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