Radiographic Technique - Hand Imaging

Radiographic Technique - Hand

• Radiographs of the hand require careful patient positioning and technique to ensure clear images.
• The relationship between the patient, image receptor, and primary beam must be considered, along with hand position, field of view, centering point, and the primary beam.
• Standard views include Dorsi-Palmer (DP) and Dorsi-Palmer Oblique (DP Oblique).

Dorsi-Palmer View (DP)

• Forearm positioned on the same plane, and pronated.
• Palmer aspect of the hand in contact with the image receptor (IR).
• Fingers are slightly separated.
• Radial and ulna styloid processes equidistant from the IR
• Vertical central beam is centered at the head of the 3rd metacarpal.
• The field of view includes soft-tissue of the distal phalanges, distal ends of radius and ulna and soft tissues laterally.

Dorsi-Palmer Oblique (DP Oblique)

• Hand externally rotated 45 degrees.
• Fingers slightly separated.
• Primary beam centered over the 5th metacarpal and angled to the 3rd metacarpal.
• The field of view includes the soft tissue of distal phalanges, distal radius and ulna and soft tissues laterally..

Lateral Hand

• Hand externally rotated 90 degrees from the DP position.
• Fingers extended and thumb abducted.
• Radial and ulna styloid processes are superimposed.
• Vertical central beam is centered at the head of the 2nd metacarpal.
• Soft tissue of distal phalanges, distal radius and ulna and soft tissues posterior aspect of hand and thumb are included in the field of view.
• Used to determine displacement and position of fracture fragments in trauma or foreign bodies.

Wrist Technique - DP/PA

• Arm is pronated.
• Radial and ulna styloid processes are equidistant from the IR.
• Fingers flexed.
• Vertical primary beam centered midway between radial and ulna styloid processes.
• Field of view includes distal 1/3 of the radius and ulna, and heads of metacarpals.

Lateral Wrist

• Forearm externally rotated into the lateral position.
• Radial and ulna styloid processes superimposed.
• Vertical central beam centered on the radial styloid process.
• Thumb abducted.
• View includes heads of metacarpals, distal 1/3 radius and ulna, and soft tissues.

Scaphoid View

• Various protocols exist between imaging centers, so the specific protocol for a scaphoid view should be determined.
• Views include PA 30-degree cranial, lateral, anterior oblique, or both.
• Ensure familiarity with specific hospital protocols.

DP Ulna Deviation (15 degrees)

• Ulna deviation elongates the scaphoid, showing it without superimposition of the radius.
• Forearm pronated, with elbow and shoulder on the same plane.
• Patient performs ulna deviation.
• Vertical central beam centered between radial and ulna styloid processes.
• Field of view includes distal radius and ulna, proximal metacarpals, and soft tissues.

Anterior Oblique View

• Rotating the hand and wrist 45 degrees from the PA position.
• Wrist has ulna deviation.
• Vertical central beam centered midway between the radial and ulna styloid processes.
• Field of view includes distal ends of the radius and ulna, proximal metacarpals, and surrounding soft tissues.

PA 30-degree Cranial Angle

• Wrist, hand, and forearm positioned in a PA (posteroanterior) position.
• Arm abducted.
• Hand with ulna deviation.
• 30 degree angle from the long-axis of the scaphoid applied to the x-ray tube.

AP Oblique/Posterior Oblique - Ulna Deviation

• Hand, wrist, and arm are supinated (rotated internally), for visualizing posterior aspect of the hand 45 degrees for the image receptor.
• Vertical central beam placed midway between the radial and ulna styloid processes.
• Foam pads may be used for patient support.

Thumb - AP

• Patient seated with arm externally rotated at the shoulder.
• 1st metacarpal parallel to the IR.
• No other fingers overlaying the palm.
• Vertical central beam centered on the 1st metacarpo-phalangeal joint.
• Image should include the 1st carpo-metacarpal and soft tissue distal to the phalanx.

Thumb - Erect AP

• Patient positioning using an erect wall stand.
• Ensuring the 1st metacarpal is parallel with the IR.
• Be mindful that the patient may struggle to keep still.

Lateral Thumb

• Internally rotate the hand from a DP position, placing the thumb laterally.
• Palms of the hand raised slightly for support, if needed.
• Lateral aspect of the thumb parallel to the IR.
• Vertical central beam centered on the 1st carpo-metacarpal joint.

Fingers (DP)

• Patient seated adjacent to the table with; hand, wrist, and forearm in the same plane.
• Finger of interests in the center of the IR.
• Phalanges positioned parallel to the IR.
• Vertical central beam is centered on the proximal interphalangeal joint (PIP).
• Soft tissue of the distal phalanx, distal one-third of the metacarpal, adjacent fingers, and lateral soft tissue are included in the FOV.

Lateral Fingers (Little/Ring/Middle/Index Fingers)

• Patient's hand externally rotated.
• Affected finger extended, other fingers flexed.
• Pad the hand as needed to separate the affected finger.
• Vertical central beam centered on the proximal interphalangeal joint (PIP).
• Distal 1/3 metacarpal and soft tissues are included in the FOV.

This quiz covers essential radiographic techniques for imaging the hand, focusing on patient positioning and the Dorsi-Palmer views. It details the correct setup for clear radiographs, including specific anatomical landmarks and beam alignment. Knowledge of these techniques is crucial for obtaining accurate and diagnostic hand images.