Hand PA is a radiography positioning projection of the Upper Extremity. Seated with forearm on table, palm down. SID 40". The centering point is located 3rd MCP joint, center of the hand. The central ray is perpendicular to the IR, directed to the 3rd MCP joint. Image-quality criteria include entire hand and wrist shown, with about 1 inch (2.5 cm) of distal forearm, the thumb appears oblique on a PA hand. A sample technique is 66 kVp with DR 0.71 or CR 1.6 mAs, at an SID of 40 inches (102 cm).
Watch the setup
All steps (5)
- Seat the patient at the end of the table.
- Place forearm on table with hand pronated (palm down).
- Extend all fingers and slightly separate digits on IR.
- Align the long axis of the hand and forearm with the long axis of the IR.
- Center the hand and wrist to the IR.
3D anatomy: BodyParts3D, © The Database Center for Life Science. Posed, rendered and labelled by RadTechPrepper. These animations are licensed CC BY-SA 4.0. Credits
Anatomy demonstrated
- Phalanges of digits 2-5 and of the thumb (thumb seen obliquely).
- Metacarpals of all five rays.
- Carpal bones of the wrist.
- About 1 inch (2.5 cm) of the distal radius and ulna.
- MCP and IP joint spaces.
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 hand pronated (palm down).
- Extend all fingers and slightly separate digits on IR.
- Align the long axis of the hand and forearm with the long axis of the IR.
- Center the hand and wrist to the IR.
Position & centering point
3rd MCP joint, center of the hand.
Central ray
Perpendicular to the IR, directed to the 3rd MCP joint.
Exposure / technique
- kVp
- 66
- mAs
- DR 0.71 / CR 1.6
- SID
- 40" (102 cm)
- Notes
- Tabletop technique, nongrid. Forearm pronated (palm down). Collimate on four sides to the outer margins of the hand and wrist. Bontrager digital range: 55 to 65 kV; Merrill's chart prints 66 kVp. Sample technique: DR 0.71 / CR 1.6 mAs at 66 kVp, 40 in SID, for a 3 cm part. Adjust for your equipment.
kVp and mAs are sample values. Use caution when applying them in your department.
Image-quality criteria
- Entire hand and wrist shown, with about 1 inch (2.5 cm) of distal forearm.
- The thumb appears oblique on a PA hand.
- Long axis of the hand and wrist aligned with the long axis of the IR.
- No rotation: metacarpal and phalangeal shaft concavities symmetric, equal soft tissue on each side of digits 2-5.
- Digits slightly separated, soft tissues not overlapping.
- MCP and IP joints open, showing correct CR placement and full pronation.
- CR and center of the collimation field at the 3rd MCP joint.
Common errors
- 1 Hand not pronated, so the palmar surface is not on the IR.
- 2 Fingers flexed, so the MCP and IP joints are not open.
- 3 CR off center: the CR and center of the field belong at the 3rd MCP joint.
- 4 Fingers held together, so the soft tissues of the digits overlap.
Clinical indications
- Fractures, dislocations or foreign bodies of the phalanges, metacarpals and hand joints.
- Pathologic processes such as osteoporosis and osteoarthritis.