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X-RAY THE WRIST

X-Ray Images the Wrist


You have a formal request for a radiologic examination of the wrist. You have the assistance of additional personnel if required. You will need a properly equipped X-ray exposure room with various sizes of film in cassettes, sandbags, lead apron, letter markers, calipers, and various sponges.

1.  Select the required view(s) based on the request.

2.  Gather the necessary materials and supplies.

a.  Appropriate cassettes.

b.  Radiographic film.

c.  Sandbags.

d.  Letter markers.

e.  Tape.

f.  Positioning sponges.

g.  Lead shielding.

h.  Calipers.

3.  Prepare the patient.

a.  Bring the patient into the X-ray room.

b.  Ensure the patient is properly dressed.

(1)  Ensure the patient's jewelry is removed as necessary.

(2)  Ensure the patient's sleeve is rolled up as necessary.

c.  Explain the procedure if applicable.

d.  Seat the patient facing the X-ray table.

4.  Place the lead apron across the patient's lap.

5.  Measure the body part through the entry-exit site of the central ray.

6.  Set the control panel.

a.  Consult the technique chart.

b.  Set the appropriate mAs and kVp on the control panel.

7.  Select the proper size cassette.

NOTE: Use 1/2 of a 10" X 12" cassette for the PA and ulnar flexion views, and 1/2 of a 10" X 12" cassette for the lateral and oblique views.

8.  Place the cassette on the table according to the desired position.

9.  Position the overhead tube.

a.  Set the tube angle perpendicular to the film.

b.  Set the source to image receptor distance (SID) to 40 inches (101 cm).

c.  Center the tube to the portion of the film being used.

d.  Adjust the conefield to area of interest.

10.  Position the wrist.

a.  PA view.

(1)  Center the wrist on the appropriate 1/2 of the cassette (should be with the ulnar flexion view coming off the lateral border of the cassette).

(2)  Flex the elbow 90 degrees.

(3)  Ensure that shoulder, elbow and wrist are on the same horizontal plane.

(4)  Place the wrist and forearm parallel to the long axis of the cassette.

(5)  Position the styloids parallel to the cassette.

(6)  Instruct the patient to flex the fingers loosely to bring the wrist in contact with the film, but not so much as to superimpose the fingers with the carpal bones.

(7)  Central ray directed towards the midcarpal region.

b.  PA ulnar flexion view.

WARNING: Do NOT attempt the ulnar flexion view with possible wrist trauma before routine series has been completed to evaluate for possible fractures of distal forearm and/or wrist.

 

(1)  Center the wrist to the appropriate 1/2 of the cassette.

(2)  Flex the elbow 90 degrees.

(3)  Ensure that shoulder, elbow and wrist are on the same horizontal plane.

(4)  Position the styloids parallel to the cassette and ulnar flex hand (towards the ulna).

(5)  Central ray directed towards the scaphoid. 3/4 inch medial and 3/4 inch distal to the lateral styloid.

c.  Oblique view.

(1)  Center the wrist on the appropriate 1/2 of the cassette.

(2)  Flex the elbow 90 degrees.

(3)  Ensure that shoulder, elbow and wrist are on the same horizontal plane.

(4)  Adjust the metacarpal and styloid plane to form a 45 degree angle to the cassette.

(5)  Central ray directed to midcarpal region.

d.  Lateral view.

(1)  Center the wrist on the appropriate 1/2 of the cassette.

(2)  Flex the elbow 90 degrees.

(3)  Ensure that shoulder, elbow and wrist are on the same horizontal plane.

(4)  Ensure the epicondyles are perpendicular to the cassette.

(5)  Supinate the hand 5 degrees to place the styloid processes perpendicular to the cassette.

(6)  Central ray directed to midcarpal region.

11.  Immobilize the body part by placing a sandbag over the forearm if needed.

12.  Place the appropriate letter marker on the cassette.

13.  Tell the patient "DO NOT MOVE."

14.  Make the exposure.

15.  Tell the patient "RELAX" and remove immobilization (if any was used).

16.  Processed the film with the patient's identification.

 

David L. Heiserman, Editor

Copyright   SweetHaven Publishing Services
All Rights Reserved

Revised: June 06, 2015