Radiography of the Upper Limb: Technical and Positioning Considerations
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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?

    <p>90°</p> Signup and view all the answers

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

    <p>With the hand and forearm resting on the table</p> Signup and view all the answers

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

    <p>The PIP joint</p> Signup and view all the answers

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

    <p>Four collimation borders</p> Signup and view all the answers

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

    <p>Parallel to the side border of the unmasked portion of the IR</p> Signup and view all the answers

    What should be included in a PA Fingers radiograph?

    <p>Soft tissue and bones up to the metacarpophalangeal joint</p> Signup and view all the answers

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

    <p>Lateromedial</p> Signup and view all the answers

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

    <p>Because the anatomy of the thumb requires it</p> Signup and view all the answers

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

    <p>Four</p> Signup and view all the answers

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

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

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

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

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

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

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

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

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

    <p>To avoid superimposition</p> Signup and view all the answers

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

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

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

    <p>Rheumatoid arthritis</p> Signup and view all the answers

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

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

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

    <p>Perpendicular to the IR, directed at the mid-carpal area</p> 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?

    <p>True PA projection</p> 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?

    <p>Distal radius and ulna</p> Signup and view all the answers

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

    <p>Mid-carpal area</p> Signup and view all the answers

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

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

    Why is gonadal shielding important in radiography?

    <p>To reduce radiation exposure to vital organs</p> Signup and view all the answers

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

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

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

    <p>Extended and externally rotated 45 degrees</p> Signup and view all the answers

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

    <p>The long axis of the arm</p> Signup and view all the answers

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

    <p>To prevent motion artifact</p> 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.

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