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.

 

Key points

Ask surgeon where to situate C-arm

Position monitor on opposite side of main table

Intensifier on top

No flip

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

Lower height

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.