4Chapter_Positioning_Considerations_Finger_Hand_Wrist_Forearm_and_Elbow_RADR1311_Accessible_Summer2020_SC (1).pdf

Positioning Considerations Digits, Hand, Wrist, Forearm, and Elbow Room and Patient Preparation Room Prep Clean room Gather supplies Positioning aids – sponge, tongue depressor, tape, cotton swab Chair Shield Prepare the equipment Patient Communication & Preparation AIDHET Remove artifacts from anat...

Positioning Considerations Digits, Hand, Wrist, Forearm, and Elbow Room and Patient Preparation Room Prep Clean room Gather supplies Positioning aids – sponge, tongue depressor, tape, cotton swab Chair Shield Prepare the equipment Patient Communication & Preparation AIDHET Remove artifacts from anatomy of interest and/or out of the FOV ie: rings, watches, bracelets, long sleeve clothing, patient arm band Secure all patient possessions in a designated location Patient Positioning & Instructions Explain and demonstrate positions as need No breathing instructions required Ambulatory patients Seated at the end of the x-ray table Affected limb placed on the IR, resting on the tabletop Nonambulatory patients Alter positioning to maximize patient comfort Wheelchair, Stretcher + bedside table Technical Factors Smallest IR available Non-grid, table top SID = 40” FOV – varies based on the size of anatomy 4 sided collimation to area of interest Affected digit, distal aspect of metacarpal Include a digit on either side when required Exposure factors ALARA Optimal density and contrast Radiation Protection Shield EVERY patient Full lead shield is preferred ½ shield used when exam is combined with a procedure that cannot accommodate a full shield Close collimation Optimal technique Markers Correct marker, correct side Marker will identify which extremity side is being radiographed Marker should not be placed in the anatomy of interest Marker should be placed inside the FOV Close to skin line to allow for close collimation Marker placed at the most narrow part of anatomy Exam Protocol Vary based on hospital or imaging center Routine Protocols (3 views) AP or PA PA oblique Lateral Routine Protocols (2 views) AP or PA Lateral Trauma and Post Reduction Protocols (2 views) AP or PA Lateral Exposure Factors for Upper Limb Lower to medium kVp 55-70 analog 60-80 digital Short exposure time Small focal spot Adequate mAs for sufficient density Increase exposure with cast 3 Positioning Principles for Correct Centering Part should be parallel to IR Ideally long axis of anatomy to the long axis of the IR CR should be 90 degrees or perpendicular to the part and IR, unless a specific CR angle is indicated CR should be directed to correct centering point These principles will help avoid shape and size distortion and demonstrate open joint spaces Pediatric Considerations Friendly & happy Build a quick rapport with the child Short exposure time to help reduce motion Immobilization devices Geriatric Consideration Clear and concise instructions May consider adaptation projections due to patient’s limited ability Immobilization Destructive pathologies - Possible reduction in technique ie: Osteoporosis – bones become brittle from loss of tissue Be gentle when positioning the patient so that you do not bruise or tear the skin Trauma Considerations & Protocol Calm demeanor Gentle positioning Good communication Patient reassurance Accurate Imaging Trauma Considerations & Protocol Radiographs can be taken in the radiology department or in the patient’s room with them in the stretcher 2 view protocol – 2 images 90 degrees from each other Common Hand Fractures Bennett’s Fracture A fracture (fx) at the base of the first metacarpal Often the result of a fist fight Common Hand Fractures Boxer’s Fracture A fracture (fx) of the 5th metacarpal Often caused by direct force to a closed fist Common Wrist Fracture Colles’ Fracture of the distal radius and ulnar styloid with posterior displacement More common in older adults who fall on an outstretched hand (foosh) Colles’ Fracture – Do you see it? Colles’ Fracture Common Wrist Fracture Smith’s Fracture of the distal radius and ulnar styloid with anterior displacement Often referred to as a reverse Colles' Smith’s Fracture – Do you see it? Smith’s Fracture Common Wrist Fracture Torus or Buckle incomplete fractures impacted fracture with a bulging of the periosteum Most common fracture of the distal radius in young children Buckle Fracture – Do you see it? Buckle Fracture Cast Technique Conversions Small to medium dry plaster cast: 5-7 kV increase Large or wet plaster cast: 8-10 kV increase Fiberglass cast: 3-4 kV increase Dislocated Proximal Antebrachial Fracture