Indications for imaging
? fracture of the Scaphoid, initial and follow up films
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Anatomy Demonstrated
Scaphoid elongated and in profile
Wrist Scaphoid Rt 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 on the cassette
with the fingers flexed to maximise contact of the wrist with the
cassette. The hand and fingers are then maximally deviated
laterally (ulna deviation).
Wrist Scaphoid Lt 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 central ray is angled 20 degrees in line with the forearm towards
the elbow and centered to the Scaphoid at the anatomical
"snuff box", and collimated to the carpal bones.
|
Exposure Factors
| Kv |
mAS |
FFD (cm) |
Grid |
Focus |
AEC |
Cassette |
| 65 |
5 |
100 |
Non |
Fine (Micro) |
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, proximally the radio scaphoid joint
distally the carpo metacarpal joints laterally the skin margins.
Exposure, adequate penetration to visualise all bone detail and
low enough contrast to visualise the soft tissues.
Rt Carpal bones Angled + Ulna deviation for scaphoid
Radiograph (note fracture)
|
Related Projections
Wrist PA
Wrist Lat
Wrist Oblique
|
Additional modalities
M.R.. for internal soft tissue structures, CT may be
helpful, RNI for equivocal fractures, macro-radiography for scaphoid.
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