Hand PA Oblique is a radiography positioning projection of the Upper Extremity. Seated with hand obliqued 45 degrees, ulnar side raised. SID 40". The centering point is located 3rd mcp joint, rotated 45 degrees.. The central ray is perpendicular to the 3rd mcp joint.. Image-quality criteria include hand shown in 45-degree oblique with minimal overlap., all phalanges, metacarpals, and carpals included.. Standard exposure ranges from 55 to 65 kVp, 3 to 4 mAs, at an SID of 40 inches (102 cm).
Anatomy demonstrated
- Distal, middle, and proximal phalanges of all five digits.
- Metacarpals of all five rays.
- Carpal bones of the wrist.
- DIP, PIP, and MCP joint spaces.
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.
- Place forearm on table. Rotate hand 45 degrees.
- Raise the ulnar side. Extend fingers on IR.
Position & centering point
3rd MCP joint, rotated 45 degrees.
Central ray
Perpendicular to the 3rd MCP joint.
Exposure / technique
- kVp
- 55–65
- mAs
- 3–4
- SID
- 40" (102 cm)
- Notes
- Tabletop technique. Ulnar side raised 45 degrees.
Image-quality criteria
- Hand shown in 45-degree oblique with minimal overlap.
- All phalanges, metacarpals, and carpals included.
- Joint spaces open and clearly visible.
- Bone trabeculae and soft tissue sharp, no motion blur.
- Collimation: 1 inch on all sides, 1 proximal to ulnar styloid.
Common errors / ARRT traps
- 1 Hand rotated less than 45 degrees minimizes the oblique.
- 2 Hand pronated or supinated changes the oblique angle.
- 3 Fingers flexed or overlapped obscures joint spaces.
- 4 CR off-centered clips digits or wrist anatomy.
Clinical indications
- Hand trauma when PA view is incomplete or unclear.
- Suspected hand joint arthritis or degenerative changes.
- Evaluation of hand soft tissue injury or swelling.
- Post-operative follow-up with hardware assessment.
Aligned to the 2025 ARRT Content Specifications.