Hand & Wrist Projections 24-25 (1) PDF

RADIOGRAPHI C TECHNIQUE THE HAND PATIENT POSITIONING – THE HAND Relationship between the patient the image receptor and the primary beam Need to consider Position of the hand Field of View Centering Point Primary beam  2 STANDARD...

RADIOGRAPHI C TECHNIQUE THE HAND PATIENT POSITIONING – THE HAND Relationship between the patient the image receptor and the primary beam Need to consider Position of the hand Field of View Centering Point Primary beam  2 STANDARD VIEWS Dorsi-Palmer (DP) Dorsi-Palmer Oblique (DP Oblique)  DORSI PALMER VIEW Forearm all on the same plane Forearm is pronated Palmer aspect in contact with IR Fingers extended and slightly separated Radial and ulna styloid processes equidistant from the IR Vertical central beam centered at the head of the 3rd Metacarpal Aspect marker placed in primary beam Field of view includes Soft tissue of distal phalanges Distal end radius and ulna Soft tissues laterally Whitley et al  DORSI PALMER OBLIQUE Hand externally rotated 45 degrees Fingers separated slightly Primary beam centered over the head of the 5th metacarpal and angled to the head of the 3rd metacarpal FOV – soft tissue of distal phalanges, distal radius and Ulna, soft tissues Whitley et al LATERAL HAND Can be standard view in trauma Can be additional view Used to determine displacement and position of fracture fragments in trauma Used to determine position of foreign bodies  LATERAL HAND Hand is externally rotated 90 degrees from DP position Fingers extended, thumb abducted Radial and ulna styloid processes superimposed Vertical beam centered at the head of the 2nd metacarpal Field of view Soft tissue of distal phalanges Distal radius and ulna Soft tissues posterior aspect of hand and thumb. Whitley et al 2015  2 STANDARD VIEWS Lateral Dorsi-palmer (DP) Posterior-Anterior Image from TECHNIQUE – WRIST – DP/PA Arm is pronated Radial and ulna styloid processes are equidistant from IR Fingers flexed – reduces OID Vertical primary beam centred to a point midway between the radial and ulna styloid processes. Field of view Distal 1/3 of the radius and ulna Heads of Metacarpals* Soft tissue borders laterally LATERAL WRIST Forearm externally rotated into lateral position Radial and ulna styloid processes superimposed Vertical central beam centered on the radial styloid process. Thumb abducted. FOV Heads of metacarpals Distal 1/3 radius and ulna Soft tissue borders Whitley et al SCAPHOID Lateral Anterior oblique PA 30 degree cranial angle/banana view/Zitter view AP Oblique ulna deviation DP/PA Ulna Deviation Protocols between Trusts may vary, ensure you know what your placement hospital protocols are. DP ULNA DEVIATION – 15 DEGREES Ulna deviation elongates the scaphoid and demonstrates the scaphoid without superimposition of the radius. Forearm pronated, elbow flexed, forearm elbow and shoulder on same plane Ask patient to do ulna deviation/demonstrate this for them Vertical central ray centred at a point midway between radial and ulna styloid processes FOV Distal radius and ulna Proximal metacarpals Soft tissue borders  ANTERIOR OBLIQUE From PA externally rotate hand/wrist 45 degrees Wrist should have ulna deviation Vertical primary beam centered midway between radial and ulna styloid processes FOV- Distal ends radius and ulna, proximal metacarpals and soft tissues laterally. Whitley et al PA – 30 DEGREE CRANIAL ANGLE Wrist, hand and forearm PA position Arm abducted Ulna deviation of the hand 30 degree cranial angle applied to the x-ray tube to the long axis of the scaphoid Angled primary beam centered to the scaphoid Ensure the patient is looking away from the primary beam Image should show the scaphoid elongated and space around the scaphoid should be visualised. AP OBLIQUE/ POSTERIOR OBLIQUE – ULNA DEVIATION Hand, wrist and arm are supinated then internally rotated so posterior aspect of hand is 45 degrees from the image receptor Vertical primary beam centered midway between radial and ulna styloid processes Foam pads can be used for supporting the patient FOV Proximal metacarpals Distal ends of radius and ulna Soft tissues  THUMB – ANTERIOR- POSTERIOR (AP) Patient sat at side of the table with arm extended and abducted. Patients arm is internally rotated from the shoulder Patient leaning forward 1st metacarpal should be parallel to the image receptor No other fingers or metacarpals overlying –palm slightly raised Can use pads to support Vertical primary beam centered at 1st metacarpal- phalangeal joint FOV - 1st carpo-metacarpal joint Soft tissue distal phalanx Lateral soft tissue Radiopedia THUMB – ANTERO-POSTERIOR (ERECT) Patient can be positioned using the erect wall stand Important that positioning with the first metacarpal parallel to the IR Can be difficult for the patient to keep still LATERAL THUMB Internally rotate hand from DP position until the thumb is lateral. Palm of hand raised slightly and can be supported by a pad Lateral aspect of the thumb parallel to the IR Vertical primary beam centered to the 1st metacarpo-phalangeal joint Must include carpo-metacarpal joint FINGERS DP FINGER Patient seated adjacent to the table Hand, wrist and forearm on the same plane Finger of interest in the centre of IR Phalanges parallel to the IR Vertical central beam centered to the proximal interphalangeal joint (PIP joint) FOV Soft tissue of the distal phalanx Distal 1/3 of the metacarpal Adjacent finger is included Lateral soft tissue of the fingers LATERAL FINGERS – LITTLE FINGER/RING FINGER Patient's hand is externally rotated Little finger is extended and all other fingers flexed out of the way Ring finger separate from the little finger Foam pads can be used to separate the affected finger away Ensure there is no rotation in the finger – condyles superimposed completely lateral Important to see the metacarpo-phalangeal joint Vertical primary beam centered at the proximal interphalangeal joint FOV Soft tissue distal phalanx Distal – 1/3 metacarapal Soft tissues LATERAL MIDDLE AND INDEX FINGERS From DP position, internally rotate the hand and wrist Affected finger separated from the other fingers Ensure there is no rotation in the finger – condyles superimposed completely lateral Important to see the metacarpo-phalangeal joint Vertical primary beam centered at the proximal interphalangeal joint FOV Soft tissue distal phalanx Distal – 1/3 metacarapal Soft tissues