Questions and Answers
What is a common congenital malformation of the hand characterized by an extra digit?
Which injury is most frequently associated with trauma to the hand?
Which type of pathological condition in bones would require hand radiography for diagnosis?
What disease is indicated by joint pathologies affecting mobility and often requires hand radiography for evaluation?
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Which aspect of radiographic technique is essential for hand assessment?
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What should be done if a patient cannot extend their hand to place its palmar surface against the cassette?
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Which projection is best for early diagnosis of rheumatoid arthritis in the hand?
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When performing a lateral hand X-ray, where should the central ray be directed?
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What indicates the presence of osteoarthritis in the fingers on a hand X-ray?
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In a lateral hand projection, what structure is primarily used to determine proper part positioning?
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Study Notes
Learning Outcomes
- Identify bones of the hand and common reasons for hand radiography.
- List routine projections for hand radiography and supplementary projections for specific clinical conditions.
- Explain key patient assessment points for hand radiography and positioning methods.
Overview
- Hand anatomy, clinical rationale, and radiographic protocols are essential components.
- Standard protocols and modifications may be necessary based on clinical indications.
Hand Anatomy Basics
- Understanding of carpal, metacarpal, and phalangeal structures is crucial.
- Recognize conditions such as polydactyly which involves an extra digit.
Clinical Rationale
- Common reasons for hand radiography include fractures, dislocations, foreign body localization, and pathologies.
- Injuries are often to the fifth metacarpal, particularly the distal part.
Radiographic Technique
- Lateral projections are essential in suspected fractures, showing bone displacement and foreign body depth.
- Use 55 kV and 7 mAs settings for a lateral hand radiograph, maintaining a 100 cm FFD.
Patient Positioning
- Position seated at the end of the radiographic table with lead shielding applied.
- Hand should be in true lateral position with the thumb perpendicular to the palm.
- Central ray directed perpendicular to the second metacarpophalangeal joint.
Supplementary Projections
- For rheumatoid arthritis, use the Norgaard Method, allowing for better visualization of MCP and IP joints.
- Brewerton's view requires a tube angle of 20 degrees across the hand from the ulnar side.
Common Hand Pathologies
- Osteoarthritis: Narrowing of interphalangeal joints with spurs and erosions.
- Rheumatoid arthritis: Chronic systemic inflammatory condition leading to cartilage destruction.
- Osteopenia: Decreased bone density resulting in weaker bones.
Protocols
- Standard protocol involves PA, PA oblique, and lateral projections.
- Modified projections may be necessary due to patient limitations in extending the hand.
Request Forms
- Key features include accurate patient identification and specific imaging requests, ensuring proper context for radiologic findings.
Patient Assessment
- Verify patient identity and history, especially concerning pregnancy and privacy.
- Identify any artifacts that could affect imaging and ensure patient understanding of procedures.
- Consider patient support for positioning and the need for demonstrations.
Aesthetic Considerations
- Ensure that images are visually clear without unnecessary obstructions or artifacts disrupting the view of anatomical structures.
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Description
This quiz covers the essential topics from Lecture 2 of RMI 221, focusing on the radiographic anatomy and positioning of the hand. You will learn to identify the bones, understand common reasons for hand radiography, and list the routine projections and key patient assessment points. Supplementary projections for specific conditions will also be discussed.
