Positioning of the Hand, Wrist, Elbow and Forearm
SID for ap elbow
40 inches
SID for lateral elbow
40 inches
What is the SID of a hand?
40 inches
SID for a wrist
40 inches table top
What should you use to straighten a patients hand if they cannot straighten it on their own?
a pen
Where should you measure for a PA hand?
at the 3rd metacarpophalangeal joint
anatomy of interest for medial oblique elbow
coronoid process is free of superimposition
Positioning of the Lateral Wrist
hand is now resting on the ulnar side in full extension, remeasure for technique, feel carpal bones, metacarpals, and distal forearm to verify in a true lateral position (roll wrist back more), collimate side to side, place marker adjacent to forearm
What is the anatomy to be seen on a PA hand?
8 carpals, 5 metacarpals, 14 phalanges, 5 MCP joints, 4 DIP and PIP joints and 1 IP joint
Anatomy to be see on a PA wrist
8 carpals, proximal metacarpals, distal 1/3 of radius and ulna
IR collimation requirement for a PA wrist
8 x 10 inches and can collimate tighter
What is the IR collimation for a hand?
8x10 or 10x12 lengthwise
anatomy of interest on AP forearm
AP projection of radius and ulna, elbow joint, wrist joint
Positioning of an ulnar deviation wrist view
PA wrist position and technique, flex fingers toward the ulna
What are the views for a hand x-ray?
PA, PA oblique, Fan lateral and Lateral in extension
CR details for oblique elbow
CR is perpendicular to elbow joint
CR details of AP elbow
CR is perpendicular to elbow joint
CR details of lateral elbow
CR is perpendicular to elbow joint
CR details of lateral forearm
CR is perpendicular to midpoint of IR and forearm
CR details of AP forearm
CR is perpendicular to midpoint of forearm
What is the CR details for the lateral hand?
CR is perpendicular to the 2nd metacarpophalangeal joint
CR details of a PA oblique hand
CR is perpendicular to the 3rd MCP joint
What are the CR details for a PA hand?
CR is perpendicular to the 3rd metacarpophalangeal joint
CR details for the scaphoid wrist view
CR is perpendicular to the mid carpal area
CR details of the AP oblique wrist
CR is perpendicular to the midpoint of carpals
CR details for a PA wrist
CR is perpendicular to the midpoint of the carpals
CR details for a PA oblique wrist
CR is perpendicular to the midpoint of the wrist
CR details of the wrist
CR is perpendicular to the midpoint of the wrist
Anatomy to be seen on the scaphoid wrist view
scaphoid free of superimposition
What view is only routine at Palmetto Health of the wrist?
scaphoid view or ulnar deviation
What should the anatomy look like on an lateral extension hand?
soft tissue and all bones are super imposed
IR collimation for AP elbow
10 x 12
IR collimation for oblique elbow
10 x 12
IR collimation for forearm
14 x 17 and collimate side to side and top to bottom
How many views are there of the wrist and what are they?
5, PA wrist, lateral, PA oblique, AP Oblique, Scaphoid deviation
Positioning for a AP oblique wrist
Pt is in AP oblique position with hand supine, 45 degrees rotation with ulnar side down, collimate side to side, place marker near the radius and on lateral aspect, arm can be straight out for this view
positioning on the AP elbow
all 3 joints on the same plane, remove clothing and artifacts, measure through the elbow joint and set technique, hand supine, epicondyles of humerus are parallel, collimate side to side with no radial crossover
positioning of medial oblique elbow
arm fully extended, all 3 joints on same plane, rotate arm to make epicondyles 45 degrees medial side down, remeasure if needed, collimate side to side
anatomy to be seen of the lateral wrist
carpal bones are super imposed
anatomy to be seen on AP elbow
distal 1/3 of humerus, elbow joint, proximal 1/3 of forearm
Positioning on lateral elbow
elbow is flexed 90 degrees, all 3 joints on same plane, remeasure, hand is in full extension, epicondyles in humerus are perpendicular, collimate to reduce scatter
Image/eval criteria for AP elbow
evidence of proper collimation, radial head, neck, tuberosity slightly superimposed over proximal ulna, elbow joint open and centered to central ray, no rotation of humeral epicondyles, soft tissue and bony trabecular detail
positioning of AP forearm
forearm in center of IR with long axis, all 3 joints on same plane, include base of metacarpals, hand must be supinated so radius isn't crossed over, measure at midpoint of forearm, set technique, remove clothing, collimate, place marker at bottom near wrist, epicondyles are parallel, shield
position of lateral forearm
from AP projection, flex elbow 90 degrees resting forearm on ulna, hand in full extension, epicondyles are perpendicular, remeasure if needed, collimate side to side, marker near wrist on lateral aspect, shield, adjust IR so the long axis is parallel to forearm
Positioning of a hand PA oblique
from PA position, rotate hand ulnar side down 45 degrees. You may use a sponge if available, make sure fingers are parallel to the IR to demonstrate open joint spaces, use the same technique from the PA, place marker at the wrist
Positioning for a PA oblique wrist
from PA position, rotate wrist 45 degrees ulnar side down, use the same technique from the PA, collimate side to side
Positioning of lateral oblique elbow
from ap position, rotate entire arm externally 45 degrees, lateral epicondyles against table, collimate side to side
What is the positioning of a fan lateral hand?
hand resting on ulnar side with an OK or duck bill sign with the first and 2nd digits open. All the fingers must be separated and metacarpals are super imposed
What is the positioning of an extension lateral?
hand resting on ulnar side, fingers fully extended and super imposed, use 1/2 was measure from before, may point to wound or puncture
Anatomy to be seen on lateral forearm
lateral projection of radius and ulna, elbow joint, wrist joint, radius and ulna superimposed over each other at distal end only
anatomy to be seen of lateral elbow
lateral view of distal 1/3 humerus, elbow joint, proximal 1/3 forearm
What is the anatomy to be seen for the lateral hand?
lateral view of the phalanges and PA/oblique of thumb, superimposed 2nd-5th metacarpals, and super imposed carpal bones
Anatomy to be seen on a PA oblique hand
oblique position of 14 phalanges, 5 metacarpals, 8 carpals, and the distal 1-2 inches of radius and ulna
anatomy to be seen on a PA oblique wrist
oblique view of carpal bones with emphasis to scaphoid
Anatomy of interest of the AP oblique wrist
oblique view of carpals with pisiform in profile
anatomy of interest for lateral oblique elbow
oblique view of elbow with radial head free of super imposition
Positioning of a PA wrist
patient sitting alongside of the table and shielded, forearm/elbow resting on the table, artifacts removed, wrist centered to the IR with the shoulder in the same plane, fingers slightly curved to reduce OID, measure at midpoint of the wrist, collimate side to side, place marker alongside the wrist on lateral aspect, make sure the head of the metacarpals and 1.2 inches of the distal radius on the image
Image/Eval criteria for medial oblique elbow
proper collimation elbow joint open and centered to CR 45 degree medial rotation of elbow- coronoid process in profile, elongated medial humeral epicondyle, ulna superimposed by radial head and neck trochlea olecranon process with olecranon fossa soft tissue and bony trabecular detail
Image/Eval criteria for lateral oblique elbow
proper collimation elbow joint open and centered to CR 45 degrees lateral rotation of elbow- radial head, neck, and tuberosity projected free of the ulna, elongated lateral humeral epicondyle capitulum soft tissue and bony trabecular detail
image/eval criteria for AP forearm
proper collimation entire forearm including wrist and distal humerus slight superimposition of the radial head, neck, and tuberosity over proximal ulna no elongation ore foreshortening of the humeral epicondyles partially open elbow joint if should was placed in same plane open radioulnar space similar image brightness and contrast of proximal and distal forearm soft tissue and bony trabecular detail
image/eval criterial for lateral forearm
proper collimation entire forearm including wrist and distal humerus in a true lateral position- S/I of the radius and ulna at the distal end, S/I of radial head over coronoid process, radial tuberosity facing anteriorly, S/I humor epicondyles, elbow flexed 90 degrees, soft tissue and bony trabecular detail along entire length of the radial and ulnar bodies
image/eval criteria of PA oblique hand
proper collimation, anatomy from fingertips to distal radius and ulna, digits separated slightly with no overlap of the soft tissues, 45 degrees of rotation of anatomy, open IP and MCP joints and soft tissue and bony trabecular detail
Image/Eval criteria for a lateral hand x-ray?
proper collimation, anatomy from fingertips to distal radius and ulna, extended digits, hand in a true lateral with the phalanges, metacarpals, and radius and ulna super imposed, thumb free of motion and super imposition, soft tissue and bony trabecular detail
Evaluation/Image criteria for a PA hand?
proper collimation, anatomy from the finger tips to distal radius and ulna, slightly separate digits with no soft tissue overlap, no rotation of the hand, open MCP and IP joints indicating that the hand is flat on the IR, soft tissue and bony trabecular detail
Image/Eval criteria for the PA oblique wrist
proper collimation, distal radius and ulna, carpals, and proximal half of metacarpals, 45 degrees rotation of anatomy, carpals on lateral side of wrist, trapezium and distal half of the scaphoid without superimposition, open trapeziotrapezoid and scaphotrapezial joint space, and soft tissue and bony trabecular detail.
image/eval criteria of an AP oblique wrist
proper collimation, distal radius and ulna, carpals, and proximal half of metacarpals, carpals on the medial side of wrist, triquetrum, hook of hamate, and pisiform free of superimposition and in profile, soft tissue and bony trabecular detail
image/eval criteria of the lateral wrist
proper collimation, distal radius and ulna, carpals, and proximal half of metacarpals, super imposed distal radius, ulna, and metacarpals and soft tissue and bony trabecular detail
Image/Eval criteria of a PA wrist
proper collimation, distal radius, ulna, carpals, and proximal half of metacarpals, no excessive flexion of digits to overlap and obscure metacarpals, no rotation carpals, metacarpals and radius and ulna, open radioulnar joint space and soft tissue and bony trabecular detail
Image/eval criteria for lateral elbow
proper collimation, elbow joint open and centered to central ray, elbow in a true lateral position- S/I humeral epicondyles, radial tuberosity facing anteriorly, radial head partially superimposing the coronoid process, olecranon process in profile, elbow flexed 90 degrees, bony trabecular detail and any elevated fat pads in soft tissue
What is the positioning of a patient for a PA hand?
pt sitting alongside the table and shielded, forearm resting on the table, elbow at 90 degrees flexion, place marker near the wrist, make sure hand is as flat as possible, remove artifacts, measure at the 3rd metacarpophalangeal joint and set technique
When is an extension lateral done?
to look for foreign bodies in soft tissue
When is a lateral hand x-ray done?
to look for fractures
why is a lateral wrist done?
to look for fractures of distal radius and ulna and look for anterior or posterior displacement
Why is a ulnar deviation view used?
to move the bones away from scaphoid and reduces super imposition that enhances visitation of the scaphoid bone
