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upper extremity
bontrager
| Question | Answer |
|---|---|
| What are the four main groups of bones in the upper limb? | 1) Hand and wrist, 2) Forearm, 3) Arm (humerus), 4) Shoulder girdle |
| How many bones are in each hand and wrist? | 27 bones |
| What are the three groups of bones in the hand and wrist? | 1) Phalanges, 2) Metacarpals, 3) Carpals |
| What is the joint between the two phalanges of the thumb called? | Interphalangeal (IP) joint |
| What is the first metacarpophalangeal (MCP) joint? | The joint between the first metacarpal and the proximal phalanx of the thumb |
| How many phalanges does each finger (2nd to 5th digits) have? | Three phalanges: distal, middle, and proximal |
| What are the names of the joints in each finger? | Distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint, and metacarpophalangeal (MCP) joint |
| What are the carpometacarpal (CMC) joints? | The joints where the metacarpals articulate with the carpals |
| Which metacarpal articulates with the trapezium? | First metacarpal |
| Which metacarpal articulates with the trapezoid? | Second metacarpal |
| Which metacarpal articulates with the capitate? | Third metacarpal |
| Which metacarpals articulate with the hamate? | Fourth and fifth metacarpals |
| What is the structure of a phalanx? | Each phalanx consists of a distal rounded head, a body (shaft), and an expanded base |
| What is the structure of a metacarpal? | Each metacarpal has a head, body (shaft), and base |
| What is the significance of joint identification in radiology? | Accurate identification is crucial to detect small chip fractures near joint spaces |
| What is the PA projection in radiography? | A posteroanterior projection that shows the phalanges and metacarpals of the hand |
| What are the components of the wrist? | The wrist consists of eight carpal bones |
| What is the anatomical position of the first metacarpal? | It is located on the thumb or lateral side when the hand is in the anatomical position |
| What is the role of the proximal phalanx in the thumb? | It connects the thumb to the first metacarpal at the MCP joint |
| What is the importance of understanding the shape and structure of upper limb bones? | It allows technologists to identify and demonstrate each part on radiographs |
| What is the total number of phalanges in both hands? | 14 phalanges (2 in the thumb and 12 in the other four fingers) |
| What is the total number of metacarpals in both hands? | 10 metacarpals (5 in each hand) |
| What is the total number of carpals in both wrists? | 16 carpals (8 in each wrist) |
| What is the significance of the carpal canal in radiography? | It is important for visualizing the carpal bones and diagnosing wrist injuries |
| What is the purpose of the PA stress projection of the wrist? | To assess stability and integrity of the wrist joints under stress |
| What is the role of the distal phalanx in the fingers? | It is the most distal bone in each digit, providing structure and support |
| What are the common projections for the wrist in radiography? | PA, PA oblique, and lateral projections |
| What is the importance of collimation in radiographic imaging? | It reduces radiation exposure and improves image quality by limiting the area being imaged |
| What are the eight bones of the wrist called? | Carpals |
| How are the carpals organized? | They are divided into two rows of four each. |
| What is the largest bone in the proximal row of carpals? | Scaphoid |
| What is the second carpal in the proximal row? | Lunate |
| Which carpal bone has three articular surfaces? | Triquetrum |
| What is the smallest carpal bone? | Pisiform |
| What is the first carpal in the distal row? | Trapezium |
| Which carpal bone is the smallest in the distal row? | Trapezoid |
| What is the largest carpal bone? | Capitate |
| What distinguishes the hamate bone? | It has a hooklike process called the hamulus. |
| What is the carpal sulcus? | A concave area formed by the anterior aspect of the carpals through which major nerves and tendons pass. |
| What is the trochlear notch? | A large concave depression that articulates with the distal humerus. |
| What is the radial notch? | A small, shallow depression on the lateral aspect of the proximal ulna. |
| What joint allows for the rotation of the forearm? | Proximal radioulnar joint |
| What is the function of the styloid processes? | They are small conical projections at the extreme distal ends of the radius and ulna. |
| Where is the radial styloid process located? | On the thumb side of the wrist joint. |
| What is the ulnar notch? | A small depression on the medial aspect of the distal radius. |
| What is the head of the radius located? | At the proximal end of the radius near the elbow joint. |
| What are the two beaklike processes of the proximal ulna called? | Olecranon and coronoid processes. |
| What is the rough oval process on the medial side of the radius called? | Radial tuberosity. |
| What is the body of the radius and ulna? | The long midportion of both bones. |
| What happens to the radius during pronation? | The radius crosses over the ulna. |
| Which carpal bone is best visualized in the ulnar deviation projection? | Scaphoid |
| What is the hamulus process? | A hooklike projection from the palmar surface of the hamate. |
| What is the primary involvement of the ulna? | Formation of the elbow joint. |
| What is the significance of the scaphoid bone? | It is the most frequently fractured carpal bone. |
| What is the olecranon process? | A bony prominence that can be palpated on the posterior aspect of the elbow joint. |
| What is the coronoid tubercle? | The medial margin of the coronoid process opposite the radial notch, commonly referred to in elbow anatomy. |
| What are the two parts of the humeral condyle? | The trochlea (medial condyle) and the capitulum (lateral condyle). |
| What is the shape of the trochlea? | It is shaped like a pulley or spool, with rimlike outer margins and a smooth depressed center called the trochlear sulcus. |
| What does the capitulum articulate with? | The head of the radius. |
| What is the significance of the olecranon fossa? | It is a deep posterior depression where the olecranon process of the ulna fits when the arm is fully extended. |
| What are the two shallow anterior depressions on the distal humerus? | The coronoid fossa and the radial fossa. |
| What is the function of the interphalangeal joints? | They allow movement in two directions only: flexion and extension. |
| What type of joint is the first carpometacarpal (CMC) joint of the thumb? | A saddle (sellar) joint. |
| What type of joint are the second through fifth CMC joints? | Plane (gliding) type joints. |
| What is the classification of all joints in the upper limb? | They are classified as synovial and are freely movable (diarthrodial). |
| What is the wrist joint classified as? | An ellipsoidal (condyloid)-type joint. |
| What two carpal bones does the radius articulate with at the wrist? | The scaphoid and the lunate. |
| What is the role of the three concentric arcs in elbow evaluation? | They help assess a true lateral position of the elbow joint. |
| What happens if the elbow is rotated from a true lateral position? | The concentric arcs do not appear symmetrically aligned, and the joint space is not as open. |
| What is the function of the radial tuberosity? | It serves as the attachment point for the biceps brachii muscle. |
| What are the movements allowed by the second to fifth metacarpophalangeal (MCP) joints? | Flexion, extension, abduction, adduction, and circumduction. |
| What is the significance of the lateral and medial epicondyles? | They serve as attachment points for muscles and are important landmarks for elbow positioning. |
| What is the olecranon fossa's role in elbow movement? | It accommodates the olecranon process during full extension of the arm. |
| What is the trochlear sulcus? | The smooth depressed center portion of the trochlea that aids in joint movement. |
| What is the anatomical position of the capitulum? | It is located on the lateral aspect of the distal humerus. |
| What joint type are the intercarpal joints? | Plane (gliding) type joints. |
| What is the primary movement allowed by the first MCP joint? | Flexion and extension, with limited abduction and adduction. |
| What is the role of soft tissue details in elbow trauma diagnosis? | They help identify injuries through the visualization of fat pads within the olecranon fossa. |
| What is the radiocarpal joint? | The wrist joint that includes the triquetral bone and the articular disk. |
| What bones form the wrist joint? | The distal radius, ulna, and three carpals. |
| What type of joint is the wrist classified as? | A synovial joint. |
| What is the function of the articular disk in the wrist? | It forms a smooth, concave-shaped articulation with the carpals. |
| What ligaments stabilize the wrist joint? | Ulnar collateral ligament, radial collateral ligament, scapulolunate ligament, and five additional ligaments. |
| What is the role of the ulnar collateral ligament? | It attaches to the styloid process of the ulna and stabilizes the wrist. |
| What is the function of the radial collateral ligament? | It extends from the styloid process of the radius to the lateral side of the scaphoid. |
| What is the triangular fibrocartilage complex (TFCC)? | A structure that stabilizes the wrist joint and is crucial for its function. |
| What type of joint is the elbow classified as? | A synovial joint, specifically a ginglymus (hinge) type joint. |
| What movements does the elbow joint primarily allow? | Flexion and extension between the humerus and the ulna and radius. |
| What is the proximal radioulnar joint? | A pivot joint that is part of the elbow joint. |
| What is the significance of lateral rotation of the elbow? | It separates the radius and ulna, which is important for imaging. |
| What is ulnar deviation in wrist movement? | A movement that opens up the carpals on the radial side of the wrist. |
| What is radial deviation in wrist movement? | A movement that opens up the carpals on the ulnar side of the wrist. |
| What is the importance of visualizing fat pads in radiographs? | They can indicate disease or significant injury within a joint region. |
| What are fat pads? | Soft tissue structures located within the joint capsule that can indicate joint injury. |
| How should the forearm be positioned for optimal imaging? | In an AP projection with the hand supinated. |
| What happens to the radius and ulna in a pronated position? | They cross over, making imaging more challenging. |
| What is the role of the synovial membrane in the wrist joint? | It lines the synovial capsule and the articular surfaces of the carpal bones. |
| What are the main types of wrist joint movements? | Ulnar deviation, radial deviation, and circumduction. |
| What is the function of the articular synovial capsule in the wrist? | It encloses the wrist joint and is strengthened by ligaments. |
| What is the relationship between the humerus and the ulna in the elbow joint? | They form hinge joints allowing flexion and extension. |
| What is the role of the scapulolunate ligament? | It stabilizes the union between the lunate and scaphoid bones. |
| What is the significance of the PA clenched wrist position? | It demonstrates the stability of the lunate and scaphoid. |
| What is the effect of medial rotation on the radius and ulna? | It superimposes them, complicating imaging. |
| What are the five additional ligaments crucial for wrist stability? | Dorsal radiocarpal ligament, palmar radiocarpal ligament, scapholunate ligament, lunotriquetral ligament, and TFCC. |
| What is the significance of the fat stripe on the radial aspect of the wrist? | Absence or displacement of this fat stripe may indicate a fracture. |
| Where is the pronator fat stripe located? | Approximately 1/4 inch (1 cm) from the anterior surface of the radius. |
| What does the visualization of the posterior fat pad on a lateral elbow radiograph indicate? | It suggests a change within the joint, indicating a pathologic process. |
| What must be done to visualize the anterior and posterior fat pads on the lateral elbow? | The elbow must be flexed 90° and in a true lateral position. |
| What is the supinator fat stripe and what does it indicate? | It is a long, thin stripe just anterior to the proximal radius, indicating possible radial head or neck fractures. |
| What are the general positioning considerations for upper limb radiography? | The patient should be seated comfortably, away from the x-ray beam, with the tabletop near shoulder height. |
| What is the common minimum source to image receptor distance (SID) for radiographs? | 40 to 44 inches (100 to 110 cm). |
| How should trauma patients be radiographed? | They can be radiographed on the table or directly on the stretcher. |
| What special considerations are needed for pediatric patients during radiography? | Immobilization may be needed, and parents should assist while ensuring proper shielding. |
| What adjustments may be necessary for geriatric patients during upper limb examinations? | Examinations may need to be altered for physical condition, and immobilization should be used to prevent movement. |
| What are the principal exposure factors for upper limb radiography? | Lower to medium kVp (60 to 80), short exposure time, small focal spot, and adequate mAs. |
| What is arthrography used for? | To image tendinous, ligamentous, and capsular pathology associated with diarthrodial joints. |
| What advantages do CT and MR provide in evaluating upper limb conditions? | They evaluate soft tissue and skeletal involvement and can determine displacement and alignment relationships in fractures. |
| What conditions can nuclear medicine bone scans detect? | Osteomyelitis, metastatic bone lesions, stress fractures, and cellulitis. |
| What is bursitis? | Inflammation of the bursae or fluid-filled sacs that enclose the joints, causing pain and limited movement. |
| What is the role of fat pads in radiographic examinations? | They serve as diagnostic indicators for joint pathologies when visualized correctly. |
| What happens to the posterior fat pad when the elbow is extended beyond 90°? | The olecranon slides into the olecranon fossa, elevating the posterior fat pad and making it visible. |
| What is the anterior fat pad formed by? | The superimposed coronoid and radial pads. |
| What is the typical appearance of the anterior fat pad on a radiograph? | A slightly radiolucent teardrop shape located just anterior to the distal humerus. |
| Why is visualization of the posterior fat pad considered more reliable? | It is less likely to be affected by positioning compared to the anterior fat pads. |
| What is the importance of soft tissue detail in radiographic exposure? | It is essential for visualization of fat pads and accurate diagnosis. |
| What should be ensured for accurate diagnosis when examining the elbow? | The elbow must be flexed 90° on the lateral view. |
| What is the effect of using grids in upper limb examinations? | Grids are not generally used unless the body part measures greater than 4 inches (10 cm). |
| What is the common appearance of a negative elbow examination? | The posterior fat pad is normally not visible. |
| What is the role of shielding in radiographic examinations? | To protect patients from unnecessary radiation exposure. |
| What is the significance of the anterior fat pad being elevated? | It may indicate trauma or infection. |
| What is Carpal Tunnel Syndrome? | A common painful disorder of the wrist and hand caused by compression of the median nerve. |
| Who is most commonly affected by Carpal Tunnel Syndrome? | Middle-aged women. |
| What is a fracture? | A break in the structure of bone caused by a force, either direct or indirect. |
| What is a Barton fracture? | Fracture and dislocation of the posterior lip of the distal radius involving the wrist joint. |
| What is a Bennett fracture? | Fracture of the base of the first metacarpal bone, extending into the carpometacarpal joint, complicated by subluxation. |
| What is a Boxer fracture? | Transverse fracture that extends through the metacarpal neck, commonly seen in the fifth metacarpal. |
| What characterizes a Colles fracture? | Transverse fracture of the distal radius with the distal fragment displaced posteriorly. |
| What is a Smith fracture? | Reverse of Colles fracture; a transverse fracture of the distal radius with the distal fragment displaced anteriorly. |
| What does joint effusion refer to? | Accumulated fluid in the joint cavity, indicating an underlying condition. |
| What is Osteoarthritis? | A noninflammatory joint disease characterized by gradual deterioration of articular cartilage and hypertrophic bone formation. |
| What is Osteomyelitis? | A local or generalized infection of bone or bone marrow, often caused by bacteria. |
| What is Osteopetrosis? | A hereditary disease marked by abnormally dense bone, leading to fractures and obliteration of the marrow space. |
| What is Osteoporosis? | Reduction in the quantity of bone or atrophy of skeletal tissue, commonly occurring in postmenopausal women. |
| What is Paget disease? | A chronic skeletal disease characterized by bone destruction followed by overproduction of dense yet soft bones. |
| What is Rheumatoid arthritis? | A chronic systemic disease with inflammatory changes throughout connective tissues, more common in women. |
| What are Scapholunate ligament injuries? | Injuries involving the ligament connecting the scaphoid to the lunate bone, indicated by widening of the space between them. |
| What is Skier's thumb? | A sprain or tear of the ulnar collateral ligament of the thumb near the MCP joint, often from hyperextension. |
| What are tumors in the context of bone health? | Growths that can be benign or malignant, with imaging techniques like CT and MRI used for assessment. |
| What is the importance of collimation in radiographic examinations? | To ensure that the collimation field size borders are visible and to minimize radiation exposure. |
| What is the general positioning rule for upper limb radiographic examinations? | The long axis of the part being imaged should be parallel to the long axis of the IR. |
| What is the ALARA principle in radiography? | As Low As Reasonably Achievable; it emphasizes minimizing radiation exposure while obtaining quality images. |
| What should be checked after processing a digital image? | The exposure indicator must be evaluated to ensure exposure factors were appropriate for optimal image quality. |
| What is the significance of accurate centering in radiographic imaging? | To avoid shape and size distortion and to clearly demonstrate narrow joint spaces. |
| What is the role of digital imaging technology in radiography? | To enhance image quality and processing while allowing for a broad range of exposure factors. |
| What is the common age group affected by Paget disease? | Most commonly affects men older than age 40. |
| What is the most common type of arthritis? | Osteoarthritis. |
| What is a common cause of Osteomyelitis? | Infection from a contiguous source, such as a diabetic foot ulcer. |
| What is the recommended projection for evaluating carpal tunnel syndrome? | PA and lateral wrist; Gaynor-Hart method |
| What imaging technique is used to visualize fluid-filled joint spaces? | AP and lateral affected area |
| What is the appearance of osteopetrosis on radiographs? | Chalky white or opaque appearance with lack of distinction between the bony cortex and trabeculae |
| What is the typical radiographic appearance of multiple myeloma? | Multiple 'punched-out' osteolytic lesions scattered throughout the affected bones |
| What are the common symptoms of Ewing sarcoma? | Symptoms similar to osteomyelitis, including low-grade fever and pain |
| What projection is used to assess fractures and dislocations of the fingers? | PA projection of fingers |
| What is the significance of the Brewerton method? | It can detect early signs of rheumatoid arthritis in hands |
| What is the typical age range for osteogenic sarcoma occurrence? | Generally affects persons aged 10 to 20 years |
| What is the appearance of Paget disease on radiographs? | Mixed areas of sclerotic and cortical thickening along with radiolucent lesions; 'cotton wool' appearance |
| What is the recommended imaging for osteoarthritis? | AP and lateral affected area to visualize narrowing of joint space |
| What is the clinical indication for a PA oblique projection of fingers? | Fractures and dislocations of the distal, middle, and proximal phalanges; distal metacarpal; and associated joints |
| What is the typical appearance of an enchondroma on radiographs? | Well-defined, radiolucent-appearing tumors with a thin cortex |
| What adjustments are made for imaging patients with osteoporosis? | May require a decrease in exposure factors for optimal visibility |
| What is the appearance of a scapholunate ligament tear on imaging? | Abnormal space between the lunate and scaphoid (>3 mm) |
| What is the purpose of using a 45° foam wedge block during a PA oblique projection? | To support the finger in a 45° oblique position parallel to the IR |
| What is the recommended field size for routine finger projections? | 8 x 10 inches (18 x 24 cm), portrait |
| What is the typical age range for osteochondromas to occur? | Usually occurring in persons aged 10 to 20 years |
| What is the appearance of soft tissue swelling in joint imaging? | Loss of fat pad detail visibility and soft tissue structures |
| What is the significance of the 'onion peel' appearance on radiographs? | It indicates stratified new bone formation, often seen in Ewing sarcoma |
| What is the recommended imaging for assessing joint effusion? | AP and lateral joint projections |
| What is the typical imaging appearance of benign bone tumors? | Generally well-defined and may appear radiolucent |
| What is the clinical significance of the Folio method? | It is used for PA bilateral stress projection of thumbs |
| What is the appearance of osteomyelitis on imaging? | Disruption in bony cortex with soft tissue swelling |
| What are the technical factors for finger projections? | Minimum SID of 40 inches, kVp range of 55 to 65 |
| What is the appearance of rheumatoid arthritis on radiographs? | Closed joint spaces with subluxation of MCP joints |
| What is the typical imaging for assessing tumors (neoplasms)? | AP and lateral affected area; appearance depends on type and stage of tumor |
| What is the recommended patient position for lateral projection of fingers? | Seat the patient at the end of the table with elbow flexed about 90°, hand and wrist resting on IR, and fingers extended. |
| What is the optimal angle for the oblique view of fingers? | The view of the finger being examined should be 45° oblique. |
| What should be aligned with the side border of the image receptor (IR) in finger positioning? | The long axis of the finger should be aligned with the side border of the IR. |
| What is the central ray (CR) location for finger projections? | CR should be directed to the proximal interphalangeal (PIP) joint. |
| What anatomical structures should be demonstrated in a lateral view of fingers? | Distal, middle, and proximal phalanges; distal metacarpal; and associated joints. |
| What are the clinical indications for finger radiography? | Fractures and dislocations of the distal, middle, and proximal phalanges; distal metacarpal; and associated joints. |
| What technical factors are recommended for finger radiography? | Minimum SID of 40 inches, field size of 8 x 10 inches, and kVp range of 55 to 65. |
| What is the patient position for an AP projection of the thumb? | Seat the patient facing the table with arms extended, and hand rotated internally to supinate the thumb. |
| What is the purpose of using a sponge support block during thumb radiography? | To support the thumb and prevent motion while ensuring correct positioning. |
| What should be visible in an AP projection of the thumb? | Distal and proximal phalanges, first metacarpal, trapezium, and associated joints. |
| What is the evaluation criterion for the thumb's interphalangeal joint in an AP projection? | The interphalangeal joint should appear open, indicating full extension of the thumb. |
| What is the recommended collimation field size for thumb radiography? | Collimate on four sides to the area of the thumb, including the entire first metacarpal and trapezium. |
| What is the recommended position for a PA oblique projection of the thumb? | Abduct the thumb slightly with the palmar surface of the hand in contact with the IR. |
| What is the significance of the long axis of the thumb being aligned with the side border of the IR? | It ensures proper positioning and minimizes distortion in the image. |
| What should be demonstrated in a lateral view of the thumb? | Distal and proximal phalanges, first metacarpal, trapezium, and associated joints. |
| What is the CR direction for the thumb in an AP projection? | CR should be perpendicular to the IR, directed to the first MCP joint. |
| What are the common pathologic processes indicated for finger and thumb radiography? | Osteoporosis and osteoarthritis. |
| What is the importance of ensuring no superimposition of adjacent fingers in radiography? | To provide a clear view of the finger being examined and avoid misinterpretation. |
| What is the recommended patient position for a mediolateral projection of the second digit? | Place the second digit in contact with the IR. |
| What is the evaluation criterion for the thumb's metacarpophalangeal joint in an AP projection? | The metacarpophalangeal joint should appear open, indicating correct CR location. |
| What should be done to immobilize other fingers during thumb radiography? | Use tape to isolate the thumb if necessary. |
| What is the purpose of demonstrating the concave appearance of the anterior surface of the phalanges? | It indicates that the finger is in true lateral position. |
| What is the recommended field size for finger radiography? | 8 x 10 inches (18 x 24 cm), portrait. |
| What should be done to ensure optimal image receptor exposure during radiography? | Achieve optimal exposure and contrast with no motion to demonstrate soft tissue margins and clear bony trabecular markings. |
| What is the significance of the CR being perpendicular to the IR? | It ensures accurate imaging and proper visualization of the anatomical structures. |
| What is the evaluation criterion for the lateral view of fingers? | Interphalangeal and metacarpophalangeal joint spaces should be open. |
| What are the clinical indications for a lateral thumb position? | Fractures and dislocations of the distal and proximal phalanges, distal metacarpal, and associated joints; pathologic processes such as osteoporosis and osteoarthritis. |
| What is the recommended field size for a lateral thumb X-ray? | 8 x 10 inches (18 x 24 cm), portrait. |
| What is the minimum SID for thumb imaging? | 40 inches (100 cm). |
| What kVp range is recommended for thumb imaging? | 55 to 65. |
| What is the optimal patient position for a lateral thumb X-ray? | Seat patient at the end of the table with elbow flexed about 90°, hand resting on IR, palm down. |
| How should the thumb be positioned for a true lateral view? | Start with hand pronated and thumb abducted, then rotate hand slightly medial until thumb is in true lateral position. |
| What anatomy should be visualized in a lateral thumb position? | Distal and proximal phalanges, first metacarpal, trapezium, and associated joints. |
| What is the CR location for a lateral thumb X-ray? | CR to the first MCP joint. |
| What is the purpose of the AP axial projection (modified Robert method) for the thumb? | To demonstrate fractures, dislocations, or pathology of the base of the first metacarpal and trapezium. |
| What is the CR angle for the AP axial projection (modified Robert method)? | 15° proximally (toward wrist), entering at the first CMC joint. |
| What is the clinical indication for the PA stress (Folio method) projection? | Sprain or tearing of the ulnar collateral ligament of the thumb at the MCP joint, often referred to as 'skier's thumb'. |
| What is the patient position for the PA stress (Folio method) projection? | Seat patient with both hands extended and pronated on the IR, positioned side by side. |
| What should be done immediately before the exposure in the PA stress (Folio method)? | Ask the patient to pull thumbs apart firmly and hold. |
| What is the CR direction for the PA stress (Folio method)? | CR perpendicular to IR, directed to midway between MCP joints. |
| What are the clinical indications for a PA projection of the hand? | Fractures, dislocations, or foreign bodies of the phalanges, metacarpals, and all joints of the hand; pathologic processes such as osteoporosis and osteoarthritis. |
| What is the recommended field size for a PA hand X-ray? | 10 x 12 inches (24 x 30 cm), portrait. |
| What is the optimal patient position for a PA hand X-ray? | Seat patient at the end of the table with hand and forearm extended. |
| How should the hand be positioned for a PA projection? | Pronate hand with palmar surface in contact with IR; spread fingers slightly. |
| What anatomy should be visualized in a PA hand projection? | All phalanges, metacarpals, and joints of the hand. |
| What is the CR location for a PA hand X-ray? | CR to the third MCP joint. |
| What is the purpose of the PA oblique projection of the hand? | To visualize fractures and dislocations of the phalanges, metacarpals, and all joints of the hand. |
| What is the patient position for a PA oblique projection of the hand? | Seat patient at the end of the table with hand and forearm extended. |
| How should the hand be positioned for a PA oblique projection? | Pronate hand with palmar surface in contact with IR; spread fingers slightly. |
| What is the evaluation criteria for a successful thumb X-ray? | Optimal image receptor exposure and contrast with no motion demonstrating soft tissue margins and clear, sharp bony trabecular markings. |
| What should be ensured about the thumbs during the PA stress (Folio method)? | Thumbs should be parallel to IR for PA projection. |
| What is the significance of the Lewis modification in the AP axial projection? | It centers the CR to the first MCP joint with a 10° to 15° proximal angle. |
| What should be done to prevent motion during the PA stress (Folio method)? | Place supports under both wrist and proximal thumb regions. |
| What is the minimum SID for hand and wrist radiography? | 40 inches (100 cm) |
| What is the recommended field size for hand and wrist radiography? | 10 x 12 inches (24 x 30 cm), portrait |
| Where should the CR be directed for a PA projection of the hand? | To the third MCP joint |
| What anatomy is demonstrated in a PA projection of the hand? | Entire hand and wrist, and about 1 inch (2.5 cm) of distal forearm |
| What indicates correct CR location in a PA projection? | MCP and IP joints appear open, indicating the hand was fully pronated |
| What is the kVp range for hand and wrist radiography? | 55 to 65 |
| What is the patient position for a PA oblique hand projection? | Rotate the hand and wrist laterally 45° and support with a wedge |
| What should be aligned with the long axis of the IR in a PA oblique hand projection? | The long axis of the hand and wrist |
| What anatomy is demonstrated in an oblique projection of the hand? | Entire hand and wrist, with midshafts of metacarpals not overlapping |
| What is the CR direction for a lateral projection of the hand? | Perpendicular to the IR, directed to the second MCP joint |
| What is the preferred lateral position for the hand if phalanges are the area of interest? | Fan lateral position |
| What should be ensured in a fan lateral projection of the hand? | All digits should be separated and parallel to the IR |
| What is the purpose of using a compensation filter in hand radiography? | To ensure optimum exposure of phalanges and metacarpals due to differences in part thickness |
| What is the evaluation criteria for a lateral projection in extension? | Phalanges and metacarpals should be superimposed and extended |
| What is the evaluation criteria for a lateral projection in flexion? | Phalanges and metacarpals should be superimposed with the hand in a natural flexed position |
| What should be visible in a true lateral position of the hand? | Distal radius and ulna superimposed, metacarpals superimposed |
| What is the importance of separating digits in a PA projection? | To prevent overlap of soft tissues and ensure open joint spaces |
| What indicates over-rotation in a PA oblique hand projection? | Excessive overlap of metacarpals |
| What indicates under-rotation in a PA oblique hand projection? | Too much separation of metacarpals |
| What should be the appearance of the thumb in a true lateral position? | Slightly oblique and free of superimposition |
| What is the CR placement for a lateral projection of the hand? | At the second to fifth MCP joints |
| What is the significance of the evaluation criteria in radiography? | To ensure optimal image quality and diagnostic value |
| What should be collated in the collimation field size? | Outer margins of the hand and wrist |
| What is the purpose of the 'fan' lateral position? | To visualize all phalanges clearly without superimposition |
| What should be demonstrated in the evaluation of soft tissue margins? | Clear, sharp bony trabecular markings |
| What is the purpose of using a radiolucent support block in lateral projections? | To support each digit and maintain separation and parallelism to the IR |
| What is the clinical indication for performing a lateral projection of the hand? | Localization of foreign bodies and assessment of fractures |
| What should be the appearance of joint spaces in a correctly positioned lateral projection? | Open joint spaces indicating proper alignment of fingers |
| What is the purpose of the Brewerton Method? | To evaluate for early evidence of rheumatoid arthritis at the second through fifth MCP joints. |
| What is the recommended field size for the Brewerton Method? | 10 x 12 inches (24 x 30 cm) portrait or 14 x 17 inches (35 x 43 cm) for bilateral study. |
| What is the minimum SID for hand radiography? | 40 inches (100 cm) |
| What angle should the hand be flexed to in the Brewerton Method? | 65° angle between the dorsum of the hand and the IR. |
| What is the CR angle for the Brewerton Method? | 15° proximally, toward the ulna, directed to the third MCP joint. |
| What anatomy should be visible in the Brewerton Method? | Entire hand from the carpal area to the tips of digits, with second through fifth MCP joints open. |
| What are common clinical indications for a PA Projection of the wrist? | Fractures of distal radius or ulna, isolated fractures of radial or ulnar styloid processes, and fractures of individual carpal bones. |
| What is the recommended field size for a PA wrist projection? | 8 x 10 inches (18 x 24 cm), portrait. |
| What is the CR direction for a PA wrist projection? | Perpendicular to the IR, directed to the midcarpal area. |
| What should be aligned with the IR in a PA wrist projection? | The long axis of the hand and wrist. |
| What is the purpose of a PA Oblique Projection of the wrist? | To visualize fractures of distal radius or ulna and assess pathologic processes like osteomyelitis and arthritis. |
| What angle should the wrist be rotated for a PA Oblique Projection? | Laterally 45°. |
| What anatomical structures should be well visualized in a PA Oblique wrist projection? | Trapezium and scaphoid with slight superimposition of other carpals. |
| What is the CR direction for a PA Oblique wrist projection? | Perpendicular to the IR, directed to the midcarpal area. |
| What are the clinical indications for a Lateromedial Projection of the wrist? | Fractures or dislocations of the distal radius or ulna, and osteoarthritis in the trapezium and first CMC joint. |
| What is the recommended field size for a Lateromedial wrist projection? | 8 x 10 inches (18 x 24 cm), portrait. |
| What position should the patient be in for a Lateromedial wrist projection? | Arm and forearm resting on the table with wrist and hand in a thumb-up lateral position. |
| What should be ensured for a true lateral position of the wrist? | Fingers should be comfortably extended and aligned with the long axis of the IR. |
| What is the importance of collimation in radiography? | To limit the radiation exposure and improve image quality by focusing on the area of interest. |
| What should be evaluated in terms of exposure in radiographic images? | Optimal image receptor exposure and contrast with no motion. |
| What anatomical structures should be visible in a PA wrist projection? | Midmetacarpals, proximal metacarpals, carpals, distal radius, ulna, and associated joints. |
| What is the significance of the MCP joints in hand radiography? | They are critical for assessing conditions like rheumatoid arthritis and fractures. |
| What is the role of the CR in radiographic positioning? | To ensure proper alignment and focus on the area of interest. |
| What is the evaluation criterion for the Brewerton Method? | Clear visibility of the second through fifth MCP joints with no superimposition. |
| What should be done to avoid superimposition of the thumb in the Brewerton Method? | Abduct the thumb away from the other digits. |
| What is the purpose of using a radiolucent support block during wrist positioning? | To stabilize the wrist and prevent motion during the radiographic procedure. |
| What is the significance of visualizing fat pads in wrist radiography? | They can indicate underlying fractures or pathologies. |
| What is the recommended collimation field size for wrist imaging? | 8 x 10 inches (18 x 24 cm), portrait |
| What is the minimum SID for wrist imaging? | 40 inches (100 cm) |
| What should be aligned with the long axis of the IR in wrist imaging? | The long axis of the hand, wrist, and forearm |
| What anatomical structures should be visible in a lateral wrist projection? | Distal radius and ulna, carpals, and at least the midmetacarpal area |
| What indicates a true lateral position in wrist imaging? | The ulnar head should be superimposed over the distal radius. |
| What is the CR angle for the PA axial scaphoid projection with ulnar deviation? | 10° to 15° proximally, toward the elbow |
| Where should the CR be centered for the scaphoid projection? | At a point 3/4 inch (2 cm) distal and medial to the radial styloid process. |
| What is the purpose of the modified Stecher method? | To visualize the scaphoid without foreshortening. |
| What is the clinical indication for wrist imaging? | Possible fractures of the scaphoid or other carpal bones. |
| What should be done if a patient has possible wrist trauma? | Do not attempt advanced positions before completing a routine wrist series. |
| What is the evaluation criterion for scaphoid visibility? | Scaphoid should be demonstrated clearly without foreshortening. |
| What does ulnar deviation indicate in wrist imaging? | The angle of the long axis of the metacarpals to that of the radius and ulna. |
| What should be visible in a bilateral PA stress projection? | Possible scaphoid fracture and scapholunate ligament injury. |
| What is the kVp range for wrist imaging? | 55 to 65 |
| What should be ensured about the wrist position for a PA projection? | Wrist and hand should be aligned with the center of the long axis of IR. |
| What is the purpose of the PA projection with radial deviation? | To assess possible fractures of the carpal bones on the ulnar side. |
| What is the significance of the CR and collimation field size in wrist imaging? | They should be centered to the midcarpal area. |
| What is the importance of optimal image receptor exposure in wrist imaging? | To visualize clear, sharp bony trabecular markings and soft tissue. |
| What should be done to visualize the scaphoid borders clearly? | Ensure optimal image receptor exposure and contrast with no motion. |
| What is the recommended patient position for wrist imaging? | Seat patient at the end of the table with wrist and hand on IR, palm down. |
| What should be avoided during wrist imaging to prevent injury? | Avoid moving the forearm if there is severe injury. |
| What anatomical structures should be visible in the PA projection of the wrist? | Distal radius and ulna, carpals, and proximal metacarpals. |
| What is the evaluation criterion for the position in wrist imaging? | No rotation of wrist evidenced by the appearance of distal radius and ulna. |
| What is the purpose of the four-projection series for scaphoid imaging? | To visualize obscured fractures of the scaphoid. |
| What should be the alignment of the long axis of the forearm in wrist imaging? | Aligned with the side border of the IR. |
| What is the significance of the hand being elevated during the modified Stecher method? | It places the scaphoid parallel to the IR. |
| What is the CR direction for the PA axial wrist projection? | Perpendicular to the IR directed to the scaphoid. |
| What should be done if the patient cannot tolerate ulnar deviation? | Gently evert or turn the hand outward unless contraindicated. |
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