Wrist - Internal Oblique

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Wrist - PA Oblique (Internal Rotation)
Area Covered	Distal radius and ulna, carpals, mid metacarpal area
Pathology shown	Fracture, dislocation, arthritis, foreign body
Radiographic Anatomy	Wrist Radiographic Anatomy
IR Size & Orientation	24 X 30cm Landscape, divided in thirds usually fits 3 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 3.2 mAs
FFD / SID	100cm
Central Ray	Directed at mid-metacarpal area Perpendicular to the IR
Collimation	Centre: mid-carpal area Shutter A: mid metacarpal to one quarter of distal radius and ulna Shutter B: Skin margin
Markers	Distal and Lateral Marker orientation AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	Not applicable
Positioning	Seat patient at end of table Flex elbow to 90° Pronate hand and wrist on IR Slightly flex hand to get carpal area flat against IR Rotate wrist and hand externally 45° Can use a 45° sponge for support / stability
Critique PACEMAN	Positioning Correct obliquity of the wrist is demonstrated by: Trapezoid and trapezium are demonstrated without super-imposition Joint space between trapezoid and trapezium is open Scaphoid waist in profile Trapezoid and capitate have a small degree of super-imposition The second carpometacarpal joint space is demonstrated as is the scaphotrapezium joint space Third metacarpal and mid-forearm are aligned with the light field Ulna head partially super-imposed by distal radius Metacarpals 3 to 5 are mostly super-imposed Area Covered Half the metacarpals, carpals, one quarter of distal radius and ulna Collimation Centre: Mid-carpal area Shutter A: Mid metacarpals to one quarter of distal radius and ulna Shutter B: Skin margin Exposure Bony trabecular patterns and cortical outlines are sharply defined Soft tissues are visualised Sufficient contrast and density to demonstrate the scaphoid fat stripe
Special Notes