Digits 2-5 PA is a radiography positioning projection of the Upper Extremity. Seated, hand pronated, palm down on IR. SID 40". The centering point is located pip joint of the affected digit.. The central ray is perpendicular to the pip joint of the affected digit.. Image-quality criteria include all four digits shown in true pa with no rotation., 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 outline 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 pronated (palm down on IR).
- Extend fingers and slightly separate digits on IR.
Position & centering point
PIP joint of the affected digit.
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. Digits extended and slightly separated.
Image-quality criteria
- All four digits shown in true PA with no rotation.
- All phalanges and metacarpals included.
- Joint spaces open and clearly visible.
- Soft tissue and bone trabeculae sharp, no motion blur.
- Collimation: 1 inch on all sides, 1 inch proximal to MCP joints.
Common errors / ARRT traps
- 1 Hand supinated (palm up) rotates digits off true PA.
- 2 Digits flexed or fanned together overlaps joint spaces.
- 3 CR off-centered clips distal or proximal digits.
- 4 Uneven digit separation causes overlapping images.
Clinical indications
- Trauma evaluation for finger fracture or dislocation.
- Suspected hand soft tissue injury or swelling.
- Assessment of finger joint arthritis or degenerative changes.
- Post-operative follow-up of finger fixation hardware.
Aligned to the 2025 ARRT Content Specifications.