Basic and supplementary projection of hand

Which deals with BASIC AND SUPPLEMENTARY PROJECTION OF HAND, it is very helpful for the imaging students and technicians to understand the projections of hand.

1. BASIC AND SUPPLEMENTARY PROJECTION OF HAND BIJOY PETER BMIT 2 nd YEAR

2. ANATOMY There are 3 major types of bones in the hand itself, including: PHALANGES The 14 bones that are found in the fingers of each hand and also in the toes of each foot. Each finger has 3 phalanges (the distal, middle, and proximal); the thumb only has 2. METACARPAL BONES The 5 bones that compose the middle part of the hand. CARPAL BONES The 8 bones that create the wrist. The 2 rows of carpal bones are connected to 2 bones of the arm--the ulna bone and the radius bone. They include Scaphoid , Lunate, Triquetral, Pisiform , Trapezium , Trapezoid , Capitate , Hamate

3. JOINTS : Radiocarpal Joint Its between radius and carpus. Carpometacarpal Joint It connect the carpal bone to the metacarpus. Metacarpophalangeal joint Its between metacarpal bones and phalanges.

4. INDICATIONS Trauma with suspected fracture Suspected metacarpal dislocation Foreign body detection and localisation Investigation of joint pain and deformity Rheumatoid arthritis Osteoarthrosis

5. Projections BASIC PROJECTIONS POSTERO-ANTERIOR VIEW OBLIQUE VIEW LATERAL VIEW SUPPLEMENTARY PROJECTIONS BALL-CATCHER VIEW (NORGAARD PROJECTION)

6. POSTERO-ANTERIOR (PA) The Hand PA view is apart of a two view series metacarpals, phalanges, carpal bones and distal radial ulnar joint. POSITION OF PATIENT Patient is seated alongside the table The forearm is pronated and placed on the table with palmer surface of the hand in contact with the image receptor The fingers are separated and extended but relaxed to ensure that they remain in contact with the image receptor. The wrist is adjusted so that the radial and ulna styloid processes are equidistant from the image receptor.

7. ESSENTIAL IMAGE CHARACTERISTICS The image should demonstrate all the phalanges, including the soft tissue of the finger tips, the carpal and metacarpal bones and distal end of the radius and ulna. The interphalangeal and metacarpo-phalangeal and carpometacarpal joints should be demonstrated clearly. No rotation of hand

8. A) POSTERO-ANTERIOR PROJECTION 1) CENTRING POINT THIRD METACARPAL HEAD 2) COLLIMATION LATERALLY TO THE SKIN MARGINS PROXIMAL TO INCLUDE DISTAL RADIO-ULNAR JOINT DISTAL TO THE TIPS OF THE DISTAL PHALANGES 3) ORIENTATION PORTRAIT 4) DETECTOR SIZE 18cm x 24cm TECHNICAL FACTORS 5) EXPOSURE 50-60kVp 1-5mAS 6) SID 100 cm 7) GRID NO

9. OBLIQUE POSITION OF PATIENT Patient is seated alongside the table From the basic postero-anterior position ,the hand is externally rotated 45 with the fingers extended. The fingers should be separated slightly and the hand supported on a 45 non –opaque pad. A sand bag is placed over the lower end of the forearm for immobilisation. ESSENTIAL IMAGE CHARACTERISTICS The image should demonstrate all the phalanges, including the soft tissue of the fingertips, the carpal and metacarpal bones and the distal end of the radius and ulna. The correct degree of rotation has been achieved when the heads of the 1 st and the 2 nd metacarpals are seen separated whilst those of the 4 th and 5 th are just superimposed

10. POSTERO-ANTERIOR PROJECTION 1) CENTRING POINT 2) COLLIMATION ORIENTATION DETECTOR SIZE Third metacarpal head Laterally to the skin margins Proximal to include distal radioulnar joint Distal to the tips of the distal phalanges Portrait 18cm X 24cm Technical Factors f) EXPOSURE 50-60 KVp 1-5 mAs e) SID 100 CM f) GRID NO

11. LATERAL POSITION OF PATIENT From the postero-anterior(DP) , the hand is externally rotated 90 The palm of the hand is perpendicular to the image receptor with the fingers extended and thumb abducted and supported parallel to the image receptor on a non opaque pad. The radial and ulnar styloid processes are superimposed DIRECTION AND LOCATION OF THE X-RAY BEAM The collimated vertical beam is centred over the head of the 2 nd metacarpal.

12. ESSENTIAL IMAGE CHARACTERISTICS The image should include the finger tips, including soft tissue , and radial and ulnar styloid processes. The heads of the metacarpal should be super imposed . The thumb should be demonstrated clearly without superimposition of other structures.

13. TECHNICAL FACTORS A) LATERAL PROJECTION 1) CENTRING POINT Over the head of the second metacarpal 2) COLLIMATION Anteroposterior to the skin margins Distal to the tips of the fingers Proximal to include one-third of the distal radius and ulna 3) ORIENTATION Portrait 4) DETECTOR SIZE 18cmx24cm EXPOSURE 50-60kVp 3-5mAs 5) EXPOSURE 50-60 KVp 1-5 mAs 6) SID 100 CM 7) GRID NO

14. BALL CATCHER VIEW (NORGAARD PROJECTION) POSITION OF PATIENT Patient may be seated alongside or facing the table Both hands are supinated with their dorsal surfaces are placed on the cassette/FPDs The hands are then rotated medially by 45 degree to assume a position likened to one about to receive or catch a ball. ESSENTIAL IMAGE CHARACTERISTICS The image should demonstrate all the phalanges, including the soft tissue of the finger tips, the carpal and metacarpal bones and distal end of the radius and ulna. The exposure factors selected must produce an accurate EI and optically demonstrate joint details. The heads of the metacarpals should not be superimposed

15. COLLIMATION Laterally to the skin margins Distal to the skin margins of the finger Proximal to the include one-third of the distal radius and ulna ORIENTATION Landscape TECHNICAL FACTORS 7) SID 100CM 8) GRID NO

16. REFERENCE CLARKS POSITIONING IN RADIOGRAPHY