The Hand

Question 1

Indications of the hand

Answer 1

• trauma to rule out fracture or dislocation
• Foreign body
• Pathology

Question 2

Basic projections

Answer 2

1. PA (dorsi-palmar)
2. PA oblique
3. Lateral

Question 3

Which projections of the hand are done to rule out foreign body.

Answer 3

• PA
• Lateral

Question 4

What projections are carried out when ruling out the fracture of the hand.

Answer 4

• PA oblique
• PA

Question 5

Dorsi-palmar patient position

Answer 5

• seat the patient along the x-ray couch
• Rest the patient’s forearm on the x-ray table with the palmar aspect in contact with the IR
• Flex the elbow 90 degrees so the long axis of the IR should be parallel to the long axis of the forearm.
• The fingers are extended and slightly separated.
• The center of the unmasked area should be aligned with the head of the 3rd metacarpal
• Collimate the beam including the phalanges, metacarpal wrist joint and surrounding soft tissues.

Question 6

Centering point of dorsi-palmar projection and direction of Centra ray.

Answer 6

• the central ray is centered over the head of the third metacarpal.
• Vertical ray at 90 degrees to the IR

Question 7

Image evaluation criteria for dorsi-palmar projection of the hand

Answer 7

• evidence of proper collimation
• Anatomy from fingertips to distal ulna and radius, including soft tissue, phalanges,
• No tissue overlap
• No evidence of rotation
• Soft tissue and bony trabeculae detail

Question 8

Dorsi-palmar oblique

Answer 8

• from dorsi-palmar projection, the patient’s hand is rotated 45 degrees and is supported with a foam pad
• The media aspect is in contact with the IR
• The fingers are separated and slightly flexed
• The thumb is supported by a foam pad
• The head of the 3rd metacarpal is on the middle of the unexposed half of the IR.

Question 9

Dorsi-palmar oblique centering point

Answer 9

Over the head of the 3rd metacarpal

Question 10

Direction of central ray in dorsi-palmar oblique

Answer 10

Vertical ray at 90 degrees to the IR

Question 11

Image evaluation criteria for dorsi-palmar oblique

Answer 11

• evidence of proper collimation
• Bony trabeculae detail
• Evidence of 45 degrees rotation of the anatomy: minimal overlap of 3rd, 4th and 6th metacarpal bodies.
• Open interphalangeal and metacarpal joints

Question 12

Lateral projection of the hand
Patient positioning

Answer 12

• seat the patient along the x-ray couch
• Rest the patient’s forearm on the image receptor and flex it 90 degrees.
• From the Dorsi-palmar projection, rotate the arm 90 degrees until the medial aspect of the hand are in full contact with the IR.
• Fingers extended with thumb abducted and is rested on a foam bad.
• The head of the 2nd metacarpal is coincident with the center for the cassette.

Question 13

Lateral projection of the hand centering point and direction of central ray

Answer 13

Cr directed to the head of the 2nd metacarpal,

Cr is directed vertical 90 degrees to the IR

Question 14

Image evaluation criteria for lateral projection of the hand

Answer 14

• evidence of proper collimation
• Anatomy from fingertips to distal radius and ulnar
• Evidence of hand in true lateral position.
• Thumb free of motion and superimposition.
• Soft tissue and bony trabeculae detail