POSITIONING questions (Hand, finger, thumb, wrist, forearm) EXAM 1
How many degrees is the CR angled in the tangential projection of the wrist?
Angle CR 25 to 30 degrees to long axis of hand.
How is the patient positioned for PA and PA Axial projections-ulnar deviation scaphoid series?
Anterior aspect of forearm rests on table. Pronated hand and wrist rest on IR. Turn hand and wrist outward, toward ulna, in extreme deviation.
All of the following steps are part of the procedure for the lateral projection of the humerus, except: A. Internally rotating the limb to place the humeral epicondyles perpendicular to the image receptor B. Externally rotating the limb to place the humeral epicondyles parallel to the image receptor C. Directing the central ray perpendicular D. Collimating to include the shoulder and elbow joints
B
What is the position of the styloid processes for the lateral projection of the wrist? A.Parallel with the image receptor B. Superimposed and perpendicular to the image receptor C. At a 45-degree angle to the image receptor, with the radial styloid placed closer D. At a 45-degree angle to the image receptor, with the ulnar styloid placed closer
B
How do you direct the CR for a lateral projection and AP projection of the forearm?
Direct the CR perpendicular to the midshaft of the forearm to the center of the IR-longitudinal and transversely
How do you direct the CR for a PA Oblique projection of the thumb?
Direct the CR through the 1st MCP joint to the center of the IR-longitudinally and transversely
The _______________ _______________ should be parallel with the IR in an AP forearm projection.
Humeral epicondyles
If the digits are not extended and separated in a PA oblique projection of the hand, what will happen?
If fingers are flexed and resting on IR, the joint spaces will be closed and the phalanges will be foreshortened
What is is the best position of the wrist to view the carpal boss (carpe bossu)?
Lateral position with palmar flexion
What projection shows the radial head superimposed over the coronoid process?
Lateral projection of the forearm
When the ulna is under examination should you take a PA projection? Why or why not?
No, an AP projection should be taken because in PA projections, the ulna is slightly oblique
How should you position a patient for a lateral wrist?
Position patient with wrist resting on ulnar surface on IR. Elbow at 90 degrees. Position styloid processes superimposed and perpendicular to IR.
In the lateral projection of the forearm, the _________ tuberosity is facing ________.
Radial Anteriorly
What projection or method can be done to view the carpal canal?
Tangential projection of the wrist; Gaynor-Hart method
How should the hand be positioned for a lateral wrist?
The hand should be relaxed with little flexion
What area of the hand MUST be held back when doing an AP thumb projection?
The metacarpal area
What 2 carpal bones can be viewed in a PA oblique projection of the wrist?
The trapezium and scaphoid
How many degrees rotated should you be for a PA oblique hand?
45 degrees laterally (externally)
For the joint spaces to be demonstrated on the PA oblique projection of the hand, the fingers must be: A.Extended and placed parallel with the image receptor B. Flexed and resting on the image receptor C. Extended and placed perpendicular to the image receptor D. Flexed and placed perpendicular to the image receptor
A
What is the purpose of positioning the upper limb in the same plane when performing radiographic procedures? A.It opens the joint spaces and reduces distortion. B. It reduces strain on the patient. C. It reduces artifacts on the image. D. It increases joint distortion to better demonstrate pathologic conditions.
A
What projection of the arm shows the elbow joint, the radius and ulna, and proximal row of carpal bones?
AP Forearm projection
What projection of the forearm shows a partially open elbow joint and open radioulnar space?
AP Forearm projection
What projection best demonstrates carpal interspaces?
AP Projection of the wrist
What projection of the hand can detect early signs of rheumatoid arthritis ?
AP oblique projection
What projection shows the triquetrum, hook of hamate, and pisiform free of superimposition and in profile?
AP oblique projection of the wrist
If a patient cannot extend their hand for a PA projection of the hand, what other projection can you do to view the metacarpals?
AP projection
True or False: The humeral epicondyles are not superimposed in a lateral forearm projection
False
What projection of the hand superimposes the metacarpals while showing each individual phalanx?
Fan lateral
How do you position a patient for a PA Oblique projection of the wrist?
Position patient with hand pronated, wrist resting flat on IR. Rotate wrist externally (laterally) to place styloid processes at a 45-degree angle. Support on radiolucent wedge sponge
For a PA oblique (2nd-5th): Direct the CR ____________ (perpendicular/parallel) to the ____________ (PIP/DIP) joint to the center of the IR ______________ & ____________________
Perpendicular PIP Longitudinally Transversely
PA Oblique Projection: Direct the CR _________ to the _________ joint to the center of the IR- longitudinally and transversely
Perpendicular midcarpal
For a PA wrist, what can you have the patient do in order to get the wrist in contact with the IR?
Slightly arch hand or flex fingers
Why must the hand be supinated in an AP projection of the forearm?
True AP; no rotation
Why must the thumb side of the hand be facing up in a lateral forearm projection?
True lateral position
For a PA oblique projection (2nd-5th digits), _______ digit of interest ___________________ to place it at a ____-degree angle.
rotate laterally (externally) 45
How do you direct the CR for the PA Axial projection of the wrist? (Stecher Method)
Direct the CR to the navicular bone to the center of the IR- longitudinally and transversely
How do you direct the CR for an AP oblique projection of the hand?
Direct the perpendicular to the 3rd MCP joint to the center of the IR-longitudinally and transversely
Name the method of the AP oblique projection of the hand
Norgaard Method
What projection of the wrist shows the scaphoid with adjacent articulations open?
PA Axial projection of the wrist; Stecher Method
What projection and deviation would be used to best demonstrate the scaphoid ?
PA Oblique projection of the wrist with ulnar deviation
What projection of the thumb is shown in a PA projection of the hand?
PA Oblique thumb
The _______ oblique projection of the _________ will best demonstrate the pisiform.
AP wrist
How is the hand positioned for the PA projection of the wrist? A. Supinated with fingers flexed B. Supinated with fingers extended C.Pronated with fingers flexed D. Pronated with fingers extended
C
Which positioning maneuver ensures that the radial head, neck, and tuberosity will be free of superimposition? A.Ulnar deviaton B. 90-degree flexion of the elbow C. 45-degree lateral rotation of the elbow D. 45-degree medial rotation of the elbow
C
How is the CR angled for the scaphoid series?
CR is directed perpendicular for one, then angled 10, 20, and 30 degrees toward elbow. CR is entered on scaphoid for each image.
On the AP oblique projection of the elbow in lateral rotation, the plane of the humeral epicondyles is positioned: A.Parallel with the image receptor B.Perpendicular to the image receptor C.At a 45-degree angle, with the medial epicondyle closer to the image receptor D. At a 45-degree angle, with the lateral epicondyle closer to the image receptor
D
The tangential projection (Gaynor-Hart method) is used to demonstrate the: A. Scaphoid carpal B. Olecranon process C. Carpometacarpal joint of the first digit D> Carpal canal
D
Which positioning maneuver prevents the radius and ulna from crossing over each other in the AP projection of the forearm? A.Placing the humeral epicondyles parallel with the image receptor B. Extending the elbow C. Placing the upper limb in the same plane D. Supinating the hand
D
How is the CR directed for an AP thumb projection?
Direct the CR perpendicular to the 1st MCP joint to the center of the IR-longitudinally and transversely
How do you direct the CR for a Lateral first digit?
Direct the CR perpendicular to the 1st MCP joint, to the center of the IR-longitudinally and transversely
How do you direct the CR for a PA Oblique hand?
Direct the CR perpendicular to the 3rd MCP joint to the center of IR longitudinally and transversely
Where is the CR directed for a PA hand?
Direct the CR perpendicular to the 3rd MCP joint to the center of IR longitudinally and transversely
How do you direct the CR for a PA projection of the 2nd through 5th digits?
Direct the CR perpendicular to the PIP joint to the center of the IR-longitudinally and transversely
Where is the CR directed for the lateral projection of the 2nd - 5th digits?
Direct the CR perpendicular to the PIP to the center of the IR-longitudinally and transversely
How do you direct the CR for a PA and AP wrist?
Direct the CR perpendicular to the mid carpal area to the center of the IR-longitudinally and transversely
How is the CR directed for an AP oblique projection of the wrist?
Direct the CR perpendicular to the mid carpal joint to the center of the IR-longitudinally and transversely
How is the elbow positioned in a lateral projection of the forearm?
Flexed at 90 degrees
Explain why it is important to have at least one joint in the radiograph.
It is the only means of determining the precise position of the part and localizing lesion
What are the two ESSENTIAL projections of the forearm?
Lateral and AP
What projection of the hand best demonstrates metacarpal fracture displacements?
Lateral in extension
What two types of lateral projections of the hand are there?
Lateral in extension and fan lateral
How do you know (in an image) if the hand was flat on the IR for a PA hand?
Open joint spaces
In a PA projection of the 2nd through 5th digits, why is it important to extend the digit of interest?
Opens joint spaces Reduces distortion
How do you position a patient for an AP Oblique projection of the wrist?
Posterior aspect of forearm rests on table. Posterior aspect of hand and wrist rests on IR. Hand is supinated. Styloid processes are medially rotated to form 45-degree angle with IR.
How is the patient positioned for an AP oblique projection of the hand?
Posterior aspect of forearm rests on table. Posterior aspect of hands and wrists rests on IR. Allow digits to remain in normal relaxed arched position ("ball-catcher's position"). Hands are oblique, at about a 45-degree angle.
In a PA projection of the 2nd through 5th digits, why is it important to position patient with hand pronated and resting flat on image receptor (IR)?
Provides PA projection and immobilization Reduces distortion
For a lateral projection of the 2nd digit, rest the hand on the _____________ surface.
Radial
In a lateral forearm projection, the _________ and ________ are superimposed at their distal end.
Radius and Ulna
True or False: In a PA projection of the 2nd through 5th digits, the wrist and forearm are in the same alignment
TRUE
How do you know your first digit is in true AP position?
The first metacarpal is in alignment with the first digit
How do you know (from an image) that you achieved a true lateral wrist?
The radius and ulna will be superimposed
For a lateral projection of the 3rd-5th digits, rest the hand on the _____________ surface.
Ulnar
What 2 ways can you achieve the correct angulation for the Stecher method?
Use a 20-degree sponge or angle the CR 20-degrees cephalad toward the elbow
For an AP projection of the first digit, should you place hand in extreme internal rotation with the thumb resting on the IR? Why?
Yes Provides AP projection of first digit Reduces object-to-image receptor distance (OID) and distortion
How do you position the wrist to open the carpal canal into view?
You have the patient hyperextend their wrist
How do you position someone for a lateral first digit?
You have the patient place their anterior surface of their hand on the IR, with their fingers flexed and thumb extended.
For the axiolateral projection of the ulnar coronoid process (Coyle method), the elbow is flexed: A.45 degrees B. 80 degrees C. 90 degrees D. 20 degrees
B
What is another name of the AP Oblique Projection (Norgaard Method)?
Ball-catcher's method