Procedures 1: Hand & Finger Radiography

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Questions and Answers

What is the relationship between the terms palmar and dorsal concerning hand anatomy?

  • Palmar and dorsal are interchangeable terms for the medial side.
  • Palmar and dorsal both refer to the lateral side of the hand.
  • Palmar refers to the back, while dorsal refers to the anterior aspect.
  • Palmar refers to the anterior, while dorsal refers to the posterior aspect. (correct)

Which type of joint allows for hinge-like movement, such as flexion and extension, as seen in the interphalangeal joints?

  • Sellar (saddle)
  • Ginglymus (correct)
  • Plane (gliding)
  • Ellipsoidal

What is the correct central ray (CR) placement for a PA projection of the third digit?

  • Base of the third metacarpal
  • Third MCP joint
  • Third DIP joint
  • Third PIP joint (correct)

Which of the following defines a Colles' fracture?

<p>A fracture of the distal radius with posterior displacement. (B)</p> Signup and view all the answers

When performing a PA oblique projection of the hand, which of the following is true regarding the positioning of the hand?

<p>The palm is rotated away from the image receptor until the MCP joints form a 45-degree angle. (A)</p> Signup and view all the answers

Which projection of the hand requires the digits to be fanned with the phalanges individually separated?

<p>Lateral in fan position (D)</p> Signup and view all the answers

For an AP projection of the thumb, how should the hand be positioned?

<p>In extreme medial rotation with the posterior surface of the thumb on the image receptor. (D)</p> Signup and view all the answers

What is the primary purpose of performing a PA stress projection of the thumb, also known as the Folio method?

<p>To assess for possible ulnar collateral ligament injury. (B)</p> Signup and view all the answers

For a lateral projection of the thumb, which surface should be placed on the image receptor (IR)?

<p>Palmar surface (A)</p> Signup and view all the answers

In the context of trauma terminology, what differentiates a sprain from a subluxation?

<p>A sprain involves rupture of connective tissues, while a subluxation is a partial dislocation. (A)</p> Signup and view all the answers

What is the primary reason for extending and separating the digits during a PA hand radiograph?

<p>To prevent soft tissue overlap and better visualize the bony structures. (D)</p> Signup and view all the answers

What is the recommended collimation guideline for imaging the thumb?

<p>1 inch (2.5 cm) on all sides of the digit, including 1 inch (2.5 cm) proximal to the CMC joint. (C)</p> Signup and view all the answers

What is a Bennett's Fracture?

<p>Fracture of the base of the first metacarpal (D)</p> Signup and view all the answers

Which term describes the displacement of a bone from a joint?

<p>Dislocation (B)</p> Signup and view all the answers

What is the definition of a comminuted fracture?

<p>A fracture in which the bone is splintered or crushed. (A)</p> Signup and view all the answers

What is the appropriate central ray (CR) angulation for the AP axial projection (modified Robert's method) of the thumb?

<p>15° proximal to the first CMC joint. (C)</p> Signup and view all the answers

Which term is used to describe the volar surface of the hand?

<p>Palmar (B)</p> Signup and view all the answers

Which carpal bone articulates with the first metacarpal?

<p>Trapezium (C)</p> Signup and view all the answers

For essential projections of the thumb, what does the term 'PA oblique' refer to?

<p>Posterior-Anterior Oblique (A)</p> Signup and view all the answers

Which carpal bone or bones articulate with the radius?

<p>Scaphoid and Lunate (C)</p> Signup and view all the answers

Which of the following must be demonstrated on an AP Axial projection for the Modified Robert's Method?

<p>Base of the first metacarpal and trapezium (C)</p> Signup and view all the answers

When positioning the patient for a PA Hand radiograph, which part of the hand should be placed directly on the image receptor?

<p>Palmar surface (C)</p> Signup and view all the answers

Which aspect of the hand should be centered to the Image Receptor (IR) for a PA Hand radiograph?

<p>Third Metacarpophalangeal Joint (C)</p> Signup and view all the answers

Which definition best describes a boxer's fracture?

<p>Fracture of the 5th metacarpal neck (A)</p> Signup and view all the answers

Where does the collimation extend to proximally for the AP projection of the first digit?

<p>1 inch (2.5 cm) proximal to the first CMC joint. (B)</p> Signup and view all the answers

In the AP projection to the thumb, which rotation should the hand be in?

<p>Extreme Medial Rotation (D)</p> Signup and view all the answers

How should the long axis of the thumb be?

<p>Aligned Parallel (A)</p> Signup and view all the answers

Which carpal bone or bones articulate with the ulna?

<p>There is no articulation with the Ulna (B)</p> Signup and view all the answers

Which carpal bone articulates with the metacarpal of the little finger?

<p>Hamate (A)</p> Signup and view all the answers

What bony landmark should be centered to the IR on a PA Oblique Hand?

<p>Third Metacarpophalangeal Joint (A)</p> Signup and view all the answers

Where is the center ray for imaging the PA Oblique 45?

<p>PIP (D)</p> Signup and view all the answers

Which of the following projections/routines would demonstrate a Bennett's fracture?

<p>AP axial projection (modified Robert's method) (A)</p> Signup and view all the answers

What type of CR angle is required for the AP axial projection (modified Robert's method)?

<p>15° proximal (B)</p> Signup and view all the answers

How many exposures (minimum) are required for the AP elbow acute flexion study?

<p>2 (C)</p> Signup and view all the answers

When performing the PA Oblique Hand projection, which of the following structures are demonstrated?

<p>IP Joints (A)</p> Signup and view all the answers

In an lateral hand radiograph with extension, where the digits extended 2 to 5 are superimposed, what position is the hand in?

<p>Medial (A)</p> Signup and view all the answers

When positioning for a PA oblique finger projection, you should make sure that

<p>The digit is parallel to the IR (D)</p> Signup and view all the answers

Flashcards

Palmar

The front surface of the hand; same as volar or anterior.

Posterior/Dorsal

The back surface of the hand; same as posterior or dorsal.

Lateral

Toward the side, away from the midline of the body.

Distal

Farther from the point of origin or attachment.

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Proximal

Nearer to the point of origin or attachment.

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Dislocation

Displacement of a bone from a joint.

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Subluxation

Partial dislocation, bone is slightly out of joint.

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Sprain

Rupture or tearing of connective tissues (ligaments).

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Contusion

Bruise without a fracture.

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Fracture

A break in a bone.

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Simple fracture

Fracture in which the bone does not break through the skin.

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Compound fracture

Fracture in which the bone breaks through the skin.

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Comminuted Fracture

Bone is splintered or crushed. Fracture with multiple fragments.

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Impacted Fracture

Fragments are driven into each other.

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Phalanges

The 14 bones that make up the fingers and thumb.

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Metacarpals

The five bones that make up the palm of the hand.

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Carpals

The eight small bones that form the wrist.

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Interphalangeal (IP) Joint

The joint between phalanges; hinge type movement.

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Metacarpophalangeal (MCP) Joints

Ellipsoidal joint type; movement is flexion, extension, abduction, and adduction.

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Carpometacarpal (CMC) Joints

Joint type that allows gliding movement.

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Procedural Guidelines

Guidelines to use when performing radiographic procedures.

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Source-to-Image Receptor Distance (SID)

Distance from the x-ray source to the image receptor.

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Radiation Protection

Applying lead shielding or collimation.

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Exposure Factors

Using appropriate exposure settings.

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Collimation

The process of narrowing the x-ray beam.

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Patient Instructions

Instructions given for cooperation and breath control.

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AP Thumb

Posterior surface on the image receptor

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Lateral Thumb

Palmar surface on the image receptor; align long axis parallel.

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PA Oblique 45°

Digit parallel to the image receptor; CR to the PIP joint.

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Perpendicular to third MCP joint

Entering at the third MCP joint.

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Interphalangeal (IP) joints

The joint classfied as a Ginglymus one.

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Study Notes

Upper Limb Radiography: Hand & Fingers

  • The ARRT Content Specifications & Quiz Guide detail radiographic projections for fingers and hands

Radiographic Projections

  • Fingers projections include: PA entire hand, PA finger only, lateral, medial/or lateral oblique, AP thumb, medial oblique thumb, lateral thumb
  • Hand projections are PA, lateral, and lateral oblique

Important Terminology

  • Palmar/Volar/Anterior is the palm side or front
  • Back/Posterior/Dorsal is the back side
  • Medial is toward the midline of the body, while lateral is away from the midline
  • Distal refers to farther from the point of attachment, proximal is closer

Trauma Terminology

  • Dislocation is displacement from a joint
  • Subluxation is a partial dislocation
  • Sprain is the rupture or tearing of connective tissues
  • Contusion is a bruise without a fracture

Types of Fractures

  • Simple (closed) fracture does not break the skin
  • Compound (open) fracture breaks through the skin
  • Comminuted fracture is splintered or crushed
  • Impacted fracture involves fragments driven into each other

More Fracture Terminology

  • Incomplete Fracture
  • Baseball (mallet) fracture
  • Barton's Fracture
  • Boxer's Fracture
  • Bennett Fracture
  • Colles Fracture
  • Smith's fracture
  • Physeal Fracture

Bones of the Hand and Wrist

  • The hand and wrist are divided into phalanges, metacarpals, and carpals
  • Each hand has 14 phalanges
  • Each hand has 5 metacarpals
  • Each wrist has 8 carpals

Joints of the Hand and Wrist

  • Interphalangeal (IP) joints are ginglymus (hinge) type joints
  • Metacarpophalangeal (MCP) joints are ellipsoidal (condyloid) type
  • Carpometacarpal (CMC) and intercarpal joints are plane (gliding) type
  • The 1st CMC joint is a Sellar (saddle) joint.

General Procedural Guidelines

  • Patient preparation
  • Patient position
  • Source-to-image receptor distance (SID)
  • ID markers
  • Radiation protection
  • Patient instructions
  • IR and collimation
  • Exposure factors

Hand: PA Projection

  • Ensure proper patient positioning with accurate central ray
  • For part position, place the palmar surface of hand on the IR, with forearm on the table
  • Extend and separate digits to prevent soft tissue overlap
  • Center the third MCP joint to the IR
  • The central ray (CR) should be perpendicular to the third MCP joint

Hand: PA Oblique Projection

  • Proper patient positioning is important for PA oblique hand projection
  • PA oblique hand projection requires accurate positioning

Hand: Fan Lateral Projection

  • Proper patient positioning is important for lateral hand projection
  • Lateral hand projection with accurate positioning is needed

Finger Projections

  • Central ray is directed to the PIP joint on PA finger projections
  • A PA finger of the fourth digit is an example to demonstrate positioning for PA finger projections
  • PA Oblique 45° projections require the digit to be parallel to the IR and CR directed to the PIP

Finger: PA Oblique Projection

  • Proper patient positioning is important for PA oblique finger projection
  • PA oblique finger projection with accurate positioning is needed

Evaluation Criteria for Finger Projections

  • For PA finger projections, the entire finger and a minimum of â…“ of the metacarpal must be demonstrated
  • The center field is positioned at the PIP joint, ensuring no rotation of phalanges

Evaluation Criteria for PA Oblique Finger Projections

  • The entire phalanx and MCP joint are demonstrated
  • IP and MCP joints are open
  • The center field is at PIP

Evaluation Criteria for Lateral Finger Projections

  • The entire phalanx and MCP joint are demonstrated
  • The center field is at PIP
  • A true lateral position with digit parallel to IR is necessary, along with proper exposure factors

Thumb: AP Projection

  • AP thumb projection requires accurate positioning and proper patient positioning

Thumb: PA Projection, An Exception

  • For PA thumb projections, the central ray target is at the first MCP joint

Evaluation Criteria for Thumb Projections

  • For AP and PA projections, the entire thumb, including the first CMC joint, must be demonstrated
  • The center field must be at the first MCP joint, with no rotation of phalanges and proper exposure factors
  • Joints should be partially open as in the 45° oblique
  • Center of field at first MCP joint

Thumb: PA Oblique Projection

  • PA oblique thumb projection requires accurate positioning and proper patient positioning

Thumb: Lateral Projection

  • Lateral thumb projection requires accurate positioning and proper patient positioning

Evaluation Criteria for Lateral Thumb Projections

  • The entire thumb must be demonstrated
  • The center of the field should be at the first MCP joint
  • There should be no rotation from the lateral view
  • Proper exposure factors are essential

AP Axial Projection: Modified Robert's Method

  • The central ray must be 15° proximal to the first CMC joint
  • The base of the first metacarpal and trapezium must be clearly visualized

PA Stress (Folio Method) Projection

  • The bilateral stress projection helps in diagnosing possible ulnar collateral ligament injuries

Essential Projections for Thumb Radiography

  • Anteroposterior (AP)
  • Lateral
  • PA oblique

Thumb Radiography: Patient Positioning

  • Seat the patient at the end of the radiographic table

Thumb Radiography: Collimation

  • Use a radiation field of 1 inch (2.5 cm) on all sides of the digit
  • Include 1 inch (2.5 cm) proximal to the CMC joint

AP Thumb Radiography: Part Positioning

  • Hand in extreme medial rotation
  • Posterior surface of thumb on the IR
  • MCP joint centered to the IR
  • Long axis of the thumb aligned parallel
  • Hold other extended digits back with tape or the opposite hand
  • Check thumb position to ensure true AP projection

AP Thumb Radiography: Central Ray

  • Perpendicular to the MCP joint

Lateral Thumb Radiography: Part Positioning

  • Place the palmar surface on the IR
  • Align long axis of thumb parallel
  • Center the MCP joint to the IR
  • Rotate the thumb until the lateral surface is on the IR (mediolateral projection)

Lateral Thumb Radiography: Central Ray

  • Perpendicular to MCP joint of thumb

PA Oblique Thumb Radiography: Part Positioning

  • Palmar surface on the IR
  • Ulnar-deviate the hand slightly
  • Align long axis of the thumb parallel
  • Center the MCP joint to the IR

PA Oblique Thumb Radiography: Central Ray

  • Perpendicular to the MCP joint

Essential Projections for Hand Radiography

  • PA
  • Lateral, including lateral in extension position and fan lateral position
  • PA oblique

Hand Radiography: Patient Positioning

  • Seat the patient at the end of the radiographic table
  • Adjust the patient's height so that the forearm is resting on the table

Hand Radiography: Collimation

  • The radiation field should be 1 inch (2.5 cm) on all sides of the hand
  • Include 1 inch (2.5 cm) proximal to the ulnar styloid

PA Oblique Hand Radiography: Part Positioning

  • Forearm should be on the table
  • Palmar surface should be on the IR
  • Rotate the palm away from IR until the MCP joint forms a 45-degree angle
  • Support the digits extended on a sponge or parallel to the IR to demonstrate IP joints and prevent foreshortening of the phalanges
  • MCP joints in the center of the IR

PA Oblique Hand Radiography: Central Ray

  • Perpendicular to the third MCP joint

Lateral Hand Radiography (Extension Position): Part Positioning

  • Forearm on table with the elbow flexed 90 degrees
  • Hand on medial surface (thumb side up, lateromedial projection)
  • Radial and ulnar styloids superimposed and perpendicular to IR
  • Palmar surface perpendicular to IR
  • Extend digits 2 to 5, superimposing phalanges
  • First digit abducted to a right angle to the palm
  • MCP joints centered to IR

Lateral Hand Radiography (Extension Position): Central Ray

  • Perpendicular to the second MCP joint

Lateral Hand Radiography (Fan Position): Part Positioning

  • Forearm on table with the elbow flexed 90 degrees
  • Hand resting on medial surface (thumb side up, lateromedial projection)
  • Radial and ulnar styloids superimposed and perpendicular to IR
  • Palmar surface perpendicular to IR
  • Fan digits with phalanges individually separated
  • MCP joints centered to IR

Lateral Hand Radiography (Fan Position): Central Ray

  • Perpendicular to the second MCP joint

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