Digits and Hand Radiographic Positioning Flashcards

A comprehensive set of 100 question-and-answer flashcards covering radiographic positioning for the digits and hand, including specialized methods like Robert, Burman, Folio, and Norgaard.

Who is the identified educator for the 'Digits and Hand Radiographic Positioning' lecture?

John Sydney P. Del Gallego, RRT

What is the recommended IR size for images of the second to fifth digits?

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

What is the primary patient position for second to fifth digit radiography?

Seated at the end of the radiographic table

For a PA Projection of the second to fifth digit, where should the PIP joint be centered?

Center the PIP joint to the IR

Where is the Central Ray directed for a PA Projection of the second to fifth digit?

Perpendicular to the PIP joint of the affected digit

What evaluation criteria indicates no rotation in a PA Projection of a digit?

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

In a PA Projection of the second to fifth digit, what anatomy must be included from the fingertip?

The entire digit from the fingertip to the distal portion of the adjoining metacarpal

What joint spaces should be open without overlap in a PA digit projection?

Interphalangeal and MCP joint spaces

How should the adjacent digits be placed during a Lateral Projection (Lateromedial or Mediolateral) of a single digit?

Close the rest of the digits into a fist

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

Lateral/radial surface

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

Medial/ulnar surface

What tools can be used to immobilize the extended digit for a lateral projection?

Strip of adhesive tape or a tongue depressor

Where is the Central Ray directed for a Lateral Projection of the second to fifth digit?

Perpendicular to the PIP joint of the affected digit

What feature of the phalanges is clearly demonstrated in a true lateral digit position?

Concave anterior surfaces of the phalanges

What is the standard degree of rotation for a PA Oblique Projection (Lateral Rotation) of the digit?

$$45^{\circ}$$

What type of support is used to maintain the digit at a $45^{\circ}$ angle for an oblique projection?

$45^{\circ}$ foam wedge

What is the common outcome of rotating the second digit medially from the prone position for an oblique projection?

Improved recorded detail and increased ability to see certain fractures

In a PA Oblique Projection of the second to fifth digit, what joint spaces must be open?

Open IP and MCP joint spaces

What are the common projections for the first digit (thumb)?

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

How is the patient positioned for an AP Projection of the thumb?

Seated at the end of the table with the arm internally rotated

Where is the Central Ray directed for an AP Projection of the thumb?

Perpendicular to the MCP joint

Where should the patient's thumb be placed for a PA Projection?

Rest the elevated and abducted thumb on a radiographic support

What is a disadvantage of the PA thumb projection mentioned in the notes?

This position magnifies the part

What carpal bone must be included in an AP/PA thumb projection evaluation?

Trapezium

How should the hand be 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

In a Lateral thumb projection, which surface of the proximal phalanx should appear concave?

Anterior surface

What is the part position for a PA Oblique Projection of the thumb?

Thumb abducted with the palmar surface in contact with the IR

What hand movement is advised to help align the thumb for a PA Oblique Projection?

Ulnar deviate the hand slightly

What specific joint is primarily evaluated using the Robert Method?

First carpometacarpal (CMC) joint

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

$$1936$$

Who modified the central ray for the Robert Method in 1988?

Lewis

Which authors further modified the Robert Method central ray in 1995?

Long and Rafert

What are the common clinical indications for the Robert Method?

Arthritic changes, fractures, displacement of the first CMC joint, and Bennett's fracture

How should the hand be positioned in the Robert Method to avoid soft tissue obscuring the 1st CMC joint?

Hand hyperextended

What is the original Robert Method Central Ray direction?

Perpendicular entering at the first CMC joint

What is the Long and Rafert modification for the Robert Method Central Ray?

Angled $15^{\circ}$ proximally to the long axis of the thumb, entering the first CMC joint

What is the Lewis modification for the Robert Method Central Ray?

$10 - 15^{\circ}$ proximally along the axis of the thumb, entering the first MCP joint

What two purposes does angling the central ray serve in the Robert Method modifications?

1. Project hand soft tissue away from the first CMC joint; 2. Help open the joint space

What is the key structure shown in a successful Robert Method projection?

First CMC joint free of superimposition of the soft tissues of the hand

In the Robert Method, the first metacarpal base should be in what profile?

Convex profile

What aspect of the first CMC joint does the Burman Method show a clearer image of compared to standard AP?

Concavoconvex aspect

What is the recommended SID for the Burman Method?

$$18\,\text{inches}$$

Why is a shorter SID recommended for the Burman Method?

It produces a magnified image for a greater field of view of the concavoconvex aspect

What is the hand position for the Burman Method?

Hyperextend the hand, rotate internally, and abduct the thumb so it is flat on the IR

Where is the Central Ray directed for the Burman Method?

Through the first CMC joint at a $45^{\circ}$ angle toward the elbow

In the Burman Method evaluation, the trapezium should be in what profile?

Concave profile

What injury is the Folio Method primarily used to diagnose?

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

What are two common clinical names for the UCL rupture demonstrated by the Folio Method?

Skier's thumb or gamekeeper's thumb

In the Folio Method, what is placed between the bodies of the first metacarpals?

A roll of medical tape

What is used to wrap the distal portion of both thumbs in the Folio Method?

A rubber band

What instruction is given to the patient just prior to the Folio Method exposure?

Pull their thumbs apart and hold

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

According to the Folio Method results, what is the MCP joint angle for a partially torn left UCL compared to an uninjured side?

$20^{\circ}$ for torn UCL versus $7^{\circ}$ for the uninjured side

How many degrees of difference in angulation suggests a diagnostic finding in the Folio Method example?

$13^{\circ}$ difference

What are the common projections for Hand Radiography?

PA, PA Oblique, Lateral, and Norgaard Method

How is the hand positioned for a standard PA Hand Projection?

Hand is pronated with fingers spread slightly

Where is the Central Ray directed for a PA Hand Projection?

Perpendicular to the third MCP joint

Which joint spaces indicate the hand is flat on the IR in a PA projection?

Open MCP and IP joints

When would an AP hand projection be used instead of PA?

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

What degree of obliquity is required for a PA Oblique Hand Projection?

$$45^{\circ}$$

Where is the Central Ray directed for a PA Oblique Hand Projection?

Perpendicular to the third MCP joint

Which metacarpal shafts should show minimal overlap in a PA Oblique hand projection?

Overlap of the third-fourth and fourth-fifth metacarpal shafts

Which metacarpals should be separated in a PA Oblique hand projection?

Second and third metacarpals

Who recommended the Reverse Oblique Projection for the hand?

Lane, Kennedy, and Kuschner

What is the indication for a Reverse Oblique hand projection?

Severe metacarpal deformities or fractures

How is the hand rotated for a Reverse Oblique hand projection?

Rotate the hand $45^{\circ}$ medially (internally) from the palm-down position

Who recommended the Tangential Oblique Projection for the hand?

Kallen

The Tangential Oblique Projection is specifically used to demonstrate fractures of what anatomy?

Metacarpal head fractures

In the Tangential Oblique hand projection, how many degrees are the MCP joints flexed?

$75$ to $80^{\circ}$

In the first step of the Tangential Oblique projection, how is the hand rotated toward the ulnar surface?

$40$ to $45^{\circ}$

Where is the Central Ray directed for a Tangential Oblique hand projection?

Perpendicular directed tangentially to enter the MCP joint of interest

What are the common lateral positions for hand radiography?

Mediolateral/Lateromedial in Extension and Fan Lateral Position

In a Lateral hand projection, the palmar surface should be in what orientation to the IR?

Perpendicular to the IR

What is the specific advantage of the Fan Lateral hand position?

Eliminates superimposition of all but the proximal phalanges

Where is the Central Ray directed for a Lateral Hand Projection?

Perpendicular to the second/fifth digit MCP joint

What is the purpose of the Lateral Hand in Extension projection?

Customary for localizing foreign bodies and metacarpal fracture displacement

What modification did Lewis recommend to better demonstrate fractures of the fifth metacarpal?

Rotating the hand $5^{\circ}$ posteriorly from the true lateral position

In the Lewis modification for the 5th metacarpal, how is the CR angled?

Parallel to the extended thumb and enters the midshaft of the fifth metacarpal

What is shown in a Lateromedial Hand Projection in Flexion?

Lateral image of bony structures and soft tissues in their normally flexed position

What does the Lateral Hand in Flexion projection demonstrate regarding fractures?

Anterior or posterior displacement in fractures of the metacarpals

Where is the Central Ray directed for the Lateromedial Hand Projection in Flexion?

Perpendicular to the second digit MCP joint

What is the AP Oblique (Medial Rotation) projection of the hand commonly called?

Norgaard Method

What is the non-technical alias for the Norgaard Method?

Ball-catcher’s position

The Norgaard Method is clinically significant for early diagnosis of which condition?

Rheumatoid arthritis

What type of intensifying screens are recommended for the Norgaard Method?

Extremely fine-grain intensifying screens

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

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

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

Stapczynski

For the Norgaard Method, what part rotation is required?

Half-supinate position ($45^{\circ}$ rotation)

In the modified Norgaard Method, how are the fingers positioned?

Cupped as if the patient were going to catch a ball

Where 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 early radiologic change in the Norgaard Method is significant for rheumatoid arthritis?

A symmetric, very slight, indistinct outline of the bone at the joint capsule insertion on the proximal end of the first phalanx

Where is the indistinct bone outline located specifically in early RA on a Norgaard radiograph?

Dorsoradial on the proximal end of the first phalanx

What associated finding is always present directly below the contour defect in the Norgaard Method for RA?

Demineralization of the bone structure

According to Norgaard, why is this position often preferred over laboratory tests?

It makes early diagnosis of rheumatoid arthritis possible before laboratory tests are positive

In a PA digit projection, what part of the anatomy distal to the metacarpal must be included?

The entire digit through to the fingertip

What is the required orientation of the hand in the Burman Method?

The forearm lies approximately parallel to the long axis of the IR

What method uses the medial aspects of the hands resting on the cassette with thumbs pulled apart?

Folio Method

In digits radiography, why should digits be separated slightly for a PA projection?

To avoid soft tissue overlap from adjacent digits

In hand PA oblique evaluation, what condition is met when fingertips touch the IR?

Proper obliquity of approximately $45^{\circ}$