Fingers/thumb Flashcards
Projections
ROUTINE
Lateral
AP
MODIFIED
PA
Room prep
Correct patient & projection selected on control panel
Chair placed parallel to table/flat bucky - affected side nearest IR
Patient prep
Id checked
Clarification of clinical details
Explanation of procedure
Informed consent obtained
LMP not applied
Any jewellery removed
Thumb
Lateral
POSITIONING
DP hand - thumb extended, fingers out of way (pad)
Medially rotated, lateral aspect in contact with IR - condyles of phalanges superimposed
CENTRING POINT
Over 1st metacarpophalngeal joint (MCP)
COLLIMATION
Distal phalange, trapezium & STB (thenar eminence)
Thumb
AP
POSITIONING
Posterior aspect in contact with IR
Hypothenar eminence cleared from thumb & thenar eminence
CENTRING POINT
Over 1st MCP joint
COLLIMATION
Distal phalange, trapezium & STB (thenar eminence)
Fingers
PROJECTION
PA
Neighbouring digit included
Index = index & middle, middle = collimation widened, ring & pinky = both digets
LATERAL
Only specific digit imaged
PA fingers
POSITIONING
DP hand, fingers extended, slightly separated
CENTRING POIINT
Proximal interphalangeal joint (PIP)
Metacarpophalangeal joint (MCP)
COLLIMATION
Distal phalange, MCP joint, STB, adjacent digit if required
Lateral fingers
Index & ring
Internally (medially) rotated, lateral border of index finger in contact with IR
Ring & pinky flexed & curled out of way - held by thumb
Index & middle fingers extended & separated
True lateral = condyles of phalanges superimposed
Lateral fingers
Ring & pinky
Hand externally rotated 90°, medial aspect of pinky in contact with IR
Index & middle fingers held by thumb
Ring & pinky fingers extended & separated, true lateral = condyles superimposed
Ensure ring & pinky fingers don’t overlap
Imaging
CENTRING POINT
Digit of interest in centre of beam
PIP or MCP joint
COLLIMATION
Distal phalange, MCP joint, lateral STB
Thumb
Image appraisal
ID, MARKER, COLLIMATION
ID = 3 forms - name, dob, address, chi
MARKER = Correct, inside beam, outside area of interest
COLLIMATION
Superiorly = soft tissue of 1st distal phalanx
Inferiorly = trapezium (joint space)
Side to side = soft tissue margins
Thumb
Image appraisal
PROJECTION & POSITIONING
AP
Thumb parallel to IR with carpometacarpal joint visible
Phalanges & metacarpals seen without foreshortening
Mid shaft concavity to either side of MC & phalanges (symmetry)
Interphalangeal, metacarpophalangeal & carpometacarpol joints seen
Thumb
Image appraisal
PROJECTION & POSITIONING
LATERAL
Metacarpal & phalanges seen without rotation
Carpometacarpal, metacarpophalangeal & interphalangeal joints seen clearly
Condyles of metacarpals & phalanges superimposed
Thumb
Image appraisal
EXPOSURE FACTORS, PATHOLOGIES, ARTEFACTS, ADDITIONAL & REPEATS
EXPOSURE FACTORS
Contrast & density adequate if bony cortex, trabecular & soft tissue margins seen - sharp
PATHOLOGIES
ARTEFACTS
Jewellery
ADDITIONAL/REPEAT
Fingers
Image appraisal
ID, MARKER, COLLIMATION
ID
MARKER
COLLIMATION (4 sides?)
Superiorly = soft tissue of distal phalanx
Inferiorly = least distal portion of metacarpal
Side to side = soft tisse margins, adjacent finger if relevant
