Elbow with patient in lateral position
Elbows present a few problems for radiography in theatre. For adults the most common position is with the patient on their side (lateral position) and the elbow flexed as shown in the diagram below. The reason for this is that the surgeons need to access the elbow from the back. The surgeon will lift the arm from the rest if it is radiopaque but the lateral view is much more difficult.
Set up and approach
As with hand and forearm it is possible to approach from the head or foot end and even from the hand end. In the 3D representation above you can see my preferred approach which is from the head end. It's best to get this set up from the start with the cooperation of the anaesthetist as the anaesthetic machine will need to be situated behind the patient. The diagram shows the horizontal lateral view with the C-arm tilted to image the distal humerus over the table. The surgeon will need to move the plane of the arm parallel to the intensifier faceplate to achieve a true lateral view. As usual slide the C-arm forwards to position the intensifier as close as possible to the elbow. It may be worthwhile having the C-arm further back in it's travel for the AP view (15 cross arm position for Siemens) to allow a forward movement in the same way as for hip imaging.
Ask surgeon where to situate C-arm
Position monitor on opposite side of main table
Intensifier on top
Centre cross arm and zero the pan or ‘wag’
Set low dose pulse
Cover X-ray tube with non-sterile polythene bag
Sterile covers on both intensifier and X-ray tube
Drive ‘in line’ and check from side
Fine correct cross and pan
Rotate image with humerus to top of screen
Look from hand end to see which side is left screen
Use round cone with perfect centering
When limb off-center to left of screen, move C-arm to side identified as left.