The Hand Flashcards
Clinical indictions
Fracture
Dislocation
Post-op
OA or RA
Tumour lesion
Foreign body
Projections
ROUTINE
Dorsi-palmar (DP)
DP oblique
(Bilateral DP only if ?RA or OA)
ADDITIONAL
Lateral
Ball catchers
Room prep
- Correct patient & projection selected on control panel
- Chair placed parallel to end of table or vertical bucky flat - placed so affected side is nearest IR
Patient prep
ID checked
Clarification of clinical details
Explanation of procedure given
Informed consent obtained
LMP not required
Any jewellery in affected area removed
DP
POSITIONING
Hand placed on-top of IR (palm down)
Fingers thumb extended slightly apart
COLLIMATION
Distal phalanges, wrist joint, lateral soft tissue borders
CENTRING POINT
Over head of 3rd metacarpal
Check marker and parameters before exposing
DP oblique
POSITIONING
Externally rotated 45° (towards pinky) - pad used to help
Palm in contact with IR, fingers extended & separated
CENTRING POINT
Over head of 3rd metacarpal
COLLIMATION
Distal phalanges, wrist joint, lateral soft tissue borders
Image appraisal
ID & marker
ID
3 forms
Name, DOB, address
MARKER
Correct marker
Inside primary beam outside area of interest
Image appraisal
Collimation
Superiorly = soft tissue borders of distal phalanges
Inferiorly = distal portion of radius & ulna
Laterally = soft tissue borders side to side
Image appraisal
Projection & positioning
DP
Hand flat against IR, no rotation
No overlap of adjacent digits
Phalanges & metacarpals seen without foreshortening
Joint spaces seen
Thumb in oblique position
Image appraisal
Projection & postioning
Oblique
30-40° rotated
No superimposition of MC 1&2
Slight imposition of MC 3-5
No soft tissue overlap
Interphalangeal joints seen without flexion
Image appraisal
EXPOSURE FACTORS, PATHOLOGIES, ARTEFACTS, ADD, REPEAT
EXPOSURE FACTORS
Contrast & density adequate if boney cortex, trabecular and soft tissue margins can be seen - appear sharp
PATHOLIGIES
ARTIFACTS
Rings/jewellery
ADDITIONAL/REPEAT
Lateral
