Paceman in Radiography: Upper Limb Quiz & Flashcards

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Questions and Answers

What is the main purpose of using the ALARA principle in radiography?

To minimize the number of exposures per imaging plate

To prioritize radiation exposure to radiosensitive organs

To produce an optimal image with the lowest exposure factors possible (correct)

To ensure maximum radiation exposure to the patient

Why is shielding important in upper limb radiography?

To reduce the number of exposures per imaging plate

To prevent exposure to radiosensitive organs from scatter radiation and divergent x-ray beam (correct)

To ensure proper patient positioning

To protect the radiographer from radiation exposure

What is the benefit of using close collimation in radiography?

To prevent unnecessary radiation exposure to the patient (correct)

To ensure proper alignment of the long axis of the finger with the IR

To reduce the risk of radiation exposure to radiosensitive organs

To increase the number of exposures per imaging plate

When positioning a patient for a PA Fingers projection, what should the elbow be flexed to?

90° Signup and view all the answers

How should the hand and forearm be positioned for a PA Fingers projection?

With the hand and forearm resting on the table Signup and view all the answers

What should the CR be directed to for a PA Fingers projection?

The PIP joint Signup and view all the answers

What should be visible on the finger area in a PA Fingers radiograph?

Four collimation borders Signup and view all the answers

What is the correct alignment of the long axis of the finger in a PA Fingers radiograph?

Parallel to the side border of the unmasked portion of the IR Signup and view all the answers

What should be included in a PA Fingers radiograph?

Soft tissue and bones up to the metacarpophalangeal joint Signup and view all the answers

What is the correct position of the finger in a Lateral Fingers radiograph?

Lateromedial Signup and view all the answers

Why is an AP Thumb radiograph used instead of a PA Thumb radiograph?

Because the anatomy of the thumb requires it Signup and view all the answers

How many collimation borders should be visible on the thumb area in an AP Thumb radiograph?

Four Signup and view all the answers

What is the purpose of the AP OBLIQUE BILATERAL (Ball Catcher) projection in radiography?

To evaluate early evidence of rheumatoid arthritis at the second through fifth proximal phalanges and MCP joints Signup and view all the answers

How should the hand and wrist be positioned for a lateral extension projection?

In a true lateral position, with the distal radius and ulna superimposed Signup and view all the answers

What is the correct position of the thumb in a lateral extension projection?

In a slightly oblique position, with the joint spaces open Signup and view all the answers

How should the fingers be positioned on the radiolucent block for a lateral extension projection?

Spread and separated, with each digit on a radiolucent block Signup and view all the answers

What is the primary purpose of abducting both thumbs in radiography of the upper limb?

To avoid superimposition Signup and view all the answers

What is the purpose of internally rotating the hands 45° in the AP OBLIQUE BILATERAL (Ball Catcher) projection?

To allow for better visualization of the proximal phalanges and MCP joints Signup and view all the answers

What is a possible diagnosis that can be demonstrated by the AP OBLIQUE BILATERAL (Ball Catcher) projection?

Rheumatoid arthritis Signup and view all the answers

In the PA Wrist projection, how should the patient position their shoulder?

Drop the shoulder so that the shoulder, elbow, and wrist are on the same horizontal plane Signup and view all the answers

What is the correct direction of the CR in the AP Wrist projection?

Perpendicular to the IR, directed at the mid-carpal area Signup and view all the answers

What is evidenced by the equal concavity shapes on each side of the shafts of the proximal metacarpals in the PA Wrist image?

True PA projection Signup and view all the answers

What should be separated in the PA Wrist projection, except for possible minimal superimposition at the distal radioulnar joint?

Distal radius and ulna Signup and view all the answers

Where should the CR be centered in the PA Wrist projection?

Mid-carpal area Signup and view all the answers

What is the direction of the central ray in a lateral elbow projection?

Through the elbow joint space, 2.5cm below the mid-point between the two humeral epicondyles Signup and view all the answers

Why is gonadal shielding important in radiography?

To reduce radiation exposure to vital organs Signup and view all the answers

What should be visible on a correctly positioned lateral elbow radiograph?

The distal humerus, elbow joint space, and proximal radius and ulna Signup and view all the answers

How should the patient's arm be positioned for a lateral elbow radiograph?

Extended and externally rotated 45 degrees Signup and view all the answers

What should be aligned with the long axis of the film in a lateral elbow radiograph?

The long axis of the arm Signup and view all the answers

Why is it important to immobilize the arm during a lateral elbow radiograph?

To prevent motion artifact Signup and view all the answers

Study Notes

Radiation Protection

Apply R/L marker in correct place
ALARA principle: use lowest exposure factors for optimal image
Shielding: use shield over radiosensitive organs to prevent exposure from scatter radiation
Collimation: close collimation prevents unnecessary radiation exposure to patient

Projections: PA Fingers

Patient position: seated at end of table, elbow flexed 90°, hand and forearm on table
Part position: pronate hand with fingers extended, center and align long axis of finger with long axis of IR
CR: perpendicular to IR, directed to PIP joint
Image evaluation criteria:
- Collimation: four collimation borders visible on finger area
- Position: long axis of finger aligned with and parallel to side border of IR and collimation field
- No rotation: symmetric appearance of both sides or concavities of phalanges and distal metacarpals
- Anatomy: distal, middle, and proximal phalanges; distal metacarpal; and associated joints

Projections: PA Fingers (continued)

Multiple exposures per imaging plate: careful collimation and lead masking must be used to prevent pre-exposure or fogging of other images

Projections: Lateral Fingers

Lateromedial or mediolateral projections:
- Second digit (mediolateral)
- Third digit (lateromedial)
- Forth digit (lateromedial)
- Fifth digit (lateromedial)

Projections: AP Thumb

Patient position: seated at end of table, hand and forearm on table
Part position: thumb in slightly oblique position, completely free of superimposition, with joint spaces open
Image evaluation criteria:
- Collimation: four collimation borders visible on thumb area
- Position: thumb appears in slightly oblique position, completely free of superimposition, with joint spaces open

Projections: Lateral Extension/In Flexion (Hand)

Lateral extension:
- Patient position: seated at end of table, hand and forearm on table
- Part position: hand and wrist in true lateral position, as evidenced by distal radius and ulna superimposed
Lateral in flexion:
- Patient position: seated at end of table, hand and forearm on table
- Part position: hand and wrist in true lateral position, as evidenced by distal radius and ulna superimposed

Projections: AP Oblique Bilateral (Ball Catcher)

Patient position: supine hands with medial aspect of both hands together at center of IR
Part position: internally rotate hands 45°, support posterior aspect of hands on 45° radiolucent blocks
Image evaluation criteria:
- Position: hands and wrists in true AP position, with fingers extended and relaxed
- Anatomy: proximal phalanges and MCP joints visible

Projections: PA Wrist

Patient position: seated at end of table, shoulder, elbow, and wrist on same horizontal plane
Part position: hand pronated, arch hand slightly to place wrist and carpal area in close contact with IR
CR: perpendicular to IR, directed midway between ulnar and radial styloid processes
Image evaluation criteria:
- Anatomy: mid metacarpals and proximal metacarpals; carpals; distal radius, ulna, and associated joints
- Position: long axis of hand, wrist, and forearm aligned with IR

Projections: AP Wrist (Alternative)

CR: directed midway between the proximal metacarpals, at the mid-carpal area
Image evaluation criteria:
- Anatomy: inter-carpal spaces and related soft tissues of the wrist joint visible

Projections: Elbow

Patient position: seated at end of table, affected arm extended and rested comfortably on table
Part position: affected arm externally rotated 45°, patient leans laterally to achieve this position
CR: directed perpendicularly through the elbow joint space, 2.5 cm below the midpoint between the two humeral epicondyles
Image evaluation criteria:
- Anatomy: distal humerus, elbow joint space, and proximal radius and ulna visible
- Position: long axis of arm aligned with long axis of film
- No rotations, with bilateral epicondyles in profile

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Description

This quiz covers the technical and positioning considerations for radiography of the upper limb, including radiation protection and ALARA principle.

Radiography of the Upper Limb: Technical and Positioning Considerations