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Radiographic Positioning of the Hand and Fingers

By: CE4RT

This article discusses radiographic positioning to show the fingers and hand for the Radiologic Technologist (X-Ray Tech).

Lateral Finger X-Ray position Lateral Finger X-Ray

 

Finger Lateral

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of the finger.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Twist wrist to position finger so that it's side is touching or as close as possible to the image receptor (IR). More importantly that it is sideways relative to the IR and so that it is isolated from the other digits. Center digit to be examined on the image receptor.

Central ray: Perpendicular to the image receptor and directed to the PIP joint of the digit being examined.

 

 

Finger PA

Fingers PA x-ray position 

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of the finger.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Palm down. Slightly separate the digits. Center digit to be examined on the image receptor.

Central ray: Perpendicular to the image receptor and directed to the PIP joint of the digit being examined.


Fingers PA oblique

 Finger PA Oblique x-ray position finger pa oblique x-ray

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of the finger.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Place forearm on the table with pronated hand placed over the image receptor. Externally rotate hand 45 degrees and separate digits. Support hand using 45 degree foam wedge if appropriate.

Central ray: Perpendicular to the image receptor and directed to the PIP joint of the digit being examined.


Thumb AP

Thumb AP x-ray position

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of the 1st digit (thumb).

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Hand rotated internally on the the table. Thumb extended thumbnail down on the table. Other digits back out of exposure. Avoid superimposition of other digits. 

Central ray: Perpendicular to the image receptor and directed to the PIP joint of the digit being examined.


Thumb PA

 Thumb PA x-ray position Thumb pa x-ray

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of the 1st digit (thumb).

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Position hand lateral side down. For true PA, thumb is elevated. Place thumb over support if needed. Dorsal surface of the thumb should be parallel to the the image receptor. 

Central ray: Perpendicular to the image receptor and directed to the PIP joint of the digit being examined.

 

 

Thumb PA Oblique

thumb pa oblique x-ray position

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of the 1st digit (thumb).

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Place palm down thumb abducted. Slightly ulnar deviate hand. 

Central ray: Perpendicular to the image receptor and directed to the PIP joint of the digit being examined.


HAnd PA

PA hand x-ray position Hand PA x-ray

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of hand including the carpals, metacarpals, phalanges. No rotation of the hand should be observed.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Hand centered palm down flat, fingers separated. The central ray should be perpendicular to the image receptor at 3rd MCP joint.

Central ray: Perpendicular to the image receptor at 3rd MCP joint.

 

 

Hand PA Oblique

PA oblique hand x-ray position Hand AP Oblique x-ray

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of hand including the carpals, metacarpals, phalanges. No rotation of the hand should be observed.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Hand in center of the image receptor rotated 45 degrees, fingers separated. Cone to part of interest.

Central ray: Perpendicular to the image receptor at 3rd MCP joint.

HAND lATERAL

 Lateral hand x-ray position Hand Lateromedial x-ray position Hand Mediolateral x-ray position Lateral hand x-ray

Purpose and Structures Shown: This view should demonstrate the bones and soft tissue of hand including the carpals, metacarpals, phalanges. No rotation of the hand should be observed.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: For Lateromedial: Thumb up.
For Lateromedial Flexion, Thumb up, hand cupped.
For Mediolateral: Thumb down.
For Fan: Thumb up, fingers separated.

Central ray: Perpendicular to the image receptor at 3rd MCP joint.

HAND AP FIRST CARPOMETACARPAL JOINT

Hand AP First Carpometacarpal Joint Robert Method x-ray position Hand AP First Carpometacarpal Joint Rotert modification Hand AP First Carpometacarpal Joint Lewis modification
Purpose and Structures Shown: This view should demonstrate the First CMC joint spaces, base of first metacarpal and trapezium.
Does not show interphalangeal joint spaces.
Modifications to show specific areas of joint spaces.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Extend the arm straight out on the the table and rotate the arm internally.
Place the posterior of the thumb on the the image receptor with the thumbnail down.
Hyperextend the hand.

Central ray: For Robert method, perpendicular to the image receptor entering at the first CMC joint.
For Rotert modification, angled 15 degrees proximally entering the first CMC joint.
For Lewis modification, angled 10 to 15 degrees proximally entering the first MCP joint.

Hand AP First Carpometacarpal Joint Burman Method

Hand AP First Carpometacarpal Joint Burman Method X-RAY POSITION

Purpose and Structures Shown: First CMC joint spaces, base of first metacarpal convex profile, and trapezium concave profile.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Extend the arm straight out on the the table and rotate the arm internally. 
Cup the hand keeping the metacarpals in line with the forearm. 
Hold the hand position with a cloth looped around the digits if needed.

Central ray: 45 degrees toward the elbow through the first CMC joint. 18 inches SID to produce a magnified image.

Hand AP First Carpometacarpal Joint Folio Method

Hand AP First Carpometacarpal Joint Folio Method x-ray position

Purpose and Structures Shown: First CMC joint spaces. Shows also the first metacarpals and the First MCP joint. Useful for the diagnosis of ulnar collateral ligament rupture.

Position of patient: Seated sideways at the end of the the table. Place arm on the table with elbow bent. Ideally, upper arm, elbow, and forearm are all resting on the table.

Position of part: Hands touching the cassette on their medial aspects.
Rubber band around the distal portion of both thumbs and a roll of medical tape between the first metacarpals.
Thumbs in the PA plane, thumbnails parallel to the cassette.
Have patient pull thumbs apart and hold. 

Central ray: Perpendicular to the image receptor between both hands.

Read more about this and other subjects and get 24 Category A ARRT CE Credits in the X-Ray CE Course "Radiography of the Upper Extremities"

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