Hand

PA HAND

100

What is the Central Ray for a PA projection of the hand and what should be included?

CR perpendicular to IR and directed to third MCP joint. PA projection of the entire hand and wrist and about 1 inch of distal forearm is visible.

200

Is this a good positioning for a PA hand?

Yes, Soft tissues of digits 2-5 are uniform, equal concavities of shaft of metacarpals and phalanges of digit 2 through 5, all pertinent anatomy is included. Marker is visible.

300

Is this a good positioning and centering for a PA hand?

No, centered to proximal, artifact present

400

Eval this image. Would you repeated or not? Explain

Yes. Clipping anatomy, rotation, no marker

500

Label anatomy

A. distal phalanx 1st digit B. Interphalangeal joint (IP) C. Proximal phalanx 1st digit D. metacarpophalangeal joint (MCP) E. 1st metacarpal F. carpometacarpal joint G. distal phalanx 5th digit H. distal interphalangeal joint 5th digit (DIP) I. Middle phalanx, J. Proximal interphalangeal joint (PIP) K. proximal phalanx L. Metacarpophalangeal joint M. Metacarpal N. Carpometacarpal joint.

OBLIQUE

100

Is the head of the metacarpal the distal or the proximal end of the metacarpal?

The head of the metacarpal is the distal end, the proximal end is the base of the metacarpal.

200

What is the proper technique for a PA Oblique hand?

55-65 kv @ 3 mas

300

Is this an optimal PA Oblique hand? What is the proper centering/positioning for this projection?

Yes this is an optimal PA Oblique hand. The central ray should be perpendicular to the IR, centered at the third MCP joint. The hand should be pronated, obliqued 45 degrees externally with digits separated and parallel to the IR.

400

Is this a good PA Oblique? Explain.

The obliquity is good, but the digits need to be separated to prevent soft tissue and bony overlap. Also, there should be a third of the distal radius and ulna included.

500

Is this an optimal PA Oblique? If not, why and would you repeat?

No, the hand is overobliqued since the third through fifth metacarpal shafts are superimposed. Also, the joint spaces appear closed and the phalanges are slightly foreshortened (1st & 2nd digits) therefore the digits were not parallel to the IR. Yes, this is repeatable.

LATERAL

100

Not including the hand position, how else and where should the patient themselves be positioned for hand x-rays?

Patient should be seated at the end of the table or beside the horizontal wall bucky with their legs not under the table (with a shield on their lap). Their elbow should be flexed 90 degrees with their hand and forearm lying on the same plane.

200

What is the proper centering/positioning for a Lateral hand?

The central ray is perpendicular to the IR, centered at the 2nd MCP joint. The hand and wrist are resting on their medial side (thumb side up) so that they are in a true lateral. Fan out fingers so they are not superimposed and making a straight-fingered “ok” sign. Be sure digits are parallel to the IR and are as separated from each other as possible.

300

Is this good positioning for a lateral hand? Why?

It is not an optimal lateral. The metacarpals are not superimposed, the hand is externally rotated and the CR is not centered at the 2nd MCP joint.

400

Is this a good lateral hand? Explain. Repeatable?

Yes, the metacarpals are entirely superimposed and the digits are fanned. The third and fourth digits are slightly superimposed, however, for some patients it may be difficult to separate further. It is not repeatable.

500

Is this an ideal lateral? Explain. If it is not, what projection is this?

No, the digits are superimposed and must be fanned out. This is an example of an extension lateral hand projection.