Hand X-Ray Lecture 3 PDF

HAND, FINGERS and THUMB Minimum of two projections on any region- long bones Lower Leg- Tibia and Fibula AP and Lateral Minimum of two projections on any region Radiographic examination: Radiographer role Checking patient’s identity Positioning of body part and al...

HAND, FINGERS and THUMB Minimum of two projections on any region- long bones Lower Leg- Tibia and Fibula AP and Lateral Minimum of two projections on any region Radiographic examination: Radiographer role Checking patient’s identity Positioning of body part and alignment with the Image Receptor and Central Ray Use of radiation protection measures Selection of exposure factors Patient instructions (no motion, weight bearing etc) Processing of the image Introduction and Identification Check Introduce yourself and your role “Hi ___, my name is Peter, and I will be your radiographer today.” Check the patient details align with the form: Name “Can you please tell me your full name?” Date of Birth “What is your date of birth?” Region of Interest and side “What are we x-raying today” Some sites may require more details to be checked such as MRN, Address, Referring Doctor etc Explain the examination about to happen “ I’ll need to take a few different views of your ankle today to see if we can find a reason why you are experiencing pain” Positioning and Imaging It is good to have knowledge of what position the patient can achieve (Range of movement/ ROM) Patient instructions- “Stay still in that position while I take the x-ray” Technical Parameters These are the elements of the examination that we use as radiographers to acquire the image. There will be different parameters for each body region, This includes: Positioning of patient and tube- FFD, tube angle Exposure (kVp and mAs) Collimation Centring Positioning of patient and tube- FFD, tube angle The position of the patient and the tube is important for each anatomical area to be displayed adequately. FFD- Film-Focus-Distance. The distance from the x-ray tube to the film. This is specified for each view to keep dose constant. Exposure Determined as appropriate by the radiographer Will change when imaging smaller or larger than the average (adult) patient Paediatric patients will receive lower exposure Collimation The area that will be included in a radiograph The shows the area that will be exposed by radiation Lead shutters will open or close the collimation Centring Centring is where we position the middle of the beam (central ray or CR) This is the straightest part of the divergent beam and should be aimed at the anatomy of interest Often the central ray will be centred on joint spaces to enable optimal viewing  Image Evaluation for Quality Images taken are evaluated against a set of criteria This ensures the image can be repeated and that pathology will be adequately shown This semester you will become very familiar with the evaluation process- it is called “critiquing” In each lecture a series of evaluation criteria for each projection will be listed ► Thumb – distal and proximal phalanx, sesamoid ► Phalanges 2-5 – distal, middle & proximal phalanx ► Metacarpals 1-5 ► Carpals 1-8 ► Distal Radius & Ulna ANATOMY: JOINTS ► DIP = Distal Inter Phalangeal joint ► PIP = Proximal Inter Phalangeal joint ► Thumb Inter Phalangeal (IP) joint ► MCP = Metacarpophalangeal joint ► CMC = Carpometacarpal joint THE CARPAL BONES: ► Scaphoid ► Lunate ► Triquetrum ► Pisiform ► Hamate ► Capitate ► Trapezoid ► Trapezium A: Trapezium bone B: Scaphoid bone C: Pisiform bone D: Hamate bone E: Triquetral bone Mnemonic to remember the carpal bones: F: Lunate bone So Long To Pinky Here Comes The Thumb INDICATIONS: ► Trauma ► Congenital abnormalities ► Pain ► Metabolic Diseases such as arthritis ► Lumps ► Bruising ► Foreign Body ► Loss of function ► Swelling ► Deformity ► Infections ► Reduced Range of ► Cuts Movement (ROM) ► Bone age ► Follow up from previous injury  BONE AGE: ► Chronological age ► Skeletal age ► Dates of appearance ► Dates of fusion ► Growth plates ► Taken of left hand or non dominant hand https://link.springer.com/article/10.1007/s13534-020-00151-y  EVALUATION CRITERIA PA FINGER: ► Regional anatomy included – tip of digit to distal metacarpal, including soft tissue ► Digit free of superimposition ► No rotation – symmetry ► Metacarpophalangeal and interphalangeal joints open ► Density and contrast optimal to visualise cortical outline and bony trabecular PA of 4th finger pattern. Soft tissue adequately visualised. Radiopaedia.org PATHOLOGY FRACTURES Fractures are often written as # Result from mechanical forces that exceed the bone’s ability to withstand them Fractures are described by: Type Complete- Transverse, Oblique, Spiral, Comminuted Incomplete- Bowing, Buckle, Greenstick Location Which bone is fractured Which part of the bone is affected Displacement Angulation of distal part relative to proximal part Complications Compound fracture, joint involvement TYPES OF BONE FRACTURES FRACTURES OF THE PHALANGES: ► Distal phalanx fracture ► Salter Harris fracture ► Shaft fracture  BOXERS FRACTURE: ► 4th or 5th neck fracture ► Anterior angulation of head ► Shortening & rotation of distal fragment SHAFT FRACTURE: ► Usually 3rd or 4th metacarpal ► Dorsal angulation AVULSION FRACTURE: ► Fragment of bone pulled off by tendon ► Mallet finger deformity- dorsal aspect/extensor Compound fracture  SALTER HARRIS FRACTURE: ► Fracture through the growth plate ► Different levels of fractures https://www.uptodate.com/contents/image?imageKey=EM%2F54582&topicKey=EM%2F6547&source=outline_link BASE OF FIRST METACARPAL FRACTURE (THUMB): ► Bennett Fracture ► # dislocation ► Shaft displaced dorso-lateral displacement due to tendon tension ► Intraarticular # http://www.wikiradiography.net/page/File:Q2hMIbN1la4qZtyRdRsN2Q124907.jpeg https://radiopaedia.org/articles/bennett-fracture DISLOCATIONS: ► Dorsal dislocation most common ► Reduced before/ after x-ray ► Could have associated avulsion fracture ► Described: distal part relative to the proximal part eg. The below are both posterior or dorsal dislocations of PIPJ’s  FOREIGN BODY LOCALISATION: ► Type of object/material ► Glass and metal seen more easily than less dense substances such as wood ► Mark entrance site if object isn’t exterior to skin ► Two projections minimum ► Tangential projections FOLLOW UP IMAGING: Open Reduction Internal Fixation (ORIF)  FOLLOW UP IMAGING: K-WIRES Used as a temporary measure of stabilizing fractures Paediatrics- temporary measure as to not affect bone growth Part of the wire protrudes from the patient’s skin- easy removal in outpatient clinic Wires covered by padded dressing and partial cast REFERENCES: ► Bontrager, K. L. (2005) Textbook of Radiographic Positioning and Related Anatomy. (6th edn.) St Louis: Mosby. ► Eisenberg, R. L. (2003) Comprehensive Radiographic Pathology (3rd edn.) St Louis: Mosby. ► McQuillen-Martensen, K. (1996) Radiographic Critique. Philadelphia : W.B. Saunders. ► Weir, J. & Abrahams, S. P. (2003) Imaging Atlas of Human Anatomy (3rd ed). London: Mosby. ► http://www.wikiradiography.net ► http://www.spineuniverse.com/displayarticle.php/article1023.html ► https://radiopaedia.org ► https://www.radiologymasterclass.co.uk/ REFERENCES: ► Bontrager, K. L. (2005) Textbook of Radiographic Positioning and Related Anatomy. (6th edn.) St Louis: Mosby. ► Eisenberg, R. L. (2003) Comprehensive Radiographic Pathology (3rd edn.) St Louis: Mosby. ► McQuillen-Martensen, K. (1996) Radiographic Critique. Philadelphia : W.B. Saunders. ► Weir, J. & Abrahams, S. P. (2003) Imaging Atlas of Human Anatomy (3rd ed). London: Mosby. ► http://www.wikiradiography.net ► http://www.spineuniverse.com/displayarticle.php/article1023.html ► https://radiopaedia.org ► https://www.radiologymasterclass.co.uk/