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PA projection of hand: Patient position

Seated lateral beside the radiographic table (RT).

PA projection of hand: Part position

Elbow flexed $90^\circ$, hand pronated, palm in contact with the image receptor (IR), digits extended and slightly separated.

PA projection of hand: Central ray (CR) direction and reference point

Perpendicular ($36\text{--}40\text{ in}$ SID) entering the 3rd Metacarpophalangeal Joint (3rd MCPJ).

PA projection of hand: Clinical objective

Demonstrates the anatomy of phalanges, metacarpals, carpals, and interpalmar joints.

Lateral projection of hand (Mediolateral/Lateromedial): Part position

Elbow flexed $90^\circ$, ulnar or radial surface resting on IR, digits extended with thumb abducted $90^\circ$, long axis of the hand parallel to the IR.

Lateral projection of hand: Clinical objective

Localizes foreign bodies and evaluates metacarpal fracture displacement.

Fan Lateral projection of hand: Part position and clinical objective

Hand placed in lateral position with a step-sponge wedge separating digits into a fan shape; demonstrates individual lateral images of digits without superimposition.

Lewis Recommendation for lateral hand: Part position, CR direction, and objective

Rotate hand $5^\circ$ posteriorly from true lateral with thumb extended; CR parallel to thumb directed to mid-shaft of 5th metacarpal; better demonstrates fractures of the 5th metacarpal.

Norgaard Method (Ball-Catcher's View): Part position

Both hands half-supinated and rotated $45^\circ$ medially on $45^\circ$ foam sponges; fingers extended or cupped as if catching a ball.

Norgaard Method (Ball-Catcher's View): Clinical objective

Early detection of Rheumatoid Arthritis (RA) at the 2nd–5th MCP joints/proximal phalanges, as well as fractures at the base of the 5th metacarpal.

PA projection of wrist: Part position

Flex elbow $90^\circ$, hand pronated, and arch hand at the MCP joint level to place the wrist in direct contact with the IR.

PA projection of wrist: Reference point

Mid-carpal area.

PA projection of wrist: Special note regarding the ulna

The projection slightly obliques the ulna; take an AP projection if the ulna is the primary area of interest.

Daffner, Emmerling, Buterbaugh Variations for wrist: Tube angulation and objective

Proximal Variation angles $30^\circ$ towards the elbow (elongates scaphoid and capitate); Distal Variation angles $30^\circ$ towards fingertips (elongates capitate only).

AP projection of wrist: Clinical objective over PA

Demonstrates carpal interspaces better than PA by eliminating superimposition caused by natural carpal obliquity.

Fiolle Method ("Carpe Bossu"): Part position and objective

Lateral wrist position with palmar flexion; demonstrates "Carpe Bossu" (carpal boss)—a small bony growth on the dorsal surface of the 3rd CMC joint.

PA Oblique projection of wrist (Lateral Rotation): Part position and structures shown

Flex elbow $90^\circ$, rotate wrist $45^\circ$ laterally from pronated position using a sponge; demonstrates lateral carpal bones, specifically the trapezium and scaphoid.

AP Oblique projection of wrist (Medial Rotation): Part position and structures shown

Semi-supinated, rotate wrist $45^\circ$ medially; demonstrates the pisiform free of superimposition, as well as the triquetrum and hamate.

PA projection of wrist in Ulnar Deviation: Clinical objective

Corrects foreshortening of the scaphoid and opens spaces between adjacent carpal bones.

PA projection of wrist in Radial Deviation: Clinical objective

Demonstrates carpal interspaces on the medial side of the wrist.

Stecher Method (PA Axial Scaphoid): Part position and CR options

Hand elevated $20^\circ$ on an angle board with wrist centered to IR and CR perpendicular; alternatively, hand flat with CR angled $20^\circ$ proximally toward the elbow.

Bridgman Variation 3 (Clenched Fist): Part position and clinical objective

Patient clenches fist; elevates the distal end of the scaphoid parallel to the IR and widens the fracture line.

Rafert-Long Method (Scaphoid Series): Exposure technique

Wrist placed in extreme ulnar deviation with 4 exposures taken at angles of $0^\circ$ (perpendicular), $10^\circ$ cranial, $20^\circ$ cranial, and $30^\circ$ cranial.

Clements-Nakayama Method (Trapezium PA Axial Oblique): CR direction and objective

CR angled $45^\circ$ distally entering the anatomical snuffbox; demonstrates the trapezium and its articulation with adjacent carpal bones.

Tangential projection of Carpal Bridge: Part position and CR direction

Hand palm-up with wrist hyperflexed $90^\circ$ (dorsum perpendicular to IR); CR angled $45^\circ$ caudal entering the anatomic snuffbox ($1.5\text{ in}$ proximal to wrist joint).

Gaynor-Hart Method (Carpal Canal Inferosuperior): Part position and CR direction

Wrist hyperextended via strap and hand rotated slightly radial; CR angled $25^\circ\text{--}30^\circ$ toward the long axis of the hand entering $1\text{ in}$ distal to base of the 3rd metacarpal.

Marshall Recommendation for Carpal Canal: Indication and adjustment

Indicated when dorsiflexion is limited; forearm rests on table with $45^\circ$ foam wedge under palmar surface, CR angled $20^\circ\text{--}35^\circ$ towards forearm.

Robert Method (1st CMCJ AP): Part position and clinical objective

Arm extended, hand internally rotated so dorsum of thumb is flat against IR; demonstrates 1st CMC joint free of superimposition (evaluates arthritic changes and Bennett fracture).

Burman Method (1st CMCJ AP): Central ray direction

Angled $45^\circ$ proximally at $18\text{ in}$ SID.

Folio Method (1st MCPJ PA Stress): Clinical objective and method

Thumbs taped together with a rubber band wrapped around distal thumbs pulled apart during exposure; demonstrates ulnar collateral ligament (UCL) rupture ("Skier's Thumb").

AP projection of Forearm: Part position requirements

Hand supinated with epicondyles parallel and equidistant to the IR to prevent radial crossover.

Griswold Method (Lateral Elbow): Clinical objective and criteria

Olecranon process seen in profile and fat pads in least compressed state (flex $25^\circ\text{--}35^\circ$ if soft tissue injury suspected).

AP Oblique projection of Elbow (Medial Rotation): Structure demonstrated

Coronoid process of ulna free of superimposition.

AP Oblique projection of Elbow (Lateral Rotation): Structure demonstrated

Radial head, neck, and tuberosity free of ulnar superimposition.

AP Partial Flexion of Elbow: Distal humerus vs. proximal forearm alignment

Distal humerus: humerus flat on IR, CR perpendicular to humerus. Proximal forearm: forearm flat on IR, CR perpendicular to forearm (elevate wrist $30^\circ$ per Holly recommendation for radial head).

Jones Orthopedic Technique (Acute Flexion Elbow): Distal humerus vs. proximal FA views

Elbow acutely flexed with fingers on shoulder; CR perpendicular to humerus ($2\text{ in}$ proximal to olecranon) for distal humerus, or CR perpendicular to forearm ($2\text{ in}$ distal to olecranon) for proximal forearm.

Radial Head 4-Position Series: Forearm rotation positions

Supination, Lateral, Pronation, and Internal Rotation (elbow flexed $90^\circ$) to demonstrate the entire circumference of the radial head.

Coyle Method: Radial Head vs. Coronoid Process positioning

Radial Head: elbow flexed $90^\circ$, CR angled $45^\circ$ medially toward shoulder. Coronoid Process: elbow flexed $80^\circ$, CR angled $45^\circ$ laterally away from shoulder.

PA Axial Projection of Olecranon Process: Two primary views

Distal Humerus View: forearm flexed $75^\circ$, CR perpendicular to ulnar sulcus. Olecranon View: humerus flexed $45^\circ\text{--}50^\circ$, CR perpendicular to olecranon (or angled $20^\circ$ toward wrist).

AP vs. Lateral projection of Humerus: Tubercle profile demonstration

AP (hand supinated, epicondyles parallel) demonstrates the Greater Tubercle in profile laterally; Lateral (hand on hip, epicondyles perpendicular) demonstrates the Lesser Tubercle in profile medially.