• Journal of the Korean Society of Radiology
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• v.17 no.4
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• pp.607-614
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• 2023

Clear overlapping of the bilateral epicondyle and proper separation of the elbow joint are crucial for obtaining accurate lateral general radiographs of the elbow. However, due to the complex anatomical structure of the elbow, achieving optimal positioning is challenging, leading to the need for repeated x-ray examinations. Therefore, the purpose of this study was to investigate the angle of the forearm in patients where accurate lateral images of the elbow joint can't be obtained after vertical incidence using a styrofoam device during elbow joint lateral x-ray imaging. Twenty patients were enrolled in our study following the established protocol. First, a vertical x-ray at an angle of 0° between the forearm and the table was taken (control group). Here, if the lateral image of the elbow joint was deemed inadequate, the forearm angle was adjusted using custom-made styrofoam supports with 5° and 10° inclinations (experimental groups). For the evaluation method, two assessors utilized a 5-point Likert scale to assess the images. The reliability of the assessments was analyzed using Cronbach's alpha coefficient. As a result, patients with inadequate overlap of the bilateral epicondyle and separation of the elbow joint in the initial examination (control group) were able to obtain the best images when setting a 10° angle between the forearm and the table. The subjective evaluation was 1.6 ± 0.8 points at 0°, 2.7 ± 0.8 points at 5°, and 4.4 ± 1.3 points at 10°, respectively. The reliability analysis for the angles of 0°, 5°, and 10° yielded Cronbach's alpha values of 0.867, 0.697, and 0.922, respectively. In conclusion, when it is not possible to obtain accurate images using the conventional position and X-ray beam direction, it is considered that by initially acquiring images with an angle of 10° between the forearm and the table, and gradually decreasing the angle while obtaining images, it would be possible to achieve the optimal image while reducing the number of repeat examinations.