Radiologic Positioning and Related Anatomy Ch.4 Upper Limb
Grids are used in upper limb radiography when body part measures more than what?
10 cm
Skin dose for the PA hand projection
10 mrad
Skin dose for the carpal canal wrist projection
20 mrad
Skin dose for the lateral humerus projection
30 mrad
Most common SID for upper limb radiography
40 inches (100cm)
Which direction is the head of a phalanx always located?
Distal
Joints that must be included in an acceptable forearm study
Distal and Proximal (all)
Which half of metacarpals should be included in PA projection of the digits?
Distal half of metacarpals
Best lateral position of the hand to demonstrate phalanges without excessive superimposition
Fan Lateral
Which bone must be included on a thumb radiograph?
First Metacarpal
Ellipsoidal joints allow movements in how many directions?
Four (4) - Diarthrodial
The only projection that shows fat pads of the elbows
Lateral Elbow
Best exposure factors for upper limb radiography
64kV, 200mA, 1/20 second, small focal spot, 40"SID, detail speed screens
When patient has large plaster cast on upper limb, add how much intensity from x-ray?
8 - 10 kV or 100% mAs
IR size for a thumb routine
8 X 10 inch
Placing palmar surface of the hand in contact with cassette is best for which projection?
PA Oblique
Projection that best demonstrates the scaphoid fat pad
PA and Oblique wrist
Degree of elbow flexion for basic positions of the wrist
90 degrees
Best projection for coronoid tuburcle
AP Elbow
Best projection for olecranon process seated in olecranon fossa
AP Elbow
Best projection for capitulum and lateral epicondyle in profile
AP Oblique, lateral rotation
Two projections required for an acceptable study of the forearm
AP and Lateral
Alternative position to routine PA wrist to best show IP joint spaces and wrist joint
AP with hand slightly arched
Most common type of primary malignant tumor occurring in bone
Multiple Myeloma
Special wrist projection showing interspaces on ulnar side of wrist between the lunate, triquetrum, pisiform and hamate bones
PA projection with Radial deviation
CR centering for a PA Oblique projection of the 2nd digit
PIP of 2nd digit
Special wrist projection used to rule out abnormal calcifications in the carpal sulcus
Carpal Canal (Gaynor-Hart method)
Possible calcification in the carpal sulcus
Carpal Tunnel Syndrome
Painful disorder of hand and wrist from compression of the median resulting nerve
Carpal-tunnel Syndrome
The forearm bone located on the lateral or thumb-side in anatomical position
Radius
Gonadal shielding for upper limb radiography is most important on which patients?
Child-bearing age or younger
The first metacarpal bone (thumb) articulates with which carpal bone?
Trapezium
The second metacarpal bone (index finger) articulates with which carpal bone?
Trapezoid
The articular portion of the medial aspect of the distal humerus
Trochlea
Third and largest arc of the elbow which is on the ulna
Trochlear Notch
Smallest concentric arc of the distal humerus
Trochlear Sulcus (groove)
Proximal and distal radioulnar is which type of joint?
Trochoidal
The Olecranon Fossa is part of which bone?
Humerus
The coronoid fossa is part of which bone?
Humerus
The trochlea is part of which bone?
Humerus
CMC of first digit (thumb) is which type of joint?
Sellar
First CMC is which type of joint?
Sellar
Exposure time for upper limb radiography
Short
The only difference between the four radial head lateral projections of the elbow
The rotational position of the hand and wrist
The forearm bone located on the medial side of the hand in anatomical position
Ulna
The olecranon process is part of which bone?
Ulna
The radial notch is part of which bone?
Ulna
The trochlear notch is part of which bone?
Ulna
Turning position of the wrist most commonly used to detect scaphoid fracture
Ulnar Deviation
Minimum amount of forearm included on a PA projection of the hand
1 inch (2.5cm)
Three superimpositions expected on an acceptable PA Oblique projection of the hand
1.3rd metacarpal (distal) 2.4th metacarpal 3.5th metacarpal
Three fractures shown in a wrist routine
1.Barton fx 2.Pott fx 3.Colle's fx
Two criteria to determine presence of rotation on a PA projection of the digits
1.Both sides of phalanges shafts should be symmetrical 2.Equal amounts of tissue on each side of phalanges
Name the four types of hand joints from wrist to fingertip
1.CMC (carpometacarpal) 2.MCP (metacarpophalangeal) 3.PIP (proximal interphalangeal) 4.DIP (distal interphalangeal)
Two special projections instead of AP if patient's elbow is flexed and will not extend at all (acute flexion projections)
1.CR perpendicular to humerus 2.CR perpendicular to Forearm
Two intermediate arcs of the distal humerus from smallest to largest
1.Capitulum 2.Trochlea
Why is the AP position better than PA for thumb? (two reasons)
1.Decrease OID 2.Increase image resolution
Five ligaments that are crucial to wrist stability
1.Dorsal Radiocarpal 2.Palmar Radiocarpal 3.Trangular Fibrocartilage Complex (TFCC) 4.Scapulolunate 5.Lunotriquetral
All projections of the thumb must include which two bones?
1.Metacarpal (entire) 2.Trapezium (entire)
Basic positioning routine for the 2nd through 5th digits of the hand
1.PA 2.PA Oblique 3.Lateral
Name the three groups and amounts of bones of the hand
1.Phalanges (14) 2.Metecarpals (5) 3.Carpals (8)
Name the three classifications of phalanges
1.Proximal phalanx 2.Middle phalanx 3.Distal phalanx
Four factors that control distortion during upper limb radiography
1.SID (40-44") 2.OID (minimal) 3.CR centering 4.Small focal spot
Four proximal-row carpals of wrist in order from the thumb
1.Scaphoid 2.Lunate 3.Triquetrum 4.Pisiform
The two carpal bones that are most anterior as seen on a Lateral Wrist x-ray
1.Scaphoid 2.Trapezium
The two (2) important fat stripes or bands around the wrist joint
1.Scaphoid Fat Stripe 2.Pronator Fat Stripe
Four distal-row carpals of the wrist in order from the thumb
1.Trapezium 2.Trapeziod 3.Capitate 4.Hamate
The two (2) special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal region
1.Ulnar Deviation 2.Radial Deviation
Correctly exposed upper limb radiographs will show two things
1.Visible Soft-tissue margins 2.Trabecular markings of all bones
CR angle during PA Axial scaphoid projection with ulnar flexion
10-15 degrees proximally
Skin dose for the lateral hand projection
15 mrad
CR angulation for Modified Robert's method projection
15-degrees proximal
CR centering for AP thumb projection
1st MCP joint
Amount of wrist elevation from the IR for the Modified Stecher method
20 degrees
Skin dose for the AP forearm projection
25 mrad
CR angulation to the long axis of the hand for the carpal canal (tunnel) projection
25 to 30 degrees
How many total bones are in one hand?
27
Which digits have three (3) phalanges?
2nd through 5th digits
For patient with fiberglass cast on upper limb, increase x-ray intensity how much?
3 - 4 kV or 25% - 30% mAs
Amount of rotation required for an oblique projection of the wrist
45 degrees
CR angulation from the long axis of the forearm required for carpal bridge (tangential) projection of wrist
45 degrees
CR angle and direction for Coyle's method involving the coronoid process
45-degrees away from the shoulder
Upper limb rotation required for a lateral (rotation) oblique projection of the elbow
45-degrees laterally
CR angle and direction for Coyle's method involving the radial head
45-degrees toward the shoulder
When patient has a small to medium dry plaster cast on upper limb how much more intensity should be added to x-ray?
5 - 7 kV
Skin dose for the PA finger projection
5 mrad
Elbow projection which best shows the radial head, neck and tuberosity without ulnar superimposition
AP Oblique with 45-degree lateral rotation
Elbow projection that best shows the coronoid process in profile
AP Oblique with 45-degrees medial rotation
Best projection for radial head and tuberosity without superimposition
AP Oblique with lateral rotation
Best projection for coronoid process in profile
AP Oblique with medial rotation
An abnormality of the cartilage affecting long bones
Achondroplasia
Sesamoid bone location in the thumb
Adjacent to MCP joint of thumb
Location of the coronoid and radial fossae
Anterior aspect of the distal humerus
Location of anterior fat pad
Anterior of distal humerus (shows up on Lateral elbow)
Location of supinator fat pad
Anterior of proximal forearm (shows up on Lateral elbow)
Radiographic procedure using contrast media injected into joint capsule to see soft-tissue pathology of the wrist, elbow, and shoulder joints
Arthography
Most common hand positioning to evaluate for early signs of rheumatoid arthritis
Ball-catcher's position (Norgaard method)
Fracture and dislocation of the posterior lip of the distal radius
Barton's fracture
Fracture that is best demontrated using modified Robert's method
Bennett's Fracture
Fluid-filled joint space with possible calcification
Bursitis
Transverse fracture extending through the distal aspect of the metacarpal neck
Boxer's fracture
The third metacarpal digit (middle-finger) atriculates with which carpal bone?
Capitate
The articular portion of the lateral aspect of the distal humerus
Capitulum
Transverse fracture of the distal radius with posterior displacement of the distal fragment
Colle's Fracture
Rule for collimation of upper limb radiography
Collimation borders should be visible on all four sides if IR is large enough without excluding essential anatomy
Most anterior process of ulna
Coronoid process
Radiocarpal is which type of joint?
Ellipsoid
Changes required in manual exposure factors for osteoporosis
Decrease
Changes requried for manual exposure factors for advanced rheumatoid arthritis
Decrease
Correction for a PA Oblique with 3,4,5 metacarpals superimposed
Decrease angle of obliqueness in hand
Type of intensification screen used for upper limb radiography
Detail Screen (film screen system)
Radiocarpal is which type of joint?
Ellipsoidal
MCP of 2nd through 5th digits is which type of joint?
Ellipsoid
Carpal sulcus/canal or tunnel view positioning
Extend hand at wrist, project axially - not used due to better exam from MRI
In which direction are joints always named?
From proximal to distal
Elbow is which type of joint?
Ginglymus
Elbow joint (humeroulnar and humeroradial) is which type of joint?
Ginglymus (hinge)
Interphalangeal is which type of joint?
Ginglymus (hinge)
The fourth and fifth digits (ring and pinky fingers) articulate with which carpal bone?
Hamate
Hooklike process extending anteriorly from the Hamate
Hamulus (hamular process)
Change required in manual exposure factors for advanced Paget's disease
Increase
Changes required in manual exposure factors for osteopetrosis
Increase
Proper name for the acute flexion projection of the elbow
Jones Method
What positioning factor will prevent distortion of phalanx and joint while demonstrating all nondisplaced fractures?
Keeping affected digit parallel to IR for PA Oblique and Lateral projections
Best projection for trochlear notch in profile
Lateral Elbow
Best projection for olecranon process in profile
Lateral elbow
Best lateral projection of the hand to detect a possible foreign body in the palm
Lateral in Extension
Best position to evaluate the posterior fat pads of the elbow joint
Lateral with elbow flexed 90-degrees
Projection that best demonstrates the pronator fat pad
Lateral wrist
Proper Radiographic Intensity range for upper extremities
Low to medium - 50-70 kVp (film screen) 60 kVp (CR/DR)
CR centering for PA projection of the hand
MCP joint of 3rd digit
Positioning modification to improve x-ray of 2nd digit from PA Oblique position
Medial Oblique is better than Lateral Oblique to decrease OID
Location of the coronoid tubercle
Medial aspect of the coronoid process
Epicondyle closest to the ulna
Medial epicondyle
Special positioning method used to demonstrate a Bennett's fracture
Modified Robert's method
Change in manual exposure factors required for joint effusion
No change
Changes required in manual exposure factors for bursitis
No changes
Difference in mrad between skin dose and midline doses for hand and wrist x-ray exposure
No difference
The other name for the ball-catcher's position
Norgaard Method
The deep depression located on the posterior aspect of the distal humerus
Olecranon Fossa
Most proximal process of ulna
Olecranon fossa
Narrowing of joint space with periosteal growths on the joint margins
Osteoarthritis
Soft tissue swelling and loss of fat-pad detail visibility
Osteomyelitis
Hereditary condition marked by abnormally dense bone
Osteopetrosis
Mixed areas of sclerotic and cortical thickening along with radiolucent lesions
Osteopetrosis
Reduction in the quantity of bone or atrophy of skeletal tissue
Osteoporosis
Relation of the epicondyles to the IR for proper AP projection of the elbow
Parallel
Bone shown by PA wrist with radial deviation projection
Pisiform
Intercarpals are which type of joint?
Plane
Third CMC is which type of joint?
Plane
Intercarpal is which type of joint?
Plane (gliding)
What Lateral wrist projection is looking for
Proper placement of scaphoid, lunate, trapezium from anterior to posterior
Which direction is the base of a phalanx always located?
Proximal
Which two joints of the forearm allow it to rotate during pronation?
Proximal and distal radioulnar joints
Appearance of the forearm when pronated for a PA projection
Proximal radius covers over the ulna
The result of a PA forearm projection
Proximal radius crosses over ulna (superimposition)
Ligament of the wrist that extends from the styloid process of the radius to the lateral aspect of the scaphoid and trapezium bones
Radial Collateral Ligament
Correction for AP Elbow showing total separation between proximal radius and ulna
Rotate upper limb medially
Correction for carpal canal projection with pisiform and hamulus superimposed
Rotate wrist laterally 5° to 10°
Bone shown by PA wrist with ulnar deviation
Scaphoid
Most fractured bone in the wrist
Scaphoid
Sprain or tear of the ulnar collateral ligament
Skier's Thumb
Focal spot size for upper limb radiography
Small
Fracture that is NOT shown in a wrist routine
Smith fx
Mnemonic device for memory of the carpal bones
Steve Left The Party To Take Carol Home
Positioning modification to improve x-ray of 2nd digit from Lateral position
Thumb-down lateral (mediolateral) projection to decrease OID
The coronoid tubercle is part of which bone?
Ulna
How many phalanges are in the thumb?
Two (2)
Alternative projections for AP elbow if the patient cannot fully extend the elbow
Two partially flexed AP projections (one with humerus parallel to IR and one with forearm parallel to IR)
The coronoid process is part of which bone?
Ulna
