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PA
PA
Pathology demonstrated:
Fractures, dislocations, or foreign bodies
of the phalanges, metacarpals, and all joints of the hand
•Pathologic processes such as osteoporo
sis and osteoarthritis
IR size : 24 / 30
Lengthwise / tabletop
SID : 100cm
Shield radiosensitive tissue outside region of interest
Patient position :
Seat pt at end of table
Elbow flexed 90°
Hand and for arm resting on table
Part position: Pronat hand with palmar surface in correct with it
Align long axis (hand , forearm) with long axis of ir
CR : CR perpendicular to IR, directed to third MCP joint
Collimation : Collimat on for sides to outer margins Hand and wrist
criteria :
Anatomy Demonstrated: • PA projection of entire hand and wrist and about 2.5 cm (1 inch) of distal forearm are visible. • PA projection of hand demonstrates oblique view of the thumb.
Position: • Long axis of hand and wrist aligned with long axis of IR. • No rotation of hand, as evidenced by symmetric appearance of both sides or concavities of shafts of metacarpals and phalanges of digits 2 through 5 and the appearance of equal amounts of soft tissue on each side of phalanges 2 through 5. • Digits should be separated slightly with soft tissues not overlapping. • MCP and IP joints should appear open, indicating correct CR location and that hand was fully pronated. • CR and center of collimation field should be to third MCP joint.
Exposure: • Optimal density (brightness) and contrast with no motion demonstrate soft tissue margins and clear, sharp bony trabecular markings
PA Oblique
PA Oblique
Pathology demonstrated:
Fractures and dislocations of the phalan
ges, metacarpals, and all joints of the hand
• Pathologic processes, such as osteoporo
sis and osteoarthritis
IR size : 24 / 30
Lengthwise / tabletop
SID : 100cm
Shield radiosensitive tissue outside region of interest
Patient position :
Seat pt at end of table
Elbow flexed 90°
Hand and for arm resting on table
Part position :
Pronat hand with palmar surface in correct with it
Align long axis (hand , forearm) with long axis of ir
CR : CR perpendicular to IR, directed to third MCP joint
Collimation : Collimat on for sides to outer margins Hand and wrist
criteria:
Anatomy Demonstrated: • PA projection of entire hand and wrist and about 2.5 cm (1 inch) of distal forearm are visible. • PA projection of hand demonstrates oblique view of the thumb.
Position: • Long axis of hand and wrist aligned with long axis of IR. • No rotation of hand, as evidenced by symmetric appearance of both sides or concavities of shafts of metacarpals and phalanges of digits 2 through 5 and the appearance of equal amounts of soft tissue on each side of phalanges 2 through 5. • Digits should be separated slightly with soft tissues not overlapping. • MCP and IP joints should appear open, indicating correct CR location and that hand was fully pronated. • CR and center of collimation field should be to third MCP joint.
Exposure: • Optimal density (brightness) and contrast with no motion demonstrate soft tissue margins and clear, sharp bony trabecular markings
Fan lateral - lateromedial
Fan lateral - lateromedial
Pathology demonstrated:
Fractures and dislocations of the phalan
ges, anterior/posterior displaced fractures, and dislocations of the metacarpals • Pathologic processes, such as osteoporo
sis and osteoarthritis especially in the phalanges
IR size : 24/30
Lengthwise / tabletop
SID : 100cm
Shield radiosensitive tissues outside region of interest
Patient position :
Seat patient at end of table with elbow flexed about 90° and hand and forearm resting on table
Part position :
Align long axis of hand with long axis of IR. • Rotate hand and wrist into lateral position with thumb side up. • Spread fingers and thumb into a “fan” position, and support
each digit on radiolucent block as shown. Ensure that all digits, including the thumb, are separated and parallel to IR and that the metacarpals are not rotated but remain in a true lateral position
CR : Second MCP joint
Collimation : Collimate on four sides to hand and wrist
criteria :
Anatomy Demonstrated: • Entire hand and wrist and about 2.5 cm (1 inch) of distal forearm are visible.
Position: • Long axis of hand and wrist should be aligned with long axis of IR. • Fingers should appear equally separated, with phalanges in the lateral position and joint spaces open, indicating that fingers were parallel to IR. • Thumb should appear in slightly oblique position
completely free of superimposition, with joint spaces open. • Hand and wrist should be in a true lateral position, as evidenced by the following: distal radius and ulna are superimposed; metacarpals are superimposed. • CR and center of collimation field should be at second MCP joint. Exposure: • Optimal density (brightness) and contrast with no motion demonstrate soft tissue margins and clear, sharp bony trabecular markings. • Outlines of individual metacarpals demonstrated are superimposed. • Midphalanges and distal phalanges of thumb and fingers should appear sharp but may be slightly overexposed
Lateral in extension and flexion - lateromedial
Lateral in extension and flexion - lateromedial
Pathology demonstrated:
The lateral in either extension or flexion is
an alternative to the fan lateral for localization of foreign bodies of the hand and fingers; it also demonstrates anterior or posterior displaced fractures of the metacarpals.
The lateral in a natural flexed position may be less painful for the patient
IR size : 24 /30
Lengthwise / tabletop
SID : 100cm
Shield radiosensitive tissues outside region of interest
Patient position : Seat patient at end of table with elbow flexed about 90° and hand and forearm resting on table
Part position :
Rotate hand and wrist, with thumb side up, into true lateral position, with second to fifth MCP joints centered to IR and CR. • Lateral in extension: Extend fingers and thumb, and support
against a radiolucent support block. Ensure that all fingers and metacarpals are superimposed directly for true lateral position. • Lateral in flexion: Flex fingers into a natural flexed position, with
thumb lightly touching the first finger; maintain true lateral position
CR : second to fifth MCP joints
Collimation : Collimate to outer margins of hand and wrist
criteria :
Anatomy Demonstrated: • Entire hand and wrist and about 2.5 cm (1 inch) of distal forearm are visible. • Thumb should appear in slightly oblique position and free of superimposition with joint spaces open.
Position: • Long axis of the hand and the wrist is aligned with long axis of the IR. • Hand and wrist should be in true lateral position, as evidenced by the following: distal radius and ulna are superimposed; metacarpals and phalanges are superimposed. • CR and center of collimation field should be at second to fifth MCP joints.
Exposure: • Optimal density (brightness) and contrast with no motion demonstrate soft tissue margins and clear, sharp bony trabecular markings. • Margins of individual metacarpals and phalanges are visible but mostly superimposed
AP Oblique Bilateral
AP Oblique Bilateral
Pathology demonstrated :
Performed commonly to evaluate for
early evidence of rheumatoid arthritis at the second through fifth proximal phalanges and MCP joints
• May demonstrate fractures of the base of the fifth metacarpal
Both hands generally are taken with one exposure for bony structure comparison of both hands. A common term for this projection is the “ball-catcher’s position.”
IR size : 30/24
Crosswise / tabletop
SID : 100cm
Shield radiosensitive tissues outside region of interest
Patient position : Seat patient at end of table with both hands extended
part position :
Supinate hands and place medial aspect of both hands together
at center of IR. • From this position, internally rotate hands 45° and support
posterior aspect of hands on 45° radiolucent blocks (Fig. 4-83). • Extend fingers and ensure that they are relaxed, slightly sepa
rated but parallel to IR. • Abduct both thumbs to avoid superimposition
CR : CR perpendicular, directed to midpoint between both hands at
level of fifth MCP joints
Collimation : Collimate to outer margins of hand and wrist
criteria:
Anatomy Demonstrated: • Both hands from the carpal area to the tips of digits in 45° oblique position are visible. Position: • 45° oblique as evidenced by the following: midshafts of second through fifth metacarpals and base of phalanges should not overlap; MCP joints should be open; no superimposition of the thumb and second digit should occur. • CR and center of collimation field to midway between both hands at level of fifth MCP joints.
Exposure: • Optimal density (brightness) and contrast with no motion are demonstrated by clear, sharp bony trabecular markings and joint space margins of MCP joints
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