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Friday 28 September 2012

Study of the Hand



PA Projection


  1. Seat the patient at the end of the table;
  2. Lower limbs remote from the radiation;
  3. Support the forearm and arm;
  4. Hand in pronation with the fingers in extension;
  5. The palmar surface of the hand resting on IP;
  6. Spread the fingers slightly.

Central ray perpendicular to the third MCP joint.



 Evaluation Criteria:

  • No rotation;
  • Hand centered and aligned with the center of collimation;
  • Visualization of a distal third of the forearm, wrist joint and distal phalanges;
  • Open MCP and interphalangeal joints, indicating that the hand is placed flat on the IP;
  • Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).


PA oblique Projection


  1. Seat the patient at the end of the table;
  2. Lower limbs away from the radiation;
  3. Forearm resting on the table;
  4. Hand in oblique position so that all digits are free of overlapping and profile;
  5. Adjust the obliquity of the hand so that the MCP joints form an angle of approximately 45º with IP.
Central ray perpendicular to the third MCP joint.

 Evaluation Criteria:


  • Visualization of a distal third of the forearm, wrist joint and distal phalanges;
  • Slight overlap of the bases and heads of the metacarpals (2nd to 5th);
  • Spaces between the third, fourth and fifth metacarpals reduced;
  • Opening interphalangeal and metacarpophalangeal joints;
  • Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).


 

Study of the Thumb (First Digit)



PA Projection


  1. Seat the patient at the end of the table;
  2. Lower limbs away from the radiation;
  3. Hand in profile position;
  4. The remaining digits away from the thumb.
Central ray is perpendicular to the interphalangeal joint or metacarpophalangeal.

 

Evaluation Criteria:

  • No rotation of the thumb;
  • View all the digit including the metacarpophalangeal (MCP) joint;
  • Open interphalangeal and MCP joint spaces without overlap of the bones;
  • Digit centered and aligned in the center of collimation;
  • Not visualization the soft tissue of adjacent fingers;
  • Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).
 

Lateral Projection


  1. Seat the patient at the end of the table;
  2. Lower limbs remote from the radiation;
  3. Support the forearm and arm;
  4. The side of the thumb resting on the IP;
  5. Flexion of the fingers.
Central ray is perpendicular to the interphalangeal joint or metacarpophalangeal.



Evaluation Criteria:

  • Thumb strictly in profile;
  • View all the digit including the metacarpophalangeal joint;
  • Open interphalangeal and MCP joint spaces;
  • Finger centered and aligned in the center of collimation;
  • Not visualization the soft tissue of adjacent fingers;
  • Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).