Standardizing wrist x-rays: The human-centered design and evaluation of a wrist x-ray positioning tool
Laura Vancer, Maxwell Campbell, Glenn Schurmans, John Henry, Jamie Kueneman, Joy MacDermid, Gregory Garvin, Emily Lalone
Abstract
Small amounts of malrotation can significantly decrease the diagnostic utility of a wrist radiograph. Poorly positioned wrist radiographs can result in repeat scans, additional imaging, and missed injuries.
Introduction
Wrists are one of the most commonly injured anatomical regions, accounting for approximately 20% of all hospitalized fractures in Canada [1]. A wrist fracture or forced hyperextension sprain can be associated with a ruptured scapholunate (SL) ligament [2] in 32% of individuals.
Materials and methods
The HCD process was implemented during the creation of the Tru-Vu through the three IDEO HCD stages: inspiration, ideation, and implementation [22]. Each stage consisted of varying methods (Fig 1), with consistent communication with end-users throughout the entirety of the design process.
Results
Throughout each stage of the design process—inspiration, ideation, and implementation—the device underwent multiple iterations, guided by end-user feedback.
Discussion
This study followed the human-centered design (HCD) process to develop the novel Tru-Vu positioning aid and training modules. Wrist radiographs have relatively high rejection rates and due to the limitations of current solutions, many radiographers rely on their best judgement to position the wrist without the use of assistive devices.
Conclusion
The development of the novel Tru-Vu positioning aid and training modules used a HCD approach in response to the challenge of capturing high-quality wrist radiographs.
Citation: Vancer L, Campbell M, Schurmans G, Henry J, Kueneman J, MacDermid J, et al. (2026) Standardizing wrist x-rays: The human-centered design and evaluation of a wrist x-ray positioning tool. PLoS One 21(10): e0359437. https://doi.org/10.1371/journal.pone.0359437
Editor: Yi Kai Wong, IMU University, MALAYSIA
Received: October 16, 2025; Accepted: September 14, 2026; Published: October 5, 2026
Copyright: © 2026 Vancer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting information files.
Funding: This study was funded through an Innovation Grant from the Arthritis Society of Canada (IG-21-0000000017) and a Frugal Biomedical Innovations Catalyst Grant from Western University, received by EL. LV completed this work with funding from the Ontario Graduate Scholarship and an NSERC CREATE in Engineering Health Equity scholarship. The funders did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors acknowledge the following competing interests: Authors Emily Lalone and Maxwell Campbell are inventors on a Canadian patent (No. 3,271,804) and a US patent (19/189,513) that are currently pending.
Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359437#sec027
