What is the PA Hand Image Criteria?
• The distance between the metacarpal heads should be 4.5mm on the right and 4.6mm on the left sides.
• How should the mid-shaft concavity appear on the medial and lateral sides of the phalanges and metacarpals? The anterior surface of the proximal phalanx should be concave, while the posterior should be convex.
• Should there be an overlap of soft tissues on adjacent digits? There should be no overlapping of the soft tissues on the adjacent digits
• Which joint spaces should be open? At least one joint space should be visible in relation to the suspected bone injury
• The goal is to demonstrate the phalanges without foreshortening. How is this accomplished? A radiograph of the anterior-posterior projection of the foot is usually conducted.
• What is the degree of the obliquity of the thumb on a PA hand? 45 degrees
• What joint should be in the center of the image? Metacarpophalangeal Joint
• What anatomy must be included?
The phalanges, metacarpals, carpals, and 1 inch (2.5cm) of the distal radius and ulna are included within the collimated field.
What is the Oblique Hand Image Criteria?
• What is the degree of rotation for the oblique hand?
45 Degrees from the rotated hand. Rotated in an Anterior-posterior direction.
• Which joints should be open? Distal phalanx joints. What is necessary to avoid foreshortening of the phalanges? Proper positioning of the hand is recommended.
• Should the concavities of the 2nd – 5th metacarpals be equal? Yes.
• What joint should be open?
• Which metacarpal heads are not demonstrated in the center of superimposed? the exposure field?
• Which metacarpal shafts will show some overlap?
• What anatomy must be included?
• Should the image of soft tissue overlap of adjacent digits?
What is the Lateral Hand in fanned position?
• How should the 2nd – 5th digits be spaced on the image?
• Where should the thumb be demonstrated on the image?
• How should the 2nd – 5th metacarpals appear on the image?
• What joints should be open?
• What anatomy must be included?
PA Oblique Projections
What is wrong in these images?
Critique this fanned lateral hand image.
What is PA Wrist Criteria?
• How do you check for rotation?
• How should the radioulnar articulation appear?
• Which intercarpal joints should be open (proximal or distal)?
• Why is it essential to see soft tissues?
• There will be the superimposition of carpals –
• What will superimpose on the triquetrum?
• What will superimpose the trapezoid?
What is PA Oblique Wrist Criteria?
• What is the degree of obliquity for the wrist oblique? Why is this necessary?
• Will there be an overlap of the distal radius and ulnar head?
• Which metacarpals will demonstrate superimposition?
What is Lateral Wrist Criteria?
• What anatomy must be included?
• How should the thumb be aligned in reference to the metacarpals?
• How do you check for rotation?
• What soft tissue structures can indicate a fracture of the distal radius?
Critique this image
What is AP Forearm Criteria?
• What anatomy must be included?
• How should the styloid processes of the radius and ulna be demonstrated?
• How will the radial tuberosity be demonstrated, in a a frontal or profile view?
• Where will the olecranon process be shown?
• Will the radial head, neck, and tuberosity superimposition be evident over the proximal ulna?
• Will the elbow joint be fully opened?
• How should the epicondyles de demonstrate?
• Why is it important to visualize soft tissues?
What is the main positioning error here?
What is Lateral Forearm Criteria?
• What anatomy must be included?
• What structures should be superimposed?
• Which direction will the radial tuberosity face (anteriorly or posteriorly)?
• What is essential to demonstrate in the soft tissue area?
What is AP Elbow Criteria?
• Where is the radial head, neck, and tuberosity positioned on the image relative to the proximal ulna?
• How should the humeral epicondyles visualize on the image?
• What anatomy should be in the center of the IR, and how should it appear?
What is Lateral Elbow Criteria?
• What anatomy should be in the center of the IR, and how should it appear?
• What angle should form between the humerus and the forearm form? Carrying angle, which usually varies in all genders,175-degree male and 165 degrees in females.
• How should the humeral epicondyles visualize on the image?
• How should the radial tuberosity face be?
• What anatomical structure does the radial head superimpose over in the image?
• How should the olecranon process be visualized in the image?
• What soft tissue structures should be visualized to indicate potential fracture?
What is the image criteria for AP?
Oblique – Medial Rotation
• How should the coronoid process be demonstrated in the image? Demonstrated using an elbow internal oblique view
• What should the ulna be superimposed by on the image? Olecranon of the ulna within the distal humeral condyle
• Where should the olecranon process be situated in the image (within what anatomical structure)? Over the posterior surface of the humerus.
What is the criteria for AP oblique – Lateral Rotation?
• How should the radial head, neck, and tuberosity be demonstrated on the image? Lateral to the coronoid process
• Which aspect of the elbow joint should be fully opened? Middle radioulnar articulation
AP oblique – Is this positioned well? Why?
What is the criteria for an AP Projection – Partial Flexion
• What is the objective of perform 2 partial flexion AP projections of the elbow for a patient who cannot fully extend the elbow? To demonstrate the elbow joint extension mobility.
• What is demonstrated when the humerus is placed parallel to the IR? The projection reveals that the humerus is in a natural anatomical position.
• What is demonstrated when the forearm is placed parallel to the IR? When the elbow joint is in its natural anatomical position allowing for assessment of suspected dislocations or fracture.
