Wrist Lateral is a radiography positioning projection of the Upper Extremity. Seated, arm and forearm on the table, wrist lateral. SID 40". The centering point is located midcarpal area, with the medial side of the wrist on the IR. The central ray is perpendicular to the IR, directed to the midcarpal area. Image-quality criteria include wrist shown in true lateral with no rotation or tilt, radius, ulna, carpals, and proximal metacarpals included. A sample technique is 70 kVp with DR 1.1 or CR 2.5 mAs, at an SID of 40 inches (102 cm).
Watch the setup
All steps (4)
- Seat the patient at the end of the table, arm and forearm resting on the table, shoulder, elbow, and wrist on the same horizontal plane.
- Place the wrist and hand on the IR in a thumb-up lateral position, medial side down.
- Align and center the hand and wrist to the long axis of the IR.
- Adjust the hand and wrist into a true lateral, fingers comfortably extended.
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
- Distal radius and ulna in lateral projection.
- Margins of the wrist fat pads.
- Carpal bones, including the trapezium, scaphoid, capitate, and lunate.
- Proximal metacarpals in lateral view.
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 watches, bracelets, and radiopaque items from the wrist.
- Seat the patient at the end of the table, arm and forearm resting on the table, shoulder, elbow, and wrist on the same horizontal plane.
- Place the wrist and hand on the IR in a thumb-up lateral position, medial side down.
- Align and center the hand and wrist to the long axis of the IR.
- Adjust the hand and wrist into a true lateral, fingers comfortably extended.
Position & centering point
Midcarpal area, with the medial side of the wrist on the IR.
Central ray
Perpendicular to the IR, directed to the midcarpal area.
Exposure / technique
- kVp
- 70
- mAs
- DR 1.1 / CR 2.5
- SID
- 40" (102 cm)
- Notes
- Tabletop technique, nongrid. Arm and forearm on the table, wrist lateral, thumb up. Collimate on four sides, including the distal radius and ulna and the metacarpal area. Sample technique: DR 1.1 / CR 2.5 mAs at 70 kVp, 40 in SID, for a 6 cm part. Adjust for your equipment.
kVp and mAs are sample values. Use caution when applying them in your department.
Image-quality criteria
- Wrist shown in true lateral with no rotation or tilt.
- Radius, ulna, carpals, and proximal metacarpals included.
- Ulnar head superimposed over the distal radius, and proximal second through fifth metacarpals superimposed.
- Bone trabeculae and soft tissue sharp, no motion blur.
- Collimation: 2.5 inches distal and proximal to wrist joint.
Common errors
- 1 Wrist rotated off true lateral (supinated or pronated): the ulnar head is not superimposed over the distal radius.
- 2 Proximal metacarpals not superimposed, a sign of rotation.
- 3 Shoulder not dropped, so the shoulder, elbow, and wrist are not on the same plane.
- 4 CR off-centered clips the carpals or the metacarpals.
- 5 Wrist rotated supinating or pronating off true lateral.
- 6 Radial side on the IR: this lateromedial projection needs the ulnar side down.
- 7 CR not at the midcarpal area.
Clinical indications
- Fractures or dislocations of the distal radius or ulna, specifically anteroposterior fragment displacement or Barton's, Colles, or Smith's fractures.
- Suspected wrist joint instability or dislocation.
- Osteoarthritis, primarily in the trapezium and first CMC joint.