Summary of How to Position a Hand Radiograph

Summary of "How to Position a Hand Radiograph"

This video provides detailed instructions on how to properly position a hand for three common radiographic views: PA (posteroanterior), oblique, and lateral. It emphasizes proper Cassette Orientation, patient preparation, positioning techniques, and common pitfalls to avoid for optimal imaging quality.

---

Main Ideas and Concepts

• Cassette Orientation:
  • Cassettes have arrows indicating the "head" or top.
  • Proper orientation is crucial to ensure images appear correctly on the PACS (Picture Archiving and Communication System).
  • Incorrect orientation can cause images to be flipped or rotated incorrectly, complicating interpretation.
  • Images can only be rotated by 90 degrees digitally, so initial positioning is important.
• Patient Preparation:
  • Remove all jewelry (rings, bracelets, watches) to avoid artifacts on the image.
  • Note any decorations or rhinestones on nails that cannot be removed, as these may affect image interpretation.
• Positioning and Centering:
  • Always center the part of interest in the middle of the cassette.
  • For a PA hand, center on the third proximal interphalangeal joint (PIP).
  • Avoid excessive collimation to prevent clipping parts of the anatomy such as the thumb or wrist.
  • Include about one-third of the distal wrist in the image.
• Marking:
  • Place markers (e.g., left or right) clearly and outside the anatomy to avoid confusion.
  • Markers should not be tucked under the patient or anatomy.

Step-by-Step Positioning Instructions

1. PA Hand Position

• Center the third PIP joint in the middle of the cassette.
• Orient the cassette with the arrow (head) at the top.
• Avoid clipping the thumb or wrist by opening the collimator adequately.
• Remove jewelry and note any nail decorations.
• Place the marker outside the anatomy, visible on the image.

2. Oblique Hand Position

• Rotate the hand approximately 45 degrees from the PA position.
• Keep the central ray centered on the same area (third PIP joint).
• Use Positioning Sponges if the patient is unsteady to maintain stability.
• Ensure the hand is still during exposure to avoid motion blur.

3. Lateral Hand Position

• Ask the patient to make an "OK" sign with the hand.
• Position the hand so fingers are splayed but relaxed.
• Keep the proximal and distal interphalangeal joints aligned and centered.
• Avoid overlapping bones by preventing the fingers from pinching tightly together.
• Orient the cassette and x-ray machine accordingly, placing the marker on the inside.
• Use hand sponges if needed, but a free-form method is demonstrated.

Additional Tips and Notes

• Motion is the biggest enemy in radiology; ensure the patient remains still.
• Be mindful of image orientation on the cassette to reduce radiologist confusion.
• Always communicate clearly with patients about removing jewelry and positioning.
• Document any unavoidable artifacts like nail decorations in patient notes.

Speakers/Sources Featured

• A single instructor/technologist (unnamed) who demonstrates and explains the positioning techniques throughout the video.

Notable Quotes

— 03:49 — « Motion is the worst enemy of radiology. »

— 04:46 — « You want them nice and relaxed here so it's going to open up all these little joints and again kind of splay these fingers out just like so. »

Category

Educational

Video