Hand Lateral is a radiography positioning projection of the Upper Extremity. Seated with medial side of hand on IR. SID 40". The centering point is located second to fifth MCP joints (second MCP joint for the fan lateral), medial side of hand on IR. Merrill's: second digit MCP joint for mediolateral, fifth digit MCP joint for lateromedial. The central ray is perpendicular to the second to fifth MCP joints (lateral in extension); to the second MCP joint for the fan lateral. Merrill's: second digit MCP joint for mediolateral, fifth digit MCP joint for lateromedial. Image-quality criteria include hand shown in true lateral with no rotation, all phalanges, metacarpals, and carpals included. A sample technique is 70 kVp with DR 1.25 or CR 2.5 mAs, at an SID of 40 inches (102 cm).
Anatomy demonstrated
- Phalanges of all five digits.
- Metacarpals of all five rays.
- Carpal bones of the wrist.
- Joint spaces of the fingers and thumb on the fan lateral; in extension the phalanges are superimposed.
Patient preparation
- WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.
- Verify patient identity using two identifiers.
- Remove rings, bracelets, and radiopaque items from the hand.
- Seat the patient at the end of the table.
- Place forearm on table with medial side of hand on IR.
- Extend all fingers for the lateral in extension, an alternative in Bontrager. Bontrager's routine is the fan lateral, preferred when the phalanges are the area of interest.
Position & centering point
Second to fifth MCP joints (second MCP joint for the fan lateral), medial side of hand on IR. Merrill's: second digit MCP joint for mediolateral, fifth digit MCP joint for lateromedial.
Central ray
Perpendicular to the second to fifth MCP joints (lateral in extension); to the second MCP joint for the fan lateral. Merrill's: second digit MCP joint for mediolateral, fifth digit MCP joint for lateromedial.
Exposure / technique
- kVp
- 70
- mAs
- DR 1.25 / CR 2.5
- SID
- 40" (102 cm)
- Notes
- Tabletop technique. Medial side of hand on IR; Merrill's also allows the radial side down, a harder position for the patient. Sample technique: DR 1.25 / CR 2.5 mAs at 70 kVp, 40 in SID, for a 7 cm part. Adjust for your equipment.
kVp and mAs are sample values. Use caution when applying them in your department.
Image-quality criteria
- Hand shown in true lateral with no rotation.
- All phalanges, metacarpals, and carpals included.
- Metacarpals and distal radius and ulna superimposed; phalanges superimposed in extension, separated with joint spaces open on the fan lateral.
- Soft tissue and bone trabeculae sharp, no motion blur.
- Collimation: 1 inch on all sides, 1 inch proximal to ulnar styloid.
Common errors
- 1 Hand not in true lateral: the distal radius and ulna and the metacarpals should be superimposed.
- 2 Thumb not drawn anteriorly and supported, so it overlaps the fingers.
- 3 CR not at the second to fifth MCP joints, or the second MCP for the fan lateral.
Clinical indications
- Fractures and dislocations of the phalanges; anterior or posterior displaced fractures and dislocations of the metacarpals.
- Localization of foreign bodies (lateral in extension or flexion).