basic views of upper extremity their positioning

1. BASICVIEWS OF UPPER EXTREMITY
MAAJIDMOHIUDDINMALIK
LECTURERCOPMSADESHUNIVERSITY
BATHINDA,PUNJAB

2. HAND

3. BASIC PROJECTIONS
It is common practice to obtain two
projections, a posteroanterior (PA) and an
anterior oblique, on one 24 X 30-cm cassette. If
possible use a cassette with high-resolution
screens. A lead-rubber mask may be used to
mask off the half of the film not in use.

4. POSTERO-ANTERIOR – DORSI-PALMAR
Position of patient and cassette :
The patient is seated alongside the
table with the affected arm nearest to
the table.
The forearm is pronated and placed on
the table with the palmer surface of the
hand in contact with the cassette.

5. CONT…
The fingers are separated and extended but
relaxed to ensure that they remain in contact
with the cassette.
The wrist is adjusted so that the radial and
ulna styloid processes are equidistant from
the cassette.
 A sandbag is placed over the lower forearm
for immobilization.

6. Direction and centring of the X-ray beam
The vertical central ray is centred
over the head of the third
metacarpal

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

8. POSTIONONG

9. NORMAL POSTERO-ANTERIOR RADIOGRAPH OF
LEFT HAND

10. RADIOGRAPHIC ANATOMY

11. Anterior oblique – dorsi-palmar oblique
Position of patient and cassette
From the basic Postero-anterior position,
the hand is externally rotated 45 degrees
with the fingers extended.
 The fingers should be separated slightly
and the hand supported on a 45-degree non-
opaque pad.
 A sandbag is placed over the lower end of
the forearm for immobilization.

12. DIRECTION AND CENTRING OF THE X-RAY
BEAM
The vertical central ray is centred over
the head of the fifth metacarpal.
The tube is then angled so that the
central ray passes through the head of
the third metacarpal, enabling a
reduction in the size of the field.

13. 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 first and
second metacarpals are seen separated
whilst those of the fourth and fifth are just
superimposed.

14. POSTIONONG

15. NORMAL ANTERIOR OBLIQUE RADIOGRAPH OF
LEFT HAND

16. POSTERO-ANTERIOR – BOTH HANDS
Position of patient and cassette
Ideally, the patient is seated alongside the
table. However, if this is not possible due to
the patient’s condition, the patient may be
seated facing the table .
Both forearms are pronated and placed on
the table with the palmer surface of the
hands in contact with the cassette.

17. CONT…
The fingers are separated and extended but
relaxed to ensure that they remain in contact
with the cassette.
 The wrists are adjusted so that the radial
and ulna styloid processes are equidistant
from the cassette.
 A sandbag is placed over the lower forearms
for immobilization.

18. DIRECTION AND CENTRING OF THE X-RAY
BEAM
The vertical central is centred over a point
midway between the inter-phalangeal joints of
both thumbs.

19. ESSENTIAL IMAGE CHARACTERISTICS
The image should demonstrate all the
phalanges, including the soft-tissue
fingertips, the carpal and metacarpal bones,
and the distal end of the radius and ulna.
The exposure factors selected must produce
a density and contrast that optimally
demonstrate joint detail.

20. POSITIONING

21. NORMAL POSTERO-ANTERIOR RADIOGRAPH,
BOTH HANDS

22. Posterior oblique – both hands (ball catcher’s projection)
Position of patient and cassette
Ideally, the patient is seated alongside the
table. However, if this is not possible due to
the patient’s condition, the patient may be
seated facing the table
Both forearms are supinated and placed on
the table with the dorsal surface of the hands
in contact with the cassette.

23. CONT….
From this position, both hands are rotated
internally (medially) 45 degrees into a ‘ball-
catching’ position.
The fingers and thumbs are separated and
extended but relaxed to ensure that they remain
in contact with the cassette.
The hands may be supported using 45-degree
non-opaque pads.
A sandbag is placed over the lower forearms for
immobilization.

24. Direction and centring of the X-ray beam
The vertical central ray is centred to a
point midway between the hands at
the level of the fifth metacarpo-
phalangeal joints

25. 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 exposure factors selected must produce
a density and contrast that optimally
demonstrate joint detail.
The heads of the metacarpals should not be
superimposed.

26. RADIATIONPROTECTION
If it has been necessary to position the patient
facing the table, it is essential to provide
radiation protection for the lower limbs and
gonads. This may be achieved by placing a lead-
rubber sheet on the table underneath the
cassette to attenuate the primary beam.

27. POSTIONING

28. Normal radiograph of hands in ball catcher’s
position

29. LATERAL
Position of patient and cassette
From the Postero-anterior position, the hand
is externally rotated 90 degrees.
The palm of the hand is perpendicular to the
cassette, with the fingers extended and the
thumb abducted and supported parallel to
the film on a non-opaque pad.
The radial and ulnar styloid processes are
superimposed.

30. DIRECTION AND CENTRING OF THE X-RAY
BEAM
The vertical central ray is centred
over the head of the second
metacarpal.

31. Essential image characteristics
The image should include the fingertips,
including soft tissue, and the radial and ulnar
styloid processes.
The heads of the metacarpals should be
superimposed.
The thumb should be demonstrated clearly
without superimposition of other structures.

32. NOTES
If the projection has been undertaken to
identify the position of a foreign body, the
kVp should be lowered to demonstrate or
exclude its presence in the soft tissues.
A metal marker placed adjacent to the
puncture site is commonly used to aid
localization of the foreign body.

33. RADIOLOGICAL CONSIDERATIONS
The hand and wrist (like the ankle and foot)
have many accessory ossicles, which may
trap the unwary into a false diagnosis of
pathology.
‘Boxer’s fracture’ of the neck of the fifth
metacarpal is seen easily, but conspicuity of
fractures of the bases of the metacarpals is
reduced by over rotation and underexposure.

34. POSTIONING

35. Lateral radiographof handwithforeign body marker. There is an old
fracture of the fifthmetacarpal

36. THANK YOU