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Radiographic Positioning


Adult
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Name of projection Hand - PA oblique
Area Covered Phalanges, metacarpals, carpals and 2.5cm of the distal radius and ulna
Pathology shown Fractures, dislocations, foreign bodies. Pathological processes - osteoporosis and osteoarthritis.
Radiographic Anatomy Hand Radiographic Anatomy
IR Size & Orientation 24 x 30cm
Landscape, divided in half, usually fits 2 projections, use lead masking for unused area
Film / Screen Combination Detail
(CR and DR as recommended by manufacturer)
Bucky / Grid No
Filter No
Exposure 52 kVp
2.5 mAs
FFD / SID 100cm
Central Ray Directed to 3rd metacarpophalangeal joint
Perpendicular to the IR
Collimation Centre: 3rd metacarpophalangeal joint
Shutter A: To include distal phalanges to 2.5cm (1 inch) of distal radius and ulna
Shutter B: To include soft tissues of the first and fifth fingers
Markers Distal and Lateral
Marker orientation AP
Shielding Gonadal (check your department's policy guidelines)
Respiration Not applicable
Positioning
  • Seat patient at end of tableor standing
  • Flex elbow to 90°
  • Hand and forearm resting on table
  • Pronate hand
  • Rotate wrist and hand laterally 45° and use a sponge for support
  • Fingers separated and parallel to IR
  • Centred to the 3rd metacarpophalangeal joint
Critique

 Positioning
  • Hand rotated externally to 30- 45° is shown by
    1. Non-uniformity of the concavity of the metacarpal mid-shafts
    2. Non-uniformity of the space between the metacarpals
    3. Separation of the 2nd and 3rd metacarpals
    4. Heads of the 3rd through to 5th metacarpals are slightly super-imposed
    5. Slight space between the 4th and 5th metacarpals
  • Non soft tissue overlap of the fingers
  • Interphalangeal and metacarpophlangeal joint spaces are open
  • Phalanges are not foreshortened
  • Long axis of hand is aligned with axis of IR
  • Thumb position varies from lateral to oblique
Area Covered
  • Phalanges, metacarpals, carpals and 2.5cm of distal radius and ulna
Collimation
  • Include the distal phalanges, distal forearm and include the soft tissue of the first and fifth fingers
Exposure
  • Bony trabecular patterns and cortical outlines are sharply defined
  • Soft tissues are visualised
Special Notes Over rotating the hand results in the superimposition of the 4th and 5th metacarpals