The Wrist Flashcards
Projections
ROUTINE
PA
Lateral
ADDITIONAL
PA/AP oblique
PA with ulna deviation (and 30° cranial angulation)
MODIFIED
HBL (trauma)
Room Prep
Correct patient & projection selected on control panel
Chair placed parallel to end of table/vertical bucky flat
Chair placed at affected site
Patient prep
ID checked
Clarification of clinical details
Explanation of procedure
Informed consent obtained
LMP not required
Remove any jewellery from affected area
PA wrist
POSITIONING
Wrist/hand placed on-top of IR palm down
Fingers & thumb extended & separated
CENTRING POINT
Midway between radial & ulnar styloid processes
COLLIMATION
Proximal 1/3 MC, distal 1/3 R&U, lateral soft tissue borders
SID=100cm, Marker placed in beam
Lateral
POSITIONING
Hand externally rotated 90° (towards pinky) - extra 5° to ensure superimposition of R&U styloid processes
Medial aspect of wrist in contact with IR
CENTRING POINT
Over radial styloid process
COLLIMATION
Proximal 1/3 MC, distal 1/3 R&U, lateral soft tissue borders
Image appraisal
ID & MARKER
ID
3 forms
Name, DOB, Address
Marker
Correct marker
Inside beam, outside area of interest
Image appraisal
COLLIMATION
4 sides
Superiorly = proximal 1/2 of MC (1-5)
Inferiorly = distal 1/3 of radius & ulna
Side to side = soft tissue margins
Image appraisal
PROJECTION & POSITIONING
PA
Wrist flat against IR, no rotation
Radius & ulna styloid processes seen in profile
Distal radioulnar joint is open
Carpals seen in centre of collimation
Image appraisal
PROJECTION & POSITIONING
Lateral
Distal ends of radius & ulna superimposed
The capitate, lunate and radius in line with each other
MC 2-5 reasonably superimposed
Image appraisal
EXPOSURE FACTORS, PATHOLOGIES, ARTEFACTS, ADD, REP
EXPOSURE FACTORS
Contrast & density adequate if boney cortex, tribeculae & soft tissue margins seen - appear sharp
PATHOLOGIES
ARTEFACTS
Jewellery
ADDITIONAL/REPEAT
Scaphoid series
