Hand X-rays

Question 1

What are sesamoids?

Answer 1

Where tendons and ligaments embed in the hand

Question 2

What do sesamoids do?

Answer 2

They help with friction

Question 3

What is the anatomy of the hand?
(4)

Answer 3

Phalanges

Metacarpals

Carpals

Sesamoids

Question 4

What are the features of the carpal bones?
(4)

Answer 4

They’re wrist bones

They’re made up of 8 irregular shaped bones

They’re organised in 2 rows- proximal and distal

They’re included in the hand x-ray to ensure that we can see the metacarpals (since the carpals are below the metacarpals)

Question 5

What are the features of the metacarpals?
(2)

Answer 5

They articulate with the carpal bones proximally

They articulate with the phalanges distally

Question 6

What is the feature of the head of the metacarpals?

Answer 6

The head is rounded at the distal end

Question 7

What are the features of the shaft of the metacarpals?
(2)

Answer 7

They’re long

The medial and lateral surfaces are concave

Question 8

What are the features of the base of the metacarpals?
(2)

Answer 8

The base is flat at the proximal end

The styloid process is on the 3rd metacarpal

Question 9

When are hand x-ray projections done?

Answer 9

For fractures

Question 10

What are the 3 hand x-ray projections we can do?

Answer 10

Dorsi palmar (DP)

Oblique

Lateral

Question 11

What does the DP hand projection look like?
(2)

Answer 11

The hand is flat, fingers extended

It’s the back of the hand to the palm

Question 12

What does the oblique projection of the hand look like?
(2)

Answer 12

The thumb faces up (externally rotated to 45 degrees)

The fingers are extended

Question 13

Why is the oblique hand projection important?

Answer 13

It opens up the metacarpals bones

Question 14

What does the lateral projection of a hand look like?
(2)

Answer 14

The hand is rotated 90 degrees (the hand is on its side)

The thumb points up, away from the metacarpals

Question 15

Why is the lateral projection of the hand important?

Answer 15

It allows us to see fractures of the metacarpals

Question 16

What is the SID of a hand DP/oblique/lateral?

Answer 16

100/110cm

Question 17

Is a grid/bucky used on a hand DP/oblique/lateral?

Answer 17

No

Question 18

What is the detector size and orientation of a hand DP/oblique/lateral?

Answer 18

24cm x 30cm

Portrait

Question 19

What is the centering point of a hand DP/lateral?
(2)

Answer 19

Perpendicular to detector

The 3rd metacarpal head is in the middle of the x-ray beam

Question 20

What is the centering point for a hand oblique?

Answer 20

The 5th metacarpal head is in the middle of the x-ray beam

Question 21

What is the collimation of a hand DP/oblique/lateral?

Answer 21

Top of fingers to wrist

Question 22

What is the focal spot for a hand DP/oblique/lateral?
Why?

Answer 22

Less than 1.3mm

Because it’s a small body part being imaged

Question 23

What do we always mean when we say exposure factors?
(2)

Answer 23

kV

mAs

Question 24

What are the exposure factors of a hand DP/oblique/lateral?

Answer 24

60 kV

2 mAs

Question 25

Fill this in:

Answer 25

Question 26

What hand projection is this?

Answer 26

DP

Question 27

What hand projection is this?

Answer 27

Oblique

Question 28

Whenever we do a hand x-ray, what 2 projections do we always do?

Answer 28

DP Oblique

Question 29

What are the 2 joints in the fingers?

Answer 29

Interphalangeal joints (joints between phalanges) Metacarpal phalangeal joints (joints between metacarpals and phalanges)

Question 30

What is DP also known as?

Answer 30

PA

Question 31

Why is DP positioning important for finger x-rays?

Answer 31

It demonstrates the phalanges and associated joint spaces

Question 32

Why is lateral positioning important for finger x-rays?

Answer 32

It’s good for revealing dislocations and volar plate avulsions

Question 33

What are the projections used in finger x-rays? (2)

Answer 33

DP/PA Lateral

Question 34

Why are oblique projections not used for finger x-rays?

Answer 34

Because we only have 1 set of bones

Question 35

How do we position the fingers when doing lateral projections?

Answer 35

The affected finger is put closest to the detector

Question 36

What are volar plate avulsions?

Answer 36

When a bit of the bone gets ripped away (usually sporting injury)

Question 37

Fill this in:

Answer 37

Question 38

Why has the exposure of DP and lateral finger x-rays been reduced?

Answer 38

Because of the collimation

Question 39

What are the 2 types of projections for a thumb x-ray?

Answer 39

AP Lateral

Question 40

Why is an AP projection used on the thumb?

Answer 40

To get the thumb close to the detector

Question 41

What do we do if we can’t do an AP projection on the thumb?

Answer 41

Use a PA projection

Question 42

Fill this in:

Answer 42