Practical approaches to obtaining hand radiographs and special techniques in hand radiology

Radiography of the hands and joints involves a certain amount of decision making by the radiographer. Many disorders of the wrists are evaluated with radiography, and the positions and radiographic technique factors should be adjusted to reveal as much of the desired anatomy as possible. Immobilizing the patient can be of significant value in obtaining good quality radiographs. It is essential that the processed radiograph contains all pertinent anatomy and that all structures have been demonstrated anatomically as well as radiographically. A number of radiographic positions and procedures are useful in identifying specific structures. The knowledge of the radiographer is essential in obtaining these projections. Other special imaging methods, such as tomography, xeroradiography, and magnification radiography, permit the study of those structures too small to be noted on conventional radiographs. Fine-grain mammography film and rare earth screens in carbon fiber cassettes are essential tools in obtaining high-quality detailed images of the hand. A proper quality assurance program of scheduled and preventative maintenance will ensure an efficient radiology service with the least radiation dose to the patient.