CT Elbow Presentation
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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
18 of 99
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
19 of 99
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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