Wrist PA Axial for Scaphoid is a radiography positioning projection of the Upper Extremity. Seated, hand in mild ulnar deviation. CR angled 15–20° toward elbow. The centering point is located at the scaphoid tubercle with hand in mild ulnar deviation. cr exits at the distal forearm.. The central ray is cr angled 15–20 degrees toward the elbow, entering at the scaphoid.. Image-quality criteria include scaphoid elongated and demonstrated without foreshortening., distal carpal row and metacarpal bases included.. Standard exposure ranges from 60 to 70 kVp, 2 to 4 mAs, at an SID of 40 inches (102 cm).
Anatomy demonstrated
- Scaphoid fully elongated without foreshortening.
- Scaphoid tubercle and waist clearly visible.
- Distal scaphoid pole without overlap.
- Lunate, capitate, and trapezium.
- First through fifth metacarpal bases.
- Distal radius and ulna.
Patient preparation
- Verify patient identity using two identifiers.
- Remove watches, bracelets, and radiopaque items from the arm.
- Seat the patient at the end of the table.
- Extend the forearm on the IR with palm up.
- Place hand in mild ulnar deviation for carpal positioning.
Position & centering point
At the scaphoid tubercle with hand in mild ulnar deviation. CR exits at the distal forearm.
Central ray
CR angled 15–20 degrees toward the elbow, entering at the scaphoid.
Exposure / technique
- kVp
- 60–70
- mAs
- 2–4
- SID
- 40" (102 cm)
- Notes
- Tabletop technique. Angle CR proximally to elongate the scaphoid.
Image-quality criteria
- Scaphoid elongated and demonstrated without foreshortening.
- Distal carpal row and metacarpal bases included.
- Radius and ulna visible without overlap at the distal forearm.
- No motion blur; scaphoid borders sharp and distinct.
- Collimation: 2.5 inches distal and proximal to the wrist.
Common errors / ARRT traps
- 1 CR angled less than 15 degrees leaves the scaphoid foreshortened.
- 2 CR angled toward the wrist instead of elbow superimposes carpals.
- 3 Radial deviation positions the scaphoid off the central axis.
- 4 Off-center CR clips the scaphoid or distal forearm.
Clinical indications
- Suspected scaphoid fracture, including stress and occult fractures.
- Scaphoid nonunion or avascular necrosis follow-up.
- Wrist trauma with scaphoid pain.
- Post-operative scaphoid fracture assessment.
Aligned to the 2025 ARRT Content Specifications.