Fingers & Hand Flashcards
What should be clearly seen in the evaluation criteria for imaging digits 2-5?
Evidence of proper collimation and presence of side marker placed clear of anatomy of interest
Proper collimation ensures that the image captures only the area of interest, reducing unnecessary exposure and improving image quality.
What is the required positioning of the digit in imaging?
Entire digit from fingertip to distal portion of the adjoining metacarpal
This ensures complete visualization of the digit and its relationship with adjacent structures.
What should be avoided to ensure clarity in imaging?
No soft tissue overlap from adjacent digits
Overlapping soft tissues can obscure important details and lead to misinterpretation.
What indicates that there is no rotation in the imaging of digits?
Equal concavity on both sides of the phalangeal bodies
This ensures that the digit is properly positioned and not rotated, which is crucial for accurate assessment.
What should be equal on both sides of the phalanges in imaging?
Equal amount of soft tissue on both sides of the phalanges
This indicates proper alignment and positioning of the digit during imaging.
Where should the fingernail be centered in an imaging evaluation?
Centered over the distal phalanx
Centering the fingernail provides a visual reference for proper positioning of the digit.
What joint spaces should be open in the imaging of digits?
Open IP and MCP joint spaces
Open joint spaces are essential for assessing joint health and potential injuries.
What detail should be visible in the imaging of digits?
Bony trabecular detail and surrounding soft tissues
This detail helps in evaluating the integrity of the bone and associated soft tissues.
True or False: Digits that cannot be extended can only be examined in whole sections.
False
Digits that cannot be extended can be examined in small sections for better assessment.
What type of projection is recommended when joint injury is suspected?
AP projection instead of a PA projection
The AP projection may provide a clearer view of the joint and surrounding structures in cases of suspected injury.
What are the three main divisions of the hand anatomy?
Phalanges, Metacarpals, Carpals
How many phalanges are in each hand?
14
How many metacarpals are in each hand?
5
How many carpals are in each wrist?
8
What are phalanges classified as?
Long bones
What is the composition of the digits?
Phalanges
How are the phalanges numbered?
1 to 5 laterally to medially
How many phalanges are in the first digit (thumb)?
2
What are metacarpals classified as?
Long bones
What do the heads of the metacarpals articulate with?
Phalanges
What do the bases of the metacarpals articulate with?
Carpals
What are carpals classified as?
Short bones
Name the mnemonic to remember the names and locations of carpals.
Steve Left The Party To Take Carol Home
What type of joints are interphalangeal (IP) joints classified as?
Synovial, diarthrotic, hinge type
What do metacarpophalangeal (MCP) joints articulate between?
Heads of metacarpals and proximal phalanges
What type of joints are carpometacarpal (CMC) joints classified as?
First CMC joint: synovial, diarthrotic, saddle type; Second to fourth CMC joints: gliding types
What type of joint is the radiocarpal joint classified as?
Synovial, diarthrotic, ellipsoidal type
What is the standard source-to-image receptor distance (SID) for hand imaging?
40 inches
Which artifacts should be removed from the anatomy of interest?
- Watches
- Rings
- Bracelets
What is the recommended patient position for ambulatory patients during imaging?
Seated at end of x-ray table
What is the appropriate collimation size for hand imaging?
10 × 12 inches (24 × 30 cm) or 14 × 17 inches (35 × 43 cm)
What is the purpose of using ID markers in imaging?
To indicate right or left side of anatomy
What instructions are not required for digit, hand, and wrist procedures?
Breathing instructions
What is the central ray (CR) direction for PA projection of digits 2 to 5?
Perpendicular to IR
What should be demonstrated in the PA projection of digits 2 to 5?
Entire digit from fingertip to distal portion of the adjoining metacarpal
What is the central ray entry point for the lateral projection of digits 2 to 5?
PIP joint of affected digit
What is the required position for the thumb in an AP projection?
Hand in extreme medial (internal) rotation
What structures should be visible in the AP projection of the thumb?
Area from distal tip of the thumb to the trapezium
What is the evaluation criterion for the PA thumb projection?
Open IP and MCP joint spaces without overlap of bones
Where does the central ray enter for the PA projection of the third digit?
Third PIP joint
What is the evaluation criterion for the PA hand projection?
Anatomy from fingertips to distal radius and ulna
What is the correct positioning for a lateral hand projection?
Palmar surface perpendicular to IR
What should be done to prevent soft tissue overlap in hand imaging?
Extend and separate digits
Which joints should be open in a PA oblique hand projection?
Open MCP joints and open IP joints
What is the part position for the fan lateral projection of the hand?
Forearm on table with elbow flexed 90 degrees, hand resting on medial surface with thumb side up
What is the central ray (CR) direction for the fan lateral projection of the hand?
Perpendicular to the second MCP joint
Which structures are evaluated in the fan lateral projection of the hand?
- Anatomy from fingertips to distal radius and ulna
- Extended digits
- Hand in true lateral position
- Superimposed phalanges
- Superimposed metacarpals
- Superimposed distal radius and ulna
What is the primary benefit of the lateral ‘fan lateral’ projection?
Best to show all the individual phalanges
What is the patient position for the PA wrist projection?
Seat patient at the end of the radiographic table with axilla in contact with the table
What is the CR direction for the PA wrist projection?
Perpendicular to midcarpal area
Which structures are shown in the PA wrist projection?
- Distal radius and ulna
- Carpals
- Proximal half of metacarpals
- Open radioulnar joint space
What is the part position for the lateral wrist projection?
Forearm and wrist resting on medial surface with radial and ulnar styloid superimposed
Which structures are evaluated in the lateral wrist projection?
- Distal radius and ulna
- Carpals
- Proximal half of metacarpals
- Superimposed metacarpals
What is the central ray (CR) for the PA oblique wrist projection?
Perpendicular to midcarpal area, just distal to radius
What is the purpose of the PA projection in ulnar deviation position?
To visualize the scaphoid with adjacent articulations open
What is the CR direction for the PA axial (Stecher method) projection of the scaphoid?
Perpendicular to the table and enters at scaphoid
What is the positioning for the tangential carpal tunnel projection (Gaynor-Hart method)?
Hyperextend wrist to place long axis of hand as vertical as possible
What is the CR angle for the tangential carpal tunnel projection?
Angled 25 to 30 degrees toward palm of hand
Which essential projection requires the central ray to be centered to the third MCP joint?
PA of the third digit
What is the anatomy of the forearm composed of?
- Ulna
- Radius
Which bone is on the medial side of the forearm?
Ulna
What are the three joints enclosed in the common capsule of the elbow?
- Humeroulnar joint
- Humeroradial joint
- Proximal radioulnar joint
What is the distal end of the humerus involved in?
Part of the elbow joint
What is the positioning for the AP forearm projection?
Elbow extended with hand supinated
What is the CR direction for the AP forearm projection?
Perpendicular to IR, entering at midpoint of forearm
What structures are shown in the AP forearm projection?
- Entire forearm
- Wrist
- Distal humerus
- Proximal row of slightly distorted carpal bones
What is the patient position for the lateral forearm projection?
Elbow flexed 90 degrees with thumb side up
What is the central ray (CR) direction for the lateral forearm projection?
Directed perpendicular to the IR, entering at midpoint of forearm
What structures are evaluated in the lateral forearm projection?
- Entire forearm
- Wrist
- Distal humerus in true lateral position
- Superimposition of radius and ulna
What is the purpose of the axiolateral (Coyle method) projection?
To demonstrate the elbow joint and radial head
What should be removed from the anatomy of interest during patient preparation?
- Watches
- Rings
- Bracelets
- Bras (for humerus procedures)
What is the standard SID for upper extremity procedures?
40 inches
What is necessary for radiation protection during imaging?
Gonadal shield should be used according to state regulations
What is the recommended size for the IR used in upper extremity procedures?
10 x 12 inches (24 x 30 cm) or 14 x 17 inches (35 x 43 cm)
Which structure must be seen on the AP projection of the thumb?
Trapezium
What is the Central Ray (CR) for the elbow joint?
Perpendicular to elbow joint
What is the radiation field for the elbow joint radiography?
3 inches (8 cm) proximal and distal to the elbow joint and 1 inch (2.5 cm) on the sides
What structures are shown on an AP elbow projection?
- Radial head, neck, and tuberosity slightly superimposed over the proximal ulna
- Elbow joint open and centered to the central ray
- No rotation of humeral epicondyles
- Coronoid and olecranon fossae approximately equidistant to epicondyles
- Bony trabecular detail and surrounding soft tissues
What is the required part position for an AP elbow projection?
- Extremity in same plane with long axis parallel to IR
- Elbow flexed 90 degrees and placed in center IR
- Forearm resting on ulnar surface (thumb side up)
- Wrist in true lateral
- Humeral epicondyles perpendicular to IR
In a lateral elbow projection, what is the positioning of the elbow joint?
True lateral position
What are the key structures shown in a lateral elbow projection?
- Elbow joint open and centered to the central ray
- Superimposed humeral epicondyles
- Radial tuberosity facing anteriorly
- Olecranon process in profile
- Bony trabecular detail
What is the required part position for an AP oblique elbow with medial rotation?
- Elbow centered to IR
- Elbow flexed 90 degrees
- Upper extremity medially rotated to place humeral epicondyles 45 degrees from true anatomic position
What structures are shown in an AP oblique elbow with medial rotation?
- Coronoid process in profile
- Elongated medial humeral epicondyle
- Ulna superimposed by the radial head and neck
- Bony trabecular detail
What is the central ray direction for the AP oblique elbow with lateral rotation?
Perpendicular to elbow joint
What structures are evaluated in an AP oblique elbow with lateral rotation?
- Radial head, neck, and tuberosity projected free of the ulna
- Elongated lateral humeral epicondyle
- Bony trabecular detail
What is the positioning for a partial flexion position of the distal humerus?
- Humerus in same plane with posterior surface resting on IR
- Support elevated forearm
- Supinate hand, if possible
What structures are shown in the AP elbow—distal humerus partial flexion position?
- Distal humerus without rotation or distortion
- Proximal radius superimposed over the ulna
- Closed elbow joint
What is the purpose of the axiolateral projection (Coyle method)?
To demonstrate radial head and coronoid process on patients who cannot fully extend the elbow
What is the central ray angle for the axiolateral projection to demonstrate the radial head?
Angled 45 degrees toward the shoulder
What structures are shown in the axiolateral projection for the radial head?
- Open joint space between radial head and capitulum
- Radial head, neck, and tuberosity in profile
- Bony trabecular detail
What is the required hand position for the axiolateral projection of the coronoid process?
Hand pronated
What structures are shown in the axiolateral projection for the coronoid process?
- Open joint space between coronoid process and trochlea
- Coronoid process in profile and elongated
- Radial head and neck superimposed by ulna
What is the positioning for the AP projection of the humerus?
- Top border of IR approximately 1½ inches (3.8 cm) above humeral head
- Slightly abduct humerus from body and supinate hand
What are the evaluation criteria for the AP humerus projection?
- Elbow and shoulder joints
- Humeral epicondyles without rotation
- Humeral head and greater tubercle in profile
What is the central ray direction for a lateral projection of the humerus?
Perpendicular to midportion of humerus and centered to IR
Which projection demonstrates the olecranon in profile?
Lateral
What is the CR angle and direction for demonstrating the radial head with the axiolateral projection (Coyle method)?
Angled 45 degrees toward the shoulder
Which structure is in profile on the lateral side of the proximal humerus on the AP projection of the humerus?
Greater tubercle
Which projections require the humeral epicondyles to be positioned parallel with the IR?
- AP forearm
- AP elbow
- PA wrist
