Procedure wrist and forearm

(NON-ROUTINE) describe the postion of patient and part for AP lteral oblique projection of the wrist, noting which surface of wrist rest of cassette and degree of obliquity used for rotating.

-patient seated 90 degrees from the table with upper extremity on the same plane. -supinate (palm up) hand and instruct patents to extend fingers. -Medially rotate wrist 45 degree from IR until it is semi supinated.

state the CR direction and location for a PA wrist.

-perpendicular to enter mid-carpals. -align CR with midpoint of IR. -collimate include distal radius and ulna in light field.

What is the size orientation of cassette, SID for the wrist projection

10x12 size cassette lengthwise to the body part SID-40 inches

describe the size/orientation of cassette, SID and collimation for forearm projections.

14x14 unless it is a child then you can use 10x12 lengthwise to body part. SID 40 inch ***collimations should include wrist and elbow joint

state how the shoulder humerus and elbow are placed in relation to the table top for positioning the wrist.

90 degree plane

review the evaluation criteria for the lateral projection of the wrist.

Distal radius and ulna truly superimposed extend of collimation depends on department protocol.

what are the structures shown in a lateral forearm projection.

Lateral view of forearm to include elbow and wrist joints (proximal row of carpals) -soft tissue and bony trabeculae -image generally displayed as hanging fingers by adhering to dept protocol.

state the CR direction and location for the AP projection of the forearm.

Mid shaft

state the CR direction and location for the lateral forearm.

Mid shaft

state the CR direction and location for the lateral oblique projection.

Perpendicular to enter mid carpals align CR with midpoint of IR collimate include distal radius and ulna in light field.

what is the evaluation criteria for the lateral oblique projection.

Pisiform seen in profile if accurate obliquity.

State the routine projection of the wrist and firearm

Wrist 1. PA 2. PA medial oblique 3. Lateral 4.Pa axial for the scaphoid ( stetcher method) 5. AP (non-routine) Forearm 1. AP 2. Lateral

list the structures show for the medial oblique noting carplas are best demonstrated.

best demonstration of lateral side carpal bones (scaphoid and trapezium) -medial side carpals superimposed -distal radius and ulna and proximal up to half of MC -soft tissue and bony trabeculae.

list the structures shown for the lateral oblique projection, noting which carpals are best demonstrated.

best demonstration of medial carpal bones ( pisiform " pops out" and is in profile) -lateral sided carpals superimposed -distal radius and ulna up to half MC -soft tissue and bony trabeculae.

review the evaluation criteria for the later projection of the forearm.

distal radial and ulna superimposed with radial tuberosity facing anteriorly. elbow flexed 90 degrees and humeral epicondyles superimposed ( should show one concentric circle, if not one epicondyle, then not in the same place).

list the structures shown for the AP projection of the forearm.

fontal view of forearm to include elbow and wrist joints, proximal row of carpals -soft issue and bony trabeculae -image generally displayed as "hanging from fingers" but heed to dept. protocol.

list the structures seen for a PA wrist projection

frontal view of the carpal bones ( some superimposed). -distal radius and distal ulna up to the MC's -wrist joint and radioulnar joints -soft tissue and boney trabecular.

list the structures shown for the lateral projection of the wrist.

lateral view of superimposed carpals, superimposed MC, and distal radius and ulna. 1st metacarpal separated (thumb) soft tissue and bony trabeculae.

describe the position of patient and part for PA projection of the wrist.

patient seated 90 degrees from table with upper extremity on same plane. center the wrist join to center of IR

describe the position of patient and part for the lateral projection of the forearm, noting degree of elbow flexion, how epicondyles are situated in relation to the cassette.

patient seated 90 degrees from the table with upper extremity on the same plane. - Instruct the patient to flex elbow at 90 degrees with a medial ulnar side of wrist/forearm against the IR. -adjust forearm so it is truly lateral by palpating distal radius and ulna to ensure they are superimposed. - Make sure to get 1.5-2 inches about elbow joint and wrist joint ***Humeral epicondyles must be perpendicular to IR

describe the postion of patient and part for the AP projection of the Forearm, noting how the epicondyles should be situated in relation to the IR/Cassette.

patient seated 90 degrees from the table with upper extremity on the same plane. - adjust forearm into a true AP by palpating humeral epicondyles to ensure they are parallel to the plan of IR. - COMPLETELY Supinate hand and instruct patient to extend fingers ( can use sandbag ) -IR must be at least 1.5 inch-2inch beyond both wrist and elbow joints to ensure they are included in the image.

descried the position of the patient for PA axial projection ( strecher method) for the scaphoid bone, noting the reason for using a 20 degree central ray or angle board and reason for using ulnar deviation.

patient seated 90 degrees from the table with upper extremity on the same plane. -Pronate hand with fingers extended, instruct the patient to ulnar deviate the wrist to isolate the scaphoid from adjacent carpals.

describe the position of the patient and part for PA (medial) oblique projection, noting which surface of wrist rest on cassete, and the degree of obliquity used for rotating.

patient seated 90 degrees from the table with upper extremity on the same plane. center the wrist join to the center of IR -pronate hand and instruct the patient to extend fingers. -Laterally rotate wrist 45 degrees (thumb-up) from IR until it is semi pronated ( use wedge sponge if needed for support)

state the position of patient and part for the Lateral projection of the wrist, noting the position of radius and ulna in relation to each other.

patient seated 90 degrees from the table with upper extremity on the same plane. center the wrist join to the center of IR instruct patient to flex elbow at 90 degrees with medial/ulnar side of the wrist against IR. ***distal radius and ulna should be superimposed to show it is a true lateral.

state the CR direction and location for the medial oblique projection of the wrist.

perpendicular to enter mid carpals align CR with Midpoint of IR Collimate include distal radius/ulna in light field.

state the CR direction and location for the lateral wrist.

perpendicular to enter mid carpals on the lateral side ( increase KVP 4-6) align CR with Midpoint of IR Collimate includes distal radius/ulna in the light field.

review the evaluation criteria for the AP projection of the forearm.

radial head, neck and tuberosity slightly superimposed over proximal ulna. -partially open elbow joint and open radioulnar articulation. -hand is supinated evidence by the radius not being superimposed over ulna.

review the evaluation criteria for medial oblique projection

scaphoid and trapezium seen if accurate obliquity extend of collimation depends on department protocol.

state which bone in forearm articulates most directly with the humerus.

unla trochlear notch.

state the central ray direction and location for the strecher method, noting central ray direction when employing a 20 degree angle board.

20 degrees towards elbow to enter the scaphoid near the anatomic snuff box. collimate tightly to scaphoid, include marker. * if using angled board and direct CR perpendicularly to the scaphoid check SID 40 inch.

state the primary carpal bone demonstrated in the stecher method.

scaphoid

review the evaluation criteria for the PA wrist projection.

someone open inter carpal joint spaces (depends on patient condition/ability) -open wrist and radioulnar joint.

why is an AP forearm projection with a supinated hand is preferred over a PA forearm projection with a pronated hand?

ulna and radius dont cross