Image Evaluation for a PA Hand x-ray.

1. 
PA Hand
By: Nicole DeStefano

2. HIPPA Compliance
 Our image is HIPPA
compliant
 Nowhere on our image does
it violate any patient
confidentiality

3. Marker & Patient ID
 The correct anatomical side
marker is visible in the
image.
 The side marker is placed
correctly with the right
marker displaying on the
viewers left.
 There are no markers
superimposed on any
pertinent anatomy.

4. Marker & Patient ID
 There were no additional
side markers used but an
arrow marker could have
been used to indicate sight
of pain/injury etc.
 The image is displayed
correctly based on marker
placement.

5. Radiation Hygiene
 Acceptable beam restriction
requires at least 3 or more sides
of collimation. There is no
evidence of beam restriction
located on our image.
 Shielding must be provided if
the gonads are within 5 cm of
the primary beam. There is no
evidence of primary shielding
on the side closest to the
gonads.
 It is always a good habit to
place a lead shield on any
patient of child bearing age.

6. Completeness of Position/Projection
 Routine positions/projections
for a hand include:
 PA
 PA Oblique 45 degree rotation
 Left fan lateral
 This is a PA hand which
complies with the routine
projections/positions.
 All anatomical parts are
correctly visualized on the
image.

7. Artifact Identification
 There does not appear
that there are any of the
following in our image:
 Physical artifacts
 Body parts superimposed
 Hospital paraphernalia
 Patient clothing/belongings
 Indwelling artifacts/foreign
bodies
 Our patient does have a
fracture of the 5th
metacarpal.

8. Artifact Identification
 There does not appear
that excess fog is visible
and/or degrading overall
image quality.
 There also does not
appear that there are
any CR/DR artifacts
visible in the image.

9. Image Sharpness
 There does not appear that
any of the following are in
the image:
 Gross voluntary motion
 Excessive quantum
mottle/image noise
 Evidence of double
exposure
 Grid lines/cut-off, or
artifacts
 When imaging a hand, it is
unnecessary to use a grid.

10. Image Sharpness
 Size distortion does not
appear greater than
expected because when
imaging a hand, the hand lies
directly on the IR.
 The CR should be entering at
the third MCP joint. Because
the CR is more than 1 cm off-
centered to the part, shape
distortion is being caused but
only to a minimal.

11. Accurate Part Positioning
 The part is adequately aligned to
the image media.
 The part is not accurately centered.
The part would have to be moved
about an inch to the left.
 The CR is not centered within 1 cm
of the anatomical part.
 The CR is aligned to the imaging
media.
 The CR does conform to an
accepted IR exposure field
recognition template.

12. Accurate Part Positioning
 According to Merrill’s Atlas or Radiographic Positioning and
Procedures for a PA hand state:
 Rest the patient’s forearm on the table and place the hand with
the palmar surface down on the IR.
 Center the IR to the MCP joints, and adjust the long axis of the
IR with the long axis of the hand and forearm.
 Spread fingers slightly.
 Shield gonads.
 Ask patient to relax hand
to avoid motion.

13. Evaluation Criteria
 Evidence of proper collimation
 No rotation of hand
 Open MCP and IP joints,
indicating hand is placed flat on
the IR
 Slightly separate digits with no
soft tissue overlap
 All anatomy distal to the radius
and ulna
 Soft tissue and bony
trabeculation

14. Judicious ExposureTechnique
 Based on criteria, the
anatomical part is correctly
positioned.
 The most radiolucent
structure visible in the image
is the soft tissue of the hand.
 The most radiopaque
structure that is visible on
the image is the bony cortex
of the hand.

15. Judicious ExposureTechnique
 I think the image displays
adequate contrast by
displaying short scale
contrast.
 The brightness of our image
is adequate as well.
 Even though we do not know
our EI value, I would say our
EI value was most likely
within normal range.

16. Accept or Reject?
 Based on the evaluation
criteria, I would ACCEPT this
image.
 However, for next time:
 I would make sure I
increased my beam
restriction especially on the
side closest to the gonads.
 Also appropriately center
the CR to correct
anatomical part.

17. Sources
 Frank, Eugene D., Bruce W. Long, Barbara J. Smith,
Vinita Merrill, and Philip W. Ballinger. Merrill's Atlas
of Radiographic Positioning & Procedures. 12th ed.
Vol. 1. St. Louis, MO: Mosby/Elsevier, 2007. Print.