Hand Projections
Patient Preparation
- Explain the procedure to the patient.
- Remove rings, jewelry, or any metallic objects from the hand.
- Position the hand comfortably on the IR.
- Use lead shielding as appropriate.
BASIC PROJECTIONS
1. Posteroanterior (PA) Projection — Hand
Positioning:
- Hand pronated (palm down) on the IR.
- Fingers extended and slightly separated.
- Wrist in contact with the IR.
Central Ray (CR):
- Perpendicular to IR.
- Directed to the third metacarpophalangeal (MCP) joint.
SID (Source-to-Image Distance):
- 100–110 cm (40–44 inches).
Collimation:
- Include distal phalanges to distal radius and ulna.
2. PA Oblique Projection — Hand
Positioning:
- Hand pronated on IR.
- Hand rotated laterally 45° with fingers slightly separated.
- MCP joints centered to IR.
Central Ray (CR):
- Perpendicular to IR.
- Directed to the third MCP joint.
SID:
- 100–110 cm (40–44 inches).
Collimation:
- Include distal phalanges to distal radius and ulna.
OTHER PROJECTIONS
3. Lateral Hand — Fan Lateral and Lateral in Extension
Positioning:
- Hand in true lateral position on IR.
- Fan Lateral: Fingers spread in a fan position, thumb positioned posteriorly or out of the field.
- Lateral in Extension: Fingers fully extended and together, thumb slightly anterior or posterior as needed.
Central Ray (CR):
- Perpendicular to IR.
- Directed to second MCP joint.
SID:
- 100–110 cm (40–44 inches).
Collimation:
- Include distal phalanges to distal radius and ulna.
4. AP Oblique Bilateral — Hands (Norgaard Method)
Positioning:
- Both hands supinated on IR.
- Fingers extended and slightly abducted.
- Hands rotated externally 45°.
- MCP joints centered to IR.
Central Ray (CR):
- Perpendicular to IR.
- Directed midway between both hands at level of MCP joints.
SID:
- 100–110 cm (40–44 inches).
Collimation:
- Include distal phalanges to distal metacarpals of both hands.
Common Pathologies Demonstrated
- Fractures of phalanges, metacarpals, or carpals.
- Dislocations of interphalangeal or MCP joints.
- Osteoarthritis or degenerative changes.
- Soft tissue swelling or foreign bodies.