4Chapter_Positioning_Finger_RADR1311_Accessible_Summer2020_SC(1) (3).pdf

Finger Positioning Digits 1 through 5 Essential Projections Digits 2-5 PA PA Oblique Routine Protocol = 3 view Lateral General Positioning Guidelines Patient Position Seated at the end of the table, facing RT(R) Part Position Position patient to their comfort Place the part in the center of the IR D...

Finger Positioning Digits 1 through 5 Essential Projections Digits 2-5 PA PA Oblique Routine Protocol = 3 view Lateral General Positioning Guidelines Patient Position Seated at the end of the table, facing RT(R) Part Position Position patient to their comfort Place the part in the center of the IR Digit aligned and parallel to the IR Digit free of superimposition Use a positioning sponge when available General Positioning Guidelines CR Perpendicular to IR Perpendicular to the part Collimation 4 sided to include anatomy of interest Includes bony detail and soft tissue PA: Digits 2-5 Part Position Pronate hand, fingers extended, and separated Palmar surface in full contact with the IR Digit aligned and parallel to the IR CR Perpendicular Enters at the PIP joint Collimation Digit of interest and digit on either side Evaluation Criteria PA Digit 2nd – 5th Entire finger Distal metacarpal Open DIP, PIP and MCP joint spaces Equal soft tissue and concavity of the shafts of the phalanges Fingers should be separated with no superimposition No motion No rotation Optimal density and contrast PA Oblique: Digits 2-5 Part Position Pronate hand, fingers extended, and separated (abducted) Fingers rotated 45 degrees Digit 2 is rotated medially Digits 3-5 are rotated laterally Digit aligned and parallel to the IR CR Perpendicular Enters at the PIP joint Collimation Digit of interest and digit on either side Evaluation Criteria PA Oblique Digit 2nd -5th Oblique view of the entire finger Distal metacarpal Open DIP, PIP, and MCP joint spaces Slight concavity on one side of the phalange shafts with a semi-straight edge on the other side No superimposition of adjacent fingers No motion Optimal density and contrast Lateral: Digits 2-5 Part Position Finger of interest fully extended and separated Digit parallel to IR Lateral rotation Digit 2 – mediolateral rotation Digits 3-5 – lateromedial rotation Digit aligned and parallel to the IR CR Perpendicular Enters at the PIP joint Collimation Digit of interest Lateral: Digits 2-5 Positioning Assistance Circular sponge 20 degree sponge Square sandbag Cotton swab Tongue depressor Evaluation Criteria Lateral Digit 2nd -5th True lateral view of entire finger Distal metacarpal Open DIP, PIP, and MCP joint spaces No superimposition of adjacent fingers Full concavity on one side of the phalange shafts with a straight edge on the other side No superimposition of adjacent fingers No motion Optimal density and contrast Essential Projections Digit 1 AP PA oblique Lateral AP: Digit 1 Part Position Hand internally rotated and supinated Posterior surface of thumb is in contact with the IR Digit aligned and parallel to the IR Other digits separated from thumb with tape or opposite hand Check true AP position by looking a the nailbed of the digit CR Perpendicular Enters at the 1st MCP joint Collimation Digit of interest to include 1st metacarpal and trapezium Evaluation Criteria AP 1st Digit Entire thumb 1st metacarpal Trapezium Open IP, MCP, and CMC joint spaces Equal soft tissue No rotation indicated by equal concavity on each side of the phalanges Optimal density and contrast No motion PA Oblique: Digit 1 Part Position Pronate hand, abduct thumb slightly away from other fingers Palmar surface in full contact with the IR Naturally places the thumb in a PA oblique position Adjust digit to be aligned and parallel to the long IR axis CR Perpendicular Enters at the MCP joint Collimation Digit of interest to include 1st metacarpal and trapezium Evaluation Criteria PA Oblique 1st Digit Entire thumb, 1st metacarpal and Trapezium all visualized in a 45 degree oblique position Slight concavity on one side of the phalange shafts with a semi-straight edge on the other side Open IP and MCP joint spaces Optimal density and contrast No motion Lateral: Digit 1 Part Position Pronate hand, thumb extended and aligned to the IR axis Curl fingers slightly and rotate the thumb and hand to place the thumb in a true lateral position. A sponge may need to be provided for support. CR Perpendicular Enters at the 1st MCP joint Collimation Digit of interest to include 1st metacarpal and trapezium Evaluation Criteria Lateral 1st Digit Entire thumb, 1st metacarpal and Trapezium all visualized in a true lateral position Long axis of the thumb aligned with the IR and FOV Full concavity on one side of the phalange shafts with a straight edge on the other side Open IP and MCP joint spaces Optimal density and contrast No motion Alternative/Special Projections Digits PA 1st Digit - Adaptation Increases OID NOT the ideal position for the 1st digit AP Axial Projection Modified Robert’s Method Clinical Indications Fractures, dislocations and pathology at the base of the 1st metacarpal and trapezium Part Position Positioned like AP thumb CR 15 degrees toward the wrist Enters at the 1st CMC joint Collimation Thumb, 1st metacarpal and trapezium Evaluation Criteria AP Axial 1st Digit AP projection of the thumb and 1st CMC joint visible without superimposition Base of 1st metacarpal and Trapezium well visualized Long axis of the thumb aligned with the IR and FOV 1st CMC and MSP joint space open No rotation Optimal density and contrast No motion PA Stress Thumb Projection Clinical Indications: Sprain or tearing of the ulnar collateral ligament of the thumb as a result from hyperflexion AKA - (skiers thumb) Trauma Protocol – 2 views