Wrist Positioning: RADR1311 Accessible Summer 2020

Wrist Positioning Essential Projections Routine Projections PA PA Oblique Lateral Special Projection PA Ulnar Deviation Clinical Indications for Hand Fractures Dislocations Osteoporosis Osteoarthritis Osteomyelitis General Positioning Guidelines Patient Position Seated at the end of the table, facin...

Wrist Positioning Essential Projections Routine Projections PA PA Oblique Lateral Special Projection PA Ulnar Deviation Clinical Indications for Hand Fractures Dislocations Osteoporosis Osteoarthritis Osteomyelitis 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 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: Wrist Part Position Pronate hand Arch hand slightly to place wrist and carpal are in close contact with IR Forearm in contact with the IR/table Digit, hand and wrist aligned and parallel to the IR CR Perpendicular Enters at midcarpal Collimation Include carpals, 2-3” of distal radius and ulna, ½ metacarpals PA Wrist: Common Positioning Errors Leaving Fingers Extended Clenched Fist PA Wrist: Positioning Error Clenched Fist Notice the digits superimposed over the metacarpals PA Wrist: Correct Positioning Arch hand slightly to place wrist and carpal are in close contact with IR, reducing OID Evaluation Criteria PA Wrist Carpals Distal radius and ulna Proximal metacarpals Optimal density and contrast No motion Radiographic Anatomy PA Wrist Trauma Collimation Routine Collimation PA Oblique: Wrist Part Position Extend arm and pronate hand Rotate hand and wrist 45 degrees laterally Use sponge if patient is unable to hold position PA Oblique: Wrist CR Perpendicular Enters at midcarpal Collimation Include carpals, 2-3” of distal radius and ulna, ½ metacarpals Evaluation Criteria PA Oblique Hand Carpals Distal radius and ulna Proximal metacarpals Trapezium and scaphoid well visualized Optimal density and contrast No motion Did you see the errors? Notice the digits superimposed over the metacarpals Marker is not fully in collimation. Radiographic Anatomy PA Oblique Hand Lateral (lateromedial): Wrist Part Position Hand and wrist in true lateral position Forearm, wrist and hand resting on medial surface Fingers extended Radial and Ulnar styloid superimposed and perpendicular to IR Apply support to wrist with a sponge if needed for stability CR Perpendicular Enters at midcarpal Collimation Include carpals, 2-3” of distal radius and ulna, ½ metacarpals Evaluation Criteria Lateral Wrist Carpals Distal radius and ulna Proximal metacarpals Trapezium and scaphoid well visualized Optimal density and contrast No rotation No motion Optimal density and contrast Radiographic Anatomy Fan Wrist 3 View Wrist Exam – Logical Order PA PA oblique Lateral PA Scaphoid with Ulnar Deviation Part Position Position wrist in PA projections Leave fingers extended Without moving forearm, gently evert/deviate hand toward the ulna as far as patient can tolerate CR Ranges from Perpendicular to 30 degrees toward the scaphoid Lab CR = perpendicualr Enters at scaphoid Collimation Include carpals, 2-3” of distal radius and ulna, ½ metacarpals Evaluation Criteria PA Scaphoid with Ulnar Deviation Wrist Scaphoid clearly seen without superimposition Scaphoid not foreshortened Optimal density and contrast No rotation No motion Optimal density and contrast Alternative/Special Projections Wrist Radial Deviation: Wrist Part Position Hand deviated to radial side CR Perpendicular Enters at midcarpal Collimation Include carpals, 2-3” of distal radius and ulna, ½ metacarpals Tangential Carpal Tunnel (Gaynor-Hart Method) Part Position Hyperextend wrist to place long axis of hand as vertical as possible to forearm Use tape or a positioning band to aid patient in holding position Rotate hand and wrist about 10 degrees toward radial side to prevent superimposition of pisiform & hamate Ensure wrist in in contact with IR Tangential Carpal Tunnel (Gaynor-Hart Method) CR Angled 25 to 30 degrees toward long axis of hand (toward elbow) CR angle must be increased if patient cannot hyperextend wrist Enters at a point approximately 1 inch (2.5 cm) distal to the base of the third metacarpal (center of palm) Collimation Include carpals Radiographic Anatomy Tangential/Carpal Tunnel Wrist Trauma Protocol – 2 views AP (without the sponge) X-table Lateral