Final Edition

HAND
CLINICAL INDICATION;
- FFracture
- dislocations
- foreign bodies of the hand
- osteoporosis (reduction in the quantity of bone or atrophy of skeletal tissue)
- osteoarthritis (gradual deterioration of the articular cartilage with hypertrophic (en-
larged or overgrown) bone formation)

TECHNICAL FACTOR
Image receptor: 24 × 30
FFD: 40 inches (102 cm)
Nongrid
KVP: 50 to 55 kV range
MA: 80
TIME: 0.01second
RECOMMENDED COLLIMATION
Collimate on four sides to outer margins of hand and wrist
distsl radious and ulna
SHIELDING
Shield radiosensitive tissues outside region of interest
1.PA
Patient Position Seat patient at end of table with elbow flexed

about 90° and hand and forearm resting on table.
Part Position
• Pronate hand with palmar surface in contact with IR; spread
fingers slightly.
• Align long axis of hand and forearm with long axis of IR.
• Center hand and wrist to IR.
• CR perpendicular to IR, directed to third MCP joint
Structures shown
PA projections of the carpals, metacarpals,
phalange (except the thumb), interarticulations
of the hand, and distal radius and
ulna are shown in Fig. 4-54. This i mage
also demonstrates a PA oblique projection
of the first digit.
EVALUATION CRITERIA
The fol lowing should be clearly demonstrated:
• No rotation of the hand:
[] Equal concavity of the metacarpal
and phalangeal shafts on both sides
[] Equal amount of soft tissue on both
sides of the phalanges
[] Fingernails, if visualized, in the center
of each distal phalanx
• Open MCP and interphalangeal joints,
indicating that the hand is placed flat on
the IR
• S lightly separate digits with no soft ti -
sue overlap
• All anatomy distal to the radius and ulna
• Soft tissue and bony trabeculation
NOTE: When the MCP joints are under examination

and the patient cannot extend the hand
enough to place its palmar surface in contact
with the fR, the position of the hand can be
2,PA OBLIQUE
Patient Position
Seat patient at end of table with elbow flexed
Part Position
• Pronate hand on IR; center and align long axis of hand with long
axis of IR.
• Rotate entire hand and wrist laterally 45° and support with
radiolucent wedge or step block, as shown, so that all digits are
separated and parallel to IR (see Exception).
Exception For a routine oblique hand, use a support block to place

digits parallel to IR (Fig. 4-70). This block prevents foreshortening
of phalanges and obscuring of interphalangeal joints. If the metacarpals
only are of interest, the image can be taken with thumb
and fingertips touching IR
CR
• CR perpendicular to IR, directed to third MCP joint
EVALUTION CRAYTERIA
The fol l owing should be clearly demonstrated:
• M in imal overlap of the third-fourth and
fourth-fifth metacarpal shaft
• S l ight overlap of the metacarpal bases
and heads
• Separation of the second and third
metacarpal s
• Open interphalangeal and MCP joints
• Digits eparated slightly with no overlap
of their soft tissues
• All anatomy distal to the di tal radius
and u l na
• Soft tissue and bony trabeculation
NOTE: If examinations of both hands or wrists are requested, generally the

body parts should be positioned and exposed separately for correct CR
placement
3.LATERAL o
Patent position
Seat the patient at the end of the radiographic
table with the forearm in contact
with the table and the hand in the
lateral position with the u lnar aspect
down (Fig. 4-59).
o Alternatively, place the radial side of
the wrist against the IR (Fig. 4-60).
However, thi position is more difficult
for the patient to assume.
o If the elbow is elevated, support i t with
sandbags
Position of part
o Extend the patient's digits and adju t the
first digit at a right angle to the palm .
o Place the palmar surface perpendicular
to the I R .
o Center the I R t o the MCP joint , and
adj ust the midline to be parallel with
the long axis of the hand and forearm.
If the hand is resting on the u lnar Ufface,
i mmobilization of the thumb may
be necessary.
Central ray
• Perpendicular to the second digit Mep
Joint
EVALUATION CRITERIA
The fol lowing should be clearly demonstrated:
• Hand in a true lateral position if the following
are seen:
c Superimposed phalanges ( i ndividually
demonstrated on fan lateral)
c Superimpo ed metacarpals
c Superimposed di tal radius and ulna
• Extended digits
• Thumb free of motion and superimposition
• Each bone outli ned through the superi
m posed shadows of the other
metacarpals
MODIFICATION OF LATTERAL HAND
FAN TATTERAL
which elimi nate uperi
mposition of all but the proximal phalanges

Part Position
• Align long axis of hand with long axis of IR.
• Rotate hand and wrist into lateral position with thumb side up.
• Spread fingers and thumb into a “fan” position, and support
each digit on radiolucent block as shown. Ensure that all digits,
including the thumb, are separated and parallel to IR and that
the metacarpals are not rotated but remain in a true lateral
position.
CR
• CR perpendicular to IR, directed to second MCP joint
Recommended Collimation Collimate on four sides to outer
margins of hand and wrist.
NOTE: The “fan” lateral position is the preferred lateral for the hand if
phalanges are the area of interest. (See next page for alternative
projections
OLTRNATIVE TO FAN LATTERAL
Part Position
Rotate hand and wrist, with thumb side up, into true lateral position,
with second to fifth MCP joints centered to IR and CR.
• Lateral in extension: Extend fingers and thumb, and support
against a radiolucent support block. Ensure that all fingers and
metacarpals are superimposed directly for true lateral position.
• Lateral in flexion: Flex fingers into a natural flexed position, with
thumb lightly touching the first finger; maintain true lateral
position.
CR
• CR perpendicular to IR, directed to the second to fifth MCP
joints

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HAND

Patient Position Seat patient at end of table with elbow flexed

NOTE: When the MCP joints are under examination

Exception For a routine oblique hand, use a support block to place

NOTE: If examinations of both hands or wrists are requested, generally the

Patient Position Seat patient at end of table with elbow flexed

Patient Position Seat patient at end of table with elbow flexed

about 90° and hand and forearm resting on table.

with second to fifth MCP joints centered to IR and CR.

• Lateral in extension: Extend fingers and thumb, and support

against a radiolucent support block. Ensure that all fingers and

metacarpals are superimposed directly for true lateral position.

• Lateral in flexion: Flex fingers into a natural flexed position, with

thumb lightly touching the first finger; maintain true lateral

• CR perpendicular to IR, directed to the second to fifth MCP

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