Hand – Lateral

Area Covered
Hand, wrist and 2.5cm (1 inch) of distal forearm

IR Size & Orientation
18 x 24cm (8 x 10 inches) Portrait

Film / Screen Combination
Detail(CR and DR as recommended by manufacturer)

Bucky / Grid
No

Filter
No

Exposure
66 kVp3 mAs

FFD / SID
100 – 115cm (40 inches)

Central Ray
Directed to the 2nd metacarpophalangeal joint

• Patient seated at end of table
• Elbow flexed at 90 degrees
• Hand and forearm resting on table
• Rotate hand and wrist into lateral position with thumb on up side
• For the “Fan” lateral, digits are spread out
• a step block may be used
• For a “Flexion” lateral, digits 2 through to 5 are superimposed and held in extension with the thumb held clear
• For an “Extension” lateral, digits 2 through to 5 are superimposed and held in flexion with the thumb held clear

Critique

PACEMAN

Positioning

• The hand is in the lateral position,
• The metacarpal midshafts are superimposed
• The ulna is slightly posterior to the radius
  (Note: the wrist is not necessarily lateral when the hand is. In a lateral wrist the radius and ulna are superimposed)
• The interphalangeal joints are open
• Phalanges are not foreshortened

“Fan lateral”

• 2nd through to 5th digits are separated with little superimposition of bony and soft tissue structures
• 2nd through to 5th metacarpals are superimposed
• Thumb has no superimposition
• Thumb position varies from PA to slightly oblique

“Extension lateral”

• 2nd through to 5th digits fully extended and superimposed

“Flexion lateral”

• 2nd through to 5th digits are flexed and superimposed

Area Covered Phalanges, metacarpals, carpals and 2.5cm (1 inch) of distal radius and ulna

Collimation Include the distal phalanges to the distal forearm and soft tissue

Exposure Bony trabecular patterns and cortical outlines are sharply defined. Soft

tissues are visualised

Special Notes

• The extension lateral is sometimes preffered in cases of suspected foreign bodies
• Metacarpals are used in assessing how lateral the hand is
• To identify metacarpals, the 2nd metacarpal is the longest and the 5th metacarpal is the shortest

You must remember that there are two standard units; the English Units and the System Internationale (International System) Standard of Units.

English Units include:

1. roentgen
2. rad
3. rem
4. curie

SI Units include:

1. gray
2. sievert
3. becquerel

Common units used in the United States in health physics.

roentgen (R)
The roentgen is a unit used to measure a quantity called exposure. This can only be used to describe an amount of gamma and X-rays, and only in air. One roentgen is equal to depositing in dry air enough energy to cause 2.58E-4 coulombs per kg. It is a measure of the ionizations of the molecules in a mass of air. The main advantage of this unit is that it is easy to measure directly, but it is limited because it is only for deposition in air, and only for gamma and x rays.

rad (radiation absorbed dose)
The rad is a unit used to measure a quantity called absorbed dose. This relates to the amount of energy actually absorbed in some material, and is used for any type of radiation and any material. One rad is defined as the absorption of 100 ergs per gram of material. The unit rad can be used for any type of radiation, but it does not describe the biological effects of the different radiations.

rem (roentgen equivalent man)
The rem is a unit used to derive a quantity called equivalent dose. This relates the absorbed dose in human tissue to the effective biological damage of the radiation. Not all radiation has the same biological effect, even for the same amount of absorbed dose. Equivalent dose is often expressed in terms of thousandths of a rem, or mrem. To determine equivalent dose (rem), you multiply absorbed dose (rad) by a quality factor (Q) that is unique to the type of incident radiation.

curie (Ci)
The curie is a unit used to measure a radioactivity. One curie is that quantity of a radioactive material that will have 37,000,000,000 transformations in one second. Often radioactivity is expressed in smaller units like: thousandths (mCi), one millionths (uCi) or even billionths (nCi) of a curie. The relationship between becquerels and curies is: 3.7 x 1010 Bq in one curie.

SI – International Standard

Note: These are the common units used throughout the world in health physics.

gray (Gy)
The gray is a unit used to measure a quantity called absorbed dose. This relates to the amount of energy actually absorbed in some material, and is used for any type of radiation and any material. One gray is equal to one joule of energy deposited in one kg of a material. The unit gray can be used for any type of radiation, but it does not describe the biological effects of the different radiations. Absorbed dose is often expressed in terms of hundredths of a gray, or centi-grays. One gray is equivalent to 100 rads.

sievert (Sv)
The sievert is a unit used to derive a quantity called equivalent dose. This relates the absorbed dose in human tissue to the effective biological damage of the radiation. Not all radiation has the same biological effect, even for the same amount of absorbed dose. Equivalent dose is often expressed in terms of millionths of a sievert, or micro-sievert. To determine equivalent dose (Sv), you multiply absorbed dose (Gy) by a quality factor (Q) that is unique to the type of incident radiation. One sievert is equivalent to 100 rem.

becquerel (Bq)
The Becquerel is a unit used to measure a radioactivity. One Becquerel is that quantity of a radioactive material that will have 1 transformations in one second. Often radioactivity is expressed in larger units like: thousands (kBq), one millions (MBq) or even billions (GBq) of a becquerels. As a result of having one Becquerel being equal to one transformation per second, there are 3.7 x 1010 Bq in one curie.