Hand, Fingers and Thumb Radiography Overview

Hand, Fingers and Thumb Radiography

• Minimum of two projections are required for any region of the hand, fingers or thumb
• This includes long bones like the tibia and fibula, which also require AP and lateral views

Radiographer Roles and Responsibilities:

• Check patient's identity, including name, date of birth, and region of interest.
• Position the body part correctly for imaging.
• Ensure proper alignment with the image receptor and central ray.
• Implement radiation protection measures.
• Select appropriate exposure factors.
• Provide clear patient instructions, including the importance of staying still during the procedure.
• Process the image.

Introduction and Identification:

• Introduce yourself and your role to the patient.
• Verify patient details.
• Explain the examination procedure.

Positioning and Imaging:

• Understand the patient's range of movement (ROM).
• Provide clear instructions to the patient to remain still during the imaging process.

Technical Parameters

• Includes:*

• Positioning of the patient and x-ray tube, including film-focus-distance (FFD) and tube angle.

• Exposure settings (kVp and mAs).

• Collimation.

• Centring.

• Key Considerations:*

• FFD: Different distances are required for each view to maintain consistent radiation dose.

• Positioning of the patient and tube is essential to ensure adequate visualization of the anatomical area.

Foreign Body Localization:

• Determine the type of object or material.
• Glass and metal are more easily visualized than materials with lower density (like wood).
• Mark the entrance site if the object is not exterior to the skin.
• Obtain at least two projections.
• Consider tangential projections.

Follow-up Imaging: Open Reduction Internal Fixation (ORIF)

• This is a surgical procedure to fix bone fractures.
• Radiography is used to assess bone healing and hardware placement after the procedure.

Follow-up Imaging: K-Wires

• K-wires, or Kirschner wires, are used as a temporary measure to stabilize fractures.
• They may be used in pediatrics, where they can be removed easily.
• K-wires may be covered by a padded dressing or partial cast while healing occurs.

Bone Age Assessment:

• Determines the developmental age of a child based on skeletal growth.
• Compares chronological age (actual age) to skeletal age (bone development).
• Images typically focus on the left hand or non-dominant hand.

Evaluation Criteria for PA Finger:

• Anatomy included: From the tip of the digit to the distal metacarpal, encompassing surrounding soft tissue.
• No superimposition of digits.
• Symmetry and absence of rotation.
• Open metacarpophalangeal and interphalangeal joints.
• Optimal density and contrast to discern cortical outlines and trabecular patterns.

Anatomy of the Hand:

• Joints:*

• DIP: Distal Interphalangeal joint

• PIP: Proximal Interphalangeal joint

• Thumb IP: Thumb Interphalangeal joint

• MCP: Metacarpophalangeal joint

• CMC: Carpometacarpal joint

• Carpal Bones:*

• Scaphoid

• Lunate

• Triquetrum

• Pisiform

• Hamate

• Capitate

• Trapezoid

• Trapezium

• Mnemonic for remembering the carpal bones*: "So Long To Pinky Here Comes The Thumb"

Indications for Hand Radiography:

• Trauma
• Pain
• Lumps
• Bruising
• Foreign Body
• Swelling
• Infections
• Cuts
• Loss of function
• Deformity
• Reduced Range of Movement (ROM)
• Bone age
• Follow up from previous injury
• Congenital abnormalities
• Metabolic diseases (e.g., arthritis)