What is the position of the arm for trauma oblique projections of the elbow Coyle method )?

The Coyle's view or trauma oblique view of the elbow is an axial projection that is performed in addition to the standard elbow series when there is suspicion of a radial head or capitellum fracture.

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Procedures II
What is the position of the arm for trauma oblique projections of the elbow Coyle method?
What position of the hand for the coyles method?

Indications

The Coyle's view is performed for any patient with a suspected radial head fracture or dislocation. It is also an effective view to better demonstrate the capitellum of the distal humerus . It is effective in patients who are unable to extend their arm fully and isolates the radial head using a modified radiographic technique.

Patient position

patient is sitting next to the table
at 90° elbow flexion, the medial border of the palm and forearm are kept in contact with the tabletop
the shoulder, elbow and wrist are kept in the same horizontal plane
rotate the hand so the thumb is pointing towards the ceiling, ensuring all aspects of the arm from the wrist to the humerus are in the same plane
the beam is angled 45° towards the long axis of the humerus

Technical factors

axial projection
centering point
- the radial head
collimation
- superior to distal third of the humerus
- inferior to include the entity of the radial head
- anterior to include the skin margin
- posterior to skin margin
orientation
- landscape
detector size
- 18 cm x 24 cm
exposure
- 55-65 kVp
- 3-6 mAs
SID
- 100 cm
grid
- no

Image technical evaluation

the radial head should be almost free from superimposition and projected away from the ulna
the radial head is slightly elongated
the radiocapitellar joint space should be open

Practical points

Tight collimation, although important, should not clip off critical anatomy, ensure when collimating for this projection you favor the radial aspect of the elbow.

Because you are using a steep angle, remember to adjust your exposure accordingly to compensate for the increased source-to-image distance (SID).

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Procedures II

Question	Answer
What projections should be taken when the elbow cannot be extended?	2 parallel projections. One with forearm parallel to IR and the other with humerus parallel to IR
What do you do if the patient can only flex elbow 90 degrees?	Take 2 projections on with forearm parallel to Ir and the other with Humerus parallel to IR but angle CR 10-15 degrees into elbow joint.
What projection do you use if the elbow is flexed more than 90 degrees?	Acute flexion projection (jones method)
What structures are shown on the AP elbow when you have the forearm parallel to the IR?	proximal radius and ulna
What structures are shown on the AP elbow when you have the humerus parallel to the IR?	Distal Humerus
How can you tell if there is no rotation on the AP elbow?	epicondyles in profile,radial head and neck separated or only slightly superimposed over ulna on forearm parallel projection
What is another name for the Trauma Axial Lateral projections of the elbow?	Axial Lateromedial & Coyle Method
Why are the Trauma Axial lateral projections of the elbow taken?	Pathological processes or trauma to the area of the radial head and/or the coronoid process of the ulna when the patient cannot extend fully for medial or lateral obliques of the elbow
How do you position the part for the Coyle Method for the Radial Head? (Axial Lateromedial projections of the elbow)	Flex elbow 90 degrees, hand pronated
Where is the CR for the coyle method for the radial head?	45 degree angle toward the shoulder, centered to radial head.
How do you position the part for the coyle Method for the Coronoid Process?? (Axial Lateromedial projections of the elbow)	Elbow flexed 80 degrees,hand pronated
Where is the Cr for the Coyle method for the Coronoid process?	45 degrees from shoulder to mid elbow joint
What pathology is demonstrated on the Coyle method?	Fracture and dislocations of the elbow, particularly the radial head and coronoid process
What is the projection for the Trauma Humerus?	Horizontal beam Lateromedial projection
What is the patient position for the Lateromedial Trauma projection of the Humerus	Patient recumbent, beam horozontal, support under arm, place cassette between arm and thorax
What projection is required in addition to the transthoracic projection of the Humerus?	AP neutral rotation
Is the Erect or Supine position prefered for the Transthoracic Lateral Projection of the Humerus?	Erect
Where do you center for the Transthoracic Lateral projection of the Humerus?	Mid-Diaphysis
What is the required respiration for the Transthoracic Lateral projection of the Humerus?	Breathing Technique
What do you do on the Transthoracic Lateral Humerus projection if the patient cannot elevate uninjured arm or drop the injured shoulder?	angle CR 10-15 degrees cephalad
Where is the CR for the Transthoracic Lateral projection of the proximal humerus?	Surgical Neck
What is another name for the Transthoracic Lateral Projection of the Proximal humerus?	Lawrence Method
What does the Modified Axiolateral=possible Trauma projection :Hip and proximal Femur demonstrate?	assessment of possible Hip fracture or with arthroplasty when the patient has limited movement in both lower limbs and the inferior projection cannot be obtained
How much do you angle the CR for the Clements-Nakayama Method?	15 degrees posterior
How much do you tilt the cassette for the Clements-Nakayama Method?	15 degrees from vertical
What is another name for the Modified Axiolateral projection of the hip and proximal femur?	Clememnts-Nakayama Method
What structures are shown on the Clements-Nakayama Method?	Lateral oblique views of the acetabulum,femoral head and neck, and trochanteric area
Where is the lesser trochanter on the Clements-Nakayama Method?	posterior to femoral shaft
What structures are shown on the lateral position, horizontal beam cervical spine	Cervical vertebral bodies, intervertebral joint spaces, articular pillars, spinous processes and zygapophyseal joints
What does ORIF stand for?	Open reduction with internal fixation
What is ORIF?	When the fracture site is exposed and hardware is installed
When multiple exams are ordered in what order should you perform the projections?	All AP first and then all lateral projections to avoid moving the patient
What are the 5 basic principles of radiographic positioning?	Obtain 2 projections 90 degrees apart, Whenever possible the projections should be AP or PA and lateral, angle the part, the CR, or the IR to avoid any interfering objects, Mainttain CR-part-IR Alignment & include the entire structure in the exam
Why should you obtain 2 projections 90 degrees apart?	It provides information in 3 dimensions (height,width and depth
How do you adjus the technique for a small to medium plaster cast?	Increase mAs 50-60% or +5-7 kVp
How do you adjust the technique for a large plaster cast?	Increase mAs 100% or +8-10 kVp
How do you adjust technique for a fiberglass cast?	increase mAs 25%-30% or +3-4kv
How is the CR angled for an AP Oblique Sternum?	15-20 degrees mediolaterally
Where is the IR placed for an AP Oblique Sternum?	1- 1 1/2" above jugular notch
Where is the CR for the lateral Sternum?	Horizontal beam, to midsternum
What is the breathing technique for the QP Sternum?	Breathing Technique
What is the breathing technique for the lateral sternum?	insperation
Whhere is the CR for the AP 2 view Elbow?	PP to the interepicondylar plane
Where is the CR for the lateral elbow?	Parallel to the interepicondylar plane
How much do you flex the elbow for the oblique Elbow (Coyle Method) for the Radial Head?	90 degrees
Where is the CR for the oblique elbow (coyle Method) for the Radial Head?	45 degrees toward shoulder
What is the Obliqu elbow (Coyle Method) for the Radial Head similar to?	Lateral External rotation oblique
How much do you flex the elbow for the oblique elbow (Coyle Method) for the Coronoid process?	80 degrees
Where is the CR for the oblique elbow (coyle Method) for the Coronoid Process?	45 degrees from shoulder
What is the Oblique elbow (Coyle Method) for the Coronoid process similar to?	Medial internal rotation oblique
What is another name for the Lateral Proximal Humerus?	Horizontal Beam Transthoracic Lateral
How can you avoid superimposition of the shoulders on the Transthoracic Lateral of the Proximal Humerus?	10-15 cephalad angle
How much do you rotate the patient for the Lateral Scapular Y?	25-30 degrees
Where is the CR for the Lateral Scapular Y?	parallel to scapular blade at mid scapula
How much do you angle the CR on a Trauma oblique of the foot?	30-40 degrees lateromedially
What do you do if the patient cannot get their leg in a true AP position?	Place the CR parallel to the long axis of the foot
Why isnt there an angle on the lateromedial knee with the horizontal beam?	The epicondyles are parallel
What is the CR angle for the medial oblique knee?	45 degrees lateromedial
What does the Medial Oblique knee demonstrate?	Fibular Head and neck
What is the Medial Oblique knee similar to?	Internal rotation
How is the grid places for the Medial Oblique knee?	crosswise to prevent grid cutoff
What is the Clements-Nakayama Method?	Lateral proximal Femur & Hip
When do you perform the Clements Nakayama?	When there is little movement of both hips
How much do you tilt the IR for the Clements Nakayama?	15 degrees from vertical
How much do you angle the CR for the Clements Nakayama?	15-20 degrees posteriorly mediolaterally so it is PP to the Femoral Neck
Where is the CR for the AP Trauma C-Spine?	Lower thyroid cartilage
What is the CR angulation for the Alternate AP Axial (c1-C2)	35-40 degrees to mml just beneath mentum
What does the Alternate AP Axial (C1-C2) demonstrate?	Dens within the foramen Magnum
How much do you angle the CR for the AP Axila Cervical Obliques?	45 degrees w/ 15 cephalad