to Ulna
 Off Axial Humerus reference:
5) Parallel to Inter-Epicondyle Line
6) Perpendicular to Epicondyle Line
If elbow is straight, only need 3!
www.radiology.wisc.edu
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