Wednesday, December 21, 2011



  • If patient has possible wrist trauma, do not attempt this position before routine wrist series has been completed and evaluated to rules out possible truama of distal forearm and/or wrist

Pathology Demonstrated:

  • Fractures of the carpal bones on the ulnar side of the wrist, specially the lunate, triquetrum, pisiform, and hamate, are demonstrated.

Technical Factors:

  • IR size - 18 x 24 cm (8 x 10 inches)
  • Division in half, crosswise
  • Detail screen, tabletop
    Digital IR - use lead masking
  • 60 or add upto 6kV range


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

Patient Position:
  • Seat patient at end of table, wrist and hand on cassette, and palm down, with shoulder, elbow, and wrist on same horizontal plane.

Part Position when Performing wrist x-ray:
  • Position wrist as for PA projection - palm down with wrist and hand align with center of long axis of portion of IR being exposed.
  • Without moving forearm, gently invert hand (move medially toward thumb side) as far as patient can tolerate without lifting or rotating distal forearm.

Central Ray:

  • CR perpendicular to IR, directed to midcarpal area
  • Minimum SID of 40 inches (100cm)


  • Collimate on four sides to carpal region.

Radiographic Criteria of Posteroanterior (PA) Wrist:

Structure shown:
  • The distal radius and ulna, the carpals, and the proximal metacarpals are visible.
  • The carpals are visible, with adjacent interspaces more open on the medial (ulnar) side of the wrist.

  • The long axis of the forearm is aligned with the side border of the IR.
  • Extreme radial deviation is evidenced by the angle of the long axis of the metacarpals to that of the radius and ulna and the spaces between the triquetrum/pisiform and the styloid process of the ulna.
  • No rotation of the wrist is evidenced by the appearance of the distal radius and ulna.

Collimation and CR:
  • Collimation should be visible on four sides to the area of the affected wrist.
  • CR and center of the collimation field should be to the midcarpal area.

Exposure Criteria:
  • Optimal density and contrast with no motion visualize the carpal borders and clear, sharp bony trabecular markings.

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