POSITIONS

PA Finger

SID: 40"
kVp: 55–65
CR: PIP joint
Metacarpal: Include 1/3–1/2 of metacarpal
Position: Patient seated 90° from table; hand fully pronated
Collimation: Collimate to affected finger and distal metacarpal
Evaluation: Look at nail bed; correct CR location opens IP joints
No rotation: Symmetric appearance of both sides of shafts of phalanges and distal metacarpals; equal amount of tissue on each side of phalanges
Grid: Use when the body part is thicker than 4"

PA Oblique Finger

SID: 40"
kVp: 55–65
CR: PIP joint
Metacarpal: Include 1/3–1/2 of metacarpal
Position: 45° oblique; can use sponge
Rotation: 1st finger = medial rotation; 2nd–5th fingers = lateral rotation
Collimation: Collimate to affected finger and distal metacarpal
Evaluation: No superimposition of adjacent fingers
Phalanges: Parallel to IR
Joints: Correct CR location; IP and MCP joint spaces open

Lateral Finger

SID: 40"
kVp: 55–65
CR: PIP joint
Metacarpal: Include 1/3–1/2 of metacarpal
Position: End of table; elbow flexed 90°
True lateral: Concave anterior surface of shaft of phalanges
Evaluation: Correct CR location and phalanges parallel to IR; IP and MCP joint spaces open
Nail bed: Use nail bed with laser
Rotation: Medial rotation for 2nd finger; lateral rotation for 3rd–5th fingers

AP Thumb

SID: 40"
kVp: 55–65
CR: 1st MCP
Anatomy: Entire 1st metacarpal and trapezium
Position: Thumb fully extended
Alternative: Use PA if patient cannot assume AP
No rotation: Concave sides of phalanges; equal amount of tissue on each side
Evaluation: Correct CR location; IP joints open

PA Oblique Thumb

SID: 40"
kVp: 55–65
CR: 1st MCP
Anatomy: 1st metacarpal and trapezium
Position: Phalanges parallel to IR
Evaluation: Correct CR location; IP and MCP joint spaces open

Lateral Thumb

SID: 40"
kVp: 55–65
CR: 1st MCP
Anatomy: 1st metacarpal and trapezium
Position: Thumb parallel to IR; true lateral
True lateral: Concave anterior surface of proximal phalanx and 1st metacarpal
Superimposition: 1st metacarpal and trapezium are superimposed
Nail bed: Parallel with laser
Evaluation: Correct CR location; IP and MCP joint spaces open

PA Hand

SID: 40"
kVp: 55–65
CR: 3rd MCP
Anatomy: Entire hand and wrist; minimum 1" distal forearm
Finger position: Separate fingers to prevent superimposition of soft tissues
No rotation: Symmetric appearance and equal soft tissue

PA Oblique Hand

SID: 40"
kVp: 55–65
CR: 3rd MCP
Anatomy: Minimum 1" distal forearm
Position: 45° oblique
Metacarpals: Midshafts of metacarpals should not overlap
Distal metacarpal heads: Some overlap of distal heads of 3rd–5th; no overlap of 2nd–3rd
Fingers: Parallel to IR
Joints: IP and MCP joint spaces open without foreshortening of mid or distal phalanges
Sponge: Can take an oblique hand without a sponge when imaging for the metacarpals

Too much overlap of metacarpals:

Means too much rotation

Too much separation of metacarpals:

Means not enough rotation

Fan Lateral Hand

SID: 40"
kVp: 55–65
CR: 2nd MCP
Anatomy: Include 1" distal forearm
Fingers: Parallel to IR; joint spaces open
Thumb: Slightly oblique and free of superimposition; joint spaces open
Hand and wrist: True lateral
Radius and ulna: Distal radius and ulna superimposed
Metacarpals: Superimposed

Lateral Hand — Extension & Flexion

SID: 40"
kVp: 55–65
CR: 2nd–5th MCP
Anatomy: Include 1" distal forearm
Position: Karate-chop position
Thumb: Make sure thumb is in front and not superimposed
Fingers/metacarpals: All fingers and metacarpals directly superimposed
Hand position: Full hand extended or naturally flexe

PA Wrist

SID: 40"
kVp: 55–65
CR: Midcarpal area
Anatomy: Midcarpals, proximal metacarpals, carpals, distal radius and ulna
Soft tissue: Fat pads and stripes
Intercarpal spaces: Not open because of irregular shapes that result in overlapping
True PA: Equal concavity shapes on either side of the shafts of proximal metacarpals
Proximal metacarpals: Near-equal distance/amount
Distal radius and ulna: Separation with minor superimposition at the distal radioulnar joint

PA Oblique Wrist

SID: 40"
kVp: 60–70
CR: Midcarpal area
Anatomy: Distal radius and ulna, carpals, midcarpal area
Trapezium and scaphoid: Well visualized with slight superimposition of their medial aspects
True 45° oblique: Ulnar head partially superimposed by distal radius; proximal 3rd–5th metacarpals mostly superimposed

Lateral Wrist

SID: 40"
kVp: 60–70
CR: Midcarpal area
Main purpose: Mainly looking for Barton, Colles, or Smith's fractures
Anatomy: Distal radius and ulna, carpals, mid metacarpals
True lateral: Ulnar head superimposed over distal radius; proximal 2nd–5th metacarpals all aligned and superimposed

PA and PA Axial Wrist — Ulnar Deviation

SID: 40"
kVp: 55–65
CR: Scaphoid
PA Axial CR: 10°–15° proximally toward elbow/perpendicular to long axis of scaphoid
Anatomy: Distal radius and ulna, carpals, proximal metacarpals
Scaphoid: Demonstrated without foreshortening of adjacent carpal interspaces
Ulnar deviation: Angle of long axis of metacarpals to that of the radius and ulna
No rotation: Minimal superimposition of distal radioulnar joint

How to Locate the Scaphoid

Location: 3/4" distal and medial to radial styloid process

AP Forearm

SID: 40"
kVp: 65–75
CR: Mid forearm
Anatomy: Entire radius and ulna
Joints: Minimum 1"–1.5" distal to wrist and elbow joints included
Additional anatomy: Minimum proximal row of carpals and distal humerus
Soft tissue: Fat pads and stripes of wrist and elbow joints
No rotation: Humeral epicondyles in profile with radial head, neck, and tuberosity slightly superimposed by ulna
Wrist and elbow joints: Partially open because of beam divergence

Lateral Forearm

SID: 40" kVp: 65–75 CR: Mid forearm Position: Elbow flexed 90° Anatomy: Entire radius and ulna, proximal row of carpals, elbow, distal humerus Soft tissue: Fat pads and stripes of wrist and elbow joints No rotation: Humeral epicondyles superimposed; head of ulna superimposed over radius Radial head: Superimposes coronoid process Radial tuberosity: Demonstrated