Monday, December 12, 2011


Pathology Demonstrated:

A normal x-ray examination of hand will be demonstrating, fractures, dislocations, or foreign bodies of the phalanges, metacarpals, and all joints of the hand are shown. PA / AP view a Pathologic processes such as osteoporosis and osteoarthritis also may be demonstrated.

Technical Factors:

IR size- 24 x 30cm (10 x 12 inches)
Division in half crosswise or for large hand - 18 x 24cm (8 x 10 inches), legthwise
Detail screen, tabletop
Digital IR (use lead masking)
PA hand xray
PA Projection
50 to 60 kV range

PA Hand Proper Patient Position


Place lead shield over patient's lap to shield gonads.

Patient Position:

Seat patient at of table with elbow flexed about 90degrees and hand and forearm resting on table.

Part Position:

Pronate hand with palmar surface in contact with cassette; spread fingers slightly.
Align long axis of hand and forearm with long axis of portion of IR that is being exposed.
Center hand ans wrist to unmasked half of IR.

Central Ray:

CR perpendicular to IR, directed to third MCP joint
Minimum SID of 40 inches (100cm)


Collimate on four sides to outer margins of hand and wrist.

PA hand radiograph
Hand Xray Anatomy
Note: If exams of both hands and/or wrist are requested, generally the body parts should be positioned and exposed separately for correct CR placement.

Radiographic Criteria: PA Projection - Hand

Structures Shown:

PA projection of entire hand and wrist and about 2.5 cm (1 inch) of distal forearm are visible. Note that PA projection of hand demonstrates oblique view of the thumb.


MCP and IP joints should appeat open, indicating correct CR location and that hand was fully pronated.
Long axis of hand and wrist aligned with long axis of IR.
No rotation of hand, as evidence by the following: symmetric appearance of both sides or concavities of shaft of metacarpals and phalanges of digits 2 though 5; the appearance of equal amounts of soft tissue on each side of phalanges 2 through 5.
Digits should be separated slightly with soft tissues not overlapping.

Collimation and CR:

Collimation should be visible on four sides.
CR and center of collimation field should be to third MCP joint.

Exposure Criteria:

Optimal density and contrast with no motion demonstrate soft tissue margins and clear, sharp bony trabecular markings

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