It can sometimes be difficult to acquire the perfectly positioned lateral elbow. The following techniques can be applied to the walk-in patient or even a patient in the stretcher. I know this is probably elementary to most people reading this blog, but I really wanted an excuse to try out my stick-figure drawing skills.
Example 1 is what should NOT be done. If you notice the humerus, it is not parallel with the image receptor. This will result in the epicondyles not being parallel on your image, which causes rotation and an inability to visualize the joint space properly.
Example 2 is probably the easiest (or at least the most popular) method for performing the lateral elbow without having the patient sit far away from the table leaning over to lower the shoulder. Simply place a sponge underneath the cassette (or several sponges) to elevate the elbow joint to the level of the shoulder.
Example 3 is another way to do basically the same thing without a sponge. If you are fortunate enough to be working with equipment that will allow it, you can simply raise the table to place the elbow and shoulder in the same plane.
Example 4 is a great one to use when you have a tilt-table that will not elevate. There is typically a degree-marker on the tilt table that will tell you exactly how many degrees of angulation the table has on it. Simply match that degree reading with the tube angulation, and you have a perpendicular beam.
And of course, if the patient can do it, pull a “Fonzie.” Rotate the thumb so that it points parallel to your central ray and voila. More stick-figures to come!