CT Training Programs – Learn how to perform the Wrist / Other Upper Extremity CT exams – some of these instructions may vary depending on the equipment you are working on.
CT Training Programs – Scanning the Wrist / Other Upper Extremities
CT Training Programs – Wrist CT images are screen shots from the Virtual CT Trainer Software causing some degrading in the image quality.
Wrist
Exam Prep:
- When scanning the wrist, attach the foot holder and position the patient prone and head first in the scanner with their arm extended above their head. If possible move the patient over on the table so their affected side is as close to the center of the table as possible.
- The wrist is typically done without IV contrast unless a mass is suspected.
- You may occasionally get a CT Wrist Arthrogram order. Contrast is injected into the joint using fluoroscopy and then scanned post injection. NOTE: MRI has become the gold standard for the wrist but the exam is still occasionally ordered as a CT procedure.
CT Training Programs – Positioning the Patient:
- Move the patient into the scanner until the positioning light is about two inches below the radiocarpal joint.
- Adjust the table height until the horizontal light is midway between the anterior and posterior aspect of the wrist.
- Turn off the positioning light.
CT Training Programs – Scanning Scout Images:
- When the patient is properly positioned – Press the confirm button
- Prep the scanner (Scan button will be solid or a flashing light – depends on manufacture)
- Scan your AP & Lateral scout images – Some manufacturers will require the patient to move back into the gantry to scan the second scout and some will move the patient back into the scanner as it acquires the second scout.
Adjusting Your Lines or Box to Cover Desired Anatomy:
- Adjust the lines or box to cover the anatomy to be scanned (lines or box depends on CT manufacture).
- When scanning the wrist, scan from about one inch into the metacarpals to about 1 – 2 inches below the radiocarpal joint.
- When the lines or box are positioned over the desired anatomy, press the confirm button.
CT Training Programs – Scanning the Patient:
- When you have your scan area covering the needed anatomy from about one inch into the metacarpals to about 1 – 2 inches below the radiocarpal joint. – Push the scan button to start the scan of the wrist.
Completing the Exam:
- Look through the images for any pathology that may need additional scanning or any possible patient motion and verify that you have covered all of the desired anatomy. Help the patient off of the scanner table.
OTHER UPPER EXTRIMITIES
The other upper extremities are scanned in the same way as the wrist. If the upper extremities are scanned with the patients arm down to their side you are now radiating the trunk of the body to get the images of the the upper extremity. Sometimes this is necessary if the patient can’t extend their arm above their head. Just be conscious about unnecessary radiation exposure whenever possible.
Elbow
- Position the patient prone or oblique and head first in the scanner. Extend the affected arm above the patient’s head with the palm of the hand in the up position so the elbow will be as straight and flat as possible.
- Adjust the patient so their elbow is as close to the center of the table as possible.
- Move the patient into the scanner until the positioning light is about two to three inches above the elbow joint.
- Adjust the table height until the horizontal light is midway between the anterior and posterior aspect of the elbow.
- Turn off the positioning light.
- Scan your scouts of the elbow and set up the scan range using the lines or box.
- Scan the elbow about two to three inches above the elbow joint (Humerus) and two to three inches below the elbow joint.
Hand
- Position the patient prone and head first in the scanner. Extend the affected arm above the patient’s head with the palm of the hand flat on the table.
- NOTE: Place a towel under the hand if the table is curved so the hand will be as straight and flat as possible.
- Adjust the patient so the hand is as close to the center of the table as possible.
- Move the patient into their scanner until the positioning light is about two inches above the wrist joint.
- Adjust the table height until the horizontal light is midway between the anterior and posterior aspect of the hand.
- Turn off the positioning light.
- Scan your scouts of the hand and set up the scan range using the lines or box.
- Scan the hand about one to two inches above the wrist joint through the tip of the fingers.
Humerus
- Position the patient supine and head first in the scanner (same as the shoulder). Extend the unaffected arm above the patient’s head if possible.
- Adjust the patient so the humerus is as close to the center of the table as possible.
- Move the patient into their scanner until the positioning light is about two to three inches above the acromioclavicular (AC) joint.
- Adjust the table height until the horizontal light is midway between the anterior and posterior aspect of the humerus.
- Turn off the positioning light.
- Scan your scouts of the humerus and set up the scan range using the lines or box.
- Scan the humerus about one to two inches above the acromioclavicular (AC) joint and one to two inches into the proximal radius and ulna to include the entire elbow joint.
Forearm
- Position the patient prone or oblique and head first in the scanner. Extend the affected arm above the patient’s head with the palm of the hand in the up position so the forearm will be as straight and flat as possible.
- Adjust the patient so their forearm is as close to the center of the table as possible.
- Move the patient into the scanner until the positioning light is about two to three inches above the elbow joint.
- Adjust the table height until the horizontal light is midway between the anterior and posterior aspect of the forearm.
- Turn off the positioning light.
- Scan your scouts of the forearm and set up the scan range using the lines or box.
- Scan the forearm about one to two inches above the elbow joint and one to two inches beyond the distal radius and ulna.
- NOTE: Some facilities may require you scan though the entire wrist.
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