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 3rd mcp joint.. Image-quality criteria include all five digits shown in true pa with no rotation., all phalanges and metacarpals included.. Standard exposure ranges from 55 to 65 kVp, 2 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 with hand pronated (palm down).
- Extend all fingers and slightly separate digits on IR.
Position & centering point
3rd MCP joint, center of the hand.
Central ray
Perpendicular to the 3rd MCP joint.
Exposure / technique
- kVp
- 55–65
- mAs
- 2–4
- SID
- 40" (102 cm)
- Notes
- Tabletop technique. Forearm pronated (palm down).
Image-quality criteria
- All five digits shown in true PA with no rotation.
- All phalanges and metacarpals included.
- Carpals of the wrist shown.
- Joint spaces open and clearly visible.
- Collimation: 1 inch on all sides, 1 proximal to ulnar styloid.
Common errors / ARRT traps
- 1 Hand supinated (palm up) rotates the hand off true PA.
- 2 Fingers flexed or fanned together overlaps joint spaces.
- 3 CR off-centered clips digits or wrist anatomy.
- 4 Uneven finger separation causes overlapping images.
Clinical indications
- Hand trauma evaluation for fracture, dislocation, or sprain.
- Suspected hand soft tissue injury or swelling.
- Assessment of hand joint arthritis or degenerative changes.
- Post-operative follow-up of hand fixation hardware.
Aligned to the 2025 ARRT Content Specifications.