Wrist - Internal Oblique

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Radiographic Positioning

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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
  • 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

  • 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
  • Centre: Mid-carpal area
  • Shutter A: Mid metacarpals to one quarter of distal radius and ulna
  • Shutter B: Skin margin
  • 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