Hand - PA

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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 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
  • 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

  • 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 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