1. Select the required view(s) based on the request.
2. Gather the necessary materials and supplies.
a. Appropriate cassettes.
c. Lead shielding.
d. Letter markers.
3. Prepare the patient.
a. Bring the patient into the X-ray room.
b. Ensure the patient is properly dressed.
(1) Ensure the patient's jewelry is removed as necessary.
(2) Ensure the patient's sleeve is rolled up as necessary.
c. Explain the procedure, if applicable.
d. Seat the patient facing the X-ray table.
4. Place the lead shielding across the patient's lap.
5. Measure the body part through the entry-exit site of the central ray.
6. Set the control panel.
a. Consult the technique chart.
b. Set the appropriate mAs and kVp on the control panel.
7. Select the proper size cassette.
NOTE: Use 1/2 of a 14" x 17" cassette, placing the AP and lateral views on the same cassette.
8. Place the cassette lengthwise on the table.
9. Position the overhead tube.
a. Set the tube angle perpendicular to the film.
b. Set the source to image receptor distance (SID) to 40 inches (101 cm).
c. Center the tube to the portion of the film being used.
d. Adjust the conefield to full field coverage.
NOTE: Full field coverage being 1/2 of a 14" x 17" cassette.
10. Position the forearm.
NOTE: Place the AP right/left forearm on the corresponding side of the cassette. This will prevent the upper arm from overlapping onto the exposed or unexposed area of the cassette when in the lateral position.
a. AP View
(1) Patient seated at the end of table with hand and arm fully extended.
NOTE: The palm should be facing upward or supinated.
(2) Drop the shoulder to place the entire limb on the same plane.
(3) Have patient lean laterally as necessary to place entire wrist, forearm, and elbow in as near a true lateral position as possible.
NOTE: Styloid processes and epicondyles will be equal distance from their respective film borders.
(4) Central ray is perpendicular to the film, directed to mid forearm.
b. Lateral view.
(1) Patient seated at the end of the table with the elbow flexed 90 degrees.
(2) Drop shoulder to place the entire upper limb on the same horizontal plane.
(3) Align and center forearm to the long axis of the unused portion of the film.
(4) Rotate hand and wrist into a true lateral position, thumb up.
(5) Position and support hand to prevent motion.
NOTE: Ensure that the distal radius and ulnas are directly superimposed.
(6) Central ray is perpendicular to the film, directed to mid forearm.
11. Immobilize the body part by placing a sandbag on or against the hand.
12. Place the appropriate letter marker on the cassette.
13. Tell the patient, "DO NOT MOVE."
14. Make the exposure.
15. Tell the patient, "RELAX."
16. Develop the film with the patient's identification.