Bane

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Bane

  1. 1. RATE 1221María de Lourdes Berríos, RT, B.S , M.S DIGITS AND HAND
  2. 2. HAND ANATOMYTHE HUMAN HAND CONSISTS OF A BROAD PALM (METACARPUS) WITH 5 DIGITS, ATTACHED TOTHE FOREARM BY A JOINT CALLED THE WRIST (CARPUS). THE BACK OF THE HAND IS FORMALLYCALLED THE DORSUM OF THE HAND.Digits• Each finger, starting with the one closest to the thumb, has a colloquial name to distinguish it from the others: • index finger : pointer finger, or forefinger • middle finger: digitus medius • ring finger: Annulus • little finger: pinky - minimus • The thumb (connected to the trapezium) is located on one of the sides, parallel to the arm. The thumb can be easily rotated 90°, on a level perpendicular to the palm, unlike the other fingers which can only be rotated approximately 45.
  3. 3. Digit 3 Digit 4 Digit 2Digit 5 Digit 1
  4. 4. Posterior
  5. 5. Anterior
  6. 6. BONES• The human hand has 27 bones: the carpus or wrist account for 8; the metacarpus or palm contains five; the remaining fourteen are digital bones; fingers and thumb.• The eight bones of the wrist are arranged in two rows of four. These bones fit into a shallow socket formed by the bones of the forearm. The bones of proximal row are (from lateral to medial): scaphoid, lunate, triquetral and pisiform. The bones of the distal row are (from lateral to medial): trapezium, trapezoid, capitate and hamate.• The palm has five bones known as metacarpal bones, one to each of the 5 digits. These metacarpals have a head, a shaft, and a base.• Human hands contain fourteen digital bones, also called phalanges, or phalanx bones: two in the thumb (the thumb has no middle phalanx) and three in each of the four fingers. These are the distal phalanx, carrying the nail, the middle phalanx, and the proximal phalanx.• Sesamoid bones are small ossified nodes embedded in the tendons to provide extra leverage and reduce pressure on the underlying tissue. Many exist around the palm at the bases of the digits; the exact number varies between different people.
  7. 7. ARTICULATIONS• Also of note is that the articulation of the human hand is more complex and delicate than that of comparable organs in any other animals. Without this extra articulation, we would not be able to operate a wide variety of tools and devices. – The articulations are: – interphalangeal articulations of hand (IP) – metacarpophalangeal joints (MCP) – intercarpal articulations – wrist (may also be viewed as belonging to the forearm.)
  8. 8. GENERAL PROCEDURE• Remove rings, watches, and other radiopaque objects, and place them in secure storge during the procedure.• Seat the patient at the side or end of the table.• Place the cassette at a location• Radiograph each side separately when performing a bilateral examination of the hand or wrist.• Shield gonads• Use close collimation • Placing multiple exposures one one cassette is a common practise• Use right or left markers and all others vital identification markers when apropiate.
  9. 9. PROJECTIONSDIGITS (FIRST THROUGH FIFTH)
  10. 10. PA PROJECTIONS (DIGITS 2-5) For all• Indications for imaging projections • Injury, Rheumatoid arthritis, Bone pain.• IR: 8 x 10 crosswise for two or more images on one cassette• SID: 40 inches• Position of the patient: seat the patient at the end of the radiographic table.• Position of the part: When radiographing individual digits (except the first), take the following steps: – Place the extended digit with the palmar surface down on the unmasked portion of the cassette. – Separate the digits slightly, and center the digit under examination to the midline portion of the cassette. – Center the PIP joint to the cassette
  11. 11. 2 3 5 4
  12. 12. CR: Perpendicular tothe PIP joint of theafected digit
  13. 13. STRUCTURES SHOWN
  14. 14. EVALUATION CRITERIA • No rotation of the digit • Entire digit from fingertip to distal portion of the adjoining metacarpal • No soft tissue overlap from adjacent digits • Open interphalangeal and MCP joint spaces without overlap of bones • Soft tissue and bony trabeculation
  15. 15. LATERAL PROJECTIONS (2-5 DIGITS)• IR: 8 x 10 crosswise for two or more images on one cassette• Basic position: Place the patient hand in true lateral position, the fingers are then flexed and the finger in question extended parallel to the film. A radiolucent pointer may aid maintenance of the extension. For fingers other than the middle, the hand is rotated to the lateral position bringing the finger in question nearest the film or in contact with it for the 2nd and 5th.
  16. 16. 2 3 4 5
  17. 17. CR: Perpendicular tothe PIP joint of theafected digit
  18. 18. STRUCTURES SHOWN
  19. 19. EVALUATION CRITERIA • Entire digit in a true lateral position • No obstruction of the proximal phalanx or MCP joint by adjacent digits • Open interphalangeal and MCP joint spaces without overlap of bones • Soft tissue and bony Is it correct trabeculation this image?
  20. 20. Lateral digit showing a dislocation
  21. 21. PA OBLIQUE PROJECTION• IR: 8 x 10 crosswise for two or more images on one cassette• Position of the patient: seat the patient at the end of the radiographic table. Position of part:  Place the patient’s forearm on the table with the hand pronated and the palm resting on the cassette.  Center the cassette at the level of the PIP joint.  Rotate the hand externally until the digits are separated and supported on a 45- degree foam wedge.
  22. 22. 2 3 4 5
  23. 23. CR: Perpendicular tothe PIP joint of theafected digit
  24. 24. STRUCTURES SHOWN
  25. 25. EVALUATION CRITERIA  Entire digit rotated at 45- degree angle, including the distal portion of the adjoinig metacarpal  No superimposition of the adjacent digits over the proximal phalanx or MCP joint  Open interphalangeal and MCP joint spaces  Soft tissue and bony trabeculation
  26. 26. FIRST DIGIT (THUMB): AP/PA PROJETION• Indications for imaging • Trauma, congenital abnormalities, and rheumatology. IR: 8 x 10 crosswise for two or more images on one cassette Basic Position  The PA position is easiest for the patient however the AP projection produces less magnification and better detail as the thumb is in contact with the cassette.  PA Position, The patient sits alongside the end of the table elbow flexed palm downwards, or at the end of the table with he elbow flexed at 90 degrees, the hand is rotated into the true later position projecting the thumb clear of superimposition with the fifth metacarpal.
  27. 27. CONT… AP Position, The patient stand with their back to the table and the arm is extended and internally rotted to bring the palmar aspect of the thumb facing upwards, adjust the table height to a comfortable position, adjust the rotation of the arm to bring the thumb into true AP position
  28. 28. CR: Perpendicular to the MCP joint
  29. 29. STRUCTURES SHOWN
  30. 30. EVALUATION CRITERIA No rotation Area of the distal tip of the thumb to the trapezium Open PIP and MCP joints spaces without overlap of bones Overlap of soft tissue profile of the palm over the midshaft of the first metacarpal
  31. 31. LATERAL PROJECTION IR: 8 x 10 crosswise for two or more images on one cassette Basic Patient Position Place the hand and wrist flat on the cassette, the elbow may need a small pad to promote contact of the hand with the cassette. The fingers can be spread slightly. The thumb is abducted and the hand internally rotated and supported in position such that the thumb is lateral and in contact with the cassette.
  32. 32. CR: Perpendicular to the MCP joint
  33. 33. STRUCTURES SHOWN
  34. 34. EVALUATION CRITERIA First digit in a true lateral projection Area from the distal tip of the thumb to trapezium Open PIP and MCP joint spaces Soft tissue and bony trabeculation
  35. 35. PA OBLIQUE PROJECTION IR: 8 x 10 crosswise for two or more images on one cassette Basic Patient Position The patient sits alongside the end of the table elbow flexed palm downwards, or at the end of the table with he elbow flexed at 90 degrees, hand and wrist flat on the cassette the elbow may need a small pad to promote contact of the hand with the cassette. With the thumb abducted, place the palmar surface of the hand in contact with the cassette. Ulnar deviate the hand slightly. Align the longitudinal axis of the thumb with the long axis of the cassette. Center the cassette to the MCP joint
  36. 36. CR: Perpendicular to the MCP joint
  37. 37. STRUCTURES SHOWN
  38. 38. EVALUATION CRITERIA Proper rotation of phalanges, soft tissue, and first metacarpal. Area from the distal tip of the thumb to the trapezium Open PIP and MCP joint spaces Soft tissue and bony trabeculation
  39. 39. QUESTIONS?
  40. 40. PROJECTIONS HAND
  41. 41. HAND: PA PROJECTION Indications for imaging • Injury, Rheumatoid arthritis, Acromegaly and Bone pain. IR: 8 x 10 inch for hand of average size or 10 x 12 inch crosswise for two images. Basic Position The patient sits alongside the end of the table elbow flexed palm downwards, or at the end of the table with he elbow flexed at 90 degrees, hand and wrist flat on the cassette the elbow may need a small pad to promote contact of the hand with the cassette. The fingers can be spread slightly.
  42. 42. CR: Perpendicular to thethird MCP joint
  43. 43. STRUCTURES SHOWN
  44. 44. EVALUATION CRITERIA ID and markers must be present and correct in the appropriate area of the film Evidence of collimation on four sides equally around the centering point. Limits of the examination, proximally the radio and ulna carpal joints, distally the tips of the distal phalanges, laterally the skin margins of first and fifth digits. Metacarpophalangeal joints should be open and the shafts of the second to fifth metacarpals should be symmetrical. Exposure, adequate penetration to visualize all bone detail and low enough contrast to visualize the soft tissues.
  45. 45. PA OBLIQUE PROJECTION IR: 8 x 10 inch for hand of average size or 10 x 12 inch crosswise for two images. Basic Position: The patient sits alongside the end of the table elbow flexed palm downwards, or at the end of the table with he elbow flexed at 90 degrees, hand and wrist flat on the cassette the hand is then rotated laterally 35 to 45 degrees laterally and supported so that the fingers are parallel to the film.
  46. 46. CR: Perpendicular to the third MCP joint
  47. 47. STRUCTURES SHOWN
  48. 48. EVALUATION CRITERIA ID and markers must be present and correct in the appropriate area of the film Evidence of collimation on four sides equally around the centering point. Limits of the examination, proximally the radio and ulna carpal joints, distally the tips of the distal phalanges, laterally the skin margins of first and fifth digits. The center of the 1st to 5th metacarpal shafts should not overlap, the heads of the 1st and 2nd metacarpals should be separated. Exposure, adequate penetration to visualise all bone detail and low enough contrast to visualise the soft tissues.
  49. 49. LATERAL PROJECTION IR: 8 x 10 inch for hand of average size or 10 x 12 inch crosswise for two images. Basic Position: The patient sits alongside the end of the table elbow flexed palm downwards, or at the end of the table with he elbow flexed at 90 degrees. Center the cassette to the MCP joints, and adjust the midline to be parallel with the long axis of the hand and forearm. Abduct the thumb of the patient.
  50. 50. CR: Perpendicular to the second digit MCP joint
  51. 51. STRUCTURES SHOWN
  52. 52. EVALUATION CRITERIA Hand in a true lateral position if the following are seen:  Superimposed phalanges  Superimposed metacarpals  Superimposed distal radius and ulna Extended digits Thumb free of motion and superimposition Each bone outlined through the superimposed shadows of the other metacarpals
  53. 53. PARA ENTREGAR!!!Favor de: Hacer un resumen de las proyecciones de los dígitos del 2 al 5:  PA  Lateral  Oblicua Hacer resumen de las proyecciones del dígito 1:  PA/AP  Lateral  Oblicua
  54. 54. QUESTIONS?
  55. 55. REFERENCES Frank, Eugene D. (2007). Merrills atlas of radiographic positioning & procedures. 11th ed. St. Louis, Missouri: Mosby/Elsevier. Vol 1-3 REF RC78.4 .B35 2007 Bontrager, Kenneth L. (2005). Textbook of radiographic positioning and related anatomy. 6th ed. Missouri: Elsevier. Brant, William E. (2006). Fundamentals of diagnostic radiology. Philadelphia: Lippincott. Enrlish, Ruth Ann. (2004). Patient care in radiography: with an introduction to medical imaging. Philadelphia: Mosby. RC78 .E48 2004 Ward, Robert J. (2007). Pediatric imaging: case review. Philadelphia: Mosby. RJ51.R3 W37 2007

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