Merrills +Digital workbook

on which hand surface should the hand be rested when performing the lateral projection image of the fourth or fifth digit.?

medial (ulnar)

for lateral projections of the third or fourth digits, why should the affected digit be positioned so that its long axis is parallel with the IR?

To demonstrate the bones and joints accurately.

how many degrees from the PA position should a finger be rotated for PA oblique projection?

45 degrees

for the PA oblique projection of the second digit, what is the advantage of rotating the second digit medially compared with the advantage of rotating the digit laterally.

places the finger closer to the IR and improves its recorded detail, because there is less OID.

for the PA oblique projection of the third digit, what is the advantage of placing the patients fingers on a 45 degree foam wedge.

the wedge supports the digits in a position parallel with the plane of the IR so that the interphalangeal joint spaces will be open.

what projection of the thumb may be substituted if the patient is unable to maintain the required position for the AP projection.

PA

what is the disadvantage of using the substitute projection mentioned above?

increased OID and magnification, resulting in a loss of recorded detail.

all thumb images should include the _____________ carpal within the collimated field

trapezium

which two groups of joints of the hand and digits should be demonstrated open on the image of the PA projection of the hand?

metacarpophalangeal and carpophalangeal

which projection of the hand should demonstrate superimposed phalanges

lateral in extension

which group of bones is of primary interest in a fan lateral hand x ray

the phalanges

what is being observed in a lateral extension hand

foreign objects and displacements of fractures in the metacarpals.

flexing the fingers for the PA projection of the wrist decreases _____________ and increases _____________.

OID,

spatial resolution

for the lateral projection of the wrist, how should the elbow be positioned?

flexed 90 degrees

for the lateral projection of the wrist, which surface of the wrist should be in contact with the IR?

medial

for a lateral wrist the carpals and the metacarpals are all superimposed what other bones are superimposed for this projection

the radius and ulna

how much should the wrist be rotated for the PA oblique projection

45 degrees

for the PA oblique projection, when the scaphoid is of primary interest, the scaphoid can sometimes be better demonstrated if the patient deviates the hand and wrist toward the

ulna

which bone is of primary interest when doing a PA wrist with ulnar deviation.

scaphoid

to delineate a fracture line better with a PA projection of the wrist in ulnar deviation, how many degrees and in which direction may the central ray be directed.

10 to 15 degrees proximally or distally.

which carpal bone is of primary interest with this position?

scaphoid

how far from horizontal should the IR be inclined toward the elbow?

20 degrees

when using a wedge to elevate the IR, how should the central ray be directed to ward the wrist?

perpendicularly.

if no wedge is used to angel the IR, how should the central ray be directed toward the wrist.

at a 20 degree angle toward the elbow.

list the essential projections for the carpal canal, and describe the positioning steps used for each, as follows:

with reference to the plane of the IR, how should the long axis of the hand be positioned?

vertical

with reference to the long axis of the hand, how much should the central ray be angled?

25-30 degrees.

for the AP projection of the forearm, how should the elbow be positioned?

fully extended

if the hand is pronated for the AP projection of the forearm, what will the image demonstrate?

radius and ulna crossed over each other

for the lateral projection of the forearm, how should the elbow be positioned?

flexed 90 degrees

True or False

the hand should be pronated for the lateral projection

false, the hand should be in lateral position with the thumb side up.

For the AP projection of the elbow, why should the hand be positioned with the palm facing up?

to prevent rotation of the bones of the forearm.

For the lateral projection of the elbow, how should the hand be adjusted?

lateral with the thumb side up.

How many degrees of flexion of the elbow are necessary for the lateral projection

90 degrees

how should the humeral epicondyles appear in the image of the lateral projections of the elbow?

superimposed

how much medial rotation of the elbow is needed to position for AP oblique projections?

45 degrees

Which AP oblique projection positioning movement (medial rotation or lateral rotation) requires the hand to be pronated?

medial rotation.

For the AP distal humerus projection (partially flexed elbow) what part of the upper extremity should be parallel and in contact with the IR.

distal humerus

in the AP distal humerus projection (partially flexed elbow image, what part of the upper extremity will appear greatly foreshortened in the image?

proximal radius and ulna

for the AP proximal forearm projection (partially flexed elbow) image, what part of the upper extremity will appear greatly foreshortened in the image.

distal humerus

for the AP proximal forearm projection (partially flexed elbow) what part of the upper extremity should be parallel and in contact with the IR.

radius and ulna

the humerus can be examined with the patient in either the ___________ or _____________ position.

supine or upright

how should the hand be placed for the AP projection of the humerus

supinated

for the AP projection with the patient supine, why is it sometimes necessary to elevate the unaffected shoulder on a firm support?

to place the affected arm in contact with the IR or table

How do you known the humerus was correctly positioned for the AP projection.

1. epicondyles are maximally seen and not rotated.

2. humeral head and greater tubercle are both seen in profile.

3. outline of the lesser tubercle is located between the humeral head and the greater tubercle.

How does the divergence of the beam affect the demonstration of the elbow joint in the lateral projection image?

the elbow joint may appear partially closed

the superimposition of what structures confirm that a true lateral image was produced?

humeral epicondyles.

For the lateral projection with the patient in the lateral recumbent position and an IR placed between the arm and the thorax, which portion of the humerus is missing from the image?

The proximal portion (including the humeral head) the lesser tubercle and the greater tubercle.

Where is the centering point for the central ray for the AP projection of the thumb

First MCP joint

Which projection of the thumb requires the patient to rotate the hand into extreme internal rotation?

AP projection

where is the centering point for the central ray for the PA projection of the third digit of the hand?

proximal interphalangeal joint of the third digit.

Explain why the hand should be rotated into extreme internal rotation until the lateral surface of the index finger (second digit) is in contact with the IR, rather than positioning that finger with its medial (ulnar) surface toward the IR, for the lateral projection of the index finger.

to minimize OID

Name the four bones that should be completely seen in the image of the AP projection of the thumb.

Dital and proximal phalanges of the thumb, the first metacarpal, and the trapezium carpal.

Excluding the thumb, name the two digits of the hand that should rest directly on the IR for the lateral projection of individual digits.

second (index finger) and fifth (little finger)

describe how and where the central ray should be directly for the PA projection of the hand.

perpendicular to the third metacarpophalangeal joint

what surface of the hand should be in contact with the IR for the PA projection of the hand?

anterior (palmar or ventral)

from the prone position, how many degrees should the hand be rotated for the PA oblique projection? for the lateral projection?

45 degrees

90 degrees

for the best demonstration of all digits, how should the thumb and index finger be positioned with respect to the IR for the PA oblique projection of the hand?

elevated from the IR and parallel with the plane of the IR.

Which bones of the hand are of primary interest if the fingertips are allowed to rest on the IR for the PA oblique projection of the hand?

metacarpals

what group of bones of the hand is best demonstrated with the fan lateral projection of the hand?

phalanges

For the Pa projection of the wrist, why should the hand be slightly arched by flexing the fingers?

to place the anterior surface of the wrist in contact with the IR

Describe how and where the central ray should be directed for the PA projection of the wrist.

perpendicular to the midcarpal area.

in addition to the eight carpal bones, what other bones should be seen in the image of the PA projection of the wrist.

distal radius, distal ulna, and proximal metacarpals

How many degrees from the prone position should the wrist be rotated for the PA oblique projection of the wrist

45 degrees

Which projection of the wrist requires the superimposition of the radial and ulnar styloid process?

lateral

which surface of the wrist should be in contact with the IR for the lateral projection of the wrist.

ulnar (medial)

In which projection of the wrist should the metacapals appear superimposed in the image.

lateral

For the PA oblique projection of the wrist which side of the wrist should be elevated from the IR

lateral (radial)

What two carpal bones on the lateral side of the wrist should be clearly demonstrated in the image of the PA oblique projection of the wrist.

scaphoid and trapezium

What carpal bone is best demonstrated with the ulnar deviation position of the wrist.

scaphoid

How does the placement of the IR for the PA axial projection of the scaphoid (stetcher method) differ from the IR placement for PA projections of the wrist.

The IR is inclined toward the elbow at an angle of 20 degrees.

How does the forearm appear if the hand is pronated when performing the AP projection of the forearm?

The radius crosses over the ulna, which results in an oblique image of the forearm.

to prevent radial crossover, how should the hand be positioned for the AP projection of the forearm?

supinated

what structure on the distal end of the ulna should be seen in the image of the AP projection of the forearm.

styloid process

how should the humeral epicondyles appear in the image of the lateral projection of the forearm

superimposed over each other.

How should the hand be positioned for the lateral projection of the forearm.

true lateral thumb side up

what would most likely cause the bones of the forearm to appear rotated in the image of the Ap projection of the elbow.

the hand was not supinated.

why should the patient lean laterally for the AP projection of the elbow?

to help adjust the humeral epicondyles and the anterior surface of the forearm parallel with the plane of the IR

what structures of the proximal radius are seen slightly superimposed over the proximal ulna in the AP projection of the elbow

head, neck and tuberosity

How should the hand be positioned for the lateral projection of the elbow, explain why

True lateral with the thumb side up

(to keep the radial head from rotating from its lateral position)

what projection and position of the elbow best demonstrates the coronoid process in profile?

ap oblique projection in medial rotation position

How should the forearm and elbow be rotated for the best demonstration of the radial head free of super imposition from the ulna.

laterally (externally)

How many AP projections are necessary for the best demonstration of the elbow without distortion when an injury prevents full extension of the elbow.

two

Explain how the humerus and the forearm are positioned differently for each AP projection of the elbow when the elbow is in partial flexion.

for one exposure, the humerus is parallel and in contact with the IR: for the other exposure, the forearm is parallel and in contact with the IR

What is CR orientation for the axiolateral projection of the elbow (coyle method) to demonstrate the coronoid process?

angled degrees away from the shoulder

what humeral process should be palpated to ensure proper alignment when the humerus is being positioned?

epicondyles

Which projection for the humerus requires the patients hand to be supinated?

AP

Describe best how to position the IR for lateral projection of the humerus if the AP projection image clearly shows a fracture 2 inches 5cm superior to the elbow.

place the IR between the humerus and the thorax``

in a digital radiographic image of the hand in the PA oblique projection, the hand should be placed at an angle of ________ to the plane of the image receptor.

45 degrees.

to insure proper positiong of the elbow during a digital radiographic image taken in the lateral projection, which factor does NOT need to be meet

the forearm and humerus are fully extended.

in a digital radiographic image of the carpal bones obtained in the PA projection the fingers are flexed in order to

decrease the part-to-image receptor distance

when bilateral hands or wrists are requested, it is important to radiograph each side separately to prevent.

the distortion of the joint spaces.

a digital radiographic image of the wrist is obtained in the ap oblique projection with a medial rotation of about 45 degrees. This is normally used to demonstrate:

the lunate and pisiform bones.

to avoid crossing the radius and ulna during the digital radiographic evaluation of the forearm in the AP projection, the hand should be:

fully supinated

which of the following digital radiographic projections will best demonstrate the carpal interspaces.

the AP projection

a digital radiographic image of the finger is obtained in the PA projection. The central ray should be directed perpendicular to the:

proximal interphalangeal joint

a bony outgrowth at the base of the third metacarpocarpal joint (carpe bossu) is best demonstrated in the :

PA projection of the wrist in acute palmar flexion

which of the following digital radiographic projections is most commonly used to provide a profile image of the olecranon process?

a lateral projection of the elbow

when performing a digital radiographic image of the hand in the PA projection, which surface should be in contact with the image receptor?

palmar surface

During digital radiographic evaluation of the hand for the localization of foreign bodies, the hand should be placed in the:

lateral position with the fingers extended