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Questions and Answers
Questions and Answers
What anatomy should be visible in a true lateral position of the hand, wrist, and forearm?
What anatomy should be visible in a true lateral position of the hand, wrist, and forearm?
- Proximal radius and ulna
- Distal radius, ulna, carpals, and at least the midmetacarpal area (correct)
- Phalanges and wrist joint
- Proximal humerus and elbow joint
Where should the CR and center of collimation field be positioned in a true lateral hand, wrist, and forearm X-ray?
Where should the CR and center of collimation field be positioned in a true lateral hand, wrist, and forearm X-ray?
- To midcarpal region (correct)
- To the distal phalanges
- To the elbow joint
- To the proximal humerus
What is the optimal exposure for a true lateral hand, wrist, and forearm X-ray?
What is the optimal exposure for a true lateral hand, wrist, and forearm X-ray?
- Optimal density (brightness) and contrast with no motion (correct)
- Blurred image with visible motion
- Low density and high contrast
- High density and low contrast
What is the clinical indication for performing a true lateral hand, wrist, and forearm X-ray?
What is the clinical indication for performing a true lateral hand, wrist, and forearm X-ray?
What is the recommended CR position for a true lateral hand X-ray?
What is the recommended CR position for a true lateral hand X-ray?
What is the patient positioning for a true lateral hand X-ray?
What is the patient positioning for a true lateral hand X-ray?
What is the purpose of using a compensation filter in a true lateral hand X-ray?
What is the purpose of using a compensation filter in a true lateral hand X-ray?
What is the purpose of aligning the long axis of the hand with the long axis of the IR in a true lateral hand X-ray?
What is the purpose of aligning the long axis of the hand with the long axis of the IR in a true lateral hand X-ray?
What should the collimation field include in a true lateral hand X-ray?
What should the collimation field include in a true lateral hand X-ray?
How should the fingers be positioned in a true lateral hand X-ray?
How should the fingers be positioned in a true lateral hand X-ray?
Where should the CR and midpoint of the collimation field be in a true lateral hand X-ray?
Where should the CR and midpoint of the collimation field be in a true lateral hand X-ray?
What indicates the correct positioning of the hand in a true lateral X-ray?
What indicates the correct positioning of the hand in a true lateral X-ray?
What is the recommended oblique angle for the oblique projection of the hand and wrist?
What is the recommended oblique angle for the oblique projection of the hand and wrist?
What should be visible in the fan lateral hand position?
What should be visible in the fan lateral hand position?
What should the lateral hand radiograph demonstrate in the lateral position?
What should the lateral hand radiograph demonstrate in the lateral position?
What is the minimum recommended SID for hand radiography?
What is the minimum recommended SID for hand radiography?
How should patients be positioned for hand radiography?
How should patients be positioned for hand radiography?
Where should the CR be directed for the fan lateral hand position?
Where should the CR be directed for the fan lateral hand position?
What anatomy should be demonstrated in the PA hand position?
What anatomy should be demonstrated in the PA hand position?
What is the recommended IR size for hand radiography?
What is the recommended IR size for hand radiography?
What is the evaluation criteria for the PA hand position?
What is the evaluation criteria for the PA hand position?
What is the recommended shielding practice for hand radiography?
What is the recommended shielding practice for hand radiography?
Where should the CR and center of collimation field be positioned in a PA hand position?
Where should the CR and center of collimation field be positioned in a PA hand position?
What is the recommended minimum source-to-image distance (SID) for hand X-ray imaging?
What is the recommended minimum source-to-image distance (SID) for hand X-ray imaging?
How should the patient's hand and wrist be positioned for hand X-ray imaging?
How should the patient's hand and wrist be positioned for hand X-ray imaging?
What is the purpose of recommended collimation in hand X-ray imaging?
What is the purpose of recommended collimation in hand X-ray imaging?
What is the alternative routine for hand X-ray imaging?
What is the alternative routine for hand X-ray imaging?
What is the recommended position for the second digit in hand X-ray imaging?
What is the recommended position for the second digit in hand X-ray imaging?
What should the lateral view demonstrate in hand X-ray imaging?
What should the lateral view demonstrate in hand X-ray imaging?
What is the purpose of optional medial oblique positioning for the second digit in hand X-ray imaging?
What is the purpose of optional medial oblique positioning for the second digit in hand X-ray imaging?
What should the oblique view demonstrate in hand X-ray imaging?
What should the oblique view demonstrate in hand X-ray imaging?
What is the recommended positioning of the patient's forearm for hand X-ray imaging?
What is the recommended positioning of the patient's forearm for hand X-ray imaging?
What is the recommended hand position for a different imaging procedure than the true lateral hand X-ray?
What is the recommended hand position for a different imaging procedure than the true lateral hand X-ray?
What is the recommended practice for shielding in hand X-ray imaging?
What is the recommended practice for shielding in hand X-ray imaging?
What is the recommended image receptor (IR) size for hand X-ray imaging?
What is the recommended image receptor (IR) size for hand X-ray imaging?
What is the recommended minimum source-to-image distance (SID) for hand X-ray imaging?
What is the recommended minimum source-to-image distance (SID) for hand X-ray imaging?
How should the patient's hand and wrist be positioned for hand X-ray imaging?
How should the patient's hand and wrist be positioned for hand X-ray imaging?
What is the purpose of aligning the long axis of the hand with the long axis of the IR in a true lateral hand X-ray?
What is the purpose of aligning the long axis of the hand with the long axis of the IR in a true lateral hand X-ray?
What anatomy should be demonstrated in the PA hand position?
What anatomy should be demonstrated in the PA hand position?
What should the collimation field include in a true lateral hand X-ray?
What should the collimation field include in a true lateral hand X-ray?
What is the purpose of using a compensation filter in a true lateral hand X-ray?
What is the purpose of using a compensation filter in a true lateral hand X-ray?
What is the recommended IR size for hand radiography?
What is the recommended IR size for hand radiography?
What is the patient position for the oblique thumb projection?
What is the patient position for the oblique thumb projection?
What is the purpose of recommended collimation in hand X-ray imaging?
What is the purpose of recommended collimation in hand X-ray imaging?
What is the purpose of the recommended patient position for the oblique thumb projection?
What is the purpose of the recommended patient position for the oblique thumb projection?
What is the recommended practice for shielding in hand X-ray imaging?
What is the recommended practice for shielding in hand X-ray imaging?
What is the recommended position for the second digit in hand X-ray imaging?
What is the recommended position for the second digit in hand X-ray imaging?
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Study Notes
Study Notes
Hand Radiography Positioning and Evaluation Criteria
- The fan lateral hand position requires the CR to be directed to the second MCP joint.
- For the fan lateral position, the entire hand and wrist, along with about 2.5 cm (1 inch) of the distal forearm, should be visible.
- The oblique projection of the hand and wrist also requires about 2.4 cm (1 inch) of the distal forearm to be visible.
- In the oblique position, the long axis of the hand and wrist should be aligned with the IR, and a 45° oblique angle is recommended.
- The lateral hand radiograph should demonstrate the distal and proximal phalanges, first metacarpal, trapezium (superimposed), and associated joints in the lateral position.
- Clinical indications for these hand radiography positions include fractures, dislocations, or foreign bodies of the phalanges, metacarpals, and all joints of the hand, as well as pathologic processes such as osteoporosis and osteoarthritis.
- The minimum SID for hand radiography is 40 inches, and the recommended IR size is 24 × 30 cm (10 × 12 inches) lengthwise.
- The shielding should be used to protect radiosensitive tissues outside the region of interest during hand radiography.
- Patients should be seated at the end of the table with the elbow flexed about 90° and the hand and forearm resting on the table for hand radiography.
- The CR for hand radiography should be perpendicular to the IR and directed to the third MCP joint.
- For the PA hand position, the CR and center of collimation field should be to the third MCP joint, and the anatomy demonstrated should include the entire hand and wrist, along with about 2.5 cm (1 inch) of the distal forearm.
- The evaluation criteria for the PA hand position include optimal density and contrast with no motion, demonstrating soft tissue margins and clear, sharp bony trabecular markings.
Hand and Finger X-ray Imaging Procedures
- Clinical indications for X-ray imaging include fractures, dislocations of phalanges, metacarpals, and associated joints, as well as pathologic conditions like osteoporosis and osteoarthritis.
- Technical factors for X-ray imaging include a minimum source-to-image distance (SID) of 40 inches, an 18 x 24 cm image receptor (IR) size, and specific kV range for both analog and digital systems.
- Patient positioning involves seating the patient at the end of the table, with the elbow flexed at 90° and the hand and wrist resting on the IR, with fingers extended.
- Part positioning requires the hand to be placed in a lateral position with the finger to be examined fully extended and centered on the IR, with a sponge block for support and to prevent motion.
- Recommended collimation involves collimating on four sides to the affected finger and distal aspect of the metacarpal, with optional medial oblique positioning for the second digit.
- Evaluation criteria for the lateral and oblique views include the demonstration of specific anatomical structures, correct positioning of the finger, and optimal density and contrast with no motion artifacts.
- An alternative routine involves using a larger IR for the PA projection of the finger to include the entire hand, followed by oblique and lateral projections of the affected finger only.
- Shielding is recommended to protect radiosensitive tissues outside the region of interest.
- The optional medial oblique position for the second digit involves a 45° rotation with the thumb side down, with specific accessories and shielding requirements.
- The patient's forearm should be rested on the table, and the hand should be pronated with fingers extended for a different imaging procedure.
- The lateral view should show the long axis of the finger aligned with the side border of the IR, and the finger should be in a true lateral position, as indicated by the concave appearance of the anterior surface of the phalanges.
- The oblique view should demonstrate a 45° oblique alignment of the finger, with no superimposition of adjacent fingers, and specific criteria for correct positioning and exposure.
Radiographic Imaging of the Hand and Thumb
- The optimal positioning of the interphalangeal and metacarpophalangeal joints is crucial for a clear image.
- The CR and center of collimation field should be at the first MCP joint for an accurate image.
- The imaging is used for clinical indications such as fractures, dislocations, and pathologic processes like osteoporosis and osteoarthritis.
- Technical factors include a minimum SID of 40 inches, IR size of 18 × 24 cm, and kV range of 50 to 60 for analog and digital systems.
- The patient should be seated at the end of the table, with the elbow flexed about 90° and the hand resting on the IR, palm down.
- The positioning of the hand involves starting with the hand pronated and thumb abducted, then rotating the hand slightly medial until the thumb is in a true lateral position.
- The evaluation criteria for the image include optimal density and contrast with no motion, demonstrating soft tissue margins and clear, sharp bony trabecular markings.
- The anatomy demonstrated in the image should include the distal and proximal phalanges, first metacarpal, trapezium, and associated joints.
- The patient position for the oblique thumb involves abducting the thumb slightly with the palmar surface of the hand in contact with the IR.
- The recommended collimation is to collimate on four sides to the thumb area, ensuring that all of the first metacarpal is included.
- The hand should be internally rotated with fingers extended until the posterior surface of the thumb is in contact with the IR for the AP projection.
- If the patient cannot position for the previous AP, the PA position is used, but it is not advisable due to the increased loss of definition caused by increased OID.
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