Radiographic positioning of the Hand, Wrist, Fingers

What is the collimated field size for all of the wrist exams?

2.5" proximal and distal to he wrist joint and 1" on the sides

How far from the horizontal should the IR be inclined toward the elbow for a Stetcher?

20 degrees

What is another name for capitate?

Os magnum

What is the position for the Carpal Canal?

Tangential (Gaynor-Hart)

How is the patient positioned for an AP thumb exam?

seated at the end of the table, affected upper limb resting on the table, hand in extreme internal rotation to place the posterior surface of the thumb on the IR

In a PA projection of the hand, how is the patient positioned?

seated at the end of the table, affected upper limb resting on the table, hand pronated and fingers extended and slightly spread

How is a patient positioned in PA ulnar deviation of the wrist?

seated at the end of the table, anterior surface of the right is on the IR, flex fingers loosely, hand turned toward ulna as much as possible

How is a patient positioned for a lateral wrist exam?

seated at the end of the table, from a PA oblique, rolled laterally until in lateral position resting on the ulnar surface

How is the patient positioned in a PA finger exam?

seated at the end of the table, with the affected upper limb resting on the table, hand should be pronated, fingers should be extended and slightly apart

How is a patient positioned for a lateral thumb exam?

seated at the end of the table, with the affected upper limb resting on the table; hand pronated, digits 2-5 flexed to roll the thumb into a true lateral

What is the CR entrance point for tangential?

angled 25-30 degrees to the long axis of the hand and enter 1" distal to the 3rd metacarpal bone

If there is no wedge in a Stetcher, how should the central ray be directed toward the wrist?

at a 20 degree angle toward the elbow

What is the most common lateral of the hand?

fanned or flared

For the lateral position of the wrist, how should the elbow be positioned?

flexed at 90 degrees

Which bone is of primary interest with a PA ulnar deviation?

scaphoid

Which carpal bone is the primary interest in a Stetcher?

scaphoid

How is a patient positioned for the lateral-in extension exam of the hand?

seated at the end of the table with the affected limb resting on the table, from a PA oblique, roll the hand laterally until in a lateral position resting on the ulnar surface, fingers should be extended and superimposed, thumb must be abducted

How is a patient positioned for the lateral-flexed or curve exam of the hand?

seated at the end of the table with the affected limb resting on the table, from a PA oblique, roll the hand laterally until in lateral position resting on the ulnar surface fingers should be curled into a "C" shape with thumb abducted

How is a patient positioned for the lateral-fanned or flared exam of the hand?

seated at the end of the table with the affected limb resting on the table, from a PA oblique, roll the hand laterally until in lateral position resting on the ulnar surface, fingers should be extended and positioned spread apart (fan shape) thumb should be abducted

How is the patient positioned in a PA oblique finger exam?

seated at the end of the table with the affected upper limb resting on the table and hand should be pronated with the digit rotated laterally 45 degrees from the IR plane

How is the patient positioned in a lateral oblique finger exam?

seated at the end of the table with the affected upper limb resting on the table and, digit should be extended and rotated to a place as close to the IR as possible

How is a patient positioned for a PA oblique of the wrist?

seated at the end of the table, affected limb in the same plane and resting on table, go from a PA and roll laterally to 45 degrees

How is a patient positioned for a PA Axial- scaphoid (Stretcher)?

seated at the end of the table, affected upper limb in same plane and resting on the table; anterior surface of wrist on IR, fingers flexed loosely and IR at distal end of wrist elevated 20 degrees (either sponge or angle tube)

How is the patient positioned for a PA position of the wrist?

seated at the end of the table, affected upper limb in the same plane resting on the table, anterior surface of the wrist resting on the IR, fingers loosely flexed

What do children have that adults don't?

growth plates

What is the size of collimation on all finger exams?

1" on all sides of the digit (also including another image), including 1" proximal to the MCP joint (want to see the top of the metacarpals)

What 2 groups of joints of the hand and digits should be demonstrated open on the radiograph of the PR projection?

metacarpophlangeal and interphalangeal

What is the collimated field size of all thumb exams?

1" on all sides of the digit, include 1" proximal to the CMC joint (want to include the metacarpal as a whole and the trapezium)

What is the size of collimation for a tangential?

1' of the 3 sides of the shadow of the wrist

What projection of the thumb may be substituted if the patient is unable to maintain the required position for the AP projection?

PA

What are the different positions for the wrist?

1. PA 2. PA oblique 3. lateral 4. PA-ulnar deviation (for scaphoid) 5. AP axial-scaphoid (for scaphoid)

What are the different positions for the hands?

1. PA 2. PA oblique 3. lateral (extension, fanned or flared, and flexed)

What are the different positions for the first digit (Thumb)?

1.AP 2.PA oblique 3. Lateral

What are the different positions for the fingers?

1.PA 2.PA oblique 3.Lateral

To better delineate a fracture line with a PA projection of the wrist in ulnar deviation, how many degrees and in which direction may the CR be directed?

10-15 degrees proximally or distally

How many degrees from the PA position should a finger be rotated for a PA oblique?

45 degrees

How much should the wrist be rotated for the PA oblique projection?

45 degrees

How is the patient positioned for a tangential exam?

seated at the end of the table, affected upper limb in the same plane resting on the table, the anterior surface of the wrist on the IR and hand hyperextended to place the palm vertical

How is a patient positioned for a PA oblique thumb exam?

seated at the end of the table, affected upper limb resting on the table and thumb abducted with a 45 degree angle to the IR

How is the patient positioned for a PA oblique exam of the hand?

seated at the end of the table, affected upper limb resting on the table, from PA rotate the hand to a 45 degree angle using the "okay" sign with straightening the fingers and slightly spreading them apart, radiolucent sponge can provide support

What is another name for hamate?

unciform

With reference to the plane of the IR, how should the long axis of the hand be positioned for a tangential exam?

vertical

What is the CR entrance point for all 3 lateral hand exams?

second MCP joint

What is another name for the lunate?

semilunar

What is the relationship of the PA ulnar deviated of the wrist to the IR?

styloid process of radius and ulna are parallel with IR, long axis of hand turned toward ulna

What is the relationship of the PA axial wrist (Stetcher) t0 the IR?

styloid process of radius and ulna paralle with the IR, parallel to long axis

What is the relationship of the lateral wrist to the IR?

styloid process of the radius and ulna are superimposed, and perpendicular to the IR, parallel to long axis

What is the relationship of PA wrist to the IR?

styloid process of the radius and ulna parallel with the IR; long axis is aligned

What is the relationship of the lateral hand to the IR?

styloid process of the radius and ulna superimposed and perpendicular to the IR, long axis of hand is aligned with the long axis of the IR

What is the relationship between tangential exam and the IR?

styloid process of ulna and radius parallel to the IR

For the PA oblique projection of the 3rd digit, what is the advantage of placing the patients fingers on a 45 degree foam wedge?

the wedge supports the digits in a position parallel with the IR so the interphalangeal joint spaces will be open

For lateral projections, of the 3rd or 4th digit, why should the affected digit be positioned so that its long axis is parallel with the image receptor?

to accurately demonstrate the bones and joints

All thumb images should include what carpal bone?

trapezium

What is another name for the triquetrum?

triangular or cuneiform

What is another name for the trapezium?

greater multangular

What is the CR entrance for a PA axial of the wrist?

at scaphoid (or 20 degrees to the elbow if IR is flat)

What is the CR entrance for PA ulnar deviation?

scaphoid

Where is the CR entrance for a PA oblique wrist?

midcarpals, enters just distal to the radius

What is the relationship of a PA oblique wrist to the IR?

styloid processes of radius and ulna at a 45 degree angle to the IR, parallel to the long axis

What is the collimated field size of all hand exams?

1" on all sides of the hand and must include 1" proximal to the ulnar stolid

With reference to the long axis of the hand, how much should the CR be angled?

25-30 degrees

pa hand

3@62 kVp, Center at 3rd MCP joint, SID 40"

What is the CR entrance for a PA oblique hand exam?

3rd MCP joint

What is the CR entrance for a PA projection of the hand?

3rd MCP joint

In long bone radiography you must include what?

both joints of the bone

What is the largest carpal bone?

capitate

Where is the CR entrance for a PA wrist?

perpendicular to metacarpals

In orothopedic radiology what is the general rule?

must have TWO projections 90 degrees

For the PA oblique projection of the second digit, what is the advantage of rotating the 2nd digit medially compared with the advantage of rotating the digit laterally?

to place the part closer to the IR and improve recorded detail

pa hand/Positioning

-Place hand and forearm at the same horizontal plane

What is the CR entrance on all thumb exams?

MCP joint of the first digit

PA Hand Radiographic Position

Merril's

flexing the fingers for the PA projection of the wrist decreases ______ and increase __________.

OID Recorded Detail

What is the disadvantage of doing a PA thumb?

increased OID and magnification, resulting in less recorded detail

What is unique about the hamate?

it has a hamulus

Which projection of the hand should demonstrate superimposed phalanges?

lateral, in extension

What is another name for the trapezoid?

lesser multangular

What carpal bone is shape like a moon in lateral position?

lunate

For the lateral projection of the wrist, which surface of the wrist should be in contact with the IR?

medial

On what hand surface should the hand be rested when performing the lateral projection radiograph of the 4th or 5th digit?

medial (ulnar)

How should all thumbs be positioned to the IR?

parallel and along the long axis

What is the relationship of the PA oblique hand to the IR?

parallel and to the long axis

What is the relationship of the PA projection hand to the IR?

parallel and to the long axis

How should the fingers be placed in relation to the IR in fingers 2-5?

parallel and with the long axis of the digit

What is the CR entrance point on fingers 2-5?

perpendicular to PIP

What is the CR entrance point of the lateral wrist?

perpendicular to the wrist joint

When using a wedge for the Stetcher to elevate the IR, how should the central ray be directed?

perpendicularly

What carpal bone is round?

pisiform

When do we use a lateral-extension?

when looking for foreign bodies