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Application of imaging > Upper limb imaging > Flashcards

Upper limb imaging Flashcards

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1
Q

Why do fractures happen?

A
  • A fracture is the scientific and medical term for a break or crack in a bone

-They occur when there is a transfer of energy through a bone that exceeds what that bone can cope with

-Where a fracture occurs depends on two things – where the bone is weakest and where the majority of the force is applied

-This refers to the method by which an injury occurs

-Fall on outstretched hand, inversion, blunt trauma etc

-Fractures tend to follow patterns so the MOI can give us a hint as to what kind of fracture is most likely to have occurred

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2
Q

What is the SID (source image receptor distance) for upper limb x-rays?

A
  • 100cm is the distance from tube to detector
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3
Q

Do we need to use grids for upper limbs?

A
  • No
  • Not a big enough area to generate enough scatter to justify the increased radiation dose
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4
Q

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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5
Q

Hand projections

A

Standard:
-DP
-Oblique
-Lateral

Additional
-Finger views
-Thumb
-Ballcatchers (Norgaard method)

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6
Q

Hand: DP patient position

A
  • Patient seated at the side of the x-ray couch
  • Elbow flexed; arm relaxed
  • Palmer aspect of the hand placed on the image receptor
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7
Q

Hand: DP Centring points

A
  • Central ray vertical to the image receptor
  • Head of the 3rd metacarpal
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8
Q

Hand: DP Collimation

A

Laterally- include skin margins

Proximally- include distal radioulnar joint

Distally- include the tips of the distal phalanges

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9
Q

Fingers: DP Centring point

A
  • Central x-ray vertical to the image receptor
  • Between the heads of the two metacarpals (buddy fingers)
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10
Q

Fingers: DP Collimation

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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11
Q

Hand: DP Oblique Patient position

A
  • Patient seated at the side of the x-ray couch
  • Elbow flexed; arm relaxed
  • Palmar aspect of the hand placed on the receptor image
  • Rotate the hand laterally 45 degrees, ensuring the medial aspect of the hand is still in contact with the image receptor
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12
Q

Hand: DP Oblique Centring point

A
  • Central ray vertical to the image receptor
  • Head of the 3rd metacarpal
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13
Q

Hand: DP Oblique Collimation

A

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

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14
Q

Hand: Lateral Patient position

A

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

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15
Q

Hand: Lateral Centring point

A

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

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16
Q

Hand: Lateral Collimation

A

Laterally- dorsal and palmar skin margins

Proximally- include distal radioulnar joint

Distally- include the tips of the distal phalanges

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17
Q

Fingers: Lateral Centring point

A
  • Central ray vertical to the image receptor
  • Over the proximal interphalangeal joint of the affected finger
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18
Q

Fingers: Lateral Collimation

A

Laterally- lateral soft tissue margins

Proximally- include metacarpophalangeal joint

Distally- include the tip of the distal phalanx

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19
Q

Hand top tips: Common error- Interphalangeal joint spaces are not clearly demonstrated. Why?

A

Fingers may be flexed; extend to clear

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20
Q

Hand top tips: Common error- Superimposition of soft tissue outlines of fingers. Why?

A

Fingers not seperated adequately

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21
Q

Hand top tips: Common error- Patients struggling to hold position, especially on the oblique view. Why?

A

Assist them with a small 30 degree sponge

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22
Q

Hand top tips: Common error- Extensive superimposition of the metacarpals of the oblique view

A

The Hand is externally elevated too much

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23
Q

Why is a ball catcher projection performed and what is its centring?

A

To see a different perspective of the joints.
-Anterior bilateral projection
-Centring: between the two hands at the level of the metacarpophalangeal joints

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24
Q

Thumb: PA Patient position

A

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

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25
Thumb: PA Centring point
- Central ray vertical to the image receptor - Over 1st metacarophalangeal joint
26
Thumb: PA Collimation
Laterally- include all skin margins Proximally- carpometacarpal joint Distally- distal phalanx
27
Thumb: Lateral Patient position
☢Patient seated at the side of the x-ray couch ☢Elbow flexed; arm relaxed ☢Palmar aspect of the hand raised off the image receptor (can use pads to assist) so that thumb is lateral
28
Thumb: Lateral centring point
- Central ray vertical to the image receptor - Over 1st metacarophalangeal joint
29
Thumb: Lateral Collimation
Laterally- include skin margins Proximally- Carpometacarpal joint Distally- distal phalanx
30
Wrist- Clinical indications
☢ OA/RA ☢ Trauma (FOOSH) ☢ Osteomyelitis ☢ ? Foreign Body ☢ Follow-up imaging
31
Wrist- projections
Standard projections ☢ DP ☢ Lateral Additional projections ☢ Scaphoid projections – oblique/zitters or banana ☢ Oblique Wrist
32
Wrist- PA Patient position
☢ Patient seated at the side of the x-ray couch ☢ Elbow flexed; arm relaxed ☢ Palmar aspect of the hand placed on the image receptor but place fingers slightly curled (or over the top edge of the image receptor if not using a wallstand)
33
Wrist- PA Centring point
- Central ray vertical to the image receptor - Midway between the radial & ulna styloid processes
34
Wrist- PA Collimation
Laterally- include skin margins Proximally- distal 1/3 radius and ulna Distally- heads of metacarpals
35
Carpal bones
scaphoid lunate triquetrum pisiform trapezium trapezoid capitate hamate
36
Wrist: lateral Patient position
☢ 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 image receptor
37
Wrist: lateral Centring point
- Central ray vertical to the image receptor - radial styloid process
38
Wrist: lateral Collimation
☢ Laterally – dorsal and palmar skin margins ☢ Proximally – distal 1/3 radius and ulna ☢ Distally – heads of metacarpals
39
PA wrist with ulnar deviation
☢ Position as for a PA wrist. ☢ Ulnar deviation of the wrist (laterally) as far as possible
40
PA Axial (Zitters/banana projection)
- Position as for PA wrist, angle tube 30degrees towards elbow - Centre to the anatomical snuff box - Ensure ulnar deviation - 10 days after initial presentation – blood supply
41
Wrist- PA Oblique Patient position
- From the DP position externally rotate arm until ulnar aspect of the hand/wrist is in contact with the image receptor -Palmar aspect of the hand/wrist 45degrees to the image receptor - Support with 45degree radiolucent pad if necessary - Extend fingers
42
Wrist- PA Oblique Centring point
- Central ray vertical to the image receptor - Midway between the radial & ulnar styloid processes
43
Wrist- PA Oblique Collimation
☢ Laterally – include skin margins ☢ Proximally – distal 1/3 radius and ulna ☢ Distally – heads of metacarpals
44
RADIUS & ULNA – CLINICAL INDICATIONS
☢ Trauma (FOOSH, guarding) ☢ Osteomyelitis ☢ ? Foreign Body ☢ Follow-up imaging ☢ Imaging for fracture alignment
45
RADIUS & ULNA - PROJECTIONS
Standard projections ☢ AP/PA ☢ Lateral Additional projections ☢ Joint specific projections if unclear from initial imaging
46
RADIUS & ULNA – AP Patient position
☢ 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 ☢ Humeral epicondyles and styloid processes equidistant from imaging plate
47
RADIUS & ULNA – AP Centring point
- Central ray vertical to the image receptor - Midway between the elbow and wrist
48
RADIUS & ULNA – AP Collimation
Laterally – include skin margins Proximally – elbow joint Distally – wrist joint
49
RADIUS & ULNA – LATERAL Patient position
☢ 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
50
Radius and ulna- lateral Centring point
- Central ray vertical to the image receptor - Midway between the elbow and wrist
51
Radius and ulna- lateral Collimation
Laterally – include skin margins Proximally – elbow joint Distally – wrist joint
52
ELBOW – CLINICAL INDICATIONS
☢ OA/RA ☢ Trauma ☢ Pain & swelling ☢ Osteomyelitis ☢ ? Foreign Body ☢ Follow-up imaging ☢ Inability to straighten
53
ELBOW – PROJECTIONS
Standard projections ☢ DP ☢ Lateral Additional projections ☢ Radial head views
54
ELBOW– AP Patient position
☢ Patient seated with their affected side next to the x-ray table without placing legs underneath ☢ Affected arm abducted and extended and placed on image receptor ☢ Arm supinated with wrist, elbow and shoulder in the same horizontal place ☢ Humeral epicondyles equidistant from image receptor
55
ELBOW– AP Centring point
Central ray vertical to the image receptor Midway between humeral epicondyles and 2.5cm distally
56
ELBOW– AP Collimation
Laterally- include all skin margins proximally- distal 1/3 of humerus Distally- proximal 1/3 of radius and ulna
57
Elbow- Lateral Patient position
☢ From the AP position, flex the elbow to 90 degrees and medially rotate the arm so that the ulnar aspect is in contact with the image receptor ☢ Ensure the 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 superimposed
58
Elbow- Lateral Centring point
Central ray vertical to the image receptor Over the lateral humeral epicondyle
59
Elbow- Lateral Collimation
Laterally- include all skin margins proximally- distal 1/3 of humerus Distally- proximal 1/3 of radius and ulna
60
HUMERUS – CLINICAL INDICATIONS
☢ Trauma ☢ Osteomyelitis ☢ ? Foreign Body ☢ Follow-up imaging
61
HUMERUS – PROJECTIONS
Standard projections ☢ DP ☢ Lateral Additional projections ☢ Joint specific projections if unclear from initial imaging
62
HUMERUS – AP Patient position
☢ Patient is stood with their back to the image receptor. ☢ The arm is in the true anatomical position, palm facing forwards ☢ The posterior aspect of the upper arm should be in contact with the image receptor to reduce movement and magnification
63
HUMERUS – AP Centring point
Central ray horizontal to the image receptor Middle of the humerus on the anterior aspect of the upper arm, midway between the shoulder and elbow joints
64
HUMERUS – AP Collimation
Laterally- include skin margins Superiorly- The skin margin above the glenohumeral joint Inferiorly- include the distal humerus including the elbow joint
65
HUMERUS – Lateral (PA) Patient position
☢ Patient is stood facing the image receptor ☢ The elbow is flexed so that the palm of the hand rests on the anterior abdominal wall ☢ The anterior aspect of the upper arm should be in contact with the image receptor to reduce movement and enlargement ☢ The patient should be rotated so that the lateral aspect of the shoulder of the affected side, the upper arm and elbow are all in contact with the image receptor
66
HUMERUS – Lateral (PA) Centring point
Central ray horizontal to the image receptor (PA) Middle of the humerus shaft, on the medial aspect of the upper arm, midway between the shoulder and elbow joints (AP) Middle of the humerus shaft, on the lateral aspect of the upper arm, midway between the shoulder and elbow joints
67
HUMERUS – Lateral (PA) Collimation
Laterally- include skin margins Superiorly- The skin margin above the glenohumeral joint Inferiorly- include the distal humerus including the elbow joint
68
SHOULDER – CLINICAL INDICATIONS
☢ Trauma ☢ Osteomyelitis ☢ ? Foreign Body ☢ Follow-up imaging ☢ OA ☢ Obvious deformity ☢ Limited ROM
69
SHOULDER - PROJECTIONS
Standard projections ☢ AP ☢ Axial Additional projections ☢ Modified Axial ☢ Y-view Scapula ☢ Clavicle ☢ Acromioclavicular joint views
70
Shoulder- AP Patient position
☢ Patient is stood with their back to the image receptor ☢ The arm is in the true anatomical position with the palm facing forwards ☢ The patient is rotated 5-10 degrees towards the affected side (straight for trauma) ☢ The posterior aspect of the shoulder is in contact with the image receptor to reduce movement and magnification
71
Shoulder- AP Centring point
Central ray horizontal to the image receptor Corocoid process
72
Shoulder- AP Collimation
Laterally- include skin margins Superiorly- skin margins inferiorly- include 1/3 of the proximal humerus
73
SHOULDER – Axial Patient position
☢ Patient is seated with the affected arm nearest to the image receptor ☢ The affected arm is abducted and ”stretched” across the image receptor ☢ The image receptor is underneath the axilla (the gleno-humeral joint over the image receptor) ☢ Legs should not be underneath the image receptor ☢ The head should be tucked towards the unaffected shoulder
74
SHOULDER – Axial Centring point
Central ray vertical to the image receptor Head of the humerus
75

Application of imaging (7 decks)

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