Hand - PA

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Hand - PA
Area Covered	Hand, wrist and 2.5cm of distal forearm
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	50 kVp 2.5 mAs
FFD / SID	100cm
Central Ray	Directed to 3rd metacarpophalangeal joint Perpendicular to the IR
Collimation	Centre: 3rd metacarpalphalangeal joint Shutter A: Includes all of the distal phalanges to 2.5cm of the distal ulna and radius Shutter B: To include soft tissues
Markers	Distal and Lateral Marker orientation AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	Not applicable
Positioning	Patient seated at end of table Elbow flexed to 90° Hand pronated Hand and forearm resting on table Place IR under hand Palm in contact with IR Fingers spread slightly Centre to 3rd metacarpophalangeal joint
Critique PACEMAN	Positioning Digits and metacarpals are demonstrated in the PA projection by Uniformity of the soft tissue of digits two through to 5 Metacarpal heads are equally spaced for digits two through to five Equal concavity of the midsgafts of the phalanges and metacarpals of digits two through to five No soft tissue overlap of the digits The following joint spaces are open Interphalangeal Metacarpophalangeal Carpometacarpal Long axis of hand is aligned with axis of IR Thumb is demonstrated at a 45º angle Area Covered Entire hand, carpals and 2.5cm of the distal radius and ulna Collimation Outer skin margins of hand on four sides and including 2.5cm of the distal forearm Exposure Bony trabecular patterns and cortical outlines are sharply defined Soft tissues are visualised
Special Notes	Effect of flexion of the hand If the palmar surface of the hand is not placed against the surface of the IR, this results in poor alignment of the joint space with the central ray. This results in closed joint spaces and and foreshortening of phalanges and metacarpals