Digits 2-5 PA Oblique is a radiography positioning projection of the Upper Extremity. Seated, hand rotated 45 degrees, ulnar side raised. SID 40". The centering point is located pip joint of the affected digit, rotated 45 degrees.. The central ray is perpendicular to the pip joint of the affected digit.. Image-quality criteria include digits shown in 45-degree oblique with minimal overlap., all phalanges and metacarpals included.. Standard exposure ranges from 55 to 65 kVp, 2 to 3 mAs, at an SID of 40 inches (102 cm).
Anatomy demonstrated
- Distal, middle, and proximal phalanges of digits 2-5.
- Metacarpals of digits 2-5.
- DIP, PIP, and MCP joint spaces.
- Soft tissue contour of the hand.
Patient preparation
- Verify patient identity using two identifiers.
- Remove rings, bracelets, and radiopaque items from the hand.
- Seat the patient at the end of the table.
- Extend the arm with hand rotated 45 degrees.
- Raise the ulnar side of the hand. Separate digits on IR.
Position & centering point
PIP joint of the affected digit, rotated 45 degrees.
Central ray
Perpendicular to the PIP joint of the affected digit.
Exposure / technique
- kVp
- 55–65
- mAs
- 2–3
- SID
- 40" (102 cm)
- Notes
- Tabletop technique. Ulnar side raised 45 degrees.
Image-quality criteria
- Digits shown in 45-degree oblique with minimal overlap.
- All phalanges and metacarpals included.
- Joint spaces open and clearly visible.
- Bone trabeculae and soft tissue sharp, no motion blur.
- Collimation: 1 inch on all sides, 1 inch proximal to MCP joints.
Common errors / ARRT traps
- 1 Hand rotated less than 45 degrees minimizes oblique effect.
- 2 Hand pronated or supinated changes the oblique angle.
- 3 Digits flexed or overlapped obscures joint spaces.
- 4 CR off-centered clips distal or proximal digits.
Clinical indications
- Finger trauma when PA view is incomplete or unclear.
- Suspected finger joint arthritis or degenerative changes.
- Evaluation of finger soft tissue injury or swelling.
- Post-operative follow-up with hardware assessment.
Aligned to the 2025 ARRT Content Specifications.