HAND

What are the routine projections of the hand on the ARRT outline?

PA, PA oblique (lateral rotation), and lateral.

Where is the CR centered for a PA hand?

Perpendicular to the 3rd MCP joint.

How is the hand positioned for a PA projection?

Palmar surface flat on the IR with fingers slightly separated.

What anatomy is demonstrated on a PA hand?

Phalanges, metacarpals, carpals, and distal radius and ulna.

What image clue indicates no rotation on a PA hand?

Equal concavity of the metacarpal and phalangeal shafts.

What should the MCP and IP joint spaces look like on a properly positioned PA hand?

Open.

Where should the fingernails appear on a properly positioned PA hand?

Centered over the distal phalanges.

How much lateral rotation is used for a PA oblique hand?

Approximately 45°.

Where is the CR centered for a PA oblique hand?

Perpendicular to the 3rd MCP joint.

How are the fingers supported for a PA oblique hand when joint spaces are the goal?

Supported so the digits remain parallel to the IR.

What image relationship confirms approximately 45° rotation on a PA oblique hand?

Decreasing separation of metacarpals 2–5, greatest between 2nd and 3rd.

Which metacarpals show partial superimposition on a properly positioned PA oblique hand?

3rd, 4th, and 5th metacarpals.

A hand image shows 45° rotation with partial metacarpal overlap. Which projection was performed?

PA oblique with lateral rotation.

Which two hand projections use the 3rd MCP joint as the centering point?

PA and PA oblique.

Where is the CR centered for a lateral hand?

Perpendicular to the 2nd MCP joint.

With the ulnar surface against the IR, what lateral beam direction is produced?

Lateromedial.

With the radial surface against the IR, what lateral beam direction is produced?

Mediolateral.

What should be superimposed on a true lateral hand?

Metacarpals and distal radius and ulna.

What should the thumb look like on a proper lateral hand?

Free of superimposition.

What is the main difference between an extension lateral and fan lateral hand?

Extension overlaps the fingers; fan lateral separates the phalanges.

Why is a fan lateral hand performed?

To demonstrate the phalanges with minimal superimposition.

What remains largely superimposed on a fan lateral hand?

The metacarpals.

What is an extension lateral hand useful for evaluating?

Foreign-body localization and metacarpal displacement.

An image shows superimposed metacarpals but separated phalanges. Which projection was most likely performed?

Fan lateral hand.

An image shows a flat hand with open MCP/IP joints and no rotation. Which projection was most likely performed?

PA hand.

Which hand projection uses a different MCP centering point than PA and PA oblique?

Lateral; center at the 2nd MCP.