The document provides guidelines for taking radiographs of the upper limb. It describes the proper positioning of the patient and image receptor for dorsi-palmar and anterior oblique hand views. For dorsi-palmar views, the hand should be pronated on the image receptor with fingers extended and separated. For anterior oblique views, the hand is externally rotated 45 degrees and supported on an angled pad. Correct centering and angulation of the x-ray beam is emphasized to visualize bones and joints clearly while avoiding overlap or under-rotation. Adherence to positioning protocols helps ensure high quality images for accurate diagnosis.

1. RADIOGRAPHY OF THE
UPPER LIMB
Mr R kidenda
Bmi,Mdu(echo&ecg)

2. Introduction
Although radiographic examinations of the upper limb are routine a high
standard of radiography must be maintained.
The importance of registering the correct right or left marker at the time of
the exposure cannot be overemphasised nor can the importance of
recording the correct patient identification and date of the examination.
To ensure maximum radiation protection when using computed
radiography (CR) cassettes, the patient should be seated at the side or end
of the table with the lower limbs and gonads away from the primary beam,
i.e. with the legs to the side of the table not under it and the beam should
be collimated within the margins of the image receptor

3. 1.HAND
Basic projections/VIEWS
Two projections are routinely taken,
1) Dorsi-palmar (DP)
2) Anterior oblique (DP oblique)
(18 cm × 24 cm) cassette size.

4. 1)Dorsi-palmar (DP)
Position of patient and image receptor
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 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.
A sandbag is placed over the lower forearm for immobilization.

5. Direction and Centring of X-ray Beam
The collimated vertical beam is
centered over the head of the
3rd metacarpal.

6. 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 interphalangeal and
metacarpo-phalangeal and
carpo-metacarpal joints should
be demonstrated clearly.
 No rotation.

7. Radiographic anatomy

8. 2.Anterior oblique (DP oblique)
Position of patient and image receptor
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 sandbag is placed over the lower end of the forearm for
immobilisation.

9. Direction and centering of the X-ray beam
The collimated vertical beam is
centred over the head of the 5th
metacarpal.
 The tube is then angled so that
the central ray passes through
the head of the 3rd metacarpal,
enabling a reduction in the size
of the field

10. 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 1st and 2nd
metacarpals are seen separated
whilst those of the 4th and 5th
are just superimposed

11. Common faults and remedies
Over rotation will project the
metacarpals and digits on top of
each other
 Under rotation will fail to open
out the metacarpals.

12. Note
The exposure should provide adequate penetration too visualize the
metacarpal bones

13. 10 point plan image quality