Hand - AP Axial (Brewerton's)

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Hand - AP Axial (Brewerton's)
Area Covered	Phalanges and metacarpal heads
Pathology shown	To show erosions of the metacarpal heads and the bases of the phalanges from rheumatoid arthritis
Radiographic Anatomy	Hand Radiographic Anatomy
IR Size & Orientation	18 x 24cm Portrait
Film / Screen Combination	Detail (CR and DR as recommended by manufacturer)
Bucky / Grid	No
Filter	No
Exposure	50kVp 2.5 mAs
FFD / SID	100cm
Central Ray	CR angled 20°laterally and to the head of the third metacarpal
Collimation	Four sides of collimation Shutter A: Includes all of the distal phalanges to carpal bones Shutter B: To include soft tissues
Markers	Distal and Lateral Marker orientation AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	Not applicable
Positioning	The patient stands alongside the end of the table Elbow extended with palm upwards Hand flexed 40° at the metacarpo phalangeal joints Posterior aspect of the fingers in contact with the cassette, and the wrist supported as required
Critique PACEMAN	Positioning Shafts of the second to fifth metacarpals should be symmetrical. The following joint spaces are open Metacarpophalangeal Interphalangeal Area Covered Phalanges (distal, intermediate, proximal), metacarpals and carpals bones Collimation Four sides of collimation Include distal phalanges and carpal bones Exposure Bony trabecular patterns and cortical outlines are sharply defined Soft tissues are visualised
Special Notes