4Chapter_Positioning_Hand_RADR1311_Accessible_Summer2020_SC(1) (3).pdf

Hand Positioning Essential Projections Extension PA PA Oblique Routine Protocol = 3 view Lateral Lateral Alternate Projection Clinical Indications for Hand Fractures Dislocations Osteoporosis Osteoarthritis Foreign Bodies General Positioning Guidelines Patient Position Seated at the end of the table...

Hand Positioning Essential Projections Extension PA PA Oblique Routine Protocol = 3 view Lateral Lateral Alternate Projection Clinical Indications for Hand Fractures Dislocations Osteoporosis Osteoarthritis Foreign Bodies 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 Digits, hand and wrist all aligned and parallel to the IR axis Use a positioning sponge when available General Positioning Guidelines CR Perpendicular to IR Perpendicular to part Collimation 4 sided to include anatomy of interest Includes bony detail and soft tissue Marker Placed at most narrow part of anatomy PA: Hand Part Position Pronate hand, fingers extended, and separated Palmar surface in full contact with the IR Digit, hand and wrist aligned and parallel to the IR CR Perpendicular Enters at 3rd MCP joint Collimation Include all digits, entire hand, wrist and 1” of distal forearm Evaluation Criteria PA Hand Entire hand and carpals 1” of radius and ulna Fingers should be separated with no superimposition No rotation – equal concavity of digits & equal soft tissue Open MCP and IP joints Optimal density and contrast No motion Radiographic Anatomy PA Hand PA Oblique: Hand Part Position Pronate hand Hand and wrist rotated 45 degrees laterally Metacarpals and digits fully extended and parallel to IR Forearm resting on table CR Perpendicular Enters at the 3rd MCP joint Collimation Include all digits, entire hand, wrist and 1” of distal forearm PA Oblique Hand: Positioning Error Metacarpals not parallel to IR PA Oblique Hand: Positioning Error Digits not parallel to IR PA Oblique Hand: Positioning Error Digits not parallel to IR foreshortening of the digit Closed joint Correct positioning Evaluation Criteria PA Oblique Hand Oblique view of the entire hand and wrist 1” of distal forearm Fingers should be separated with no superimposition Metacarpal shafts should not overlap Slight overlap of the 3rd-5th metacarpal head and bases No overlap of distal 2nd and 3rd metacarpal Open MCP and IP joints Optimal density and contrast No motion demonstrated by soft tissue margins and sharp bony trabecular markings Radiographic Anatomy PA Oblique Hand Fan Lateral (lateromedial): Hand Part Position “Make an okay sign” – could be culturally sensitive Rotate hand and wrist into lateral position with medial side of hand in contact with IR Metacarpals in a true lateral position, superimposed Radial and ulnar styloid superimposed Separate fingers to a “fan” position, free of superimposition Digit fully extended and parallel to IR Support digits with sponge when available Forearm resting on table Fan Lateral (lateromedial): Hand CR Perpendicular Enters at the 2nd MCP joint Collimation Include all digits, entire hand, wrist and 1” of distal forearm Fan Lateral Hand: Positioning Error Digits not parallel to the IR Fan Lateral Hand: Positioning Error Digits not fully extended Fan Lateral Hand: Positioning Error Digits not fully extended Fan Lateral Hand: Positioning Error Digits not fully extended Evaluation Criteria Fan Lateral Hand Entire hand and wrist 1” of distal forearm Fingers should be separated with no superimposition Metacarpal shafts should be superimposed Distal radius and ulna should be superimposed Open MCP and IP joints Optimal density and contrast No motion demonstrated by soft tissue margins and sharp bony trabecular markings Radiographic Anatomy Fan Lateral Hand Alternative/Special Projections Hand Extension Lateral: Hand Part Position “Make a karate chop” Rotate hand and wrist into lateral position with medial side of hand in contact with IR Metacarpals in a true lateral position, superimposed Radial and ulnar styloid superimposed Digit fully extended and parallel to IR Forearm resting on table CR Perpendicular Enters at the 2nd-5th MCP joint Collimation Include all digits, entire hand, wrist and 1” of distal forearm Evaluation Criteria Extension Lateral Hand Entire hand and wrist 1” of distal forearm Fingers should be superimposed Metacarpal shafts should be superimposed Distal radius and ulna should be superimposed Optimal density and contrast No motion demonstrated by soft tissue margins and sharp bony trabecular markings AP Obique Bilateral: Hand “Ball Catcher’s” Position Part Position Supinate hands Internally rotate hand 45 degrees Digit extended, relaxed, separated and parallel to IR Forearm resting on table CR Perpendicular Enters between both hands at level of 5th MCP joint Collimation Include all digits, entire hand, wrist and 1” of distal forearm Evaluation Criteria AP Oblique Hand Entire hand and wrist in 45 degree oblique position 1” of distal forearm No superimposition of metacarpals or digits Open MCP joints Optimal density and contrast No motion Trauma Protocol – 2 views Firework Explosion Lateral X-table AP/AP