Upper Limb (Extremity)

Published on 03/05/2015 by admin

Filed under Radiology

Last modified 22/04/2025

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Chapter 2

Upper Limb (Extremity)

Upper Limb (Extremity)*

Technical Factors

The following technical factors are important for all upper limb procedures to maximize image sharpness.

• 40-44″ (102-113 cm) SID, minimum OID

• Small focal spot

• Nongrid or TT (tabletop), detail (analog) screens

• Digital imaging requires special attention to accurate CR and part centering and close collimation.

• Short exposure time

• Immobilization (when needed)

• Multiple exposures per imaging plate: Multiple images can be placed on the same IP. When doing so, careful collimation and lead masking must be used to prevent pre-exposure or fogging of other images.

• Grid use with digital systems: Grids generally are not used with analog (film-screen) imaging for body parts measuring 10 cm or less. However, with certain digital systems, the grid may or may not be able to be removed from the receptor. In those cases, it is departmental protocol that determines if a grid is left in place or removed. Important: If a grid is used, the anatomy must be centered to it to avoid grid cutoff.

AP Axial Thumb*

AP Oblique Bilateral Hand*

PA Axial Wrist—UInar Deviation and Modified Stecher (Scaphoid)*

image

Warning: The ulnar deviation view should be attempted only with possible wrist trauma after a routine wrist series rules out gross fractures to wrist or distal forearm. PA axial projection recommended for obscure fractures. If patient can’t ulnar deviate wrist, elevate hand on 20° angle sponge.

Note: See p. 26, 8th ed textbook for joint movement terminology.

Wrist—Carpal Canal*

(Gaynor-Hart Tangential Projection)

image

Warning: This position is sometimes called the “tunnel view” and should be attempted for possible wrist trauma only after a routine wrist series rules out gross fractures to wrist or distal forearm.