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Radiographic Image Analysis Ch.4 - Upper Extremities, Exams of Radiography

A.T. Still University of Health Sciences (ATSU)Radiography

Radiographic Image Analysis Ch.4 - Upper Extremities

Typology: Exams

2023/2024

Available from 06/23/2024

CarlyBlair
CarlyBlair 🇺🇸

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Radiographic Image Analysis Ch.4 - Upper
Extremities
What are the technical factors for a finger, thumb or hand? -
kV: 55-65
mAs: 1
What are the technical factors for a wrist? -
kV: 65-70
mAs: 2
What are the technical factors for a forearm or elbow? -
kV: 70-75
mAs: 2
What are the technical factors for a humerus? -
kV: 75-80
mAs: 3
T or F: On a PA oblique projection of the finger, the amount of concavity increases on the side towards
which the anterior (palmer) surface is rotated, whereas the side toward which the posterior surface
rotates demonstrates less concavity. -
true
T or F: The side demonstrating the greatest soft tissue width on a rotated PA or PA oblique projection, is
the side toward which of the anterior surface was rotated. -
true
What 2 joint spaces on a finger x-ray should be open if the phalange is fully extended and the CR is
perpendicular? -
Interphalangeal Joints and Metacarpophalangeal Joint
Phalanges will appear foreshortened and will have superimposed joint spaces, closing them if..... -
the finger is bent, and not fully flexed
What should you do if the patient is unable to extend the fingers for a PA image of the finger? -
take image in AP projection
* elevate the proximal metacarpal phalangeal joints until affected finger is parallel with IR
On a PA oblique finger how much rotation is needed? -
45 degrees
How can you tell if an oblique finger projection was over-rotated? -
- the soft tissue with on one side of the digit is MORE than twice as much as that on the other
one
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Radiographic Image Analysis Ch.4 - Upper

Extremities

What are the technical factors for a finger, thumb or hand? - kV: 55- mAs: 1 What are the technical factors for a wrist? - kV: 65- mAs: 2 What are the technical factors for a forearm or elbow? - kV: 70- mAs: 2 What are the technical factors for a humerus? - kV: 75- mAs: 3 T or F: On a PA oblique projection of the finger, the amount of concavity increases on the side towards which the anterior (palmer) surface is rotated, whereas the side toward which the posterior surface rotates demonstrates less concavity. - true T or F: The side demonstrating the greatest soft tissue width on a rotated PA or PA oblique projection, is the side toward which of the anterior surface was rotated. - true What 2 joint spaces on a finger x-ray should be open if the phalange is fully extended and the CR is perpendicular? - Interphalangeal Joints and Metacarpophalangeal Joint Phalanges will appear foreshortened and will have superimposed joint spaces, closing them if..... - the finger is bent, and not fully flexed What should you do if the patient is unable to extend the fingers for a PA image of the finger? - take image in AP projection

  • elevate the proximal metacarpal phalangeal joints until affected finger is parallel with IR On a PA oblique finger how much rotation is needed? - 45 degrees How can you tell if an oblique finger projection was over-rotated? -
  • the soft tissue with on one side of the digit is MORE than twice as much as that on the other one
  • one aspect of the phalangeal mid-shaft is concave but the other aspect is slightly convex When the hand and fingers are rotated to obtain a PA oblique, all but the fifth finger are positioned away from the IR at varying OID's; this naturally tilts them towards the IR with their fingertips resting on it, what would this cause to happen? -
    • closes IP and MCP joints
  • foreshortens phalanges The anterior surface of the middle and proximal phalanges demonstrates midshaft _____________, the posterior surfaces show slight ___________ when the lateral finger projection is obtained without rotation. - concavity convexity T or F: the anterior surface of the finger demonstrates MORE than twice as much soft tissue with than the posterior surface in a lateral finger. - TRUE T or F: An immobilization device can be used to extend the finger if a fracture is suspected. - FALSE
  • this can make the fracture worse For a lateral finger projection if the patient is unable to move unaffected fingers out of way what should be done? -
    • leave fingers as they are (if there is a suspected fracture)
  • use higher kV to penetrate through other fingers T or F: For an AP thumb, if the arm is internally rotated more than needed, the anterior thumb surface will be demonstrated next to the hand on the projection. When arm has not been internally rotated enough the posterior thumb surface will be done demonstrated toward the hand. - true On the PA projection of the thumb, which joint is closed? - carpometacarpal joint How can you tell if a PA hand projection is medially rotated? (4) -
    • narrowing or slight superimposition of the third through fifth metacarpal heads
  • unequal soft tissue thickness
  • midshaft concavity on sides of phalanges
  • MC's also show un-equal spacing and midshaft concavity. T or F: for a PA hand, ensure that the thumb is not positioned too far away from the hand so you can get better collimation. - TRUE What is a paediatric bone age assessment? What part is imaged? - assess the skeletal versus the chronologic age of a child
  • laterally located carpal bones and MC bases demonstrate increased super imposition and decreased intercarpal and MC joint space visualization
  • pisiform form and hamate hook demonstrate increased visibility
  • radioulnar articulation closed When a PA wrist is ___________ rotated, the posterior radius superimposes is the ulna. When a PA wrist is ___________ rotated, the ulna superimposes the anterior radius. - externally internally If the proximal forearm is elevated higher than the distal forearm, the PA wrist demonstrates the posterior radial margin at a distance greater than ________ inches distal to the anterior margin, and increased super imposition of the posterior radius on the scaphoid and lunate. - 0.25 inches When looking at the radial margin, the posterior edge of the surface is __________, where is the anterior edge is ____________. - blunt rounded When imaging a PA wrist on a large muscular or thick proximal forearm, it may be necessary to do what? - allow proximal forearm to extend off of the IR or table to position the forearm parallel to the IR On a PA wrist, how would you demonstrate an open radio-scaphoid and radio-lunate joint? - Proximal aspect of forearm should be positioned slightly lower than the distal forearm by about 5 to 6° from horizontal. On a PA wrist, when the hand is too extended what will occur? (2)
  • MC's positioned less than 10° with IR -
  • obscured third through fifth CM joint spaces
  • severely foreshortened scaphoid that has taken a signet ring configuration (large circle with a smaller circle within it) On a PA wrist, when the hand has been over flexed what will occur? (3)
  • MC's positioned more than 15° with IR -
  • foreshortened MC's
  • closed 2nd through 3rd CM joint spaces
  • decreased scaphoid for shortening T or F: If the third MC and the midforearm are aligned, the patient's wrist has been placed in a neutral position without deviation. - TRUE ulnar vs. radial deviation -

What type of deviation of the wrist causes the distal scaphoid to tilt anteriorly and demonstrates increased foreshortening as it forms a signet ring configuration on the projection. It also causes the lunate to shift immediately towards the ulna? - RADIAL DEVIATION What type of deviation of the wrist causes the distal scaphoid to tilt posteriorly and demonstrates decreased foreshortening, and lunate to shift laterally towards the radius? - ULNAR DEVIATION For a PA oblique wrist, flex the hand until the 2nd MC is placed at a ______ to _______ degree angle with the anterior plane of the wrist. - 10 to 15 degree For a PA oblique wrist, how much should the wrist be rotated? - 45 degrees What occurs is a PA oblique wrist is over-rotated? (3) -

  • trapezium superimposes the trapezoid, closing the trapezium-trapezoidal joint space,
  • more than 1/4 of the trapezoid superimposes the capitate
  • 4th and 5th metacarpal mid shafts are superimposed T or F: On a properly rotated PA oblique wrist projection, the trapezium is drawn from beneath the trapezoid, providing clear visualization of those carpal bones and joints space. It also rotates the trapezoid on top of the capitate (about 1/4 superimposing) - TRUE What occurs is a PA oblique wrist is under-rotated? - Trapezoid superimposes portion of trapezium, closing trapezial-trapezoidal joint space, capitate, and 4th and 5th metacarpal mid-shaft demonstrating a larger separation. What is the pronator fat stripe? -
  • located parallel to anterior surface of distal radius
  • normally convex
  • lies within 0.25 inches of radial cortex *visualized on lateral wrist What is in profile on the posterior aspect of a lateral wrist projection? - ulnar styloid The relationship between the ____________ and the distal aspect of the ___________ can be used to discern whether a proper lateral projection of the wrist has been obtained - pisiform scaphoid *you want them superimposed! How can you tell if a patient's wrist is externally rotated on a lateral projection? -

What two joint spaces open up around the scaphoid during ulnar deviation? -

  1. scapholuante
  2. scaphocapitate How do you know if the PA axial view of the scaphoid was under rotated? (2) -
  • scaphocapitate joint space is closed
  • capitate and hamate are demonstrated without superimposition How do you know if the PA axial view of the scaphoid was over rotated? (2) -
  • scapholunate joint space is closed
  • capitate and hamate demonstrate some degree of superimposition How can you open the radio-scaphoid joint on a PA axial scaphoid view? -
  • anterior and posterior margins of distal radius need to be superimposed
  • accomplished by elevating proximal forearm very slightly above distal forearm (2°) What are the three parts of the scaphoid bone, in which part is most likely to be fractured? What angle should you use to image each part? -
  • Distal End: 20%
  • 20 to 25 degree cephalic angle
  • Waist: 70% of fractures
  • 15 degree
  • Proximal End: 10%
  • 5 to 10 degree cephalic angle Rotation of the distal forearm result from inaccurate positioning of what two things? - hand and wrist If the wrist and hand are ___________ rotated,
  • the laterally located 1st and 2nd MC bases and carpal bones are superimposed
  • medially located MC bases, pisiform, and hamate hook are better demonstrated. - internally If the wrist and hand are ___________ rotated,
  • medially located 4th and 5th MC bases and carpal bones will be superimposed
  • laterally located MC bases and carpal bones will demonstrate less superimposition - externally T or F: on an AP forearm, proximal forearm rotation results when humeral epicondyle or poorly positioned. - true How much of the radial head should be super imposing the owner on an AP forearm? - 1/8th (0.25 inch) One more than 1/8 of the radial head is superimposed over the owner the elbow has been ___________ rotated. -

internally The position of the ulnar styloid on an AP forearm is determined by which 2 things? - humerus and elbow On an AP forearm projection, if the elbow is rotated _________ and the wrist remains in the AP projection, the ulnar styloid is demonstrated laterally, next to the radius. - internally On an AP forearm projection, if the elbow is rotated _________ and the wrist remains in the AP projection, the ulnar styloid is demonstrated in profile medially - externally What occurs when an AP forearm is taken with the elbow flexed and the proximal humerus elevated? -

  • olecranon process moves away from olecranon fossa
  • coronoid process shifts proximally
  • the greater the elbow flexion the farther the olecranon process is positioned away from the fossa and more foreshortening in the distal humerus T or F: On an AP forearm projection, there should be super imposition of distal radial margins and open radio-scaphoid and radio-lunate joint spaces due to diverging rays - TRUE! T or F: On an AP forearm projection, the radial head is projected into the elbow joint due to diverging rays - TRUE! T or F: For an AP forearm projection, if the patient is unable to fully extend the arm position a joint closer to the fracture in a true position. - TRUE On a lateral forearm projection, if the wrist and distal forearm are ________ rotated the radius is visible anterior to the ulna. If the wrist and distal forearm are ___________ rotated, the radius is visible posterior to the ulna. - internally externally Visibility of the radial tuberosity on a lateral forearm is determined by the position of the: - wrist T or F: When the wrist is placed in a lateral projection, the radial tuberosity is situated on the medial aspect of the radius and is super imposed by the radius and is not demonstrated in profile - TRUE For a lateral forearm projection , if the wrist is externally rotated, the radial tuberosity is demonstrated __________. If the wrist is internally rotated 40° or more, the radial tuberosity is seen ______________. - ANTERIORLY

When CR is centred DISTAL to the elbow joint, radial head is projected into the joint space An accurately rotated __________ oblique elbow projection, demonstrates the coronoid process in profile, and 3/4 of the radial head superimposing the ulna - medial How much should the elbow be rotated for an oblique projection? - 45 degrees FOR MEDIAL OBLIQUE ELBOW (INTERNAL): If the humeral epicondyle's are at _______ than 45° of obliquity, less than 3/4 of the radial head superimposes the ulna if the humeral epicondyle's are at _______ than 45° of obliquity, more than 3/4 of the radial head are super imposed on the ulna - less more FOR LATERAL OBLIQUE ELBOW (EXTERNAL): If the humeral epicondyle's are at _______ than 45° of obliquity, the radial head and radial tuberosity still partially superimpose the ulna if the humeral epicondyle's are at _______ than 45° of obliquity, the coronoid process partially superimposes the radial head, the radial tuberosity and ulna demonstrating no superimposition, radial tuberosity is no longer in profile. - less more Internal vs External Oblique Elbow - Internal:

  • coronoid process in profile
  • 3/4 of radial head super imposing the ulna External:
  • rotates radius away from ulna
  • demonstrated ulna without radial superimposition For an AP oblique elbow projection, if the humerus is parallel with the IR and the forearm is elevated what will be demonstrated? (4) -
    • undistorted distal humerus
  • proximal forearm foreshortened medial oblique: closed capitulum-radial head

lateral oblique: closed trochlear coronoid process joint spaces with articulating surfaces of a radial head or trochlea visualized. For an AP oblique elbow projection, if the forearm is parallel with the IR and the humerus is elevated what will be demonstrated? (3) -

  • undistorted proximal forearm medial oblique:
  • open capitulum radial head lateral oblique:
  • open trochlear-coronoid process joint space and foreshorten distal humerus. For an AP oblique elbow projection for someone who cannot fully extend their elbow: if the _____________ or _____________ is of interest, position the forearm parallel with the IR. If the ____________ or ______________ is of interest, position of humerus parallel with the IR - radial head or coronoid process capitulum or medial trochlea What are the three soft tissue pads on a lateral elbow projection? -
  1. anterior
  2. posterior
  3. supinator What might a change in the shape or placement of the anterior fat pad on a lateral elbow projection indicate? - Joint effusion or elbow injury T or F: On the lateral elbow projection, the posterior your fat pad is normally obscured because of its location. When an injury occurs, joint a fusion may push this pad out of the fossa allowing it to be visualized. - true On a lateral elbow projection, displacement of the supinator fat pad stripe may indicate: - fracture of the radial head or neck On a lateral elbow projection, the proximal humerus positioning determines the alignment of what? (3)
  1. distal surfaces of capitulum
  2. medial trochlea
  3. anterior alignment of radial head and coronoid process On a lateral elbow projection, the distal forearm positioning determines the alignment of what? (2) -
  • medial trochlea demonstrates capitular superimposition
  • radial head superimposes over more than the tip of the coronoid process
  • can also occur if CR is angled less than 45 degrees For an axiolateral projection of the elbow, what would improper alignment of the forearm affect? (3) -
  • openness of elbow joint space
  • anterior alignment of capitulum and medial trochlea
  • proximal alignment of radial head and coronoid process for an axiolateral projection of the elbow, if the distal forearm is positioned too close to the IR (depressed), what would the projection demonstrate? (3) -
  • closed elbow joint space
  • capitulum to far anterior to medial trochlea
  • radial head distal to coronoid process for an axiolateral projection of the elbow, if the distal forearm is positioned too far away from the IR (elevated), what would the projection demonstrate? (3) -
  • capitulum too far posterior to medial trochlea
  • radial head proximal to coronoid process For an axiolateral projection of the elbow, if the patient's wrist is in an AP position, what will be demonstrated? (2) -
  • radial tuberosity and medial aspect of radial head are demonstrated in profile on posterior arm surface
  • lateral aspect of radial head appears in profile on anterior arm surface For an axiolateral projection of the elbow, if the patient's wrist is in an later position, what will be demonstrated? (3) -
  • radial tuberosity not demonstrated in profile but is super imposed by the radius
  • anterior aspect of radial head is demonstrated in profile on anterior arm surface
  • posterior aspect of radial head is demonstrated in profile on posterior arm surface For an AP projection of the humerus, if less than 1/8 of the radial head superimposes the ulna, the humerus has been __________ rotated more than needed. - externally For an AP projection of the humerus, if more than 1/8 of the radial head superimposes the ulna, the humerus is _____________ rotated. - internally T or F: if a fracture of the humerus is suspected or a follow up is being done, the patient's arm can be externally rotated to obtain the AP projection - FALSE
  • it can increase the risk of radial nerve damage. What are the two projections that can be taken for a lateral humerus? -
  1. mediolateral
  1. lateromedial T or F: when imaging a PA lateral humerus, do not allow the patient to rotate the body towards the affected humerus. Such body obliquity causes increase in tissue thickness at proximal humerus because shoulder tissue is superimposing. - true
  • causes lower contrast resolution lateromedial humerus - mediolateral humerus - What a fracture of the distal humerus is present, how should you be taking a lateral projection of the humerus? - slide an IR are between patient and distal humerus
  • place shielding between patient and IR to absorb any radiation that would penetrate and expose the patient When a fracture of the proximal humerus is present, what are the 2 options on how to take a lateral projection? (2) -
    1. scapular Y PA axial projection upright
  1. trans thoracic lateral How would you proceed to take a transthoracic lateral of the proximal humerus? -
    • patient's body is placed in lateral position with affected humerus resting against the grid IR
  • unaffected arm raised above patient's head
  • to prevent superimposition of the shoulder, either:
  1. elevate on affected shoulder by tilting upper mid sagittal plane toward the IR and using horizontal CR
  2. position shoulders on same transverse plane and angle CR 10 to 15° cephalically. Direct the CR to the mid-thorax at level of affected shoulder What breathing technique should you use for transthoracic lateral of the humerus? - Use breathing technique to blur vascular lung markings and auxiliary ribs long exposure time used while patient breathes shallowly