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Application of imaging > imaging of the upper limb > Flashcards

imaging of the upper limb Flashcards

1
Q

What is a fracture and why do they occur?

A

-break or crack in a bone.
-Occurs when there is a transfer of energy through a bone that exceeds what that bone can cope with.

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2
Q

What type of injuries csan fractures occur from?

A

Fall onto outstretched hand (FOOSH), inversion, blunt trauma etc.

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3
Q

What are the two most common upper limb fractures.

A

-boxers fracture
-Colles fracture.

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4
Q

What is the SID (Distance from the tube to the detector) for upper limb x-rays?

A

100cm

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5
Q

Do we need to use grids for an upper limb x-ray? and why?

A

-No.
-Not a big enough area to generate enough scatter to justify the increased radiation dose

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6
Q

Name some hand clinical indications

A

☢OA/RA
☢Trauma (Punch injury, FOOSH, stab wounds)
☢Osteomyelitis
☢?Foreign Body (specific views – what are these?)
☢Follow-up imaging
☢Congenital abnormalities

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7
Q

What are the standard projections for a hand x-ray?

A

☢ DP (Dorsi palmar)
☢ Oblique
☢ Lateral

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8
Q

What are some additional hand projections?

A

☢ Finger views
☢ Thumb
☢ Ball catcher’s (Norgaard method)

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9
Q

What is the patients position in a hand DP?

A

*Patient seated at the side of the x-ray couch
*Elbow flexed; arm relaxed
*Palmar aspect of the hand placed on the image receptor

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10
Q

What is the centring point of a hand DP?

A

1.Central ray vertical  to the image receptor
2.Head of the 3rd metacarpal

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11
Q

What is the collimation of a hand DP?

A

*Laterally – include skin margins
*Proximally – include distal radioulnar joint
*Distally – include the tips of the distal phalange

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12
Q

What is the centering point of a finger DP?

A

*Central ray vertical  to the image receptor
*Between the heads of the two metacarpals (buddy fingers)

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13
Q

How do we collimate a finger DP?

A
  • Laterally – lateral margins of both fingers and metacarpals
  • Proximally – include distal radioulnar joint
  • Distally – include the tips of the distal phalanges
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14
Q

What is the patient position for a hand DP Oblique?

A

*Patient seated at the side of the x-ray couch
*Elbow flexed; arm relaxed
*Palmar aspect of the hand placed on IR
*Rotate the hand laterally 45degrees, ensuring the medial aspect of the hand is still in contact with the IR

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15
Q

What is the centring point of a hand DP Oblique?

A

*Central ray vertical  to the image receptor
*Head of the 3rd metacarpal

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16
Q

How do you collimate a hand DP Oblique?

A

☢Laterally – include skin margins
☢Proximally – include distal radioulnar joint
☢Distally – include the tips of the distal phalanges

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17
Q

How do you position a patient for a Lateral Hand?

A

*Patient seated at the side of the x-ray couch
*Lateral aspect of affected hand in contact with IR.
*Palmar aspect of the hand 90 degrees to the IR.
*Slightly abduct the thumb

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18
Q

What is the centring point of a lateral hand?

A

☢Central ray vertical  to the image receptor
☢Head of the 2nd metacarpal

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19
Q

How do you collimate for a lateral hand?

A

*Laterally – dorsal and palmar skin margins
*Proximally – include distal radioulnar joint
*Distally – include the tips of the distal phalanges

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20
Q

What is the centring point of a lateral finger?

A

*Central ray vertical  to the image receptor
*Over the proximal interphalangeal joint of the affected finger

21
Q

How do you collimate for a lateral finger scan?

A

*Laterally – lateral soft tissue margins
*Proximally – include metacarpophalangeal joint
*Distally – include the tip of the distal phalanx

22
Q

Why are interphalangeal joint spaces sometimes not clearly demonstrated?

A

Fingers may be flexed, extend to clear.

23
Q

Why can there sometimes be superimposition of the soft tissue outlines of fingers?

A

Fingers not separated adequately.

24
Q

What can you do if a patient is struggling to hold position, especially on the oblique view?

A

Assist them with a small 30 degree sponge

25
Q

What happens if the hand is externally elevated too much?

A

Extensive superimposition of the metacarpals on the oblique view.

26
Q

How do we centre for a ball catcher scan?

A

-Anterior bilateral projection
-Centring: between the two hands at the level of the metacarpophalangeal joints

27
Q

What is the patient position for a thumb PA.

A

☢Patient seated at the side of the x-ray couch
☢Elbow extended
☢Posterior aspect of the thumb on the image receptor

28
Q

centring point of the thumb PA

A

*Central ray vertical ò to the image receptor
*Over 1st metacarophalangeal joint

29
Q

How do we collimate for a thumb PA

A

*Laterally – include skin margins
*Proximally – carpometacarpal joint
*Distally – distal phalanx

30
Q

How do we position a patient for a thumb lateral?

A

☢Patient seated at the side of the x-ray couch
☢Elbow flexed; arm relaxed
☢Palmar aspect of the hand raised off the IR (can use pads to assist) so that thumb is lateral

31
Q

what is the centring point of a lateral thumb?

A

☢Central ray vertical ò to the image receptor
☢Over 1st metacarophalangeal joint

32
Q

How do we collimate for a lateral thumb?

A

*Laterally – include skin margins
*Proximally – carpometacarpal joint
*Distally – distal phalanx

33
Q

What are the standard and additional projections of the wrist?

A

standard:
-DP
-Lateral
Additional:
-Scaphoid projections
-oblique wrist.

34
Q

Patient position for a wrist PA?

A

☢Patient seated at the side of the x-ray couch
☢Elbow flexed; arm relaxed
☢Palmar aspect of the hand placed on the IR but place fingers slightly curled (or over the top edge of the image receptor if not using a wallstand)

35
Q

Whats the centring point for a wrist PA?

A

*Central ray vertical ò to the image receptor
*Midway between the radial & ulna styloid processes

36
Q

How do we collimate for a wrist PA?

A

*Laterally – include skin margins
*Proximally – distal 1/3 radius and ulna
*Distally – heads of metacarpals

37
Q

What is the acronym used to describe the carpal bones?

A

-Some- scaphoid
-lovers-lunate
-try- triquetrum
-positions- pisiform
-that-trapezium
-they-trapezoid
-cannot-capitate
-handle-hamate

38
Q

Patient position for wrist lateral?

A

☢From the PA position, externally rotate the arm until the ulnar aspect of the hand/wrist is in contact with image receptor
☢Extend fingers
☢Palmar aspect of the hand is perpendicular to the IR.

39
Q

What is the centring point of a wrist lateral?

A

*Central ray vertical  to the image receptor
*Radial styloid process

40
Q

How do we collimate for a wrist lateral?

A

☢Laterally – dorsal and palmar skin margins
☢Proximally – distal 1/3 radius and ulna
☢Distally – heads of metacarpals

41
Q

Standard and additional projections for Radius and Ulna?

A

Standard projections
☢ AP/PA
☢ Lateral
Additional projections
☢ Joint specific projections if unclear from initial imaging

42
Q

patient position for Radius and Ulna AP?

A

☢Patient seated with affected side next to the x-ray couch without placing legs underneath
☢Affected arm abducted and extended and placed on image receptor
☢Arm supinated with wrist and elbow and shoulder in same horizonal plane (all the same height)
☢Humeral epicondyles and styloid processes equidistant (Cant be rotated one way or the other) from imaging plate

43
Q

What is the centring point for Radius and ulna AP?

A

*Central ray vertical to the image receptor
*Midway between elbow and wrist

44
Q

How do we collimate for a radius and ulna AP?

A
  • Laterally – include skin margins
  • Proximally – elbow joint
  • Distally – wrist joint
45
Q

What is the patient position for a radius and ulna lateral?

A

☢From the AP position, flex the elbow 90 degrees and medially rotate the arm so that the ulnar aspect is in contact with the imaging receptor
☢Ensure wrist, elbow and shoulder are in the same transverse plane
☢Palmar aspect of the hand should be 90 degrees to the image receptor
☢Humeral epicondyles and styloid processes superimposed

46
Q

what is the centring point for radius and ulna lateral?

A

*Central ray vertical to the image receptor
*Midway between elbow and wrist

47
Q

How do we collimate for a radius and ulna lateral?

A
  • Laterally – include skin margins
  • Proximally – elbow joint
  • Distally – wrist joint
48
Q
A

Application of imaging (11 decks)

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