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application of imaging 1 > imaging of the upper limb > Flashcards

imaging of the upper limb Flashcards

1
Q

lateral?

A

away from the midline of the body

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2
Q

medial?

A

towards the midline of the body

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3
Q

distal?

A

furthest from, distant from (the furthest point from the center of the body)

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4
Q

proximal?

A

nearest to, closer to or in proximity to (closest to centre of the body)

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5
Q

why do fractures happen?

A
  • fracture is the scientific term for a break/crack in a bone
  • occur when there is a transfer of energy through a bone that exceeds what that bone can cope with
  • a fracture that occurs depends on two things: where bone is weakest and where majority of force is applied
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6
Q

what is the SID for upper limb x-rays?

A

100cm

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7
Q

do we need to use grids?

A

no because there is not a big enough area to generate enough scatter to justify the increased radiation dose

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8
Q

what are hand clinical indications?

A
  • OA/RA
  • Trauma (punch injury, FOOSH, stab wounds)
  • foreign body
  • follow-up imaging
  • congenital abnormalities
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9
Q

what are hand projections?

A

standard:
- DP
- Oblique
- Lateral
additional:
- finger views
- thumb
- ball catchers (norgaard method)

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10
Q

what is the hand dp patient position?

A
  • patient seated at the side of the x-ray couch
  • elbow flexed arm relaxed
  • palmar aspect of the hand placed on the IR
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11
Q

what is the centering point of a hand DP?

A
  • central ray vertical to the IR
  • head of the third metacarpal
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12
Q

what is the collimation for a hand DP?

A
  • laterally = include skin margins
  • proximally = include distal radioulnar joint
  • distally = include the tips of the distal phalanges
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13
Q

finger DP centering point?

A
  • central ray vertical to the IR
  • between the heads of the two metacarpals (buddy fingers)
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14
Q

what is the collimation for fingers DP?

A
  • laterally = lateral margins of both fingers and metacarpals
  • proximally = include distal radioulnar joint
  • distally = include the tips of the distal phalanges
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15
Q

patient position hand DP oblique

A
  • patient seated at side of x-ray couch
  • elbow flexed arm relaxed
  • palmar aspect of the hand placed on IR
  • rotate hand laterally 45 degrees ensuring medial aspect of hand is still in contact with IR
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16
Q

centering point of hand dp oblique

A
  • central ray vertical to the IR
  • head of third metacarpal
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17
Q

collimation of hand dp oblique

A
  • laterally = include skin margins
  • proximally = include distal radioulnar joint
  • distally = include the tips of the distal phalanges
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18
Q

patient position of hand lateral?

A

• patient seated at the side of the x-ray couch
• lateral aspect of affected hand in contact with the IR
• palmar aspect of the hand 90 degrees to the IR
• slightly abduct the thumb

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19
Q

centering point of hand lateral?

A
  • central ray vertical to the IR
  • head of the second metacarpal
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20
Q

collimation of a hand lateral?

A

laterally = dorsal and palmar skin margins
proximally = include distal radioulnar joint
distally = include the tips of the distal phalanges

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21
Q

what is centering point of fingers lateral?

A
  • central ray vertical to the IR
  • over the proximal interphalangeal joint of the affected finger
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22
Q

collimation of fingers lateral?

A

laterally = lateral soft tissue margins
proximally = include metacarpophalangeal joint
distally = include the tip of the distal phalanx

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23
Q

ball catchers?

A
  • anterior bilateral projection
  • centering: between the two hands at the level of the metacarpophalangeal joints
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24
Q

thumb PA patient position?

A
  • patient seated at the side of the xray couch
  • elbow extended
  • posterior aspect of the thumb on the IR
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25
Q

centering point of thumb PA

A
  • central vertical ray vertical to the IR
  • over first metacarpophalangeal joint
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26
Q

collimation of thumb PA

A

laterally = include skin margins
proximally = carpometacarpal joint
distally = distal phalanx

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27
Q

patient position thumb lateral?

A
  • patient seated at the side of the xray couch
  • elbow flexed; arm relaxed
  • palmar aspect of the hand raised off the image receptor (can used pads to assist) so that thumb is lateral
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28
Q

centering point of thumb lateral?

A
  • central ray vertical to the IR
  • over 1st metacarpophalangeal joint
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29
Q

collimation of thumb lateral?

A

laterally = includes skin margins
proximally = carpometacarpal joint
distally = distal phalanx

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30
Q

the wrist clinical indications?

A
  • OA/RA
  • trauma (FOOSH)
  • osteomyelitis
  • foreign body?
  • follow-up imaging
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31
Q

what are standard wrist projections?

A

DP
lateral

32
Q

additional wrist projections?

A

scaphoid projections - olique/zitters or banana
oblique wrist

33
Q

wrist PA patient position?

A
  • patient seated at the side of the xray couch
  • elbow flexed; arm relaxed
  • palmar aspect of the hand placed on the IR but place fingers slightly curled or over the top edge of the IR if not using a wall stand
34
Q

centering point of wrist PA?

A
  • central ray vertical to the IR
  • midway between the radial and ulnar styloid processes
35
Q

collimation of wrist PA?

A

laterally = include skin margins
proximally = distal 1/3 radius and ulna
distally = heads of metacarpals

36
Q

wrist lateral patient position?

A
  • from the PA position externally rotate the arm until the ulnar aspect of the hand/wrist is in contact with the IR
  • extend fingers
  • palmar aspect of the hand is perpendicular to the IR
37
Q

some lovers try positions they cannot handle

A

scaphoid
lunate
triquetrum
pisiform
trapezium
trapezoid
capitate
hamate

38
Q

wrist lateral centering point?

A

central ray vertical to the IR
radial styloid process

39
Q

collimation of lateral wrist?

A

laterally = dorsal and palmar skin margins
proximally = distal 1/3 radius and ulna
distally = heads of metacarpals

40
Q

additional views of wrist?

A

PA wrist with ulnar deviation
- position as a PA wrist
- ulnar deviation of the wrist (laterally) as far as possible

41
Q

additional wrist view - PA axial (zitters/banana projection)

A
  • position as for PA wrist, angle tube 30 degrees towards elbow
  • centre to the anatomical snuff box
  • ensure ulnar deviation
  • 10 days after intial presentation - bloody supply
42
Q

radius and ulnar clinical indications?

A
  • trauma (FOOSH, guarding)
  • osteomyelitis
  • foreign body?
  • follow up imaging
  • imaging for fracture alignment
43
Q

radius and ulnar standard projections?

A

AP/PA
lateral

44
Q

radius and ulnar additional projections?

A

joint specific projections if unclear from initial imaging

45
Q

radius and ulnar AP patient position?

A
  • patient seated with affected side next to the xray couch without placing legs underneath
  • affected arm abducted and extended and placed on IR
  • arms supinated with wrist elbow and shoulder in same horizontal place
  • humeral epocondykes and styloid processes from imaging plate
46
Q

radius and ulnar AP centering points?

A

central ray vertical to the IR
midway between elbow and wrist

47
Q

radius and ulnar AP collimation?

A

laterally = include skin margins
prximally = elbow joint
distally = wrist joint

48
Q

radius and ulnar lateral patient position?

A
  • from the AP position flex elbow 90 degrees and medially rotate arm so that the ulnar aspect is in contact with the IR
  • ensure wrist elbow and shoulder are in the same transverse plane
  • palmar aspect of hand should be 90 degrees to the IR
  • humeral epicondyles and styloid processes superimposed
49
Q

radius and ulnar lateral centering point?

A

central ray vertical to the IR
midway between elbow and wrist

50
Q

radius and ulnar lateral collimation?

A

laterally = includes skin margins
proximally = elbow joiny
distally = wrist joint

51
Q

elbow clinical indications?

A

OA/RA
Trauma
Pain and welling
osteomyelitis
foreign body?
follow up imaging
inability to straighten

52
Q

elbow standard projections?

A

DP
lateral

53
Q

elbow additional projections?

A

radial head views

54
Q

elbow AP patient position?

A
  • patient seated with their affected side next to the xray table without placing legs underneath
  • affected arm abducted and extened and placed on the IR
  • arm supinated with wrist elbow and shoulder in the same horizontal place
  • humeral epicondyles equidistant from IR
55
Q

elbow AP centering point?

A

central ray vertical to the IR
midway between humeral epicondyles and 2.5cm distally

56
Q

elbow AP collimation?

A

laterally = include skin margins
proximally = distal 1/3 of humerus
distally = proximal 1/3 of radius and ulna

57
Q

elbow lateral patient position?

A
  • from the AP position flex the elbow to 90 degrees and medially rotate the arm so that the ulnar aspect is in contact with the IR
  • ensure the wrist elbow and shoulder are in the same transverse plane
  • palmar aspect of the hand should be 90 degrees to the IR
  • humeral epicondyles superimposed
58
Q

elbow lateral centering point?

A

central ray vertical to the IR
over the lateral humeral epicondyle

59
Q

collimation of elbow lateral?

A

laterally = include skin margins
proximally = distal 1/3 of the humerus
distally = proximal 1/3 of radius and ulna

60
Q

humerus clinical indications?

A

trauma
osteomyelitis
foreign body?
follow up imaging

61
Q

humerus standard projections?

A

AP
lateral

62
Q

humerus additional projections?

A

joint specific projections if unclear from initial imaging

63
Q

humerus AP patient position?

A
  • patient is stood with their back to the IR
  • the arm is in the true anatomical position, palm facing forwards
  • the posterior aspect of the upper arm should be in contact with the IR to reduce movement and magnification
64
Q

humerus AP centering point?

A

central ray horizontal to IR
middle of the humerus on the anterior aspect of the upper arm, midway between the shoulder and elbow joints

65
Q

collimation of humerus AP

A

laterally = include skin margins
superiorly = the skin margin above the glenohumeral joiny
inferiorly = include the distal humerus including the elbow joint

66
Q

humerus lateral PA patient position?

A

patient is stood facing the IR
the elbow if flexed so that the palm of the hand rests on the anterior abdominal wall
the anterior aspect of the upper arm should be in contact with the IR to reduce movement and enlargement
the patient should be rotated so that the lateral aspect of the shoulder of the affected side, the upper arm and elbow are all in contact with the IR

67
Q

humerus lateral centering point?

A

central ray horizontal to the IR
(PA) middle of yhe humerus shaft on the medial aspect of the upperarm midway between shoulder and elbow joints
(AP) middle of ghe humerus shaft on the lateral aspect of the upperarm midway between the shoulder and elbow joints

68
Q

collimation of lateral humerus?

A

laterally = include skin margins
superiorly = the skin margin above the glenohumeral joiny
inferiorly = include the distal humerus including the elbow joint

69
Q

shoulder clinical indications?

A

trauma
osteomyelitis
foreign body?
follow up imaging
OA
obvious deformity
limited ROM

70
Q

standard projections shoulder?

A

AP
axial

71
Q

shoulder additional projections?

A

modified axial
Y-view scapula
clavicle
acromioclavicular joint views

72
Q

shoulder AP patient position?

A

patient is stood with their back to the IR
arm is in the true anatomical position with the palm facing forwards
patient is rotated 5-10 degrees towards the affected side (straight for trauma)
posterior aspect of the shoulder is in contact with the IR to reduce movement and magnification

73
Q

shoulder AP centering point?

A

central ray horizontal to IR
corocoid process

74
Q

collimation shoulder AP?

A

laterally = include skin margins
superiorly = skin margins
inferiorly = include 1/3 of the proximal humerus

75
Q

shoulder axial patient position?

A

patient is seated with the affected arm nearest to IR
affected arm is abducted and “stretched” across the IR
IR is underneath the axilla (the gleno-humeral joint over the IR)
legs should not be underneath the IR
head should be tucked towards the unaffected shoulder

76
Q

shoulder axial centering point?

A

central ray vertical to the IR
head of the humerus

application of imaging 1 (8 decks)

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