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17 Cards in this Set
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Clinical Indications: *Non-grid * 5mAs/66kVp
CR: CRperpendicular to IR, directed to midcarpalarea
Recommended Collimation:Collimate on four sides; include distal radius and ulna and metacarpal area.
*Shieldradiosensitive tissues outside region of interest* *RoutineWrist includes PA, PA oblique, Lateral* |
Lateral—LateromedialProjection: Wrist Evaluation Criteria Anatomy Demonstrated: Distal radius, ulna, carpals, and at least themidmetacarpal areas are visible. Position:•Long axis of the hand, wrist and forearm should be aligned with the long axisof IR. • True Lateral position isevidenced by the following: ulnar head should be superimposed over distalradius; proximal second through fifth metacarpals all should apear aligned andsuperimposed • CR and center of collimation field should be to midcarpal region. Exposure: Optimal density (brightness)and contrast with no motion demonstrateclear, sharp bony trabecular markings and soft tissue, such as margins ofpertinent fat pads of the wrist and borders of the distal ulna, seen throug thesuperimposed radius. |
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Clinical Indications: *Non-grid * 2mAs/60kVp CR:CR perpendicular to IR, directed to PIP Joint RecommendedCollimation: Collimate on four sides to area ofaffected finger and distal aspect of metacarpal. Note: For seconddigit, a mediolateral is advised if the patient can assume this position Placethe second digit in contact with the IR (Definition is improved with less OID) *Shieldradiosensitive tissues outside region of interest* *RoutineFingers includes PA, PA oblique, Lateral* |
Lateral—Lateromedialor Mediolateral Projections: Fingers Evaluation Criteria Anatomy Demonstrated: Lateral views of distal, middle, and proximalphalanges; distal metacarpal; and associated joints are visible. Position:• Long Axis of finger should be aligned with side border of IR • Finger should be in true lateral position, as indicated by the concave appearance ofthe anterior surface of the shaft of the phalanges. • Interphalangeal andmetacarpophalangeal joint spaces should be open, indicating correct CR locationand that the phalanges are parallel to the IR •CR and center of collimationfield should be to the PIP joint Exposure: Optimal density (brightness) and contrast with no motion demonstrate soft tissuemargins and clear, sharp bony trabecular markings. |
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Clinical Indications: *Non-grid * 3mAs/60kVp
CR: CRperpendicular to IR, directed to MCPJoint
Recommended Collimation:Collimate on four sides to thumb area. (remember that thumb includes entire first metacarpal.)
*Shieldradiosensitive tissues outside region of interest* *RoutineThumb includes AP, PA oblique, Lateral* |
LateralPosition: Thumb Evaluation Criteria Anatomy Demonstrated: Distal and proximal phalanges, first metacarpal,trapezium (superimposed), and associated joints are visualized in the lateralposition. Position:• Long axis of thumb should be aligned with side border of IR • Thumb should bein a true lateral position, evidenced by the concave-shaped anterior surface ofthe proximal phalanx and first metacarpal and relatively straight posteriorsurfaces • Interphalangeal and metacarpophalangeal joints should appear open ifthe phalanges are parallel to the IR and if the CR location is correct. • CRand center of collimation field should be at the first MCP joint. Exposure: Optimal density (brightness)and contrast with no motion demonstratesoft tissue margins and clear, sharp bony trabecular markings. |
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Clinical Indications: *Non-grid * 3mAs/66kVp
CR: CRperpendicular to IR, directed to second MCPJoint
Recommended Collimation:Collimate on four sides to outer margins of hand and wrist.
Note:the “fan” lateral position is the preferred lateral for the hand if phalangesare the area of interest.
*Shieldradiosensitive tissues outside region of interest* *RoutineHand includes PA, PA oblique, Lateral* |
“Fan” Lateral—LateromedialProjection: Hand Evaluation Criteria Anatomy Demonstrated: Entire hand and wrist and about 2.5 cm of distalforearm are visible. Position:• Long axis of hand and wrist should be aligned with long axis of IR • Fingersshould appear equally separated, with phalanges in the lateral position andjoint spaces open, indicating that fingers were parallel to IR. • Thumb shouldappear in slightly oblique position completely free of superimposition, withjoint spaces open. •Hand and wrist should be in a true lateral position, asevidenced by the following: distal radius and ulna are superimposed; metacarpasare superimposed• CR and center of collimation field should be at second MCP joint. Exposure: Optimal density (brightness)and contrast with no motion demonstratesoft tissue margins and clear, sharp bony trabecular markings. • Midphalangesand distal phalanges of thumb and fingers should appear sharp but may beslightly overexposed. |
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Clinical Indications: *Non-grid * 3mAs/60kVp CR:CR perpendicular to IR, to first MCP Joint RecommendedCollimation: Collimate on four sides to area of thumb,remembering that thumb includes entirefirst metacarpal. Exception(PA): Place hand in near-lateral position and restthumb on sponge support block that is high enough so that thumb is not rotatedbut is in position for a true PAprojection. (see Fig. 4-52, pg 144) Note: As a rule thePA is not advisable because it results in loss of definition caused byincreased OID *Shieldradiosensitive tissues outside region of interest* *RoutineThumb includes AP, PA oblique, Lateral* |
AP Projection:Thumb Evaluation Criteria Anatomy Demonstrated: Distal and proximal phalanges, first metacarpal,trapezium, and associated joints are visible. • Interphalangeal andmetacarpophalangeal joints hsould appear open Position:• Long axis of the thumb should be aligned with side border of IR. • No rotation as evidensed by the concave sides of thephalanges and by equal amounts of soft tissue appearing on each side of thephalanges, should be present. Interphalangeal joint should appear open,indicating that thumb was fully extended and corret CR location was used •CRand center of collimation field should be at the first MCP joint Exposure:Optimal density (brightness) and contrast with no motion demonstrate soft tissue margins and clear, sharp bony trabecular markings. |
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Clinical Indications: *Non-grid * 6mAs/62kVp
CR: CRPerpendicular to IR, directed to mid-forearm
Recommended Collimation:Collimate lateral borders to actual forearm area with minimal collimation atboth ends to avoid cutting of anatomy at either joint. Considering divergenceof the x-ray beam, ensure that a minimumof 3-4 cm distal to wrist and elbow joints is included on IR. *Shieldradiosensitive tissues outside region of interest* |
AP Projection: Forearm Evaluation Criteria Anatomy Demonstrated: •AP Projection of the eintre radius and ulna isshown, with a minimum of proximal row carpals and distal humerus and pertinentsoft tissues, such as fat pads and stripes of the wrist and elbow joints Position:•Long axis of forearm should be aligned with long axis of IR. • No Rotation is evidenced by humeralepicondyles visualized in profile, with radial head, neck, and tuberosityslightly superimposed by the ulna. • Wrist and elbow joint spaces are onlypartially open because of beam divergence. • CR and center of collimation fieldshould be to the approximate midpoint of the radius and ulna. Exposure: Optimal density (brightness) and contrast with no motion should visualize soft tissueand sharp, cortical margins and clear, bony trabecular markings. |
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Clinical Indications: *Non-grid * 6mAs/64kVp
CR: CRPerpendicular to IR, directed to mid-elbowjoint, which is approximately 2 cm (3/4 inch) distal to midpoint of al inebetween epicondyles
Recommended Collimation:Collimate on all four sides to area of interest
*Shieldradiosensitive tissues outside region of interest* RoutineElbow: AP, Lateral Oblique (external) Medial Oblique (internal), Lateral |
AP Projection: Elbow EvaluationCriteria Anatomy Demonstrated: •Distalhumerus, elbow joint space, and proximal radius and ulna are visible. Position: •Long axis of arm should bealigned with long axis of IR • No Rotationis evidenced by the appearance of bilateral epicondyles seen in profiel andradial head, neck, and tubercles separated or only slightly superimposed byulna. • Olecranon process should be seated in the olecranon fossa with fullyextended arm • Elbow joint space appears open with fully extended arm andproper CR centering. • CR and center of collimation field should be to the midelbow joint. Exposure: Optimal density (brightness)and contrast with no motion shouldvisualize soft tissue detail; sharp, bony cortical margins; and clear, bonytrabecular markings. |
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Clinical Indications: *6mAs/64kVp CR:CR Perpendicular to IR, directed to mid-elbow joint, (a point approximately4 cm (1.5 in) distal to midpoint of line between the epicondyles as viewed fromthe x-ray tube) RecommendedCollimation: Collimate on all four sides to areaof interest *Shieldradiosensitive tissues outside region of interest* Routine Elbow:AP, Lateral Oblique (external) Medial Oblique (internal), Lateral Note: Diagnosis ofcertain important joint pathologic processes (e.g., possible visualization ofthe posterior fat pad) depends on 90° flexion of the elbow joint Exception:Certain soft tissue diagnosis requires less flexion (30° to 35°) but theseviews should be taken only when specifically indicated |
Lateral—LateromedialProjection: Elbow Evaluation Criteria Anatomy Demonstrated: •Lateral projection of distal humerus and proximalforearm, olecranon process, and soft tissues and fat pads of the elbow jointare visible. Position:•Long axis of arm should be aligned with the long axis of the IR, with theelbow joint flexed 90° •About ½ of radial head should be superimposed by thecoronoid process, and olecranon proces should be visualied in profile. • Truelateral view is indicated by three concentric arcs of the trochlear sulcus,double ridges of the capitulum, and trochlea, and the trochlear notch of theulna. In addition, superimposition of the humeral epicondyles occurs. • CR andcenter of collimation field should be to mid-elbowjoint. Exposure: no motion and optimal density (brightness) and contrast shouldvisualize sharp cortical margins and clear trabecular markings as well as softtissue margins of the anterior and posterior fat pads. |
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Clinical Indications: *Non-grid * 6mAs/66kVp
CR: CRPerpendicular to IR, directed to mid-forearm
Recommended Collimation:Collimate both lateral borders to actual forearm area. Also, collimate at both ends to avoid cuttingoff anatomy at either joint. Considering divergence of the x-ray beam, ensurethat a minimum of 3-4cm (1-1.5 in)distal two wrist and elbow joint is included on IR. *Shieldradiosensitive tissues outside region of interest* |
Lateral—Lateromedial Projection: Forearm Evaluation Criteria Anatomy Demonstrated: •Lateral projection of entire radius and ulna, proximal row of carpal bones, elbow, and distal end of the humerus are visible as well as pertinent soft tissue, such as fat pads and stripes of the wrist and elbow joints. Position: •Long axis of forearm should be aligned with long axis of IR. • Elbow should be flexed 90° • No rotation as evidenced by head of ulna being superimposed over the radius, and humeral epicondyles should be superimposed. • Radial head should superimpose coronoid process, with radial tuberosity demonstrated. • CR and center of collimation field should be to midpoint of the radius and ulna. Exposure: Optimal density (brightness) and contrast with no motion should visualize sharp cortical margins and clear, bony trabecular markings and fat pads and stripes of the wrist and elbow joints. |
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Clinical Indications: *Non-grid * 3mAs/60kVp
CR: CRperpendicular to IR, directed to MCPJoint
Recommended Collimation:Collimate on four sides to thumb, ensuring that all of first metacarpal is included.
*Shieldradiosensitive tissues outside region of interest* *RoutineThumb includes AP, PA oblique, Lateral* |
Lateral Position: Thumb Evaluation Criteria Anatomy Demonstrated: Distal and proximal phalanges, first metacarpal, trapezium (superimposed), and associated joints are visualized in the lateral position. Position: • Long axis of thumb should be aligned with side border of IR • Thumb should be in a true lateral position, evidenced by the concave-shaped anterior surface of the proximal phalanx and first metacarpal and relatively straight posterior surfaces • Interphalangeal and metacarpophalangeal joints should appear open if the phalanges are parallel to the IR and if the CR location is correct. • CR and center of collimation field should be at the first MCP joint. Exposure: Optimal density (brightness) and contrast with no motion demonstrate soft tissue margins and clear, sharp bony trabecular markings. |
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Clinical Indications: *Non-grid * 3mAs/64kVp
CR: CRperpendicular to IR, directed to second MCPJoint
Recommended Collimation:Collimate on four sides to outer margins of hand and wrist.
Exception:For a routine oblique hand, use a support block to place digits parallel to Ir.This block prevents foreshortening of phalanges and obscuring of interphalangealsjoints. If the metacarpals only areof interest, the image can be taken with thumb and fingertip touching IR.
*Shieldradiosensitive tissues outside region of interest* *RoutineHand includes PA, PA oblique, Lateral* |
PA Oblique Projection: Hand Evaluation Criteria Anatomy Demonstrated: Oblique projection of the entire hand and wristabout 1 inch of distal forearm are visible Position:• Long axis of hand and wrist should be aligned with IR • 45° oblique isevidenced by the following: midshafts of metacarpas hsould not overlap; someoverlap of distal heads of third, foruth, and fifth metacarpas but no overlapof distal second and third metacarpas should occur; excessive overlap ofmetacarpals indicates over-rotation, and too much separation indicatesunder-rotation. • MCP and IP joints are open without foreshortening ofmidphalanges or distal phalanges, indicating that fingers are parallel to IR • CRand center of collimation field should be at third MCP joint. Exposure: Optimal density (brightness)and contrast with no motion demonstratesoft tissue margins and clear, sharp bony trabecular markings. |
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Clinical Indications: *Non-grid * 2mAs/60kVp CR:CR perpendicular to IR, directed to PIP Joint OptionalMedial Oblique: Second digit also may be taken in a45° medial oblique (thumb side down) with thumb and other fingers flexed toprevent superimposition (fig 4-39). This position places the part closer to theIR for improved definition but may be more painful for the patient RecommendedCollimation: Collimate on four sides to area ofaffected finger and distal aspect of metacarpal. *Shieldradiosensitive tissues outside region of interest* *RoutineFingers includes PA, PA oblique, Lateral* |
PA Oblique Projection:Medial or Lateral Rotation Fingers Evaluation Criteria Anatomy Demonstrated: 45° oblique view of distal, middle, and proximalphalanges; distal metacarpal; and asociated joints. Position:• Long Axis of finger should be aligned side border of IR • View of finger being examined should be 45°oblique • No superimposition of adjacent fingers should occur • IP and MCPjoint spaces should be open, indicating correct CR location and that thepahalnges are parallel to IR •CR and center of collimation field should be tothe PIP joint Exposure: Optimal density (brightness) and contrast with no motion demonstrate soft tissuemargins and clear, sharp bony trabecular markings. |
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Clinical Indications: *Non-grid * 4mAs/64kVp
CR: CRperpendicular to IR, directed to midcarpalarea
Recommended Collimation:Collimate to wrist on all four sides; include distal radius and ulna andmidmetacarpal area.
*Shieldradiosensitive tissues outside region of interest* *RoutineWrist includes PA, PA oblique, Lateral* |
PA ObliqueProjection—Lateral Rotation: Wrist Evaluation Criteria Anatomy Demonstrated: Distal radius, ulna, carpals, and at least tomidmetacarpal are visible. • Trapezium and scaphoid should be well visualized,with only slight superimposition of other carpals on their medial aspects. Position:•Long axis of the hand, wrist and forearm should be aligned with IR. • True 45°oblique of the wrist is evidenced by the following: ulnar head partiallysuperimposed by distal radius; proximal third through fifth metacarpals (metacarpal bases) shouldappear mostly superimposed. • CR and center of collimation field should be tomidcarpal area. Exposure: Optimal density (brightness) and contrast with no motion demonstrate carpals and theiroverlapping borders; soft tissue margins; and clear, sharp bony trabecularmarkings. |
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Clinical Indications: *Non-grid * 2mAs/60kVp
Recommended Collimation:Collimate on four sides to area of affected finger and distal aspect ofmetacarpal.
*Shieldradiosensitive tissues outside region of interest* *RoutineFingers includes PA, PA oblique, Lateral* |
PAProjection: Fingers Evaluation Criteria Anatomy Demonstrated: Distal, middle, and proximal phalanges; distalmetacarpal; and asociated joints. Position:Long Axis of finger should be aligned with and parallel to side border of IR •No rotation of fingers is evidenced bysymmetric appearace of both sides or concavities of the shafts of the phalangesand distal metacarpals • The amount of tissue on each side of the phalangesshould appear equal • Fingers should be separated with no overlapping of softtissues • Interphalangeal joints should appear open, indicating that hand wasfully pronated and the correct CR position was used • CR and midpoint ofcollimation field should be to the PIP joint Exposure: Optimal density (brightness) and contrast with no motion demonstrate soft tissuemargins and clear, sharp bony trabecular markings. |
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Clinical Indications: *Non-grid * 3mAs/62kVp
CR: CRperpendicular to IR, directed to third MCPJoint
Recommended Collimation:Collimate on all four sides to outer margins of hand and wrist
Note:If examinations of both hands or wrists are requested, generally the body partsshould be positioned and exposed separately for correct CR placement.
*Shieldradiosensitive tissues outside region of interest* *RoutineHand includes PA, PA oblique, Lateral* |
PA Projection: Hand Evaluation Criteria Anatomy Demonstrated: PA projection of entire hand and wrist and about 2.5cm (1in.) of distal forearm are visible • PA projection of hand demonstratesoblique view of the thumb Position:• Long axis of hand and wrist aligned with long axis of IR • No Rotation of hand, as evidenced bysymmetric appearance of both sides or concavities of shafts of metacarpals andphalanges of digits 2 through 5 and the appearance of equal amounts of softtissue on each side of phalanges 2 through 5. • Digits should be separatedslightly with soft tissues not overlapping. • MCP and IP joints should appearopen, indicating correct CR location and that hand was fully pronated. • CR andcenter of collimation field should be to thirdMCP joint. Exposure: Optimal density (brightness) and contrast with no motion demonstrate soft tissuemargins and clear, sharp bony trabecular markings. |
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Clinical Indications: *Non-grid * 4mAs/62kVp
CR: CRperpendicular to IR, directed to midcarpalarea
Recommended Collimation:Collimate to wrist on all four sides; include distal radius and ulna andmidmetacarpal area.
Alternative AP:an AP wrist may be taken, with hand slightly arched to place wrist and carpals in close contact with IR. To demonstrateintercarpal spaces and wrist joint better and to place the intercarpal spacesmore parallel to the divergent rays. This wrist projection is good forvisualizing the carpals of the patient can assume this position easily.
*Shieldradiosensitive tissues outside region of interest* *RoutineWrist includes PA, PA oblique, Lateral* |
PA (AP) Projection: Wrist Evaluation Criteria Anatomy Demonstrated: Midmetacarpals and proximal metacarpals; carpals; distalradius, ulna, and associated joints; and pertinent soft tissues of the wristjoint, such as fat pads and fat stripes, are visible • All the intercarpalspaces do not appear open because of irregular shapes that result inoverlapping. Position:• Long axis of the hand, wrist and forearm is aligned with IR• True PA isevidenced by the fllowing: proximal metacarpals; near-equal ditances existamong the proximal metacarpals; separation of the distal radius and ulna ispresent except for possible minimal superimposition at the distal radioulnarjoint • CR and center of collimation field should beto the midcarpal area. Exposure: Optimal density (brightness) and contrast with no motion should visualize sot tissue,such as pertinent fat pads, and sharp bony margins of the carpals and cleartrabecular markings. |
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ClinicalIndications: *Minimum SID – 40 inches (102 cm) * Non-grid * Detail screens for analog imaging * 4mAs/62kVp
CR:CRPerpendicular to IR, directed to midcarpal area
RecommendedCollimation:Collimate on four sides to carpal region.
*Shield radiosensitivetissues outside region of interest* WARNING: If patient has possible wrist trauma,do NOT attempt this position before a routine wrist series has been completedand evaluated to rule out possible fracture of distal forearm or wrist or both. |
PA Projection—RadialDeviation: Wrist Evaluation Criteria Anatomy Demonstrated: • Distal radius and ulna, carpals, and proximalmetacarpals are visible. • Carpals are visible, with adjacent interpaces moreopen on the medial (ulnar) side of the wrist. Position:•Long axis of wrist and forearm is aligned with side border of IR • Extremeradial deviation is evidenced by the angle of the long axis of the metacarpalsto that of the radius and ulna and the space between the triquetrum/pisiformand the styloid process of the ulna. •No Rotation of wrist is evidenced byappearance of distal radius and ulna, with minimal superimposiition of distalradioulnar joint. • CR and center of collimation should be to the midcarpal area. Exposure: Optimal density (brightness)and contrast with no motion visualizethe carpal borders and clear, sharp bony trabecular markings. |
