Hand - Oblique

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

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 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 PACEMAN	Positioning Hand rotated externally to 30- 45° is shown by Non-uniformity of the concavity of the metacarpal mid-shafts Non-uniformity of the space between the metacarpals Separation of the 2nd and 3rd metacarpals Heads of the 3rd through to 5th metacarpals are slightly super-imposed 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