Hand Part 1

RADIOGRAPHY OF THE UPPER LIMB

SESSION: 04

PART: 1

Introduction

Although radiographic examinations of the upper limb are routine a high standard of radiography must be maintained.

The importance of registering the correct right or left marker at the time of the exposure cannot be over emphasised nor can the importance of recording the correct patient identification and date of the examination.

To ensure maximum radiation protection when using computed radiography (CR) cassettes, the patient should be seated at the side or end of the table with the lower limbs and gonads away from the primary beam, i.e. with the legs to the side of the table not under it and the beam should be collimated within the margins of the image receptor

HAND

Clinical Indications

• Fractures, dislocations.
• Foreign bodies of the phalange metacarpals, and all joints of the hand

Pathologic processes such as osteoporosis and osteoarthritis

Basic projections/VIEWS

• Two projections are routinely taken,
• Dorsi-palmar (DP)
• Anterior oblique (DP oblique)

(18 cm × 24 cm) cassette size.

Dorsi-palmar (DP)

• Position of patient and image receptor

The patient is seated alongside the table with the affected arm nearest to the table.

The forearm is pronated and placed on the table with the palmer surface of the hand in contact with the image receptor.

The fingers are separated and extended but relaxed to ensure that they remain in contact with the image receptor.

The wrist is adjusted so that the radial and ulna styloid processes are equidistant from the image receptor.

A sandbag is placed over the lower forearm for immobilization.

Direction and Centering of X-ray Beam

The collimated vertical beam is centered over the head of the 3rd metacarpal.

Esseimage characteristicsntial

The image should demonstrate all the phalanges, including the soft-tissue fingertips, the carpal and metacarpal bones, and the distal end of the radius and ulna.

The interphalangeal and metacarpo-phalangeal and carpo-metacarpal joints should be demonstrated clearly.

No rotation.

Radiographic anatomy

2.Anterior oblique (DP oblique)

Position of patient and image receptor From the basic postero-anterior position, the hand is externally rotated 45° with the fingers extended.

• The fingers should be separated slightly and the hand supported on a 45° non-opaque pad.

A sandbag is placed over the lower end of the forearm for immobilisation.

Direction and centering of the X-ray beam

The collimated vertical beam is centred over the head of the 5th metacarpal.

The tube is then angled so that the central ray passes through the head of the 3rd metacarpal, enabling a reduction in the size of the field

Essential image characteristics

The image should demonstrate all the phalanges, including the soft tissue of the fingertips, the carpal and metacarpal bones and the distal end of the radius and ulna.

The correct degree of rotation has been achieved when the heads of the 1st and 2nd metacarpals are seen separated whilst those of the 4th and 5th are just superimposed

Common faults and remedies

• Over rotation will project the metacarpals and digits on top of each other

Under rotation will fail to open out the metacarpals.

Note

The exposure should provide adequate penetration too visualize the metacarpal bones

10 point plan image quality