1. The Thumb and Wrist

2. Things to know for the thumb  3 views AP, lateral, Oblique  8 x 10 divided 3 times  Shield  Marker  Hold still  Collimation

3. AP Positioning for thumb  Take the 1/3 of 8x10  Internally rotate the hand until the posterior surface of hand is in contact with Image Receptor(IR)/Cassette  Align long axis of thumb with long axis of IR  Patient holds finger out of way with other hand

4. Source Image Distance (SID) 40”

5. Radiograph Critic  Distal and proximal phalanges  First metacarpal  Trapezium and joint  No rotation

6. Oblique  Place hand palm side down  Long axis of thumb to long axis of cassette  Thumb in natural 45 angle

7. SID 40 Collimate

8. What to look for  Distal and proximal phalanges  Joints open  Oblique thumb

9. Lateral Thumb  Palm surface of hand on IR  Take and slightly arch fingers until thumb reaches a lateral position  Long axis with long axis

10. CR is at First MP joint SID 40 Collimate

11. Radiograph Critic  Entire first digit  Trapezium is superimposed

12. The Wrist  4 views PA, Both Obliques, Lateral  8x 10 divided in half crosswise  Mark  Shield  Hold still  Collimate

13. PA  Place Wrist and hand palm side down on IR  Center wrist to middle of divided cassette  Curl fingers slightly to bring wrist in contact with IR.

14. SID 40 Collimate all 4 sides

15. Seen on radiograph  All the metacarpals  Distal radius and Ulna

16. Lateral  Turn wrist so the medial side is on IR (thumb Up)  Put wrist in true lateral position

17. SID 40 Collimate

18. Critic  All the carpals  Distal radius and ulna superimposed

20. Obliques  Lateral rotation-Lay wrist palm side down and rotate wrist up to a 45 degrees angle laterally  Medial rotation- from lateral position turn hand 45 degrees laterally

21. Critic  Materal- the trapezium and scaphoid are visualized  Medial- Pisiform