Radiographic Positioning for Upper Limb Imaging

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Questions and Answers

What is the proper angling of the tube during the PA axial (Zitters/banana projection)?

30 degrees towards the elbow (correct)

20 degrees towards the elbow

40 degrees towards the elbow

15 degrees towards the elbow

Where should the central ray be centered for the PA projection of the wrist?

At the proximal wrist crease

At the distal radius

At the midpoint of the hand

At the anatomical snuffbox (correct)

What is a common error when positioning for the PA oblique view of the wrist?

Over-rotating the arm (correct)

Not extending the fingers

Improper collimation

Incorrect angling of the tube

When performing the ulnar deviation technique, which aspect of the wrist should be in contact with the image receptor?

Palmar aspect of the wrist Signup and view all the answers

What is one of the clinical indications for imaging the radius and ulna?

Osteomyelitis Signup and view all the answers

What does the term 'distal' refer to in anatomical terminology?

Furthest from the center of the body Signup and view all the answers

Which of the following is NOT a factor to consider before entering the imaging room?

Handling equipment Signup and view all the answers

What is the primary reason for fractures occurring?

Exceeding the bone's capacity to handle stress Signup and view all the answers

Which statement best describes the mechanism of injury?

It indicates how an injury occurs Signup and view all the answers

What is the standard Source to Image Distance (SID) for upper limb x-rays?

100 cm Signup and view all the answers

Which anatomical landmark is NOT included in the essential lumps and bumps to know?

Patella Signup and view all the answers

What does the term 'proximal' indicate in anatomical terminology?

Closest to the center of the body Signup and view all the answers

Why are grids not necessary for upper limb imaging?

The area is not large enough to require it Signup and view all the answers

What is the correct patient position for an AP projection of the radius and ulna?

Affected arm abducted and extended on the image receptor Signup and view all the answers

Where should the central ray be directed for an AP projection of the radius and ulna?

Vertical to the image receptor midway between elbow and wrist Signup and view all the answers

What is the collimation requirement for the AP projection of the radius and ulna?

Laterally include skin margins; proximally elbow joint; distally wrist joint Signup and view all the answers

What adjustment should be made to the arm when performing a lateral projection of the radius and ulna?

Flex the elbow 90 degrees and medially rotate the arm Signup and view all the answers

For the lateral projection of the radius and ulna, how should the humeral epicondyles be positioned?

Superimposed on the image receptor Signup and view all the answers

What is the indication for examining the elbow when considering pathology such as OA/RA?

Pain and swelling Signup and view all the answers

Which condition might warrant specific joint projections in imaging?

Unclear findings from initial imaging Signup and view all the answers

What should be done to the arm's position when performing the lateral projection if the AP position was previously used?

Flex the elbow to 90 degrees and medially rotate the arm Signup and view all the answers

What is the correct position for the arm in the true anatomical position during imaging?

Palm facing forwards Signup and view all the answers

Where should the central ray be directed when imaging the humerus?

Horizontal to the image receptor Signup and view all the answers

For an AP view of the humerus, where is the centering point located?

Middle of the humerus, anterior aspect Signup and view all the answers

What is the required patient position for imaging the upper arm in AP view?

Stood facing the image receptor with palm on the abdomen Signup and view all the answers

During imaging, how should the upper arm be positioned to reduce movement and enlargement?

Upper arm in contact with the image receptor Signup and view all the answers

Which margins should be included when collating for the humerus imaging?

Lateral, superior, and inferior skin margins Signup and view all the answers

What is the correct arm position for the AP view of the elbow?

Arm abducted and extended with wrist, elbow, and shoulder in the same horizontal plane Signup and view all the answers

In the lateral (PA) view of the humerus, where is the centering point located?

On the medial aspect of the upper arm Signup and view all the answers

Where should the central ray be directed for the AP view of the elbow?

Midway between the humeral epicondyles and 2.5 cm distally Signup and view all the answers

Which clinical indication is NOT mentioned for shoulder imaging?

Fractures Signup and view all the answers

For the lateral view of the elbow, what is the required angle of the elbow?

Flexed to 90 degrees Signup and view all the answers

What collimation is required for the AP view of the elbow proximally?

Distal 1/3 of the humerus Signup and view all the answers

In the lateral view of the elbow, how should the hand be positioned?

Palmar aspect of the hand should be 90 degrees to the image receptor Signup and view all the answers

What is one of the clinical indications for imaging the humerus?

Trauma Signup and view all the answers

What is the positioning of the patient for the AP view of the humerus?

Patient standing with their back to the image receptor Signup and view all the answers

For the lateral projection of the elbow, which aspect of the arm should be in contact with the image receptor?

Ulnar aspect Signup and view all the answers

What is the correct centration point for a DP projection of the hand?

Over the head of the 3rd metacarpal Signup and view all the answers

What is the purpose of collimating laterally during a hand DP projection?

To include skin margins Signup and view all the answers

How should the hand be positioned for an oblique projection?

Laterally rotated 45 degrees Signup and view all the answers

For lateral projection of the hand, what should the angle between the palmar aspect and the image receptor be?

90 degrees Signup and view all the answers

Which projection is specifically mentioned for visualizing congenital abnormalities?

DP projection Signup and view all the answers

What is the key error to avoid when performing a DP projection of the fingers?

Positioning the hand too flat Signup and view all the answers

When centering for a lateral projection of the fingers, where should the central ray be located?

Over the proximal interphalangeal joint of the affected finger Signup and view all the answers

What is required when including the distal radioulnar joint in the DP hand projection?

Collimation also includes the wrist joint Signup and view all the answers

What is the appropriate patient position for obtaining a DP projection of the hand?

Seated at the side of the x-ray couch with arm relaxed Signup and view all the answers

Which additional projection is specified for visualizing the thumb?

DP projection of the thumb Signup and view all the answers

Study Notes

Diagnostic Imaging Technique of the Upper Limb

The presentation details various imaging techniques for the upper limb, including the arm, hand, and wrist.
Learning outcomes include understanding terminology, common clinical indications, radiographic techniques, and additional projections.

Terminology Recap

Lateral: Away from the body's midline.
Medial: Towards the body's midline.
Distal: Farthest point from the center of the body or torso.
Proximal: Nearest to, closest to, or in proximity to the center of the body or torso.

RE-CAP

Before entering a room, check for necessary preparations.
For each patient, ensure privacy, dignity, and respect.
Radiation protection is crucial.
Assessing anatomical landmarks aids positioning and centring.
Clear communication builds rapport.

Anatomical Snuff Box

The anatomical snuff box is a depression in the hand.
It's a reference point for tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL).
It also encompasses the extensor pollicis longus (EPL) tendon.

Landmarks

Thenar eminence: A fleshy mound located at the base of the thumb.
Hypothenar eminence: A fleshy mound located at the base of the little finger.

Bones of the Hand

The hand's skeletal structure includes distal, middle, and proximal phalanges.
Metacarpals and carpals also contribute to the hand structure.
A palmar view diagram shows these bones.
Sesamoids are small bones within the hand's structure.

Radial Styloid Process and Dorsal Tubercle

The radial styloid process and dorsal tubercle are prominent bone landmarks in the wrist area, discernible from x-rays.
These x-ray-visible landmarks are crucial for accurate anatomical positioning.

Bones of the Elbow

The elbow comprises the humerus, radius, and ulna, each featuring distinct processes (heads, necks, eminences).
The presentations provide diagrams defining the key bony structures

Shoulder Anatomy

The shoulder includes bones like the clavicle and scapula along with anatomical landmarks such as acromion, greater/lesser tuberosity, surgical neck, and coracoid process.

Why Do Fractures Happen?

A fracture is a break or crack in a bone.
Fractures occur when energy transfer through the bone exceeds its capacity.
Fracture location depends on bone weakness and force application site.

Mechanism of Injury

Mechanism of injury (MOI) describes how an injury occurs during a specific event.
Fall on outstretched hand, inversions, and blunt trauma are examples of MOI.

Imaging Parameters

The source image distance (SID) for upper limb x-rays is 100cm.
Grids are not typically used for upper limb x-rays due to insufficient scatter.

Importance of Two Views

X-ray imaging often requires two views (e.g., lateral and anterior-posterior) for a comprehensive assessment.

Hand - Clinical Considerations and Indications

X-rays of the hand can diagnose various conditions, including osteoarthritis, trauma, foreign bodies, and osteomyelitis.
Assessing these conditions, and providing accurate diagnoses requires multiple views and precise techniques.

Hand Projections: Standard and Additional Projections

Standard hand projections incorporate "DP", "Oblique", and "Lateral" views.
Additional projections include finger views, ball-catcher or Norgaard views for specific views, and thumb projection variations (PA and Lateral).

Hand - Positions and Central Points

Hand x-ray positioning varies based on the desired projection.
The central ray's orientation also varies based on the projection.

Fingers – DP (Dorsal-Palmer) Projections

The central ray is placed vertical to the image receptor.
It's positioned between the heads of metacarpals.

Collimation

Laterally, collimation extends to the skin margins.
Proximally, collimation includes the distal radioulnar joint.
Distally, collimation includes the tips of the distal phalanges.

Hand - Oblique Projections

45 degree rotation is necessary for the hand's oblique position.
The central ray is perpendicular to the image receptor.

Hand – Lateral Projections

The central ray is fixed perpendicular to the image plane.
Palmar aspect of the hand is positioned on the receptor.

Fingers - Lateral Projections

The central ray is oriented vertically to the image receptor.
It's positioned over the proximal interphalangeal joint of the affected finger.
Proper collimation is necessary.

Common Errors and Tips

Interphalangeal joint spaces may be obscured by superimposition.
Ensuring proper positioning, adequate separation, and proper patient support minimizes this error.

Forearm Series/Radius and Ulna

Forearm series X-rays provide comprehensive views of the radius and ulna.
Accurate clinical indications include trauma, osteomyelitis, and foreign body assessments.

Elbow - Clinical Considerations

Osteoarthritis, trauma, pain, and swelling are common clinical indications for elbow imaging.

Elbow Projections: Standard and Additional Projections

Standard projections for elbow X-rays encompass DP, Lateral, and Radial head views.
Additional projections, often used when the initial imaging isn't conclusive.

Elbow - AP (Anterior-Posterior) Projections

The patient is seated facing the X-ray source.
The affected arm is placed on the imaging receptor, supinated.
The wrist, elbow, and shoulder are in the same plane.

Elbow - Lateral Projections

In the lateral projection, the patient positions themselves with the affected arm's ulnar aspect facing the image receptor.

Humerus - Clinical Indications and Projections

Trauma, osteomyelitis, and foreign bodies are identified via x-rays.
Standard humerus projections are AP and Lateral.

Humerus - AP (Anterior-Posterior) Projections

Patient stands with their back to the image receptor.
The arm is in anatomical position, facing forward.
The humerus posterior aspect rests on the image receptor.

Humerus - Lateral (PA) Projections

For lateral imaging, the patient stands facing the image receptor.
The arm is flexed with the hand palm anterior.
Ensuring the lateral aspect of the affected arm is next to the receptor prevents unclear images arising from the position.

Shoulder - Clinical Indications and Projections

Trauma, osteomyelitis, and foreign bodies can be imaged.
Common projections include AP, axial, modified axial, Y-view scapula, clavicle, and acromioclavicular joint views.

Shoulder - AP Projections

Patient stands with their back to the image receptor.
The arm is in anatomical position, palm forward.
The patient is rotated 5-10 degrees towards the affected side.

Shoulder - Axial Projections

The patient is seated with the affected arm nearest the image receptor.
The affected arm is abducted and extended.
The image receptor lies beneath the axilla.

Additional views and alternative methods for common errors.

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Description

Test your knowledge on proper radiographic positioning techniques for upper limb imaging, including PA axial projections, wrist imaging, and anatomical terminologies. This quiz covers essential concepts and common errors associated with radiographic practices in the upper limb region.