Scaphoid Series - Long Rafert Method Wrist Xray Positioning

Scaphoid Series - PA and PA Axial Projection

Rafert-Long Method - Ulnar Deviation

   Scaphoid fractures account for 60% of all carpal bone injuries. In 1991, Rafert and Long describe this method of diagnosing scaphoid fractures using a four image, multi angle central ray series. The series is performed after routine wrist radiograph do not identify a fracture.

Image receptor: 8 X 10 inches, crosswise for two images.

Patient Position

Let seat patient at the end of the radiographic table with the arm and forearm resting on the table.

Part Position

• Position the wrist on the IR for a PA projection.
• Without moving the forearm, turn the hand outward until the wrist is in extreme ulnar deviation.
• Shield gonads.

Central Ray:

• Central ray is perpendicular and with multiple cephalad angles. With the hand and wrist in same position for each projection, four separate exposure are made at 0, 10, 20, 30 degrees cephalad.
• The central ray should directly enter the scaphoid bone.
• Collimation should be close to improve image quality.

Structure shown

The scaphoid is demonstrated with minimal superimposition

A. 0 degrees B.10 degrees C.20 degrees D.30 degrees

Evaluation Criteria:

• The following should be clearly demonstrated:
• Not rotation of the wrist
• Scaphoid with adjacent articular areas open
• Extreme ulnar deviation