Wrist - PA

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Wrist - PA
Area Covered	Mid and proximal metacarpals, carpals, distal radius and ulna, and associated joints; soft tissue
Pathology shown	Fractures, arthritis and osteomyelitis may be shown
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 2.5 mAs
FFD / SID	100cm
Central Ray	Directed to midcarpal area Perpendicular to IR
Collimation	Centre: Midcarpal area Shutter A: From mid metacarpal to one quarter of the 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	Patient seated at end of table Elbow flexed to 90° Hand pronated (palm down) Hand and forearm resting on table IR under wrist Hand arched to place wrist and carpals close to cassette
Critique PACEMAN	Positioning No rotation of the wrist is demonstrated by: Styloids of radius and ulna are at extreme edges Articulation between the radius and ulnar is open (or slightly super-imposed) Minor super-imposition of the metacarpal bases No foreshortening of distal radius Posterior margin of distal raius projects slightly to obscure radiocarpal joints Carpometacarpal joints 2 through to 5 are open Scaphoid slightly foreshortened Lunate is trapezoidal Long axis of hand, wrist, and forearm is aligned with IR Equal concavity shapes are on each side of the shafts of the proximal metacarpals Near equal distances among the proximal metacarpals Separation of the distal radius and ulna present, except possible minimal superimposition at the distal radioulnar joint Area Covered Proximal to midmetacarpals, carpals, and distal radius and ulna Collimation Centre: midcarpal area Shutter A: From mid metacarpal to one quarter of the 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

Source: Textbook of Radiographic Positioning and Related Anatomy, Kenneth L. Bontrager