Digits and Hand Radiographic Positioning

This set of 100 flashcards covers radiographic positioning and procedures for the digits and hand, including standard projections, special methods (Robert, Burman, Folio, Norgaard), and evaluation criteria based on the University of Makati lecture notes.

What is the standard IR size for the radiography of the second to fifth digits?

$8 \times 10$ (lengthwise or crosswise for two or more images)

Where should the PIP joint be centered for a PA projection of the second to fifth digits?

To the center of the IR

What is the central ray (CR) for a PA projection of the second to fifth digits?

Perpendicular to the PIP joint of the affected digit

In a PA projection of the digits, what should be demonstrated to show no rotation?

Concavity of the phalangeal shafts and equal soft tissue on both sides

What joint spaces must be open in a PA projection of the second to fifth digits?

Interphalangeal and MCP joint spaces

What are the two types of lateral projections for the second to fifth digits?

Lateromedial or mediolateral

On which surface should the hand rest for a lateral projection of the second and third digits?

Lateral (radial) surface

On which surface should the hand rest for a lateral projection of the fourth and fifth digits?

Medial (ulnar) surface

What should be done with the unaffected digits during a lateral projection of a single digit?

Close the rest of the digits into a fist

Where is the central ray directed for a lateral projection of the digits?

Perpendicular to the PIP joint of the affected digit

What is a key evaluation criterion for the phalanges in a true lateral digit projection?

Anterior surfaces of the phalanges should be concave

What is the degree of rotation required for a PA oblique projection of the second to fifth digits?

45^\regular{ \text{degrees} }

What device is used to support the digits at a specific angle during a PA oblique projection?

A 45^\regular{ \text{degree} } foam wedge

Where is the central ray directed for a PA oblique projection of the digits?

Perpendicular to the PIP joint of the affected digit

What is the advantage of rotating the second digit medially for an oblique projection?

Improved recorded detail and increased ability to see certain fractures

Which projections are listed for radiographic examination of the first digit (thumb)?

AP, PA, Lateral, PA Oblique, Robert method, Burman method, and Folio method

How is the arm positioned for an AP projection of the thumb?

Internally rotated

Where is the central ray directed for an AP or PA projection of the thumb?

Perpendicular to the MCP joint

Which bone must be included in the area from the distal tip of the thumb in an AP/PA projection?

The trapezium

What is a recognized disadvantage of the PA thumb projection compared to the AP projection?

The PA projection is magnified

How is the hand placed for a lateral projection of the thumb?

In its natural arched position with the palmar surface down and fingers flexed

Where is the central ray directed for a lateral projection of the thumb?

Perpendicular to the MCP joint

Which bone surface should be concave in a true lateral thumb projection?

The anterior surface of the proximal phalanx

How is the hand positioned for a PA oblique thumb projection?

Palm resting on the IR with the thumb abducted and palmar surface in contact with the IR

In which direction should the hand be slightly deviated for a PA oblique thumb?

Ulnar deviate the hand slightly

What is the central ray for a PA oblique thumb?

Perpendicular to the MCP joint

What year did Robert first describe the radiographic projection of the first CMC joint?

1936

What structures are demonstrated by the Robert method?

The first CMC joint free of superimposition of the soft tissues of the hand

Name the two individuals who modified the Robert method central ray in 1995.

Long and Rafert

Who modified the Robert method central ray in 1988?

Lewis

What type of fracture is commonly demonstrated using the Robert method?

Bennett's fracture

In the Robert method, how is the hand positioned to avoid soft tissue obscuring the joint?

The hand is hyperextended

Where does the central ray enter for the original Robert method?

Perpendicular entering at the first CMC joint

What is the central ray angulation for the Long and Rafert modification of the Robert method?

15^\regular{ \text{degrees} } proximally to the long axis of the thumb

What is the central ray angulation for the Lewis modification of the Robert method?

$10$ to 15^\regular{ \text{degrees} } proximally along the axis of the thumb

Where is the central ray directed in the Lewis modification of the Robert method?

The first MCP joint

Which carpal bone is shown in the evaluation criteria for the Robert method?

The trapezium

What is the recommended SID for the Burman method?

$$18 \text{ inches}$$

Why is a short SID recommended for the Burman method?

To produce a magnified image with a greater field of view of the concavoconvex aspect of the joint

What is the central ray for the Burman method?

A 45^\regular{ \text{degree} } angle toward the elbow through the first CMC joint

What specific outline is shown in a Burman method image?

A magnified concavoconvex outline of the first CMC joint

What is the Folio method primarily used to diagnose?

Ulnar collateral ligament (UCL) rupture in the MCP joint of the thumb

What are the two common names for the injury diagnosed by the Folio method?

Skier's thumb or gamekeeper's thumb

What items are used to stress the thumbs in the Folio method?

A rubber band and a roll of medical tape

Where is the central ray directed for the Folio method?

Perpendicular to a point midway between both hands at the level of the MCP joint

How many thumbs are typically radiographed at once in the Folio method?

Both thumbs (bilaterally)

In the Folio method, what angulation difference suggests a UCL tear?

A 13^\regular{ \text{degree} } difference compared to the uninjured side

What is the central ray for a PA projection of the hand?

Perpendicular to the third MCP joint

What anatomy should be demonstrated distal to the radius and ulna in a PA hand?

All carpals, metacarpals, phalanges (except the thumb in PA), and inter-articulations

What type of projection of the first digit is seen in a PA hand radiograph?

PA oblique projection

When might an AP projection of the hand be used instead of PA?

When the hand cannot be extended due to injury, pathologic conditions, or dressings

What is the degree of hand obliquity for a PA oblique hand projection?

Approximately 45^\regular{ \text{degrees} }

Where is the central ray directed for a PA oblique projection of the hand?

Perpendicular to the third MCP joint

What is the result of using radiolucent material to elevate the index finger and thumb in an oblique hand?

Opens joint spaces and reduces foreshortening of the phalanges

In an oblique hand radiograph, which metacarpals show minimal overlap of their shafts?

The third, fourth, and fifth metacarpals

What is the reverse oblique projection used for?

Better demonstration of severe metacarpal deformities or fractures

Who recommended the reverse oblique projection?

Lane, Kennedy, and Kuschner

How is the hand rotated for a reverse oblique projection?

45^\regular{ \text{degrees} } medially (internally) from the palm-down position

Who recommended the tangential oblique projection?

Kallen

What is the tangential oblique projection used to demonstrate?

Metacarpal head fractures

What is the degree of MCP joint flexion in the Kallen tangential oblique projection?

$75$ to 80^\regular{ \text{degrees} }

In the tangential oblique projection, how much is the hand rotated toward the ulnar surface?

$40$ to 45^\regular{ \text{degrees} }

What are the three common lateral hand positions described?

Mediolateral or lateromedial in extension, and fan lateral position

Which lateral hand position is used for localizing foreign bodies?

Lateral in extension

What is the purpose of the fan lateral position?

Eliminates superimposition of all but the proximal phalanges

Where is the central ray directed for a lateral hand projection?

Perpendicular to the second through fifth digit MCP joint

Which modification did Lewis recommend for fifth metacarpal fractures?

Rotate the hand 5^\regular{ \text{degrees} } posteriorly from the true lateral position

What projection is used to demonstrate anterior or posterior displacement in metacarpal fractures?

Lateromedial in flexion

Where is the central ray directed for a lateromedial flexion lateral hand?

Perpendicular to the second digit MCP joint

What is the common name for the Norgaard method?

Ball-catcher's position

For what condition is the Norgaard method particularly useful in early diagnosis?

Rheumatoid arthritis

What is the recommended kilovoltage peak ($\text{kVp}$) for the Norgaard method?

$60$ to $65 \text{ kVp}$

What kind of intensifying screens are recommended for the Norgaard method?

Extremely fine-grain intensifying screens

Who recommended the Norgaard projection for fractures of the base of the fifth metacarpal?

Stapczynski

In the Norgaard method, to what degree should the hands be rotated?

45^\regular{ \text{degrees} } medially (to a half-supinate position)

How is the central ray directed for the Norgaard method?

Perpendicular to a point midway between both hands at the level of the MCP joints

What is the specific modified position for the fingers in the Norgaard method?

Fingers are cupped as if the patient were going to catch a ball

What is a key radiologic change in early rheumatoid arthritis seen on a Norgaard image?

An indistinct outline of bone at the insertion of the joint capsule dorsoradial on the proximal phalanx

What condition is always present directly below the contour defect in early RA?

Demineralization of the bone structure

Why must the entire limb be on the same plane for the Robert method?

To prevent elevation of carpal bones and closing of the first CMC joint

On a PA projection of the digit, what indicates the hand was flat on the IR?

Open MCP and IP joints

What anatomical structure must the base of the first metacarpal show in the Burman method?

A convex profile

What carpal bone is shown in concave profile in the Burman method?

The trapezium

What is the purpose of instruction for the Folio method before exposure?

Have the patient pull their thumbs apart and hold

What is the patient position for a PA hand projection?

Seated at the end of the table with the forearm resting on the table

For a PA oblique hand, which metacarpals should be separated?

The second and third metacarpals

In a lateral hand in extension, how is the first digit adjusted?

At a right angle to the palm

What does a lateral projection in flexion demonstrate besides bony structures?

Soft tissues of the hand in their normally flexed position

What does the fan lateral superimpose?

The metacarpals

What part of the proximal phalanges remains superimposed in a fan lateral?

The most proximal portions

How many images are often placed on an $8 \times 10$ IR for digits?

Two or more

What is the orientation of the IR for a PA thumb if one image is taken?

The long axis of the thumb parallel with the long axis of the IR

Which digit's MCP joint does the CR enter for a PA hand?

Third MCP joint

Where does the CR enter for the Lewis modification of the Robert method specifically?

The first MCP joint

What is the degree of CR angulation for the Lewis modification?

$10$ to 15^\regular{ \text{degrees} } proximally

What structure is the CR directed to in the tangential oblique projection?

The MCP joint of interest

What is the specific part rotation direction for the Norgaard method?

Medial rotation (half-supinate)

For a lateromedial flexion lateral, which aspect of the hand is down?

The ulnar aspect

What is the purpose of shielding in digit radiography?

Shield gonads

Who is the author of the radiographic positioning material?

John Sydney P. Del Gallego, RRT