Hand - Lateral

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Hand - Lateral
Area Covered	Hand, wrist and 2.5cm of distal forearm
Pathology shown	Displacement of fractures, location of foreign bodies.
Radiographic Anatomy	Hand Radiographic Anatomy
IR Size & Orientation	18 x 24cm Portrait
Film / Screen Combination	Detail (CR and DR as recommended by manufacturer)
Bucky / Grid	No
Filter	No
Exposure	54 kVp 3.2 mAs
FFD / SID	100cm
Central Ray	Directed to the 2nd metacarpophalangeal joint Perpendicular to the IR
Collimation	Centre: 2nd metacarpophalangeal joint Shutter A: Distal phalanges to 2.5cm of distal radius and ulna 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 at 90° Hand and forearm resting on table Rotate hand and wrist into lateral position with thumb on up side For the "Fan" lateral, digits are spread out a step block may be used For a "Flexion" lateral, digits 2 through to 5 are superimposed and held in extension with the thumb held clear For an "Extension" lateral, digits 2 through to 5 are superimposed and held in flexion with the thumb held clear
Critique PACEMAN	Positioning The hand is in the lateral position, shown by The metacarpal midshafts are superimposed The ulna is slightly posterior to the radius (Note: the wrist is not necessarily lateral when the hand is. In a lateral wrist the radius and ulna are superimposed) The interphalangeal joints are open Phalanges are not foreshortened "Fan lateral" 2nd through to 5th digits are separated with little superimposition of bony and soft tissue structures 2nd through to 5th metacarpals are superimposed Thumb has no superimposition Thumb position varies from PA to slightly oblique "Extension lateral" 2nd through to 5th digits fully extended and superimposed "Flexion lateral" 2nd through to 5th digits are flexed and superimposed Area Covered Phalanges, metacarpals, carpals and 2.5cm of distal radius and ulna Collimation Include the distal phalanges to the distal forearm and soft tissue Exposure Bony trabecular patterns and cortical outlines are sharply defined Soft tissues are visualised
Special Notes	The extension lateral is sometimes preffered in cases of suspected foreign bodies Metacarpals are used in assessing how lateral the hand is To identify metacarpals, the 2nd metacarpal is the longest and the 5th metacarpal is the shortest