DR. ESAM ABUSAOUD.
Upper limb1
THE SCAPHOID RADIOGRAPHY
The scaphoid is the largest of the proximal row of carpal bones and forms the radial
portion of the carpal tunnel. It is important for stability and movement at the wrist.
Scaphoid fractures are often a result of fall onto an outstretched hand and may result
in avascular necrosis if missed.
Projections
1. PA view
The posteroanterior is the best view to inspect the joint spaces of the carpal bones and
the distal radioulnar joint.
Patient position
1.
Patient is seated alongside the table.
2.
The affected arm if possible is flexed at 90° so the arm and wrist can rest on the
table.
3.
The affected hand is placed, palm down on the image receptor with hand in ulnar
deviation.
4.
Shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to
the central beam.
5.
The wrist and elbow should be at shoulder height which makes radius and ulna
parallel (lowering the arm makes radius cross the ulna and thus relative shortening
of radius).
Technical factors

Posteroanterior projection.

Centering point:
o

anatomical snuffbox
Collimation:
o
laterally to the skin margins
o
distal to the midway up the metacarpals
o

Orientation:
o


portrait
Detector size:
o

proximal to the include one-quarter of the distal radius and ulna
18 cm x 24 cm
Exposure:
o
50-60 kVp
o
3-5 mAs
SID
o
100 cm
2. PA view angled
In the scaphoid posteroanterior axial view (Posteroanterior view angled) the tube
angulated to present the scaphoid en face.
Patient position
1.
Patient is seated alongside the table.
2.
The affected arm if possible is flexed at 90° so the arm and wrist can rest on the
table.
3.
The affected hand is placed, palm down on the image receptor with hand in ulnar
deviation.
4.
Shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to
the central beam.
5.
The wrist and elbow should be at shoulder height which makes radius and ulna
parallel (lowering the arm makes radius cross the ulna and thus relative shortening
of radius).
Technical factors

Posteroanterior axial projection.

centering point:

o
anatomical snuffbox
o
the central beam is angled 15-30° proximally along the long axis of the arm
towards the elbow
Collimation:
o
laterally to the skin margins
o
distal to the base of the first metacarpal
o

Orientation:
o


portrait
Detector size:
o

proximal to the radiocarpal joint
18 cm x 24 cm
Exposure:
o
55-65 kVp
o
3-5 mAs
SID:
o
100 cm
3. oblique view
This is a great projection to assess the tubercle of the scaphoid and most of the distal
aspect of the scaphoid.
Patient position
1.
Patient is seated alongside the table.
2.
The affected arm if possible is flexed at 90° so the arm and wrist can rest on the
table.
3.
The affected hand is placed, palm down on the image receptor.
4.
Shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to
the central beam.
5.
From the positioning of the PA projection, the wrist is externally rotated 40°; a
sponge can be placed under the wrist to aid stability.
6.
If possible maintain some ulnar deviation.
Technical factors

Posteroanterior projection.

Centering point:
o


mid carpal region
Collimation:
o
laterally to the skin margins
o
distal to the midway up the metacarpals
o
proximal to the include one-quarter of the distal radius and ulna
Orientation:
o

Detector size:
o


portrait
18 cm x 24 cm
Exposure:
o
50-60 kVp
o
3-5 mAs
SID:
o
100 cm
4. lateral view
Limited by multiple carpal bones overlapping
Patient position
1.
Patient is seated alongside the table.
2.
The affected arm if possible is flexed at 90°, so the arm and wrist can rest on the
table.
3.
Abduct the humerus until it is parallel to the image receptor.
4.
Shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to
the central beam.
5.
Hand and wrist in lateral position, thumb up.
Technical factors

Lateral projection.

Centering point:
o


Collimation:
o
anteroposterior to the skin margins
o
distal to the midway up the metacarpals
o
proximal to include one-quarter of the distal radius and ulna
Orientation:
o

portrait
Detector size:
o

mid carpal region
18 cm x 24 cm
Exposure:

o
50-60 kVp
o
3-5 mAs
SID:
o
100 cm
THUMB RADIOGRAPHY
Thumb pathology is wide and includes all lesions involving the tendons, ligaments,
muscles, bone, and articulations of the thumb.
Projections
1.



AP view
Demonstrates the first metacarpal in the natural anatomical position.
Excellent view to inspect shafts of the metacarpal.
It is an ideal view to inspect the metacarpal joint spaces, as well as the regions of
ligamentous attachments and possible avulsion.
Patient position
1.
Patient is seated alongside the table.
2.
The arm is extended and medially rotated so as bring the dorsal aspect of thumb
in contact with the cassette.
Technical factors

Anteroposterior projection.

Centering point:
o


Collimation:
o
laterally to the skin margins
o
distal to skin margin
o
proximal to the carpometacarpal joint
Orientation:
o


portrait
Detector size.
o

base of the thumb
18 cm x 24 cm
Exposure.
o
50-60 kVp
o
3-5 mAs
SID.
o
100 cm
2.

Lateral view
Essential view to examine joint spaces.
Patient position
1.
Patient is seated alongside the table.
2.
The forearm is placed on table.
3.
The wrist is kept in ulnar deviation and thumb abducted.
4.
Lateral aspect of thumb is brought into contact with the cassette by bending
fingers.
Technical factors

Lateral projection.

Centering point:
o


Collimation:
o
laterally to the skin margins
o
distal to skin margin
o
proximal to the carpometacarpal joint
Orientation:
o


portrait
Detector size:
o

first metacarpophalangeal joint space
18 cm x 24 cm
Exposure:
o
50-60 kVp
o
3-5 mAs
SID:
o
100 cm
HAND RADIOGRAPHY
The hand series primarily examines the radiocarpal and distal radioulnar joints,
the carpals, metacarpals, and phalanges.
Projections
1.



PA view
Demonstrates the metacarpals, phalanges, radius and ulna in the natural
anatomical position.
Excellent view to inspect the metacarpals.
Ideal for identifying early signs of rheumatoid arthritis and osteoarthritis.
Patient position
Patient is seated alongside the table.
The affected arm if possible is flexed at 90° so the arm and hand can rest on the
table.
3. The affected hand is placed, palm down on the image receptor.
4. Shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to
the central beam.
5. The hand and elbow should be at shoulder height which makes radius and ulna
parallel.
1.
2.
Technical factors







Posteroanterior projection.
Centering point:
o third metacarpal head
Collimation:
o laterally to the skin margins
o proximal to include distal radioulnar joint
o distal to the tips of the distal phalanges
Orientation:
o portrait
Detector size:
o 18 cm x 24 cm
Exposure:
o 50-60 kVp
o 1-5 mAs
SID:
o 100 cm
2.
Oblique view
Patient position
1.
Patient is seated alongside the table.
2.
The affected arm if possible is flexed at 90° so the arm and hand can rest on the
table.
3.
The hand is rotated externally by 45 degrees from the basic PA position with
fingers kept in extension and parallel to image receptor.
4.
Shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to
the central beam.
5.
The hand and elbow should be at shoulder height which makes radius and ulna
parallel.
Technical factors

Posteroanterior projection.

Centering point:
o


Collimation:
o
laterally to the skin margins
o
proximal to include distal radioulnar joint
o
distal to the tips of the distal phalanges
Orientation:
o


portrait
Detector size:
o

third metacarpal head
18 cm x 24 cm
Exposure:
o
50-60 kVp
o
1-5 mAs
SID:
o
100 cm
3.
Lateral view
It is particularly useful for visualizing the degree of fracture displacement and the exact
location of a foreign body.
Patient position
1.
Patient is seated alongside the table.
2.
Hand is externally rotated by 90 degrees from the PA position so that the palm is
perpendicular to the image receptor.
3.
Fingers are kept extended with thumb abducted.
4.
Fingers should ideally be separated (fan lateral view) to visualize each phalange
separately.
Technical factors

Lateral projection.

Centering point:
o


Collimation:
o
anteroposterior to the skin margins
o
distal to the tips of the fingers
o
proximal to include one-third of the distal radius and ulna
Orientation:
o


portrait
Detector size:
o

over the head of the second metacarpal
18 cm x 24 cm
Exposure:
o
50-60 kVp
o
3-5 mAs
SID:
o
100 cm