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First published online January 19, 2009
British Journal of Radiology (2009) 82, 554-560
© 2009 British Institute of Radiology
doi: 10.1259/bjr/42223683
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British Journal of Radiology 82 (2009),554-560 ©2009 The British Institute of Radiology

Rheumatoid arthritis: a novel radiographic projection for hand assessment

L PEARMAN, BSc J LAST, MD O FITZGERALD, MD D VEALE, MD M JOYCE, MSc L RAINFORD, PhD M MCENTEE, PhD J MCNULTY, BSc E THOMAS, BSc J RYAN, PhD A MCGEE, MSc R TOOMEY, BSc C D'HELFT, PhD J LOWE, BSc and P C BRENNAN, PhD

UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland

Correspondence: Patrick C Brennan, UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland. E-mail: Patrick.brennan{at}ucd.ie

Rheumatoid arthritis (RA) is the most common form of inflammatory disease, affecting 1–2% of the population. Posteroanterior (PA) and Brewerton projections are well established in radiographic practice for scoring and monitoring RA, but there is little evidence to demonstrate the diagnostic efficacy of these techniques. This work, by varying the positioning of a cadaveric hand, investigates whether an alternative radiographic projection could yield greater diagnostic information than the traditional techniques. Phase I of the study evaluated moving the hand 15° from the anteroposterior position and then in 5° increments in four directions: medial rotation, lateral rotation, flexion of the wrist and extension of the wrist. Phase II of the study took the optimum projections from Phase I and further manipulated these positions in a direction at right angles to the original position. Images were scored based on joint space visualisation in 29 joints. Results demonstrated that significantly higher diagnostic efficacy was evident with 15° lateral rotation of the hand or 15° flexion at the wrist compared to the Brewerton projection. Either projection is recommended, but on the basis of patient comfort, the latter of these novel positions, now known as the UCD projection, was chosen as the optimum procedure to replace the Brewerton projection. The value of using cadavers for the establishment of optimum radiographic procedures is highlighted.






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