Hand & Wrist Positioning

What is the minimum SID for PA hand projection?

40 inches

At what joint does the CR enter for a PA hand?

3rd MCP (metacarpophalangeal)

What anatomy should be demonstrated on a PA projection hand?

Entire hand, wrist, and about 1 inch of distal forearm

Which surface should be in contact with the IR with a PA hand?

Palmar surface

What is the kV range for a PA and oblique hand?

Analog: 50-55 kV

Digital: 55-60 kV

Where do you center the CR for a PA oblique hand?

3rd MCP

How many degrees do you rotate the hand and wrist for a PA oblique and in what direction?

45 degrees laterally

Do you mark to the far left or right for hand radiographs?

Far right

How should the digits be positioned in a PA oblique and fan lateral hand?

Separated and parallel to IR

In which hand radiographs are all digits in contact with the IR?

PA and PA Oblique

For a PA oblique hand, what does excessive overlap of metacarpals indicate?

Over-rotation

For a PA oblique hand, what does too much separation of metacarpals indicate?

Under-rotation

Where should CR enter for a "fan" lateral hand?

2nd MCP

Which projection is done for localization of foreign bodies & ant/post metacarpal fractures in the hand and wrist?

Lateral in extension & flexion

Where should the CR enter for the lateral hand in extension and flexion?

2nd MCP

What are the two types of lateral hand projections?

Extension & flexion

What is another name for the AP bilateral projection?

"Ballcatchers position"

What does the "ballcatchers position" evaluate?

Early evidence of RA

Where do you center the CR for a PA wrist?

Midcarpal area

Where should the top border of the light field be for a PA hand?

Midmetacarpal area

Which projection best demonstrates the carpal interspaces?

AP wrist

How is the hand rotated for a PA oblique wrist?

45 degrees laterally

In which projection is the trapezium & scaphoid well visualized?

PA oblique wrist

Which projection best demonstrates the pisiform & medial carpals?

AP oblique wrist

How should the CR be aligned for PA scaphoid with ulnar deviation?

10-15 degrees proximally, centered to scaphoid

In modified stecher method, how much is the hand elevated?

20 degrees

What is an alternative to the axial projection of the PA scaphoid with ulnar deviation?

Modified Stecher Method

Which projection is used to help determine carpal tunnel syndrome?

Carpal Canal

During a carpal canal projection, how far internally should you rotate hand and wrist to prevent superimposition of pisiform and hamate?

10 degrees

At what degrees do you angle the CR for a carpal canal projection?

25-30 degrees cephalic (to the long axis of the hand)

Where do you center the CR for a carpal canal projection?

1 inch distal to base of 3rd metacarpal(center of palm of hand)

Which projection allows for a tangential view of the dorsal aspect of the scaphoid, lunate, & triquetrum?

Carpal bridge

How should the CR be angled for a carpal bridge projection?

45 degrees to the long axis of the forearm

In which projection is the wrist hyperextended?

Carpal canal

In which projection is the wrist hyperflexed?

Carpal bridge

How should you collimate for hand and wrist exposures?

Collimate on all four sides to outer margins of hand and wrist

Which hand projection would be used to rule out fractures, dislocations, or foreign bodies of the phalanges, metacarpals, and all joints of the hands and pathologic processes, such as osteoporosis and osteoarthritis?

PA projection

Should the midshafts of metacarpals overlap when looking at a PA oblique hand radiograph?

No

When looking at a PA oblique hand radiograph, how can you tell if the fingers were parallel to the IR?

MCP and IP joints are open

What is the kV range for a "fan" lateral?

Analog: 60-65

Digital: 65-70

Which projection would you use to rule out fractures and dislocations of the phalanges, anterior/posterior displaced fractures, and dislocations of the metacarpals, as well as osteoporosis and osteoarthritis of the phalanges?

"Fan" lateral

Which position is preferred if the phalanges are the area of interest?

"Fan" lateral

Which structures should appear superimposed for a "Fan" lateral image?

-distal radius and ulna

-metacarpals

Which projection may demonstrate fractures of the base of the fifth metacarpal?

"Ball catchers position"

Where should CR enter for the ball-catcher'a position?

Midpoint between both hands at level of 5th MCP

What are the 3 routine wrist radiographs?

PA, oblique, & lateral

When doing a PA wrist radiograph, how do you get the pt's carpal bones to tough the IR?

Have them arch their hand or make a fist

What anatomy should be demonstrated on a PA oblique wrist?

-Distal radius & ulna

-Carpal bones

Which projection best demonstrates fractures or dislocations of the distal radius or ulna, specifically anteroposterior dislocations of Barton's, Colles', or Smith's fractures?

Lateral wrist

Which projection would best demonstrate osteoarthritis in the trapezium and first CMC jt?

Lateral wrist

How far should the elbow be flexed for a lateral elbow projection?

90 degrees

Which projection best demonstrates possible fractures to the medial carpal bones?

Radial deviation

Which projection best demonstrates calcification of the dorsal aspect of the carpal bones?

Carpal Bridge

If a patient has advanced RA should you increase, decrease, or leave the exposure factors the same?

Decrease

Which projection of the hand best demonstrates a possible foreign body in the palm of the hand?

Lateral in extension

A sesamoid bone is frequently found adjacent to what joint of the thumb?

MCP

Which projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the IR?

PA oblique

How much of the metacarpals should be included for PA projection of the digits?

Distal aspect of the metacarpal

Which routine projection best demonstrates the pronator fat stripe?

Lateral wrist

Which routine projections best demonstrate the scaphoid fat pad?

PA & oblique wrist