Wednesday 25 April 2012

Wrist

Lateral

Indications for imaging
Injury, pain, carpal tunnel syndrome,
Anatomy  Demonstrated
Distal radius and Ulna, carpal bones and proximal metacarpals
Wrist Rt lateral Anatomy
Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London
Basic Patient Position
The patient sits alongside the long edge of the table arm extended palm downwards, or at the end of the table with he elbow flexed at 90 degrees, hand and wrist flat rotated exteranl to bring the radio and ulna styloid processes in vertical alignment.

Wrist Lt Lateral Patient Position
Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London
Radiation protection
Direct lead rubber gonad protection using a "half apron".
Ensure the lower limbs and torso are not below the table top in the primary beam.
Central Ray
The vertical central ray is centered to a point 1 cm distal to the radial styloid process midway between the medial and lateral skin margins.
Exposure Factors
Kv mAS FFD (cm) Grid Focus AEC Cassette
65 5 100 No Fine nO 18 X 24 CM
Evaluation of the Image
ID and markers must be present and correct in the appropriate area of the film
Evidence of collimation on four sides equally around the centering point.
Limits of the examination, superiorly the lower quarter of the radius and ulna, distally the metacarpals, lateral and medially the skin margins.
Distal radius, ulna and proximal metacarpals should be superimposed,
Exposure, adequate penetration to visualise all bone detail and low enough contrast to visualise the soft tissues.

Wrist Rt lateral 
 
Related Projections
Hand DP
Hand DP "Ball catching for rheumatoid)
Hand DP Oblique
Fingers Lat.
Thumb AP
Thumb Lat. Wrist AP
Wrist PA
Wrist Oblique
Wrist AP Angled for Scaphoid
Additional modalities
M.R.. for internal soft tissue structures, CT may be helpful, RNI for equivocal fractures, macro-radiography for schaphoid.

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