Upper Extremities
Upper extremity imaging is all about precision. Small joints, overlapping structures, and patients who can’t always move the way you need — it’s a recipe for repeat images if you’re not intentional.
Here, you’ll get guidance that focuses on:
- Keeping the patient comfortable and stable
- Opening joint spaces cleanly and consistently
- Maintaining true anatomical alignment on the first attempt
- Reducing dose through smart technique instead of guesswork
Think of this as the “don’t overthink it — just do it this way” guide.
How to Use This Section
Each region is broken into its own page, and every page includes:
- Positioning and shield placement
- CR entry points
- SID and IR orientation
- Common pitfalls and how to avoid them
If you’re ever unsure, start with the quick references — they’re built to get you through a busy shift without slowing down.
Hand & Wrist
- CR: Perpendicular to the 3rd MCP joint (Hand) or mid‑carpal area (Wrist).
- SID: 40 inches.
- Position: PA hand flat; 45° oblique; lateral fan or straight lateral depending on indication.
- Collimation: Include all phalanges, metacarpals, and distal radius/ulna.
- Richie’s Tip: Curl fingers for PA wrist to reduce OID and improve carpal detail.
Shoulder & Humerus
- CR: 1 inch inferior to coracoid (AP Shoulder); mid‑humerus for AP/Lateral Humerus.
- SID: 40 inches.
- Position: AP external rotation; Y‑view 45–60° oblique; humerus AP with epicondyles parallel.
- Collimation: Include AC joint to surgical neck; entire humerus including both joints.
- Richie’s Tip: For Y‑view, ensure scapula forms the “Y” — body, acromion, coracoid aligned.
Clavicle
- CR: Mid‑clavicle; AP Axial requires 15-30 degree cephalad angle.
- SID: 40 inches.
- Position: Supine or upright; arms at sides; chin up to clear the field.
- Collimation: Include both the AC and SC joints.
- Richie’s Tip: For the AP Axial, use more angle for thin patients and less for thick patients to project the clavicle above the ribs and scapula.
Elbow & Forearm
- CR: Mid‑forearm (Forearm); mid‑elbow joint (Elbow views).
- SID: 40 inches.
- Position: AP with hand supinated; lateral with thumb up; elbow AP fully extended if possible.
- Collimation: Include wrist and elbow joints on forearm; include distal humerus and proximal radius/ulna on elbow views.
- Richie’s Tip: Keep shoulder, elbow, and wrist on the same plane to avoid distortion.

