Hand - Bone Age

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Radiographic Positioning

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Name of projection Hand - PA
Area Covered Hand, wrist and 2.5cm of distal forearm
Pathology shownEstimate of the maturity of a child's skeletal system
Radiographic AnatomyHand Radiographic Anatomy
IR Size & Orientation 18x 24cm or 24x 30cm as required
Film / Screen Combination Detail
(CR and DR as recommended by manufacturer)
Bucky / Grid No
Exposure 48 KvP
2 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 (1 inch) 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)
RespirationNot applicable
  • 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

  • Digits and metacarpals are demonstrated in the PA projection by
    1. Uniformity of the soft tissue of digits two through to 5
    2. Metacarpal heads are equally spaced for digits two through to five
    3. 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
    1. Interphalangeal
    2. Metacarpophalangeal
    3. 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
  • Outer skin margins of hand on four sides and including 2.5cm of the distal forearm
  • Bony trabecular patterns and cortical outlines are sharply defined
  • Soft tissues are visualised
Special Notes