Upper Extremity

  1. Hand
    Projection - PA
    • Method: N/A
    • CR Size: 18x24cm or 24x30cm
    • Patient Position: Seated
    • Collimation: 1 inch (2.5cm) on all sides of the hand, including 1 inch (2.5cm) proximal to the ulnar styloid. 
    • Part Position: Place patien's forearm on table with the hand flat on palm surface. Center IR to MCP joints.
    • C/R: Perpendicular to 3rd MCP
    • Demonstrates: All anatomy distal to radius and ulna. No rotation of the hand. Open MCP and IP joint spaces. Soft tissue and bony trabeculae.
  2. Hand
    Projection - PA Oblique
    • Method: N/A
    • CR Size: 18x24 cm or 24x30 cm lw
    • Collimation: Same as PA Hand. 
    • Patient Position: Seated. 
    • Part Position: Place patient's forearm on table with the hand flat on palmar surface. Rotate hand externally. To Demonstrate IP joints keep fingers parallel to IR. 
    • C/R: Perpendicular to 3rd MCP. 
    • Demonstrates: Hand in 45* lateral rotation. Slight overlap of metacarpal bases and heads. Open IP and MCP joints, IP joints will not be open if digts are not parallel to IR. All anatomy distal to radius and ulna. 
    • Comments: Use gonadal shielding for all extremity projections. 14 phalanges, 5 metacarpals, and 8 carpals.
  3. Hand - Lateral Extension & Fan Lateral
    • Positioning: Place palmar surface of hand perpendicular to IR with ulnar side down. Extend/fan digits and abduct first digit from the palm.
    • Lateral Ext. Demonstrates: Superimposed phalanges, metacarpals, distal radius and ulna, and anterior and/or posterior fracture displacements. 
    • Fan Lateral Demonstrates: Superimposed metacarpals and distal radius and ulna. Demonstrates all of the individual phalanges.  
    • SID: Same as PA hand, 40 inches. 
    • IR: Same as PA hand. 18x24 cm or 24x30 cm.
    • Collimation: Same as PA hand.
    • 1 inch (2.5cm) on all sides of the shadow of the hand and thumb, including 1 inch (2.5cm) proximal to the ulnar styloid.
    • Comments: An alternative position to a lateral is positioned with the radial side down. However, this position is more difficult to assume. Lateral projections are referred to mediolateral or lateromedial, depending on the position of the hand. 
    • Remember to use gonadal shielding for all extrimity projections. 14 phalanges, 5 metacarpals, and 8 carpals.
  4. Wrist - PA
    • Positioning: Center anterior surface of wrist on the IR. Place wrist in close contact with IR by arching hand at the MCP joints. 
    • Reason: Fractures, foreign bodies, arthritis, bone age and other pathologic conditions.  
    • Demonstrates: All carpal bones, distal radius and ulna, and the proximal half of the metacarpals. 
    • SID: 40 inches
    • C/R: Directed perpendicular to the mid carpal area. 
    • IR: 8x10" (18x24cm) lengthwise or crosswise for two or more images on one IR. 
    • Grid: No
    • Collimation: 2.5 inches (6 cm) proximal and distal to the wrist joint and 1 inch (2.5 cm) on the sides. 
    • Comments: The PA and PA Oblique may be positioned with either ulnar deviation which will better demonstrate the scaphoid bone, or with radial deviation which will demonstrate the carpal interspaces on the medial side of the wrist. 
    • The Stetcher Method is another projection that best demonstrates the scaphoid bone. The CR is either angled 20' towards the wrist or kept perpendicular and the body part is elevated 20'.
  5. Wrist - PA Oblique
    • Positioning: From the PA, rotate wrist 45 degrees laterally. 
    • Demonstrates: Same as PA, except the carpals are rotated 45', this procedure best demonstrates the scaphoid and the trapezium.
    • SID: Same as PA, 40 inches
    • C/R: Same as PA, directed perpendicular to the mid carpal area. 
    • IR: 8x10" (18x24cm), or 10x12 (24x30cm) 
    • Grid: No
    • Collimation: Same as PA. 2.5 inches (6 cm) proximal and distal to the wrist joint and 1 inch (2.5 cm) on the palmar and dorsal surfaces. 
    • Comments: Same as PA.
  6. Wrist - Lateral
    • Positioning: Have patient flex elbow 90 degrees to rotate ulna to a lateral position and place wrist in a true lateral position. 
    • Demonstrates: Same as PA, except lateral demonstrates a lateral image of the carpals with superimposed radius and ulna and superimposed proximal metacarpals. 
    • SID: Sam as PA, 40 inches. 
    • C/R: Directed perpendicular to the wrist joint. 
    • Grid: No 
    • Collimation: Same as PA. Same as PA. 2.5 inches (6 cm) proximal and distal to the wrist joint and 1 inch (2.5 cm) on the palmar and dorsal surfaces. 
    • Comments: Same as PA.
  7. Wrist - Ulnar Deviation
    • Positioning: Position as PA wrist and turn hand outward until wrist is in extreme ulnar deviation. 
    • Demonstrates: Scaphoid without foreshortening and adjacent articulations open. 
    • SID: 40 inches
    • C/R: Perpendicular to scaphoid. Clear delineation of scaphoid bone may require 10'-15' C/R angle proximally or distally.
    • Collimation: Same as PA. 2.5 inches (6 cm) proximal and distal to the wrist joint and 1 inch (2.5 cm) on the palmar and dorsal surfaces.
  8. Wrist - Radial Deviation
    • Positioning: Position as PA wrist and turn hand medially until wrist is in extreme radial deviation. 
    • Demonstrates: Interspaces b/t carpals on medial side of wrist. 
    • C/R: Perpendicular to midcarpal area.
    • Collimation: Same as PA. 2.5 inches (6 cm) proximal and distal to the wrist joint and 1 inch (2.5 cm) on the palmar and dorsal surfaces.
  9. Wrist - PA Axial Stecher Method
    • Positioning: Position as PA, center wrist on the IR. Elevate finder end of IR 20'.
    • Demonstrates: Scaphoid free of superimposition. No rotation of carpals, metecarpals, radius, or ulna. Soft tissue and bony trabeculae. 
    • SID: 40 inches
    • C/R: Perpendicualr to scaphoid. Variation of C/R angles 20' degrees towards elbow with IR and wrist horizontal.
    • Collimation: Same as PA. 2.5 inches (6 cm) proximal and distal to the wrist joint and 1 inch (2.5 cm) on the palmar and dorsal surfaces.
  10. Digits 2nd-5th 
    Projection - PA
    • Method: N/A
    • CR Size: 18x24cm lw, or cw for two or more image on one. 
    • Collimation: 1 inch (2.5cm) on all sides of the digit, including 1 inch (2.5cm) proximal to the MCP joint.  
    • Patient Position: Seated
    • Part Positioned: Extend digit with palm side down. Center PIP joint of digit to IR. 
    • C/R: Perpendicular to PIP. 
    • Demonstrates: Entire digit from fingertip to distal metacarpal. No rotation of the digit. 
    • Open IP and MCP joints. Soft tissue and bony trabeculae.
  11. Digits 2nd-5th 
    Projection - Lateral
    • Method: N/A
    • CR Size: 18x24cm lw or cw, or more images on one.
    • Collimation: 1 inch (2.5cm) on all sides of the digit, including 1 inch (2.5cm) proximal to the MCP joint. 
    • Patient Position: Seated
    • Part Position: Extend affected digit and flex the rest into a fist. For 2nd and 3rd digits, rest hand on lateral surface. For 4th and 5th digits, rest hand on medial surface. IR is parallel to long axis of the digit. IR is centered to PIP joint.
    • C/R: Perpendicular to PIP
    • Demonstrates: Entire digit in true lateral.
    • No rotation. Open IP joint spaces. 
    • Include the MCP joint. Soft tissue and bony trabeculae.
  12. Digits 2nd-5th
    Projection - PA Oblique
    • Method: N/A
    • CR Size: 18x24cm lw or cw, or more images on one.
    • Collimation: 1 inch (2.5cm) on all sides of the digit, including 1 inch (2.5cm) proximal to the MCP joint.
    • Patient Position: Seated.
    • Part Position: Extend digit with palm side down. Center IR to IP. Rotate hand 45* externally with a foam wedge to support digit parallel to IR. 
    • C/R: Perpendicular to PIP
    • Demonstrates: Entire digit rotated 45* externally. Distal metacarpal. Open IP and MCP joint spaces. Soft tissue and bony trabeculae. ***Most common oblique projection for 2nd-5th digits.
  13. First Digit (Thumb)
    Projection -   AP
    • Method: N/A
    • CR Size: 18x24cm lw or cw, or more images on one.
    • Collimation: 1 inch (2.5cm) on all sides of the digit, including 1 inch (2.5cm) proximal to the CMC joint.
    • Patient Position: Seated.
    • Part Positioned: Place arm in extreme internal rotation. Rest thumb on IR and have pt. hold extended digits back. Center long axis of thumb parallel w/ IR.
    • C/R: Perpendicular to MCP joint. 
    • Demonstrates: Area from distal tip of thumb to trapezium. Open IP and MCP joint spaces. Soft tissues and bony trabeculae. 1st CMC joint.
  14. First Digit (Thumb)
    Projection - AP Axial
    • Method: Lewis Method
    • CR Size: 18x24cm lw or cw, or more images on one.
    • Collimation: 1 inch (2.5cm) on all sides of the digit, including 1 inch (2.5cm) proximal to the CMC joint.
    • Patient Position: Seated.
    • Part Positioned: Place arm in extreme internal rotation. Rest thumb on IR and have pt. hold extended digits back. 
    • Center long axis of thumb parallel w/ IR. 
    • C/R: CR angles 1-15* toward wrist though the MCP joint. 
    • Demonstrates: Area from distal tip of thumb to trapezium. Open IP and MCP joint spaces. Soft tissue and bony trabeculae. 1st CMC joint. 
    • ***Lewis method demonstrates the first metacarpal free of sesamoids and palmar soft tissue.
  15. First Digit (Thumb) 
    Projection - PA
    • Method: N/A
    • CR Size: 18x24cm lw or cw, or more images on one.
    • Collimation: 1 inch (2.5cm) on all sides of the digit, including 1 inch (2.5cm) proximal to the CMC joint.
    • Patient Position: Seated.
    • Part Positioned: Place hand in lateral position resting on medial surface. Place digit parallel with IR and support in place. Center MCP joint to IR. 
    • C/R: Perpendicular to MCP joint. 
    • Demonstrates: Area from distal tip of thumb to trapezium. Open IP and MCP joint spaces. Soft tissue and bony trabeculae. 1st CMC joint.
  16. First Digit (Thumb) 
    Projection - Lateral
    • Method: N/A
    • CR Size: 18x24cm lw or cw, or more images on one.
    • Collimation: 1 inch (2.5cm) on all sides of the digit, including 1 inch (2.5cm) proximal to the CMC joint.
    • Patient Position: Seated.
    • Part Positioned: Place hand on IR palmar side down in natural arched position. Center IR to MCP joint and place parallel with digit. Adjust arch of hand until thumb is in true lateral position. 
    • C/R: Perpendicular to MCP joint. 
    • Demonstrates: Area from distal tip of thumb to trapezium. Open IP and MCP joint spaces. Soft tissue and bony trabeculae. 1st CMC joint.
  17. First Digit (Thumb)
    Projection - PA Oblique
    • Method: N/A
    • CR Size: 18x24cm lw or cw, or more images on one.
    • Collimation: 1 inch (2.5cm) on all sides of the digit, including 1 inch (2.5cm) proximal to the CMC joint.
    • Patient Position: Seated.
    • Part Positioned: Place hand palmar side down on IR. Ulnar deviate hand slightly. Center IR to MCP joint and align the longitudinal axis of thumb with the long axis of the IR. 
    • C/R: Perpendicular to MCP joint. 
    • Demonstrates: Area from distal tip of thumb to trapezium. Open IP and MCP joint spaces. Soft tissue and bony trabeculae. 1st CMC joint.
  18. Forearm
    Projection - AP
    • Method: N/A
    • CR Size: 35x43 cm lw
    • Patient Position: Seated. 
    • Part Position: Entire limb on same plane. Supinate hand, extend hand, extend elbow, and center forearm to IR. ***True AP = epicondyles equidistant to IR.
    • C/R: Perpendicular to mid-forearm. 
    • Demonstrates: Entire radius and ulna. Elbow jt. Proximal carpals. Slight superimposition of radius and ulna. Soft tissue and bony trabeculae.
  19. Forearm 
    Projection - Lateral
    • Method: N/A
    • CR Size: 35x43 cm lw
    • Patient Position: Seated. 
    • Part Position: Entire limb on same place. Flex elbow 90* and center forearm to IR. Adjust limn in a true lat position with ulnar side down. Place humeral epicondyles perpendicular to IR. 
    • C/R: Perpendicular to mid forearm. 
    • Demonstrates: Distal humerus. Elbow jt. Proximal carpals. Superimposition of radius and ulna at proximal and distal ends. Elbow flexed 90*. Superimposed humeral epicondyles. Soft tissue and bony trabeculae.
Author
roadcrush
ID
334882
Card Set
Upper Extremity
Description
X-ray Positioning for Upper Extremity
Updated