CR Quiz Upper Extremetiesss

PA Projection- Fingers

Position: hand and forearm resting on table

Part: pronate hand with fingers extended, center and align long axis of affected fingers with long axis of IR

CR: perpendicular to IR, directed at the PIP joint

kVp: 55-65

PA Oblique Projection- Medial or Lateral Rotation: Fingers

Position: hand and wrist resting on IR

Part: fingers are extended at an 45* degree angle and affected finger is parallel to IR

CR: perpendicular to IR, directed at the PIP joint

kVp: 55-65

Lateromedial or Mediolateral Projections: Fingers

Position: hand and wrist resting on IR

Part: place hand in lateral position, finger being examined is fully extended. Ensure long axis is parallel to IR.

CR: perpendicular to IR, directed at the PIP joint

kVp: 55-65

AP Projection: Thumb

Position: hand rotated internally to supinate the thumb for projection

Part: Internally rotate hand until the posterior side of thumb is touching the IR. Center first MCP joint to CR and to center of IR.

CR: perpendicular to IR, directed at first MCP joint

kVp: 55-65

PA Oblique Projection- Medial Rotation: Thumb

Position: Patient seated with hand resting on IR

Part: Abduct thumb slightly with palmar surface of hand against the IR. (The thumb is already in a natural 45* angle) Center to first MCP joint

CR: perpendicular to IR, directed at first MCP joint

kVp: 55-65

Lateral Position: Thumb

Position: pt seated with hand resting on IR palm down

Part: hand pronated and thumb abducted, fingers slightly arched, rotate hand slightly medial to get thumb into a true lateral. Center first MCP joint

CR: perpendicular to IR, directed at first MCP joint

kVp: 55-65

PA Projection: Hand

Position: pt seated with hand and forearm extended

Part: pronate hand with palmar surface against IR and spread fingers slighlty

CR: perpendicular to IR, center at third MCP joint

kVp: 55-65

PA Oblique Projection: Hand

Position: pt seated with hand and forearm extended

Part: pronate hand on IR, hand and wrist rotate laterally to 45*. All digits parallel to IR

CR: perpendicular to IR, directed at third MCP joint

kVp: 55-65

"Fan" Lateral - Lateromedial Projection: Hand

Position: pt seated with hand and forearm extended

Part: rotate hand and wrist into a lateral position with thumb up. Spread fingers and thumb into a "fan" position (making an okay sign). Ensuring that all digits are separated and parallel to the IR.

CR: perpendicular to IR, directed to 2nd MCP joint

kVp: 55-65

Lateral in Extension and Flexion- Lateromedial Projections: Hand

Position: pt seated with hand and forearm extended

Part: Rotate hand and wrist with thumb side up, into a true lateral position

Extension- all metacarpals are superimposed for true lateral

Flexion- flex into a natural position with thumb slightly touching the first finger, maintain lateral

CR: perpendicular to IR, directed from the 2nd to 5th MCP joint

kVp: 55-65

AP Axial Projection - Hand (Brewerton Method)

Position: stand pt at the end of table with hand supinated and flexed

Part: supinate hand, flex the hand into a 65* angle between the dorsum of the hand and IR. Extend fingers and slightly separate and abduct thumb

CR: angle CR 15* proximal, directed at 3rd MCP joint

kVp: 55-65

PA Projection: Wrist

Position: hand and forearm on table with shoulder, elbow, and wrist on same horizontal plane

Part: hand pronated, making sure carpals are in contact with the IR (can make bring fingers into a fist to help)

CR: perpendicular to IR, directed to midcarpal area

kVp: 55-65

PA Oblique Projection - Lateral Rotation: Wrist

Position: hand and forearm on table with shoulder, elbow, and wrist on same horizontal plane

Part: from pronated, rotate hand and wrist laterally 45* (finger tips can rest slightly on board)

CR: perpendicular to IR, directed to midcarpal area

kVp: 60-70

Lateromedial Projection: Wrist

Position: Place wrist and hand with thumb up for lateral. Hand and forearm on table with shoulder, elbow, and wrist on same horizontal plane.

Part: adjust hand and wrist into a true lateral position, with fingers extended

CR: perpendicular to IR, directed to midcarpal area

kVp: 60-70

Axial Scaphoid- ulnar deviation: Wrist

Position: wrist and hand on IR, palm down, and shoulder, elbow, and wrist on same horizontal plane

Part: position for a PA projection (scaphoid at center of IR), have pt do ulnar deviation

CR: 10-15 proximal, center CR to scaphoid

kVp: 55-65

Carpal Canal (Tunnel) - Tangential, Inferosuperior Projection: Wrist

Gaynor-Hart Method

Position: pt seated, with wrist and hand on IR and palm down

Part: pt will dorsiflex wrist (band or tape), will become as vertical as possible without lifting forearm off IR. Rotate wrist and hand about 10* internally to prevent superimposition

CR: angle CR 25- 30 proximal to long axis of hand. CR 1 inch distal to the base of the third metacarpal

kVp: 55-65

AP Projection: Forearm

Position: pt seated with hand and forearm fully extended and palm up

Part: drop shoulder so it is on same plane. Align and center forearm to insure wrist and elbow joints are included. include 1 1/2 distal wrist and elbow. True frontal position (adjust pt as needed)

CR: perpendicular to IR, directed at midforearm

kVp: 65-75

Lateromedial Projection: Forearm

Position: pt seated with elbow flexed 90*

Part: drop shoulder so it is on same plane. rotate hand and wrist into a true lateral with thumb up. make sure both wrist and elbow joints are included.

CR: perpendicular to IR, directed to midforearm

kVp: 65-75

AP Projection: Elbow

Position: elbow fully extended, drop shoulder to match horizontal plane

Part: extend elbow, supinate hand, and align arm and forearm with IR. Ask patient to lean as much as necessary for a true AP projection. Making sure epicondyles are in a parallel plane to IR.

CR: perpendicular to IR, directed to midelbow joint which is 2cm distal to midpoint of the epicondyles

kVp: 65-75

AP Oblique Projection- Lateral (external) Rotation: Elbow

Position: pt seated, with arm fully extended and shoulder and elbow on same horizontal plane

Part: supinate hand and rotate externally the entire arm so the distal humerus and the anterior surface of the elbow joint are 45* to IR.

CR: perpendicular to IR, directed to midelbow joint which is 2cm distal to midpoint of the epicondyles

kVp: 65-75

AP Oblique Projection- Medial (internal) Rotation: Elbow

Position: pt seated, with arm fully extended and shoulder and elbow on same horizontal plane

Part: pronate hand into a natural palm-down position and rotate arm as needed until distal humerus and anterior surface of elbow are rotated 45*

CR: perpendicular to IR , directed to midelbow joint which is 2cm distal to midpoint of the epicondyles

kVp: 65-75

Lateromedial Projection: Elbow

Position: pt seated with elbow flexed 90*, drop shoulder so the humerus and forearm are on the same horizontal plane

Part: rotate hand and wrist into a true lateral positionm thumb side up. place epicondyle plane perpendicular to IR.

CR: perpendicular to IR, directed to midelbow joint (go 1 1/2 medially)

kVp: 65-75

AP axial projection- Modified Roberts Method: Thumb

Position: hand and arm fully extended with arm rotated internally, with posterior thumb resting on IR

Part: thumb in center and extended

CR: angle directed 15* proximally (toward wrist) entering at the first CMC joint

kVp: 55-65

For Lewis Modification: CR angle 10-15 proximal to MCP joint

PA stress thumb projection: Folio Method

Postion: both hands extended and pronated on IR

Part: looking for a PA projection of both thumbs. Hands are positioned side by side. Wrap a rubberband around thumbs and have them relaxed until the exposure is taken than ask the patient to pull them apart.

CR: perpendicular to IR directed to midway between MCP joints

kVp: 55-65

Bilateral PA Stress Projection (clenched PA Wrist)

Position: forearms extended and hands pronated. Drop shoulders so everything is on the same plane

Part: ensure no rotation, do the same for a singular PA wrist. Pt will then clench fists for the picture.

CR: perpendicular to IR directed to midpoint between both carpal regions

kVp: 55-65

AP Projection- Alternate Partial Flexion: Elbow

Position: pt will have elbow partially flexed

Part: Obtain 2 projections one where the forearm is parallel to IR and one where the humerus is parallel to IR.

CR: directed at the midelbow joint

kVp: 65-75

Trauma Axial LM and ML Projection of Elbow

"Coyle Method"

Radial Head (LM)

Position: erect or seated, elbow flexed 90* if possible with hand pronated.

CR: directed 45* angle toward shoulder, center to radial head, midelbow joint

Coronoid Process (ML)

Position: elbow flexed only 80* from extended position and hand pronated.

CR: angled 45 away from the shoulder, into midelbow joint

kVp: 70-80