MRT 1144 – Class 5.pdf

MRT 1144 – Class 5 Essential Projections of the Digits, Thumb, and Hand  Digits, Thumb and Hand IR size – 18 x 24 cm for all Technical factor settings: mAs 1.6 – 2.5 kVp: 63 – 70 Central ray perpendicular to IR for all images Essential Projections: Digits 2...

MRT 1144 – Class 5 Essential Projections of the Digits, Thumb, and Hand  Digits, Thumb and Hand IR size – 18 x 24 cm for all Technical factor settings: mAs 1.6 – 2.5 kVp: 63 – 70 Central ray perpendicular to IR for all images Essential Projections: Digits 2 to 5 PA Lateral PA oblique  Essential Projections: Digits 2 to 5 Collimated field size – 2.5 cm on all sides of the digit, including 2.5 cm proximal to the MCP joint  Position of Part – Digits 2 - 5 Center the digit requested in the middle of the image receptor. Separate the fingers slightly.  PA Digits 2 to 5 Part position – Extended with palmar surface in center of the IR, center the digit requested in the middle of the image receptor. Separate the fingers slightly. – Long axis of digit aligned parallel CR – Perpendicular to IR – Enters patient at PIP joint 8 Evaluation Criteria – PA Digits 2 - 5 Proper collimation Phalanges should not be rotated Distal, middle and proximal phalanges included Distal end of metacarpal included Open IP and MCP joint spaces No superimposition of digit Proper technical factors used (soft tissue and bony trabeculae) Right or left marker  Lateral Digits 2 to 5 Part Position Separate digit of interest using cotton swab or tape, and fold other digits into fist Digit of interest in center of IR Long axis of digit parallel with IR  Lateral Digits 2 to 5 (Cont.) Part position – second and third digits – Extended with lateral surface in contact with IR (mediolateral projection) – This positioning is to minimize OID or object image distance  Lateral Digits 2 to 5 (Cont.) Part position – fourth and fifth digits – Extended with medial surface in contact with IR (lateromedial projection) – This positioning is to minimize OID or object image distance  Lateral Digits 2 to 5 (Cont.) CR – Directed perpendicular to the IR – Enters patient at PIP joint Evaluation Criteria – Lateral Projection Digits 2 - 5 Proper collimation Phalanges should not be rotated from true lateral Distal, middle and proximal phalanges included Distal end of metacarpal included Open IP joint spaces No superimposition of digit from other fingers Proper technical factors used (soft tissue and bony trabeculae) Right or left marker  PA Oblique Digits 2 to 5 Part position – Extended with palmar surface resting on 45-degree wedge sponge – Digit of interest separated to prevent soft tissue overlap  PA Oblique Digits 2 to 5 (Cont.) CR – Perpendicular to PIP joint of affected digit Collimation: 2.5 cm on all sides of the digit  Evaluation Criteria – PA Oblique Projection Digits 2 - 5 Proper collimation Phalanges should look obliqued Distal, middle and proximal phalanges included Distal end of metacarpal included Open IP and MCP joint spaces No superimposition of digit from other fingers Proper technical factors used (soft tissue and bony trabeculae) Right or left marker  Essential Projections: Thumb Anteroposterior (AP) Lateral PA oblique  Essential Projections: Thumb Collimated field size – 2.5 cm on all sides of the digit, including 2.5 cm proximal to the CMC joint  AP Thumb Part position – Hand in extreme internal rotation – Posterior surface of thumb on IR – MCP joint centered to IR – Long axis of thumb aligned parallel – Other digits separated from thumb with tape or opposite hand – Check thumb position to ensure true AP projection  AP Thumb (Cont.) CR – Perpendicular to MCP joint  Evaluation Criteria – AP Thumb Projection Proper collimation Entire thumb to trapezium Concavity of the phalangeal bodies Open IP and MCP joint spaces Proper technical factors used (soft tissue and bony trabeculae) Left or right marker Alternative Thumb Projection - PA Center the thumb and the CR appropriately to the IR Evaluation criteria the same as for AP thumb projection Large OID – magnification occurs  Lateral Thumb Part position – Palmar surface on IR – Align long axis of thumb parallel – Center MCP joint to unmasked portion of IR – Rotate thumb until lateral surface is on IR (mediolateral projection) CR – Perpendicular to MCP joint of thumb  Evaluation Criteria – Lateral Thumb Projection Proper collimation Entire thumb to trapezium No rotation of the phalanges Open IP and MCP joint spaces Proper technical factors used (soft tissue and bony trabeculae) Left or right marker  PA Oblique Projection - Thumb Part position – Palmar surface on IR – Ulnar-deviate hand slightly – Align long axis of thumb parallel – Center MCP joint to unmasked portion of IR CR Perpendicular to MCP joint  Evaluation Criteria – PA Oblique Projection Thumb Proper collimation From distal tip to trapezium included Open IP and MCP joint spaces Concave surface of elevated side 45 degree obliquity  Essential Projections: Hand PA Lateral – Lateral in extension position – Fan lateral position PA oblique Essential Projections: Hand (Cont.) Collimated field size – 2.5 cm on all sides of the hand, including 2.5 cm proximal to the ulnar styloid  PA Hand Part position – Palmar surface on IR – Forearm on table – Extend and separate digits to prevent soft tissue overlap – Center third MCP joint to unmasked portion of IR  PA Hand (Cont.) CR – Perpendicular to third MCP joint  Evaluation Criteria – PA Hand All phalanges, metacarpals and carpals must be included. No rotation - Equal concavity of the metacarpal and phalangeal bodies on both sides No superimposition Equal distance between the metacarpal heads Proper technical factors and appropriate marker  PA Oblique Hand Part position – Forearm on table – Palmar surface on unmasked portion of IR – Rotate palm away from IR until MCP joint forms 45-degree angle – Support digits extended on sponge Demonstrates IP joints Prevents foreshortening of phalanges – MCP joints in center of IR  PA Oblique Hand (Cont.) CR – Perpendicular to third MCP joint  PA Oblique Hand Same position – palmer surface towards IR, hand rotated 45 degrees Difference in this position – no sponge is used and fingers are resting on the IR, i.e. they are slightly curved  Evaluation Criteria – PA Oblique Hand All phalanges, metacarpals and carpals must be included. No superimposition 45 degree obliquity – minimal overlap of 3rd, 4th and 5th metacarpals. Open joint spaces when fingers are fully extended. Proper technical factors and marker shown.  Evaluation Criteria – PA Oblique Hand All phalanges, metacarpals and carpals must be included. No superimposition 45 degree obliquity – minimal overlap of 3rd, 4th and 5th metacarpals. Joint spaced in the phalanges are not open. Proper technical factors and marker shown.  Lateral Hand Part position – extension position – Forearm on table – Elbow flexed 90 degrees – Hand on medial surface – Radial and ulnar styloids superimposed and perpendicular to IR (lateromedial projection) – Palmar surface perpendicular to IR – First digit abducted to right angle to palm – MCP joints centered to IR – Digits and long axis of hand aligned parallel  Lateral Hand (Cont.) CR – Perpendicular to second MCP joint  Lateral Hand (Cont.) Part position – fan lateral position – Forearm on table with elbow flexed 90 degrees – Hand resting on medial surface – Radial and ulnar styloids superimposed and perpendicular to IR (lateromedial projection) – Palmar surface perpendicular to IR – Digits positioned out of superimposition supported by a wedge sponge – MCP joints centered to IR – Digits and long axis of hand aligned parallel  Lateral Hand (Cont.) CR – Perpendicular to second MCP joint  Evaluation Criteria – Lateral Hand Metacarpals, digits and radius and ulna are superimposed on each other. Tips of fingers to distal radius and ulna are included. Thumb appears in a PA position, unsuperimposed. Proper technical factors and marker on image.  Evaluation Criteria – Fan Lateral Hand Metacarpals are superimposed on each other. Radius and ulna are superimposed Digits 2 – 5 appear unsuperimposed and in lateral position. Tips of fingers to distal radius and ulna are included. Thumb is not superimposed. Proper technical factors and marker on image. Boxer’s Fracture  AP Oblique Projection – Norgaard Method (bilateral hands) Bigger IR size (24 x 30 cm) Part Position Supinate hands and place medial aspect of both hands together at center of IR. From this position, internally rotate hands 45degrees and support posterior of hands on 45degrees, use sponge if necessary. Extent fingers and ensure that they are relaxed, slightly separated but parallel to IR. Abduct both thumbs to avoid superimposition.  AP Oblique Projection – Norgaard Method (bilateral hands) CR A point midway between the two hands at the level of the MCP joint. Evaluation Criteria – Norgaard Method Both hands from the fingertips to the distal radius and ulna. Proper technical factors (bony trabeculae and soft tissue) and markers on image. Rheumatoid Arthritis