WRIST

PA

Pathology demonstrated:

FX of distal radius and ulna

Isolated fx of radial or ulnar styloid proccesses

Arthritis

IR size : 18*24cm

SID: 100cm

Crosswise / tabletop

Place lead sheild over pt’s lap

Patient position :

Set pt of end table , with elbow flexed 90° and hand and forearm resting on table palm down .

Drop the shoulder so the shoulder, elbow, and wrist aro on same horizontal line

Part position:

Hand and wrist align of long axis of lR

Hand pronate , close contact ( wrist,carpals)

CR : Direct Midcarpal area

Collimation : 4 side Include distal radius and ulna and MC area

criteria :

Structure shown : midmetacarpals,proximal metacarpals,carpals,distal radius,ulna,associated joints,

Position : hand , wrist long axis of IR and forearm,

True AP —> 1- equal concavity shapes are on each side shaft of the proximal metacarpals

2-separation of the distal radius and ulna is present.

lateral

Pathology demonstrated : Fx of distal radius and ulna

Isolated fx of radial or ulnar styloid processes

Arthritis.osteomyelitis

IR size : 18*24

crosswise / tabletop

SID : 100cm

Place lead shield over pt’s lap

Patient position : Set pt at end of table , with both hands extended and pronated on IR

Part position : Align and center long axis of hand and wrist to portion of IR being exposed

From pronated position, rotate wrist and hand laterally 45°

CR : Direct midcarpal area

Collimation : 4sides Include distal radius and ulna MC area

criteria :

Structure shown : distal radius and ulna , carpals and at least to mid metacarpal area are visible.trapezium and scaphoid should be well visualized,with only slight superimpostion of other carpals on their medial aspect

Position: long axis of hand and wrist ,forearm should be aligned with IR

True—> evident by ulnar head being partially superimposed by distal radius

2- the proximal third , fourth , fifth metacarpals should appear mostly superimposed

PA OBLIQUE WRIST

Pathology demonstrated: Fx of distal radius and ulna, Isolated fx of radial or ulnar styloid processes , arthirts

IR size : 18*24 cm

Crosswise / tabletop

SID : 100cm

Place lead shield over pt’s lap

Patient position : Set pt at end table , with both hands extended and pronated on IR

Part position :

Hand , wrist align and center long axis of IR

From pronated position,rotate wrist and hand laterally 45°.

For stabillety, place a 45° support under thumb side of hand , or partially flex fingers to arch hand so that figertips rest slightly on cassette .

CR : Direct midcarpal area

Collimation : 4 side from wrist Include distal radius and ulna and MC

criteria:

Structure shown: distal radius , ulna ,carpals , and at least to midmetacarpal area . The trapezium and scaphoid should be well visualized. Other carpals slightly superimpostions

Position: long axis of the hand , wrist , forearm should be aligned with IR

True —> wrist should be evident by ulnar head being paritally superimposed by distal radius

2- proximal third ,fourth,fifth metacarpals should appear mostly superimposed.

PA Scaphoid ( Ulnar deviation )

Pathology demonstrated : fx of scaphoid

Warning: if patient has possible wrist trauma, don’t

attempt this position before routine wrist series

IR size : 18*24

Crosswise / tabletop

SID : 100 cm

place lead shield over patient’s lap

Patient position : seat pt at end of table with wrist and hand on

cassette, palm down, and shoulder, elbow, and wrist on same horizontal plane

Part position :

Position wrist as for a PA projection – palm down and hand and wrist

aligned to center of long axis of portion of IR being exposed, with scaphoid centered to CR Without moving forearm, gently evert hand (move toward ulnar side)

as far as patient can tolerate without lifting or rotating distal forearm

CR : Angle CR 10o to 15o proximally, along long axis of forearm and toward

elbow. (CR should be ┴ to long axis of scaphoid)

Center CR to scaphoid. (locate scaphoid at a point 2 cm or ¾ inch distal

and medial to radial styloid process)

Collimation : collimate on 4 sides to carpal region

criteria :

Structure shown : Distal radius and uina, carpals, and proxi-

a metacarpals are visible, • Scaphoid should be demon-ated clearly without foreshortening, with adjacent carpal in-aspaces open (evidence of CR angle).

Position : Long axis of wrist and forearm should be aligned with side border of IR. • Ulnar deviation should be evident by the angle of the long axis of the metacarpals to that of the radius and ulna. - No rotation of wrist is evidenced by appearance of distal radius and ulna, with minimal superimposition of distal radioulnar joint.

Radial deviation

Pathology demonstrated :

Warning: if patient has possible wrist trauma, don’t

attempt this position before routine wrist series

has been completed to rule out possible #’s of

distal forearm and/or wrist

Pathology demonstrated

Fx of carpals on the ulnar side, especially the

lunate, triquetrum, pisiform, and hamate

IR size: 18*24

crosswise / tabletop

SID : 100 cm

place lead shield over patient’s lap

patient position : seat pt at end of table with

elbow flexed 90o. Place wrist and hand on

cassette, palm down. Shoulder, elbow, and wrist should be on same horizontal plane

part position :

Position wrist as for PA projection—palm down with wrist and

hand aligned with center of long axis of IR.

Without moving forearm, gently invert the hand (move medially

toward thumb side) as far as patient can tolerate without lifting

or rotating distal forearm

CR : CR ┴ to IR and centered to midcarpal area

COLIIMATION : collimate on 4 sides to carpal region

criteria :

Structures Shown: • The distal radius and ulna, the carpals, and the proximal metacarpals are visible. • The carpals are visi-ble, with adjacent interspaces more open on the medial (ul-nar) side of the wrist.

Position: • The long axis of forearm is aligned to the side border of the IR - Extreme radial deviation is evidenced by the angle of the long axis of the metacarpals to that of the radius and ulna and the space between the triquetrum/pisiform and the styloid process of the radius. - No rotation of the wrist is evidenced by the appearance of the distal radius and ulna.

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