Stecher and Bridgman Method - PA Axial Projection Scaphoid Xray Positioning

Thursday, April 12, 2018

Stecher Method and Bridgman Method

Strecher Method is roentgenography of the carpal navicular bone.
Bridgman Method is radiography of the carpal navicular bone.

Image Receptor: 8 X 10 inches, lengthwise

Patient Position:

  • Let patient seat at the end of the radiographic table with the arm and axilla in contact with the table.
  • Rest the forearm on the table.

Part Position:

  • Place one end of the image receptor on a support and adjust the image receptor so that the finger end of the IR is elevated 20 degrees.
  • Adjust the wrist on the image receptor for a PA projection, and center the wrist to the IR.
  • Bridgman suggested positioning the wrist in ulnar deviation for this radiograph.
  • Shield gonads.

Central ray:

Perpendicular to the table and directed to enter the scaphoid.

Structure shown:

The 20 degree angulation of the wrist places the scaphoid at right angles to the central ray so that it is projected without self-superimposition.

Evaluation Criteria:

The following should be clearly demonstrated:

  • Scaphoid
  • No rotation of carpals, metacarpals radius and ulan
  • Distal radius and ulna, carpals and proximal half of the metacarpals
  • Soft tissue and bony trabeculation

Positioning Varations:

   Stecher recommended the previous method as preferable. However, a similar position can be obtained by placing the IR and wrist horizontally and directing the central ray 20 degrees toward the elbow.

   To demonstrate a fracture line that angles superoinferiorly, these positions may be reversed. In other words, the wrist may be angled inferiorly, or from the horizontal position the central ray may be angled toward the digits.

   The third method recommended by Stecher is to have the patient clench the fist. This elevates the distal end of the scaphoid so that it lies parallel with the IR. It also widens the fracture line. The wrist is positioned as for the PA projection, and no central ray angulation.

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